Cove Of Cascadia, The

F 0684

Resident #30's physician orders for bowel care management were documented as:

Level of Harm - Minimal harm or potential for actual harm

- Bisacodyl Tablet Delayed Release, Give 10 mg by mouth every 24 hours as needed for constipation on Bowel Day 3. If no result within 24 hours follow bowel day 4. Start date 11/6/25

Residents Affected - Some

- Dulcolax Suppository 10 MG (Bisacodyl) Insert 1 unit rectally every 24 hours as needed for constipation

on Bowel Day 4 -Start Date 11/6/25 - Fleet Enema Enema 7-19 GM/118ML (Sodium Phosphates) Insert 1 application rectally as needed for constipation on Bowel Day 5. Notify MD, note bowel evaluation. -Start Date 11/6/25 Resident #30 had a documented bowel movement on 11/14/25 at 3:38 PM and not again until 11/19/25 at 5:19 AM, over 110 hours with no documented bowel movement.

No documentation of Resident #30 receiving the physician ordered medications for constipation management during 11/14/25 to 11/19/25.

On 11/21/25 at 8:25 AM, the CNO stated the nurse had not documented any bowel medication interventions for Resident #30 and should have.

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

11/21/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Cove of Cascadia, The

620 North Sixth Street Bellevue, ID 83313

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0732

Post nurse staffing information every day.

Level of Harm - Minimal harm or potential for actual harm

Based on observation, record review, and staff interview, it was determined the facility failed to ensure nurse staffing information was accurate and posted daily for each shift. This failed practice had the potential to affect all residents residing in the facility and their representatives, visitors, and others who wanted to

review the facility's staffing levels. Findings include:On 11/19/25 at 2:45 PM, the surveyor noted the posted daily licensed and CNA staffing list had the scheduled hours listed at 72 hours for days and 48 hours for nights but not the actual hours worked for RN, LPN, and CNA as required. Additionally, the daily staffing sheet for 2/12/25 had not been completed with any staffing information.On 11/19/25 at 3:30 PM, the CEO stated the posted daily staffing list should have had scheduled and actual hours worked for each of the nursing categories and had not.

Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

11/21/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Cove of Cascadia, The

620 North Sixth Street Bellevue, ID 83313

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

record review and staff interview, it was determined the facility failed to ensure controlled medications were tracked and kept secure from potential theft and/or diversion. This was true for 1 of 2 medication carts reviewed. This failure created the potential for undetected misuse and/or diversion of controlled medications and had the potential to affect all residents who received controlled medication in the facility. Findings include:On 11/18/25 at 11:20 AM, during the [NAME] Unit medication cart audit, observed the narcotic accountability sheets, dated 11/1/25 to 11/18/25, with 1 licensed nurse signature not documented. On 11/18/25 at 11:22 AM, LPN #1 stated two nurses should have signed the narcotic accountability sheet when they accepted the medication cart or released the medication cart. On 11/20/25 at 4:40 PM, during

the [NAME] Unit medication cart audit, observed the narcotic accountability sheets, dated 11/1/25 to 11/20/25, with 1 licensed nurse signature not documented. On 11/20/25 at 4:41 PM, RN #2 stated I should have signed the narcotic accountability sheet this morning when I accepted the medication cart but did not.

On 11/21/25 at 8:05 AM, the CNO stated two nurses should have signed the narcotic accountability record when they accepted the medication cart or released the medication cart.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

11/21/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Cove of Cascadia, The

620 North Sixth Street Bellevue, ID 83313

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0760

Ensure that residents are free from significant medication errors.

Level of Harm - Minimal harm or potential for actual harm

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

observation, record review and interview, the facility failed to ensure residents were free of medication preparation and administration errors for 1 of 1 resident (Resident #9) observed for medication preparation and administration of insulin. This failed practice placed the resident at risk for not receiving their prescribed medication dosage and other adverse outcomes. Findings include: Resident #9 was initially admitted to the facility on [DATE REDACTED] and readmitted to the facility on [DATE REDACTED], with multiple diagnoses which include diabetes and heart failure. Resident #9's physician orders documented Novolog OG Injection Solution inject 15 IU subcutaneously three times a day related to Type 2 Diabetes Mellitus and Novolog Injection Solution as per sliding scale: blood sugar 70-149 = 0 units, 150-199 = 1 unit, 200-249 = 2 units. On 11/20/25 at 11:30 AM, observed RN #2 remove Novolog insulin pen from the medication cart and dial the insulin pen to 15 Units as ordered plus 2 units for the sliding scale for a total of 17 units (Resident #9's blood glucose was 233).

