Teton Healthcare Of Cascadia

F 0584

the over the bed table.

Level of Harm - Minimal harm or potential for actual harm

On 8/14/25 at 10:31 AM, the DON stated the trash cans with dirty briefs should have been taken out every time the resident’s briefs were changed, the resident’s supplies should not have been stored

on the floor, the CNAs should have cleaned the over the bed tables, and the night shift were to clean the wheelchairs at night, but they did not have documentation that the wheelchairs were being cleaned.

Residents Affected - Few

On 8/14/25 at 1:02 PM, the Administrator with the Maintenance Assistant present, stated the over the bed tables should have been cleaned daily by the housekeepers.

On 8/14/25 at 7:05 AM, the blue crossbeam pad on the Hoyer lift on the 100 hall was dirty with whitish and brown marks on it. LPN #1 stated she was not sure how they get dirty because they try not to allow the residents to touch the pad.

On 8/14/25 at 7:12 AM, the gray crossbeam pad on the Hoyer lift on the 400 hall was dirty to the point of being black. CNA #1 stated she was not sure how or when the crossbeam pad gets cleaned.

On 8/14/25 at 10:50 AM, the DON stated the Hoyer lift cross beam pads should be kept clean or removed.

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

08/15/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Teton Healthcare of Cascadia

3111 Channing Way Idaho Falls, ID 83404

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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

record review, policy review, and staff interview, it was determined the facility failed to ensure resident's care plans were revised to reflect current needs and interventions. This was true for 1 of 3 residents (Resident #5) whose care plans were reviewed. This placed residents at risk for adverse outcomes if care and services were not provided due to care plans not being revised as residents' needs changed. Findings include:The facility Accidents and Supervision to Prevent Accidents policy dated 10/15/22, documented under falls, development of a person-center plan of care by the interdisciplinary team can evaluate potential use of therapy, devices, environmental adjusts, review of medications, and treatment of other impacting factors may reduce the number of outcome severity of falls. If fall occurs, manage the fall, then determine root-cause analysis to assist with updates to the fall prevention plan. When reviewing root-cause, evaluate all the causal factors leading to the resident fall as the(y) may also assist in developing and implementing relevant, consistent, and person-centered interventions to prevent future occurrences.Resident #5 was admitted to the facility on [DATE REDACTED], with multiple diagnoses including acute osteomyelitis on right ankle and foot (a bone infection, usually occurring within two weeks of the initial infection) and adult failure to thrive.Resident #5's medical record documented he had a fall on 3/14/25, when he leaned forward in his wheelchair to reach his drink and food in the dining room and he slipped out of his wheelchair to the ground. The IDT assessment directed that staff were to ensure Resident #5's drink and food are closer to him in the dining room, so he did not have to lean forward in his wheelchair. Resident #5's care plan fall prevention interventions had not included the IDT assessment recommendationsOn 8/14/25 at 11:10 AM,

the DON stated Resident #5's care plan fall interventions had not including the IDT assessment recommendation from the 3/14/25, fall and should have.

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

08/15/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Teton Healthcare of Cascadia

3111 Channing Way Idaho Falls, ID 83404

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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

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

observation and staff interview, it was determined the facility failed to ensure medications available for residents were stored appropriately; this was true for 1 of 18 resident's rooms inspected (Resident #1). This failure created the potential for adverse effects if residents self-administered medications inappropriately or did not take their medications. Findings include:Resident #1 was admitted to the facility on [DATE REDACTED], with multiple diagnoses including Chronic obstructive pulmonary disease (a group of lung diseases that block airflow and make it difficult to breathe) and hypertension.On 8/14/25 at 8:44 AM, observed on Resident #1's bedside table a medication cup with a purple substance with multi-colored specks and a spoon in it.On 8/14/25 at 8:48 AM, RN #1 stated Resident #1 did not have an order to self-administer medications, she did not have it documented in her care plan to self-administer medication so she should not have left the medications in her room.On 8/14/25 at 11:38 AM, the DON stated residents should not have medications left in their room.

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

08/15/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Teton Healthcare of Cascadia

3111 Channing Way Idaho Falls, ID 83404

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 0880

Provide and implement an infection prevention and control program.

Level of Harm - Minimal harm or potential for actual harm

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

observation and staff interviews, the facility failed to ensure adherence to infection control and prevention practices to provide a safe and sanitary environment, when staff did not follow proper enhanced barrier precautions protocol. These failures had the potential to impact 1 of 5 residents (Resident #70) observed with EBP signs on their room doors, placing them all at risk for cross-contamination and infection. Findings include:Resident #70 was admitted to the facility on [DATE REDACTED], with multiple diagnoses including acute cystitis (inflammation of the bladder) and dysphagia (difficulty or pain with swallowing). On 8/14/25 at 7:36 AM, observed CNA #2 had not donned a gown or gloves when she assisted Resident #70 with a transfer from her bed into her wheelchair and then into the shower room where she assisted her with a shower. Resident #70 was on EBP with a sign on her door that documented for staff to wear gown and gloves when assisting with transfers and showering. On 8/14/25 at 7:40 AM, CNA #2 stated she thought she only needed to donn gown and gloves when assisting Resident #70 with her catheter.On 8/14/25 at 7:45 AM, CNA #3 stated the EBP sign indicated staff were to wear gloves and gown when assisting residents with bathing/showering, transferring, and catheter care.On 8/14/25 at 11:00 AM, the DON stated staff were to wear gloves and gowns when assisting residents with cares who have EBP signs on their door.

Residents Affected - Few

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

Event ID:

Facility ID:

If continuation sheet