The resident, identified only as Resident 1 in state inspection records, required substantial help with basic movements like rolling from side to side, sitting up, and transferring to a wheelchair. Their care plan showed they could only walk with therapy supervision and needed two-person assistance for all other mobility.
During three separate visits in late August and early September, state inspectors found the resident lying in bed doing leg exercises. The resident told inspectors they had missed some therapy sessions early in their stay due to dialysis appointments, but said they "did not understand why sometimes the therapists just didn't show up."
The resident's physician had ordered occupational therapy five times per week and physical therapy three times per week, starting June 6. But therapy records showed the resident consistently received fewer sessions than prescribed.
During the week of June 23-27, the resident got physical therapy twice instead of three times and occupational therapy three times instead of five. The following week of July 7-11, they received physical therapy twice and occupational therapy four times. For the week of July 28-August 1, records showed only three occupational therapy sessions and no physical therapy at all.
Staff A, when asked about the missed sessions, said they would expect therapy staff to treat patients as ordered but couldn't answer whether therapy was short or not.
The therapy director, identified as Staff E, acknowledged during a September 11 interview that therapy sessions had been missed. The director said missed sessions "should have been documented why they were missed or refused" but admitted not seeing those entries in the records.
When inspectors asked for documentation of treatment refusals that would explain the gaps, none were provided.
The resident's medical complexity made the missed therapy particularly concerning. Their quarterly assessment from July showed multiple diagnoses considered medically complex conditions. The assessment indicated the resident couldn't attempt to walk due to medical conditions or safety concerns and needed substantial or maximal assistance with upper and lower body dressing, rolling over, sitting up, lying down, toilet transfers, and wheelchair mobility.
State inspectors noted the failure to provide ordered therapy services placed residents at risk for decline in physical and functional mobility and diminished quality of life.
The therapy director claimed the facility provided five treatments weekly, but the calendar records provided by staff showed a different pattern. Week after week, the resident received fewer sessions than the physician had ordered, with some weeks showing significant shortfalls.
During the week of August 11-15, records showed three occupational therapy sessions and no physical therapy. The week of August 25-29 showed four occupational therapy sessions but again no documented physical therapy.
The inspection found the facility failed to ensure specialized rehabilitative services were provided as determined by physician orders. While the violation was classified as minimal harm or potential for actual harm, it affected a resident whose mobility limitations made consistent therapy crucial for maintaining whatever function remained.
The resident's comment about therapists who "just didn't show up" highlighted a gap between what was ordered and what was delivered. With no documentation explaining the missed sessions and no evidence of patient refusals, the facility couldn't account for why a resident with complex medical needs wasn't receiving prescribed rehabilitation services.
State regulations require nursing homes to provide or obtain specialized rehabilitative services as ordered by physicians. The facility's inability to document why sessions were missed or provide evidence of patient refusals suggested a breakdown in both service delivery and record-keeping for essential medical care.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Enumclaw Health and Rehabilitation from 2025-09-23 including all violations, facility responses, and corrective action plans.
Additional Resources
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