Manor Care Health Services-spo

F-F625 for additional information.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 3 of 29 505322 Department of Health & Human Services Printed: 08/28/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 505322 B. Wing 04/24/2025

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

Spokane Health & Rehabilitation North 6025 Assembly Spokane, WA 99205

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 0658 Ensure services provided by the nursing facility meet professional standards of quality.

Level of Harm - Minimal harm or **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 40297 potential for actual harm Based on observation, interview, and record review the facility failed to ensure services provided consistently Residents Affected - Some and routinely met professional standards of practice for 12 of 13 sampled residents (Resident 6, 262, 69, 16, 41, 83, 312, 63, 65, 311, 79, and 85), reviewed for skin conditions, constipation and accidents. Failure of staff to monitor wounds, follow and/or clarify physician orders when indicated, develop and implement an effective fall prevention policy and consistently monitor residents for injury after falls, placed residents at risk for a delay in treatment, injury, hospitalization , and a diminished quality of life.

Findings included .

The American Nurses Association (ANA) is a national professional organization that represents the interests of registered nurses in the United States and sets and promotes high standards of nursing practice to ensure quality and ethical care for patients. The ANA developed the document, Nursing: Scope and Standards of Practice, with its fourth edition released in 2021. The resource informs and guides nurses in providing safe, quality, and competent patient care. The resource outlined and described 18 standards of practice for nursing professionals to follow.

Review of the Nursing: Scope and Standards of Practice resource showed the first six standards included:

1. Assessment: effectively collect data and resident information that is relative to their condition or situation.

2. Diagnosis: analyze the data gathered during the assessment phrase, to determine potential or actual diagnoses.

3. Outcomes Identification: effectively predict outcomes for the resident.

4. Planning: After identifying a diagnosis and outcomes, develop a plan or strategy to attain the best possible outcome for the resident in need.

5. Implementation: Implement the identified plan. This may be done by coordinating care for the residents, such as administering treatment, or implementing/following provider orders.

6. Evaluation: After implementation, a nurse must monitor and evaluate the patient's progress towards the expected outcome or health goals.

FAILURE TO ASSESS AND IMPLEMENT TREATMENT FOR NON-PRESSURE SKIN CONDITIONS

Review of an undated facility policy titled, Skin Tears, Abrasions, and Bruises Management showed, the nurses completed weekly skin observations and documented their findings in the medical record. The documentation included the location of the skin condition and its description, to include the size, along with treatment orders and interventions to promote healing. The policy instructed the nurses to evaluate the effectiveness of the treatment weekly.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 4 of 29 505322 Department of Health & Human Services Printed: 08/28/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 505322 B. Wing 04/24/2025

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

Spokane Health & Rehabilitation North 6025 Assembly Spokane, WA 99205

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 0658 <Resident 6>

Level of Harm - Minimal harm or Review of a 02/23/2025 significant change in condition assessment showed Resident 6 admitted to the potential for actual harm facility on [DATE REDACTED] with medically complex conditions, to include Sjogren's syndrome (a chronic autoimmune disease that can cause dry skin). The assessment showed the resident had moderately impaired cognition Residents Affected - Some and had no lesions, skin tears, or abrasions.

An observation on 04/14/2025 at 11:28 AM showed Resident 6 sitting in a wheelchair in a resident lounge area. An undated dressing was observed towards the top of the resident's head, partially lifted on the right side and exposed an open area of an undetermined size. The exposed area was not actively draining and seemed to have a dry, red wound bed, like an abrasion. Resident 6 stated the staff, Change the dressing if I need it every day.

Observations on 04/16/2025 at 09:25 AM and 04/17/2025 at 8:39 AM showed Resident 6 up in a wheelchair and out of their room, with no dressing present. Observed was a dry abrasion, approximately 1.5 centimeters (cm, a unit of measurement) by 2 cm. No active drainage or signs of infection were observed. Review of the April 2025 Treatment Administration Records (TAR) showed no instructions to monitor or care for the abrasion to Resident 6's head.

A 03/06/2025 progress note documented Resident 6 had opened several scabbed wounds by scratching on [their] forehead and right leg resulting in bleeding. Antibiotic antibiotic ointment and skin prep was applied to

the wounds and dressed with bordered dressings. Another 03/06/2025 progress note showed the staff identified abrasions to the right lower leg and to the right side of the scalp. Review of the March 2025 Treatment Administration Records (TAR) showed no orders for the application of the antibiotic ointment and bordered dressings to the wounds on the forehead or right leg.

Review of a 03/13/2025 Wound Consultant note showed, the staff assessed Resident 6 had, bruises and abrasions from falls and scratching [themselves]. The consultant instructed the staff to apply one or more ounces of emollient [moisturizing] cream to all the skin at least two times a day. Subsequent notes by the Wound Consultant on 03/20/2025, 03/27/2025, 04/03/2025, and 04/10/2025 showed the same instructions.

Review of the March and April 2025 TAR or care plan showed no documentation the nurses implemented

the Wound Consultant's specific instruction.

Review of the progress notes from 03/21/2025 to 04/12/2025 showed the staff identified various skin conditions as follows:

- On 03/21/2025, an abrasion to the forehead

- On 03/24/2025, skin tears and abrasions

- On 03/26/2025, abrasions to knees

- On 03/28/2025, skin abrasions

- On 04/12/2025, a skin tear that is not covered; skin found to be open, size is about 8cm in length with moderate amount of blood; Per the documentation, the resident was sent to the hospital, returned to the facility at 8:15 PM, and had obtained 9 stitches and 5 steri-strips [adhesive strips].

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 5 of 29 505322 Department of Health & Human Services Printed: 08/28/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 505322 B. Wing 04/24/2025

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

Spokane Health & Rehabilitation North 6025 Assembly Spokane, WA 99205

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 0658 Review of provider notes showed they also identified the following various skin conditions:

Level of Harm - Minimal harm or - On 02/19/2025 and 03/17/2025 - abrasions to both knees and scalp potential for actual harm -On 03/06/2025, 03/11/2025, 03/14/2025, 3/27/2025, 03/28/2025, 4/17/2025 - Wound on scalp or Scabbed Residents Affected - Some wound on scalp.

Review of the medical record showed the nurses completed weekly Skin Observation assessments on 02/17/2025, 02/24/2025, 03/03/2025, 03/06/2025, 03/11/2025, 03/13/2025, 04/10/2025, and 04/17/2025. The medical record showed no documentation that showed the nurses assessed or evaluated the status or progress of the multiple identified non-pressure skin conditions, to include the substantial skin tear of unknown location, or developed and implemented measures to ensure adequate healing and/or prevent complications associated with the non-pressure skin conditions. Review of the physician orders showed no instructions to care for the substantial skin tear of unknown location that required the resident's transfer to

the hospital for invasive treatment on 04/12/2025.

The above findings were shared with Staff C, Assistant Director of Nursing (ADON), on 04/18/2025 at 11:21 AM. Staff C acknowledged the nurses should have, but did not procure or implement provider orders for the management of non-pressure skin conditions, assessed or evaluated the status or progress of non-pressure skin conditions, or developed and implemented measures to ensure adequate healing and prevent complications associated with the non-pressure skin conditions.

<Resident 63>

According to the 02/12/2025 quarterly assessment, Resident 63 was dependent on staff assistance to perform personal hygiene which included washing/drying their face. Resident 63 had moderate cognitive impairment and was able to clearly verbalize their needs.

Review of the 02/04/2025 weekly skin assessment observation showed Resident 63 had dry skin.

Review of the 02/11/2025 weekly skin assessment observation showed Resident 63 had extremely dry skin.

Review of Resident 63's care plan showed no documentation or interventions to address Resident 63's extremely dry skin.

During observation and interview on 04/14/2025 at 9:00 AM, Resident 63 had thick white dry skin flakes covering their entire forehead, down both sides of their face, inside both ear crevices, down both sides of their neck, and behind both ears. Resident 63 stated they had Psoriatic [skin condition that resulted in red patches covered with silvery scales] Arthritis [joint pain, stiffness, and swelling]. Resident 63 stated they were experiencing a bad flare up and explained their skin itched and was irritated. Resident 63 stated they had a cream to help but they had to request it and I never seem to get it. Resident 63 further stated it took their skin

a while to calm back down after a flare up. Similar observations were made at 11:31 AM, 1:20 PM, on 04/15/2025 at 8:58 AM and 12:03 PM, on 04/16/2025 at 12:14 PM, and on 04/18/2025 at 8:43 AM.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 6 of 29 505322 Department of Health & Human Services Printed: 08/28/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 505322 B. Wing 04/24/2025

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

Spokane Health & Rehabilitation North 6025 Assembly Spokane, WA 99205

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 0658 In an interview on 04/22/2025 at 1:18 PM, Staff C reviewed Resident 63's medical record. Staff C acknowledged Resident 63 had extremely dry skin and no treatment for psoriasis. Staff C stated they Level of Harm - Minimal harm or expected staff to follow up on skin issues as needed. potential for actual harm <Resident 16> Residents Affected - Some According to the 03/11/2025 assessment, Resident 16 was cognitively intact and able to clearly verbalize their needs.

