Olympic View Post Acute

F 0553 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

and the plan was to order labs and start IV fluids for 48 hours for hydration. The noted showed staff were to discontinue medications to include medications for diabetes and bipolar disorder.Resident 1's EMR (electronic medical record) showed no notification to CC 1 regarding the medications being discontinued, lab orders and/or the IV hydration.Resident 1's medical provider notes, dated 08-29-2025, showed a care conference was held with the resident and CC1. The note showed the staff discussed multiple issues regarding Resident 1's admission, medication management and progress.On 09/17/2025 at 1:12 PM, CC2, resident advocate, said they had attended Resident 1's care conference on 08/29/2025 and the facility staff were unable to answer all CC1's questions. CC2 said it was very frustrating.Review of an email from CC1 to facility staff, dated 09/04/2025, showed CC1 addressed concerns to the team that was taking care of Resident 1 to include: the plan for Resident 1 due to their insurance ending, an assessment of Resident 1's current condition, Resident 1's medication list, a final report from PT [physical therapy], OT [occupational therapy] and ST [speech therapy]. The email showed that CC1 did not know Resident 1's plan of care and it was not discussed in the care meeting.Review of an email from facility staff, dated 09/04/2025, showed facility staff responded to CC1's questions but wrote that CC1 should let them know if they still had concerns.Review of an email from CC1 to facility staff, dated 09/05/2025, showed CC1 had questions that were not addressed in the 09/04/2025 email from facility staff and had asked for a care plan and had not received it. CC1 wrote it was a deep concern to them. CC1 requested information about a swallowing issue from the evening prior. Facility staff responded to the email on 09/05/2025 and said they would schedule a care conference to address the rest of the questions.Review of an email from CC1 to facility staff, dated 09/10/2025, showed CC1 was following up regarding the care conference, they had not heard from the staff.Review of an email from CC1 to facility staff, dated 09/11/2025, showed CC1 had asked for a care meeting to answer CC1's questions and had not heard back. The email showed CC1 had questions regarding medication status, therapy and discharge, and the email showed CC1 was upset at the lack of response to their questions and requests.On 09/17/2025 at 2:33 PM, Staff A, Resident Care Manager and licensed practical nurse, said they had been Resident 1's care manager since admission on [DATE REDACTED]. Staff A said they had a care conference on 09/16/2025 with CC1 and that was the first time they had spoken to them. Staff A said it was the responsibility of the license nurses on the floor to notify residents' representatives of changes in a resident's care.On 09/17/2025 at 4:00 PM, Staff B, Director of Nursing, said

they expected when residents had a change in condition and/or changes to the plan of care the DPOA-HC should be notified. Staff B said CC1 should have been notified of Resident 1's clinical change of condition, medications changes and plan of care. When asked if CC1 should have been sent Resident 1's plan of care, Staff B said yes, they should have had that information. On 09/17/2025 at 5:33 PM, Staff C, Administrator, said they understood why CC1 was frustrated, and they should have been involved in Resident 1's care since admission to include the plan of care and changes to their medications.WAC Reference 388-97-1000(1)(a),1020 (2)(f)

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If continuation sheet

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

09/17/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Olympic View Post Acute

1116 E Lauridsen Boulevard Port Angeles, WA 98362

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 0770

Provide timely, quality laboratory services/tests to meet the needs of residents.

Level of Harm - Minimal harm or potential for actual harm

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

interview and record review the facility failed to obtain and monitor laboratory tests timely per physician orders for 1 of 3 residents (Resident 1) reviewed. This failure placed residents at risk of clinical complications, unstable medical conditions and delayed recovery. Findings included.Resident 1 was admitted to the facility on [DATE REDACTED] with diagnoses of dementia, bipolar disorder (a chronic mental health condition characterized by extreme mood swings) and diabetes (a condition where the body does not produce or use insulin effectively, leading to high blood sugar levels).Resident 1's medical provider notes, dated 08/07/2025, showed since arrival at the facility, Resident 1 had nausea and vomiting, somnolence (sleepiness), and poor intake. The note showed the nausea, vomiting, and somnolence was possible due to medication or metabolic cause and the plan was to order labs and start IV fluids (liquids administered through a catheter in the vein) for 48 hours for hydration. The note showed the plan was to order laboratory tests. Resident 1's physician orders, dated 08/07/2025, showed an order to draw a CMP (test to monitor electrolyte balance), CBC (blood test that measures the number and types of cells in the blood), TSH (blood test to monitor thyroid function), Hgb A1C (lab related to diabetes) and a valproic acid level (anti-seizure medication - checking for level of medication in blood).Resident 1's provider notes, dated 08/19/2025, showed labs still pending and Depakote was held pending labs.Review of Resident 1's laboratory results, dated 08/25/2025, showed results for CMP, CBC, and TSH.Review of Resident 1's laboratory results, dated 09/04/2025, showed results for a valproic level.Review of Resident 1's electronic medical record (EMR) showed no result for the Hgb A1C.On 09/17/2025 at 2:33 PM, Staff A, Resident Care Manager and Licensed Practical Nurse, reviewed Resident 1's EMAR and contacted the facility laboratory to obtain all lab results from Resident 1. Staff A could not locate a Hgb A1C lab result and verified the CMP, CBC and TSH were not collected until 08/25/25 and the valproic acid level was completed on 09/04/2025.On 09/17/2025 at 4:00 PM, Staff B, Director of Nursing, said when medical providers order labs to be drawn they expect them to be completed timely.WAC Reference 388-97-1620(2)(b)(i)

Residents Affected - Few

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

Event ID:

Facility ID:

If continuation sheet