Heartwood Extended Healthcare: MDS Coding Failures - WA
The March inspection, completed March 30, 2026, found two residents whose medical records had been coded inaccurately on federally required assessments, obscuring conditions that inspectors and staff later confirmed were real and documented.
The first involved a resident identified in the inspection report as Resident 10, who has high blood pressure, depression, and a condition affecting part of the body. During an interview on March 24, the resident told inspectors directly: it took longer to chew food because of the broken upper teeth, and they were still waiting for staff to set up the extraction appointment.
The dental visit form from August 11, 2025 was unambiguous. It documented broken teeth or root tips, missing upper and lower teeth, red and irritated gum tissue, and a handwritten note that tooth number four was causing pain. The resident had requested an extraction.
That was more than seven months before inspectors arrived.
Despite what the dental form showed, the facility's Minimum Data Set assessments, the standardized records Medicare and Medicaid use to track resident conditions and care needs, told a different story. A significant change MDS was coded No for obvious or likely cavity or broken natural teeth. No for mouth or facial pain, discomfort, or difficulty with chewing. A subsequent quarterly MDS repeated the same coding. No pain. No broken teeth.
When inspectors reviewed the electronic health record with Staff B, the Director of Nursing Services, on March 30, the DNS acknowledged the assessments were wrong. The MDS, she said, should have been coded for broken and missing teeth.
The second case involved a resident with dementia, unsteadiness on their feet, and a cognitive communication deficit that made speaking, listening, and processing information difficult. Because of those conditions, the facility had placed a wander guard on the resident's left wrist, a device that triggers an alarm when someone with dementia approaches an exit. Inspectors observed the band securely fastened during a visit on March 26.
The care plan showed the wander guard intervention had been initiated on March 13, 2026, two weeks before the inspection. But the resident's quarterly MDS had been coded Not used for wander and elopement alarm.
Staff O, a registered nurse who handles MDS assessments, told inspectors on March 26 that the coding was inaccurate and the MDS needed to be modified. The device, she confirmed, was being used daily.
The Director of Nursing Services said the next morning she had not been aware the quarterly MDS was coded incorrectly.
The wander guard error matters beyond paperwork. MDS records inform care planning, staffing decisions, and the level of supervision a resident receives. A resident with dementia whose elopement risk goes unrecorded in the formal assessment is a resident whose risk may not be communicated consistently to the people responsible for watching them.
Both deficiencies were cited at a level of minimal harm or potential for actual harm, and the inspection report notes some residents were affected. The facility's plan of correction was not included in the publicly available inspection documents; CMS directs those questions to the nursing home or the state survey agency.
What the records don't capture is how long Resident 10 sat with a painful broken tooth while the paperwork said nothing was wrong. The dental form requesting an extraction was dated August 2025. The inspectors came in March 2026. In the months between, two separate assessments were completed and filed. Neither one reflected what the dentist had written down, what the resident said they were feeling, or what was making it harder to eat.
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
Data source: Official federal inspection data from the Centers for Medicare & Medicaid Services (CMS).
Editorial process: AI-synthesized regulatory data, reviewed for accuracy by our editorial team.
Professional review: All content reviewed by Christopher F. Nesbitt, Sr., NH EMT & BU-trained Paralegal.
Last verified: June 18, 2026 · Our methodology
HEARTWOOD EXTENDED HEALTHCARE in TACOMA, WA was cited for violations during a health inspection on March 30, 2026.
The dental visit form from August 11, 2025 was unambiguous.
Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. Review the full report below for specific details and facility response.