Royal Park Health And Rehabilitation

Findings included .

Review of the facility policy titled, Medication Regimen Review published March 2019, showed a pharmacist reviewed the resident's medication regimen monthly and report irregularities to the attending physician, medical director, and Director of Nursing (DNS).

The pharmacist was to exit with the DNS or designee prior to leaving the facility and email their report of any irregularities, at the end of their visit.

The attending physician was to respond to pharmacist recommendations within 2-4 weeks and provide documentation pharmacy recommendations were reviewed. If a change was made, the facility notified the pharmacy and completed the order.

According to the 11/16/2024 quarterly assessment, Resident 24 had diagnoses including high cholesterol. Resident 24 was cognitively intact and able to verbalize their needs.

Review of provider orders showed Resident 24 had an active 03/22/2024 order for staff to administer a cholesterol lowering medication daily at bedtime.

Review of the 07/31/2024 pharmacy medication review note to attending prescriber showed Resident 24 took a cholesterol lowering medication.

The consultant pharmacist recommended obtaining baseline and yearly liver function test (LFT) and lipid panel blood work to monitor the therapeutic effects and side effects of the medication.

The form included a handwritten note that indicated Resident 24's primary care physician was from outside the facility's provider group. A 08/22/2024 typed provider response showed LFTs were done on 05/09/2024 and instructed the facility to repeat the LFTs and fasting lipids next time lab rounds at the facility.

Review of the 08/31/2024 pharmacy medication review note to the attending prescriber showed Resident 24 took a cholesterol lowering medication.

The consultant pharmacist repeated their 07/31/2024 recommendation to obtain baseline and yearly LFTs and lipid panel blood work to monitor the therapeutic effects and side effects of the medication. No documentation of a provider response was found.

Review of the 09/30/2024 pharmacy medication review note to attending prescriber showed Resident 24 took a cholesterol lowering medication.

The consultant pharmacist made a recommendation for the third month in a row to obtain baseline and yearly LFTs and lipid panel blood work to monitor the therapeutic effects and side effects of the medication. No other documentation of a provider response was found.

On 10/18/2024, Resident 24 had blood tests drawn by the lab that included liver function tests.

A lipid panel, which was ordered on 08/22/2024, was not included in the blood work.

505379

Form Approved OMB

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

Building 505379 B.

Wing 01/17/2025

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

Royal Park Health & Rehabilitation Center 7411 North Nevada Spokane, WA 99208

Findings included .

<Expired/undated food>

During an initial tour of the kitchen on [DATE] at 8:47 AM, the dry storage area revealed a container of French salad dressing and two containers of Caesar salad dressing with no received or expiration date, six cartons of thickened cranberry cocktail that expired [DATE], a bag of coconut that expired [DATE], and twelve containers of a vanilla nutritional drink that expired on [DATE].

The refrigerator in the main kitchen contained a bag of brown, wilted salad, two bags of brown wilted lettuce and a bag of spinach that was brown that had no received or expiration dates.

The freezer contained a bag of ham with a use by date of [DATE], a bag of tortillas with a use by date of [DATE], a bag of zucchini with a use by date of [DATE], two pecan pies with a use by date of [DATE], three bags of meatballs that expired on [DATE], a bag of opened egg rolls and chicken breasts with no open or expiration date, and an opened bag of beef fritters and uncovered wheat rolls that were freezer burned.

During an interview on [DATE] at 9:34 AM, Staff S, Registered Dietician, stated there needed to be a date on all food items and it was important for quality, safety and to prevent food borne illnesses.

<Food Temperatures>

During observation of a lunch tray line on [DATE] at 11:19 AM, Staff Q, Dietary Manager, had checked the temperatures of the cold items.The salad was 52.1 degrees Fahrenheit (F), cottage cheese was 44 degrees F, and the Jello was 64.6 degrees F., all above the recommended food temperature of 41 degrees.

Staff Q placed the cottage cheese, salads, and sandwiches on an ice bath.

At 11:39 AM, Staff Q served the items from the ice bath, no further temperatures of the food were obtained.

At 11:58 AM, Staff Q served a chicken breast from a warmer and no temperature was obtained. At 12:02 PM, Staff Q served a sandwich from the refrigerator and no temperature was obtained. At 12:19 PM, Staff Q served another chicken breast and no temperature was obtained.

505379

Form Approved OMB

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

Building 505379 B.

Wing 01/17/2025

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

Royal Park Health & Rehabilitation Center 7411 North Nevada Spokane, WA 99208

Findings included .

<Resident 77>

According to the 11/09/2024 annual assessment, Resident 77 admitted to the facility on [DATE] with diagnoses including dysphagia and muscle weakness.

The assessment further showed Resident 77 showed no signs and/or symptoms of a swallowing disorder. Resident 77's weight was 159 lbs within the last 30 days. Resident 77 was cognitively intact and able to clearly verbalize their needs.

Review of the 01/05/2024 initial nutrition evaluation by the Registered Dietician showed Resident 77's weight was 181.6 lbs on 01/04/2024.

The assessment further showed Resident 77 was on a regular texture diet with thin liquids and nourishment supplement ordered at bedtime. Resident 77 consumed 75-100% of all three meals.

Nutritional interventions were listed as monitoring with a goal weight of 180 lbs, plus or minus 5%.

Review of a 05/01/2024 nutrition hydration skin committee review form showed Resident 77 was reviewed related to weight loss. Resident 77's weight was 165.8 lbs on 04/30/2024 with a 5% weigh loss in the last month from 174.9 lbs on 03/29/2024. Resident 77's average meal intake was 26-100%. An interdisciplinary team evaluation summary showed Resident 77 had an 11 lbs significant weight loss in April 2024 unrelated to intake, no recommendations were made at that time.

