What is an F-tag violation?

F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.

Were these violations corrected?

Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.

How often do nursing home inspections happen?

CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.

What should families do about these violations?

Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in SPOKANE, WA, (5) Report new concerns to state authorities.

Where can I see the full inspection report?

Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from Royal Park Health and Rehabilitation or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.

Health Inspection: Royal Park Health And Rehabilitation

FF0550

Honor the resident's right to a dignified existence, self-determination, communication, and to exercise

During an interview at 01/16/2025 at 1:05 PM, Staff G, Nursing Assistant, observed Resident 154 with the surveyor from the hall. Resident 154 was resting in bed.

Their urine collection bag was visible and not covered with a dignity bag.

Staff G stated Resident 154 needed a dignity cover over their urine collection bag.

Staff G stated it was probably still on the resident's wheelchair when the resident was out of bed earlier.

They stated they would put the cover on.

Staff G stated any resident's urine collection bag was never to be left touching the floor as doing so could contribute to infections.

During an interview on 01/17/2025 at 5:24 PM, Staff B stated urine collection bags were to be kept off the floor, hanging below the level of the bladder to help the flow of urine, and covered in a dignity bag.

Reference: WAC 388-97-0180(1-4)

505379 01/17/2025

Royal Park Health and Rehabilitation 7411 North Nevada Spokane, WA 99208

FF0554

Allow residents to self-administer drugs if determined clinically appropriate.

potential safety concern.

ensure medications were safely secured when stored at the bedside.

Reference WAC 388-97-0440, -1060 (3)(I)

505379 01/17/2025

Royal Park Health and Rehabilitation 7411 North Nevada Spokane, WA 99208

FF0584

Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not

During observation and interview on 01/15/2025 at 10:26 AM, Staff G, Nursing Assistant (NA), stated if staff noticed something was broken or in disrepair, they would write it down in the maintenance binder.

Staff G observed the large hand size hole behind Resident 28's room door.

Staff G stated they were unsure how long the hole had been there.

During observation and interview on 01/15/2025 at 10:44 AM, Staff BB, Maintenance, stated they checked they maintenance request binder frequently throughout the day.

Staff BB observed the large hand size hole behind Resident 28's room door.

Staff BB stated they checked the facility for wall penetrations and/or dents that if left unaddressed could lead to potential penetrations monthly.

Documentation of wall penetration rounding was requested from Staff BB.

Staff BB stated they did not have any documentation.

Staff BB further stated the hole in the drywall appeared to be caused by a hard pushing force and the elongated door nob penetrated the wall.

Staff BB acknowledged the large hole in the drywall was a potential fire hazard and was not a homelike environment. <Exit Door> During observation on 01/10/2025 at 11:42 AM, the outside door leading to the foyer at the back of the building, outside of 100 hall, was offset, did not latch, and slammed on the outer portion of the door jamb.

Similar observations were made on 01/13/2025 at 3:58 AM and on 01/15/2025 at 10:23 AM.

During observation and interview on 01/15/2025 at 10:28 AM, Staff G, NA, observed the outside door leading to the foyer at the back of the building, outside of 100 hall, was offset, did not latch, and slammed on the outer portion of the door jamb.

Staff G stated they knew the door had been slamming but never noticed the door was offset and did not latch.

During observation and interview on 01/15/2025 at 10:44 AM, Staff BB observed the outside door leading to the foyer at the back of the building, outside of 100 hall.

Staff BB stated they were unsure how long the door had been offset and did not latch.

Staff BB acknowledged the offset door was a potential safety issue.

In an interview on 01/15/2025 at 3:49 PM, Staff A, Administrator, stated they would defer to maintenance to determine if a wall penetration was a potential fire hazard or if things in disrepair were a potential safety issue.

Reference WAC 388-97-0880

505379 01/17/2025

Royal Park Health and Rehabilitation 7411 North Nevada Spokane, WA 99208

FF0585

Honor the resident's right to voice grievances without discrimination or reprisal and the facility must

prohibition policy.

grievances without fear of retaliation and protected residents by not disclosing persons involved to

further stated if a grievance sounded like a potential allegation of abuse, they followed the facility's abuse prohibition process.

Staff B acknowledged staff should not approach a resident saying they were thrown under the bus when a concern was voiced because it could be considered retaliation that would need to be investigated.

In an interview on 01/17/2025 at 3:56 PM, Staff A, Administrator, stated they reviewed grievances for potential allegation of abuse and followed the abuse policy if a grievance appeared to rise to the level of a potential allegation of abuse or neglect.

