Spokane Health & Rehabilitation

Findings included .

The 04/01/2025 significant change in condition assessment documented Resident 22 had diagnoses that included Parkinson's disease (a disorder of the central nervous system that affected movement), and acid reflux (stomach acid irritates the lining of the esophagus). Resident 22 had moderate cognitive impairments and was able to make their needs known.

On 04/14/2025 at 1:33 PM, Resident 22 was observed in their room lying in bed.

The resident had a bottle of Tums chewable tablets on their overbed table. Resident 22 stated they took the Tums whenever they needed them.

Subsequent observations of the Tums chewable tablets on Resident 22's tray table were made on 04/15/2025 at 12:12 PM, 04/16/2025 at 9:11 AM and 12:03 PM, 04/17/2025 at 8:56 AM, and 04/21/2025 at 8:44 AM.

A review of the record documented on 11/22/2022, the provider ordered Tums E-X 750 milligram chewable tablets, two tablets twice daily as needed for gastro-intestinal (GI) upset.

The resident's record did not include an order for the resident to self-administer their Tums, or an assessment that documented Resident 22 was able to administer their Tums safely and at the frequency ordered.

A review of the April 2025 Medication Administration Record had no administrations of Tums documented.

In an interview on 04/22/2025 at 2:02 PM, Staff F, Resident Care Manager, stated residents who wanted to self-administer medications needed to be assessed by the provider, have an order obtained, and a self-medication assessment completed.

Then if approved, the residents were given a lock box to store their medications in.

Staff F stated the assessments were important so staff knew if a resident was able to take their own medications safely, and Resident 22 should have had that assessment completed.

Reference: WAC 388-97-0440

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since January 2025 to complete admission packets timely because of the admissions

paperwork was not reviewed with them timely.

In an interview on 04/22/2025 at 10:22 AM, Staff A, Administrator, stated the admissions director/coordinator and/or Staff U reviewed and completed the admission agreement packets and the associated paperwork with residents and/or their representatives.

Staff A acknowledged the facility had identified admission packets were not being completed timely but were unable to implement corrective action due to staffing.

Staff A stated they expected admission agreements to be reviewed and signed within 72 hours of an admission.

Reference WAC 388-97-0300 (1)(a), (7)(b) Refer to F-F552, F-F578, F-F579, F-F582, F-F620, and F-F625 for additional information.

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agreements to be reviewed and signed within 72 hours of admission.

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facility had been struggling since January 2025 to complete admission packets timely because of the

benefits if admission paperwork was not reviewed with them timely.

In an interview on 04/22/2025 at 10:22 AM, Staff A, Administrator, stated admission agreement packets that contained included information on how to apply for and use Medicare and/or Medicaid benefits, Denial of Medicare and Medicaid, discontinuation of Medicaid or Medicare were reviewed and completed with residents and/or their representatives by the admissions director/coordinator or Staff U.

Staff A acknowledged the facility had identified admission packets were not being completed timely but were unable to implement corrective action due to staffing.

Staff A stated they expected admission agreements to be reviewed and signed within 72 hours of an admission.

Reference WAC 388-97-0300 (9) Refer to F-F552, F-F578, F-F572, F-F582, F-F620, and F-F625 for additional information.

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11/25/2024.

Record review found no documentation that showed the facility provided a SNF ABN to

On 04/23/2025 at 1:46 PM, the SNF Beneficiary Notification Review forms were reviewed with Staff

because, there was no BOM in the facility since the beginning of February [2025].

Staff A stated the BOM's duties were absorbed between them and Corporate oversight.

Reference WAC 388-97-0300 (1)( e) (5), (6) Refer to F-F552, F-F578, F-F572, F-F579, F-F620, and F-F625 for additional information.

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During an interview on 04/21/2025 at 10:16 AM, Staff Y, Nursing Assistant (NA) stated that they would wipe down a wheelchair when they noticed it was needed.

Staff Y was unsure if it was an assigned task.

During an interview on 04/23/2025 at 3:18 PM, Staff T, NA stated that wheelchairs were supposed to be cleaned by the night shift NA's twice weekly, the same day as the shower was scheduled.

Staff T did not think that the wheelchair cleaning was documented anywhere.

During an interview on 04/24/2025 at 11:17 AM, Staff F, Resident Care Manager stated that wheelchairs were cleaned on night shift but was unsure of the exact schedule.

After an observation of Resident 64's wheelchair with Staff F, Staff F acknowledged the wheelchair was dirty and should have been cleaned. <Resident 69> The 03/07/2025 significant change in condition assessment documented Resident 69 was cognitively intact, able to make their needs know, and had diagnoses which included high blood pressure, anxiety.

In an interview on 04/16/2025 at 12:06 PM, Resident 69's family member stated staff were not changing the resident's sheets and the sheets that were currently on the bed had been on there for two weeks.

Subsequent observations of Resident 69 having the same sheets on their bed were made on 04/18/2025 at 8:44 AM, 04/22/2025 at 1:55 AM, and 04/23/2025 at 10:51 AM.

In an interview on 04/22/2025 at 8:47 AM, Staff W, NA, stated sheets were changed on the resident's showers days and whenever soiled.

In an interview on 04/22/2025, Staff C, Assistant Director of Nursing, stated sheets were changed on showers days and when visibly soiled.

Staff C stated it was important to change the resident's sheets for skin integrity, hygiene and infection control.

Reference: WAC 388-97-0880

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Review of the inventory sheet provided included the statement We urge you not to keep cash/valuables or irreplaceable items at the facility. We encourage you to take these items home or allow staff to lock them in the facility safe.

The facility is not responsible for items of value that you elect to keep unlocked.

Staff C was asked if the inventory sheet statement waived potential facility liability for losses of personal property.

Staff C referred the surveyor to Staff A, Administrator.

In an interview and record review on 04/22/2025 at 10:05 AM, Staff V, Social Service Director, explained when a resident reported a missing or broken item, the inventory sheet would be checked, and a grievance filled out so the facility could follow up as needed.

Staff V was shown the admission agreement and inventory sheet.

Staff V acknowledged every resident should have that admission agreement and inventory sheet completed upon admission.

Staff V reviewed verbiage on the inventory sheet and admission agreement related to valuables and personal effects. and acknowledged the verbiage sounded like it waived potential facility liability for losses of personal property.

Staff V acknowledged there was no grievance for Resident 85's reported broken cell phone screen.

In an interview and record review on 04/22/2025 at 10:22 AM, Staff A stated the facility would provide residents with the following options to secure their valuables, 1) take items home, 2) use of the facility safe, and 3) a lock box.