Review of the 04/07/2025 facility unwitnessed fall report showed Resident 16 attempted to self-transfer but their legs gave out and fell . Resident 16 sustained a skin tear to the back of their left hand that was closed with steri-strips (thin strips of tape used to close small cuts).

Review of April 2025 nursing progress notes showed on 04/07/2025 Resident 16 fell and sustained a skin tear to the back of their left hand that was closed with steri-strips. On 04/08/2025 the left hand steri-strips were getting a little dirty and were covered with gauze. No documentation of skin tear monitoring or assessment for signs and/or symptoms of infection was found until 04/15/2025. On 04/15/2025 the left-hand dressing was dislodged, the wound was cleansed, assessed, and redressed. Resident 16 informed the staff

the skin tear was an injury from their recent fall.

Review of provider orders as of 04/14/2025, seven days after Resident 16 sustained a fall, showed no provider orders to monitor the left-hand skin tear for signs and/or symptoms of infection or to change the bandage.

During observation and interview on 04/14/2025 at 11:18 AM, Resident 16 stated they sustained a skin tear to their left hand when they attempted to self-transfer recently and fell . Resident 16 pointed to a white undated bandage on the back of their left hand with a dark blood drainage stain spot observed through the bandage. Resident 16 stated the bandage had not been changed for a week and thought the skin tear was worsening because it was becoming painful, warm, and continued to bleed. Similar observation was made

on 04/15/2025 at 8:52 AM.

In an interview on 04/22/2025 at 12:02 PM, Staff H, Licensed Practical Nurse (LPN), explained if a resident fell and sustained a skin tear the provider would be notified and orders to monitor and/or skin treatment orders implemented. Staff H stated skin issues could worsen or get infected if they were not monitored. Staff H reviewed Resident 16's medical record. Staff H acknowledged Resident 16 experienced a fall on 04/07/2025, sustained a skin tear to the back of their left hand, and staff should have implemented orders to monitor the skin tear.

In an interview on 04/22/2025 at 12:19 PM, Staff C, ADON, stated skin issues could worsen or get infected if

they were not consistently monitored. Staff C reviewed Resident 16's medical record. Staff C acknowledged Resident 16 sustained a skin tear from a fall on 04/07/2025, but treatment orders were not implemented until 04/16/2025, nine days later. Staff C stated they expected staff to follow-up on skin issues.

In an interview on 04/22/2025 at 2:01 PM, Staff A, Administrator, stated they expected staff to follow up on skin issues.

FAILURE TO ASSESS AND IMPLEMENT ORDERS FOR CONSTIPATION

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 7 of 29 505322 Department of Health & Human Services Printed: 08/28/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 505322 B. Wing 04/24/2025

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

Spokane Health & Rehabilitation North 6025 Assembly Spokane, WA 99205

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 0658 Review of provider standing orders showed directions to address constipation before and after 48 hours of not experiencing a bowel movement (BM). The protocol was time-specific regarding administration of the Level of Harm - Minimal harm or different laxatives. potential for actual harm

The standing orders showed that after 48 hours of no BM, the nurses were instructed to administer Lactulose Residents Affected - Some every two hours as needed and if the resident did not have a BM after six hours, then Milk of Magnesia (MOM). If the resident did not have a BM after six hours of receiving the MOM, the nurses were to administer

a Bisacodyl suppository. If the suppository proved ineffective after six hours, the nurses were ordered to administer a Fleets enema once and to notify the provider if they wished to repeat it. The orders instructed

the nurses to notify the provider if a resident did not have a BM greater than 3 days and to let them know of all medications that were already attempted.

<Resident 262>

Review of a 04/03/2025 admission assessment showed Resident 262 admitted to the facility on [DATE REDACTED] with medically complex conditions, which included Parkinsonism (a neurological disorder) and chronic pain syndrome. The assessment showed the resident was cognitively intact and presented with a bowel pattern of constipation.

An observation and interview on 04/18/2025 at 1:04 PM showed Resident 262 sitting up in a chair in their room. Resident 262 said they independently walked to the bathroom. The resident said they had a BM one every 4 or 5 days here [in the facility] which was a change from home where they had a BM, almost every day. The resident shared that at home they took a a big gulp of Milk of Magnesia about once a week and, Apparently [staff] don't know about Milk of Magnesia here. The resident referred to being offered a liquid twice a day that they thought was for the management of constipation but, I wonder about it because I'm still not pooping. Maybe I should mention it to [the staff]. That would make me go poop. I'd like that. When asked if the staff inquired if they had a bowel movement, Resident 262 stated, No, I don't think anybody has asked that.

Review of the April 2025 Medication Administration Records (MAR) showed physician orders for routine or scheduled administration of medications that had the side effect of constipation, to include amiodarone (a cardiac agent), bupropion (an antianxiety agent), iron tablets, semaglitude (for diabetes), and carbidopa-levidopa (for Parkinsons). The MAR showed that both scheduled senna tablets and gavilax (both over the counter [OTC] medications used to treat constipation) were discontinued on 04/07/2025. The MAR showed no as needed orders for medications to treat episodes of constipation.

Review of a 03/29/2025 care plan showed the staff assessed and determined the resident was at risk for constipation related to medications. The care plan showed, if the resident experiences constipation it will be resolved thru the review period. The interventions directed the nurses to administer medications as ordered, implement bowel protocol when indicated, observe for signs and symptoms of constipation or extended abdomen that may indicate constipation, and track and record bowel movements.

Review of a Bowel Elimination Record from 03/28/2025 to 04/18/2025 showed Resident 262 did not have a BM recorded for three days from 03/28/2025 to 03/30/2025, for six days from 04/04/2025 to 04/09/2025, and for three days from 04/11/2025 to 04/13/2025 and from 04/15/2025 to 04/17/2025.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 8 of 29 505322 Department of Health & Human Services Printed: 08/28/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 505322 B. Wing 04/24/2025

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

Spokane Health & Rehabilitation North 6025 Assembly Spokane, WA 99205

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 0658 The above findings were shared with Staff C on 04/18/2025 at 1:30 PM. Staff C clarified that the bowel protocol the care plan referred to was the provider's standing orders and the nurses had to manually input Level of Harm - Minimal harm or those orders into the electronic medical record for their use. Staff C acknowledged the medical record potential for actual harm showed no documentation the nurses assessed Resident 262 or implemented the standing orders for constipation, as per professional standards of practice, to include notifying the provider when Resident 262 Residents Affected - Some did not have a BM greater than 3 days.

46115

<Resident 69>

The 03/07/2025 significant change in condition assessment documented Resident 69 had diagnoses which included constipation and high blood pressure. The resident was cognitively intact and able to make their needs known.

In an interview on 04/14/2025 at 10:04 AM, Resident 69 stated they had constipation and MOM helped.

The 12/09/2025 care plan instructed nursing to monitor for signs and symptoms of constipation, implement bowel protocol when indicated, administer medications as ordered, and track and record bowel movements.

The care plan documented if the resident experienced constipation it would be resolved through the review period.

The bowel record from 03/01/2025 to 04/18/2025 documented Resident 69 did not have a BM on the following dates:

03/05/2025 to 03/12/2025, eight days

03/21/2025 to 03/24/2025, four days

04/14/2025 to 04/19/2025, six days

Review of the March and April 2025 MARs showed Resident 69 had as needed Bisacodyl to treat episodes of constipation and none was administered.

<Resident 38>

The 02/01/2025 quarterly assessment documented Resident 38 had diagnoses which included diabetes and heart failure. The resident was cognitively intact and able to make their needs known.

The 10/30/2024 care plan instructed nursing to monitor signs and/or symptoms of constipation, implement bowel protocol when indicated, administer medications as ordered, and track and record bowel movements.

The care plan documented if the resident experienced constipation it would be resolved through review period.

The bowel record from 03/01/2025 to 04/18/2025 documented Resident 38 did not have a BM on the following dates:

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 9 of 29 505322 Department of Health & Human Services Printed: 08/28/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 505322 B. Wing 04/24/2025

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

Spokane Health & Rehabilitation North 6025 Assembly Spokane, WA 99205

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 0658 03/18/2025 to 03/27/2025, ten days

Level of Harm - Minimal harm or 04/01/2025 to 04/04/2025, four days potential for actual harm 04/06/2025 to 04/12/2025, seven days Residents Affected - Some

Review of the March and April 2025 MARs showed Resident 38 had no as needed medications to treat episodes of constipation.

In an interview on 04/22/2025 at 9:00 AM, Staff X, Licensed Practical Nurse, stated the bowel protocol was started on day three of no BM and they were to administer DOSS (a stool softener), Senna (a laxative) and Miralax (a stimulant). Staff X stated small bowel movements did not count. Staff X stated it was important to follow the protocol, so blockage and pain did not occur.