Staff A further stated the facility attempted to resolve grievances within five days, but some grievances might take longer.

Staff A acknowledged staff should not approach residents asking them why they were thrown under the bus as that could be considered potential retaliation.

Reference WAC 388-97-0460 Refer to F-F607, F-F725, and F-F804 for additional information.

505379 01/17/2025

Royal Park Health and Rehabilitation 7411 North Nevada Spokane, WA 99208

FF0607

Develop and implement policies and procedures to prevent abuse, neglect, and theft.

resident and staff interviews.

Staff T acknowledged if a resident reported staff was rude, rough, and

reporters and should follow the appropriate steps when an allegation of abuse was received.

Staff B acknowledged Resident 31's [DATE] grievance of rude staff with rough care and pinched skin should have been reported as an allegation of abuse and investigated as such.

In an interview on [DATE] at 3:56 PM, Staff A, Administrator, stated they reviewed grievances for potential allegations of abuse and/or neglect.

Staff A further stated if a grievance appeared as a potential allegation, then it would be reported and investigated following all the steps in the abuse policy.

In a follow-up interview on [DATE] at 4:01 PM, Staff A, acknowledged if a resident reported staff was rough and pinched their skin, it would be considered an allegation of potential abuse.

Reference WAC 388-97-0640 (2) Refer to F-F585, F-F730, and F-F842 for additional information.

505379 01/17/2025

Royal Park Health and Rehabilitation 7411 North Nevada Spokane, WA 99208

FF0625

Notify the resident or the resident?s representative in writing how long the nursing home will hold the

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 01/17/2025

Royal Park Health and Rehabilitation 7411 North Nevada Spokane, WA 99208

FF0676

Ensure residents do not lose the ability to perform activities of daily living unless there is a medical

resident was to be evaluated for a second area of decline to determine if there had been a significant

Reference: WAC 388-97-1060(2)(a)(b) Refer to F-F725 for additional information.

505379 01/17/2025

Royal Park Health and Rehabilitation 7411 North Nevada Spokane, WA 99208

FF0677

Provide care and assistance to perform activities of daily living for any resident who is unable.

During an interview on 01/16/2024 at 4:05 PM, Staff L, Certified Occupational Therapist Assistant,

meals, on 01/09/2025, and was currently receiving OT to address their activities of daily living skills.

Staff L explained Resident 90's gross motor skills (use of large muscle groups in the arms, legs and core to perform coordinated movements) were impaired .

Staff L reviewed Resident 90's care plan.

Staff L stated stand by assistance during meals was a more appropriate level of care for Resident 90 and the care plan should have been updated to reflect that.

Reference WAC 388-97-1060 (2)(C ) This is a repeat deficianry from 01/24/2024.

505379 01/17/2025

Royal Park Health and Rehabilitation 7411 North Nevada Spokane, WA 99208

FF0684

Provide appropriate treatment and care according to orders, resident?s preferences and goals.

505379 01/17/2025

Royal Park Health and Rehabilitation 7411 North Nevada Spokane, WA 99208

FF0690

Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate

they never used a bed pan with Resident 81 or seen a bedpan in the room.

Staff DD stated using a

In an interview on 01/17/2025 at 06:05 PM, Staff B, Director of Nursing, reviewed Resident 81's care

toileting use, as care planned.

Reference WAC 388-97-1060 (3)(c ) Refer to F-F725 for additional information.

505379 01/17/2025

Royal Park Health and Rehabilitation 7411 North Nevada Spokane, WA 99208

FF0692

Provide enough food/fluids to maintain a resident's health.

During an interview on 01/16/2025 at 2:19 PM, Staff B, Director of Nursing, stated Resident 54 had not triggered for weight loss, but had lost 15 lbs.

Staff B added interventions would be placed prior to weight loss.

Staff B stated a resident that requires sippy cups should have them for all liquids and this was important to control the flow of the liquids and stated residents on thickened liquids should not have ice cubes unless they have signed a risk/benefit form, and this could cause aspiration.

In an interview on 01/17/2025 at 2:41 PM, Staff S, Registered Dietician, stated Resident 54 had a downward trend in their weight.

When asked what interventions were put in place for the resident over the past six months, Staff S stated they had a downgrade in their diet, change in adaptive equipment and aspiration precautions.

Staff S added house supplement had been added on 12/23/2024.

When asked if interventions should have been placed prior to December 2024, Staff S stated it possibly could have helped to start the house supplement sooner or to have increased it.

Staff S acknowledged Resident 54 was diabetic and added they did not have sugar free house supplement in stock, and it had to be ordered when needed.

