Marianwood Health And Rehabilitation

Findings included . <Facility Policy> Review of the facility's revised 05/2017 Resident Trust policy stated the facility would notify the resident and/or resident's guardian/durable power of attorney, facility social worker, and the local department of social and health services, in writing, when a resident, who was on Medicaid, reached an individual account balance of two hundred dollars less than the Supplemental Security Income (SSI) resource limit for one individual.

The policy stated the notification would advise if the amount in the account exceed the SSI limit, the resident may lose eligibility for Medicaid or SSI. <Resident 10> Review of the facility's Fund Balances report showed Resident 10's balance was over the SSI resource limit, as of 07/23/2024. Resident 10's current balance was at $2496.53, which was $696.53 over the amount where the facility was required to notify the resident they were approaching the SSI resource limit. Resident 10's current trust balance was $496.53 over the SSI resource limit, putting the resident at risk for personal financial liability for their care.

In an interview on 07/31/2024 at 11:31 AM, Staff W (Administrative Assistant) confirmed Resident 10 had a current balance over $1800 in their trust account.

Staff W stated they were unaware of any Medicaid SSI resource limitations for residents and stated they did not discuss resident trust balances with the social worker.

In an interview on 07/31/2024 at 11:48 AM, Staff E (Social Services Director) stated, It has been years since they were notified regarding a resident who was over their SSI resource limits.

In an interview on 08/01/2024 at 2:03 PM, Staff A (Administrator) stated they reviewed the facility policy and Resident 10 should have been but was not notified as required when they reached an account balance of two hundred dollars less than the SSI resource limit.

REFERENCE: WAC 388-97-0340(4). .

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Marianwood Health and Rehabilitation 3725 Providence Point Drive Southeast Issaquah, WA 98029

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Marianwood Health and Rehabilitation 3725 Providence Point Drive Southeast Issaquah, WA 98029

will address the issue and look further into it.

In an interview on 07/30/2024 at 8:46 AM, Staff B stated the staff were to provide the resident with a grievance report if there was an issue, our social workers are then in charge of grievances and in keeping the logs.

Staff B stated the nursing staff should report grievances to their nursing managers and interview the resident.

REFERENCE: WAC 388-97-0460. .

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Marianwood Health and Rehabilitation 3725 Providence Point Drive Southeast Issaquah, WA 98029

or unwitnessed, and whether neurological (involving the brain) assessment was initiated and/or

did not, it being a witnessed fall.

The investigation report did not include a neurological assessment

Further review of the 07/22/2024 Fall Occurrence UDA showed the staff completing the assessment did not identify: (1) the nursing aide who was the last person to observe Resident 239 eating breakfast in the room, and (2) the nursing aide who claimed to have provided the last incontinent care to Resident 239 at 7:30 AM.

The Fall Occurrence UDA's instruction for staff completing the assessment read, Please enter (at a minimum) first name and last initial on these line items but only wrote aid/aide on both.

In an interview on 07/31/2024 at 1:42 PM, Staff B (Director of Nursing) stated Resident 239's fall was unwitnessed.

When asked if there were any documented interviews/testimony from staff who were working at that time when the fall happened, Staff B stated they had conversations with staff but did not document them.

Staff B stated they knew an event investigation should be completed within five days of the event occurring, including having all appropriate documentation from record review and staff/witness statements or interviews, but did not have them.

The facility was not able to provide any documentation to support staff offered Resident 239 toileting assistance several times as indicated in the investigation report, where Resident 239 declined their assistance prior to the resident's unwitnessed fall.

In an interview on 08/01/2024 at 10:13 AM, Staff A (Administrator) stated it was important for facility event investigations to be conducted completely and thoroughly so that resident abuse and/or neglect could be ruled out.

Staff A stated they expected the designated staff responsible for facility event investigations to conduct a complete and thorough investigation and report as required.

Refer to F-F657- Care Plan Timing and Revision.

REFERENCE: WAC 388-97-0640 (6)(a)(b)(c). .

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Marianwood Health and Rehabilitation 3725 Providence Point Drive Southeast Issaquah, WA 98029

Review of Resident 20's medical records showed an unsigned transfer notice acknowledging the resident and/or their representative was notified of the discharge.

The transfer notice was observed incomplete and did not provide an explanation to support Resident 20's discharge to the hospital was warranted as required.