In an interview on 04/22/2025 at 1:30 PM, Staff C stated they had standing orders for the bowel protocol from a group of their providers, and they had a provider that ordered MOM on day three of no BM, if no results a suppository was given, and if no results the next day an enema was given. Staff C stated the bowel protocol should have been followed for the above residents or a progress note made stating they spoke to

the residents and inquired if they had a BM. Staff C stated it was important to follow the bowel protocol to prevent pain and blockage.

<Resident 16>

According to the 03/11/2025 assessment, Resident 16 was always incontinent of bowel and their bowel patterns showed constipation was present. Resident 16 was cognitively intact and able to clearly verbalize their needs.

Review of the 02/21/2025 care plan showed Resident 16 was at risk for constipation and instructed staff to administer medications as ordered, track BMs, observe for signs of constipation, and implement the bowel protocol when indicated.

Review of provider orders showed a 02/11/2025 order for Resident 16 to be administered MOM every 24 hours as needed for constipation, MiraLAX to be administered every 24 hours as needed for constipation, and a Bisacodyl suppository daily as needed for bowel care.

Review of the bowel elimination record from 03/19/2025 to 04/17/2025 showed Resident 16 did not have a BM for three days from 03/27/2025 to 03/29/2025, for four days from 04/01/2025 to 04/03/2025, for four days from 04/05/2025 to 04/08/2025, and for four days from 04/11/2025 to 04/14/2025.

Review of the March 2025 through April 2025 MAR showed Resident 16 was not administered any as needed bowel medication from 03/24/2025 through 04/16/2025.

<Resident 41>

According to the 02/13/2025 admission assessment, Resident 41 was continent of bowel, was cognitively intact and able to clearly verbalize their needs.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 10 of 29 505322 Department of Health & Human Services Printed: 08/28/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 505322 B. Wing 04/24/2025

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

Spokane Health & Rehabilitation North 6025 Assembly Spokane, WA 99205

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 0658 Review of the 02/05/2025 continence care plan showed Resident 41 was usually continent of bowel and instructed staff to record BMs, provide staff assistance with toileting, and provide toileting/incontinence Level of Harm - Minimal harm or supplies as needed. potential for actual harm

Review of provider orders showed a 02/04/2025 order for Resident 41 to be administered MiraLAX every 24 Residents Affected - Some hours as needed for constipation.

Review of the bowel elimination record from 03/20/2025 to 04/18/2025 showed Resident 41 did not have a BM for five days from 03/30/2025 to 04/03/2025 and for four days from 04/06/2025 to 04/09/2025.

Review of the April 2025 MAR record showed Resident 41 was not administered MiraLAX for constipation as needed.

<Resident 85>

According to the 03/30/2025 quarterly assessment, Resident 85 was always incontinent of bowel and their bowel patterns showed constipation was present. Resident 85 was cognitively intact and able to clearly verbalize their needs.

Review of the 01/14/2025 opioid (class of drugs used to reduce moderate to severe pain) use care plan showed Resident 85 was at risk for complications and instructed staff to administer medications as ordered, record/track bowel movements, and implement the bowel regimen protocol.

Review of provider orders showed a 12/30/2024 order for Resident 85 to be administered a bisacodyl suppository every 24 hours as needed for constipation, and a 02/17/2025 order for Resident 85 to be administered MOM every 24 hours for constipation lasting more than 48 hours.

Review of 12/18/2024, 12/30/2024, 02/06/2025, 03/01/2025, and 03/17/2025 provider progress notes showed Resident 85 struggled with recurrent constipation going up to several days before having a hard BM.

Review of February 2025 nursing progress notes showed on 02/23/2025 Resident 85 had an incident of hard impacted stool. Several large hard stools were passed after Resident 85 was administered a Bisacodyl suppository. Resident 85 will require education on bowel maintenance when taking scheduled [opioid] medication.

Review of the bowel elimination record from 03/18/2025 to 04/16/2025 showed Resident 85 did not have a BM for 10 days 03/20/2025 to 03/29/2025, for four days from 04/04/2025 to 04/07/2025, and for five days from 04/12/2025 to 04/16/2025.

Review of the March 2025 through April 2025 MAR showed Resident 85 was not administered MiraLAX or a Bisacodyl suppository for constipation as needed.

In an interview on 04/22/2025 at 9:23 AM, Resident 85 stated the facility did not monitor or track BMS and often went 9-10 days without a BM. Resident 85 further stated it was painful to have a BM after 10 days, staff did not offer bowel interventions and often had to request a suppository or enema.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 11 of 29 505322 Department of Health & Human Services Printed: 08/28/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 505322 B. Wing 04/24/2025

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

Spokane Health & Rehabilitation North 6025 Assembly Spokane, WA 99205

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 0658 In an interview on 04/22/2025 at 9:43 AM, Staff F, Resident Care Manager, stated residents were at risk for bowel blockages if the bowel protocol was not implemented when indicated and staff should document bowel Level of Harm - Minimal harm or interventions attempted and/or refused. Staff F reviewed Resident 85's medical record. Staff F potential for actual harm acknowledged Resident 85 went 9-10 days without a BM and staff should have implemented the bowel protocol. Residents Affected - Some

In an interview on 04/22/2025 at 10:34 AM, Staff A, Administrator, stated they expected staff to implement

the bowel protocol when indicated.

47328

FAILURE TO IMPLEMENT FALL PRECAUTIONS

Review of the facility policy titled, Fall Safety- Everyone is at Risk of Falling dated October 2022, showed anyone could fall regardless of age, gender, or illness. The policy instructed staff to be alert to situations that could lead to falls and included some potential situations to avoid and interventions to implement. The Falling Leaves program consisted of a leaf sticker placed next to a high fall risk resident's door name tag. The sticker was to notify staff the identified resident required frequent rounding to help reduce falls. The policy did not instruct staff how to assess fall risk, what steps to take when a fall occurred, or how to monitor residents when falls were sustained.

Review of an undated facility incident report form instructed staff to use the format as a guide on what steps were required after a resident sustained a fall. Staff were to place the resident on alert charting: every shift for 72 hours, or longer if not resolved. The form additionally instructed staff to complete a neurological evaluation (neuro and/or neuro checks, a series of tests that assess mental status, reflexes, movement, and pupil reaction to evaluate brain and nervous system function) if a resident hit their head or the fall was unwitnessed by staff.

Review of the Neurological Evaluation Flow Sheet used by the facility to assess for any changes instructed staff to complete a neuro evaluation with vital signs every 30 minutes for two hours, then every hour for four hours, then every 8 hours for nine hours (72 hours), compare vital signs over time and pay close attention to respiratory patterns. The form included a graph to document the required information on.

<Resident 65>

According to the 02/11/2025 admission assessment, Resident 65 admitted to the facility on [DATE REDACTED] with diagnoses including Dementia, syncope (to faint) and collapse. The assessment further showed Resident 65 sustained a fall in the month prior to admission and a non-injury fall since their admission. Resident 65 had severe cognitive impairment, disorganized thinking and inattention.

Review of the 01/30/2025 hospital history and physical showed Resident 65 experienced a fall at home and was down for approximately an hour. The notes further showed Resident 65 had a history of falls, needed assistance with walking, had a soft-spoken voice, and spoke minimally per their baseline.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 12 of 29 505322 Department of Health & Human Services Printed: 08/28/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 505322 B. Wing 04/24/2025

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

Spokane Health & Rehabilitation North 6025 Assembly Spokane, WA 99205

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 0658 Review of the 02/05/2025 admission assessment showed Resident 65 arrived to the facility at 3:00 PM, had cognitive impairment, was confused, oriented to self only, and unable to make their needs known. The Level of Harm - Minimal harm or assessment further showed Resident 65 had post fall injuries including significant bruising, four lacerations, potential for actual harm and an eyebrow abrasion.

Residents Affected - Some Review of the 02/06/2025 care plan showed Resident 65 was at risk for falls related to cognitive and functional impairments, weakness, recent hospitalization , unsteady gait, and incontinence. The care plan instructed staff to anticipate Resident 65's needs, have the bed against the wall in the lowest position, non-skid strips at bedside, educate resident on safe transfers, provide and use non-skid socks while out of bed. An intervention implemented on 02/13/2025 showed Resident 65 was added to the Falling Leaves program. Revisions on 03/03/2025 instructed staff that resident was to be in high visibility areas when up in

the wheelchair (WC), and on 03/13/2025 a fall mat was to be placed to the left side of the bed.

Review of the February 2025 through March 2025 facility incident reporting log showed fall entries related to Resident 65 were made on 02/05/2024, 02/13/2025, 02/28/2025, 03/12/2025, and 03/14/2025.

Review of Resident 65's fall reports showed:

- Unwitnessed fall on 02/05/2025 at 4:50 PM (1 hour and 50 minutes after their admission), staff entered Resident 65's room to answer their call light and found them lying on the floor. Resident 65 was restless, continued to attempt to self-transfer out of bed. Resident 65 had aphasia (disorder that made it hard to understand and speak) and could not explain the situation. Interventions implemented were to place the bed against the wall in the lowest position and provide the resident with non-skid socks. No documentation of neuro checks was found.

