The sequence began when Resident 12, identified in inspection records only by number, wandered into the room occupied by Resident 52.
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He had complained that he hadn't been changed.
Inspectors documented the scene during a survey completed April 24, 2025, at the facility on North Assembly Street.
The inspection, conducted on March 25 and 27, 2025, documented what happened at 10:44 in the morning on the facility's east unit.
Federal inspectors classified the finding as immediate jeopardy, the most serious level of harm designation available under the inspection process.
The citation affected a few residents, according to the report.
A Stage IV pressure wound is the most severe classification.
The missing money belonged to Resident 38.
When a federal inspector walked into the room at 9:09 a.m.
Not two folders out of a small handful.
The facility, located at North 6025 Assembly in Spokane, received a deficiency citation following an April 24, 2025 inspection.
The incident at Grand Trace Health and Rehabilitation was observed on March 26, 2025, at 8:45 in the morning.