The verbiage on the inventory sheet and admission agreement related to valuables and personal effects was reviewed with Staff A.

Staff A stated verbiage referred to resident clothing.

Staff A was asked if the verbiage waived potential facility liability for losses of personal property.

Staff A stated the facility provided reasonable care for resident's property.

Staff A was asked about Resident 85's broken cell phone screen.

Staff A stated they thought there was a grievance about Resident 85's broken cell phone. A copy of the grievance was requested at that time, no documentation was provided.

Reference WAC 388-97-0040 (2)(a)(b),-0180 (4)(i)(ii) Refer to F-F552, F-F578, F-F572, F-F579, F-F582, and F-F625 for additional information.

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During an interview on 04/24/2025 at 10:42 AM, Staff CC, LPN stated when a resident went to the hospital, the nurse sent them with copies of current provider orders, their med list, code status, vital signs and face sheet.

Staff CC further stated the facility did not have a checklist, but the nurse needed to make a progress note and fill out the Transfer Form.

Staff CC searched for the form in Resident 90's electronic medical record and was unable to find the transfer form.

During an interview on 04/24/2025 at 11:17 AM, Staff F, RCM, stated copies of the resident face sheet, POLST, current med list and any chart notes were sent to the hospital.

Staff F stated they just found out about the transfer form in the electronic documentation system, they had not been aware of it before.

They further stated they hoped staff put in a progress note.

Staff CC acknowleged this information should have been sent to the hospital, and documented in the resident's record.

Reference WAC 388-97-0120 (1) Refer to F-F623 and F-F625 for additional information.

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Review of April 2025 nursing progress notes showed no progress notes documented on 04/18/2025.

During observation on 04/18/2025 at 8:50 AM, Resident 41 was not in their room and their bed was stripped of linens.

Similar observations were made at 10:47 AM and on 04/21/2025 at 6:16 AM.

During interview on 04/18/2025 at 12:25 PM, Staff Z, LPN, stated Resident 41 was out of the facility at a surgery appointment today. <Resident 16> According to the 03/11/2025 assessment, Resident 16 had diagnoses including heart failure (heart unable to pump sufficient blood) and muscle weakness. Resident 16 was cognately intact and able to clearly verbalize their needs.

Review of February 2025 nursing progress notes showed on 02/04/2025 Resident 16 was ashy in color, unresponsive, had an increased temperature, decreased oxygen levels, and they were transported to the hospital for evaluation.

In an interview on 04/22/2025 at 1:54 PM, Staff A, Administrator, stated they believed social services notified the Ombudsman of hospital transfers and discharges at the end of each month.

In an interview on 04/22/2025 at 2:07 PM, Staff V, Social Service Director, stated they were unsure who was responsible for notifying the Ombudsman of hospital transfers or discharges.

In an interview 04/22/2025 at 3:11 PM, the Regional LTC Ombudsman stated, [The facility] did not send [notifications] to us. I went back as far as May 2024 to current. We found one notice from the facility dated 12/30/2024.

Reference WAC 388-97-0120 (2)(a-d), -1040 (1)(a)(b)(c )(i-iii) Refer to F-F622 and F-F625 for additional information.

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the body) and respiratory failure (a condition where the lungs cannot exchange oxygen and carbon

A 03/09/2025 progress at 12:21 PM documented the resident developed difficulty breathing and a fever.

The resident's family member requested they be sent to the emergency room for evaluation and treatment.

A 03/09/2025 progress note at 12:37 PM documented the resident was transported by ambulance and admitted to the hospital.

A review of the medical record found no documentation a bed hold had been offered to the resident's representative, after the hospital transfer.

In an interview on 04/22/2025 at 12:06 PM, Staff H, Licensed Practical Nurse, stated the nurse that transferred a resident to the hospital did not offer and/or provide information on bed holds, upon hospital transfer.

Staff H explained bed holds were offered by nurse management if/when a resident was out of the facility after midnight.

In an interview on 04/22/2025 at 12:24 PM, Staff C, Assistant Director of Nursing, stated residents were offered a bed hold at time of hospital transfer, if not offered at that time, then staff followed up the next day.

Staff C acknowledged the facility was inconsistent about offering bed holds and completing the bed hold form.

In an interview on 04/22/2025 at 1:54 PM, Staff A, Administrator, stated they expected staff to offer residents a bed hold at time of hospital transfer.

Reference WAC 388-97-0120 (4) Refer to F-F622 and F-F623 for additional information.

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During an interview on 04/23/2025 at 3:36 PM, Staff V, Social Services Director, stated for residents admitted under an exempted hospital discharge should be referred for a PASARR Level 2 if they had not discharged within 30 days.

When asked about Resident 79, they looked in the record and confirmed there was no documentation a PASARR Level 2 was requested, and it should have been.

Reference (WAC): 388-97-1915 (1)(2)(a-c)

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According to an admission assessment dated [DATE], Resident 263 was admitted with diagnoses

tissue replaced healthy liver tissue) and Ascites (an abnormal buildup of fluid in the abdomen, often caused by late-stage cirrhosis of the liver.) The resident was alert and able to make their needs known.

A physician note, dated 04/02/2025, documented that the resident had required weekly paracentesis (a medical procedure in which a tube is inserted into the abdomen, to drain excess fluid) and was taking a diuretic (medication to decrease fluid retention) twice daily.

The resident had admission orders for weekly weights for three weeks, then monthly for four weeks.

The resident's weight dropped from 142.7 pounds on 03/31/2025 to 116.2 pounds on 04/15/2025, a loss of 26.5 pounds in 15 days.

A review of the resident's care plan documented a focus of Nutrition/Hydration status: The resident was at risk for dehydration, weight loss or malnutrition related to chronic disease.

The care plan goal was to have optimal nutrition and hydration status, and interventions included ice water at the bedside, record meal intake, dietician consult as needed, review dietary preferences and diet and weights as ordered.

This care plan focus was initiated on 04/02/2025.

Another care plan focus, dated 04/03/2025, documented the resident had a history of alcoholism with alcoholic cirrhosis with ascites.

The care plan goal was for the resident to not have any adverse reaction related to alcoholism, and interventions included administer ordered medications, vital signs as needed and to observe for any signs of intoxication or alcohol withdrawal, and notify the physician as indicated.

There was not any documentation in the resident's care plan that they required weekly paracentesis and daily diuretics, which would significantly impact their fluid retention and weight.

A review of the medical record showed the resident was transferred to the hospital on [DATE], three weeks after admitted .

