North Auburn Care

According to the 01/31/2025 Quarterly MDS Resident 17 was assessed as cognitively intact and able

In an interview on 04/14/2025 at 10:58 AM Resident 17 stated they had a missing iPhone, which the facility would not replace stating, I had to buy an android, I couldn't afford an iPhone. I really liked that phone.

The resident at this time indicated she would prefer an iPhone.

Observation at that time showed Resident 17 had an android cell phone.

According to the grievance log Resident 17 reported the phone was missing on 01/20/2025.

According to the grievance notes facility staff documented SSD followed up with admin and (they) notified SSD to see if resident (family) would like for phone to be replaced and (they) declined stating,I already purchased another phone for (the resident).

In an interview on 04/21/2025 at 8:30 AM Staff G reviewed the grievance form and confirmed staff did not follow up with Resident 17 regarding the missing phone.

REFERENCE: WAC 388-97-0460. .

505195 04/21/2025

North Auburn Care 2830 I Street Northeast Auburn, WA 98002

they were instructed they did not have to notify the LTCO with the reason for transfer to hospital so

02/16/2025.

In an interview on 04/21/2025 at 10:38 AM Staff R (Business Office Manager) stated Resident 7 .wouldn't do anything with paperwork if it was provided to them and they're on Medicaid.

Staff R confirmed the Transfer or Discharge Notice document was not signed by the resident and they were responsible for providing written transfer notifications to the residents and/or resident representatives.

Staff R stated Staff C (Corporate Nurse) completed the written transfer notice for Resident 7's 02/16/2025 transfer to hospital and says it was sent via email to Resident 7's guardian.

In an interview on 04/21/2025 at 12:56 PM Staff D (Chief Nursing Officer) stated they talked to Staff C and they were unable to provide a copy of the emailed written transfer notification to the guardian for Resident 7's transfer to the hospital on [DATE].

REFERENCE: WAC 388-97-0120 (2)(a-d). .

505195 04/21/2025

North Auburn Care 2830 I Street Northeast Auburn, WA 98002

Hold) document explained the resident was being discharged for acute treatment needs that could not be met at the facility.

Under the section Bed Hold Notification Duration of Transfer/Discharge showed TBD with no documentation of the guardianships decision on whether to hold the bed or not.

The form does not show the cost of holding the bed, have a place for the resident/representative to sign to consent the bed hold, or decline the bed hold.

In an interview on 04/21/2025 at 10:38 AM Staff R (Business Office Manager) stated Resident 7 .wouldn't do anything with paperwork if it was provided to them and they're on Medicaid so the facility did not need to offer a bed hold because they couldn't afford it anyway.

Staff R confirmed the Bed Hold document was not signed by the resident or their representative.

Staff R stated they were responsible for providing Bed Holds to the residents and/or resident representatives and when another staff member completed the form, they (Staff R) were responsible to follow up to ensure a copy was provided and documentation was in the residents health record to show the form was provided and whether or not they agreed to a bed hold.

Staff R stated Staff C (Corporate Nurse) completed the Bed Hold form for Resident 7's 02/16/2025 transfer to hospital and stated it was sent via email to Resident 7's guardian, but Staff R was unable to provide documentation of the residents/representatives wishes for the bed hold.

Staff R stated they expected the forms to be emailed to representatives for evidence of notification.

In an interview on 04/21/2025 at 12:56 PM Staff D (Chief Nursing Officer) stated they talked to Staff C and they were unable to provide a copy of the emailed written transfer notification/bed hold to the guardian for Resident 7's transfer to the hospital on [DATE].

REFERENCE: WAC 388-97-0120(4). .

505195 04/21/2025

North Auburn Care 2830 I Street Northeast Auburn, WA 98002

According to Resident 69's 02/24/2025 Discharge MDS, Resident 69 discharged from the facility on 02/24/2025 to a short-term general hospital.

Review of a 02/24/2025 Resident Discharge Summary/Instructions evaluation form showed Resident 69 discharged to their private home.

In an interview on 04/16/2025 at 11:39 AM, Staff N reviewed Resident 69's 02/24/2025 MDS and discharge summary.

Staff N confirmed the MDS was coded incorrectly.

REFERENCE: WAC 388-97-1000 (1)(b). .

505195 04/21/2025

North Auburn Care 2830 I Street Northeast Auburn, WA 98002

505195 04/21/2025

North Auburn Care 2830 I Street Northeast Auburn, WA 98002

According to a 06/29/2024 admission MDS Resident 35 had diagnoses of, but not limited to, Depression and Anxiety Disorder.

