The resident had arrived in July with multiple serious conditions including kidney and heart disease, unstable blood sugar, bone infection, and a recent toe amputation. Their care plan specifically required staff to provide "timely communication to the physician and/or nurse practitioner regarding any change in condition."
The diarrhea started August 20 and continued daily through August 29, according to the facility's own bowel monitoring logs. On August 27, staff recorded four separate diarrhea episodes.
By that point, the resident was telling their physical therapist about "a terrible night sleep related to frequent brief changes because of their ongoing diarrhea." Two days later, the resident reported feeling "very fatigued" with no energy. The physical therapy notes documented the resident "exhibited distress during therapy session due to their weakness."
An occupational therapist grew concerned enough to report the resident's anxiety to nursing staff.
Nobody acted.
The resident finally took matters into their own hands on August 29, telling nursing staff directly to send them to the hospital. They were discharged that same day.
The resident's representative later told inspectors that staff "did not realize [the resident] was in distress" despite the multiple documented episodes and the resident's own reports of exhaustion and sleepless nights.
When inspectors asked Director of Nursing Staff B for documentation showing nurses had assessed the ongoing diarrhea, provided interventions, or notified the physician, the response was blunt: "There was no documentation to provide."
The director acknowledged that nursing staff should have assessed the diarrhea, provided appropriate interventions, and notified the physician within 24 hours. "But the staff did not do them as expected," Staff B admitted.
The facility had no policy addressing care standards for residents with diarrhea, the director confirmed.
This was a resident who could communicate clearly and advocate for themselves. They were alert, oriented, and able to verbalize their needs, according to their admission assessment. Yet even with their direct complaints about sleepless nights and fatigue, and despite documented anxiety reported by therapists, nursing staff failed to recognize distress requiring medical attention.
The resident's complex medical history made the oversight particularly concerning. They were already at high risk for rehospitalization, according to their own care plan. Kidney disease patients face heightened risks from dehydration. Heart disease patients can suffer dangerous complications from electrolyte imbalances caused by prolonged diarrhea.
The inspection found that prolonged diarrhea episodes like this place residents at risk for nutrition and hydration problems and decreased quality of life. For nine consecutive days, this resident experienced exactly those risks while staff documented the episodes but took no clinical action.
Physical therapy sessions became exercises in documenting decline rather than rehabilitation progress. The August 27 session noted sleep disruption from frequent clothing changes. The August 29 session recorded fatigue so severe the resident couldn't participate effectively in therapy.
The occupational therapist's decision to report the resident's anxiety to nursing staff represented the kind of interdisciplinary communication that should trigger assessment and intervention. Instead, it apparently triggered nothing.
The resident's representative emphasized that it was the resident themselves who ultimately demanded hospital transfer. After nine days of documented diarrhea, multiple therapy sessions noting distress and fatigue, and reported anxiety from occupational therapy, nursing staff still required the resident to self-advocate for emergency care.
The failure occurred despite clear care plan requirements for physician communication about condition changes. The resident's August 11 care plan explicitly stated staff would provide timely physician notification regarding any changes. Ongoing diarrhea in a medically complex patient with kidney disease clearly qualified as a condition change requiring medical evaluation.
Director of Nursing Staff B's acknowledgment that the facility lacked any policy for diarrhea care standards revealed a broader gap in clinical protocols. Diarrhea in elderly residents, particularly those with multiple chronic conditions, requires systematic assessment for causes, complications, and interventions.
The resident was ultimately hospitalized on August 29, the same day they demanded transfer. Whether earlier physician notification could have prevented hospitalization, or whether the nine-day delay worsened their condition, remains unknown from the inspection record.
What is clear is that a resident with serious medical conditions spent over a week experiencing documented distress while staff recorded symptoms but provided no clinical response. The resident's own voice, raised repeatedly through therapy sessions and direct communication, went unheard by the nursing staff responsible for their care.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Garden Terrace Healthcare Center of Federal Way from 2025-09-12 including all violations, facility responses, and corrective action plans.
Additional Resources
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