The resident has Alzheimer's disease and severe cognitive impairment. Their care plan documents a history of behavior problems, refusing care, and aggression with staff. The family member filed a complaint with state regulators after the facility continued using the nurse they had specifically asked to avoid.
Federal inspectors reviewed medication records that showed Licensed Practical Nurse #1 administered drugs and performed assessments for the resident after April 11. The family had clearly requested this nurse be removed from the care team, but the facility made no accommodation.
When inspectors interviewed Director of Nursing staff on November 5, they learned LPN #1 no longer worked at the facility as of May or June 2025. The timing suggests the nurse left on their own rather than being reassigned due to the family's concerns.
The Director of Nursing told inspectors the standard procedure when families request specific staff be removed involves holding a family meeting or care team conference. The goal is discussing concerns and trying to solve problems first before making changes.
Nobody followed that procedure.
A Regional Nurse told inspectors they spoke with the family member about LPN #1, but the family member didn't explain what their specific concern was with the nurse. The facility appeared to use this lack of detail as justification for ignoring the removal request entirely.
The resident's admission record shows diagnoses including progressive mental decline from Alzheimer's disease and difficulty swallowing. A cognitive screening assessment gave the resident a score of zero, indicating severe impairment. These conditions make residents particularly vulnerable and dependent on family advocates to speak for them.
Federal regulations require nursing homes to reasonably accommodate residents' needs and preferences. Families have the right to choose representatives to exercise those rights on behalf of residents who cannot advocate for themselves.
When inspectors met with the Licensed Nursing Home Administrator and Director of Nursing on November 5 to discuss the violation, staff could not provide any explanation for why LPN #1 remained on the resident's care team after the family's request.
The facility provided no additional information to justify their decision.
The inspection found the facility's own policy on residents' rights, reviewed as recently as June 11, clearly states residents have the right to self-determination with care and reasonable accommodation of their needs. The policy also recognizes the right to choose a family member representative to exercise rights on their behalf.
Optima Care Harborview violated both their own written policies and federal regulations by refusing to honor a straightforward family request. The facility offered no care-related justification for keeping the specific nurse assigned to this vulnerable resident.
The violation occurred during a complaint investigation, meaning family members felt compelled to contact state regulators when the facility proved unresponsive to their concerns. The complaint process represents a last resort for families who have exhausted direct communication with nursing home staff.
For residents with Alzheimer's disease and severe cognitive impairment, family members serve as essential advocates. These residents cannot communicate their own preferences or concerns about care quality. When facilities ignore family requests without explanation or accommodation attempts, they effectively silence the only voice these vulnerable residents have.
The inspection report shows a pattern of institutional indifference. Staff acknowledged receiving the family's request but made no effort to understand their concerns or find alternative arrangements. The nurse continued caring for the resident until leaving the facility months later for unrelated reasons.
Federal inspectors classified this as a violation causing minimal harm or potential for actual harm. However, the precedent of ignoring family preferences without justification creates risks for all residents who depend on family advocacy.
The facility must now submit a plan of correction explaining how they will ensure family requests for staff changes receive proper consideration in the future. The violation becomes public record, alerting other families to potential advocacy challenges at Optima Care Harborview.
The resident remains at the facility. Their family's experience demonstrates the vulnerability of Alzheimer's patients whose care preferences can be dismissed without consequence when facilities choose institutional convenience over accommodation.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Optima Care Harborview from 2025-11-05 including all violations, facility responses, and corrective action plans.