Review of Resident 35's health records showed a 06/22/2024 PASSR I with no SMI's documented and no level II referral necessary. Resident 35's records showed a 12/18/2024 updated PASRR I that included SMI's, documented a level II PASRR was indicated, and the PASRR II referral was made.

In an interview on 04/18/2025 at 8:55 AM Staff G stated they were expected to review the PASRR I's after the resident admitted to the facility to ensure they were correct.

Staff G stated Resident 35's PASRR I review was missed.

Staff G stated they completed an updated PASRR I on 12/18/2024 to reflect the SMI's and that a PASRR II referral was indicated.

Staff G stated they communicated with the state PASRR coordinator since questions came up during survey about PASRR's and the coordinator had informed them they had not received a PASRR II referral for Resident 35.

Staff G stated they were responsible to follow up on PASRR's within 3 weeks after a referral was made but they did not follow up on Resident 35's because they were running behind.

REFERENCE: WAC 388-97-1915(1)(2)(a-c). .

505195 04/21/2025

North Auburn Care 2830 I Street Northeast Auburn, WA 98002

evaluation showed only the daughter was in attendance.

conferences were within 72 hours after admission to the facility, quarterly, and as needed.

Staff G

conferences.

Staff G stated only the daughter and Staff G attended Resident 28's care conference on 03/14/2025.

Staff G stated there was no documentation in Resident 28's health records as to why they were not invited to their own care conference and could not recall any reason for this.

Staff G stated Resident 28 and other interdisciplinary team members did not, but should have, participated in Resident 28's care conference.

REFERENCE: WAC 388-97-1020(2)(c-d)(f), (4)(b).

REFER TO: F-F692-Nutrition/Hydration Status Maintenance. F-F700- Bedrails .

505195 04/21/2025

North Auburn Care 2830 I Street Northeast Auburn, WA 98002

According to the 03/11/2025 admission MDS, Resident 64 had unclear speech, was usually understood, and was able to understand others.

The MDS showed Resident 64 had diagnoses including stroke, malnutrition, and a swallowing disorder due to the stroke.

The assessment showed Resident 64 received nutrition via a tube surgically placed in their stomach.

Review of Resident 64's 04/16/2025 order summary report showed the resident had a 03/04/2025 order directing staff the resident was to have nothing by mouth.

Review of Resident 64's April 2025 MAR showed an order directing staff to offer the resident a snack at bedtime and document the percentage of the snack consumed by Resident 64.

The MAR showed from 04/01/2025 to 04/17/2025, staff documented Resident 64 ate 100% of the snack offered on 11 of 17 opportunities.

Staff documented not applicable on one occasion and a dash or 0 on 4 occasions.

In an interview on 04/18/2025 at 10:21 AM, Resident 64 stated staff did not bring them or offer snacks at bedtime because they were unable to swallow.

In an interview on 04/21/2025 at 10:20 AM, Staff E confirmed Resident 64 had a nothing by mouth order.

Staff E stated staff should not be documenting tasks that were not done and staff should have clarified the order to provide Resident 64 with a snack at bedtime. <Resident 7> According to a 11/08/2024 Annual MDS Resident 7 experienced frequent 6/10 pain on a pain scale of 1-10 with 10 being the worst pain they've experienced.

The MDS showed Resident 7 received scheduled pain medication during the assessment period.

Review of Resident 7's health records showed a 02/24/2025 physician order for an as needed pain medication without parameters.

In an interview on 04/17/2025 at 9:24 AM Staff O (Resident Care Manager) stated Resident 7 had no pain level or maximum dose in 24 hours parameter in place for their as needed pain medication.

Staff O stated Resident 7's pain medication should not exceed 3000 milligrams in 24 hours and the order should include this.

REFERENCE: WAC 388-97-1620(2)(b)(ii). .

505195 04/21/2025

North Auburn Care 2830 I Street Northeast Auburn, WA 98002

Findings included . <Facility Policy> According to a facility policy titled, Against Medical Advice Discharge, revised 05/2023, the facility would complete an AMA form, read the information with the resident, and carefully explain the information before witnessing the resident sign the form before the resident left the facility AMA.

The facility would treat the situation similarly to a refusal of care, discuss the reasons for leaving AMA with the resident/their representative.

Staff were to document the risks of discharging AMA, the resident's reason for leaving AMA, the condition of the resident at discharge, the transportation method used, and items the resident removed from the facility. <Resident 67> According to the 03/13/2025 Discharge Minimum Data Set (MDS - an assessment tool), Resident 67 was admitted to the facility on [DATE] and was discharged with return not anticipated.