During an interview on 04/23/2025 at 3:47 PM, Staff HH, Registered Dietician (RD) stated that they were aware of her liver disease, ascites and paracentesis and expected weight fluctuation for that reason.

They concurred that should be on the care plan, and the nutrition care plan was not resident specific.

During an interview on 0424/2025 at 11:17 AM, Staff F, Residential Care Manager (RCM) stated that it was important for the care plan to show the resident got regular paracentesis, as it would impact their care, and they would add it to the care plan when the resident returned from the hospital.

Reference: WAC 388-97-1020(3)

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resident information) showed no instruction to the staff regarding the resident's preference to have

requested.

Sometimes we don't have time to do all that. If we see a lot of hair we will do it. We do offer.

They will usually let us know or will have their own razors in the room.

Staff Y said they would offer to shave a female resident because of, personal hygiene and I wouldn't want to have facial hair.

Staff Y said Resident 60, refuses a lot of care.

In an interview on 04/24/2025 at 10:20 AM, Staff V, Social Services Director, said there was no involvement of Resident' 60's spouse with their care at this time, and hasn't been in the facility since a month ago.

In an interview on 04/18/2025 at 1:25 PM, Staff F, Unit Manager, said that preferences and inclusion of non-staff persons to provide cares was documented in the care plan, in the Tasks area of the electronic medical record, or under orders if clinically related, and flows into the Kardex.

Staff F stated Resident 60's, spouse has taken a step back recently regarding coming in and if they were aware of the resident's preference to have their spouse shave them, they would, make that note in the care plan.

Our staff should be offering to do it for [them] or assisting [the resident] if the spouse does not come in.

Staff F acknowledged the resident's preference for shaving was not and should have been included in the care plan. <Resident 311> The 04/04/2025 admission assessment documented Resident 311 had diagnoses which included cancer.

The resident had moderate cognitive impairments and was on hospice (a specialized type of care focused on comfort and quality of life for individuals with a serious illness and a life expectancy of six months or less).

A review of the 04/05/2025 comprehensive care plan showed there were no interventions developed to delineate what care the nursing staff would provide versus what care hospice provided.

The care plan had no contact information for the hospice facility.

In an interview on 04/18/2025, Staff W, NA, stated they knew what care to provide the residents with by looking at their care plan.

In an interview on 04/18/2025 at 2:10 PM, Staff AA, Licensed Practical Nurse, stated the care provided by the facility versus what care hospice provided needed to be included in the care plan.

Staff AA stated this was important because if they had staff work that were unfamiliar with the residents they would need that information.

In an interview on 04/18/2025 at 2:14 PM, Staff C stated hospice provided bathing and normally that was placed in the care plan.

Staff C acknowledged the information was not a part of Resident 311's care plan and stated the care plan was basic and needed to be updated.

Reference: WAC 388-97-1020(1), (2)(a)(b) Refer to F-F867 for additional information.

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conference in February.

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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. <b[TRUNCATED]

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jeopardy to resident health or safety

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Review of the nursing progress notes showed no mention of the CPAP not functioning, not in use or the resident stating that it was not working.

Review of the provider notes on 03/21/2025, 03/24/2025, 03/26/2025 and 04/12/2025 documented the resident had not used their CPAP for over 6 months.

During an interview on 04/15/2025 at 11:17 AM, Resident 17 stated they brought their CPAP from home, but it was not working.

They were informed by the staff that they did not repair them and they had not helped them to replace the CPAP. Resident 17 further stated since they were unable to use it, they had difficulty falling sleep and woke up in the night and were unable to fall back asleep.

During an interview on 04/23/2025 at 9:25 AM, Staff NN, Central Supply, stated if a resident needed a CPAP, it was easy to obtain.

They would get a doctor's order with the settings and correct size mask and fax it over to the supply company to rent one and it usually arrived the same day.

Staff NN further stated no one had asked about renting a CPAP for Resident 17.

During an interview on 04/23/2025 at 9:55 AM, Staff BB, Licensed Practical Nurse (LPN) stated that they would ask Resident 17 if they needed help with their CPAP and many times they would say they could do it themselves at bedtime.

Staff BB further stated they were not aware that Resident 17's CPAP was not working, or they would have told management.

During an interview on 04/23/2025 at 10:55 AM, Staff C, Assistant Director of Nursing, stated they were not informed that Resident 17's CPAP was not working.

Staff C stated that staff should have noted that the resident was not using the CPAP and followed up on it.

During an interview on 04/23/2025 at 11:52 AM, Staff C and Staff E, Regional Director of Clinical Operations, acknowledged that staff were not following up on the use and function of the CPAP and the discrepancy of the documentation was failed practice.

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

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Review of progress notes showed no rejection of care from 12/12/2024 to 04/20/2025.

Review of 12/06/2024 note from the prosthesis clinic showed Resident 31 received their prosthesis.

The notes showed the clinic provided information on the function of the prosthesis, its care and cleaning, how and when to report problems related to the prosthesis or changes in physical condition, benefits and precautions to take, usage and break-in period, removing and applying the prosthesis, fitting issues, skin inspection, and other safety issues.

Review of 12/27/2024 note from the prosthesis clinic showed the resident informed the clinic staff they were able to wear the prosthesis daily for short amounts of time, but mostly laying in bed with the prosthesis on, but has done some standing with a forearm walker.

The resident complained of some discomfort when wearing the prosthesis when in bed or sitting, and the clinic staff discussed with the resident that wearing the prosthesis for a prolonged period of sitting or lying down changed the pressure in the socket and was the reason for the discomfort.

The clinic educated the resident to ensure the full prosthesis was supported to decrease gravity pull.

The notes showed the resident increased the limb sock thickness and currently wearing 5 ply [a thickness or layer] with good fit. In this visit, the clinic staff re-educated Resident 31 on applying the prosthesis and cleaning the liner, including written instructions.

Review of 01/29/2025 note from the prosthesis clinic showed the clinic became aware all therapy was stopped as Resident 31 needed, to work on upper body strength from wheelchair and leg exercises from bed.

The notes showed the resident wore the prosthesis for 30 minutes, three times a week while sitting, and a shrinker when not wearing the prosthesis.

Review of the provider orders showed no directions on the care or management of the prosthesis, including application of the shrinker or limb sock.

Review of the provider notes on 12/31/2024, 01/10/2025, 01/30/2025, 02/03/2025, 02/06/2025, 02/27/2025, 03/08/2025, 03/13/2025, 03/21/2025, 03/27/2025, and 04/09/2025 made no mention of a prosthesis in existence or use.

Review of a 01/30/2025 Physical Therapy (PT) discharge summary showed Resident 31 was able to apply and remove the left leg prosthesis with minimum assistance.

