Spokane Valley Health And Rehabilitation Of Cascad

F 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

hurting [residual right sided groin pain].In an interview on 11/03/2025 at 10:05AM, a Collateral Contact (CC) stated they heard Resident 3 issue a blood curdling scream as they approached their room on 10/27/2025. When the CC entered Resident 3's room they found Staff H in the room along with Resident 3 and another family member. The CC stated they visited Resident 3 daily, multiple times throughout the day.

When asked how many staff they observed transfer and assist the resident with bed mobility, the CC stated, It's bad. I have never seen two people in there with [the resident] and I come down there quite often.In an

interview on 10/31/2025 at 3:40 PM, Staff H stated they did not ask other staff to assist them with the lift transfer or position Resident 3 in bed and that they usually transferred or completed bed mobility for Resident 3 by themself, Always one person since taking care of [the resident].Review of a 10/27/2025 schedule showed Staff H and Staff N, Licensed Practical Nurse (LPN), were assigned to Mountain View Unit, where Resident 3 resided. Review of an undated facility investigation showed the facility interviewed Resident 3, the CC, Staff H, other residents and other staff. The investigation showed the facility reviewed Resident 3's care plan and would provide staff education on bed mobility. The investigation concluded that

the pain Resident 3 experienced was from bed mobility and/or positioning and that the way Staff H adjusted their legs resulted in pain. Staff H did not respond with professionalism and will be educated.Review of staff interviews showed no documentation the facility obtained a statement from Staff N. The facility interviewed 10 staff; all of the interviews were unsigned and undated and only one interview showed the title of the staff member. The interviews asked the staff three questions, What would you immediately do if a resident reported something that could be abuse or neglect to you? Who is the abuse coordinator of the facility? And do you need more training on abuse or neglect situations? Only one of the 10 staff answered, Protect resident. The investigation showed no documentation the facility interviewed the family member who was with Resident 3 and witnessed the staff -to-resident event on 10/27/2025. The investigation showed no documentation the facility investigated why Staff H did not follow Resident 3's care plan instruction to transfer and assist with bed mobility with two people and if the practice extended to the other staff and shifts. The investigation showed no documentation the facility asked other staff how Staff H treated other residents, including observations of yelling. The above findings were shared with Staff A on 11/04/2025 at 1:43 PM. No further information was provided.Reference: WAC 388-97- 0640 (6)(a)

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Facility ID:

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

11/12/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Spokane Valley Health and Rehabilitation of Cascad

East 17121 Eighth Avenue Spokane Valley, WA 99016

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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

11/03/2025 at 10:05AM, a Collateral Contact (CC) stated they visited Resident 3 daily, multiple times throughout the day. When asked how many staff they observed transfer and assist the resident with bed mobility, the CC stated, It's bad. I have never seen two people in there with [the resident] and I come down there quite often. The CC explained that on some occasions when the staff assisted getting Resident 3 out of bed, they saw the resident almost hit their head on the headboard and, I just cringed. I've seen where [the resident is] sitting on the bed and [the staff] just lift [their] legs from under the bed and [the resident] falls over onto [their] right side. The CC added, I've not seen two people and I said that to [Resident 3] who goes, ‘Well, sometimes they have two people in here and I told [the resident], ‘sometimes' isn't enough.In

an interview on 10/31/2025 at 3:40 PM, Staff H stated they knew how to care for the residents by obtaining report from their nurse or the aide from the previous shift. When asked how many people were required when mechanical lifts were used, Staff H stated two people, but with a sit-to-stand not always. It just happens that way. Staff H said she did not ask other staff to assist them with the lift transfer or help position Resident 3 in bed and that they usually transferred Resident 3 by themself, Always one person since taking care of [the resident].In an interview on 10/30/2025 at 12:35 PM, Staff I, who wished to remain anonymous, stated that some of the staff did not use the mechanical lifts because they were physically big enough to lift and transfer the residents on their own.In an interview on 10/31/2025 at 3:16 PM, Staff J, who wished to remain anonymous, said they became aware of changes to the care plan or resident needs by checking the Kardex or the aide who worked the previous shift. Staff J said Resident 3 had become more dependent on

