Colfax Health And Rehabilitation Of Cascadia

Findings included .

Review of the resident's medical record showed the resident was admitted to the facility on [DATE] (age 39) with diagnoses to include obesity and a history of falls.

The 07/03/2024 comprehensive assessment showed the resident required stand by to partial assist with activities of daily living and used a mechanical lift as needed for transfers.

The assessment showed the resident was oriented and able to make their needs known and used a motorized wheelchair for mobility.

During an interview on 07/08/2024 at 3:30pm, Resident 24 stated that they needed a large bedside commode because the bathroom in their room was too small and there was no way they could use the toilet in the bathroom.

For toileting the resident stated they used a urinal and a bedpan but, stated that a commode would increase their quality of life and feel more dignified.

During an interview on 07/11/2024 at 8:55am, Staff NN, Physical Therapy, stated Resident 24 was walking more over the past couple of months.

They had been receiving physical therapy two times per week.

Staff NN reported Resident 24 is very motived, and encourages other clients.

They are an excellent candidate for assisted living or group home.

When asked about a bathroom in the facility able to accommodate the resident, staff NN stated, Functionally, he can do stand pivot transfers with a front wheel walker.

When asked If a bariatric commode was available, would Resident 24 be able to use it, Staff NN stated Yes, they would.

On 07/12/2024 at 11:30am, Resident 24 was observed walking 25 feet with physical therapy. He required stand by assistance.

During an interview on 07/12/2024 At 2:30pm, Staff PP ,Nursing Assistant, stated, resident 24 Never had a problem with incontinence with him. He uses a urinal and a bed pan. He can tell us when he needs to go.

On 07/16/2024 at 10:58am, Staff B, Director of Nursing, stated Resident 24 seems to be making great progress, we have watched him walk.

When asked what staff is doing for bowel and bladder care.

Staff B stated, He needs assistance, he is aware of when he needs to go. He asks staff for assistance. He does not fit into the bathroom in his room. We talked about getting a bariatric toilet into his room.

This is something more recently where he can use a commode, I believe it has been ordered for him.

Therapy will work with staff on the best way to safely transfer him. We should promote independence for highest level of function. I also believe it will aide him into getting into a group home.

When asked for documentation of bariatric commode order, none was provided.

Reference: (WAC) 388-97-0860 (2)

505251 07/22/2024

Colfax Health and Rehabilitation of Cascadia 1150 West Fairview Road Colfax, WA 99111

Findings included . <Resident 17> A review of the record documented Resident 17 admitted to the facility on [DATE].

A 04/29/2024 quarterly assessment documented Resident 17 had diagnoses which included a stroke, lung disease and depression. Resident 17's record did not contain documentation that they had been informed of their right to form an advance directive or if they had accepted assistance in forming one until 06/02/2024, more than four months after admission to the facility. <Resident 33> A review of the record documented Resident 33 admitted to the facility on [DATE].

A 07/25/24 quarterly assessment documented Resident 33 had diagnoses which included heart disease, high blood pressure and chronic pain. Resident 33's record did not contain documentation that they had been informed of their right to form an advanced directive or if they had accepted assistance in forming one.

During an interview on 07/18/2024 at 11:09 AM, Staff B, Director of Nursing, stated the advanced directives were offered upon admission and during the initial care conference.

Reference: WAC 388-97-0300(1)(b), (3)(a-c)

505251 07/22/2024

Colfax Health and Rehabilitation of Cascadia 1150 West Fairview Road Colfax, WA 99111

the facility for 38 years.

Staff P stated the facility was not homelike.

When asked about the toilets

holes and nails in the walls Staff P stated, Sometimes they move them (residents) around so fast, we

On 07/15/2024 at 9:59am.

Staff G, Maintenance Director, reported, The last CEO had a plan to replace all the blinds in resident rooms.

When they are broken and sagging, they need to be replaced. We have a couple right now that need to be replaced. I have replaced ones where residents have said something, they express they want new blinds, prefer to see the wooden colored blinds, gives them a more homely appearance.