The summary showed the resident would not commit to being out of bed beyond trying to stand during their therapy session and would not wear the prosthesis limb except during the therapy treatment time.

In an interview on 04/23/2025 at 8:39 AM, Staff FF, PT, stated Resident 31 would not wear the prosthesis except during therapy treatment time because, It's kind of a behavior thing. It was a lot of work to get out of bed. It was painful for [the resident], too, to a certain degree.

Staff FF stated the resident was, not receptive to being out of bed for a longer period of time.

Staff FF stated that prosthesis wear-time is gradual, starting at one to two hours a day, up to eight hours a day, and off at night.

Staff FF said since discharge from therapy, I have not seen [the resident] with the prosthetic

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F 0696 on.

stated they never put the prosthesis on Resident 31's stump and, I don't think [they] really use it

night.

In an interview on 04/23/2025 at 8:34 AM, Staff X, Licensed Practical Nurse, stated, Never really seen [the resident] walk and occasionally [they] will ask for the prosthetic to be put on and the aides could do that.

Staff X stated the aides also applied the shrinker.

Review of a 06/11/2024 care plan showed, The resident has an amputation of left lower extremity and that The resident's wound will heal and progress without complications.

The care plan showed no documentation that acknowledged the presence of the prosthesis, instructions on wear time, how to ensure proper fit to prevent skin breakdown, the care of the prosthesis, or the use of the shrinker and limb sock.

On 04/21/2025 at 8:16 AM, a Collateral Contact (CC) from the clinic who built Resident 31's prosthesis was interviewed.

The CC stated the prosthesis was issued on 12/06/2024.

The CC stated the facility notify was supposed to notify the clinic when they identified issues with the fit of the prosthesis, pain, impaired skin integrity, or if any components were loose or feeling unstable when the resident wore the prosthesis.

The CC stated the prosthesis should be worn daily by the resident, as long as no sores or not painful, and the shrinker also worn daily as it helps with swelling and phantom pain (when you feel pain in your missing body part after an amputation).

The CC stated that the risk of the prosthesis not being worn daily was, not training your body to use it which can keep you wheelchair bound.

The above findings were shared with Staff F, Unit Manager, on 04/21/2025 at 9:55 AM.

Staff F stated they were not aware of any refusals with the prosthetic as Resident 31 was very eager to have it.

Staff F stated, I believe [the resident] puts on the shrinker [themselves]. At first the nursing staff was helping [them].

Staff F acknowledged the care plan did not reflect the status of the stump and stated, I believe that area is healed.

Staff F acknowledged the medical record showed no direction on the care of the prosthesis and associated components, including instructions from the prosthesis clinic, its care and cleaning, how and when to report problems related to the prosthesis, wear-time, skin inspection, and other safety issues.

Reference WAC 388-97-1060 (3)(j)(ix). .

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come [to the facility]. No further information was provided.

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

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.

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 staff would bring staffing concerns to them, if there were any.

Staff A stated if/when residents reported 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.

Reference WAC 388-97-1080 (1), 1090 (1) Refer to F-F658 and F-F919 for additional information.

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Findings included .

In an interview on 04/14/2025 at 8:34 AM, Staff A, Administrator, identified Staff B as the interim Director of Nursing.

Staff A stated the facility had no nurse staffing waivers in place.

Review of the facility staff list provided on 04/15/2025 showed Staff B was the MDS (Minimum Data Set, standardized resident assessment tool) RN/DNS.

Staff C was identified as Licensed Practical Nurse (LPN)/Assistant Director of Nursing (ADON).

In an interview on 04/18/2025 at 11:29 AM, Staff C, explained they reviewed the facility incident reports after they were completed by floor staff, they tried to implement other interventions, but did not always have a chance to complete reviews.

In an interview on 04/23/2025 at 11:16 AM, Staff B, Interim Director of Nursing, stated they were the MDS Coordinator.

Staff B explained they became the interim DNS in February 2025 but Staff C, LPN/ADON, handled most of the DNS duties.

Staff B further stated they worked a 40-hour work week and focused on MDS duties.

Staff B stated they were not on-call after hours, staff contacted Staff C in case of emergencies and/or if there were allegations of abuse/neglect made but they were kept in the loop.

In a follow-up interview on 04/23/2025 at 12:01 PM, Staff A, again stated Staff B was the interim DNS since 02/22/2025 and worked 40-ish hours a week.

Staff A was asked if they expected Staff B to perform DNS duties 40 hours a week.

Staff A stated Staff B was available to work 40 hours a week as a DNS if needed.

Staff A further stated Staff B reviewed incident reports and was notified if/when allegations of abuse were made.

Payroll data was requested at that time for Staff B from February 2025 until current. No documentation was provided.

Reference WAC 388-97-1080 (2)(b) Refer to F-F552, F-F554, F-F622, F-F625, F-F655, F-F656, F-F657, F-F658, F-F689, F-F695, F-F698, F-F725, F-F730, F-F757, F-F761, F-F880, F-F881, F-F883, F-F887, WAC 1380 and 1480 for additional information.

505322 04/24/2025

Spokane Health & Rehabilitation North 6025 Assembly Spokane, WA 99205

Findings included . &lt;Staff K &gt; Review of Staff K's, Nursing Assistant, personnel file showed they were hired on 04/01/2023. No documentation of a performance evaluation was found. &lt;Staff L&gt; Review of Staff L's, Nursing Assistant, personnel file showed they were hired on 11/29/2023. No documentation of a performance evaluation was found. &lt;Staff M&gt; Review of Staff M'S, Nursing Assistant, personnel file showed they were hired on 12/06/2023. No documentation of a performance evaluation was found.

In an interview on 04/23/2025 at 3:18 PM, Staff A, Administrator, acknowledged Staff K, L, and M did not have performance evaluations on file.

Staff A stated they expected staff to complete performance evaluations yearly, as required.

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

505322 04/24/2025

Spokane Health & Rehabilitation North 6025 Assembly Spokane, WA 99205

Findings included .

During an observation on 04/14/2025 at 10:19 AM, daily staffing information was not posted in a prominent place readily accessible to residents, families, and/or visitors.

Similar observations were made at 1:15 PM, on 04/15/2025 at 8:28 AM, 9:50 AM, and 11:21 AM, on 04/16/2025 at 8:23 AM, 12:04 PM, 2:33 PM, on 04/17/2025 at 8:21 AM, on 04/18/2025 at 8:35 AM, 10:45 AM, and 3:17 PM, on 04/21/2025 at 4:17 AM and 7:45 AM.

