Bremerton Trails Post Acute
Bremerton Trails Post Acute in BREMERTON, WA — inspection on May 29, 2026.
Found 2 citations. Severity: Standard violations.
Health inspections identify deficiencies that facilities must correct within required timeframes. Violations range from minor documentation issues to serious safety concerns and are subject to follow-up verification.
Inspection Findings
12:49 PM, Resident 2 said their narcotic pain medication was never available on time, the medication
not want to do anything and they were in a lot of pain, it is horrible.Resident 2's physician orders,
05/01/2026 through 05/31/2026, showed Resident 2's Oxycodone was not administered on 05/06/2026 at 8:00 PM and 05/26/2026 at 4:00 PM and 8:00 PM.Resident 2's progress notes, dated 05/06/2026, showed Oxycodone was not administered because on call from pharmacy and not able to get pull code at that time.Resident 2's progress notes, dated 05/26/2026, showed Resident 2's Oxycodone was not administered because staff contacted the pharmacy and the pharmacist stated they required a new script.On 05/29/2026 at 3:48 PM, Staff A, ADON, said they reviewed Resident 2's medical chart and said they did not know why Resident 2 missed their dose on 05/06/2026 and/or why the staff could not obtain a code to access the emergency medication dispensing cabinet if the resident did not have their medication available.
Staff A said there was a new script for the Oxycodone signed on 05/26/2026.
Staff A said the licensed nurse should have pulled the Oxycodone from the emergency medication dispensing cabinet.
Staff A said they did not know why licensed staff did not follow the facility process and/or contact management or the resident's physician if they did not have access to the physician's prescribed medication.
Reference WAC 388-97-1300(1)(a)(4)(e).
505123 05/29/2026
Bremerton Trails Post Acute 2701 Clare Avenue Bremerton, WA 98310
notified and would be at the facility on 05/14/2026.On 05/14/2026 at 1:00 PM, observed Staff B,
PM but did not investigate the amount of call lights not working on the Cove and/or ensure all
Staff D, Plant Operations/Maintenance Director Consultant, said they were already scheduled to come to the facility on [DATE] for other repairs to the call light system.
Staff D said they were contacted on 05/14/2026 at 10:47 AM and notified the call light system was down on the Cove unit.
Staff D said that was their first notification that the system was down.
Staff D said if they had been notified on 05/13/2026 that the call light system was not working they would have sent someone out and/or came themselves at that time.
Staff D said it was an urgent matter because it related to resident safety and the expectation was the facility would notify them immediately when there was a resident safety issue.On 05/14/2026 at 1:46 PM, Staff E, Scheduling Coordinator, said they were notified around 4:00 PM on 05/13/2026 that some of the call lights on the Cove unit were not working.
Staff E said between 6:00 PM and 6:30 PM they found out no call lights on the Cove unit were working.
Staff E said all the staff knew at this point and Staff F, Maintenance Director, was notified and they reported that Staff D, Plant Operations/Maintenance Director Consultant, was coming on 05/14/2026 at around 11:00 AM.On 05/14/2026 at 3:17 PM, Staff G, Administrator, said they found out the call light system was not functioning by reading a grievance they retrieved from the grievance box that morning.
Staff G said they were not aware the call light system had been down since 05/13/2026.
Staff G said if they knew they would have contacted Staff D, Plant Operations/Maintenance Director Consultant, for immediate repair.
Reference WAC 388-97-2280(1) (a-c).
Frequently Asked Questions
More Reports
Source: This inspection report was downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases nursing home inspection reports in bulk. The findings reflect what state surveyors documented in the official Form CMS-2567 Statement of Deficiencies on the date of the inspection.
Plan of correction not included: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to their state survey agency and those responses may not appear in CMS public data at the time of release. The absence of a plan of correction in this report does not mean one was not filed. Readers who want information about corrective steps taken by the facility are encouraged to contact the facility or their state survey agency directly.
Corrections may have been made: This report reflects conditions observed on the date of the survey. The facility may have implemented staffing changes, additional training, policy revisions, or other corrective actions since this report was issued. We publish what CMS provides and encourage readers to seek current information from the facility.