Canyon West Of Cascadia

Level of Harm - Minimal harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on or potential for actual harm observation, record review, policy review, and resident and staff interview, it was determined the facility failed to ensure residents were assessed for safety to self-administer medication. This was Residents Affected - Few true for 1 of 1 resident (Resident #2) reviewed for self-administration of medication. This failure created the potential for adverse outcomes if Resident #2 self-administered inhaler medication and received too much or too little of the medication. Findings include:The facility's Self-Administration of Medications policy revised 9/16/25, documented residents may self-administer medications when it was determined to be safe and appropriate.Resident #2 was admitted to the facility on [DATE REDACTED] and readmitted [DATE REDACTED], with multiple diagnoses including chronic obstructive pulmonary disease (COPD -

a group of lung disease characterized by increasing breathlessness) and diabetes.Resident #2's physician's order dated 4/9/26, included an Albuterol Sulfate (inhaler) HFA Inhalation Aerosol solution mcg/act, one puff inhale orally every four hours as needed for shortness of breath, and he may keep

the medication at his bedside.A Self-Administration of Medication Evaluation dated 3/24/26, documented Resident #2 was fully capable of administering nebulizer treatments after set-up by the nurse.Review of Resident #2's physician's order did not include an order for him to use a nebulizer.On 4/12/26 at 10:53 AM, an inhaler was observed on Resident #2's over the bed table. Resident #2 stated

he had asthma, and used the inhaler when he needed it. When asked how often he uses the inhaler, Resident #2 stated, sometimes two times a day.On 4/13/26 at 9:40 AM, Resident #2 was observed taking two puffs of the inhaler albuterol. On 4/13/26 at 4:36 PM, the CNO stated Resident #2 had an assessment to self-administer his inhaler. Surveyor told CNO that an assessment to self-administer

the inhaler was not found in his record. CNO stated she would look for Resident #2's assessment to self-administer the inhaler.On 4/14/26 at 10:15 AM, the CNO stated she was unable to find Resident #2 was assessed to self-administer the inhaler and he should have one.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete 135051 Page 3 of 1 2 Department of Health & Human Services Printed: 06/12/2026 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391 STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.Building 135051 04/16/2026 B. Wing NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Canyon West of Cascadia 2814 South Indiana Avenue Caldwell, ID 83605 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)

actions that can be measured.

Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

record review, policy review, SOM Appendix PP, and staff interview, it was determined the facility Residents Affected - Few failed to ensure comprehensive centered care plans' interventions were implemented. This was true for 1 of 20 residents (Resident #2) whose care plans were reviewed. This failure created the potential for harm should Resident #2 experience complications and receive inappropriate or inadequate care.

Findings include:The State Operations Manual Appendix PP dated 7/23/25, documented, The comprehensive care plan must reflect interventions to enable each resident to meet his/her objectives. Interventions are the specific care and services that will be implemented.The facility's Comprehensive Care Plans revised 9/3/25, documented the facility will ensure that each resident has

a timely, person-centered comprehensive care plan developed and maintained in accordance with professional standards of practice. The care plan will reflect the resident's individual conditions, risks, needs, behaviors, cultural values, and preferences and will include measurable goals, appropriate interventions, and realistic timeframes.Resident #2 was admitted to the facility on [DATE REDACTED] and readmitted [DATE REDACTED], with multiple diagnoses including diabetes, and chronic obstructive pulmonary disease.A physician's order dated 12/27/25, directed staff to administer apixaban (anticoagulant) oral tablet 5 mg by mouth two times a day to Resident #2.A care plan initiated 12/27/25, documented Resident #2 was on anticoagulant therapy and staff were directed to give the medications as directed by the physician and monitor/document the effectiveness and potential side effects: abnormal bleeding/bruising, black stools, pink-tinged urine, leg/pain swelling, nausea and vomiting, sudden onset of chest pain/shortness of breathing, and to notify the physician as indicated.Review of Resident #2's records did not include documentation he was being monitored for

the side effects of his anticoagulant.On 4/14/26 at 10:15 AM, the CNO stated Resident #2 did not have monitoring for his anticoagulant and there should be a monitor.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete 135051 Page 4 of 1 2 Department of Health & Human Services Printed: 06/12/2026 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391 STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.Building 135051 04/16/2026 B. Wing NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Canyon West of Cascadia 2814 South Indiana Avenue Caldwell, ID 83605 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)