Reference: WAC 388-97-1060 (3)(h) Refer to F-F804 for additional information.

505379 01/17/2025

Royal Park Health and Rehabilitation 7411 North Nevada Spokane, WA 99208

FF0695

Provide safe and appropriate respiratory care for a resident when needed.

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.

Reference WAC: 388-97-1060(3)(j)(vi)

505379 01/17/2025

Royal Park Health and Rehabilitation 7411 North Nevada Spokane, WA 99208

FF0725

Provide enough nursing staff every day to meet the needs of every resident; and have a licensed

needed based on census.

Staff B further stated management also attempted to keep the facility

care and attempted to adjust section assignments accordingly.

In a confidential interview on 01/17/2025 at 2:00 PM, an anonymous staff stated the back part of Oak hall was heavy care related to a high use of transfer lifts, it was too much for one person to handle.

The anonymous staff further stated they had informed management, but nothing had been done yet; the section assignments did not get adjusted.

The staff added sometimes it took them 20 minutes to find a peer to assist them with full body mechanical lift transfers because those should not be done with only one staff for safety.

In an interview on 01/17/2025 at 4:07 PM, Staff A, Administrator, stated staffing levels were determined based on the facility population.

Staff A further stated section assignments were readjusted based on resident acuity nightly.

Reference WAC 388-97-1080 (1), -1090 (1) Refer to F-F585, F-F676, and F-F727 for additional information.

505379 01/17/2025

Royal Park Health and Rehabilitation 7411 North Nevada Spokane, WA 99208

FF0730

Observe each nurse aide's job performance and give regular training.

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 F-F585 for additional information.

505379 01/17/2025

Royal Park Health and Rehabilitation 7411 North Nevada Spokane, WA 99208

FF0756

Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart,

Review of 11/25/2024 blood test results showed results for a lipid panel, 95 days after it was

In an interview on 01/15/2025 at 12:37 PM, Staff E, Registered Nurse, stated they were unsure of the facility monthly pharmacy medication review process.

In an interview on 01/15/2025 at 12:48 PM, Staff D, Resident Care Manager, stated they were unsure how an outside provider received and/or reviewed the pharmacist monthly medication review recommendations.

Staff D acknowledged Resident 24's lipid panel was not obtained timely as recommended by the pharmacist.

In an interview on 01/15/2025 at 1:48 PM, with Staff B, Director of Nursing, and Staff C, Assistant Director of Nursing, they explained the pharmacist monthly medication review process.

Both Staff B and C expected the provider to respond to a pharmacy recommendation within two-four weeks and expected pharmacy recommendations to be completed by the end of the month.

Staff C acknowledged Resident 24 had an outside primary care physician.

Both staff B and C reviewed Resident 24's medical record.

Staff C acknowledged Resident 24 had blood work obtained 10/17/2024 but a lipid panel was not obtained until 11/25/2024.

In an interview on 01/15/2025 at 3:26 PM, Staff A, Administrator, reviewed Resident 24's medical record.

Staff A acknowledged Resident 24's order to obtain fasting lipid blood work was entered into the medical record on 11/22/2024 with the blood work obtained on 11/25/2024, 95 days after it was originally ordered by Resident 24's provider.

Staff A stated they expected staff to follow the facility monthly medication review process.

Reference WAC 388-97-1300 (4)(c )

505379 01/17/2025

Royal Park Health and Rehabilitation 7411 North Nevada Spokane, WA 99208

FF0760

Ensure that residents are free from significant medication errors.

During an interview on 01/17/2025 at 5:24 PM, Staff B, Director of Nursing, stated they had signed the authorization that day, 01/17/2025, for Resident 156's Enbrel. It was a policy that an authorization had to be signed for medications that cost over a certain amount.

Staff B stated they usually received an email when an authroization was needed but did not remember getting one for the Enbrel.

Staff D expected staff to call the pharmacy and notify the provider so medication doses were not missed.

This is a repeat citation from the previous recertification survey conducted on 10/04/2023 and on 03/07/2024.

Reference: WAC 388-97-1060(3)(k)(iii)

505379 01/17/2025

Royal Park Health and Rehabilitation 7411 North Nevada Spokane, WA 99208

FF0761

Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted

staff only documented temperatures once a day for the refrigerator and did not document freezer

at 12:07 PM.

Staff J acknowledged the omissions in temperature recordings. <Unsanitary Medication Cart> An observation of the Oak Hall Medication Cart 1 on 01/09/2025 at 10:08 AM showed extensive dry stains inside the medication cart drawers, to include the plastic storage bins in the top drawer that held eye drops and other medications.