Review of a 08/22/2024 nutrition hydration skin committee review form showed Resident 77 was reviewed related to weight loss. Resident 77's weight was 158.8 lbs on 08/22/2024 with a 7.5% weight loss in the last three months from 169.2 on 05/09/2024 and a 10% weight loss in the last six months from 179.9 on 02/16/2024. Resident 77's average meal intake was 51-100%. An interdisciplinary team evaluation summary showed Resident 77 had documented weights indicating weight loss, weight were obtained sitting, standing, and in wheelchair and recommended consistent weighing method be used.

Review of a 08/23/2024 nutrition note showed Resident 77's body mass index (BMI, calculated weight relative to height) was at the lower end of normal for their age and a calorie dense supplement was added twice daily for calorie and protein support.

Review of provider orders showed Resident 77 was ordered a nutritionally enhanced meals (NEM, extra calories added through use of butter, brown sugar and gravy for example) on 08/22/2024 and a calorie dense supplement twice daily on 08/23/2024.

Review of the nutrition care plan revised 08/23/2024 instructed staff to provide Resident 77 a diet and calorie dense supplement as ordered, offer liquids between meals, obtain weights per facility protocol, and offer a meal substitute or supplement if 50% or less of a meal was consumed.

505379

Form Approved OMB

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

Building 505379 B.

Wing 01/17/2025

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

Royal Park Health & Rehabilitation Center 7411 North Nevada Spokane, WA 99208

Findings included .

Review of Staff F, Nursing Assistant, personnel file showed they were hired on 11/03/2022.

The personnel file included a 01/10/2023 verbal warning for not completing training as required and a 07/29/2024 written warning for a verbal altercation with a peer which included use of profanity and threatening language at the nurse's station. No documentation of a performance evaluation was found.

In an interview on 01/17/2025 at 12:28 PM, Staff G, Nursing Assistant, stated staff evaluations were done yearly.

In an interview on 01/17/2025 at 12:52 PM, Staff E, Registered Nurse, stated staff evaluations were done yearly.

In an interview on 01/17/2025 at 12:59 PM, Staff D, Resident Care Manager, stated staff evaluations were supposed to be completed yearly.

Staff D stated resident care was a priority and acknowledged staff evaluations were not completed yearly as required.

In an interview on 01/17/2025 at 1:46 PM, Staff B, Director of Nursing, stated staff evaluations were to be completed yearly.

Staff B acknowledged the facility was behind on completing staff evaluations yearly as required.

Reference WAC 388-97-1680 (1), (2)(a-c)

Refer to

Findings included .

The 11/14/2024 quarterly assessment documented Resident 81 was moderately cognitively impaired, was able to make their needs known, and had diagnoses which included stroke and impaired ability to move the upper and lower extremity on one side of their body. In addition, the assessment documented the resident was dependent on nursing staff to complete activities of daily living (ADLS) for getting dressed.

Review of Resident 81's care plan showed a respiratory care plan was developed on 12/10/2024 to provide interventions to treat the resident's sleep apnea, a condition that caused breathing to stop during sleeping.

The care plan informed nursing staff the resident had a BIPAP machine, and the licensed staff were to ensure the BIPAP was worn by the resident while sleeping, including naps as ordered.

Observations of Resident 81 sleeping in bed and/or their wheelchair without the BIPAP being worn were made on the following:

- 01/10/2025 at 11:34 AM, 11:42 AM, and 11:58 AM.

- 01/13/2025 at 8:01 AM, and 10:41 AM; and 01/14/2025 at 8:34 AM.

During the observation on 01/14/2025 at 8:34 AM of Resident 81 not wearing the BIPAP, the resident woke up and stated they didn't get much sleep yesterday.

In an interview on 01/15/2025 at 3:38 PM, Resident 81's spouse stated it was important for the resident to wear the BIPAP anytime they were asleep due to the high risk for another stroke and decreased alertness from not sleeping well.

In an interview on 01/17/2025 at 5:11 PM, Staff DD, Nursing Assistant, stated Resident 81 used a BIPAP at night, did not use it during the day when they nappped, just when they slept at night to help them breath.

When asked how the nursing staff knew what the care needs were for residents, Staff DD, stated the resident's care plans provided information and instructions.

In an interview on 01/17/2025 at 6:00 PM, Staff B, Director of Nursing, was informed of the multiple observations of Resident 81 not wearing the BIPAP while sleeping.

After review of the residents' orders and record, Staff B confirmed the resident needed to wear the BIPAP whenever sleeping, including naps as ordered.

505379

Form Approved OMB

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

Building 505379 B.

Wing 01/17/2025

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

Royal Park Health & Rehabilitation Center 7411 North Nevada Spokane, WA 99208

Findings included

Per the 12/23/2024 significant change in condition assessment, Resident 54 had diagnoses which included high blood pressure, diabetes, and dementia, and had severe cognitive impairments.

Review of Resident 54's record showed a 12/12/2024 nursing progress note which documented the resident had a rapid heart rate and their oxygen level was 74 percent (the normal oxygen level is 90-100).

The resident was assessed and was sent to the hospital for evaluation.

Additional record review found no documentation that showed the resident had been provided a bed-hold notice until 12/16/2024, not within 24 hours as required.

In an interview on 01/17/2025 at 8:57 AM, Staff K, Admissions Director, stated bed holds were offered upon admission and within 24 hours of a discharge to the hospital, unless it was on a Friday, then it would have been offered on a Monday.

Staff B stated no one offered bed holds when they were gone and it was important to offer bed holds because some residents want to return to their same room.

Reference WAC 388-97-0120 (4)

505379

Form Approved OMB

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

Building 505379 B.

Wing 01/17/2025

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

Royal Park Health & Rehabilitation Center 7411 North Nevada Spokane, WA 99208