- Unwitnessed fall on 02/13/2025, Resident 65 was found on the floor next to their roommate's bed. The mattress on the floor next to [Resident 65's] bed had been moved away from the bed about 4-5 inches and appeared the resident self-transferred. Intervention implemented was to add Resident 65 to the Falling Leaves program. The attached neurological evaluation flow sheet vital signs section showed only five of 12 sets of vital signs were documented.

- Unwitnessed fall on 02/28/2025, Resident 65 slid out of their WC, was confused, unable to state what happened and neuro checks were started, however, no documentation of neuro checks were found.

- Unwitnessed fall on 03/12/2025, Resident 65 was found sitting on the floor next to their bed with the fall mat again pushed away from the bed, neuro checks were initiated. The incident summary showed Resident 65's care plan remained appropriate. No documentation of intervention implemented, or neuro checks was found.

- Unwitnessed fall on 03/14/2025, Resident 65 was found lying on the floor next to their WC near the nurses' station, and neuro checks were initiated. Intervention implemented was a therapy referral for WC evaluation.

The attached neuro sheet showed omissions in documentation for four of 12 neuro assessments and eight of 12 sets of vital signs.

Review of February 2025 through March 2025 nursing progress notes showed Resident 65 was inconsistently monitored for latent injuries after falls occurred.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 13 of 29 505322 Department of Health & Human Services Printed: 08/28/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 505322 B. Wing 04/24/2025

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

Spokane Health & Rehabilitation North 6025 Assembly Spokane, WA 99205

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 0658 In an interview on 04/24/2025 at 10:34 AM, Staff H, Licensed Practical Nurse (LPN), stated residents were assessed for fall risk upon admission. Staff H explained when a fall occurred, an incident report was Level of Harm - Minimal harm or completed, the resident assessed for injuries, placed on alert to monitor for potential latent injuries, provider potential for actual harm notified, and interventions implemented. Staff H further stated all unwitnessed falls and falls with head injury needed to have neuro checks completed and documented on the paper form. A fall intervention needed to Residents Affected - Some be implemented when a fall occurred to prevent further falls and/or injury. Staff H acknowledged a resident's health and safety was in jeopardy if a resident was not consistently monitored after a fall occurred.

In an interview on 04/24/2025 at 10:40 AM, Staff C, ADON, explained neuro checks were to be completed for unwitnessed falls or falls with head injury. Staff C stated staff were to document neuro checks on the paper neurological evaluation flow sheet when implemented. Staff C further stated residents were monitored for latent injuries via the neuro check flow sheet and nursing progress notes, if a resident was not monitored then staff would not know if or when a resident had a worsening injury, pain, or change of condition. Staff C reviewed Resident 65's fall reports and acknowledged there were omissions in Resident 65's neuro check monitoring, and staff should have monitored neuros consistently.

<Resident 69>

The 03/07/2025 significant change assessment documented Resident 69 had diagnoses including high blood pressure, anxiety and repeated falls. Resident 69 was cognitively intact and was able to make their needs known.

The 12/10/2024 risk for falls care plan documented Resident 69 was at risk for falls related to weakness, poor vision, incontinence and functional impairments. The care plan had multiple fall interventions in place.

Review of the September 2024 through March 2025 facility incident log showed Resident 69 sustained a fall

on 09/19/2025.

A 09/19/2024 progress note documented Resident 69 reported they fell in their room and had gotten themselves up off the floor. The resident stated they landed on their right side. The nurse stated they initiated neuros.

The neuro monitoring sheet revealed 10 omissions and documented the resident was asleep. Review of Resident 69's record revealed there were no further progress notes regarding the fall.

<Resident 311>

The 04/04/2025 admission assessment documented Resident 311 had diagnoses including cancer, high blood pressure and diabetes. Resident 311 had moderate cognitive impairments and was able to make their needs known.

The 12/10/2024 risk for falls care plan documented Resident 311 was at risk for falls related to deconditioning, pain and medications. The care plan had multiple fall interventions in place. <br[TRUNCATED]

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 14 of 29 505322 Department of Health & Human Services Printed: 08/28/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 505322 B. Wing 04/24/2025

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

Spokane Health & Rehabilitation North 6025 Assembly Spokane, WA 99205

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 0689 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Level of Harm - Immediate jeopardy to resident health or **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 40297 safety Based on observation, interview, and record review the facility failed to consistently and accurately assess Residents Affected - Many residents smoking abilities and implement safety interventions to prevent smoking related injuries for 3 of 3 sampled residents (Resident 73, 86 and 461), reviewed for smoking. The failure to accurately assess residents' smoking abilities and implement safety interventions to prevent smoking related injuries represented an immediate jeopardy (IJ).

On 04/15/2025 at 5:21 PM, the facility was notified of the identified IJ related to

F-F689 CFR S483.25 Accidents and Supervision. Onsite verification by surveyors on 04/17/2025 showed, the facility removed the immediacy by placing Resident 73 on one-to-one surveillance, secured the resident's smoking paraphernalia, re-assessed the resident's ability to smoke, and revised the care plan to show the level of assistance and supervision the resident required to smoke safely. The facility closed access to unsupervised patio areas. The facility added a fire blanket and an outdoor ashtray to the designated smoking area. The facility interviewed other residents and staff to identify other residents who smoked and completed smoking safety evaluations of all the residents in the facility and for any residents identified as a smoker/tobacco user, to include development or revision of their care plans to show individualized interventions and supervision levels related to smoking preference. The facility completed a facility-wide sweep to remove unauthorized smoking materials. The facility notified the residents of the smoking policy. The facility educated the staff on

the smoking policy, and identifying, managing, and reporting unsafe smoking behaviors. Immediacy was removed 04/16/2025.

Findings included .

Review of a facility admission agreement showed smoking or vaping was prohibited within and on the grounds of the facility. The agreement informed the residents that possessing smoking related items, like cigarettes and lighters, was strictly prohibited. Residents were informed that the facility would provide information and assistance with exploring smoking cessation interventions and products if they had a history of smoking or tobacco use prior to admission to the facility and if so desired. Violation of the Smoke-Free Facility policy endangered the health and safety of the residents in the facility and was ground for discharge.

Review of the facility policy titled, Smoking Prohibited for Residents But Allowed For Staff dated October 2021, showed if staff found a resident with smoking materials, they were to be given to the nurse who secured them. The policy further showed staff would notify the provider for each incident of policy violation, document incident in the medical record, and investigated by the facility leadership team to evaluate the scope and potential endangerment to other residents and staff. The results of the investigation determined

the course of action to protect other residents and staff from endangerment, to include re-education of the resident, removal of smoking materials, discussion about smoking cessation support, evaluation of the resident's ability to smoke safely without staff assistance or supervision in a location out of the facility and off

the facility grounds, and/or discharge from the facility.

During the entrance conference on 04/14/2025 at 8:42 AM, Staff A, Administrator, stated the facility was a non-smoking facility and there were no residents that smoked.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 15 of 29 505322 Department of Health & Human Services Printed: 08/28/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 505322 B. Wing 04/24/2025

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

Spokane Health & Rehabilitation North 6025 Assembly Spokane, WA 99205

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 0689 <Resident 73>

Level of Harm - Immediate Review of a 01/24/2025 hospital document showed Resident 73 fell asleep easily during the interview but jeopardy to resident health or awakens easily again. The document showed the resident smoked cigarettes on some days. safety

Review of a 02/03/2025 facility provider note showed Resident 73 was, Current smoker some days. Residents Affected - Many

Review of a 02/07/2025 facility admission assessment showed Resident 73 admitted to the facility from the hospital on 02/01/2025 with medically complex conditions, including Parkinson's disease (a neurological disorder) and diabetes. The assessment showed Resident 73's speech was unclear, was cognitively intact, experienced fluctuating altered levels of consciousness and required staff assistance during transfers and walking. The assessment showed Resident 73 did not use tobacco.

Review of progress notes showed on 02/17/2025, the staff observed Resident 73, smoking outside in the parking lot. Social worker went out to speak to resident and remind [them] that we are a non-smoking facility. [The resident] was agreeable and put out [their] cigarette.

Review of a 02/17/2025 Smoking - Resident Safety Evaluation, signed off as completed on 03/05/2025 (16 days later), showed the staff identified Resident 73 used tobacco products, allowed the resident to smoke, and used Cigarettes / Cigars. The staff assessed Resident 73 was unable to hold or extinguish a cigarette safely or use an ashtray to extinguish the cigarette. The staff concluded, Resident is not a safe smoker at

this time. [They] agreed to Nicotine patches and to not smoke at this time. Family notified and nicotine patch order placed.

Review of a 03/03/2025 progress note showed, the facility informed the resident, that this is a non-smoking facility as was noted to be smoking at one point. Smoking materials obtained until safety can be established.

