BELLINGHAM, WA - Federal inspectors issued an immediate jeopardy citation to Shuksan Healthcare Center in late April 2025 after discovering that the facility's failure to pay a laboratory services vendor resulted in a service hold, leaving multiple residents without critical blood testing — including residents taking medications that require routine monitoring to prevent toxic buildup.
Laboratory Shutdown Put Residents at Risk
A federal complaint investigation completed on May 1, 2025 revealed that Trident Lab Corporation placed Shuksan Healthcare Center's account on a non-payment hold on April 23, 2025. The lab company was owed $9,536.92 with unpaid invoices dating back to November 30, 2024 — nearly five months of overdue payments.
The hold meant that lab technicians stopped visiting the facility on their regular schedule of Sundays, Mondays, Tuesdays, and Thursdays. As a result, at least four residents had ordered laboratory tests that were never completed. Inspectors noted that additional residents could have been affected had new lab orders been placed during the period of interrupted service.
Two of the affected residents — identified in the report as Residents 10 and 34 — were prescribed Depakote, an anticonvulsant medication used to control seizures. Both were due for blood draws to check their Depakote levels, and neither test was completed.
Depakote level monitoring is not optional or routine in the way a standard wellness check might be. The drug has a narrow therapeutic window, meaning the difference between an effective dose and a dangerous one is relatively small. When blood levels climb too high, patients can experience liver damage, pancreatitis, and central nervous system depression. When levels drop too low, seizure control is lost. Without laboratory confirmation of where a patient's blood level falls, clinicians are essentially operating without critical safety data.
A third resident, Resident 95, was due for a Comprehensive Metabolic Panel and a Complete Blood Count — two foundational tests that provide an overview of organ function, electrolyte balance, and blood cell composition. These tests are commonly ordered to monitor chronic conditions and detect emerging problems before they become emergencies.
Resident 7 was due for a Hemoglobin A1C test, which measures average blood sugar levels over a two- to three-month period. For individuals with diabetes, this test is essential for evaluating whether current treatment is adequately controlling blood glucose. Uncontrolled blood sugar can lead to kidney damage, vision loss, nerve damage, and cardiovascular complications over time.
Widespread Vendor Debt Revealed Systemic Financial Problems
The laboratory hold was not an isolated billing oversight. Inspectors uncovered a pattern of delinquent payments to multiple vendors that provide essential services to the 60-bed facility.
The scope of the facility's financial troubles was striking:
- Kavala staffing agency was owed $191,210.01 for invoices spanning from November 25, 2024 through March 21, 2025 — a four-month accumulation of unpaid temporary staffing bills. - Clipboard staffing agency was owed $2,563.89 and had notified the facility it would stop sending staff after May 5, 2025. - KCI, a medical supply company, sent a demand notice on April 21, 2025 for $12,550 in overdue payments with invoices dating back to October 2024. - The City of Bellingham water utility issued a shutoff notice on April 7, 2025 for $2,487.91 past due, with disconnection scheduled for May 7, 2025. - Cascade Natural Gas sent an urgent past-due notice on April 14, 2025 requesting $1,877.85 be paid by 5:00 PM on April 22, 2025 or service could be disconnected. - The Safety Net Assessment account was 60 days past due in the amount of $119,996.01, which included a December 2024 balance of $29,377.00 that had been due on January 20, 2025.
In total, the documented debts exceeded $340,000 across these vendors alone.
The threat of water and natural gas disconnection raised additional concerns. A nursing home without running water cannot maintain basic sanitation, prepare food safely, or meet infection control requirements. Loss of natural gas service could affect heating and hot water — both essential for resident comfort and hygiene, particularly during Washington state's cooler spring months.
Staff Reported Payroll Delays and Lost Benefits
The financial instability extended beyond vendor relationships to affect facility employees directly. An anonymous staff member told inspectors during an April 25 interview that the facility had recently delayed payroll. During that period, staff members temporarily lost their benefits and were forced to pay out of pocket for medical appointments and prescriptions.
Payroll instability at a nursing home carries implications beyond the financial hardship it places on employees. Staff turnover in long-term care facilities is already among the highest of any industry. When workers cannot depend on receiving their paychecks on time or maintaining their health insurance, retention becomes even more difficult — and the residents who depend on consistent, familiar caregivers bear the consequences.
The fact that one staffing agency had already announced plans to stop sending workers and another was owed nearly $200,000 suggested the facility's ability to maintain adequate staffing levels was in genuine question.
Administration Pointed to Corporate Payment Processes
Interviews with facility leadership revealed a recurring theme: local administrators said they forwarded invoices to the corporate office for payment but had limited control over whether those payments were actually made.
Staff L, the Business Office Manager, told inspectors that invoices were processed and sent to the corporate office, explaining, "The corporate office cuts the checks and pays the vendors unless we were instructed by them to pay for something by credit card." Regarding the laboratory payment specifically, Staff L said a check "was supposed to have been sent overnight," but the payment did not arrive in time to prevent the service hold. Staff L added that they received calls from vendors about overdue balances on a daily basis and "all they could do was forward that information to corporate."
Staff A, the facility Administrator, acknowledged awareness of the lab services hold but "thought it had been taken care of." Staff A also confirmed knowing about the natural gas demand notice and that the facility was paying bills late or had negotiated payment plans with some vendors. In some cases, the administrator had resorted to using a company credit card to obtain resident supplies.
Staff D, identified as the Chief Operating Officer, described the situation as the corporation "managing cash flow" and stated that vendor contracts and payment plans were handled according to individual arrangements.
The facility's own policy, titled Administrative Management, stated that the appointed Facility Administrator was accountable for facility management and operations, with reporting to a governing board. Yet the inspection findings indicated that the administrator lacked the authority or resources to ensure that essential services — from laboratory testing to utilities — remained uninterrupted.
Immediate Jeopardy Citation and Resolution
Inspectors determined that the immediate jeopardy began on April 23, 2025 — the date laboratory services were placed on hold due to non-payment. The citation was classified under F-tag 835, which addresses the facility's responsibility to maintain effective administration and management of operations, including the financial resources necessary to provide required services.
The level of harm was designated as immediate jeopardy to resident health or safety, the most serious classification available to federal inspectors. The citation noted that many residents were affected.
Shuksan Healthcare Center removed the immediate jeopardy by April 26, 2025, three days after services were interrupted. A surveyor confirmed onsite that the facility had completed past-due resident lab testing, established an active laboratory services vendor, provided evidence of vendor contract payments, audited all resident laboratory orders, and obtained ordered tests for the affected residents.
It is worth noting that the facility is disputing the citation.
What Families Should Know
For families with loved ones in any long-term care facility, this case highlights an often-overlooked vulnerability. Most families evaluate nursing homes based on staffing ratios, cleanliness, and clinical quality measures. Few consider whether the facility is paying its bills on time — yet as this inspection demonstrates, financial instability can directly interrupt medical care.
Warning signs that a facility may be experiencing financial difficulties can include high staff turnover, frequent use of temporary agency workers, delayed maintenance, and changes in the brands or quality of supplies and food. Families who observe these patterns may want to inquire about the facility's financial health and review publicly available inspection reports.
The full inspection report for Shuksan Healthcare Center is available through the Centers for Medicare & Medicaid Services and provides additional details about the findings and the facility's corrective actions.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Shuksan Healthcare Center from 2025-05-01 including all violations, facility responses, and corrective action plans.
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