What we have are the wooden ones in stock.

When asked why they are not replacing them, Staff G stated, I don't know I don't have an excuse.

Staff G stated he monitors the window washing schedule, Windows should be done every 2-3 weeks.

Staff G stated he is Starting the window cleaning schedule again, but there is no manpower to get it done. We started doing it last week we have been very short staffed.

Staff G stated Carpet cleaning has not been done in 6-8 months.

Time consuming, not conducive to being cleaned. I would love to see the carpet replaced.

Staff G did not have a systematic schedule for maintenance repairs. I feel like we have done better in that regard in the past. I am not sure what it is, lack of staffing or culture piece. We have improvements to make, the last Administrator was supportive, I feel a little unsupported at the moment. We have been very short staffed. I have two housekeepers, one laundry person, and an assistant who main job is transportation, so he is not always available. It is absolutely not enough.

Staff G reported Currently we have no sanitizing scheduled for wheelchairs.

Does not exist.

Talked about many times.

On 07/16/2024 at 10:58am.

Staff B, stated Cleaning and sanitizing of wheelchairs happens on the night shift.

The Staff N, CNA Staffing Coordinator, is responsible for making the schedule.

On 07/16/2024 at 11:15am Staff N stated, It (wheelchair cleaning and stocking of supplies) is something we are going to be implementing now on nightshift.

On 07/16/2024 at 11:26am Staff A, Interim Administrator, stated, Every building I go into needs some love, it's the nature of the building, I really have not had time to see the building, I was brought in as the interim the day the survey team walked in. I do not think there is anything critical that is wrong like electric or plumbing issues.

When asked about the overall condition of the facility, to include, cleanliness and maintenance concerns, Staff A stated, Over time, they will be taken care. I am the fifth administrator in a year, they have not had the consistent leadership they deserve.

Someone new is going to come August 1st, a new administrator.

They are going to be the permanent administrator.

Reference WAC 388-97-0880 (1)(2)

505251 07/22/2024

Colfax Health and Rehabilitation of Cascadia 1150 West Fairview Road Colfax, WA 99111

facility, Resident 28 stated, Everyone knows (in reference to the abuse) everyone who has been here

505251 07/22/2024

Colfax Health and Rehabilitation of Cascadia 1150 West Fairview Road Colfax, WA 99111

Reference (WAC): 388-97-0640 (5)(a)

505251 07/22/2024

Colfax Health and Rehabilitation of Cascadia 1150 West Fairview Road Colfax, WA 99111

Review of the facility reporting log for May and June 2024 showed no incidents had been logged related to the above resident-to resident incidents for Resident 40.

Further record review found no documentation that showed the facility did an investigation to determine if abuse had occurred.

In an interview on 07/22/2024 at 12:45 PM, the resident-to-resident altercations involving Resident 40 were discussed.

With regards to the incident on 05/30/2024 it was felt the incident did not need to be logged into the facility reporting log or investigated as it was just a verbal outburst.

When asked about the incident on 06/25/2024, Staff B stated they were not aware of the incident.

When asked if the incident should have been entered into the facility reporting log and an investigation completed, Staff B stated, no since staff had been able to redirect the resident and no further incident occurred.

Refer to F-600 and F-609 Reference WAC 388-97-0640 (1)(2)(3)(a) Reference (WAC) 388-97-0640 (6)(a)(b)

505251 07/22/2024

Colfax Health and Rehabilitation of Cascadia 1150 West Fairview Road Colfax, WA 99111

Review of the residents comprehensive Minimum Data Set Assessment (MDS) dated [DATE] documented are delusions and psychosis.

On 07/08/2024 at 8:45am, Resident 28 observed sitting in the hallway by the nursing station.

Not engaged with other residents talking incoherently to themself.

When approached Resident asked surveyor to address them as GOD.

Review of Resident 28's July 2024 Medication Administration Records (MARs) showed Resident 28 had refused medication for mental health diagnosis since admission.

