Shuksan Rehab: Lab Services Cut Over Unpaid Bills - WA
The lab company placed the facility on a non-payment hold on April 23, 2025, over an unpaid balance of $9,536.92. Two residents missed blood tests to monitor therapeutic levels of Depakote, a seizure medication. Another resident couldn't get routine blood work to check metabolic function and blood cell counts. A fourth resident went without diabetes monitoring through a hemoglobin A1C test.
The laboratory crisis exposed broader financial troubles at the 41-bed facility on James Street. Federal inspectors found the nursing home owed nearly $340,000 to vendors and faced potential shutoffs of water and natural gas services.
Trident Lab Corporation confirmed to inspectors on April 25 that services remained suspended. The lab provider typically visited Sundays, Mondays, Tuesdays and Thursdays to collect blood samples from residents.
Staff F, the facility's Resident Care Manager, told inspectors she "heard something about a bill not being paid" when asked why the lab work wasn't completed. She said the facility had an alternative lab only for urine tests, not blood work.
The missed tests had direct medical consequences. Residents 10 and 34 both needed Depakote level monitoring to ensure their seizure medication remained at therapeutic levels. Without the blood work, doctors couldn't determine if the drug dosage was safe or effective.
Resident 95 missed a Comprehensive Metabolic Panel and Complete Blood Count, tests that provide an overview of the body's chemical and metabolic status and monitor blood cell types and numbers. Resident 7 couldn't get a hemoglobin A1C test, which measures average blood sugar levels over several months.
Staff F acknowledged the residents' providers had not been notified that the lab work wasn't obtained.
The financial crisis extended far beyond the laboratory bill. The City of Bellingham sent a water shut-off notice on April 7, 2025, demanding payment of $2,487.91 by May 7. Cascade Natural Gas issued an urgent past-due notice on April 14, requesting $1,877.85 by 5 p.m. on April 22 or service would be disconnected.
Two staffing agencies were owed substantial amounts. Kavala staffing was owed $191,210.01, while Clipboard staffing was owed $2,563.89. Clipboard notified the facility it would cease sending staff after May 5.
KCI, a medical supply company, sent a demand bill on April 21 for $12,550, requiring immediate payment.
The facility also fell behind on state-mandated Safety Net Assessment payments. According to the Office of Rates Management, Shuksan owed $119,996.01 as of April 7, with the account 60 days past due. This included $29,377 for December 2024 that was due January 20, 2025.
Staff L, the Business Office Manager, explained the payment process to inspectors. Invoices came to her and the administrator, then were processed and sent to the corporate office for payment. The corporate office cut checks and paid vendors unless instructed to use a credit card.
"We get calls daily from vendors regarding overdue balances and all we could do was forward on that information to corporate," Staff L said.
Administrator Staff A acknowledged awareness of the lab services hold but thought it had been resolved. Staff A knew about the natural gas company's demand bill and that the facility was paying bills late or had payment plans with some vendors. The facility had used a company credit card to obtain some resident supplies.
Staff D, Chief Operating Officer, told inspectors the corporation managed vendor contracts and payment plans according to individual arrangements. Staff D said they received invoices weekly and processed them. The laboratory payment was supposedly sent, and the facility was "managing cash flow."
But by April 29, Staff E, another Chief Operating Officer, provided a different explanation. The facility was behind on Safety Net Assessment payments, which had been referred for collection to the Office of Financial Recovery. This resulted in unannounced garnishments that impacted cash flow.
"They have had to prioritize payments which has meant allowing some accounts to go to collections," Staff E said.
The financial troubles affected staff directly. An anonymous employee told inspectors the facility had delayed payroll on one recent occasion. During that time, staff lost benefits and had to pay out of pocket for medical appointments and prescriptions.
Beyond the financial crisis, inspectors found serious problems with medical record keeping. The facility failed to maintain complete and accurate records for three of five residents reviewed.