Resident #8 refused to wear her nasal cannula and BiPAP, and requested a consideration to reduce Level of Harm - Minimal harm oxygen requirements and/or physician's orders. or potential for actual harm

On 4/15/26 at 3:03 PM, the CNO stated Resident #8's care plan related to nasal cannula and BiPAP Residents Affected - Few refusal behaviors should have been updated on 4/13/26, when the physician saw her.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete 135051 Page 6 of 1 2 Department of Health & Human Services Printed: 06/12/2026 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391 STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.Building 135051 04/16/2026 B. Wing NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Canyon West of Cascadia 2814 South Indiana Avenue Caldwell, ID 83605 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)

Level of Harm - Minimal harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on or potential for actual harm observation, record review, resident and staff interviews, it was determined the facility failed to ensure physician's orders for bowel care were followed. This was true for 1 of 4 residents (Resident Residents Affected - Few #8) reviewed for bowel care management. This deficient practice created the potential for residents to experience discomfort related to constipation. Findings include:Resident #8 was readmitted to the facility on [DATE REDACTED], with multiple diagnoses including pneumonia, diabetes, respiratory disorders, respiratory failure, shortness of breath, and pulmonary edema.Physician's orders documented the following:-Miralax oral powder, 17 gm/scoop, give 17 gm by mouth two times a day for bowel care mix with at least 4 oz fluid of choice, ordered 3/16/26.-Bisacodyl EC Oral Tablet Delayed Release 5 mg, give 1 tablet by mouth one time a day for constipation prevention, ordered 3/16/26.-Senna plus oral tablet 8.6-50 mg, give 2 tablets by mouth two times a day for bowel care, ordered 2/16/26.-Senna oral tablet 8.6 mg, give 3 tablets by mouth as needed for bowel protocol step #1 if no BM in 72 hours (day 3), ordered 3/24/26.-Bisacodyl Oral Tablet Delayed Release 5 mg, give 3 tablets by mouth as needed for bowel protocol step #2 if no BM in 96 hours (day 4), ordered 3/24/26.-Bisacodyl Rectal Suppository 10 mg, insert 1 suppository rectally as needed for bowel protocol step #3 if no BM by morning following after (day 5) completing oral bisacodyl, ordered 3/24/26.A review of Resident #8's medical record documented she did not have a bowel movement from 4/9/26 through 4/12/26 (4-days).A review of Resident #8's MAR dated 4/9/26 to 4/13/26, documented she did not receive bowel protocol step #1, step #2, or step #3.No records were available for 4/12/26 related to bowel care.On 4/14/26 at 9:35 AM, the ACNO confirmed Resident #8's MAR did not document she had received bowel protocol medication on 4/12/26 or 4/13/26. She confirmed there were no progress notes related to Resident #8's refusal or education provided by staff.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete 135051 Page 7 of 1 2 Department of Health & Human Services Printed: 06/12/2026 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391 STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.Building 135051 04/16/2026 B. Wing NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Canyon West of Cascadia 2814 South Indiana Avenue Caldwell, ID 83605 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)

staff had added a sticker with the date of 4/13/26 onto the oxygen tubing.

Level of Harm - Minimal harm or potential for actual harm A review of Resident #89's medical record on 4/12/26 and 4/13/26 did not document a physician's oxygen order.

Residents Affected - Few

A review of Resident #89's care plan did not document oxygen therapy until 4/13/26.

On 4/13/26 at 3:14 PM, it was observed Resident #89's oxygen concentrator was set at 4 LPM.