In an interview on 07/31/2024 at 10:42 AM, Staff S stated they were responsible for record-keeping transfer/discharge notices and Ombudsman notification.

Staff S confirmed the transfer notice had no resident or resident representative signature to acknowledge receipt and understanding of the required written notification and stated the notice should be signed.

Staff S stated there was no documentation found to support the Ombudsman was notified of Resident 20's hospital transfer as required.

In an interview on 07/31/2024 at 12:39 PM, Staff A (Administrator) stated it was important to provide residents and their representative written transfer/discharge notification to communicate the resident's current location and to ensure the resident and their representative were notified of the rights and regulations associated with their transfer/discharge.

Staff A stated the provision of a written transfer/discharge notice went hand in hand with the required Ombudsman notification and that they expected every staff member involved (nursing and medical records) to do their part in the process.

REFERENCE: WAC 388-97-0120(2)(a-d), -0140(1)(a)(b)(c)(i-iii). .

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Marianwood Health and Rehabilitation 3725 Providence Point Drive Southeast Issaquah, WA 98029

Findings included . <Resident Assessment Instrument (RAI - instructional guidelines for MDS completion) Manual> The October 2023 RAI Manual showed a Quarterly MDS was a non-comprehensive assessment used to track the resident's status between comprehensive assessments that ensured residents were monitored for critical indicators of a gradual onset of significant change(s) in their status.

The RAI outlined a Quarterly MDS must be completed no later than 14 days after the established Assessment Reference Date (ARD) of the assessment and no later than 92 days from the ARD of the most recent prior quarterly or comprehensive assessment (counting ARD to ARD). <Resident 67> Review of Resident 67's MDS schedule showed the comprehensive 03/15/2024 admission assessment was completed on 03/18/2024.

The next scheduled 06/03/2024 Quarterly assessment was not completed until 06/17/2024 as timestamped on the MDS' assessment history report and was three days past the 92 days' regulatory completion timeframe as required.

In an interview on 07/29/2024 at 11:31 AM, Staff T (MDS Coordinator) stated it was important to ensure timely completion of MDS assessments because the appropriate and safe care necessary for care planning relied on the timeliness of these assessments.

Staff T confirmed Resident 67's Quarterly MDS was late.

In an interview on 07/29/2024 at 1:14 PM, Staff A (Administrator) stated they expected the MDS coordinators to complete assessments accurately and timely as required.

Refer to F-F642- Coordination/Certification of Assessments.

REFERENCE: WAC 388-97-1000 (4)(a). .

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Marianwood Health and Rehabilitation 3725 Providence Point Drive Southeast Issaquah, WA 98029

resident did not respond or was nonresponsive during the interview.

Instead, a staff assessment was

was not offered the opportunity. Resident 68 said they had other interests besides just watching television in their room.

In an interview on 07/31/2024 at 3:43 PM Staff T stated Resident 68 was sleepy and unresponsive during the resident activity preferences interview.

Staff T stated another activities interview was not attempted.

When asked why Resident 68 was able to answer questions about their mood, pain, and daily preferences but not activities, Staff T stated that's a good question.

Staff T stated that because the staff assessment only captured general interest in a given activity rather than the degree of interest, it provided less detailed information.

REFERENCE: WAC 38-97-1000 (1)(b). .

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Marianwood Health and Rehabilitation 3725 Providence Point Drive Southeast Issaquah, WA 98029

dates was an unacceptable practice and that Staff T should be educated.

Staff A stated they

REFERENCE: WAC 388-97-1000 (5)(a). .

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Marianwood Health and Rehabilitation 3725 Providence Point Drive Southeast Issaquah, WA 98029

Review of the (POs) showed a 05/15/2024 order for an AP medication prescribed for dementia, unspecified severity, with behavioral disturbance.

Record review showed the facility completed a Significant Change MDS for Resident 32 on 03/07/2024 related to the resident's decision to be placed on hospice services. A second Significant Change MDS for Resident 32's health improvement was completed on 05/07/2024 following their dis-enrollment from hospice services.

Record review showed the most current Level 1 PASRR in Resident 32's chart was dated 01/19/2021.

This PASRR did not include Resident 32's dementia diagnosis. No Level 1 PASRR screening was completed in relation to Resident 32's 03/07/2024 and 05/07/2024 Significant Change MDSs.