During observation and interview on 04/21/2025 at 8:21 AM, Staff N, Staffing Coordinator, stated nurse managers were to post the daily head count staffing information.

Staff N walked the surveyor to Staff C, Assistant Director of Nursing's office.

Staff N asked Staff C for the head count sheets.

Staff C pulled out a blank daily staffing sheet and stated they thought Staff N had been posting the daily staffing information.

Daily staffing sheets from January 2025 through 04/21/2025 were requested at that time.

During an interview on 04/21/2025 at 8:36 AM, Staff N provided the daily staff posting sheets they had on file.

Staff N acknowledged there were no daily staffing sheets after 03/14/2025.

Review of the daily staffing sheets provided showed no daily staffing information for the following dates: - January: 01/03/2025, 01/07/2025-01/12/2025, 01/14/2025, 01/16/2025-01/19/2025, 01/21/2025, and 01/28/2025-01/29/2025 - February: 02/03/2025, 02/07/2025-02/10/2025, 02/11/2025, 02/14/2025-02/16/2025, 02/18/2025-02/20/2025, 02/24/2025-02/26/2025, and 02/28/2025 - March: 03/01/2025-03/09/2025, 03/11/2025-03/13/2025. No documentation was found after 03/14/2025.

In an interview on 04/21/2025 at 8:43 AM, Staff A, Administrator, stated they expected staff to post the daily staffing, as required.

No associated WAC

505322 04/24/2025

Spokane Health & Rehabilitation North 6025 Assembly Spokane, WA 99205

controlled medication that was used to treat anxiety (Ativan).

The first kit contained two vials of

Ativan and two bottles of oral liquid.

When asked if the Ativan vials/bottles were counted by the nurses to ensure not being diverted, Staff C stated the kits should have seals and the Ativan was not counted.

Additional observations of the medication room showed a locked medication safe was used to store medications that needed to be destroyed, including controlled medications.

The safe was a drop box style with an opening that allowed the medications to be dropped into.

Staff C stated medications were put in the safe until they could be destroyed and/or returned to pharmacy and there were only two keys to unlock the safe and they were kept by the nurse managers.

On 04/24/2025 at 9:51 AM, when Staff C was asked if the controlled medications were counted to ensure diversion was not occurring during the waiting period to be destroyed, Staff C stated the count was not done once the medication had been placed in the safe.

Reference (WAC): 388-97-1300 (2), 2340

505322 04/24/2025

Spokane Health & Rehabilitation North 6025 Assembly Spokane, WA 99205

meals on 12 out of the 25 days they resided at the facility.

specific goals or interventions related to the resident's diagnoses of malnutrition or adult failure to

and/or information to the nursing staff to inform them of Resident 313's dietary likes/dislikes or preferences. - The admission nutrition assessment was completed on 04/16/2025, 22 days after the resident was admitted to the facility.

The assessment showed Resident 313 was offered and refused the facility's house nutritional drink, but aside from monitoring food intake at meals and encouraging food and fluid intake, no other nutritional interventions or considerations were offered or implemented.

The assessment documented Resident 313's dietary preferences and dislikes were included on the dietary profile and referred nursing staff to the profile for details, however, no dietary profile was found in Resident 313's record. -

Review of the progress notes from 03/25/2025 through 04/15/2025 found no documentation related to the nutritional or dietary needs for Resident 313.

In an interview on 04/18/2025 at 10:29 AM, Staff P, NA, stated they encouraged Resident 313 to eat, they often refused meals, but liked chocolate, water and juice, so they tried to make sure it was provided.

In an interview on 04/22/2025 at 11:33 AM, Staff HH stated they attempted to complete nutritional assessments within a week of a resident's admission to the facility, but was behind on getting them completed.

When asked what nutritional interventions were offered for Resident 313, Staff HH stated the house supplement was offered, but was refused.

When asked if there were other nutritional interventions such as offering ice cream or NEM (nutritionally enhanced meals which contain more nutrients than a normal meal), Staff HH stated yes, once they spoke to Resident 313's representative, they would have a better idea of what to offer.

When asked if they had spoken to Resident 313's representative, Staff HH stated no, but now that they were aware they would.

Reference: WAC 388-97-1160(1) Refer to F-F804 and F-F806 for additional information.

505322 04/24/2025

Spokane Health & Rehabilitation North 6025 Assembly Spokane, WA 99205

Review of the menu for the 04/22/2025 lunch meal showed the meal consisted of roasted chicken, mashed potatoes, buttered corn and peach cobbler or ravioli and tossed salad.

On 04/22/2025 at 12:31 PM, a test tray of the lunch meal was sampled by the survey team.

The entr&eacute;e meal consisted of roasted chicken that appeared colorless and dry, without sauce or toppings, mashed potatoes without butter or gravy, corn, ravioli with marinara sauce, and peach cobbler.

The roasted chicken was bland, dry, and tasted like plain boiled chicken breast, not roasted chicken.

The mashed potatoes tasted bland, similar to plain unseasoned instant boxed mashed potatoes.

The ravioli had dried edges which made it difficult to cut, the marinara had good flavor.

The peach cobbler appeared watery and soupy but had good peach cobbler flavor.

During an interview on 04/22/2025 at 2:12 PM, Staff GG, Dietary Manager, was informed of the survey team's evaluation of the test tray (unflavorful, chicken was dry and food not hot).

Staff GG stated that they changed food suppliers when the facility had a change of ownership, and just started the new spring/summer menu from that new company three days ago.

They usually prepared the food exactly as directed the first time, then would make adjustments with the dietician after that.

Staff GG acknowledged that today's lunch was bland, looked colorless and not very appetizing.

In a follow-up interview on 04/24/2025 at 8:34 AM, Staff GG, stated they tasted the food, after they made it.

Staff GG acknowledged they received complaints of the food being bland.

Staff GG further stated they tried to alter the recipes to their abilities to make them more palatable but could not add too much salt because of the resident's dietary restrictions.

Staff GG stated the food was cooked to the proper temperatures then placed onto hot plates, but it was up to nursing to get the meal trays passed.

Staff GG stated they had occasional complaints of the food not being hot and they replaced the meals.

Reference WAC 388-97-1100 (1),(2) Refer to F-F806 for additional information.

505322 04/24/2025

Spokane Health & Rehabilitation North 6025 Assembly Spokane, WA 99205

During an interview on 04/23/2025 at 1:26 PM, Staff II, Nursing Assistant, stated they had to take

&lt;Resident 63&gt; The 02/12/2025 quarterly assessment documented Resident 63 had diagnoses that included failure to thrive. Resident 63 had moderate cognitive impairment and was able to clearly verbalize their needs and received a therapeutic diet.

