Heartwood Extended Healthcare: Advance Directive Failures - WA

That finding, along with an identical failure for a second resident, is at the center of a March 2026 federal inspection of the facility at 1649 East 72nd Street.

The second resident, identified in inspection records only as Resident 99, came to Heartwood with diabetes and foot wounds. Both residents were capable of communicating their needs. Both were admitted without receiving written information about advance directives, the legal documents that allow a person to appoint a decision-maker and specify their wishes for care before a crisis forces someone else to guess.

Nobody had given them the paperwork. Nobody had offered to help them fill it out.

Inspectors reviewed the electronic health records for both residents and found no documentation that written information had been provided or that any assistance with completing advance directives had been offered. The records were simply silent on the subject, as if the question had never come up.

It had not.

The Social Services Director, identified in inspection records as Staff D, told inspectors on March 27 that both residents should have been offered help with advance directives at admission. They hadn't been. The administrator, identified as Staff A, said on March 30 that it was their expectation that residents be reviewed for advance directives and offered assistance if needed. That expectation had not translated into action for either resident.

Advance directives carry particular weight for someone on dialysis. End-stage kidney disease is a condition without a cure. Dialysis filters the waste the kidneys can no longer remove, but it is not a path back to health. It is a maintenance treatment, often grueling, sometimes three sessions a week, and patients face decisions about whether and when to continue it. The question of who speaks for a patient when they can no longer speak for themselves is not abstract for someone in that position. It is one of the most consequential questions their care team will ever face.

Heartwood's resident with end-stage kidney disease went through admission without anyone raising it.

Federal inspectors classified the violation as causing minimal harm or potential for actual harm, a designation that reflects the absence of an immediate medical crisis rather than an absence of consequence. A resident who loses decision-making capacity without an advance directive in place loses the ability to control what happens to them. Decisions pass to whoever the law designates, which may or may not be the person the resident would have chosen.

The inspection covered a sample of three residents reviewed for advance directive compliance. Two of the three had no documentation of the required information being provided. The facility's own administrator acknowledged the expectation existed. The Social Services Director acknowledged it had not been met.

Inspectors noted the findings under Washington Administrative Code provisions governing resident rights and social services, and the deficiency was recorded as affecting a few residents.

For the resident on dialysis, sitting in a facility that had never handed them a form or explained what it was for, the gap between policy and practice was not a paperwork problem. It was the difference between having a say in what happens at the end and not having one at all.

The inspection was completed March 30, 2026.

Full Inspection Report

The details above represent a summary of key findings. View the complete inspection report for Heartwood Extended Healthcare from 2026-03-30 including all violations, facility responses, and corrective action plans.

Additional Resources

• View all inspection reports for Heartwood Extended Healthcare
• Browse all WA nursing home inspections