A PASRR form was completed by the hospital 05/12/2024, indicating no need for a mental health level 2 PASRR review.

An additional PASRR form (undated) was initiated but not completed by the Staff E, Social Services.

On 07/11/2024 at 8:24 am, Staff E when asked what the facilities process was for identifying residents with a mental illness or intellectual disabilities and how does the facility ensure the psychosocial needs these residents are met? Staff E stated, I am still in the learning process.

Reviewed of the medical records with Staff E confirmed no level 2 PASRR was requested or completed as required by state law.

REFERENCE: WAC 388-97-1915 (1).

505251 07/22/2024

Colfax Health and Rehabilitation of Cascadia 1150 West Fairview Road Colfax, WA 99111

Findings included . <Resident 1> The 5/10/2024 quarterly assessment documented Resident 1 had diagnoses which included dementia, and was dependent on nursing staff for transferring to/from the wheelchair to bed.

The assessment also documented the resident had weakness, was unsteady on their feet, and had a history of falling.

On 07/08/2024 at 2:49 PM, Resident 1 was observed sleeping in bed in their room. A sign on the wall above the bed instructed staff, DO NOT leave resident alone in room.

Transfer immediately or leave in common area.

Thanks! Review of Resident 1's fall/safety care plan documented the resident was at high risk for falls and interventions were implemented on 11/21/2019. A revision of the care plan on 10/25/2023 informed staff that the resident was not to be left alone in their room when they were up in their wheelchair.

On 07/09/2024 at 9:45 AM, Resident 1 was observed alone in their room.

The resident was sitting in their wheelchair, leaned over, with their upper body lying on the bed. At 9:48 AM, an unidentified female staff member was heard telling Staff C, Clinical Resource Nurse, that the resident didn't want to lay down earlier, so they just left her alone.

On 07/10/2024 at 4:13 PM, Resident 1 was observed sitting in their wheelchair, alone in their room.

On 07/11/2024 at 9:51 AM, Resident 1 was again observed alone in their room.

The resident was sitting in their wheelchair next to the bed, leaned over with their upper body on the bed and a blanket covering their back/shoulders.

In an interview on 07/19/2024 at 11:54 AM, Staff Q, Nursing Assistant, stated Resident 1 was a fall risk and for safety reasons, was not to be left alone in their room if they were up in their wheelchair.

During an interview on 07/19/2024 at 2:25 PM, when informed of multiple observations of Resident 1 being left alone in their room while up in their wheelchair, Staff B, Director of Nursing, stated staff were not to leave the resident alone in the room and should transfer them to bed or move to the nurse's station or other area where they would be visible.

505251 07/22/2024

Colfax Health and Rehabilitation of Cascadia 1150 West Fairview Road Colfax, WA 99111

According to the Institute for Safe Medication Practices, a delay between preparation and administration of a medication or the preparation of multiple medications for different clients is a contributing factor to medication errors and a risk to patient safety. (ISMP Canada Safety Bulletin - Volume 23 o Issue 12 o December 19, 2023, Pre-pouring Medications: A Risky Approach) Findings included: During an inspection of the 100-hall medication cart on 07/22/2024 at 4:28 PM with Staff R, Medication Technician, eight medication cups, each labeled with a different resident's name, and containing medications and were observed in the top drawer of the cart.

In an interview on 07/22/2024 at 4:28 PM Staff R, said they prepared the 2:00pm medications but could not administer the medications because the residents were unavailable at the time.

Staff R stated they had been told by Staff B, Director of Nursing (DON), if a resident was unavailable to take the medication once it had been prepared, they should label the medication cup with the resident name and store it in the medication cart drawer.

In an interview on 7/22/2024 at 4:42PM, Staff B, DON, stated medications should be prepared and immediately be administered to the resident.

When asked what the procedure was if a medication could not be given once it was prepared, they stated the cup needed to be labeled with the resident name and put in the top drawer of the medication cart until it could be administered to the resident.

Staff B stated it was improbable to have eight separate occurrences, within the same time frame, of residents unavailable to take their prepared medications.