The 03/14/2025 dietary profile documented Resident 63's food dislikes including sweet potatoes, potatoes, and scrambled eggs.

On 04/18/2025 at 8:43 AM, Resident 63 was observed lying in bed with their breakfast tray in front of them.

The plate contained an uneaten scoop of scrambled eggs and hashbrowns. Resident 63 stated they did not like scrambled eggs or potatoes and only ate a piece of sausage and their oatmeal. Resident 63 stated they were not offered alternative options.

Review of the breakfast tray card documented Resident 63 disliked scrambled eggs and potatoes.

During an interview on 04/22/2025 at 1:22 PM, Staff C, Assistant Director of Nursing, stated resident food preferences were obtained by completing a dietary profile assessment and the preferences were printed on the tray cards.

Residents were also able to circle meal options on provided menus.

Staff C stated they expected staff to honor a resident's food preferences.

During an interview on 04/24/2025 at 8:34 AM, Staff GG, Dietary Manager, acknowledged staff returned meals to the kitchen because it was not what residents ordered.

Staff GG stated at times residents were not provided menus, or the menus were not returned to the kitchen timely. At other times, menu selections contradicted information on the tray cards.

Staff GG stated they were unsure why the named residents received foods they did not want or disliked. It was possible kitchen staff hurried, did not look at the menu items closely, or were new employees.

Reference: WAC 388-97-1120 (2)(a), -1100 (1), -1140 (6)

505322 04/24/2025

Spokane Health & Rehabilitation North 6025 Assembly Spokane, WA 99205

During an interview on 04/22/2025 at 2:12 PM, Staff GG, Kitchen Manager, explained the red line near

hairnet or cap.

Staff GG stated they had not received clear guidance on beard coverings but acknowledged beard coverings/nets should also be worn past that red line.

Staff GG acknowledged Staff WW should have washed their hands after touching their face and headphones and before returning to their tasks.

Staff GG was informed of the unclean areas of kitchen observed earlier.

Staff GG acknowledged surfaces should be cleaned and acknowledged there was no cleaning schedule/log sheet for those tasks at this time.

NOURISHMENT REFRIGERATORS &lt;North Hall&gt; During an inspection of the North hall nourishment refrigerator on 04/21/2025 at 5:15 AM, the following was observed: 1) Three strawberry Ensure and 4 Premier Protein Shakes labeled with room numbers but no resident name. 2) One container from Olive Garden labeled with a last name and room number, but no date. 3) A partially used container of roasted red pepper hummus, without a resident name, room number or date. &lt;South Hall&gt; During an inspection of the South hall nourishment refrigerator on 04/21/2025 at 7:40 AM, the following was observed: 1) Two opened containers of Simply Orange juice with a room number, but no resident name or open date. 2) A pitcher of clear yellow liquid, about a quarter full, without a date or label identifying the liquid contents.

During an interview on 04/23/2025 at 3:47 PM, Staff HH, Registered Dietician, stated any staff that past the red line in the kitchen should have appropriate hair and beard coverings on.

Staff HH was informed of the surveyor's observations including staff in kitchen without full coverage of beards, incidents of missing hand hygiene, incomplete labeling/dating of foods, and crumbs/spills on surfaces in the kitchen.

Staff HH acknowledged the findings did not meet their expectations for food service safety.

Reference WAC 388-97-1100(3) and WAC 388-97-2980

505322 04/24/2025

Spokane Health & Rehabilitation North 6025 Assembly Spokane, WA 99205

Findings included .

On 04/23/2025 at 11:17 AM, Staff A, Administrator, and Staff E, Regional Director of Clinical Operations, were asked to provide the facility-hospital transfer agreements.

In an interview on 04/23/2025 at 1:11 PM, Staff E acknowledged the facility did not have a transfer agreement with any local hospital.

Reference: WAC 388-97-1620(6)(a) Refer to F-F622, F-F623, and F-F625 for additional information.

505322 04/24/2025

Spokane Health & Rehabilitation North 6025 Assembly Spokane, WA 99205

completed and they still had some holes.

survey dated 01/19/2024 and during a complaint investigation on 05/29/2024.

In an interview on 04/24/2025 at 1:17 PM, Staff A stated they were not aware there were concerns with monitoring after falls occurred.

Staff A stated the previous Director of Nursing (DNS) completed a PIP in December 2024 in which they performed audits and educated the staff.

Staff A stated the DNS felt the PIP was successful as they reduced their number of falls from 28 to 23 and they no longer needed to do a full QAPI on falls. -Care Conferences See F-F657 for additional information.

In an interview on 04/24/2025 at 1:17 PM, Staff A stated they were unaware there were issues with care conferences not being offered or held.

Staff A asked how they were out of compliance, and it was explained that 12 residents were reviewed and only one resident had a care conference for those that were scheduled in February 2025.

Staff A stated the PIP included looking at the scheduled care conferences daily and asking if they had been completed and the staff said they were.

Staff A did not check to see that the care conferences had been completed. -admission Processes See F-F552, F-F572, F-F579, F-F582, and F-F625 for additional information.

In an interview on 04/24/2025 at 1:17 PM, Staff A stated they were aware they were out of compliance with completing admission documents with the residents.

Staff A stated they monitored the progress of the PIP through a report from the admissions staff on who was still outstanding.

Staff A stated the PIP was not sustained.

Reference: WAC 388-97-1760 (1)(2)

505322 04/24/2025

Spokane Health & Rehabilitation North 6025 Assembly Spokane, WA 99205

were wearing, blew on the resident's food to cool it down, and asked the resident is that better? as

In an interview on 04/22/2025 at 2:54 PM, Staff Y, NA, stated hand hygiene was using alcohol-based

staff should perform hand hygiene when indicated to prevent the spread of germs.

Staff Y further stated staff should not blow on a resident's food to cool it down because it could spread germs.

In an interview on 04/22/2025 at 2:57 PM, Staff H, Licensed Practical Nurse (LPN), explained hand hygiene was washing hands with soap and water for 20 seconds or using ABHR and should be performed before/after resident cares and before/after dispensing/administering medications.

Staff H stated staff should perform hand hygiene when indicated to prevent the spread of infection from person to person.

Staff H acknowledged staff should not blow on a resident's food to cool it down as that could spread germs.

In an interview on 04/22/2025 at 3:16 PM, Staff C explained hand hygiene was washing hands with soap and water or using ABHR before/after resident cares, before applying gloves, and after glove removal.