Review of a 03/04/2025 Tobacco Use care plan showed, Resident 73 preferred to smoke cigarettes. The goal was for the resident to follow non-smoking policy. The interventions included, Instruct the resident about smoking risks and hazards and about smoking cessation aids that are available, Notify social services or nurse manager if patient is found to be smoking, and smoking assessment as needed. The interventions were dated 03/04/2025 and 03/05/2025. The care plan showed no documentation the facility developed interventions to keep the resident safe from smoking related injuries or that compensated for their inability to manage smoking supplies. The care plan showed no documentation where smoking supplies were kept.

Review of 03/03/2025, 03/06/2025 and 03/14/2025 facility provider notes showed once more Resident 73 was, Current smoker some days.

Review of March and April 2025 Medications Administration Records (MAR) showed no documentation the provider prescribed nicotine patches for Resident 73 prior to 04/15/2025, as indicated in the 02/17/2025 resident smoking safety evaluation.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 16 of 29 505322 Department of Health & Human Services Printed: 08/28/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 505322 B. Wing 04/24/2025

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

Spokane Health & Rehabilitation North 6025 Assembly Spokane, WA 99205

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 0689 An observation on 04/15/2025 at 2:23 PM, by the entire survey team, showed Resident 73 self-propelling in their wheelchair in the patio area with a lit cigarette in their hand. The resident attempted to enter the Level of Harm - Immediate conference room where surveyors were with the lit cigarette, but was unable to open the door. Resident 73 jeopardy to resident health or then wheeled over to the barbecue area under the [NAME] and sat next to a propane tank with the lit safety cigarette. At 2:34 PM, a surveyor entered the patio area, and it smelled of cigarette smoke. No fire blanket or ashtrays were observed. Resident 73 stated that they liked to smoke three times a day, and when asked if Residents Affected - Many there was an ashtray outside, they said, No. Observation of a white plastic fold-up table showed black streaks on its surface resembling the stubbing of a cigarette (to put out a cigarette by pressing the lit end against a surface, often done using a surface like an ashtray or the ground). Resident 73 again attempted to get into the conference room but was unable to do so. The resident then self-propelled across to the other side of the patio to enter another side of the building. A staff member was observed to escort Resident 73 back in the building.

In an interview on 04/15/2025 at 3:23 PM, Staff Q, Registered Nurse (RN), stated that the facility was a non-smoking establishment, and smoking was allowed out on the street or off the premises. Staff Q became aware if a resident actively smoked and the assistance required by checking the resident's roster (a basic information sheet used by the staff). Staff Q stated that they did not have any resident smoking materials secured. Staff Q stated that they were unaware of any residents who smoked in the facility but that if they did see a resident smoke, they would stop the resident and notify the Unit Manager.

In an interview on 04/15/2025 at 3:29 PM, Staff R, Nursing Assistant (NA), stated that they became aware of resident information by review of the Kardex (a summary of the care plan). Staff R stated, We are non-smoking so I am unsure if there are smokers [in the facility] but if they did smoke, they would have to go off property. Staff R stated that there was no designated place for a resident to smoke on facility premises. Staff R stated if they saw a resident violate the facility smoking policy they would, stop it from happening and let the nurse supervisor know and report it up above. Go through the chain [of command] not just the nurse. Staff R stated that smoking materials would be kept in a lock box with the Social Services department.

In a confidential interview on 04/15/2025 at 3:36 PM, an Anonymous Staff stated, Not a lot of residents here smoke and As long as [the resident] is on the sidewalk, that's considered off property. The staff stated if they saw a resident violate the facility smoking policy they would, Ask them if they can go to the sidewalk and educate them on the policy. I'd let my Unit Managers know or the ADON [Assistant Director of Nursing]. The staff identified Resident 73 was the only resident they were aware of that currently smoked and stated the resident kept their smoking materials in their jacket and never has it out in the open. The Anonymous Staff was unaware how long Resident 73 smoked since admission to the facility.

An observation and interview on 04/15/2025 between 3:36 PM and 4:00 PM showed, Resident 73 lying in bed. Resident 73 stated that they kept their cigarettes in their pocket along with the lighter and smoked more than twice a day and off the property. Additionally, Resident 73 stated that when the front doors to the facility were locked after 7:00 PM or 8:00 PM, I have to wait until someone sees me to let me in because the doors are locked. Resident 73 stated that their preferred smoking time began at noon or after lunch.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 17 of 29 505322 Department of Health & Human Services Printed: 08/28/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 505322 B. Wing 04/24/2025

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

Spokane Health & Rehabilitation North 6025 Assembly Spokane, WA 99205

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 0689 The above findings were shared with Staff A, Administrator, in an interview on 04/15/2025 at 5:21 PM. Staff

A confirmed the patio was not a smoking area and that, North [Hall] staff said they were not aware of [any] Level of Harm - Immediate smoker [in the facility]. Staff A stated that when staff escorted Resident 73 back to the facility, the resident jeopardy to resident health or had a faint smell of smoke. Staff A stated the resident was known to have paraphernalia on [them] which was safety relinquished to the facility and the resident, will not tell us how [they] got the smokes and lighter [afterwards and] we are assuming the family brought it in or visitors. Staff A stated that since Resident 73 refused to Residents Affected - Many relinquish the cigarettes and lighter they were placed on a one-to-one surveillance after the 04/15/2025

observations in the patio.

In an interview on 04/24/2025 at 9:45 AM, Staff C, ADON, described the process on how the facility identified residents who smoked and ensured their safety. Staff C stated that hospital paperwork was reviewed, and part of the facility's admission assessment completed by the nurse asked about smoking preferences. Once

a resident was identified as currently smoking, We care plan if they are an active smoker and let them know

we are a non-smoking facility and if they prefer to smoke, come up with a smoking plan and establish locations to smoke and smoking times. Staff C stated the facility identified concerns related to smoking, At initial assessment if admitting, observations of the resident, communication at Stand Up [a daily Inter-disciplinary meeting], and review of the 24-hour report [progress notes]. Staff C stated that when a resident was identified as unsafe to smoke or noncompliant with the smoking policy, the facility should ensure the resident, does not have smoking paraphernalia in their room, provide a smoking apron and supervision, and re-do their smoking assessment.

On 04/28/2025 at 8:13 AM in a follow up telephone conversation, the facility provided additional information. Staff C stated the facility should have added instructions to the care plan to direct the staff on the level of supervision and amount of assistance Resident 73 required during smoking after completion of the 02/17/2025 Smoking Safety Evaluation, to include staying with the resident while they smoked. Staff C stated that the additional safety interventions did not show in the care plan because the evaluation concluded a smoking cessation program (nicotine patches) would be started. Staff C acknowledged upon review of the medical record that the nicotine patches never started as mentioned in the 02/17/2025 smoking evaluation.

47328

<Resident 461>

According to the 01/03/2025 quarterly assessment, Resident 461 admitted to the facility on [DATE REDACTED] with diagnoses including Chronic Obstructive Pulmonary Disease (COPD, progressive lung disease that makes it difficult to breathe). The assessment further showed Resident 461 was cognitively intact, did not exhibit behaviors and was able to clearly verbalize their needs.

Review of the 07/04/2024 hospital history and physical provided to the facility during the admisson process showed Resident 461 smoked tobacco and had a tobacco abuse diagnosis.

Review of the 07/11/2024 resident safety assessment showed Resident 461 used tobacco products including cigarettes/cigars and the facility did not allow smoking. A nicotine patch was listed as a smoking cessation intervention. Resident 461 was identified as safe to smoke with supervision.

Review of provider orders showed a 07/12/2024 order for Resident 461 to use a nicotine patch daily for nicotine dependence.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 18 of 29 505322 Department of Health & Human Services Printed: 08/28/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 505322 B. Wing 04/24/2025

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

Spokane Health & Rehabilitation North 6025 Assembly Spokane, WA 99205

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 0689 Review of the July 2024 through September 2024 MAR showed Resident 461 began to refuse the nicotine patch on 08/10/2024. The nicotine patch was discontinued on 09/11/2024. Level of Harm - Immediate jeopardy to resident health or Review of the 08/21/2024 care plan showed Resident 461 smoked and was agreeable to smoke off safety premises. Interventions instructed staff to educate the resident about smoking risks and hazards, smoking cessation aids available, educate the resident about the facility smoking policy to include smoking off Residents Affected - Many premises only, notify the charge nurse immediately if the resident was suspected of violating the facility smoking policy, and monitor clothing and skin for signs of cigarette burns.

Review of the 08/22/2024 resident safety assessment showed Resident 461 used tobacco products including cigarettes/cigars and the facility allowed resident smoking. The assessment further showed Resident 461 was offered a nicotine patch but refused it and requested to smoke. Resident 461 was educated on not smoking in their room and to store cigarettes and lighter in a safe location. Resident 461 was identified as safe to smoke without supervision.

Review of the 10/11/2024 resident safety assessment showed Resident 461 used tobacco products including cigarettes/cigars, resident declined smoking cessation interventions, and the facility allowed resident smoking. Resident 461 was identified as safe to smoke without supervision.