The MDS showed Resident 67 had impaired memory and required two-person assistance with personal hygiene, transferring, and toileting needs.

Review of a 03/13/2025 nursing progress note showed Resident 67 was taken out of the facility AMA by family and AMA paperwork was signed.

Review of Resident 67's record showed an AMA form was signed by Resident 67's family on 03/13/2025.

This AMA form showed the medical risks and benefits were not explained to the resident/representative by staff members and none of the medical risks listed on the form were marked by staff.

Review of the nursing progress notes from 03/10/2025 through 03/13/2025 showed no documentation Resident 67's primary care provider was notified of Resident 67's AMA discharge.

There was no documentation staff discussed with Resident 67's representative the care, medications, or equipment the resident needed at home.

In an interview on 04/21/2025 at 11:00 AM, Staff D (Clinical Nursing Officer) reviewed Resident 67's record and stated the facility did not follow the AMA discharge policy.

Staff D stated staff should discuss with the resident/representative the reason for leaving AMA, explain the risks and benefits of leaving AMA, notify the provider, arrange medications as ordered, and document all these efforts in Resident 67's record, but they did not.

REFERENCE: (WAC) 388-97-0080 (5)(6). .

505195 04/21/2025

North Auburn Care 2830 I Street Northeast Auburn, WA 98002

Observation on 04/17/2025 at 11:27 AM showed Resident 31 lying in bed, with their right foot exposed.

The toenails were long, extending past the toes. At that time, Staff X (CNA) observed and confirmed Resident 31's toenails were long.

Staff X removed Resident 31's sock on the left foot revealing long toenails to the resident's left foot.

Review of Resident 31's April 2025 CNA task documentation showed staff were to document every day shift if staff provided nail care to the resident.

This documentation showed staff documented Y for yes-nail care was provided to the resident on 04/15/2025.

This documentation did not specify if the nail care provided was to the resident's finger or toe nails.

Review of Resident 31's 04/16/2025 physician orders and 03/31/2025 Activities of Daily Living CP showed no orders or directions to staff regarding what assistance the resident required for finger or toe nail care, or who was to provide the care and when.

In an interview on 04/21/2025 at 9:28 AM, Staff E stated nail care should be done as needed.

Staff E stated they expected CNAs to report to the nurse if they noted long toe nails on a resident.

Staff E stated they expected nurses to note long toe nails on weekly skin checks and provide trimming as needed.

REFERENCE: WAC 388-97-1060(2)(c). .

505195 04/21/2025

North Auburn Care 2830 I Street Northeast Auburn, WA 98002

level was not completed for Resident 7.

In an interview on 04/18/2025 at 12:05 PM Staff E reviewed Resident 7's health records and stated they did not see a Vitamin D level was ever obtained for Resident 7, but it should be, prior to starting the high dose Vitamin D supplement.

Staff E stated it was important to obtain the Vitamin D level to ensure they were not administering unnecessary medications.

REFERENCE: WAC 388-97-1060 (1). .

505195 04/21/2025

North Auburn Care 2830 I Street Northeast Auburn, WA 98002

Findings included . <Resident 30> Resident 30 admitted to the facility on [DATE] and according to the 09/13/2024 admission Minimum Data Set (an assessment tool) had adequate vision and did not require the use of corrective lenses.

Observation on 04/14/2025 at 1:20 PM showed Resident 30 lying in bed, a pair of eyeglasses were noted on the overbed table. In an interview at this time, Resident 30 indicated they needed an eye exam stating, I put in for an eye exam a few months ago, but it didn't happen, nobody's gotten back to me.

In an interview on 04/16/2025 at 8:19 AM, Resident 30 stated. I can't read and when attempting to read a written document stated, it's a blur.

The resident clarified at this time, I got glasses over two years ago . I need new glasses.

Record review showed a progress note dated 11/01/2024 which indicated, Resident scheduled to be seen by [NAME] Vision on 11/01/2024, (resident) has declined due to feeling ill.

Next F/U (follow up) will be December 2024.

Record review showed no evidence Resident 30 received vision services.

In an interview on 04/21/2025 at 9:16 AM, Staff G (Social Service Director) stated the facility has an eye service that comes in and sees residents when requested.

Staff G confirmed staff should have, but did not, reschedule the resident until survey staff brought it to their attention on 04/17/25 with the next available appointment being in June.

Staff G indicated they forgot about Resident 30.

Refer to F-F641 Accuracy of MDS REFERENCE: WAC 388-97-1060(3)(a). .

