Life Care Center Of Puyallup

Findings included.

Review of the facility's Unnecessary Medications policy, dated 08/09/2023, showed each resident's drug regimen would be free from unnecessary drugs, including antipsychotic drugs without adequate indications for its use.

The resident's medical record should show documentation of adequate/appropriate indications for the medication's use, the diagnosed condition for which a medication was prescribed, and in accordance with clinical practice guidelines and standards of practice.

Review of the 03/25/2026 admission minimum data set (MDS, a required assessment tool) showed Resident 125 admitted to the facility 03/23/2026 and had some problems with cognition but was able to understand and be understood. Resident 125 had no behaviors, symptoms of delirium, or rejection of care. Resident 125's diagnoses included an infection, depression, and non-Alzheimer's dementia (diminished cognition skills). Resident 125 received an antipsychotic medication (medication affecting the brain).

Review of the 03/23/2026 antipsychotic (AP) medication care plan (CP) showed the medication was administered due to behavior management and dementia with behavior and psychosis.

The interventions directed staff to administer the AP medications as ordered by the physician, observe for adverse effects, and effectiveness every shift.

The non-person-centered target behaviors for the AP medication use were agitation, anxiety, delusions, hitting/kicking and the non-medication interventions included redirection, providing reassurance, talking with the resident to problem-solve, encourage activities, and return the resident to their room.

Review of the March and April 2026 Medication Administration Records (MAR) showed a physician order (PO) dated 03/23/2026 to administer Seroquel (an antipsychotic medication) 12.5 milligram (mg, unit of weight) every night at bedtime.

The indication for use showed unspecified dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, or anxiety.

The documentation showed the medication was administered every night.

Review of the target behavior documentation showed Resident 125 had no behaviors.

During an interview on 04/09/2026 at 4:19 PM, Staff D, Social Services Director, stated dementia was never an appropriate indication for use of antipsychotic medication and Resident 125 should have been evaluated for the use of the medication and/or it should have been discontinued, but was not.

Reference WAC 388-97-1060 (1)(3)(e)(k)(i)

505324 04/10/2026

Life Care Center of Puyallup 511 10th Avenue Southeast Puyallup, WA 98372

Review of the EHR showed no documentation that a bed hold was offered or a notice of transfer was

During an interview on 04/09/2026 at 11:10 AM, Staff D, Social Services Director (SSD), stated it was their expectation that the nursing staff offer the bed hold and complete the transfer form to provide to the resident and ombudsman when a resident was sent to the hospital but this did not happen for Resident 12 or Resident 3.

During an interview on 04/09/2026 at 2:17 PM, Staff E, Regional Registered Nurse, stated it was their expectation that bed holds would be offered when residents were transferred to the hospital and a notice should have been provided to the Resident, 3, Resident 12, and the ombudsman.

Reference WAC 388-97- 0120(1)(2)(a)-(d)(3)(a)(4)(b)(5), -0080 -0140(1)(a)-(c)(i)-(iii)

505324 04/10/2026

Life Care Center of Puyallup 511 10th Avenue Southeast Puyallup, WA 98372

During an observation and interview on 04/07/2026 at 11:28 AM, Resident 11 was observed to have some natural teeth present, but not all.

During an interview on 04/10/2026 at 4:10 PM, Staff P, Licensed Practical Nurse-LPN/Unit Care Coordinator, stated the assessment should accurately reflect the resident's current status but did not.

Reference WAC 388-97-1000(1)(a)(b)(4)(a).

505324 04/10/2026

Life Care Center of Puyallup 511 10th Avenue Southeast Puyallup, WA 98372

Observation on 04/08/2026 at 9:32 AM showed Resident 20 sat in their bed with commode next to the bed. Resident 20 stated they had two falls because they slipped on the floor during transfers.

Review of the second fall investigation dated 01/01/2026 showed Resident 20 had a fall due to self-transferring from commode to the bed.

Investigation showed Resident 20 needed extensive assistance with transferring and Resident 20 had forgotten to put their nonskid socks on.

Review of the investigation showed Resident 20 had previously used interventions in the summary of the fall.

Review of care plan with focus area of fall, initiated 10/30/2025, revised on 12/26/2025 and 12/30/2025, showed Resident 20 did not have any new interventions initiated after the fall on 01/01/2026.