Reference WAC 388-97-1620(2)(b)(ii)

505251 07/22/2024

Colfax Health and Rehabilitation of Cascadia 1150 West Fairview Road Colfax, WA 99111

expectation is the nursing assistants, offer care, residents have a right to refuse care.

On 07/12/2024 at 11:15am, observed with staff AA, clients room.

Toothbrush (electric) dry not used, razors in package not used.

Per review of the electronic medical record there was no documentation that resident 34 had refused ADL care for the month of July 2024.

Reference: 483.24(a)(2) -1060 (2)(c)

505251 07/22/2024

Colfax Health and Rehabilitation of Cascadia 1150 West Fairview Road Colfax, WA 99111

subsequent day.

Resident 26 had occasional constipation and should have been offered bowel medications when no

developing a blockage.

In an interview on 07/18/2024 at 11:45 AM, Staff B, Director of Nursing (DON) stated the nursing assistants documented resident BMs and the nurses received an alert when a resident had gone 48 and 72 hours without a BM.

Staff B stated there were standing orders for MOM, Miralax, suppositories, and enemas.

Staff B reviewed Resident 26's bowel pattern and stated the resident should have been given the as needed bowel medications to assist with their constipation.

When asked, Staff B stated a small size BM did not count for Resident 26.

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

505251 07/22/2024

Colfax Health and Rehabilitation of Cascadia 1150 West Fairview Road Colfax, WA 99111

During an interview on 07/10/2024 at 9:55 AM, when asked if they smoked Resident 22 stated the last time, they smoked was about one month ago at a doctor's appointment.

They stated they kept their cigarettes and lighter in their bag and proceeded to remove a lighter and sealed pack of cigarettes from their bag.

During an interview on 07/16/2024 at 03:50 PM with Staff A, Staff O, and Staff C, Staff C stated they talked to Resident 22 about surrendering their cigarettes the prior week and Resident 22 became upset and stated they would keep them in their purse.

When asked what process was place in ensure safety since the resident refused to give the facility their cigarettes and lighter Staff O stated it should have been added to the care plan for nurses to check each shift.

In an interview on 07/22/2024 at 04:49 PM, Staff B stated a smoking evaluation and safety plan for Resident 22 should have been completed on 03/11/2024 when Resident 22 was identified as a smoker.

Reference (WAC): 388-97-1060 3(g)

505251 07/22/2024

Colfax Health and Rehabilitation of Cascadia 1150 West Fairview Road Colfax, WA 99111

According to the 01/25/24 care plan, Resident 17 had nutritional risks related to their stroke and swallowing difficulties and the goal for the resident was not to have any unplanned significant weight loss.

The 02/19/2024 Nutritional evaluation documented Resident 17's average intake was 26-50% of meals and recommended that 1-3 teaspoons of margarine or sugar be added to each meal to promote adequate intake until Resident 17's intake improved.

Further record review showed no documentation that the recommendation had been followed up on.

A 06/25/2024 progress note documented Resident 17 had an 8.4% weight loss in 2 weeks related to recent acute changes in the resident's health.

The resident had increased nausea that had started on 06/13/2024 and had been refusing meals and dietary supplements. Resident 17 had tested positive for COVID-19 (an acute respiratory illness caused by a virus, capable of producing severe symptoms and in some cases death, especially in older people and those with underlying health conditions) on 06/17/2024 and had been sent to the hospital for weakness and nausea.

In an interview on 07/18/2024 at 11:09 AM, Staff B, Director of Nursing, stated interventions for weight loss were added based off the recommendations from the dietician.

Staff B confirmed the recommendation to add margarine or sugar to Resident 17's diet order had not occurred.

Staff B added if Resident 17 would have been offered and accepted the recommendation it may have helped their weight.

During an interview on 07/17/2024 at 2:55 PM, Staff MM, Doctor, stated they were unaware Resident 17 had experienced nausea and was sent to the hospital.

Staff MM stated if they would have been notified, they would have ordered labs and possibly changed the resident's medications.