In an interview on 08/01/2024 at 11:55 AM, Staff E demonstrated they had a newer Level 1 PASRR dated 04/11/2024 in a file in their office that was more current.

Staff E stated they did not know a Level 1 screening was required for a significant change and so did not complete a Level 1 screening after the 05/07/20234 Significant Change MDS as required.

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

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Marianwood Health and Rehabilitation 3725 Providence Point Drive Southeast Issaquah, WA 98029

Review of Resident 66's comprehensive CP showed a 06/28/2024 severe protein calorie malnutrition CP was initiated, but staff failed to develop any resident goals or interventions. <Resident 75> According to a 06/06/2024 admission MDS, Resident 75 had medical conditions including the loss of the ability to use one side of their body and required the use of a feeding tube to provide at least half of the resident's nutritional intake.

Review of Resident 75's comprehensive CP showed a 06/07/2024 altered nutrition CP was initiated, but staff failed to develop any resident goals or interventions. <Resident 189> According to a 06/12/2024 admission MDS, Resident 189 had multiple medically complex diagnoses and required the use of a feeding tube to provide at least half of their nutritional intake.

Review of Resident 189's comprehensive CP showed a 06/12/2024 altered nutrition CP was initiated, but staff failed to develop any resident goals or interventions.

In an interview on 07/30/24 at 10:31 AM, Staff B stated it was important for CPs to be complete to ensure the interventions residents required where in place.

Staff B stated they expected CPs to be developed and implemented.

REFERENCE: WAC 38-97-1020(1), (2)(a)(b). .

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Marianwood Health and Rehabilitation 3725 Providence Point Drive Southeast Issaquah, WA 98029

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Marianwood Health and Rehabilitation 3725 Providence Point Drive Southeast Issaquah, WA 98029

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Marianwood Health and Rehabilitation 3725 Providence Point Drive Southeast Issaquah, WA 98029

nail bed; their nail polish was mostly chipped off and their toenails were long enough to curl back into

On 07/26/2024 at 8:39 AM, Resident 64 stated they had the same clothing on from yesterday and they

On 07/29/2024 at 8:26 AM, Resident 64 stated, I helped myself get dressed this morning, I rarely have help, I would love to sometimes get some help.

On 07/30/2024 at 8:37 AM, Resident 64 stated their hair was not combed from the shower the other day and stated, they [staff] do not help me with my hair.

On 07/31/2024 at 11:32 AM, observed Resident 64's hair was not combed and was standing straight up on their head.

On 08/01/2024 at 8:28 AM, Resident 64 stated, another patient said they would do my hair for me, I like to keep my hair up and I am trying to get it braided.

In an interview on 07/30/2024 at 8:42 AM, Staff B stated they still encourage residents who refuse care and staff were to do whatever they can to help.

Staff B observed Resident 64's toenails were not cut and stated they should be cut/trimmed.

Staff B stated staff should tell us when there were residents with long nails and refusals for care, but did not.

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

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Marianwood Health and Rehabilitation 3725 Providence Point Drive Southeast Issaquah, WA 98029

with crossword puzzles, small puzzles, reading and providing one on one discussions. If a resident

In an interview with (Director of Nursing) on 08/01/2024 at 10:15 AM, Staff B stated staff did not sit

B stated there were limited interactions in the unit because of the outbreak.

Staff B stated staff were encouraged to engage with residents.

Staff B stated the activities department should be involved in all activities for Resident 64.

Staff B stated their expectation was that one-on-one activities be provided, and for the activity team to touch base with the resident regarding activity preferences.

Staff B stated activities were one of the most important interventions for Resident 64 because of their cognitive and behaviors.

Staff B stated for residents with dementia, the CP should be individualized for the residents needs.

Staff B could not find an activity assessment for Resident 64 and stated, I don't see an activity assessment was done for the resident.

Staff B stated more specific activities guidance should be added to the CP for Resident 64.

Staff B stated activity assessments were important because they showed the resident's likes and dislikes are which helped with redirection and helped calm residents. &lt;Resident Council&gt; In an interview with Resident Council members on 07/29/2024 at 1:17 PM, council members stated during the current COVID outbreak, no activities were provided.

Resident (27) stated there was nothing to do. Resident 27 stated on the daily activity newsletter, there was a puzzle on the back, but Resident 27 stated they found them boring, so they were limited to only phone calls or watching television for recreation.