505195 04/21/2025

North Auburn Care 2830 I Street Northeast Auburn, WA 98002

Review of Resident 7's health records showed a safety device air mattress with bolsters CP with an intervention to keep the air mattress set at 180 pounds and 30-minute cycle time/alternating. Resident 7's records showed a physician order to set the air mattress at 165 pounds and cycle time/alternating with the staff to check for correct settings every shift.

In an interview on 04/18/2025 at 8:28 AM Staff L (Resident Care Manager) stated Resident 7's bed was set incorrectly and should not be set at 340 pounds.

Staff L stated the nursing staff are to monitor air mattress settings every shift to ensure they are set according to the physician order to prevent skin breakdown.

REFERENCE WAC: 388-97-1060 (3)(b). .

505195 04/21/2025

North Auburn Care 2830 I Street Northeast Auburn, WA 98002

Review of the 02/08/2025 Quarterly MDS showed Resident 23 had diagnoses including heart failure, end-stage kidney failure, and diabetes (inability to control their blood sugar levels).

The MDS showed Resident 23 had a diabetic foot ulcer.

Review of Resident 23's progress notes showed an 11/17/2025 consulting wound provider note recommending a Podiatry referral for management and evaluation of hammer toes as foot deformity may complicate wound healing.

The consulting wound provider wrote additional notes recommending a podiatry referral for Resident 23 on 11/23/2024, 12/08/2024, 12/13/2024, 12/22/2024, 12/28/2024, 01/04/2025, 01/11/2025, 01/19/2025, and 01/24/2025.

Review of Resident 23's 04/14/2025 order summary showed a 01/14/2025 physician's order instructing staff to refer the resident to a podiatrist for a right foot wound.

Review of Resident 23's comprehensive records on 04/21/2025 showed no progress notes, orders, or scanned documents indicating facility staff followed the wound provider's recommendation to refer Resident 23 to a podiatrist.

In an interview on 04/21/2025 at 8:11 AM, Staff G stated they were responsible for arranging the facility's podiatry services and confirmed Resident 23 was not seen by a podiatrist since the referral made in November 2024.

Staff G stated the facility was having issues with podiatry services and did not currently have a date of when the podiatrist would be available to the facility.

In an interview on 04/21/2025 at 9:17 AM, Staff E (Assistant Director of Nursing) confirmed Resident 23 was not seen by a podiatrist as recommended.

Staff E stated staff should have followed the wound provider's recommendation for a podiatrist but they did not.

Refer to: F-F684 REFERENCE: WAC 388-97-1060(3)(j)(viii). .

505195 04/21/2025

North Auburn Care 2830 I Street Northeast Auburn, WA 98002

to determine if they were safe to smoke independently or needed supervision, but they did not

In an interview on 04/16/2025 at 9:36 AM, Staff A (Administrator) stated they were unaware Resident

REFERENCE: WAC 388-97-1060(3)(g). .

505195 04/21/2025

North Auburn Care 2830 I Street Northeast Auburn, WA 98002

According to the Urinary Elimination Care Plan dated 12/06/2024, interventions included, Urology consult as needed but the record revealed staff did not consider a urology consult to confirm the resident's urinary retention could not be treated or corrected medically.

Record review showed no documentation to support the resident had untreatable urinary blockage or any history of being unable to void prior to the most recent hospitalization.

There was no indication in the record facility staff considered prolonged use of the indwelling urinary catheter could lead to a decrease in bladder tone and function, or what interventions might be done to mitigate those effects.

In an interview on 04/18/2025 at 9:23 AM Staff C (Corporate Nurse) confirmed no post void residuals were obtained and there was no attempt at bladder retraining stating, We could have done better.

Staff C confirmed staff failed to follow the facility policy to ensure the catheter was necessary.

REFERENCE: WAC 388-97-1060(3)(c). .

505195 04/21/2025

North Auburn Care 2830 I Street Northeast Auburn, WA 98002

Review of the 11/08/2024 Annual MDS showed Resident 7 had no memory impairment.

The MDS showed Resident 7 did not have swallowing difficulties.

Review of Resident 7's health records showed an 11/14/2024 at risk for dehydration CP indicating staff would encourage fluids with each care. Resident 7's health records showed a 04/03/2025 diet order with no restrictions on fluids.

In an interview on 04/15/2025 at 9:21 AM, Resident 7 stated staff do not bring them water. Resident 7 stated they were always thirsty. Resident 7 stated they had to ask staff to bring them a water pitcher and sometimes they would get one, but sometimes they would not come back with one.