On 4/13/26 at 3:37 PM, the CNO confirmed the oxygen concentrator was set at 3.5 LPM. Resident #89 disagreed with the CNO and stated she had been using oxygen at 4 LPM as she did while at home.

On 4/13/26 at 3:48 PM, the CNO confirmed there was an oxygen order dated 4/13/26 for 2 LPM. She further stated, Resident #89's oxygen should not have been set at 3.5 or 4 LPM. When asked if oxygen is normally provided to residents without a physician's order, the CNO stated, a physician's order should have been received before Resident #89 was placed on oxygen.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete 135051 Page 9 of 1 2 Department of Health & Human Services Printed: 06/12/2026 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391 STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.Building 135051 04/16/2026 B. Wing NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Canyon West of Cascadia 2814 South Indiana Avenue Caldwell, ID 83605 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)

nurses on a full time basis.

Level of Harm - Minimal harm or potential for actual harm Based on record review and staff interviews, it was determined the facility failed to have an RN on duty for at least 8 consecutive hours a day. This created the potential for harm if routine and/or Residents Affected - Few emergency nursing services went unmet and had the potential to affect all residents residing at the facility. Findings include:On 4/13/25, during review of the facility Daily Staffing sheets and licensed nurse timesheets, the surveyor noted the facility only had 3 hours of RN coverage in a 24 hour period for August 10, 2025.On 4/14/26 at 3:36 PM, the Director of Clinical Resources stated an RN had not worked for at least eight hours during August 10, 2025, and should have.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete 135051 Page 1 0 of 1 2 Department of Health & Human Services Printed: 06/12/2026 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391 STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.Building 135051 04/16/2026 B. Wing NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Canyon West of Cascadia 2814 South Indiana Avenue Caldwell, ID 83605 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)

Level of Harm - Minimal harm Based on observation, record review, and staff interview, it was determined the facility failed to or potential for actual harm 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 Residents Affected - Some others who wanted to review the facility's staffing levels. Findings include:On 4/13/25, during review of the facility Daily Staffing sheets, the surveyor observed the following issues: - September 2025 - 23rd, 24th, 25th, 26th: Missing census data on the Daily Staffing sheets.- September 2025 - 27th, 28th, 29th: Missing Daily Staffing sheets. - January 2026, 18th, 19th, 20th: No nursing data (number of hours worked by nurses) documented on Daily Staffing sheets.On 4/16/26 at 10:26 AM, the CNO and Director of Clinical Resources stated the Daily Staffing sheets should not have been missing, nor missing required data but were.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete 135051 Page 2 of 1 2 Department of Health & Human Services Printed: 06/12/2026 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391 STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.Building 135051 04/16/2026 B. Wing NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Canyon West of Cascadia 2814 South Indiana Avenue Caldwell, ID 83605 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)

services of a licensed pharmacist.

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 staff interview, it was determined the facility failed to ensure Residents Affected - Few medications were stored securely. This was true for 1 of 1 resident (Resident #5) whose medication was observed in the room with no physician orders, and a medication cup with pills observed on the medication cart unattended. This deficient practice created the potential for harm if residents picked up and took medication not prescribed to them. Findings include:The facility's policy, Medication Storage & Labeling, released 10/13/25, stated, The facility will ensure that medications are stored and labeled in accordance with CMS regulations, state law, and acceptable professional principles to ensure safety, efficacy and compliance.1. Resident #5 was admitted to the facility on [DATE REDACTED], with multiple diagnoses including toxic encephalopathy (a brain dysfunction caused by toxic exposure to toxins) and acute respiratory failure with hypoxia (sudden inability to oxygenate the blood).On 4/13/26 at 10:08 AM, Resident #5 was observed storing a bottle of Lactaid (provides lactase enzymes for lactose intolerance) in her bedside nightstand. Resident #5 stated she was sensitive to milk, and takes Lactaid one or two tablets as needed. On 4/15/26 at 10:07 AM, LPN #1 reviewed Resident #5's MAR for Lactaid, and stated she did not have an order for Lactaid, then stated, I will get them out of the room.2. On 4/14/26 at 9:30 AM, LPN #1 left the medication cart and entered a resident's room, a medication cup containing a small pill was observed unattended on top of the medication cart. When asked about leaving the medication out, LPN #1 stated, I shouldn't have done that.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete 135051 Page 1 1 of 1 2 Department of Health & Human Services Printed: 06/12/2026 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391 STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.Building 135051 04/16/2026 B. Wing NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Canyon West of Cascadia 2814 South Indiana Avenue Caldwell, ID 83605 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)