REFERENCE: WAC 388-97-0940 (1). .

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Marianwood Health and Rehabilitation 3725 Providence Point Drive Southeast Issaquah, WA 98029

According to the 07/18/2024 admission MDS, Resident 239 had clear speech, intact memory, and had medical conditions including cancer of the bladder, lungs, and liver and was on hospice care services during the assessment period.

The MDS showed Resident 239 had functional limitation in ROM to one side (upper extremity) of their body.

Observation and interview on 07/24/2024 at 12:14 PM showed Resident 239 was lying in bed, wearing a brace on their right hand/wrist. Resident 239 stated they sprained their wrist a while back and was unable to use it effectively, .I can move it [right wrist/hand] but it gives out once in a while. Resident 239 stated they were unsure if staff conduct skin checks underneath their splint.

A 07/12/2024 Occupational Therapy (OT) note showed Resident 239 had joint contractures (deformity) on both hands from arthritis (joint inflammation).

The note showed Resident 239 indicated they wore a right soft wrist support due to an old fracture they sustained in the past.

Review of Resident 239's medical records did not show the resident had any current RNP in place.

The facility was not able to provide any documentation to support Resident 239's functional limitation in ROM was assessed and/or evaluated for the need for RNP.

Review of Resident 239's POs did not show any order for the use of a brace or skin checks.

In an interview on 07/26/2024 at 11:08 AM, Staff D reviewed Resident 239's MDS with Staff T and confirmed they have identified Resident 239's functional limitation in ROM in the assessment, but did not address the situation.

Staff D confirmed the presence of the 07/12/2024 OT note regarding Resident 239's wrist brace use, and stated they missed it.

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

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Marianwood Health and Rehabilitation 3725 Providence Point Drive Southeast Issaquah, WA 98029

jeopardy to resident health or safety .

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Marianwood Health and Rehabilitation 3725 Providence Point Drive Southeast Issaquah, WA 98029

07/26/2024, but did not identify what the fluids were in the bag or the rate at which the TF was to be

In an interview and observation on 07/26/2024 at 9:19 AM, Staff CC (LPN) confirmed staff was

of the required information.

In an interview on 08/01/2024 at 1:03 PM, Staff B stated their expectation was for staff to label the TF bags in resident rooms with the date, time, rate, and the product being administered.

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

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Marianwood Health and Rehabilitation 3725 Providence Point Drive Southeast Issaquah, WA 98029

reflect documentation of the resident's pain in their left leg.

were not aware of Resident 12's calf pain.

Staff V stated residents must tell the nurses when

monitoring on Resident 12's CP or in the progress notes, and not every shift would have known about the resident's concerns.

Staff V stated nurses did not document at shift change but verbally report off to the next nurse.

Staff V stated Resident 12's pain was not mentioned at shift change.

Staff V stated it was up to each resident to tell nurses daily about their pain issues so nurses could put a resident on alert if needed.

In an interview on 07/31/2024 at 12:26 PM, Staff B (Director of Nursing) stated they expected nursing staff to document notes of residents' pain, both to the doctor and from nurse to nurse in the progress notes because it alerted the nursing team to review the problem and obtain orders when documentation were captured and seen by the care team.

Staff B stated alert charting and progress notes should have, but were not completed for Resident 12.

Staff B stated documentation was important so residents' pain could be identified and treated as fast as possible.

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

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Marianwood Health and Rehabilitation 3725 Providence Point Drive Southeast Issaquah, WA 98029

In an interview on 07/25/2024 at 9:13 AM, Resident 12 stated during shift change was an issue for

to their call light for a long time and the resident had to yell out for help to get care staff to answer their call light.

In an interview on 07/26/2024 at 1:25 PM, Resident 12 stated they had pain in their hips, and sometimes needed help but the facility was occasionally short staffed.

In an interview on 07/30/2024 at 1:08 PM, Staff GG (Staff Development) stated the facility was within required staffing ratios and adjusted schedules for call outs.

Staff GG stated they used staffing ratios to ensure there are enough nurses and staff on call.

Staff GG also stated the facility used agency staffing and contracted staff to support nursing shortages.

In an interview on 08/01/2024 at 8:26 AM, Staff M (Registered Nurse) stated the facility may be short staffed and could use more nursing assistants and licensed practical nurses.

Staff M stated staffing should not be based on how many residents the facility had but should be more about the care that residents needed.