Staff RR, LPN, identified the stains as medication residue.

Some of the stains ranged in color from opaque white to darker grey steaks.The medication cart was observed with run off stains to the outside, to include the attached garbage can.

Staff RR stated the night shift was supposed to clean the medication carts weekly and acknowledged the medication cart required cleaning. <Drug Storage> An observation with Staff QQ on 01/09/2025 at 8:48 AM identified a tube of Triamcinolone acetonide cream on the Resident 70's bed and a bottle of ammonium lactate 12% lotion on their bedside table. Resident 70 stated that they applied it to their right foot at night and in the morning.

Record review with Staff QQ on 01/09/2025 at 9:05 AM showed no orders for the medications found in the resident's room.

Staff QQ stated that there should be an order for the application of the medications, and both an evaluation and an order to safely store at bedside.

Reference: WAC 388-97-1300(2) Refer to F-F554 and WAC 1080 for additional information.

505379 01/17/2025

Royal Park Health and Rehabilitation 7411 North Nevada Spokane, WA 99208

FF0802

Provide sufficient support personnel to safely and effectively carry out the functions of the food and

Findings included .

A review of the dietary cards showed Staff P had no Washington State Food Workers card.

Staff P had an expired certificate that was not provided.

Staff M, N, and O had a certificate from Food Handler Solutions for completing the food handler's course.

Review of Food Handler Solutions website, foodhandlersolutions.com/[NAME]-food-handler-card/ showed, the Food Handler Solutions Program was not currently an approved credentialing program in the State of [NAME].

This program was only intended to be used for personal development and preparation for the State provided training.

During an interview on 01/14/2025 at 2:24 PM, Staff Q, Dietary Manager, stated they were unaware the program did not meet credentialing requirements.

Reference: WAC 388-97-1160

505379 01/17/2025

Royal Park Health and Rehabilitation 7411 North Nevada Spokane, WA 99208

FF0804

Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.

During an interview on 01/14/2025 at 1:56 PM, Staff Q, Dietary Manager, stated the food was under seasoned and they had received complaints about the food.

Staff Q explained some residents were not allowed to have salt and recently they had a resident allergic to black pepper.

Staff Q added, the residents were tired of the food because the menu had not been changed in years.

Reference WAC 388-97-1100 (1), (2) Refer to F-F585 and F-F692 for additional information.

505379 01/17/2025

Royal Park Health and Rehabilitation 7411 North Nevada Spokane, WA 99208

FF0812

Procure food from sources approved or considered satisfactory and store, prepare, distribute and

During a second observation of the kitchen seven days later on 01/14/2025 at 1:25 PM, the thick layer of burned food debris remained on the bottom of the oven and the outside of the warmer and oven were unclean.

Reference: WAC 388-97-1100 (3), 2980

505379 01/17/2025

Royal Park Health and Rehabilitation 7411 North Nevada Spokane, WA 99208

FF0842

Safeguard resident-identifiable information and/or maintain medical records on each resident that are

Review of additional information provided by the facility on [DATE] showed a handwritten statement dated [DATE] and signed by Staff MM, Licensed Practical Nurse.

The statement acknowledged Staff MM used their personal mobile phone to take a picture of Resident 98, transmitted the photo to the ME as requested, and immediately deleted the picture from my phone.

Reference WAC 388-97-1720 (1)(b), (5)(a)(b)

505379 01/17/2025

Royal Park Health and Rehabilitation 7411 North Nevada Spokane, WA 99208

FF0847

Inform resident or representatives choice to enter into binding arbitration agreement and right to

oriented to self only, and on 12/19/2024 at 11:49 AM, the day Resident 88 signed the arbitration

In an interview on 01/15/2025 at 12:23 PM, Staff GG stated Resident 88 was very confused, and

On 01/15/2025 at 12:33 PM, Resident 88 was observed in their room, lying in bed, visiting with their spouse.

When Resident 88 and their spouse were asked if the facility's arbitration process had been explained to them, and if they had signed the arbitration agreement, the resident stated they knew nothing about that, and the spouse stated they were not aware of any arbitration process or agreement.

When the spouse was asked if they were aware the resident had signed the arbitration agreement, they stated no. Resident 88 then asked for clarification about what they had signed when they were in high school.

After the arbitration process was explained, Resident 88 stated, That is over my head, I know nothing. Do you have a business card? You can bring me a report when you finish.

In an interview on 01/15/2025 at 12:05 PM, Staff K, admission Coordinator, provided a copy of the facility's arbitration agreement and stated the agreement was offered and explained to residents and/or family, representatives when the resident was admitted to the facility.