Staff MM added they were supposed to be notified of changes in the resident's condition by nursing staff and felt the nausea had impacted the resident's weight.

In an interview on 07/19/2024 at 10:20 AM, Staff SS, Dietician, stated the butter and sugar was not enough to have impacted Resident 17's weight and felt the weight loss was related to COVID-19 and nausea.

Reference: WAC 388-97-1060(3)(h)

505251 07/22/2024

Colfax Health and Rehabilitation of Cascadia 1150 West Fairview Road Colfax, WA 99111

05/27/2024 had no documentation to provide interventions for respiratory care.

a concentrator.

Per review of the progress notes, it was documented that Resident 27 was administered three liters of oxygen continuously on 07/01/2024 and 07/02/2024.

On 7/11/2024 at 11:44 AM, an observation and interview were conducted.

The concentrator was in Resident 27's room plugged in.

The resident stated they were told by staff that they were no longer on oxygen.

Subsequent observations were made of the Resident 27 with a portable oxygen tank on the back of their wheelchair on 7/11/2024 at 01:58 PM and 7/11/2024 at 04:49 PM.

On 7/15/2024 at 7:06 AM, an observation of a portable oxygen tank was in the resident's room. On 7/15/2024 at 09:53 AM there was signage on Resident 27 door stating, Oxygen in Use.

In an interview on 07/17/24 at 01:23 PM, Staff AA, Registered Nurse, stated that Resident 27 became short of breath approximately three weeks ago, in which they required oxygen.

Reference: WAC 388-97-1060 (3)(j)(vi)

505251 07/22/2024

Colfax Health and Rehabilitation of Cascadia 1150 West Fairview Road Colfax, WA 99111

During an interview on 07/12/24 at 01:33 PM, Resident 294 stated that their pain level was an 8 out

During an interview with Resident 294 on 07/16/2024 at 02:43 PM, they stated, I'm not doing good today, and that their pain level was at an 8 out of 10.

The resident stated they told the staff and physician this date that they remain in constant pain.

Per record review of a 30-day look back at the nursing bed repositioning monitoring task, from 06/18/24 to 07/18/2024, required staff to document the level of assistance for bed rolling.

The resident was dependent on the staff to roll in bed every day, except for two days.

There was no documentation of bed repositioning after 8:00pm for 13 days and before 7:00am for 15 days.

During an observation and interview on 07/18/2024 at 3:01 PM, Resident 294 was sitting upright in their wheelchair and showed intense facial grimacing and arched their head back pressing into the headrest of their wheelchair.

The resident stated that his pain level was 9 out of 10 and stated, Sometimes it [pain medication] works and sometimes it doesn't. Resident 294 indicated that they would desire to be at least at a pain level of 4 out of 10.

During an interview on 07/18/24 at 4:10 PM, RN, Staff M, Registered Nurse, stated that Resident 294 constantly complained of pain.

Staff M stated they consulted with the physician regarding changing the resident's prescription for Oxycodone to be a routine order instead of as needed.

Staff M stated non-pharmacological interventions for pain included getting the resident a bariatric bed and air mattress and were not available within the facility until recently.

On 07/19/24 at 09:37 AM, an observation and interview were conducted with Resident 294.

The resident was sitting in their wheelchair dozing off listening to music.

They stated their pain level was 7 out of 10 and did not remember when they had last taken their pain medication. Resident 294 stated that the staff usually tells them when their pain medications are due.

During an interview on 07/22/2024 at 10:19 AM with Staff B, Director of Nursing Services and Infection Prevention, stated that the process for residents that have uncontrolled pain includes offering pain medications for control, monitoring changes in their medical condition, and conducting pain evaluations (including an assessment completed by the facility physician).

Staff B stated they were aware that Resident 294 had a diagnosis of chronic pain, which is an indicator that their pain needs to be managed per the care plan.

Staff B confirmed there was no documentation by the physician addressing Resident 294's pain.