In an interview on 08/01/2024 at 9:11 AM, Staff FF (Licensed Practical Nurse) stated sometimes there is not enough staff and it gets hard to complete tasks.

Staff FF stated tasks could take up to one hour, with a half hour give or take to complete.

Staff FF stated,staffing should be based more about how hard a resident's care is rather than the amount of people scheduled.

REFERENCE: WAC 388-97-1080(9). .

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Marianwood Health and Rehabilitation 3725 Providence Point Drive Southeast Issaquah, WA 98029

order to keep the inhaler at bedside but indicated staff should have done an assessment and assured

.

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Marianwood Health and Rehabilitation 3725 Providence Point Drive Southeast Issaquah, WA 98029

comes late to be able to use them, .I am not able to request want I prefer, especially during breakfast .

20 stated, their [facility] rule is for menu to come at least 2 hours so we could choose, but this is not

roommate. Resident 20 stated provision menus was inconsistent.

In an interview on 08/01/2024 at 11:16 AM, Staff N, in the presence of Staff A (Administrator), stated the distribution of the weekly menu was the responsibility of the dietary manager but that employee had left the facility.

Staff N confirmed the weekly menu was not being distributed in resident rooms and stated it should be, to ensure residents' food preferences were obtained and honored, but was not.

REFERENCE: WAC 388-97-1120 (2)(a). .

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Marianwood Health and Rehabilitation 3725 Providence Point Drive Southeast Issaquah, WA 98029

food was covered appropriately during meal tray service.

Staff N stated it was important to ensure

meal tray cart located near the nurse's station.

Staff pulled a meal tray out of the cart, with an uncovered bowl of fruit, and carried the tray past other rooms and residents in hallway to deliver it to room [ROOM NUMBER], the last room on the unit.

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

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Marianwood Health and Rehabilitation 3725 Providence Point Drive Southeast Issaquah, WA 98029

Review of the Hand Hygiene [HH] facility policy, revised 09/2019, showed HH would be performed after removing Personal Protective Equipment (PPE), after contact with patient surroundings, after patient contact, and upon exiting the patient room.

The policy showed compliance with the proper HH procedure before and after patient contact was an expectation of all healthcare disciplines. <Resident 68> According to the 06/04/2024 admission Minimum Data Set (MDS - an assessment tool), Resident 68 had medical conditions including a wound infection.

The MDS showed Resident 68 admitted with a Stage IV (full thickness) Pressure Ulcer (PU) and was provided PU treatment during the assessment period.

On 07/25/2024 at 9:06 AM, the wound care team, together with Staff B (Director of Nursing), was observed providing Resident 68 PU care and treatment to Resident 68's buttocks.

When the procedure was completed, Staff Y (Certified Nursing Assistant) removed all their personal protective equipment and left Resident 68's room to retrieve a garbage bag from the clean wound cart without washing their hands.

In an interview on 07/25/2024 at 9:23 AM, Staff B stated HH was important in infection control to prevent cross-contamination of bacteria (germs).

Staff B stated they expected all staff to wash their hands and/or apply an alcohol-based hand sanitizer after touching dirty surfaces and prior to touching clean areas. <Resident 55> According to the 06/17/2024 Annual MDS, Resident 55 had a long-term indwelling urinary catheter (tubing to drain urine from the bladder for people with certain urinary problems).

Observation on 07/30/2024 at 8:40 AM, showed Resident 55 lying in bed with their catheter drainage bag lying on the floor.

In an interview on 07/30/2024 at 10:50 AM, Staff V (Licensed Practical Nurse) stated the catheter drainage bag should not have touched the floor because of infection control concerns.

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

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Marianwood Health and Rehabilitation 3725 Providence Point Drive Southeast Issaquah, WA 98029

Observation on 07/26/2024 at 9:35 AM with Staff K (Licensed Practical Nurse) showed Resident 45

button that adjusted the food part of the bed on hand-held bed controller was not working.

There was no pillow wedged between the bed mattress and the foot board at this time, exposing a gap that measured 10 inches.

In an interview on 07/26/2024 at 10:16 AM, Staff C (Facilities Manager) confirmed the gap measurements and stated it was an entrapment risk for Resident 45.

Staff C stated it was important to ensure the air mattress was well-fitting on the bed frame to avoid injury and entrapment.

