Avalon Care Center At Northpointe

Review of the 12/02/2024 fall risk evaluation showed Resident 4 had a history of falls and was at risk for additional falls.

Review of the 12/02/2024 risk for falls care plan showed Resident 4 was at risk for falls related to confusion, balance problems, and history of falls.

An 11/10/2024 progress note documented the resident was found lying on their floor mat in their room.

The resident was sent to the hospital for behaviors.

On 02/05/2025 the investigation for the fall on 11/10/2024 was requested and Staff A sent an email stating there was no investigation as the resident was sent to the hospital.

In an interview on 02/07/2025 at 9:36 AM, Staff B stated the fall on 11/10/2024 should have been logged on the required incident log and investigated. <Resident 14> According to the 12/03/2024 admission assessment, Resident 14 had diagnoses including atrial fibrillation (irregular heartbeat), dementia and repeated falls.

The assessment further showed Resident 14 had a fall prior to admission. Resident 14 was cognitively impaired and was able to make their needs known.

Review of the 11/27/2024 fall risk evaluation showed Resident 14 had a history of falls and was at risk for additional falls.

Review of the 11/27/2024 risk for falls care plan, last updated 01/30/2025, showed Resident 14 was at risk for falls related to deconditioning, balance problems, incontinence, vision and hearing problems and medication use.

A 01/16/2025 progress note documented Resident 14 was found in their room on the floor mat next to the bed.

On 02/03/2025 at 12:30 PM the investigation for the fall on 01/16/2025 was requested and Staff A stated there was no investigation as they were not notified of the fall.

In an interview on 02/07/2025 at 9:34 AM, Staff B stated the fall on 01/16/2025 should have been logged on the incident log and investigated and it was important to put interventions in place to help prevent falls and monitor the effectiveness of the interventions.

Reference: WAC 388-97-0640 (6)(a)(b)

505496 02/07/2025

Avalon Care Center at Northpointe 9827 North Nevada Spokane, WA 99218

Refer to F-F625 for additional information.

505496 02/07/2025

Avalon Care Center at Northpointe 9827 North Nevada Spokane, WA 99218

Review of the January 2025 nursing progress notes showed Resident 30 was found on the floor on 01/18/2025 at 1:15 AM.

The resident was sent to the hospital for further evaluation. No documentation was found to show a bed hold was explained or offered, as required. <Resident 71> Per the 12/11/2024 admission assessment, Resident 71 had diagnoses which included renal insufficiency (a condition in which the kidneys lose the ability to remove waste and balance fluids) and diabetes (a group of diseases that result in too much sugar in the blood).

The resident was cognitively intact to make decisions regarding their care.

Review of Resident 71's record showed a 12/27/2024 progress note documented the resident had experienced vomiting, fever and high blood sugar. Resident 71 was assessed and sent to the hospital for evaluation. No documentation was found to show a bed hold was explained or offered, as required.

In an interview on 02/07/2025 at 9:49 AM, Staff U, Resident Care Manager, reviewed Resident 71's medical record.

Staff U confirmed there was no documentation a bed-hold was offered, as required.

Staff U further stated a bed-hold should have been offered and this was important because residents had a choice if they wanted to keep their bed once they were discharged to a hospital.

Reference WAC 388-97-0120(4) Refer to F-F623 for additional information.

505496 02/07/2025

Avalon Care Center at Northpointe 9827 North Nevada Spokane, WA 99218

According to the 12/26/2024 admission MDS assessment, section B showed Resident 109 was

conflicted with the information under section C which documented Resident 109 was not interviewed due to being severely cognitively impaired and rarely or never understood. <Resident 90> According to the 11/26/2024 admission assessment, Resident 90 had diagnoses including dementia.

Section B of the assessment documented Resident 90 was able to make themselves understood and understood others, however this conflicted with the information under section C which documented Resident 90 was not interviewed due to being severely cognitively impaired and rarely or never understood.

The assessment further showed the observation end date was 11/26/2024 and was signed as completed on 12/04/2024.

Review of Resident 90's quarterly assessment showed the observation end date was 01/14/2025 and was signed as completed on 02/01/2025.

Review of Resident 90's 01/24/2025 discharge assessment showed Resident 90 discharged from the facility on 01/24/2025 with a return not anticipated.

The assessment further showed it was not signed as completed as of 02/03/2025.

In an interview on 02/04/2025 at 3:18 PM, Staff B, Director of Nursing, was asked about the conflicting information in sections B and C of Resident 14, 109, and 90's MDS assessments.

Staff B stated a resident was marked as being able to make themselves understood and understanding others when they have the ability to make their needs known whether in a verbal or non-verbal manner and staff understood them.