During an interview on 04/10/2026 at 1:07 PM, Staff E, Regional Registered Nurse, stated the care plan for Resident 20 should have been updated and that did not meet expectations.

Reference WAC 388-97-1020(2)(c)(d)

505324 04/10/2026

Life Care Center of Puyallup 511 10th Avenue Southeast Puyallup, WA 98372

Observation and interview on 04/07/2026 at 1:34 PM showed Resident 91 laid in bed. Resident 91 stated they had not brushed their teeth in the facility, and they did not have any oral care supplies.

During an interview and observation on 04/08/2026 at 12:57 PM Resident 91 stated they still did not have any oral supplies.

Observation of the sink area showed no oral care supplies.

During an interview and observation on 04/09/2026 at 8:05 AM, Resident 91 stated that they could not brush their teeth.

Observation showed a gray box on a nightstand out of reach of Resident 91 that had a new, unopened toothbrush and travel sized toothpaste that was not opened.

During an interview on 04/09/2026 at 8:09 AM, Staff M, Certified Nursing Assistant (CNA), stated the process for oral care was to assist residents that could not perform the task, and set up and remind the ones that could perform oral care them self.

Staff M stated they did not know about oral care of Resident 91 as they were not assigned to them.

During an interview won 04/09/2026 at 8:12 AM, Staff O, Licensed Practical Nurse, stated the oral care supplies should be easily available and the staff were expected to assist residents with oral care.

During an interview on 04/09/2026 at 8:13 AM, Staff N, CNA, stated they were assigned to the care of Resident 91 but did not remember if they had assisted with oral care.

During an interview on 04/09/2026 at 8:34 AM, Staff B, Director of Nursing Services (DNS), stated the expectation was for staff to assist with oral care.

Observation on 04/09/2026 at 8:39 AM, showed Staff B in Resident 91's room telling them they have seen them brush their teeth and Resident 91 stating No, you did not.

During an interview on 04/09/2026 at 9:33 AM, Staff A, Administrator, stated the expectation was for oral care to be done every day per residents' preferences.

Reference WAC 388-97-1060 (2) (b)

505324 04/10/2026

Life Care Center of Puyallup 511 10th Avenue Southeast Puyallup, WA 98372

During an interview and record review of Resident 13's 04/09/2026 Kardex and CP on 04/10/2026 at 9:58 AM, Staff U, CNA, stated PU/PIs were caused by sitting too long in one place (or prolonged pressure), excessive skin moisture, and shearing.

Staff U stated the professional standards of care for the prevention of PU/PIs depended on each residents care needs but could include: turn/reposition every two hours, pressure relieving air mattress and/or wheelchair cushion, getting up for meals to sit in a chair (not in bed with the head of the bed elevated so they slide down in bed), turning side to side (or side lying to keep them off their tailbone) with the use of pillows, keeping their skin clean and dry, applying barrier ointment to protect their skin, using pillows or a wedge device/heel lift boots to keep their heels off the bed, keeping pressure off their boney prominences (defined as back of the ears if wearing oxygen, spine, elbows, tailbone, sides of the hip, sides of the ankle bone, back of the heel, top of the toes) using pillows to elevate the body part, and using a draw sheet to lift them in bed (not drag them in bed).

Staff U stated they would read their Kardex to find out what each resident needed for care.

Staff U stated the information should be simple and to the point so they could quickly get the information they needed to provide the care.

Staff U stated Resident 13's Kardex and CP did not provide sufficient information or interventions related to the care they required. REFERENCE WAC: 388-97-1060 (1), (3)(b).

505324 04/10/2026

Life Care Center of Puyallup 511 10th Avenue Southeast Puyallup, WA 98372

Observation and interview on 04/07/2026 at 1:01 PM and 1:34 PM showed Resident 91 laid in bed receiving oxygen (O2) set to 4 liters (L) per minute via a nasal canula (devise to deliver O2 through a tube into the nose) that was connected to an O2 concentrator (a device used to deliver O2 therapy).

Observation on 04/09/2025 at 1:23 PM showed Resident 91 was receiving O2 at 3L via nasal cannula. Resident 91 stated they were unable to reach and adjust the liters of the O2 delivery.