Observation on 04/16/2025 at 8:56 AM showed staff did not offer Resident 7 hydration services. Resident 7 asked staff to bring them a water pitcher with fresh water. <Resident 35> According to a 06/29/2024 admission MDS, Resident 35's ability to make daily decisions was severely impaired.

The MDS showed a dehydration/fluid maintenance care area was triggered for Resident 35 and staff would assess and manage their fluid needs.

Review of Resident 35's health records showed a 06/22/2024 peripheral vascular disease related to diabetes CP with an intervention for staff to encourage good hydration.

Observations on 04/15/2025 at 12:05 PM showed no water pitcher or fluids available in Resident 35's room.

In an interview on 04/18/2025 at 12:05 PM, Staff E (Assistant Director of Nursing) stated they expected staff to offer and provide water pitchers to all residents every shift and as needed.

Staff E stated they expected staff to automatically provide hydration services, and the residents should not have to ask to get them.

REFERENCE: WAC 388-97-1060(3)(h). .

505195 04/21/2025

North Auburn Care 2830 I Street Northeast Auburn, WA 98002

on Resident 22's bed.

Staff E stated they expected staff to notify the maintenance department about

REFERENCE: WAC 388-97-1060(3)(g), -2100 (1).

.

505195 04/21/2025

North Auburn Care 2830 I Street Northeast Auburn, WA 98002

Review of the 12/13/2024 antipsychotic medication CP included the instructions for staff to discuss with provider regarding ongoing need for use of medication.

Review of Resident 54's record showed a 03/31/2025 interdisciplinary team nursing progress note that Resident 54 received antipsychotic medication related to depression from cancer and the provider agreed to discontinue the antipsychotic medication and to start on an antidepressant medication daily.

Review of Resident 54's record on 04/17/2025 including physician orders and MARs showed no documentation Resident 54's antipsychotic medication was discontinued, and an antidepressant medication was started.

In an interview on 04/17/2025 at 1:09 PM, Staff C stated they reviewed Resident 54's medications in a psych meeting and the provider ordered to discontinue the antipsychotic medication.

Staff C reviewed Resident 54's record and stated staff should have followed the provider's recommendations and discontinue the antipsychotic medication, but they did not. <Resident 35> According to a 06/29/2024 admission MDS, Resident 35 admitted to the facility on [DATE].

The MDS showed Resident 35 had a diagnosis of, but not limited to, depression.

The MDS showed Resident 35 received antidepressant medications during the assessment period.

Review of Resident 35's records showed a 03/27/2025 antidepressant medication use care plan with an intervention to attempt a GDR per pharmacist recommendations. Resident 35's records showed a 06/22/2024 physician order for an antidepressant medication.

In an interview on 04/18/2025 at 12:05 PM Staff E (Assistant Director of Nursing) reviewed Resident 35's health records and stated they did not attempt a GDR for Resident 35's antidepressant medication since admission to the facility.

Staff E stated it was important to attempt GDRs for psychotropic medications to ensure they were not over medicating the resident or administering and unnecessary medication to the resident.

REFERENCE: WAC 388-97-1060(3)(k)(i). .

505195 04/21/2025

North Auburn Care 2830 I Street Northeast Auburn, WA 98002

According to the April 2025 MAR, the blood sugar check and injectable medication coverage for the blood sugar results was ordered for 11:30 AM but completed at 12:52 PM.

In an interview on 04/16/2025 at 9:23 AM, Staff B and Staff C confirmed if the physician's order for blood sugar check and the injectable medication were scheduled at 11:30 AM, they should be done within 30 minutes of that scheduled time.

Staff B and Staff C stated if the injectable medication was done late, You need to call the doctor .yes that would be an error.<Resident 19> Observation of medication pass on 04/16/2025 at 7:00 AM showed Staff W (Licensed Practical Nurse) administer Resident 19 nine medications.

Review of Resident 19's physician orders on 04/16/2025 showed one of the nine medications administered to the resident was not ordered for Resident 19. Resident 19's records showed a single stool softener ordered for the residents that Staff W did not administer and instead Staff W administered a medication that had two stool softeners in one tablet.

In an interview on 04/16/2025 at 9:38 AM, Staff W stated they administered the wrong stool softener to Resident 19.

Staff W stated they should have administered the single stool softener and not the medication with two stool softeners in it.

In an interview on 04/18/2025 at 12:05 PM Staff E (Assistant Director of Nursing) stated they expected staff to follow physician orders when administering residents their medications.

