Gig Harbor Health And Rehabilitation

F 0675

Honor each resident's preferences, choices, values and beliefs.

Level of Harm - Minimal harm or potential for actual harm

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

observation, interview, and record review, the facility failed to consistently provide necessary supplies for toileting needs for 2 of 3 residents (Residents 5 and 6) reviewed for Activities of Daily Living. This failure placed residents at risk for increased discomfort and a diminished quality of life. RESIDENT 5Resident 5 admitted to the facility on [DATE REDACTED] with multiple diagnoses. The admission minimum data set (MDS, an assessment tool), dated 06/17/2025 showed Resident 5 had moderate cognitive impairment, but was able to make their needs known and was moderately dependent on staff for toileting hygiene. During an

interview on 07/24/2025 at 2:02 PM, Resident 5 said the facility had run out of briefs three times since their admission to the facility. Resident 5 said it could take the facility between 3-5 days to get their size of brief in

the building. Resident 5 said when the facility ran out of briefs, the staff would put a smaller size brief on them until they were able to get the right size. Resident 5 said the smaller size would feel uncomfortable and would not hold urine. Resident 5 said they had urine leak down their leg because of the wrong size of brief. RESIDENT 6Resident 6 admitted to the facility on [DATE REDACTED] with multiple diagnoses. The admission MDS, dated [DATE REDACTED] showed Resident 6 had moderate cognitive impairment, but was able to make needs known and was totally dependent on staff for toileting hygiene. During an interview on 08/05/2025 at 1:50 PM, Resident 6 said the facility sometimes ran out of briefs. Resident 6 said the staff would always be looking for briefs. Resident 6 said when the facility ran out of briefs, the staff would put a bigger size brief

on them. Resident 6 said the larger brief did not always catch all the urine and they would feel wet.During

an interview on 08/06/2025 at 10:59 AM Staff I, Certified Nursing Assistant (CNA), said the facility did sometimes run out of briefs for the residents. Staff I said when they did run out of briefs, the staff would use

a different sized brief.During an interview on 08/06/2025 at 12:42 PM Staff H, Central Supply, said when

they placed the order for necessary supplies, multiple people would have to approve it. Staff H said there had been times they had ran out of briefs. Staff H said when that happened, they would contact their sister facility and pick up briefs. Staff H said the briefs could usually be obtained on the same day but there could have been a delay of up to 12 hours. During an interview on 08/07/2025 at 11:33 AM, Staff A, Administrator, said they had not been aware they needed to approve orders for supplies every day. Staff A said the facility should not have been running out of briefs. Reference WAC 388-97-1060 (1).

Residents Affected - Few

Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date

these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.

LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE

TITLE

(X6) DATE

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

Facility ID:

If continuation sheet

Event ID:

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

08/27/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Gig Harbor Health and Rehabilitation

3309 45th Street Court Northwest Gig Harbor, WA 98335

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 0684 Level of Harm - Actual harm Residents Affected - Few

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

911 was called and Resident 3 was sent to the ED. ALERT CHARTINGRESIDENT 2Review of the facility incident log showed Resident 2 had a fall on 07/17/2025.Review of the nursing progress notes , 07/16/2025 through 07/19/2025 [72 hours post fall] showed no documentation or alert charting was completed every shift for 72 hours to monitor Resident after the fall.Review of the facility incident log showed Resident 2 had

a fall on 07/23/2025.Review of the progress notes showed a note titled Alert Charting on 07/24/2025 at 1:42 AM to document post fall monitoring. Review of the progress notes showed no further documentation to monitor Resident 2 after the fall.Review of the progress notes 07/23/2025 through 07/26/2025 showed alert charting was not completed every shift for 72 hours to monitor Resident after the fall.Review of the facility incident log showed Resident 2 had a fall on 07/27/2025.Review of the nursing progress notes showed a note titled Daily Skilled Note on 07/28/2025 at 3:41 AM with no post fall monitoring. Review of the progress notes showed a note titled Daily Skilled Note dated 07/29/2005 at 3:39 AM with no post fall monitoring. Review of the progress notes showed alert charting was not completed every shift for 72 hours to monitor Resident after the fall. Review of the hospital ED notes dated 07/27/2025, showed Resident 2 was sent to the ED for a fall. Resident 2 returned to the facility at an unknown time on 07/27/2025.RESIDENT 3Review of a nursing progress note dated 07/21/2025 at 11:02 AM showed Resident 3 had a fall on 07/21/2025. Review of a progress note titled eINTERACT SBAR Summary for Providers (an inhouse communication form between nurses and providers) dated 07/21/2025 at 12:20 PM showed Resident 3 was sent to the ED per provider recommendations. Review of a progress note dated 07/21/2025 at 5:44 PM, showed Resident 3 returned to the facility from the hospital. Review of the progress notes showed fall follow up alert charting on 07/22/2025 at 8:37 PM, 07/23/2025 at 6:37 PM, and 07/24/2025 at 5:06 AM. Review of the progress notes showed alert charting was not completed every shift for 72 hours. During an interview on 08/04/2025 at 3:16 PM, Staff F, RN, said if a resident had a fall they would fill out an incident checklist, which included a head-to-toe assessment, pain assessment, and neurological assessment. Staff F said they would place the resident on alert charting. During an interview

on 08/04/2025 at 3:19 PM, Staff G, Licensed Practical Nurse (LPN), said if a resident had a fall, they would use the incident checklist, then they would place the resident on alert charting to monitor for any changes in behavior or medical condition. During an interview on 08/07/2025 at 11:15 AM, Staff B, Director of Nursing Services (DNS)/RN said if a resident had a fall, they would be placed on alert charting for 72 hours. Staff B said alert charting should be completed every shift. Staff B said the nurses worked 12-hour shifts, so alert charting would be completed at least twice a day. Staff B said it is their expectation that alert charting should be completed at least twice a day after a fall. Reference WAC 388-97-1060 (1) .

Event ID:

Facility ID:

If continuation sheet