Review of the providers' orders dated 03/27/2026 showed Resident 91 had an order for Oxygen at 2L/minute via nasal cannula.

During an interview on 04/09/2026 at 3:03 PM, Staff T, Registered Nurse, verified the O2 delivery rate was at 3L/min and stated the nursing report two days prior discussed how Resident 91 was desaturating (oxygen level below normal of 90%) and the O2 rate was increased.

Staff T stated that the expectation was for the nurses to notify provider and obtain new orders.

During a joint interview on 04/10/2026 at 12:21 PM, Staff A, Administrator, and Staff E, Regional Registered Nurse, stated the expectation was to follow oxygen orders.

Reference WAC 388-97 -1060(3)(j)(iv)-(vi)

505324 04/10/2026

Life Care Center of Puyallup 511 10th Avenue Southeast Puyallup, WA 98372

Findings included.

Review of the electronic health record (EHR) showed Resident 15 admitted to the facility on [DATE] with diagnoses to include high blood pressure, diabetes (high blood sugar), and arthritis (conditions that cause pain, swelling, stiffness, and reduced movement in one or more joints). Resident 15 was able to make needs known.

Review of the pharmacist consultation report recommendation, dated 03/23/2026, showed Resident 15 received as needed oxycodone (narcotic medication used to treat moderate to severe pain) one to three times a day; however, nonpharmacological interventions (NPI, health interventions/approaches used instead of medication) were not linked to the as needed oxycodone order. It showed, Please ensure nonpharmacological therapies are attempted prior to prn [as needed] oxycodone administration.

Review of Resident 15's April 2026 medication administration records (MAR) from 04/01/2026 - 04/09/2026 showed an order dated 01/08/2026 to monitor and document pain level every shift and to attempt non-medication interventions prior to administering as needed pain medication with NPI interventions listed.

Documentation showed Resident 15's pain level was documented; however, NPI was not.

Review showed an order with a start date of 03/27/2026 for oxycodone one tablet every eight hours as needed for moderate to severe pain.

Review showed Resident 15's pain levels documented and oxycodone was provided; however, there was no NPI linked to the order to ensure NPI was provided prior to being given the oxycodone per pharmacy recommendation.

During an interview on 04/09/2026 at 4:57 PM, Staff E, Regional Registered Nurse, stated Resident 15's pharmacy recommendation on 03/23/2026 was not followed up on.

Staff E stated that Resident 15 should have had specific NPIs linked to the oxycodone order and needed to be addressed per pharmacy recommendation.

During an interview on 04/09/2026 at 5:02 PM, Staff A, Administrator, stated Resident 15's pharmacist consultation report dated 03/23/2026 was noted on 03/27/2026 by the nurse, and should have been linked per pharmacy recommendation, and this did not meet their expectations.

Reference WAC 388-97-1300 (1)(c)(iv)

505324 04/10/2026

Life Care Center of Puyallup 511 10th Avenue Southeast Puyallup, WA 98372

Review of the list showed Resident 43

they could pull up the bowel and bladder TASK responses in PCC.

Staff AA acknowledged they did not

stool softener, but did not.In an interview on 04/10/2026 at 1:10 PM, Staff G, LPN/Unit Care Coordinator, stated stool softener medications should be held after any episode of loose stool and monitored on alert for loose stool until resolved. To evaluate loose stools, the nurses are expected to include a review of the resident's bowel record daily under the TASK tab in PCC; Question 3, which shows the consistency of bowel movements.

Staff G stated medication prescription labels should match the current medication orders and when they don't, the orders should be clarified and notated on the card (to the side of the prescription label) that the order was clarified and which order is correct until the card with the current order on the prescription label has arrived. <RESIDENT 98>

Review of the 01/28/2026 Annual Comprehensive MDS showed Resident 98 admitted to the facility on [DATE], had short-term and long-term memory problems, was dependent on staff for assistance with toileting, bed mobility, and transfers.

Diagnoses included cerebral palsy (a condition that affects a person's ability to move and control their muscles due to changes or damage in the brain during development before, during, and/or shortly after birth) and was incontinent of bowel and bladder.During a medication administration observation on 04/10/2026 at 10:29 AM, Staff H, LPN, showed a PO from the April 2026 MAR for Senna-Docusate sodium oral tablet 8.6mg - 50mg, one tabled two times a day for constipation.