Staff B explained to be marked rarely or never understood meant the resident could not respond verbally, in writing or by using any other method.

Staff B acknowledged Resident 14, 109 and 90's assessments did not accurately reflect the resident's status as of the ARD and should have.

In a follow-up interview on 02/05/2025 at 12:29 PM, Staff B acknowledged the facility was behind on completing MDS assessments, as required.

In an interview on 02/05/2025 at 12:37 PM, Staff A, Administrator, acknowledged the facility was behind on completing MDS assessments, as required.

Staff A stated they expected staff to complete MDS assessments per the required time frames.

Reference (WAC) 388-97-1000(b)(d) Refer to F-F640 for additional information.

505496 02/07/2025

Avalon Care Center at Northpointe 9827 North Nevada Spokane, WA 99218

Resident 110's medical record.

Staff A reviewed Resident 110's medical record.

Staff A acknowledged

Reference WAC 388-97-0080 (7)(a)(b)

Refer to F-F689 and F-F758 for additional information.

505496 02/07/2025

Avalon Care Center at Northpointe 9827 North Nevada Spokane, WA 99218

During an interview on 02/06/2025 at 2:57 PM, Staff B, Director of Nursing, stated bathing was provided one to two times per week per the resident's preference.

Staff B stated they were aware that Resident 54 had refused bathing and stated they preferred bed baths in the evening.

Review of the care plan showed no preference for Resident 54's desire to have been given bed baths in the evening.

Reference: WAC 388-97-1060 (2)(c)

505496 02/07/2025

Avalon Care Center at Northpointe 9827 North Nevada Spokane, WA 99218

During an interview on 02/06/2025 at 1:49 PM, Staff N, Registered Nurse, stated skin checks were completed weekly by the nurse.

Staff N stated when a wound was identified, the provider and resident representative were notified, a treatment order was obtained, alert charting, and measurements of the wound were taken.

Staff N stated Resident 54 had a wound on their heel, and was unsure when it developed, they added they started working at the facility in September and thought it was acting up again but would have to check.

In an interview on 02/06/2025 at 2:05 PM, Staff C, Resident Care Manager, stated Resident 54's representative brought the pressure ulcer to their attention on 01/27/2025 and they placed a referral that day to United Wound Healing.

Staff C stated a treatment for the pressure ulcer was implemented on 01/28/2024.

Reference: WAC 388-97-1060 (3)(b)

505496 02/07/2025

Avalon Care Center at Northpointe 9827 North Nevada Spokane, WA 99218

Review of the attached neurological flow sheet instructed staff to obtain vital signs and complete neuro checks every 15 minutes x one hour, then every 30 minutes x one hour, then every hour x four hours, then every four hours x 24 hours.

The form documented vital signs, and neuro checks every 15 min x the first hour through 2:15 AM, then starting again at 6:00 AM, nearly four hours later, not as instructed on the form.

Review of the January 2025 nursing progress notes showed Resident 30 had an unwitnessed fall on 01/18/2025 at 1:15 AM. No documentation of vital signs or neuro assessment was found between 2:15 AM and 6:00 AM. At 7:04 AM, Resident 30 was medicated for a headache. At 1:44 PM, Resident 30's family member visited and was unhappy with cares.

The provider was notified of Resident 30's fall that morning, the provider assessed Resident 30, and Resident 30 was transported to the hospital for further evaluation related to hitting their head after having a recent craniotomy.

Review of 01/18/2025 provider progress note showed Resident 30 sustained a fall around 1:00 AM with redness and swelling noted to the right side of the head. Resident 30 reported 5 out of 10 pain (on a scale of 0-10, 0 being no pain and 10 being worst pain experienced). Resident 30 explained they hit the same location on their head as the previous fall that occurred on 12/23/2024 (prior to admission) that resulted in a craniotomy. Resident 30 was transferred to the hospital for additional testing.

In an interview on 01/31/2025 at 4:06 PM, Resident 30's family member explained Resident 30 had a recent fall out of bed and hit their head. Resident 30 was on blood thinners and experienced a brain bleed before. Resident 30's family member had to insist Resident 30 be sent to the hospital for further evaluation because the facility was not monitoring them.

In an interview on 02/06/2025 at 3:54 AM, Staff N, Registered Nurse, explained residents were assessed for fall risk upon admission, quarterly, and when a fall occurred.

Staff N further stated when a fall was unwitnessed neuro checks were to be performed, a fall incident report was to be completed, and care plan updated with a new intervention.

Staff N acknowledged if a new fall intervention was not implemented timely it could lead to further falls.