In an interview with Staff K, admission Coordinator, and Staff II, admission Director, on 01/15/2025 at 2:51 PM, they were asked the facility had a process or assessment to determine if the resident was cognitively able and had the mental capacity to enter into and sign an arbitration agreement.

Staff II stated Staff JJ, Nursing Assistant/Transportation driver, assisted with completing the arbitration agreements, and they would not be able to assess the resident.

Staff II stated if a resident was cognitively impaired or unable to sign the agreement, it was offered to the resident's guardian, power of attorney, or next of kin.

When informed both Residents 13 and 88 had severe cognitive impairment, and had signed the arbitration agreement, Staff II stated they would need to follow up with Staff JJ to find out if the resident's representative/family had been offered the agreement.

When informed that no documentation had been found that showed either Resident 13 or 88's family and/or representative had been offered the agreement, and asked if the residents should have signed the arbitration agreement, Staff II stated they did not believe they should have.

In an interview on 01/16/2025 from 11:04 to 11:20 AM, Staff JJ stated their main responsibility was as the transportation driver, but they assisted with completion of the admission paperwork and the arbitration agreements.

Staff JJ stated they had received training on arbitration from the previous transportation driver and the agreements were offered when residents admitted to the facility.

Staff JJ was unable to explain the arbitration process and when asked if the resident and/or representative gave up the right to go to court if they entered into an agreement, Staff JJ stated they did not believe they gave up the right.

When the arbitration process and agreement was explained to Staff JJ, they stated they did not know the right to sue the facility was lost when the agreement was signed.

In a follow up interview on 01/16/2025 at 3:54 PM with Staff H and Staff JJ, Staff JJ stated they understood the arbitration process and stated any issues/conflicts were resolved by a third party instead of going to court.

When Staff H and Staff JJ were asked if the resident and/or family gave up the right to sue or take the facility to court if they entered into an arbitration agreement, Staff H stated, no, the resident and/or representative was still able to take the facility to court.

No Associated WAC

FF0880

Provide and implement an infection prevention and control program.

was not performed when indicated it could potentially spread germs.

Staff J stated they expected

In an interview on 01/17/2025 at 11:25 AM, Staff B, DNS, stated hand hygiene was using ABHR or

indicated, including during meal service when passing different resident meal trays.

In an interview on 01/17/2025 at 3:53 PM, Staff A, Administrator, stated they expected staff to perform hand hygiene when indicated.

Reference WAC 388-97-1320 (1)(c ), (2)(b)

505379 01/17/2025

Royal Park Health and Rehabilitation 7411 North Nevada Spokane, WA 99208

FF0887

Educate residents and staff on COVID-19 vaccination, offer the COVID-19 vaccine to eligible residents

encouraged the staff to see their primary care provider or pharmacies that offered discounted

offering COVID-19 vaccines.

They stated if staff did not bring in evidence of their vaccine, the facility had no documentation.

Staff J stated they did not keep track of staff education or who had received or declined the COVID-19 vaccine.

Reference: WAC 388-97-1320

505379 01/17/2025

Royal Park Health and Rehabilitation 7411 North Nevada Spokane, WA 99208

FF554

Minimal harm or Few Based on observation, interview and record review, the facility failed to ensure dietary staff had the required affected

Findings included .

A review of the dietary cards showed Staff P had no Washington State Food Workers card.

Staff P had an expired certificate that was not provided.

Staff M, N, and O had a certificate from Food Handler Solutions for completing the food handler's course.

Review of Food Handler Solutions website, foodhandlersolutions.com/[NAME]-food-handler-card/ showed, the Food Handler Solutions Program was not currently an approved credentialing program in the State of [NAME].

This program was only intended to be used for personal development and preparation for the State provided training.

During an interview on [DATE] at 2:24 PM, Staff Q, Dietary Manager, stated they were unaware the program did not meet credentialing requirements.

Reference: WAC [DATE]

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

FF585

Minimal harm or Few Based on interview and record review the facility failed to timely act upon the pharmacist's monthly affected

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

FF692

Minimal harm or Many Based on observation, interview, and record review, the facility failed to store food in accordance with affected

Findings included .

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.

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

FF725

Minimal harm or 37544 Few mealtimes for 1 of 4 sampled residents (Resident 90), reviewed for activities of daily living. This failure affected

Findings included .

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

FF727

Minimal harm or 47328 Some as required and provide education based on the outcome of these reviews for 1 of 5 sampled staff (Staff F), affected