No documentation was found that showed Resident 461's smoking materials were stored securely for safety

after additional record review.

Review of August 2024 through December 2024 nursing progress notes showed the following:

- 08/21/2024, Resident 461 stated they had five packs of cigarettes, knew how to wean themselves off, and did not need a nicotine patch.

- 08/22/2024 the facility non-smoking policy was reviewed with Resident 461, they were no longer wearing

the nicotine patch and continued to smoke on the facility property, no additional smoking safety interventions were implemented at that time.

- 12/27/2024 Resident 461 continued to demonstrate unsafe behavior of smoking on the facility property. When Resident 461 was reminded smoking was not permitted on the premises, Resident 461 stated they were not leaving the premises and would continue to smoke on the property. A 30-day notice was discussed with Resident 461 related to their health had improved sufficiently so they no longer needed services provided by the facility and their continued smoking on the property endangered other facility residents. No additional smoking safety interventions were implemented at that time.

- 12/29/2024 the fire alarm was set off at approximately 2:30 AM, staff smelled smoke in Resident 461's bathroom, Resident 461 denied smoking indoors and refused to hand over their cigarettes or lighter, frequent checks for safety were implemented. At noon, Resident 461 was placed on 1:1 monitoring due to safety concerns. Resident 461 again refused to give staff their lighter and stated, I'm going to smoke no matter what.

- 12/30/2024 Resident 461 was provided a discharge notice.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 19 of 29 505322 Department of Health & Human Services Printed: 08/28/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 505322 B. Wing 04/24/2025

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

Spokane Health & Rehabilitation North 6025 Assembly Spokane, WA 99205

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 0689 Review of the 12/29/2024 fire alarm detailed activity report showed at 2:18 AM the fire alarm was activated,

the fire department was dispatched, facility staff were contacted by the fire alarm monitoring company, the Level of Harm - Immediate fire alarm was cleared and restored. jeopardy to resident health or safety Review of the 12/30/2024 nursing home transfer or discharge notice showed Resident 461's health improved sufficiently so that they no longer needed services provided by the facility and the safety of other individuals Residents Affected - Many in the facility was endangered due to the status of the resident. A brief explanation showed Resident 461 was independent with all activities of daily living and left the facility daily in their car or motorcycle. Resident 461 continues to smoke on property and has been found smoking in [their] room.

In an interview on 04/21/2025 at 9:29 AM, Staff G, Maintenance Director, acknowledged the fire alarm went off on 12/29/2024 because Resident 461 smoked in their bathroom. Staff G further stated Resident 461 was placed on 1:1 monitoring after that incident and did not smoke indoors after that. Staff G explained Resident 461 was a challenging resident and would ignore staff when asked to do things.

In an interview on 04/21/2025 at 9:36 AM, Staff C, ADON, stated Resident 461 smoked, they were offered a nicotine patch but refused it and chose to smoke. Staff C explained on 12/29/2024, Resident 461 exercised their right to smoke in their bathroom and was placed on 1:1 monitoring after that incident. Staff C stated Resident 461 was not safe to smoke independently, they were self directed and did what they wanted to do.

In an interview on 04/23/2025 at 2:44 PM, Staff A stated Resident 461 would smoke in the facility parking lot and refused to quit smoking. Staff A explained on 12/29/2024 the fire alarm went off, staff thought Resident 461 had smoked in their room, but Resident 461 denied it and refused to give staff their smoking paraphernalia. Staff A stated Resident 461 was placed on 1:1 monitoring after the 12/29/2024 fire alarm incident and was given a 30-day notice.

<Resident 86>

According to the 03/31/2025 quarterly assessment, Resident 86 admitted to the facility on [DATE REDACTED] with diagnoses including weakness. Resident 86 had severe cognitive impairment and was able to verbalize their needs.

Review of the 11/06/2024 hospital history and physical that was provided to the facility during the admission process showed Resident 86 smoked cigarettes every day.

Review of the 11/12/2024 safety assessment showed Resident 86 did not use tobacco products and the facility did not allow resident smoking.

Review of the 11/19/2024 tobacco use care plan showed Resident 86 preferred to smoke cigarettes daily. Interventions instructed staff to educate the resident about smoking risks and hazards, smoking cessation aids available, remind the resident the facility was non-smoking, there was no smoking on the facility property, and to complete a smoking assessment as needed.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 20 of 29 505322 Department of Health & Human Services Printed: 08/28/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 505322 B. Wing 04/24/2025

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

Spokane Health & Rehabilitation North 6025 Assembly Spokane, WA 99205

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 0689 In an interview on 04/16/2025 at 9:24 AM, Resident 86 stated they used to smoke but had not smoked in a while. Resident 86 further stated staff had not spoken to them about smoking and they were unaware the Level of Harm - Immediate facility was a non-smoking building. jeopardy to resident health or safety In a follow-up interview on 04/24/2025 at 9:55 AM, Staff A stated they expected staff to accurately assess residents for tobacco use and safe smoking abilities when a resident chose to smoke. Staff A further stated Residents Affected - Many they also expected staff to implement smoking safety interventions as needed for resident safety.

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

Refer to

F-F867 for additional information

42802

46115

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 21 of 29 505322 Department of Health & Human Services Printed: 08/28/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 505322 B. Wing 04/24/2025

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

Spokane Health & Rehabilitation North 6025 Assembly Spokane, WA 99205

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 Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 47328

Residents Affected - Many Based on observation, interview and record review, the facility failed to repeatedly ensure the facility had enough staff to provide care according to the facility acuity (the level of severity of residents' illnesses, physical, mental, and cognitive limitations, and conditions) and/or care plans for 9 of 17 sampled residents (Resident 16, 46, 61, 64, 65, 15, 22, 63 and 85), reviewed for sufficient staffing. This failure placed all residents at risk for potentially avoidable accidents, unmet care needs, and diminished quality of life.

Findings included .

Review of the facility assessment reviewed 09/01/2023 showed the assessment was conducted annually to determine and update the capacity to meet the needs of and competently care for the residents during day-to-day operations. The assessment further showed the facility was licensed for 125 beds, had an average daily census of 84 which included 55 long-term care residents and 29 short term skilled (received higher level of medical care and/or rehabilitation services) residents. The facility had between two to five admissions during the week and two to three admissions on weekends. The facility provided care to residents who required specialized care, had mobility impairments, required assistance completing activities of daily living (ADLS) such as toileting, and were incontinent (unintentional leakage of urine or stool). The assessment showed on average the facility cared for 78 residents with urinary incontinence, 44 residents with bowel incontinence, and 15 residents that required a toileting program. The assessment further showed

the facility had adequate staffing, staffing was reviewed daily to ensure that adequate staff was available to meet the needs of facility residents, the facility employed a full-time staffing coordinator (during weekdays) and used contracted/agency staff when facility staff was unable to meet the needs of [facility] residents.

<Resident 65>

According to the 02/11/2025 significant change assessment, Resident 65 admitted to the facility on [DATE REDACTED] with diagnoses including syncope (to faint) and collapse. The assessment further showed Resident 65 required substantial staff assistance for toileting hygiene, was frequently incontinent of urine and always incontinent of bowel. Resident 65 had severe cognitive impairment.

Review of the 02/06/2025 rehabilitation care plan showed Resident 65 required maximum assistance from two staff for transfers and was dependent for toileting. The 02/06/2025 risk for falls care plan instructed staff to anticipate Resident 65's needs, ensure appropriate footwear, place common items within reach, keep the bed against the wall, and ensure Resident 65 was in areas of high visibility when up in their wheelchair.

Review of the 02/15/2025 allegation of neglect incident investigation showed at 6:54 PM it was reported Resident 65 was not changed.

Review of the February 2025 through March 2025 facility incident log showed Resident 65 sustained falls on 02/05/2025 (1 hours and 50 minutes after admission), 02/13/2025, 02/28/2025, 03/12/2025, and 03/14/2025.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 22 of 29 505322 Department of Health & Human Services Printed: 08/28/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 505322 B. Wing 04/24/2025

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

Spokane Health & Rehabilitation North 6025 Assembly Spokane, WA 99205

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 <Resident 46>

Level of Harm - Minimal harm or According to the 03/29/2025 significant change assessment, Resident 46 required moderate staff assistance potential for actual harm to complete most of their ADLS which included toileting hygiene. The assessment further showed Resident 46 had severe cognitive impairment and was frequently incontinent of bowel and bladder. Residents Affected - Many

Review of the 01/08/2025 continence care plan showed Resident 46 was frequently incontinent of bowel and bladder and instructed staff to assist with toileting, apply barrier cream, provide toileting hygiene, monitor for signs of a bladder infection, and check and change incontinence brief every two hours. The 01/08/2025 risk for fall care plan instructed staff to keep items within reach, do not leave in the bathroom unattended, ensure proper footwear, and encourage Resident 46 to stay in areas of high visibility when up in their chair.