Staff E stated it was important to follow physician orders to ensure administration of correct medications.

REFERENCE: WAC 388-97-1060(3)(k)(ii). .

505195 04/21/2025

North Auburn Care 2830 I Street Northeast Auburn, WA 98002

Observation at this time showed 15 bags of Intravenous antibiotics were identified in the refrigerator

antibiotics were dispensed by the pharmacy on [DATE] and [DATE]. In an interview on [DATE] at 10:33 AM, Staff C (Corporate Nurse) stated staff should have contacted the pharmacy after the medication was received on [DATE] and destroyed the medication when there was no longer an order for it.

In an interview on [DATE] at 10:35 AM Staff C stated staff should dispose of discontinued medications, as soon as possible, we try to do it once a week.

When asked at what time, after a resident is discharged , their medications should be destroyed/removed from the medication cart, Staff C stated, I would take it out within 24 hours of discharge. <Medications at Bedside> Observations on [DATE] at 12:41 PM showed Resident 52 had a bottle of vision supplements for eye health and one bottle of multivitamins on their overbed table.

Similar observations were noted on [DATE] at 7:38 AM and [DATE] at 8:31 AM.

In an interview on [DATE] at 12:14 PM Staff E (Assistant Director of Nursing), confirmed the presence of the unsecured medications at the bedside and stated the resident should have their medications in a lockbox.

Staff E stated staff should, but did not, report when they found medications at the bedside.

REFERENCE: WAC 388-97-1300(1)(B)(II), (c)(ii-iv)(2). .

505195 04/21/2025

North Auburn Care 2830 I Street Northeast Auburn, WA 98002

Findings included .

Observation of the kitchen during rounds, on 04/17/2025 at 9:47 AM, showed Staff I (Dishwasher) running dishes from breakfast service through the dishwasher.

Staff F (Dietary Manger) explained the facility used a low temperature dishwasher which required chemical sanitation (Chlorine used to kill viruses, bacteria, and other microorganisms to prevent foodborne illness) to clean dishes and kitchen utensils stating, I try to keep it (test strips which registered chlorine) at 200 Parts Per Million.

During this observation, Staff F, tested the dishwasher for proper sanitizing solution.

The chlorine test strip was dipped into the dishwasher water and was noted to be white, indicating an absence of chlorine.

Staff F tested for adequate levels of sanitizer two additional times with the same results of a white strip (no/low levels chlorine/sanitizer in the solution).

In an interview at 9:54 AM, Staff F stated the dishwasher checks for sanitizer three times a day with each meal but was unable to locate the log that staff used to documented testing of the dishwasher function.

Staff I, in an interview on 04/17/2025 at 9:47 AM stated the sanitizer test was really low when it was checked before breakfast.

Staff I acknowledged that if the test strip remained white it meant, there was no chemical.

When asked to whom this issue was reported, Staff I replied, No one. In an interview at this time, Staff F stated Staff I should have reported there was no sanitizer and that the log on which staff documented the sanitation levels was missing.

Staff F proceeded to contact the company that services the dishwasher, and was instructed to Prime the sanitizer bucket by toggling a switch on the side of the dishwasher.

Observations on 04/17/2025 at 10:52 AM, showed that after replacing the sanitizer bucket and priming the machine two times, chlorine levels were noted to meet required sanitizing levels.

Further interview revealed Staff F replaced the sanitizer bucket the previous day at 3:00 PM but was not aware of the need to prime the new sanitizer bucket.

Staff F said it was reasonable to conclude the sanitizer was not functioned since then.

Staff F was requested to provide documentation to support staff were educated / trained on how to replace the sanitizer bucket and what to do if inadequate amounts of sanitizer were noted. No information was provided.

REFERENCE: WAC 388-97-1100(3) & -2980. .

505195 04/21/2025

North Auburn Care 2830 I Street Northeast Auburn, WA 98002

Refer to F-F687 - Foot Care.

Refer to F-F641 - Accuracy of Assessments.

Refer to F-F758 - Free From Unnecessary Psychotropic Medications.

REFERENCE: WAC 388-97-1720 (1)(a)(i-iv); (2)(a-m). .

505195 04/21/2025

North Auburn Care 2830 I Street Northeast Auburn, WA 98002

Observation on 04/17/2025 at 12:06 PM showed Staff V (CNA) providing incontinent cares to Resident 6 for an incontinent episode of loose stool in their brief.

Staff V was observed to clean Resident 6's loose stool off their catheter (tube inserted into the bladder to drain urine) tubing.

