Columbia Crest Center

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

urinal, or interventions for maintaining and/or storing personal equipment.During an interview, on 10/01/2025 at 10:02 AM, Staff C, Infection Preventionist (IP), stated the process for cleaning bedside urinals was to rinse with water after each use and to discard and replace urinals when they became stained or odorous. Staff C stated they were unaware of Resident 1's specialized urinal and a plan for cleaning, disinfecting, storing, and maintaining would need to be developed. Staff C confirmed the current process for cleaning and maintaining Resident 1's specialized urinals did not meet infection control expectations.During

an interview, on 10/01/2025 at 10:10 AM, Staff F, Housekeeping/Laundry Supervisor, stated Resident 1's room was deep cleaned on the morning of 09/30/2025. Staff F stated housekeeping staff used hot water to clean Resident 1's room because Resident 1 did not like the smell of cleaners. Staff F stated the facility had not attempted to use odorless or fragrance-free cleaning solutions for Resident 1's room. Staff F stated housekeeping clean every resident room every day and did a deep clean of every room at least once a month.During an interview, on 10/01/2025 at 10:30, Staff G, Housekeeper, stated their process for daily resident room cleans was to wipe down all surfaces, sweep and mop the floors, clean the toilet, sink and shower, and empty the garbage. Staff G stated multiple residents kept a lot of personal belongings in their rooms making it difficult to move things around to clean surfaces. Resident 2Review of the medical record showed Resident 2 was admitted to the facility on [DATE REDACTED] with diagnoses of diabetes mellitus (a chronic condition that affects how the body uses sugar for energy), circulatory complications (blood flow impairment) and a foot ulcer (a wound that does not heal properly) related to DM. Review of the comprehensive assessment, dated 07/12/2025, showed Resident 2 was cognitively intact, required the set up assistance for dressing, personal hygiene, toileting, bathing, and was independent with self-propelling in

the wheelchair.During a concurrent observation and interview, on 10/01/2025 at 1:10 PM, Resident 2 was

in their room finishing lunch when a fly was noted to land on Resident 2's bedside table, lunch tray, shoulder, and bed. Resident 2 stated they always had a fly in their room. Observation of Resident 2's bed showed it was covered with personal belongings, food wrappers, empty soda bottles, and random loose papers. Observation of the sink and counter in Resident 2's room showed it was cluttered with personal belongings, hygiene supplies, empty medicine cups with ointment residue, food wrappers, and food crumbs. Multiple soda bottles were observed on the counter, on the bed, and on the nightstand to have a dark, moist substance inside (not soda), and Resident 2 stated it was chewing tobacco and spit. Resident 2 stated their room was cleaned two-three times per week which included sweeping, mopping, and cleaning

the bathroom. Resident 2 stated housekeeping did not throw away any garbage that was in the room unless

they put it in the garbage can. Resident 2 stated it had been a long time since their counter and sink were cleared off and wiped down.During an interview, on 10/01/2025 at 2:25 PM, Staff B, Director of Nursing, stated Resident 1's specialized urinals had been disposed of and replacements ordered. Staff B stated the current process for cleaning and maintaining Resident 1's specialized urinals did not meet infection control expectations.During an interview, on 10/01/2025 at 2:30 PM, Staff A, Administrator, stated resident rooms should be cleaned daily and have a deep cleaning at least once a month. Staff A confirmed facility policy for cleaning resident rooms and personal equipment was not followed for Resident 1 and Resident 2.Reference: WAC 388-97-0880 (1-2)

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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

11/17/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Columbia Crest Center

1100 East Nelson Road Moses Lake, WA 98837

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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

stated Licensed Nurses (LNs) were documenting the number of beers dispensed to Resident 3 in the Controlled Substance Log Book for the past month. Staff H stated it was not their practice to review the total amount of alcohol Resident 3 consumed in a day. Staff H stated they had been instructed to notify local law enforcement if/when Resident 3 appeared intoxicated and chose to leave the facility in their personal vehicle.During an interview, on 10/01/2025 at 12:55 PM, Staff I, NA, stated Resident 3 required assistance

in loading their wheelchair into their personal vehicle. Staff I stated Resident 3 did not use the facility sign out sheet when leaving or returning from an outing, and staff were aware of Resident 3's absence through verbal report.During an interview, on 10/01/2025 at 2:30 PM, Staff B, DON, stated Resident 3 had been non-compliant with a lot of the facility's attempts to monitor their safety and confirmed implementation and documentation regarding Resident 3's alcohol consumption should have been done prior to 10/01/2025 as ordered by the physician.During an interview, on 10/01/2025 at 2:40 PM, Staff A, Administrator, stated they were aware of Resident 3's alcohol consumption and the plan for monitoring, documenting, and reducing

the amount of alcohol Resident 3 consumed. Staff A stated they were unaware the reduction plan was not being implemented.Reference: WAC 388-97-1060 (1)(3)(g)

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If continuation sheet