Staff H removed a bottle from the top drawer of the medication cart, placed a tablet in the medication cup, and the bottle read ?Senna 8.6mg'.

The senna 8.6 mg was administered to Resident 98.In an interview on 04/10/2026 at 10:40 AM, Staff H provided the bottle they removed the senna 8.6 mg from and administered to Resident 98.

Staff H re-read the PO listed in the MAR and realized they administered the wrong medication.

Staff H stated they should have administered the senna with docusate sodium 8.6mg-50mg tablet but did not.

Reference WAC: 388-97-1060 (3)(k)(ii).

505324 04/10/2026

Life Care Center of Puyallup 511 10th Avenue Southeast Puyallup, WA 98372

04/07/2026 at 9:50 AM and 04/08/2026 at 1:35 PM of Resident 125's IV Pole and IV solutions, the

when to discard if not used.An observation on 04/10/2026 at 2:25 PM of Resident 125's IV Pole and IV

approximately 100 ml used.

Both IV bags did not show the date/time of the dose administered, the nurse initials who hung the bag, and the Saline did not include the Resident's name.Review of Resident 125's April 2026 MAR showed the last IV antibiotic dose was administered by Staff Q at 2:00 PM.In an interview on 04/10/2026 at 4:00 PM, Staff P, LPN/Unit Care Coordinator, stated the professional standards for IV administration should be followed and all intravenous fluids/medications administered must be properly labeled with the Resident's name, the name of the medication if there was one added, the rate of infusion, the date and time of the dose that was hung, and initialed by the nurse that hung the dose. If the antibiotic IV medications did not indicate the date/time of the dose and the nurses' initials, then professional standards were not followed.

Reference WAC: 388-97-1060 (3)(k); -1300(2).

505324 04/10/2026

Life Care Center of Puyallup 511 10th Avenue Southeast Puyallup, WA 98372

During an interview on 04/07/2026 at 10:06 AM, Resident 17 stated their dentures did not fit and they had seen a dentist three months ago for new dentures but had not heard anything further.

Review of the EHR showed a form titled Dental Progress Note dated 02/05/2026 which recommended new upper and lower dentures and extractions for Resident 17.

Review of a progress note dated 02/12/2026 showed Resident was seen by [outside dental provider].

Will need a referral out for x-rays, ex [extractions] FOR ALL LOWER TEETH.

Referral and Transportation specialist is aware and working on it.

During an interview on 04/09/2026 at 1:24 PM, Staff F, Central Supply/Transportation Specialist, stated they had not seen the recommendation for new dentures and Resident 17 was scheduled for a recall exam in one year.

During an interview on 04/09/2026 at 1:27 PM, Staff G, Unit Care Coordinator, stated it was their expectation that transportation schedule the follow up and send them notice when it was done, but they had not received notice yet for Resident 17.

During an interview on 04/09/2026 at 2:21 PM, Staff E, Regional Registered Nurse, stated it was their expectation Resident 17 be referred for dentures timely.

Reference WAC 388-97 -1060(1)(3)(j)(vii)

Findings included.TrackingReview of the infection control line listings for January, February and March 2026 showed no documentation that the organisms present for residents with a diagnosis of urinary tract infection (UTI) were identified and tracked for the months of January and February 2026.

During an interview on 04/10/2026 at 12:40 PM, Staff C, Registered Nurse/Infection Preventionist (RN/IP), stated they were aware of the missing organisms on the monthly tracking for January and February 2026 and stated the laboratory results should have been reviewed for all infections but were not.

Transmission Based Precautions (TBP)

Review of the posted contact precautions signs on 04/09/2026 showed staff were to perform hand hygiene and put on a gown and gloves when entering the room.

Observation on 04/07/2026 at 9:35 AM showed room [ROOM NUMBER] with contact precautions sign posted at the door. An unidentified staff member was observed entering the room without performing hand hygiene or putting on a gown or gloves and failed to perform hand hygiene when exiting the room.

