Frontier Rehab & Extended Care

F-F610

Reference WAC 388-97-0960 (1)

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 18 of 21 505276 Department of Health & Human Services Printed: 09/09/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 505276 B. Wing 02/07/2025

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

Frontier Rehab & Extended Care 1500 3rd Avenue Longview, WA 98632

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 0842 Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 50416

Residents Affected - Few Based on interview and record review, the facility failed to ensure medical records were maintained to be complete and accurate for 2 of 5 sampled residents (43 & 70) reviewed for resident records. This failure placed residents at risk for unmet care needs and a diminished quality of life.

Findings included .

1) Resident 43 was admitted to the facility on [DATE REDACTED] with diagnoses including Depression and Post Traumatic Stress Disorder (PTSD). The Annual Minimum Data Set (MDS) assessment, dated 11/20/2024, showed Resident 43 was alert and oriented.

Review of Resident 43's PASARR Level I, dated 11/13/2020, documented Resident 43 showed indicators for mood disorders, but section IV of the Level I PASARR did not indicate service needs.

Review of Resident 43's electronic health records (EHR) did not show a corrected PASARR Level I, dated 11/13/2020, and did not show a Level II PASARR determination or evaluation.

On 02/05/2025 at 2:28 PM, when asked if Resident 43's Level I PASARR was accurate, Staff H, Social Services Assistant, stated, We need to do a new PASARR. When asked if there was an updated or corrected Level I PASARR in the EHR, Staff H was unable to locate a corrected Level I PASARR in Resident 43's EHR.

2) Resident 70 was admitted to the facility on [DATE REDACTED] with diagnoses including Major Depressive Disorder and Psychotic Disorder with Delusions due to known physiological condition. The Annual MDS, dated [DATE REDACTED], documented Resident 70 was alert and oriented.

Review of Resident 70's Level I PASARR, dated 10/19/2023, documented, Level II evaluation required for SMI [serious mental illness].

A Level II PASARR evaluation was not located in Resident 70's EHR.

On 02/05/2025 at 2:33 PM, when asked if there was a Level II PASARR evaluation in Resident 70's EHR, Staff H was not able to locate a Level II PASARR in Resident 70's EHR.

Reference WAC 388-97-1720 (1)(a)(i-iii)

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 19 of 21 505276 Department of Health & Human Services Printed: 09/09/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 505276 B. Wing 02/07/2025

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

Frontier Rehab & Extended Care 1500 3rd Avenue Longview, WA 98632

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 0880 Provide and implement an infection prevention and control program.

Level of Harm - Minimal harm or 37934 potential for actual harm Based on observation and interview, the facility failed to ensure staff properly donned (putting on) and doffed Residents Affected - Few (removing) personal protective equipment (PPE) for 1 of 1 sampled licensed nurse (Staff O, Licensed Practical Nurse) reviewed for infection prevention and control. This failure placed residents at risk for the spread of infection transmission in the facility and a diminished quality of life.

Findings included .

The Center for Disease Control and Prevention's (CDC) Contact Precautions sign, undated, indicated, Everyone must: Clean their hands, including before entering and when leaving the room. Providers and staff must also: .Put on gown before room entry. Discard gown before room exit.

On 02/07/2025 at 12:45 PM, Staff O was observed in Resident 46's room. Staff O had Resident 46's right arm in her gloved hands. Outside of Resident 46's room, next to the right side of the door, was a sign that read Contact Precaution. After Staff O exited the room, Staff O said she was attempting to find Resident 46's vein. Staff O said she was supposed to wear PPE anytime they provided care to Resident 46.

At 1:10 PM, Staff A, Administrator, said he expected staff to abide by the posted precaution signs.

Reference WAC 388-97-1320 (1)(a)

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 20 of 21 505276 Department of Health & Human Services Printed: 09/09/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 505276 B. Wing 02/07/2025

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

Frontier Rehab & Extended Care 1500 3rd Avenue Longview, WA 98632

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 0908 Keep all essential equipment working safely.

Level of Harm - Minimal harm or **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 51254 potential for actual harm Based on observations and interviews, the facility failed to ensure essential equipment was in safe operating Residents Affected - Few condition when batteries died while transferring residents on 2 of 4 mechanical lifts reviewed for physical environment. This failure placed residents at risk of being injured and a diminished quality of life.

Findings included .

On [DATE REDACTED] at 2:07 PM, Resident 17 said the battery on the mechanical lift had died numerous times during transfers. Resident 17 said he was left suspended in the mechanical lift between the bed and chair while staff left the room or called others to swap out the battery. Resident 17 said the nursing staff also struggled with maneuvering the mechanical lifts due to hair tangled in the wheels of the mechanical lifts. Resident 17 said he felt there was a concern for safety due to both issues.

On [DATE REDACTED] at 10:13 AM, the mechanical lift in the Country Side short hall was observed sitting in the hallway with hair tangled in the rear wheels.

On [DATE REDACTED] at 11:50 AM, Resident 17 was observed when Staff L, Nursing Assistant (NA), and Staff F, NA, were using a mechanical lift to transfer Resident 17 from the bedside commode to the bed. During the transfer the mechanical lift stopped midway with the resident suspended in the sling when the battery died . Resident was left hanging in the air for two minutes while staff went to the door of the room and asked another staff to bring a different charged battery. Staff F said some of the Hoyer (type of lift) batteries held charges longer than other, and sometimes they died while in use. During the transfer of Resident 17, the wheels appeared difficult to turn causing a jerking motion of Resident 17. The wheels on the mechanical lift were tangled with a large amount of what appeared to be hair and lint making the wheel motion less smooth.

On [DATE REDACTED] at 10:15 AM, Staff K, Housekeeping Supervisor, said there was no schedule for cleaning the wheels on the mechanical lifts. After inspecting the Hoyer lift machine, Staff K stated, Oh, yes. That does need to be cleaned.

At 12:54 PM, Staff J, Maintenance Supervisor, said the Hoyer lift batteries dying had been an ongoing issue. Staff J said the staff did not put them into the charger correctly. Staff J said this was user error and he had told the staff multiple times how to insert the batteries correctly. When asked about routine maintenance on

the batteries, Staff J said he did random tests on the batteries to see if they were still good. Staff J said he did not have a maintenance log for these checks but did them when he thought of it.

Reference WAC [DATE REDACTED] (1)(2)

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FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 21 of 21 505276