Staff V changed their gloves between dirty and clean cares without performing hand hygiene. 04/17/2025 at 1:45 PM Staff V stated they should have performed hand hygiene between dirty and clean care glove changes, but they did not.

In an interview on 04/21/2025 at 9:40 AM Staff P (Infection Preventionist) stated they expected staff to wear surgical masks in resident areas.

Staff P stated they expected staff to perform hand hygiene upon entering a resident room, prior to providing resident care, between clean and dirty cares, and between glove changes.

REFERENCE: WAC 388-97-1320 (1)(c)(2)(a). .

Findings included .

<Facility Policy>

According to a facility policy titled, Safety Device Application, revised 04/07/2023, showed the facility would apply the safety device as directed.

The policy showed staff would follow the safety device Care Plan (CP) and interventions.

According to a facility policy titled, Wound Prevention and Treatment, revised 02/03/2023, the facility would reduce the occurrence of pressure over bony prominence to minimize injury, manage risk factors, and provide preventive interventions.

The policy showed the staff would ensure residents received continuous preventative interventions to promote healing and prevent skin issues.

<Resident 6>

According to a 01/04/2025 Annual Minimum Data Set (MDS - an assessment tool) Resident 6 had no memory impairment.

The MDS showed Resident 6 was at risk of developing PUs and had three PUs.

Review of Resident 6's health records showed a 04/22/2023 physician order for air mattress settings to be at alternate level 5 and staff would check for correct settings every shift.

Residents 6's records showed a 10/24/2023 air mattress CP with an intervention for staff to monitor appropriate functioning of air mattress every shift. Resident 6's records showed a 03/05/2025 right heel PU CP with an intervention for staff to frequently reposition the resident to prevent new PU's or worsening of active PUs.

In an observation and interview on 04/14/2025 at 9:25 AM showed Resident 6's air mattress settings at float level 8.

Staff S (Registered Nurse) stated Residents 6's air mattress should be at alternate level 5.

Staff S stated nursing staff were responsible for checking the air mattress settings every shift to ensure they were set per physician orders to prevent skin breakdown.

In an interview on 04/14/2025 at 12:51 PM Resident 6 stated they depended on staff to reposition them in their bed with the air mattress. Resident 6 stated the staff were supposed to reposition them every two to three hours but often did not.

In a continuous observation on 04/17/2025 from 7:56 AM until 12:06 PM Resident 6 was lying in bed flat on their back.

505195

Form Approved OMB

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.

Building 505195 B.

Wing 04/21/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

North Auburn Rehab & Health Center 2830 I Street Northeast Auburn, WA 98002

F-F658 - Services Provided Meet Professional Standards.

Refer to

Findings included .

<Facility Policy>

Record review of the facility policy titled, Smoking, revised 06/2023, showed the facility would screen all residents for smoking via the nursing admission evaluation.

Residents who wished to continue smoking would have smoking reflected in their care plan.

The policy showed the facility would store all smoking materials in a locked storage cabinet in the resident's room, at the nurse's station, or another designated location in the facility.

<Resident 62>

According to the 01/03/2025 Admission Minimum Data Set (MDS - an assessment tool), Resident 62 had clear speech, their memory was intact, and they understood others during communication.

The MDS showed Resident 62 required one person assistance with transfers, toileting, and bed mobility.

The MDS showed Resident 62 used a wheelchair for mobility.

In an interview on 04/14/2025 at 10:57 AM, Resident 62 stated they smoked once or twice a day and had their smoking materials in a drawer in their room. Resident 62 stated they knew the rule to not smoke on facility property and they had to go 50 feet away from the facility property.

Review of Resident 62's record showed Resident 62 did not have a smoking assessment completed.

Review of a Social Services evaluation completed on 03/31/2025 showed Resident 62 as a smoker.

In an interview on 04/16/2025 at 7:44 AM, Resident 62 stated the facility staff knew they smoked. Resident 62 stated the facility staff provided them with a metal lock box to keep their smoking materials in their room in a drawer. Resident 62 stated they last smoked yesterday around 5:00 PM.

Observation on 04/16/2025 at 7:50 AM showed Resident 62 had a curtain of cigarettes and a lighter in a metal box in a drawer in Resident 62's room.

In an interview on 04/16/2025 at 8:44 AM, Staff G (Social Services Director) stated Resident 62 was not smoking currently.

Staff G stated Resident 62 was found vaping outside the facility a couple of months ago and it was discussed with the resident that the facility was a non-smoking facility.

Staff G stated they were not aware of Resident 62 currently smoking or of the lock box in their room.