Staff C stated staff should perform hand hygiene when indicated to prevent the spread of germs and infections.

Staff C acknowledged staff should not blow on a resident's food because staff could pass germs onto a resident's food.

In an interview on 04/22/2025 at 3:25 PM, Staff D stated hand hygiene was washing hands with soap and water or using ABHR before entering a resident's room, after exiting a resident's room, between providing care to different residents, between delivering different resident meal trays, and after adjusting residents in their WCs.

Staff D stated staff should perform hand hygiene when indicated to prevent the spread of microorganisms.

Staff D acknowledged staff should not blow on a resident's food to cool it down because it was an infection control issue.

In an interview on 04/22/2025 at 3:31 PM, Staff A, Administrator, stated they expected staff to change gloves and perform hand hygiene when indicated.

Staff A acknowledged staff should not blow on residents' food to cool it down because that was a potential infection control issue.

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

505322 04/24/2025

Spokane Health & Rehabilitation North 6025 Assembly Spokane, WA 99205

Findings included .

The 08/2023 facility policy titled Administrative Infection Control Processes documented the elements of the Infection Prevention and Control program included antibiotic stewardship.

The staff used surveillance data to determine whether ABT usage patterns required change.

The policy documented the facility used McGeer Criteria, a set of standardized definitions that helped identify potential infections and guided appropriate ABT use.

A review of Monthly Infection Surveillance Logs for January, February, and March 2025 with Staff D, Infection Preventionist, occurred on 04/21/2025 at 8:44 AM.

Staff D clarified that residents identified with CA [community acquired] infections, admitted from the hospital with an ABT or were prescribed the ABT by a community provider.

Review of the January 2025 Monthly Infection Surveillance Log with Staff D showed 28 residents identified with CA infections received an ABT.

The log showed no answer to the question, If ABT used, McGeer's minimum criteria met?, for eight of the 28 residents.

Review of the February 2025 Monthly Infection Surveillance Log with Staff D showed 24 residents identified with CA infections received an ABT.

The log showed no answer to the question, If ABT used, McGeer's minimum criteria met?, for nine of the 24 residents, N/A [not applicable] for four other residents, and No for one resident.

Review of the March 2025 Monthly Infection Surveillance Log with Staff D showed 35 residents identified with CA infections received ABT.

The log showed no answer to the question, If ABT used, McGeer's minimum criteria met?, for 31 of the 35 residents, No for one resident, and N/A for two other residents.

On 04/21/2025 at 8:44 AM, Staff D acknowledged the ASP was not implemented for new admissions to the facility or residents prescribed an ABT by community providers.

Staff D stated they did not apply the ASP process because, I am under the impression the hospital ensures McGeer is being followed on their end. No further information was provided.

No Associated WAC

505322 04/24/2025

Spokane Health & Rehabilitation North 6025 Assembly Spokane, WA 99205

Resident 6 should have but did not receive the influenza vaccine as consented to.

505322 04/24/2025

Spokane Health & Rehabilitation North 6025 Assembly Spokane, WA 99205

Findings included .

According to the 03/26/2025 admission assessment, Resident 17 was cognitively intact to make decisions regarding their care and able to make their needs known.

On 04/15/2025 at 11:11 AM, Resident 17's call light/television (TV) cord was observed with various colored wire cords exposed near the control.

The resident stated they told staff and asked if it could be replaced, but nothing had been done about it.

Similar observations of the call light/TV cord with exposed wires were made on 04/17/2025 at 11:30 AM, 04/18/2025 at 1:45 PM, 04/21/2025 at 7:35 AM, and on 04/22/2025 at 9:22 AM.

During an interview on 04/23/2025 at 9:26 AM, Staff G, Maintenance Director, stated if a call light was not working, there was usually a spare one in a drawer in the nurses station.

For any non-urgent maintenance issues, staff filled out a work order on the computer.

Staff G was informed of the observations of Resident 17's call light/TV cord with exposed wires.

During a follow-up interview on 04/23/2025 at 10:36 AM, Staff G stated they replaced the call light in Resident 17's room.

They verified that it was the first work order they received about the call light.

Staff G stated that even though the break in the plastic did not go though the individual coating of the wires, it was still a safety issue and should have been replaced when first noticed.

During an interview on 04/23/2025 at 10:55 AM, Staff C, Assistant Director of Nursing, stated they expected staff to let maintenance know when they noted any issues, and if it was urgent, they should inform management to contact Staff G.

Staff C further clarified that Resident 17's call light should have been replaced as soon as staff noticed or were informed of it.

Reference: WAC 388-97-2100

505322 04/24/2025

Spokane Health & Rehabilitation North 6025 Assembly Spokane, WA 99205

During an interview on 04/21/2025 at 10:54 AM, Staff A, Administrator, stated they expected their staff to leave resident call lights where residents could use them to call for assistance.

Reference WAC 388-97-2280 (1)(a)

505322 04/24/2025

Spokane Health & Rehabilitation North 6025 Assembly Spokane, WA 99205

.

Findings included .

ENHANCED BARRIER PRECAUTIONS

According to a 06/28/2024 Centers for Disease Control article, EBP involved gown and glove use during high-contact resident care activities for residents known to be colonized or infected with a MDRO, as well as those at increased risk of MDRO acquisition (e.g., residents with wounds or indwelling medical devices). EBP expanded the use of gown and gloves beyond anticipated blood and body fluid exposures. EBP directed staff to don (put on) gowns and gloves when dressing, bathing/showering, transferring, changing linens, providing hygiene, wound care and assisting with toileting.

<Resident 6>

Review of the 02/23/2025 significant change assessment showed Resident 6 admitted to the facility on [DATE] with medically complex conditions.

The assessment showed Resident 6 had moderately impaired cognition and an indwelling urinary catheter.

Review of the medical record showed the staff treated Resident 6 for wounds to the right foot.

An observation on 04/14/2025 at 11:31 AM showed Resident 6 in their wheelchair, and the urinary catheter bag was covered. No EBP signage was observed near Resident 6's room to show the staff needed to don PPE prior to entering the room when providing high contact activities.

<Resident 88>

Review of a 03/22/2025 admission assessment showed Resident 88 admitted to the facility on [DATE] with medically complex conditions, including an MDRO.

The assessment showed the resident was cognitively intact and received dialysis (a procedure that removed waste products and excess fluid from the blood when the kidneys failed to do so).

505322

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 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

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.

505322

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 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

F-F657 for additional information.

In an interview on 04/24/2025 at 1:17 PM, Staff A stated they were unaware there were issues with care conferences not being offered or held.