Staff C stated the Rehabilitation Department would usually put wedges on both ends of the bed if there was a significant gap but obviously did not see any in place.

In an interview on 07/26/2024 at 10:47 AM, Staff D (Director of Rehabilitation) ensuring resident beds were free of significant gaps that could pose as an entrapment risk was a collaborative effort between the interdisciplinary team including the Maintenance Department.

Staff D saw the actual gap in Resident 45's bed and stated they were surprised the Rehab Department did not catch it since they see the resident more often than Staff C.

Staff D stated, .definitely a miss on our part for this one.

REFERENCE: WAC 388-97-2100. .

Review of the 04/26/2023 Level 1 PASRR showed this PASRR did not include Resident 28's dementia diagnosis.

This PASRR included a handwritten note showing reviewed but no dx (diagnosis) of dementia.

In an interview on 07/31/2024 at 10:24 AM, Staff E (Social Services Director) stated it was important for PASRRs to be available in the chart and accurately reflect the resident's current condition.

In an interview on 08/01/2024 at 11:55 AM Staff E stated it was important for PASRRs to be accurate and updated with changes.

<Resident 45>

According to the 06/17/2024 Quarterly MDS, Resident 45 admitted to the facility on [DATE] and had medical conditions including depression and anxiety.

Review of Resident 45's Physician Orders (POs) showed a 01/12/2024 order for daily administration of AD and AA medications since the resident's facility admission.

A 04/11/2024 social services progress note showed staff reviewed and updated Resident 45's Level 1 PASRR and referred the resident to the PASRR office for a Level 2 evaluation due to the presence of SMI.

Review of Resident 45's medical records did not show the resident's Level 1 PASRR form was accessible to staff.

505418

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 505418 B.

Wing 08/01/2024

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

Marianwood Health and Rehabilitation 3725 Providence Point Drive Southeast Issaquah, WA 98029

Findings included .

<Resident 189>

According to a 06/12/2024 Admission MDS, Resident 189 admitted to the facility on [DATE].

Review of a 06/23/2024 Discharge MDS showed Resident 189 was transferred to an acute care hospital with their return to the facility anticipated.

Upon Resident 189's return to the facility 12 days later, staff completed a 07/05/2024 Entry Tracking MDS and indicated the resident's type of entry was an admission, rather than a reentry as required.

In a joint interview with Staff T (MDS Coordinator) and Staff X (MDS Coordinator) on 08/01/2024 at 2:25 PM, Staff X stated it was their expectation an Entry Tracking MDS be coded as a reentry if a resident was hospitalized less than 30 days.

Staff X stated it was important to accurately code reentry versus an admission on an Entry Tracking MDS and stated, it is the Medicare rules.

Staff X stated having accurate coding also assists with the continuity and coordination of care for a resident.

Staff T reviewed Resident 189's 07/05/2024 Entry Tracking MDS and stated, I did it wrong, it should be coded as a reentry.

42203

<Resident 28>

According to the 05/20/2024 Quarterly MDS, Resident 28 exhibited no delusions during the assessment period, and had a diagnosis of depression.

The MDS did not identify Resident 28 with a diagnosis of psychosis.

The MDS showed Resident 28 received an antipsychotic medication.

Review of the Physician's Orders showed a 05/25/2023 order for an antipsychotic medication to be given twice daily for delusions.

Record review showed Resident 28 had an 04/03/2023 potential for violence due to [ .] paranoia/delusions about staff Care Plan (CP), a 07/24/2020 History of delusions . CP, and a 05/31/2022 psychotropic medication CP that addressed Resident 28's use of an antipsychotic medication use.

In an interview on 08/01/2024 at 9:05 AM Staff B (Director of Nursing) stated Resident 28 had a diagnosis of a psychosis.

Staff B stated this should be reflected on the 05/20/2024 Quarterly MDS but was not.

<Resident 68>

505418

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 505418 B.

Wing 08/01/2024

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

Marianwood Health and Rehabilitation 3725 Providence Point Drive Southeast Issaquah, WA 98029

Findings included .

<Facility Policy>

According to the facility's 01/2022 Transfer or Discharge and Ombudsman Notification policy, when a facility resident was temporarily/emergently hospitalized , a notice of transfer must be provided to the resident or their representative as soon as practical.

The policy showed copies of all transfer notices were provided to the LTCO office on at least a monthly basis.

