The December inspection found that staff members confidently described detailed procedures for monitoring and treating residents' bowel movements, referencing standing orders and protocols they said were kept in notebooks at the nursing station. When inspectors looked inside those notebooks, they found nothing.
Resident 2's medication record showed no bowel medications were given between December 15 and December 20, 2025, despite the resident's bowel record documenting no movement for five consecutive days. The resident had standing orders for Milk of Magnesia, but there was no documentation showing when staff should start the medication or in what sequence multiple bowel medications should be administered.
Staff H, a nursing assistant, told inspectors on December 23 that she documented when residents had bowel movements in the medical record. She said she didn't tell nurses when residents failed to have bowel movements — she only charted what happened.
The registered nurses painted a different picture of the system they thought was in place.
Staff B, an RN, said she checked the bowel movement list at the start of each shift. She described receiving computer alerts when residents went three days without a bowel movement, at which point she would "start the bowel protocol." Staff B said the orders showed which medication to give first, and she followed the protocol for additional medications. She told inspectors the bowel protocol was located at the nurses' station in the standing orders book.
Another RN, Staff I, described a similar process during her interview. She said the clinical dashboard would alert staff after three days without a bowel movement, and she would administer Milk of Magnesia while the evening shift followed the protocol. Staff I said she used her own paper tracking system for bowel movements and would ask alert residents directly about their bowel status. For residents who couldn't respond, she said she would complete a bowel assessment and ask nursing assistants.
Staff I told inspectors that standing orders for bowel protocols were entered into the computer system when residents were admitted. She said there should be standing orders or a protocol in the standing orders notebook.
At 10:29 AM on December 23, inspectors observed two notebooks at the nurses' station labeled "Standing Orders." When they reviewed the contents, they found no standing orders or bowel protocol indicating which medications to use or when to start treatment.
The administrator, Staff A, acknowledged the problem during a 3:03 PM interview the same day. She agreed the facility should have a clearly defined bowel management protocol signed by a provider. Staff A admitted there was not a defined process or protocol for bowel management.
The violation represents a breakdown in one of nursing homes' most basic care responsibilities. Constipation can cause serious complications in elderly residents, including bowel obstruction, urinary retention, and increased fall risk from straining.
The inspection found that while staff believed they were following established procedures, the actual protocols they referenced simply didn't exist. Nurses described computer alerts, medication sequences, and assessment procedures as if they were reading from a manual that was never written.
The gap between what staff thought they were doing and what actually existed in writing left residents vulnerable to extended periods without proper bowel care. Resident 2's five-day period without bowel movement or appropriate medication demonstrates how the missing protocols translated into delayed treatment.
Federal regulations require nursing homes to provide necessary care and services to maintain each resident's highest practicable physical, mental, and psychosocial well-being. The Washington state regulation cited in the violation mandates that facilities follow physician orders and maintain proper medication administration procedures.
The December 23 complaint inspection classified the violation as causing minimal harm or potential for actual harm to few residents. But the discovery that multiple staff members were operating under the assumption that detailed bowel care protocols existed when they didn't raises questions about what other gaps might exist between perceived and actual care procedures.
Staff I's admission that she used her own paper tracking system for bowel movements suggests nurses were creating individual workarounds for what should have been standardized facility-wide protocols. The result was a patchwork of personal systems rather than consistent, documented care procedures.
The inspection narrative doesn't indicate whether Resident 2 eventually received appropriate bowel care or suffered any complications from the five-day delay. What remains clear is that the resident experienced extended constipation while staff operated under the illusion they were following proper protocols that existed only in their collective imagination.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Avalon Health & Rehabilitation Center - Pasco from 2025-12-23 including all violations, facility responses, and corrective action plans.
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