Staff B also confirmed nursing should have documented that Resident 294's pain was not being managed and notified the physician.

Per review of the Physician's Communication Book on 07/22/2024 at 10:44 AM, an undated entry documented after 07/20/2024 requested the provider to review Resident 294's pain.

Reference WAC 388-97-1060 (1)

505251 07/22/2024

Colfax Health and Rehabilitation of Cascadia 1150 West Fairview Road Colfax, WA 99111

Findings included: Record review of employee files on 07/22/2024 documented Staff V was hired as a nursing assistant on 04/01/2024.

Documentation in the file revealed that Staff V had a nursing assistant license that was pending.

Staff V was observed in the facility on 07/09/2024, 07/11/2024 and 07/16/2024 providing care and services to the residents.

Record review of employee files on 07/22/2024 documented Staff W was hired as a nursing assistant on 05/01/2024.

Documentation in the file revealed that Staff W had a nursing assistant license that was pending.

Staff W was observed in the facility on 07/08/2024, 07/09/2024, 07/11/2024, 07/12/2024, and 07/13/2024 providing care and services to the residents.

In an interview on 07/22/2024 at 2:30 PM, Staff X, Administrator from a sister facility, stated staff must have a nursing assistant certification before providing direct patient care.

Reference: WAC 388-97-1660 (3)(a)(i)

505251 07/22/2024

Colfax Health and Rehabilitation of Cascadia 1150 West Fairview Road Colfax, WA 99111

Findings included .

Review of competency training records for Staff W, Nursing Assistant, Staff BB, Cook, Staff JJ, Licensed Practical Nurse, Staff KK, Registered Nurse and Staff LL, Registered Nurse revealed they had not received any training on dementia and behaviors.

During an interview on 07/22/2024 at 3:54 PM, Staff C, Clinical Resource Nurse, stated dementia and behavior training was important so that staff could meet the needs of the residents and should be offered to new employees and annually thereafter.

Review of the 2024 Facility Assessment Tool provided by the facility documented training requirements included full time, part time and contracted staff.

No Associated WAC

505251 07/22/2024

Colfax Health and Rehabilitation of Cascadia 1150 West Fairview Road Colfax, WA 99111

Findings included: The resident admitted to the facility in May 2023.

Review of the Minimum Data Set (MDS) assessment, dated 04/30/2024, revealed they did not have any cognitive impairment.

The MDS indicated resident 28 had behaviors, the facility coded her behaviors did not significantly intrude on the privacy or activity of others, and that the behaviors did not significantly disrupt care or living environment.

The MDS indicated she was independent with Activities of Daily Living (ADL's) to include, bed mobility, transfers, locomotion on/off unit, dressing, toilet use and personal hygiene.

On 07/08/2024 at 2:42pm, Resident 28 stated she would like to be living somewhere else.

When asked if she was getting assistance with finding alternate placement, Resident 28 stated No.

On 07/10/24 at 10:00am, Resident 28, observed walking in the facility hallways independently.

She dropped off her laundry in front of the facilities laundry room door, went to the kitchen, got the food she requested and walked back to her room.

On 07/11/2024 at 11:00am, Interview with Social Services, staff E, regarding discharge planning for Resident 28.

Staff E stated, She does talk with her about discharging every day.

She would like to discharge to the hotel.

Resident has also requested to be discharged to the street.

Functionally, she is independent with ADL's mental health issues interferes with her ability to live independently.

Like an Adult family home she would be OK. I think she would be OK there.

When asked for inquiries for alternate living arrangements, there was no documentation.

When asked if the State Social Worker had been contacted to assist with discharge planning, Staff E, stated No, she had not talked with the State Social Worker about Resident 28's discharge.

There was no level 2 PASRR completed to ascertain if specialized mental health services would be beneficial to ensure appropriate placement of Resident 28.

On 07/16/2024, at 4:15pm, staff II, nursing assistant, stated resident is independent with her ADL's, except for bathing.

On 07/16/2024 at 4:30pm, staff B, Director of Nursing, stated a Less restrictive environment, most definitely, she has not pushed for going anywhere else. A group home would be a good place for her.