the staff and required more physical assistance. Staff J said that when they could not find anyone to help them transfer a resident, they would physically pick them up and put them in bed but only if they were semi-mobile. Staff J said that every once in a while they would transfer a resident in a sit-to-stand by themself.In an interview on 10/31/2025 at 3:26 PM, Staff K, Registered Nurse (RN), stated that at first the staff transferred Resident 3 with a Hoyer lift (a mechanical lift) and then transitioned to a sit-to- stand lift and had been using a sit-to-stand for a couple of months. Staff K said they assisted Resident 3 with bed mobility, By myself numerous times. Turning [the resident] in bed you can do with one person. You have to go slow and easy and [the resident's] legs are heavy, so you have to be a strong person. I've done it. In an

interview on 10/31/2025 at 3:10 PM, Staff L, NA, said they assisted Resident 3 with no assistance for bed mobility. The above findings were shared with Staff A on 11/04/2025 at 1:43 PM. Staff A said Resident 3 required two-person assistance for bed mobility and transfers because of weakness to the legs and decreased mobility. When asked if Staff H implemented the care plan instruction to provide two people for transfers and bed mobility, Staff A said, No. Reference: WAC 388-97-1020(1), (2)(a)(b).

Event ID:

Facility ID:

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

11/12/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Spokane Valley Health and Rehabilitation of Cascad

East 17121 Eighth Avenue Spokane Valley, WA 99016

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 - Few

AM showed that Staff A's multistate registered nurse (RN) license (an agreement between states that allowed a professional to practice in all participating states with a single license from their home state) had expired on [DATE REDACTED]. A Registered Nurse Temporary License was issued on [DATE REDACTED], 10 days later, and was current.

Review of a NURSYS (the national database for nurse licensure verification and discipline, maintained by

the National Council of State Boards of Nursing, provided primary-source data from United States boards of nursing for license verifications for nurses and institutions) showed Staff A had a multi-state RN license that expired on [DATE REDACTED].

In a telephone interview on [DATE REDACTED] at 2:44 PM, a staff member from the Idaho Department of Professional Licensing stated that an RN temporary license only granted authority to practice in the State of Idaho, not Washington State. The staff member confirmed Staff A's license was a temporary license issued by the state of Idaho.

In a telephone interview on [DATE REDACTED] at 4:15 PM, a staff member from the WA Board of Nursing stated that in order for an out-of-state RN to be able to work in Washington State they must have a permanent out-of-state license and apply through the endorsement process (a request for the local state nursing board to verify the nursing credentials) or a permanent multi-state (compact) license from another state; having a temporary Idaho license did not allow an individual to practice working as an RN in Washington State. They further added that multi-state licensure was granted based on the state of residence and that a person's driver's license state of residence must match the RN license state of residence.

During an interview on [DATE REDACTED] at 10:54 AM, Staff A stated that when they had obtained their temporary nursing license, they were told it was a multi-state license, just as their previous license (with the same license number). When informed that temporary nursing licenses were only valid in the state they were issued by, Staff A stated they must have been misinformed.

During an interview on [DATE REDACTED] at 12:50 AM, Staff O, Administrator was informed that Staff A's credentials were not valid in the state of [NAME]. Staff O confirmed another staff RN to act as the Director of Nursing and provided their current credentials.

During an interview on [DATE REDACTED] at 10:12 AM, Staff A and Staff O acknowledged that Staff A needed either a current [NAME] or multi-state license to practice as an RN in the facility. Staff A provided a copy of their newly issued [NAME] RN license, issued on [DATE REDACTED].

WAC 388-97-1080 (1)

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

Event ID:

Facility ID:

If continuation sheet