RN #2 did not prime the insulin pen with 2 Units before dialing the ordered dose. On 11/20/25 at 11:35 AM, RN #2 administered the Novolog insulin to Resident #9. On 11/20/25 at 11:45 AM, RN #2 stated he did not prime the insulin pen and was unaware of the need to prior to administering insulin. On 11/21/25 at 8:10 AM, the CNO stated insulin pens should be primed with 2 units prior to administering the ordered insulin dosage.

Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

11/21/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Cove of Cascadia, The

620 North Sixth Street Bellevue, ID 83313

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

Federal health inspectors cited COVE OF CASCADIA, THE in BELLEVUE, ID for a deficiency under regulatory tag F-F0761 during a standard health inspection conducted on 2025-11-21.

Category: Pharmacy Service Deficiencies

The facility was found deficient in the following area: Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.

Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 6 deficiencies cited during this inspection of COVE OF CASCADIA, THE.

Correction Status: Deficient, Provider has plan of correction.

The facility reported correction as of 2026-01-05.

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

observation, interview, policy review, and review of the Idaho Food Code, the facility failed to appropriately store, distribute, and label foods. This deficient practice had the potential to affect all residents who received meals prepared in the facility's kitchen. This placed residents at risk for potential contamination and use of spoiled foods, and adverse health outcomes including food-borne illnesses. Findings include:The Idaho Food Code, revised February 2021, stated, 3-501.17 Ready-to-Eat, Time/Temperature Control for Safety Food, Date Marking . refrigerated, ready-to-eat, time/temperature control for safety food prepared and held

in a food establishment for more than 24 hours shall be clearly marked to indicate the date or day by which

the food shall be consumed on the premises, sold, or discarded when held at a temperature of 5 C (41 F) or less for a maximum of 7 days. The day of preparation shall be counted as Day 1.The facility Food Safety and Storage policy dated 11/28/17, documented under Labeling and Rotation:- Opened or repackaged food must be labeled with contents and use-by-date.- Food removed from original packaging must be labeled with its common name (unless clearly identifiable) and use-by or expiration date. On 11/18/25 at 9:20 AM,

the following was observed in the [NAME] kitchen dry food storage area and again with the Culinary Manager present at 1:30 PM:- Unopened Home Brand Syrup with best used date of 10/28/25. - Opened Marshmallow syrup with no opened date.- Opened Peach syrup with no opened date and best used date of 3/20/25.- Opened [NAME] Bag was not properly sealed and was spilling out rice.On 11/18/25 at 9:25 AM,

the following was observed in the [NAME] kitchen prep area and again with the Culinary Manager present at 1:32 PM:- Squeeze bottle and small plastic tub were not labeled with contents, or use-by-dates. The contents were later identified by the cook as melted butter.On 11/18/25 at 9:27 AM, the following was observed in the [NAME] kitchen area:- Observed cook #1 with gloved hands, cutting up bell peppers. She then slipped on oven mitts over her gloved hands to remove some items from the oven. [NAME] #1 removed the oven mitts to continue cutting the bell peppers with the same gloves with no hand washing or change of gloves. On 11/18/25 at 9:30 AM, the following was observed in the [NAME] reach-in freezer and refrigerator area and again with the Culinary Manager present at 1:35 PM:- Opened bag of broccoli that had not been labeled with opened date.- Half cut onion and half cut head of lettuce both wrapped in saran wrap plastic, with no opened dated.- Observed dirt and food particles on top of the refrigerator that had large cooking pots stored upside down on top of refrigerator.On 11/18/25 at 10:00 AM, the following was observed in the [NAME] kitchen dry food storage area and again with the Culinary Manager present at 1:40 PM:- Krusteaz buttermilk pancake mix with open date of 6/25 but no use by date on it. On 11/18/25 at 10:05 AM, the following was observed in the [NAME] reach-in freezer and refrigerator area and again with the Culinary Manager present at 1:42 PM:Reach in Refrigerator:- Open container of cranberry juice without opened date labeled. On 11/18/25 at 4:30 PM, the Culinary Manager stated those food items without opened dates or use by dates should have been discarded and were not.

Event ID:

Facility ID:

If continuation sheet