In an interview on 04/16/2025 at 9:10 AM, Staff B (Director of Nursing) stated they were a non-smoking facility and everyone had to follow the facility policy.

505195

Form Approved OMB

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.

Building 505195 B.

Wing 04/21/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

North Auburn Rehab & Health Center 2830 I Street Northeast Auburn, WA 98002

Findings included .

<Failure to Follow/Clarify Physician Orders>

<Resident 52>

Resident 52 admitted to the facility on [DATE] and according to the most recent Quarterly Minimum Data Set (MDS-an assessment tool) received regularly scheduled and as needed pain medication.

Review of March 2025 Medication Administration Records (MARs) showed a Physician's Order for a pain patch Apply to bilateral (both) knees topically one time a day for Pain Do not exceed 3 patches for up to 12 hours (hr) with 24 hr period.

Wash hands after handling and remove per schedule.

The order directed staff to apply the patches at 9:00 AM and remove them at 5:59 AM next morning.

According to the MAR, staff applied the patches for 15 hours per day rather than the 12 hours as directed.

A second order directed staff to apply a pain patch to Bilateral shoulders topically one time a day for (joint disease). Do not exceed 3 patches for up to 12 hrs with 24 hr period.

Wash hands after handling and remove per schedule.

This order similarly directed staff to apply the patches at 9:00 AM and remove them at 5:59 AM.

According to the MAR, staff applied the patches for 15 hours per day rather than the 12 hours as directed.

After reviewing the MAR, in an interview on 04/16/2025 at 10:56 AM Staff C (Nurse Consultant) stated, The patch should only be on for 12 hours, the nurse should have clarified the order since the time code indicated a time of greater than 12 hours.

Staff C also confirmed that the nurses, by following the physicians orders would exceed the do not exceed 3 patches directive and should have clarified the order.

Observation of the resident on 04/15/2025 at 12:07 PM showed the resident had an undated white patch applied to the right shoulder.

Observations on 04/16/2025 at 10:26 AM showed the resident had an undated white patch applied to the right shoulder.

During observations of the resident on 04/16/2025 at 10:56 AM, Staff C stated the nurse who applied the patch to the right shoulder should have, but did not, initial and dated it upon application.

505195

Form Approved OMB

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.

Building 505195 B.

Wing 04/21/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

North Auburn Rehab & Health Center 2830 I Street Northeast Auburn, WA 98002

The facility failed to: ensure staff performed hand hygiene before and after resident care for 3 of 3 staff observed, ensure proper labeling and containment of resident's personal care items observed in 2 resident rooms, administer medications while maintaining infection control measures, and wear facility required face masks appropriately to prevent the spread of infection.

These failures placed residents at risk for the development of infectious diseases and living in an unclean environment.

Findings included .

<Facility Policy>

According to the facility's October 2023 revised Handwashing/Hand Hygiene policy, all personnel were trained and regularly in-serviced on the importance of hand hygiene in preventing the transmission of healthcare-associated infections.

This policy showed staff were expected to perform hand hygiene before applying non-sterile gloves and before touching a resident.

<Environment>

<room [ROOM NUMBER]>

Observations during initial rounds showed: on 04/14/2025 at 9:14 AM the bathroom for room [ROOM NUMBER] had a blue basin on the floor that was not bagged or labeled, two unlabeled urinals with no lids on the back of the toilet and a bag of garbage on the floor.

Similar observations of the unbagged basin on the floor and unlabeled urinals on the toilet were made on 04/16/2025 at 5:52 AM and 04/17/2025 at 2:17 PM.

<room [ROOM NUMBER]>

Observation of the bathroom for room [ROOM NUMBER] on 04/14/2025 at 9:14 AM showed a lidless urinal on the back of the toilet not labeled or bagged; a blue basin in a bag on floor which was not labeled, one graduate cylinder (a plastic container used to collect or measure bodily fluids) on the back of the toilet labeled for 32-2 but not bagged, and a denture cup at the sink which was not labeled.

Similar observations of the urinal, basin, graduate cylinder were noted on 04/16/2025 at 6:06 AM.

In an interview on 04/21/25 12:15 PM Staff E (Assistant Director of Nursing) stated that personal care items in bathrooms should be labeled with resident names, anything stored on the floor should be bagged. and urinals should have lids and be stored in a bag.

<Medication Administration>

<Resident 2>

505195

Form Approved OMB

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.

Building 505195 B.

Wing 04/21/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

North Auburn Rehab & Health Center 2830 I Street Northeast Auburn, WA 98002