Staff A asked how they were out of compliance, and it was explained that 12 residents were reviewed and only one resident had a care conference for those that were scheduled in February 2025.

Staff A stated the PIP included looking at the scheduled care conferences daily and asking if they had been completed and the staff said they were.

Staff A did not check to see that the care conferences had been completed.

-Admission Processes

See

F-F658 for additional information.

Similar deficiencies were cited during the annual recertification survey dated 01/19/2024 and during a complaint investigation on 05/29/2024.

In an interview on 04/24/2025 at 1:17 PM, Staff A stated they were not aware there were concerns with monitoring after falls occurred.

Staff A stated the previous Director of Nursing (DNS) completed a PIP in December 2024 in which they performed audits and educated the staff.

Staff A stated the DNS felt the PIP was successful as they reduced their number of falls from 28 to 23 and they no longer needed to do a full QAPI on falls.

-Care Conferences

See

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.

505322

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 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

Findings included .

<Resident 15>

The 01/01/2025 quarterly assessment documented Resident 15 was cognitively intact and was able to make their needs known.

On 04/16/2025 at 12:05 AM, Resident 15's meal was observed.

They were served barbequed ribs and mashed potatoes. Resident 15 stated they were upset.

They had ordered the shrimp scampi and filled out their menu twice. Resident 15 attempted to eat the ribs and stated they were going return their meal.

On 04/17/2025 at 12:13 AM, Resident 15's meal included a chicken patty, green beans and mashed potatoes. Resident 15 stated they had ordered the alternate menu choice but their menu must have been lost.

They stated they had filled out their menu twice and had given it to an aide.

They were going to request a sandwich.

On 04/18/2025 at 8:47 AM, Resident 15 stated they were frustrated because they were supposed to get boiled eggs but was served scrambled eggs.

On 04/18/2025 at 12:34 PM, Resident 15 had pudding and fluids on their meal tray.

They stated they had been given fish and that was not what they ordered. Resident 15's visitor stated Resident 15 did not eat rice, but it was served to them. Resident 15 stated they were tired of getting sent the wrong things despite filling out the menus.

<Resident 89>

The 01/23/2025 significant change in condition assessment documented Resident 89 was cognitively intact and was able to make their needs known.

On 04/18/2025 at 8:49 AM, Resident 89 stated they did not get their yogurt and milk and got orange juice instead of apple juice.

On 04/18/2025 at 12:32 PM, Resident 89 stated they were upset because they did not get yogurt again. Resident 89's tray card instructed staff to send yogurt on the meal trays.

505322

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 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

Findings included .

According to the 03/26/2025 admission assessment, Resident 17 had diagnoses which included heart failure (where the heart cannot pump enough blood for the body's needs), Chronic Obstructive Pulmonary Disease (COPD, a lung disease that causes chronic respiratory symptoms and airflow limitations) and obstructive sleep apnea (OSA, a condition where the airway becomes blocked during sleep, causing pauses in breathing).

The resident was alert and able to make their needs known.

A review of the medical record showed the following provider orders for use of their CPAP machine:

1) CPAP home setting, to be worn at bedtime every evening and night shift, started on 03/20/2025.

2) CPAP on at bedtime, started on 03/20/205.

3) CPAP mask cleaning every morning on day shift, started on 03/21/2025.

4) Change CPAP tubing on night shift, every month on the 19th, started on 04/19/2025.

Resident 17's Respiratory care plan, initiated on 04/02/2025, documented they were at risk for respiratory complications due to OSA.

One of the interventions was to assist the resident as needed to administer/setup their CPAP machine.

Review of the March 2025 Treatment Administration Record (TAR) documented the following:

1) CPAP home setting every evening and night, initialed by nurse as done on evening and night shift from 3/20/25 through 03/31/2025.

2) CPAP on at bedtime, initialed by the nurse as done on night shift from 3/20/25 through 03/31/2025.

3) CPAP mask cleaning every morning on day shift, initialed by the nurse as done on from 3/21/25 through 03/31/2025.

Review of the April 2025 TAR documented the following:

1) CPAP home setting every evening and night, initialed by nurse as done on evening and night shift from 04/01/2025 through 04/14/2025.

The only exception was the 04/09/2025 evening shift slot was blank.

505322

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 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

Findings included .

<Staff K >

Review of Staff K's, Nursing Assistant, personnel file showed they were hired on 04/01/2023. No documentation of a performance evaluation was found.

<Staff L>

Review of Staff L's, Nursing Assistant, personnel file showed they were hired on 11/29/2023. No documentation of a performance evaluation was found.

<Staff M>

Review of Staff M'S, Nursing Assistant, personnel file showed they were hired on 12/06/2023. No documentation of a performance evaluation was found.

In an interview on 04/23/2025 at 3:18 PM, Staff A, Administrator, acknowledged Staff K, L, and M did not have performance evaluations on file.

Staff A stated they expected staff to complete performance evaluations yearly, as required.

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

505322

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 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

Findings included .

In an interview on 04/14/2025 at 8:34 AM, Staff A, Administrator, identified Staff B as the interim Director of Nursing.

Staff A stated the facility had no nurse staffing waivers in place.

Review of the facility staff list provided on 04/15/2025 showed Staff B was the MDS (Minimum Data Set, standardized resident assessment tool) RN/DNS.

Staff C was identified as Licensed Practical Nurse (LPN)/Assistant Director of Nursing (ADON).

In an interview on 04/18/2025 at 11:29 AM, Staff C, explained they reviewed the facility incident reports after they were completed by floor staff, they tried to implement other interventions, but did not always have a chance to complete reviews.

In an interview on 04/23/2025 at 11:16 AM, Staff B, Interim Director of Nursing, stated they were the MDS Coordinator.

Staff B explained they became the interim DNS in February 2025 but Staff C, LPN/ADON, handled most of the DNS duties.

Staff B further stated they worked a 40-hour work week and focused on MDS duties.

Staff B stated they were not on-call after hours, staff contacted Staff C in case of emergencies and/or if there were allegations of abuse/neglect made but they were kept in the loop.

In a follow-up interview on 04/23/2025 at 12:01 PM, Staff A, again stated Staff B was the interim DNS since 02/22/2025 and worked 40-ish hours a week.

Staff A was asked if they expected Staff B to perform DNS duties 40 hours a week.

Staff A stated Staff B was available to work 40 hours a week as a DNS if needed.

Staff A further stated Staff B reviewed incident reports and was notified if/when allegations of abuse were made.

Payroll data was requested at that time for Staff B from February 2025 until current. No documentation was provided.

Reference WAC 388-97-1080 (2)(b)

Refer to