She is independent with a lot of her cares in her room.

Reference WAC 388-97-0960(1)

505251 07/22/2024

Colfax Health and Rehabilitation of Cascadia 1150 West Fairview Road Colfax, WA 99111

Based on observation, interview, and record review, the facility failed to ensure expired medications

medication storage rooms.

The facility further failed to ensure narcotics were locked in a permanently affixed narcotic container in 1 of 1 medication storage room refrigerators.

These failures placed residents at risk for receiving compromised or ineffective medication and placed the facility at risk for potential diversion or misappropriation of narcotic medications.

Findings included .

During an observation of the medication storage room on 07/15/2024 at 7:45 AM with Staff, AA, Registered Nurse (RN), the refrigerator contained influenza vaccines that had expired on 06/30/2024 and Tuberculin (used to check for tuberculosis) that was opened on 04/27/2024 and not discarded after 30 days as required.

The medication refrigerator held a white box, which was used to store narcotic medication, and was not locked as required.

During an interview on 07/22/2024 at 5:49 PM, Staff B, Director of Nursing, stated the vaccines and the Tuberculin should have been discarded as the effectiveness of the medications could have been altered.

Staff B added the Ativan should have been in a locked container. <Undated Insulin> According to the American Diabetes Association, insulin products contained in vials or cartridges supplied by the manufacturers (opened or unopened) may be left unrefrigerated at a temperature between 59°F and 86°F for up to 28 days and continue to work.

During an audit of the 100-hall medication cart on 7/22/2024 at 4:28pm with Staff R, Medication Technician, an insulin pen (an injection device used to deliver preloaded insulin into the body) was observed to have been opened and it was not dated with the date it was opened or the discard date. In a concurrent interview Staff R stated they did not know when the insulin pen had been opened.

In an interview on 07/22/2024 at 5:47 PM, Staff M, Registered Nurse (RN) stated insulin should be dated when opened and discarded after 30 days.

They stated this was important because the insulin could be less effective after 30 days of being opened.

Reference: WAC 388-97-1300 (2), 2340

505251 07/22/2024

Colfax Health and Rehabilitation of Cascadia 1150 West Fairview Road Colfax, WA 99111

before putting on gloves, after removing gloves, and between gloves changes, to prevent the spread

505251 07/22/2024

Colfax Health and Rehabilitation of Cascadia 1150 West Fairview Road Colfax, WA 99111

Findings included .

According to the facility policy titled Smoking Campus Policy, dated 11/28/2017 and updated 7/10/2024, residents were unable to smoke on the facility premises. It documented at the time the facility went tobacco free, if there were current residents still smoking, the current residents were allowed to use tobacco or tobacco products in a designated area outside, weather permitting.

These residents were required to have a smoking assessment completed to determine the level of supervision to be provided and interventions to mitigate the risk of injury.

Additionally, a smoking assessment was not required if a resident did not smoke and the policy would be enforced by asking residents to immediately comply, assessing for distress, and storing any tobacco products or lighting material at the nursing station with the resident's consent.

During the entrance conference meeting on 07/08/2024 at 9:04 AM, with Staff A, Interim Administrator, and Staff B, Director of Nursing (DON), when asked if the facility had residents who smoked, Staff B stated the facility was a non-smoking campus and residents who smoked were assessed on admission to ensure they were safe to smoke independently, and there were no designated smoking areas or times, since residents had to be independent to smoke.

The facility had four residents who smoked (30, 31, 24, and 20).

Record review showed the following residents all had smoking assessments completed on 05/30/2024.

Additional information is as follows:

*Resident 30, admitted [DATE], no admission smoking assessment completed, the only smoking assessment found was the assessment on 05/30/2024

*Resident 31, admitted [DATE], first smoking evaluation 01/03/2024

505251

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 505251 B.

Wing 07/22/2024

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

Colfax of Cascadia, LLC 1150 West Fairview Road Colfax, WA 99111