Review of the 03/25/2025 allegation of neglect incident investigation showed at 7:00 AM it was reported Resident 46 had not been checked and/or changed during the night shift. The investigation included a 03/25/2025 staff statement that showed Resident 46 had not been changed by night shift and was soiled through brief when checked on day shift.

In an interview on 04/15/2025 at 9:31 AM, Resident 46's family member stated the facility needed more staff, Resident 46 did not get help needed, and had a few falls.

Review of the November 2024 through March 2025 facility incident log showed Resident 46 sustained falls

on 11/06/2024, 12/12/2024, 01/08/2025, 02/06/2025, 02/24/2025, 03/07/2025, 03/09/2025, and on 03/17/2025.

<Resident 64>

According to the 03/25/2025 annual assessment, Resident 64 was frequently incontinent of urine and was dependent on staff assistance for toileting. Resident 64 was cognitively intact.

Review of the 01/07/2025 continence care plan showed Resident 64 was frequently incontinent of bowel and bladder and instructed staff to provide maximal assistance with toileting, apply barrier cream, and check and change their incontinence brief frequently as needed.

Review of the 02/13/2025 Resident Council (group of facility residents that met normally to discuss care and/or concerns) Meeting Minutes showed the Council voiced concerns related to excessively long call light wait times.

Review of the 03/26/2025 allegation of neglect incident investigation showed it was reported Resident 64 had not been changed. The investigation included a 03/26/2025 staff statement that showed Resident 64 was unhappy and yelling because staff had not checked or changed them. Resident 64 did not have their call light, their bed and brief was completely soaked with a wet brown ring of urine.

In an interview on 04/14/2025 at 11:14 AM, Resident 64 stated there were excessively long call light wait times, sometimes up to an hour.

<Resident 63>

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 23 of 29 505322 Department of Health & Human Services Printed: 08/28/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 505322 B. Wing 04/24/2025

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

Spokane Health & Rehabilitation North 6025 Assembly Spokane, WA 99205

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 According to the 02/12/2025 quarterly assessment, Resident 63 was always incontinent of bowel and bladder, and dependent on staff assistance for toileting hygiene and bed mobility. Resident 63 had moderate Level of Harm - Minimal harm or cognitive impairment and was able to clearly verbalize their needs. potential for actual harm

Review of the 01/03/2025 respiratory care plan showed Resident 63 utilized supplemental oxygen and Residents Affected - Many instructed staff to administer oxygen as ordered, obtain vital signs as needed, and monitor for signs and/or symptoms of respiratory complications. The 02/11/2025 continence care plan showed Resident 63 was frequently incontinent of bowel and bladder and instructed staff to apply barrier cream, provide maximal assistance with toileting, provide the bed pan as requested, and check/change Resident 63's incontinence brief as needed.

In an interview on 04/14/2025 at 1:22 PM, Resident 63 stated the facility did not have enough staff because

they experienced excessively long call light wait times and seldom got changed on time. Resident 63 further stated they were unable to get up or walk, they wore oxygen but sometimes was unable to get to their call light or oxygen.

<Resident 16>

According to the 03/11/2025 significant change assessment, Resident 16 required substantial staff assistance for toileting hygiene and was always incontinent of bowel and bladder. The assessment further showed Resident 16 was cognitively intact and able to clearly verbalize their needs.

Review of the 03/17/2025 rehabilitation care plan showed Resident 16 required substantial/maximal assistance with bed mobility and toileting. The 03/17/2025 continence care plan showed Resident 16 was usually continent of bladder and instructed staff to apply barrier creams and observe for signs and/or symptoms of a bladder infection. The 04/10/2025 interventions instructed staff to provide assistance with toileting, provide the bed pan upon request, provide toileting hygiene as needed, record bowel movements, and check and change the incontinence brief while in bed.

Review of the 04/01/2025 allegation of neglect incident investigation showed at 2:15 PM Resident 16 reported they had not been changed since that morning and their bed was found to be wet with odor. The investigation included a 04/01/2025 2:18 PM staff statement that showed Resident 16's bed was found to be saturated when [Resident 16] got up. [Resident 16's] brief found to be completely soaked through and heavy.

In an interview on 04/14/2025 at 11:08 AM, Resident 16 stated they were incontinent, did not know how much or when they urinated, and needed to be routinely checked and changed. Resident 16 stated the facility had been short staffed for a while. Resident 16 explained they could tell the facility was short staffed because they did not receive care when needed and have had to wait up to an hour for assistance, which occurred three weeks ago. Resident 16 further stated, I wish they could do something to level out this staffing issue, it is not the resident's fault they don't have enough staff, they got to be able to hire some more people.

Review of the 04/07/2025 unwitnessed fall investigation showed Resident 16 attempted to self-transfer but their legs gave out and they sustained a fall with a left-hand skin tear.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 24 of 29 505322 Department of Health & Human Services Printed: 08/28/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 505322 B. Wing 04/24/2025

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

Spokane Health & Rehabilitation North 6025 Assembly Spokane, WA 99205

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 In a follow-up interview on 04/14/2025 at 11:18 AM Resident 16 stated they recently fell and sustained a skin tear to their left hand. Resident 16 explained I did not want to keep waiting for [staff] to help me, I wanted to Level of Harm - Minimal harm or get in bed, so I did it myself. potential for actual harm <Resident 61> Residents Affected - Many According to the 02/26/2025 quarterly assessment, Resident 61 was dependent on staff assistance for toileting hygiene, was frequently incontinent of urine and always incontinent of bowel. Resident 61 was cognitively intact and able to clearly verbalize their needs.

Review of the 06/12/2024 self-care deficit care plan showed Resident 61 required extensive staff assistance for bed mobility and personal hygiene. The 09/20/2024 care plan showed Resident 61 required long-term care and instructed staff to render appropriate nursing care. The care plan showed no documentation Resident 61 was incontinent of bowel and bladder.

Review of the 04/01/2025 allegation of neglect incident investigation showed at 2:15 PM Resident 61 reported they had not been changed all day. The investigation included an undated handwritten staff statement that showed Resident 61 stated they had not been changed since 7:30 AM and their bed was soaked.

In an interview on 04/14/2025 at 9:47 AM, Resident 61 stated the facility absolutely did not have enough staff, day shift was extremely short staffed, and weekends were worse than other days. Resident 61 explained they had excessive long call light wait times and has had to wait up to 45 minutes to be changed, which happened a few weeks ago on day shift.

Review of the October 2024 through April 2025 facility incident log showed the following:

- October: 10/01/2024 allegation of abuse, 10/06/2024 four different allegations of neglect, 10/09/2024 allegation of neglect, and 10/15/2024 injury of unknown origin.

- November: 11/02/2024 allegation of neglect, 11/05/2024 allegation of abuse, and 11/29/2024 allegation of abuse.

- December: 12/09/2024 allegation of abuse, 12/17/2024 allegation of misappropriation, 12/23/2024 three different allegations of neglect, 12/25/2024 allegation of abuse, and 12/31/2024 allegation of abuse.

- January: 01/01/2024 allegation of neglect, 01/02/2024 one allegation of abuse and one allegation of neglect, 01/10/2025 two different allegations of neglect, 01/21/2025 allegation of abuse, 01/23/2025 allegation of neglect, 01/24/2025 allegation of neglect, 01/29/2025 allegation of neglect, 01/30/2025 allegation of misappropriation, and 01/31/2025 allegation of neglect.

- February: 02/12/2025 allegation of abuse and two residents were involved in resident-to-resident altercation, 02/15/2025 five different allegations of neglect, 02/21/2025 allegation of neglect, 02/22/2025 allegation of abuse, 02/26/2025 two residents were involved in a resident-to-resident altercation, and 02/27/2025 allegation of neglect

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 25 of 29 505322 Department of Health & Human Services Printed: 08/28/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 505322 B. Wing 04/24/2025

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

Spokane Health & Rehabilitation North 6025 Assembly Spokane, WA 99205

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 - March: 03/06/2025 allegation of neglect, 03/09/2025 three different allegations of neglect, 03/20/2025 two residents were involved in a resident-to-resident altercation, 03/22/2025 allegation of neglect, and Level of Harm - Minimal harm or 03/25/2025 two different allegations of neglect. potential for actual harm - April: 04/01/2025 two different allegations of neglect and one allegation of misappropriation, 04/07/2025 Residents Affected - Many allegation of neglect, 04/13/2025 allegation of abuse, and 04/17/2025 two different allegations of neglect.

In a follow-up interview on 04/18/2025 at 10:52 AM, Resident 61 again stated, the facility is so short staffed, but that does not even begin to describe it.

<Resident 22>

According to the 04/01/2025 significant change assessment, Resident 22 had diagnoses which included diabetes. Resident 22 had moderate cognitive impairment and was able to clearly verbalize their needs.

Review of provider orders showed an active 11/09/2023 order for staff to monitor for signs and/or symptoms of low blood sugar and implement the facility low blood sugar protocol as needed.