Resident 6's medication records showed multiple gaps. In February, there was no documentation that Atorvastatin or Melatonin were given as ordered. Behavior monitoring and side effect monitoring had 9 omissions out of 84 opportunities. Anti-coagulant bleeding monitors and sleep monitoring had 10 omissions.
March records for Resident 6 showed six medications not documented as given on March 15 during the day shift, including Cephalexin, Eliquis, Fluoxetine, Losartan, Senna, and Medroxyprogesterone. Various monitoring requirements had 18 omissions out of 93 opportunities. A weekly skin check on March 12 wasn't signed as completed.
Resident 10's records showed similar problems. In March, there was no documentation that Clonazepam was given on March 28 during evening shift. Seven medications weren't documented as administered on March 30 and 31 during evening shifts, including Metoprolol, Tamsulosin, Depakote, Erythromycin, Memantine, Senna, and lubricating eye drops.
Weekly skin checks and nail checks for March 9, 23, and 30 weren't signed as completed for Resident 10.
April records showed continued gaps. Clonazepam wasn't documented as given on April 6 at noon. Four medications weren't documented as administered on April 13 during evening shift. Weekly pain assessments for April 6 and 13 weren't signed as completed.
The facility also failed to correct a diagnosis error for Resident 7. The resident was admitted following a hospital stay for wound infection and was referred for a psychiatric evaluation because records showed bipolar disorder.
The evaluator determined on November 7, 2024, that the bipolar disorder diagnosis was inaccurate and appeared in the hospital record by error. The resident showed no indicators of serious mental illness.
Despite this finding, the facility failed to remove the erroneous diagnosis from the resident's medical record and care plan. The incorrect diagnosis remained on Medication Administration Records when inspectors reviewed the file on April 25, 2025.
Staff B, interim Director of Nursing Services, told inspectors on April 30 that she wasn't aware of the diagnosis error. She said nursing or social services were supposed to follow up on psychiatric evaluation recommendations and would need to get a provider's order to remove a diagnosis.
Staff H, a Licensed Practical Nurse, explained that medications, treatments, and behavior monitors needed to be completed and signed so other nurses would know if care had been provided.
Administrator Staff A told inspectors on May 1 that she wasn't aware of documentation concerns and no documentation audits were in place. She said she would add documentation review to daily audits.
The facility also failed to provide required training to at least one nursing assistant. Staff M, hired in December 2022, had not received mandated 12-hour annual training, dementia care training, abuse prevention training, communication training, or quality assurance training.
Staff M's training file contained only an abuse/neglect policy acknowledgment from March 2024, a mandated reporter document from February 2024, an abuse and neglect quiz from February 2024, and a completed test on care of cognitively impaired residents.
Staff L, the Business Office Manager, told inspectors the facility wasn't gathering information on 12 hours of education for agency nursing assistants. For in-house staff, there was an online training system.
Both the record-keeping problems and training deficiency were repeat violations from the facility's previous inspection in May 2024.
The governing body's failure to ensure financial oversight placed all 41 residents at risk of not receiving necessary care and services, inspectors concluded. The laboratory services suspension demonstrated how unpaid bills could directly impact resident medical care.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Shuksan Rehabilitation and Health Care from 2025-05-01 including all violations, facility responses, and corrective action plans.
Additional Resources
Data source: Official federal inspection data from the Centers for Medicare & Medicaid Services (CMS).
Editorial process: AI-synthesized regulatory data, reviewed for accuracy by our editorial team.
Professional review: All content reviewed by Christopher F. Nesbitt, Sr., NH EMT & BU-trained Paralegal.
Last verified: June 20, 2026 · Our methodology
SHUKSAN REHABILITATION AND HEALTH CARE in BELLINGHAM, WA was cited for violations during a health inspection on May 1, 2025.
The lab company placed the facility on a non-payment hold on April 23, 2025, over an unpaid balance of $9,536.92.
Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. Review the full report below for specific details and facility response.