<Resident 32>

According to the 05/07/2024 Significant Change Minimum Data Set (MDS - an assessment tool), Resident 32 had severe memory impairment.

The MDS showed Resident 32 had diagnoses including Alzheimer's disease (memory impairment) and Diabetes Mellitus (a condition making regulating blood glucose more difficult).

According to a 06/14/2024 progress note, at 1:05 PM, Resident 32 experienced an acute change in condition including elevated blood glucose, rapid heart rate, and involuntary movements.

The progress note showed Resident 32 was sent to the hospital emergently at 1:35 PM. A 06/18/2024 progress note showed Resident 32 was readmitted to the facility.

Record review showed no evidence a transfer notice was completed and given to Resident 32 of their representative as required.

In an interview on 07/31/2024 at 12:28 PM, Staff S (Health Information Manager) stated they were unable to find a written transfer notification for Resident 32's 06/14/2024 hospitalization .

Staff S stated the facility should have notified the resident or their representative but could not demonstrate this happened.

Staff S stated as the notice did not exist, it could not be sent to the LTCO office.

46471

<Resident 20>

505418

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 505418 B.

Wing 08/01/2024

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

Marianwood Health and Rehabilitation 3725 Providence Point Drive Southeast Issaquah, WA 98029

Findings included .

<Facility Policy>

The Enteral Nutrition policy, revised 01/2023, showed it was a nursing responsibility to document the amount of feeding given on each shift in the Medication Administration Record (MAR).

The policy showed the facility would label TF bags with the date, time, initial of the nurse hanging the feeding, and the amount hung to prevent contamination when open feeding systems were used.

The policy showed new formula would not be added to formula already hanging, and formula would not hang for longer than eight hours.

The Weight and Nutrition Monitoring policy, revised 10/2021, showed the intent was to ensure no resident would have significant unplanned weight loss or gain, unless clinically unavoidable.

The policy showed all weights would be recorded in the resident's medical records, to be reviewed and monitored by designated clinicians, including those residents who were identified as at nutritional risk.

<TF Volume and Weight Monitoring>

<Resident 45>

According to the 06/17/2024 Quarterly Minimum Data Set (MDS - an assessment tool), Resident 45 had clear speech, intact memory, and had medical conditions including heart and kidney failure, uncontrolled blood sugar levels in the body, and a brain injury with resulting weakness in one side of the body and difficulty swallowing.

The MDS showed Resident 45 received TF via a surgical opening in their stomach during the assessment period.

Review of a 01/16/2024 Nutrition Care Plan (CP) showed Resident 45 was on TF for nutritional support because of the resident's swallowing difficulty. A CP intervention directed the nursing staff to administer the TF as ordered.

Review of Resident 45's Physician Orders (POs) showed a 05/17/2024 TF order that read: [a type of TF formula] 1.5 Cal Suspension- Soy Protein, Infuse 30 milliliters/hour via Enteral Tube three times daily for supplement from 8:00 PM to 5:00 AM

505418

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 505418 B.

Wing 08/01/2024

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

Marianwood Health and Rehabilitation 3725 Providence Point Drive Southeast Issaquah, WA 98029

Findings included .

<Hot Water Temperature>

<Facility Policy>

The facility's Domestic Water Policy, revised 01/2019, showed the facility's domestic hot water would be checked monthly to ensure a hot water temperature of 105 to 115 F was maintained.

<Centers for Medicare and Medicaid Service (CMS) Hot Water Guidelines>

According to revised 02/03/2023 CMS guidelines: A third-degree burn would occur after five minutes of exposure to a hot water temperature of 120 F, after three minutes of exposure to a hot water temperature of 124 F, after one minute of exposure to a hot water temperature of 127 F, and after 15 seconds of exposure to a hot water temperature of 133 F.

Observation on 07/23/2024 at 10:57 AM showed room [ROOM NUMBER] had two sinks, one labeled for Resident 33, and the other for Resident 68 who shared the room.

When temperatures were taken, the hot water from Resident 33's sink became hot very quickly after turning on the faucet and felt uncomfortable for hand washing.

The temperature measured at that time was 127 F. At the same time, Resident 68's sink's hot water measured 125 F.

505418

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 505418 B.

Wing 08/01/2024

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

Marianwood Health and Rehabilitation 3725 Providence Point Drive Southeast Issaquah, WA 98029