serve food in accordance with professional standards.

Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, 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 Affected - Many 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.On 4/12/26 at 9:30 AM, observed the following

in the kitchen with the food service manager.- In the dry food storage area - a container of garlic powder with a use by date of 12/18/24, a container of chili powder with a use by date of 2/25/25, an opened bag of taco seasoning with no opened date or use by date, a container of chocolate sauce with

a use by date of 3/13/26.- In the refrigerators - cut onions in a container with use by date of 4/10/26,

an opened undated bag of cut cabbage, a tray with bagged cheese and an unsealed bag of salami with liquid in it that had leaked on to the tray that held both the cheese and salami, ham in a container with no use by date, small individual cups labeled as salad (dressing) with a prepped date of 3/28, but no use by date.- In the freezers - opened undated bag of chicken wings, opened unsealed and undated box of seasoned beef patties.- In the clean pan area - a skillet with encrusted food on the inside and outside of the pan.On 4/12/26 at 10:10 AM, the Food Service Manager stated the opened food items should have been closed and sealed correctly, all food items needed use by dates, and the encrusted pan should have been cleaned correctly.

Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date

these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.

LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER TITLE (X6) DATE REPRESENTATIVE'S SIGNATURE FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete 135051 Page 1 of 1 2 Department of Health & Human Services Printed: 06/12/2026 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391 STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.Building 135051 04/16/2026 B. Wing NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Canyon West of Cascadia 2814 South Indiana Avenue Caldwell, ID 83605 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)

Level of Harm - Minimal harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on or potential for actual harm observation, staff interviews and record review, it was determined the facility failed to ensure an Enhance Barrier Precaution was implemented. This was true for 1 of 1 resident (Resident #89) whose Residents Affected - Few medication administration was observed. This deficient practice created the potential for the spread of infection and its associated complications. Findings include:Resident #89 was admitted to the facility on [DATE REDACTED], with multiple diagnoses including nicotine dependence, hypertension, anxiety, and insomnia.A physician's order dated 4/10/26, directed staff to administer meropenem (an antibiotic) intravenous solution reconstituted one gram three times day for septic shock related to urinary tract infection.A care plan revised 4/12/26, documented Resident #89 was on enhanced barrier precautions to reduce the risk of MDRO (multiple drug-resistant organism) transmission related to PICC (Peripherally Inserted Central Catheter). The care plan directed staff to use gowns and gloves when performing high-contact resident care (dressing, bathing, transferring, incontinence or toileting care, dressing, changing linens, or device or wound care).An Enhanced Barrier Precaution signage was observed posted on Resident #89's door.On 4/14/26 at 3:39 PM, LPN #2 entered Resident #89's room with the meropenem medication in her hand. LPN #2 performed hand hygiene and donned gloves. LPN #2 sanitized the PICC's line needle connector cap, flushed the line with normal saline and then administered the meropenem. LPN #2 was not observed to put on a gown before accessing Resident #89's PICC line.On 4/14/26 at 3:40 PM, LPN #2 stated she forgot to put on the gown. She stated she should have put on the gown before accessing Resident #89's PICC line.On 4/14/26 at 4:14 PM, the IP stated, Yes, gown is required prior to administering the antibiotic. The nurse should have worn a gown.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete 135051 Page 1 2 of 1 2