In an interview on 02/07/2025 at 8:58 AM, Staff C, Resident Care Manager, explained neuro checks were performed for unwitnessed falls, if the resident was a poor historian and when a resident hit their head during a fall.

Staff C further stated a resident was to be placed on alert charting to monitor for latent injuries and care plan updated with a new fall intervention to prevent reoccurrence.

Staff C stated they expected staff to monitor residents and implement interventions when falls occurred.

In an interview on 02/07/2025 at 9:18 AM, Staff B, Director of Nursing, defined a fall as any unplanned change in plane and explained a new intervention should be implemented each time a fall occurred to prevent further falls.

Staff B stated staff were expected to complete fall incident reports, implement new interventions, and follow the facility fall policies when falls occurred.

Reference WAC 388-97-1060 (3)(g)

505496 02/07/2025

Avalon Care Center at Northpointe 9827 North Nevada Spokane, WA 99218

reviewed Resident 22 and 23's records.

Staff B acknowledged documentation had not been completed

Reference (WAC): 388-97--1060 (3)(k)(i) Refer to F-F552 and F-F661 for additonal information.

Findings included .

<Resident 109>

The 12/26/2024 admission assessment documented Resident 109 was severely cognitively impaired, was dependent on nursing staff for activities of daily living (ADLS) such as toileting and had diagnoses which included medically complex conditions.

Review of the State Agency's reporting database showed a concern had been reported which documented Resident 109 was wheelchair bound and had conditions that required a caregiver to be with them while attending appointments with providers outside the facility.

The report further documented on 01/06/2025, Resident 109 had been dropped off at an appointment without a caregiver and while at the appointment, the resident needed assistance to the bathroom.

Review of the ADL care plan documented Resident 109 required two nursing staff to assist with using the bathroom, and the resident required the use of a mechanical lift for transferring (such as from the wheelchair to the toilet).

A progress note on 01/06/2025 at 4:37 PM documented the facility's transportation driver had been sent to pick up Resident 109 from the appointment with the outside provider due to the resident exhibiting behaviors and screaming.

In an interview on 02/03/2025 at 12:15 PM, Staff O, Nursing Assistant, stated the facility sometimes scheduled a nursing assistant to go to appointments with a resident and reached out to family also to see if they could attend with the resident.

In an interview on 02/05/2025 at 1:37 PM, Staff B, Director of Nursing, confirmed Resident 109 should have had a staff member and/or family member with them at the appointment due to needing assistance for ADLS.

<Resident 54>

In an interview on 01/28/2025 at 10:53 AM, Resident 54's representative stated the resident was not getting bathed as care planned and was told they had no one to bathe them or the facility had not hired anyone to do bathing.

According to the 10/22/2024 quarterly assessment, Resident 54 was cognitively intact and needed assistance from staff for activities of daily living, such as bathing.

505496

Form Approved OMB

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.

Building 505496 B.

Wing 02/07/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Avalon Care Center at Northpointe 9827 North Nevada Spokane, WA 99218

Findings included .

Review of the facility policy titled, Freedom from Abuse, Neglect and Exploitation revised November 2017, showed staff would conduct a thorough investigation of allegations.

<Resident 83>

In an interview and observation on 01/28/2025 at 2:49 PM, Resident 83 stated a week or two ago a nursing assistant was rough when they repositioned them and bumped their arm on the tray table.

The resident stated they did not think staff liked them because they had to call for things because they could not get out of the bed.

The resident was lying in bed and had a scab similar in size to a sunflower seed on their right forearm.

Per the 09/26/2024 quarterly assessment, Resident 83 had diagnoses of stroke with hemiplegia (paralysis that affected one side of the body) and anxiety. Resident 83 had severe cognitive impairments and was not able to make their needs known.

The 06/20/2024 care plan stated the resident had an activity of daily living performance deficit and required substantial to maximal assistance with repositioning in bed.

Review of the 01/28/2025 facility investigation showed Resident 83 had an older scab, a light purple/pink discoloration and a dark blue bruise to their right forearm.

According to the investigation, Resident 83 was cognitively intact, and never stated someone was rough with them.

The resident used their forearms to scoot and adjust themselves which would explain the bruising and scabbed areas.

There were no staff interviews included in the investigation. It was determined that no abuse or neglect occurred.

During an interview on 02/06/2025 at 1:01 PM, Staff L, Social Service Director, stated they asked Resident 83 how they got the scab, and the resident stated they got it from a girl.

Staff L stated the resident was more cognizant since medications changes had been made.

505496

Form Approved OMB

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.

Building 505496 B.

Wing 02/07/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Avalon Care Center at Northpointe 9827 North Nevada Spokane, WA 99218