Shelton Health And Rehabilitation

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

observation, interview and record review, the facility failed to treat residents with respect and honor privacy while having private conversations for 1 of 1 sampled resident (1) reviewed for privacy. This failure placed residents at risk for diminished self-worth, self-esteem, and feelings of embarrassment.Findings included.Resident 1 was admitted to the facility on [DATE REDACTED] with diagnoses of dementia, post-traumatic stress syndrome (a mental health condition that's caused by an extremely stressful or terrifying event), and diabetes mellitus. The quarterly minimum data set, an assessment tool, dated 06/30/2025, documented Resident 1 had moderate cognitive impairment and required substantial assistance with activities of daily living.The care plan, dated 12/08/2024, documented Resident 1 was dependent on staff to meet emotional, intellectual, physical, and social needs. Staff will converse with the resident while providing care and will anticipate the residents' needs.On 08/18/2025 at 2:08 pm, Resident 1 reported that sometimes staff would hang out in their room when they have company. Resident 1 motioned towards the entry of their room and pointed out Staff J, Housekeeping, was doing this during our conversation. Resident 1 said they felt like staff did this intentionally to overhear conversations. At this time, Resident 1 asked Staff J if someone could address the toilet bowl as it was still soiled after housekeeping had cleaned their room earlier. Staff J went and got Staff K, Housekeeping, to address the residents' concerns. While Resident 1 and this writer continued to speak about the resident's care, Staff K proceeded to dust the area around resident's bed, where the resident was laying. Staff K leaned over the bedside table, directly between the resident and this writer, and dusted the light fixture above the bed. Next, Staff K dusted the light fixture in an unoccupied space next to Resident 1's bed. Then, Staff K dusted the bottom of the bedside table directly next to this writer's feet. Staff K proceeded to clean and dust other areas in Resident 1's main room, where we were talking. Resident 1 then asked Staff K to go and clean the bathroom, where the original concern was, while

we were talking. Staff K went to the bathroom and cleaned the area of concern. Staff J remained at the entrance of the room during the entire conversation. Resident 1 said see, this is what I was talking about.

Resident 1 explained how uncaring it is to intrude on the residents' privacy and how staff lacked empathy.

After Staff K was done cleaning the bathroom, Staff K came out into the room and asked if we were done talking. We concluded our conversation at that time.On 09/12/2025 at 3:00 pm, Staff I, Housekeeping, said housekeeping staff should respect the resident's privacy when they have guests. If privacy were required, Staff I would do another task instead.On 09/18/2025 at 2:15 pm, Staff B, Registered Nurse and Director of Nursing Services, said there was a privacy issue where housekeeping staff were cleaning in Resident 1's room. Staff B said staff should not have been cleaning near Resident 1 and this writer while having a conversation. Staff B said she would be talking with housekeeping about the issue.Reference WAC 388-97-0180(1-4)

Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date

these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.

LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE

TITLE

(X6) DATE

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

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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

09/18/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Shelton Health and Rehabilitation

153 Johns Court Shelton, WA 98584

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 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

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

happened when they went to leadership with their concerns.On 09/12/2025 at 2:29 pm, Staff G, NA, said it could be a challenge to get showers done when they were short staffed.On 09/12/2025 at 2:33 pm, Staff C, licensed practical nurse (LPN), said staffing was an issue with the facility. Sometimes the nurses had up to 30 residents to care for. They get late with passing medication. Showers do not get done. Staff C says they feel bad for the residents as it's their basic human need and right; Staff D, LPN, said there were 27 showers to do this day. There were, at times, not enough NAs and all that could be done was providing for basic needs. Staff feel overwhelmed and stressed.On 09/12/2025 at 2:52 pm, Staff F, BA and NA, said they had 4 to 8 baths scheduled unless they were removed from working on the floor. This happens pretty often. The amounts of baths [NAME] when the BA is pulled to the floor. They can have 20 or more showers to do in a day in this situation. This is a challenge to get done. Sometime baths or refusals are not documented due to time constraints. Voicing concerns to leadership regarding staffing was ineffective.On 09/12/2025 at 3:38 pm, Staff E, registered nurse (RN), said she was an agency nurse and was new to the facility. Staff E said

the facility had residents who were high acuity and have a lot of needs. The facility was experiencing a COVID outbreak, has staffing issues, and printers and fax machines were not working, making staffing even more challenging. Due to all the issues, they could not get things like daily orders or treatments done resulting in a delay in care. Staff E said there was not enough support.On 09/18/2025 at 2:15 pm, Staff B, RN and Director of Nursing Services, said they started having a BA to help address missed showers. When people called off, they would pull the BA to the floor. They do have agency staff they use to try and cover shifts. Staff B acknowledged concerns have been reported in both Resident Council and through the grievances process related to showers and staffing concerns. Staff B said showers are an issue. Staff B said the facility has residents who have complex needs. Staff B said they had been trying to do things like consolidating medications to reduce the medication pass.On 09/18/2025 at 2:52 pm, Staff A, Administrator, acknowledged they had issues with bathing and staffing. Staff A said they have done many things such as job fairs and bonuses to increase staffing levels. They use agency staff but, at times, when they are scheduled to work they do not show up. Leadership is expected, and does, cover shifts and help on the floor.Reference: (WAC) 388-97-1080 (1)

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