Life Care Center: Outdated Care Plans Risk Safety - WA
State inspectors found Life Care Center of Skagit Valley failed to keep care plans current for a resident whose medical status had changed significantly since admission. The outdated plans created confusion about basic care needs and discharge planning.
The resident, identified as Resident 4, was admitted with perineal and sacral wounds, urinary incontinence, and cognitive impairment. But the facility's quarterly assessment showed no cognitive problems and indicated the person was continent of bowel and bladder with no indwelling catheter.
The contradictions were stark. Care plans from April still instructed staff to perform catheter care every shift, but medication records showed the Foley catheter was removed July 25. For the 30 days before the September inspection, nursing assistants consistently documented the resident was incontinent with no catheter present.
When inspectors visited September 4, they observed the resident lying in bed with no catheter. The person told them, "I want to go home."
Family members who arrived during the inspection said the resident's doctor had told them a safe discharge was needed. But the resident couldn't return to their previous living situation because it was unsafe, the family explained.
The discharge care plan, initiated April 10 and revised April 17, listed the goal as developing a comprehensive discharge plan. The only intervention noted was that "the resident wished to return home."
Staff D, a registered nurse and MDS coordinator, acknowledged the problems when inspectors reviewed the care plans. Asked about the resident's continence status, Staff D said the most recent assessment showed the person was continent. But when shown the care plan indicating an indwelling catheter was still in place, Staff D admitted "the CP should be updated."
The social service director, Staff I, had similar acknowledgments about the discharge planning. When inspectors reviewed the discharge care plan, Staff I said the initial meeting to discuss status happened within 48 hours of admission when discharge planning began. But Staff I admitted the plan "did not reflect the resident's current discharge goal and should be updated."
The inspection found these failures placed residents at risk for unmet care needs and diminished quality of life. Federal regulations require care plans to be reviewed and revised by health care teams to accurately reflect residents' current conditions.
The resident's case highlighted how outdated care plans can create dangerous gaps between what staff are supposed to do and what residents actually need. While nursing assistants documented the reality of daily incontinence care, the formal care plan still directed catheter maintenance for equipment that no longer existed.
The facility received a citation for failing to ensure care plans were properly maintained and reflected actual care needs. Inspectors noted the problems affected the resident's discharge planning process and day-to-day care coordination.
During the inspection, the resident remained in bed wearing a hospital gown, expressing the desire to return home while family members and staff grappled with discharge planning based on incomplete and contradictory documentation.
The state found Life Care Center violated Washington administrative code requirements for maintaining current, comprehensive care plans that guide resident treatment and services.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Life Care Center of Skagit Valley from 2025-09-04 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
LIFE CARE CENTER OF SKAGIT VALLEY in SEDRO WOOLLEY, WA was cited for violations during a health inspection on September 4, 2025.
The outdated plans created confusion about basic care needs and discharge planning.
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.