The wound appeared on January 14. Staff didn't assess its measurements and characteristics until January 19.
When asked why the assessment was delayed, a staff member told inspectors on February 11 that they "would have to ask the wound nurse and was not able to answer the question."
The same resident had refused 17 meals over a six-week period between late December and early February. Progress notes showed no indication staff informed the resident's doctor about the repeated refusals or tried to determine why the resident was declining food and care.
Staff B told inspectors during a January 30 interview that the resident "refused to get out of bed and refusing most intakes by mouth." When asked why the resident was refusing care, Staff B said "it was resident driven and the staff were having difficulties getting care done."
The resident's medical records revealed a pattern of refusals that extended beyond meals. Between December 29 and February 5, the resident also refused one bath, had one documented episode of refusing care, refused weekly weight checks five times, and refused medications at various times.
A facility investigation into the pressure injury found the resident was at "extreme risk for impaired skin integrity" due to "profound immobility, deconditioning from sepsis, malnutrition and inadequate hydration." Staff implemented interventions including documentation of frequent turns and a new order for Ensure three times daily.
The resident's risk assessment presented conflicting information. Staff B told inspectors the resident was at "extreme risk for wounds," but when asked why the formal Braden assessment showed only "moderate risk," Staff B maintained that "Resident 1 was at extreme risk."
Staff B acknowledged the resident was "dependent on staff for turning/repositioning in bed and for all transfers out of bed."
During the February interview, Staff B told inspectors there "should be weekly documentation of wounds including measurements and wound characteristics." The five-day gap between discovering and assessing the new pressure injury violated this standard.
The inspection narrative doesn't indicate whether the facility's wound nurse was available during the five-day period or what factors prevented the timely assessment. Staff B's inability to explain the delay suggests a breakdown in communication or documentation protocols.
Federal inspectors classified the violation as causing "minimal harm or potential for actual harm" affecting "few" residents. The finding relates to federal regulations requiring nursing homes to ensure residents receive proper treatment and services to attain or maintain their highest level of physical well-being.
The resident's combination of meal refusals, care refusals, and immobility created multiple risk factors for skin breakdown. Pressure injuries develop when sustained pressure reduces blood flow to skin and underlying tissue, particularly in immobile residents who cannot reposition themselves.
Malnutrition and inadequate hydration, identified as contributing factors in the facility's root cause analysis, can significantly impair wound healing and increase susceptibility to new injuries. The resident's documented sepsis and resulting deconditioning further complicated their medical status.
The inspection occurred on January 30, 2026, as part of a complaint investigation. The facility's response to the resident's declining condition included nutritional supplements and positioning protocols, but the delayed wound assessment and failure to notify medical providers about persistent care refusals raised concerns about care coordination.
Staff B's admission that the team was "having difficulties getting care done" with this resident suggests the facility may have lacked adequate strategies for engaging resistant residents or addressing the underlying causes of their refusals.
The resident's medical complexity, including sepsis recovery and profound immobility, required heightened vigilance for skin integrity issues and coordinated medical oversight of nutritional status and care acceptance.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Transitional Care of Seattle from 2026-01-30 including all violations, facility responses, and corrective action plans.