Observation and interview on 04/10/2026 at 1:24 PM showed room [ROOM NUMBER] with a contact precautions sign posted at the door.

Staff H, Licensed Practical Nurse, was observed standing in room [ROOM NUMBER] next to the resident and did not have on a gown or gloves.

Staff H stated they should have followed the posted sign.

Wound CareObservation on 04/09/2026 at 9:39 AM showed Staff J, Licensed Practical Nurse/Treatment Nurse, provided wound care for Resident 11.

Staff J removed the soiled bandage and with the same gloves cleansed the wound and applied a new bandage. No hand hygiene or glove changes were performed during the bandage change.

During an interview on 04/10/2026 at 12:40 PM, Staff C, RN/IP, stated it was their expectation staff followed the posted precautions signs.

Staff C stated when changing a bandage staff should perform hand hygiene after removing the soiled bandage before cleansing and applying a new one.

During an interview on 04/10/2026 at 1:38 PM, Staff E, Regional Registered Nurse, stated it was their expectation for the infection preventionist to review lab results and track the identified organisms, and staff should have followed the posted precautions signs.

Staff E stated wound care should have been performed following proper infection control procedures.

Reference WAC 388-97-1320(2)(b)

505324 04/10/2026

Life Care Center of Puyallup 511 10th Avenue Southeast Puyallup, WA 98372

Findings included.

Review of the facility policy titled Antibiotic Stewardship revised 07/22/2025 showed the facility would implement Antibiotic Reassessment at two to three days after empiric antibiotic initiation [the immediate prescribing of antibiotics based on clinical suspicion, patient symptoms, and risk factors before specific laboratory culture or susceptibility results are known] or first dose in the facility, each resident should be reassessed for consideration of antibiotic need. At this time, laboratory testing results, response to therapy and resident condition will be considered.

Resident 80

Review of the electronic health record (EHR) showed Resident 80 admitted to the facility on [DATE] with a diagnosis of Parkinson's disease (a movement disorder of the nervous system).

The resident was able to make needs known.

Review of a provider's order, dated 01/27/2026, showed Resident 80 received Macrobid (an antibiotic) for a UTI for five days.

Review of a provider's order, dated 02/10/2026, showed Resident 80 received Cephalexin (an antibiotic) for a skin infection for five days.

Review of Resident 80's provider note dated 03/08/2026 showed, Treat with Keflex [an antibiotic] (Cephalexin) per susceptibility for E Coli [a bacteria] UTI.

Review of Resident 80's provider orders showed Cephalexin with a start date of 03/08/2026 for a urinary tract infection (UTI) for seven days.

Review of the progress notes dated between 01/22/2026 and 03/12/2026 showed no documented signs and symptoms of a UTI for Resident 80.

During an interview on 04/09/2026 at 11:27 AM, Staff C, Registered Nurse/Infection Preventionist (RN/IP), stated the provider was responding to a laboratory report that was collected on 01/27/2026 but they had not received the results until 03/07/2026.

Staff C stated Resident 80 should have been assessed using the McGeers criteria (an infection assessment) and an Antibiotic Reassessment should have been done but was not.

Resident 52

Review of the EHR showed Resident 52 admitted to the facility on [DATE] with a diagnosis of broken leg.

The resident was able to make needs known.

Review of Resident 52's EHR showed an order for Macrobid for a UTI for four days with a start date of 03/18/2026.

Review of Resident 52's EHR showed no laboratory results were received or reviewed, and no antibiotic reassessment was completed.

Review of the progress notes dated between 03/18/2026 and 03/22/2026 showed no reports of symptoms of a UTI for Resident 52.

During an interview on 04/09/2026 at 11:27 AM, Staff C, RN/IP, stated they should have requested and reviewed the lab results and completed an antibiotic reassessment but had not.

During an interview on 04/10/2026 at 1:38 PM, Staff E, Regional Registered Nurse, stated it was their expectation that the Infection Preventionist review all infection associated lab results and follow up with antibiotic reassessments to ensure appropriate treatment and this did not happen for Residents 80 and 52 but should have.

Reference WAC 388-97-1620(2)(b)(i)(ii)

505324 04/10/2026

Life Care Center of Puyallup 511 10th Avenue Southeast Puyallup, WA 98372