Review of the 01/20/2025 diabetes care plan showed Resident 22 was at risk for blood sugar fluctuations and instructed staff to administer medications as ordered, provide diabetic foot care, and observe for signs and/or symptoms of high or low blood sugars.

In an interview on 04/14/2025 at 1:33 PM, Resident 22 stated they had excessively long call light wait times and has had to wait an hour or longer for their call light to be answered. Resident 22 explained they were diabetic, they had a low blood sugar during the night and it took staff 45 minutes to get them a glass of juice. Resident 22 voiced concern because they did not want staff to take forever if and/or when their blood sugar dropped again.

<Resident 15>

According to the 03/20/2025 quarterly assessment, Resident 15 was frequently incontinent of bowel and bladder and was dependent on staff assistance for toileting hygiene and bed mobility. Resident 15 was cognitively intact and able to clearly verbalize their needs.

Review of the 03/24/2023 self-care deficit care plan showed Resident 15 was dependent on Hoyer (full body mechanical lift) for transfers and required moderate staff assistance for toileting. The 03/24/2023 elimination care plan showed Resident 15 was usually continent of bowel and bladder and instructed staff to encourage Resident 15 to get out of bed daily, monitor bowel movements, and implement the bowel protocol as needed.

In an interview on 04/14/2025 at 1:59 PM, Resident 15 stated they were not impressed with resident care because the facility was totally understaffed especially when residents required a lot of care. Resident 15 explained they can never find [staff] if we need help and had waited up to three hours to have their brief changed, which happened at least once a week. Resident 15 further stated when they talked to staff about their excessive long call light times, Resident 15 was told they are shorthanded.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 26 of 29 505322 Department of Health & Human Services Printed: 08/28/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 505322 B. Wing 04/24/2025

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

Spokane Health & Rehabilitation North 6025 Assembly Spokane, WA 99205

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 <Resident 85>

Level of Harm - Minimal harm or According to the 03/30/2025 quarterly assessment, Resident 85 was dependent on staff assistance for potential for actual harm toileting hygiene and bed mobility. The assessment further showed Resident 85 was always continent of bowel and occasionally incontinent of bladder. Resident 85 was cognitively intact and able to clearly Residents Affected - Many verbalize their needs.

Review of the 10/31/2024 care plan showed Resident 85 was administered diuretics (medication used to help rid the body of excess fluid). The 01/14/2025 rehabilitation care plan showed Resident 85 required extensive assistance for bed mobility and was dependent for transfers and toilet use.

During observation on 04/14/2025 at 11:47 AM, Resident 85 was wheeled into their room by an unidentified female staff and then walked out of the room. With an upset and loud tone of voice, Resident 85 began to yell out, that girl took off! you need to find her! I need to go pee! At 11:48 AM Resident 85's roommate walked out into the hall in search of staff to assist Resident 85. At 11:50 AM, as an unidentified male staff walked past Resident 85's room, Resident 85 again yelled out, I am going to pee my pants! The lady that brought me in here disappeared!

In an interview on 04/14/2025 at 1:44 PM, Resident 85 stated they had been out of the facility from 6:45 AM until 11:30 AM at a doctor appointment in Idaho and really needed to urinate. Resident 85 stated they did not like to be incontinent of urine. Resident 85 further stated the facility was short staffed and they were stuck in bed when there was not enough staff to get them up, because two staff were required to use the Hoyer, even though their record showed they needed to be up daily. Resident 85 preferred to be up in their wheelchair by 10 AM. Resident 85 stated they had excessively long call light wait times, waiting up to 50 minutes to be toileted.

Review of provider orders showed an active 03/17/2024 order for Resident 85 to be out of bed and in their wheelchair twice daily for at least an hour.

Review of the Medication Administration Record from 03/17/2025 through 03/31/2025 showed Resident 85 was not gotten out of bed and into their wheelchair 10 out of 29 times, only three refusals were documented.

Review of 04/01/2025 through 04/15/2025 showed Resident 85 was not gotten out of bed and into their wheelchair 19 out 30 times, only three refusals were documented.

During observation on 04/16/2025 at 11:54 AM 38 out of 60 residents on the North (100 hall, long-term care) were observed eating lunch in bed.

Review of the 04/17/2025 allegation of neglect incident investigation showed Resident 85 was upset because they were not gotten out of bed. The investigation included a 04/17/2025 staff statement that showed Resident 85 reported they were very upset because they requested to get out of bed but was told most of the Hoyers were not working, only one Hoyer was in working order, but other residents needed to get up and Resident 85 was not gotten out of bed as requested.

During observation and interview on 04/17/2025 at 1:37 PM, Resident 85 was observed lying in bed. Resident 85 stated staff did not get them out of bed today because staff told them there was only one functioning Hoyer lift and all staff were fighting to use it. Resident 85 stated I am stuck in bed for the day. I am not happy. I do not like to be in bed all day long. My preference is to be up in my chair for a while.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 27 of 29 505322 Department of Health & Human Services Printed: 08/28/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 505322 B. Wing 04/24/2025

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

Spokane Health & Rehabilitation North 6025 Assembly Spokane, WA 99205

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 In an interview on 04/17/2025 at 2:33 PM, the Resident Council stated the facility did not have enough staff,

they experienced excessively long call light waiting times, up to an hour. The Resident Council explained Level of Harm - Minimal harm or sometimes staff were also unable to find a second staff to assist with cares, when cares required two staff. potential for actual harm

In a follow-up interview on 04/22/2025 at 9:34 AM, Resident 85 again stated they were stuck in bed all day Residents Affected - Many yesterday because staff told them they were shorthanded, I was pissed.

During a confidential interview on 04/18/2025 at 10:25 AM, Confidential Staff A, stated the facility did not have enough staff, the North (100 hall, long-term care) unit was heavy care, and normally staffed with only four nursing assistants but that was not enough staff, it was hard to get things done.

Review of the 04/19/2025 facility census showed Residents 15, 16, 22, 46, 61, 63, 64, 65, and 85 all resided

on the North 100 long-term care hall.

In an interview on 04/22/2025 at 9:30 AM, Staff W, Nursing Assistant (NA), stated the facility was short staffed most of the time and they typically cared for about 15 residents.

During observation on 04/22/2025 at 9:32 AM, Staff KK, NA, was observed asking several NAs for assistance to change the resident in room [ROOM NUMBER] but was unable to get help. Staff W told Staff KK to ask a manager for help because they needed to help a resident who asked for help. At 9:47 AM Staff KK was observed asking Staff LL, Registered Nurse, for help but Staff LL stated, I am sorry, I can't help you, I am running way behind and asked Staff KK to let them know when they changed the resident in room [ROOM NUMBER] because they needed to apply cream to them. Staff KK replied, that is what I have been trying to do, I have been trying to get help. At 9:49 AM Staff KK told the resident they would change them alone, since they were unable to find staff to help.

In an interview on 04/23/2025 at 12:07 PM, Staff N, Staffing Coordinator, stated they used a HPD (hours per resident day, minimum staffing requirements) spreadsheet that was based on census, not based on acuity as

a guide to see how many staff were needed. A copy of the spreadsheet was requested at that time. Staff N explained if the facility needed to provide 1:1 monitoring for a resident they would make an exception to the budget and cover the 1:1 needs. Staff N stated if the facility acuity increased they would have to pull staff from the other units and adjust section assignments to better staff the more acute unit. Staff N explained the North 100 hall was the easier unit, it was more consistent because the residents were long-term care and the South hall was the more acute unit because that was where residents admitted to and were typically more ill. Staff N was asked what would happen with staffing if the census increased. Staff N stated if the census increased they would have to schedule more agency staffing because the facility did not have enough facility staff. Staff N further stated the facility used agency staffing seven days a week, for both NAs and nurses. Staff N further stated the facility had a high staff turnover rate and needed more staff. Staff N acknowledged staff voiced staffing concerns related to the need for more staff, residents with excessively long call light wait times, and residents not changed timely.

In an interview on 04/23/2025 at 12:43 PM, Staff A, Administrator, had a copy of the HPD spreadsheet used by Staff N as a guide for staffing. Staff A stated the form was just a quick and fast tool used to see if the facility had enough staff, based on census. Staff A did not provide a copy of the spreadsheet as requested.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 28 of 29 505322 Department of Health & Human Services Printed: 08/28/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 505322 B. Wing 04/24/2025

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

Spokane Health & Rehabilitation North 6025 Assembly Spokane, WA 99205

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 In a follow-up interview on 04/24/2025 at 8:34 AM, Staff A, explained the facility reassessed staffing every shift and attempted to balance staffing, census, and acuity. Staff A stated they used agency staffing daily and Level of Harm - Minimal harm or staff would bring staffing concerns to them, if there were any. Staff A stated if/when residents reported potential for actual harm excessively long call light wait times, it was reported as an allegation of neglect. Staff A acknowledged the facility had an increased number of allegations of abuse and/or neglect. Staff A stated, I am not short staffed. Residents Affected - Many Reference WAC 388-97-1080 (1), 1090 (1)

Refer to

F-F919 for additional information.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 29 of 29 505322