Sullivan Park Care Center

Findings included .

<Electrical Appliances>

Review of a 12/16/2024 admission assessment showed Resident 78 admitted to the facility on [DATE] with medically complex conditions.

The assessment further showed Resident 78's cognition as intact and had both vision and hearing impairment. Resident 78 required assistance from the staff to complete Activities of Daily Living.

An observation on 02/25/2025 at 10:19 AM showed Resident 78 in bed, head slightly up, and a heating pad to their right side.

When asked about its use, Resident 78 stated, I just put it on there. Resident 78 stated their family brought the heating pad in and they used it when they get cold at night.

An observation on 02/27/2025 at 10:08 AM showed Resident 78 in bed with the heating pad observed to the left side of the head of the bed. Resident 78 stated they used the heating pad, This morning.

When touched, the heating pad was warm to touch and set at 100 degrees for 45 minutes.

Review of Resident 78's physician orders showed no instructions for the use of a heating pad.

Review of Resident 78's care plan showed no documentation of the heating pad, its purpose or interventions for its safe use.

An observation on 02/28/2025 at 8:32 AM, showed Resident 78 in bed on their left side with a heating pad on edge of the bed next to them. On 02/28/2025 at 8:35 AM, Staff T, Licensed Practical Nurse (LPN), identified the appliance as a hot pad.

Staff T stated, I think [Resident 78's] family brought it in. [Resident 78] is using it for just relaxing.

Staff T then asked Resident 78 why they used the hot pad, and Resident 78 stated, When I get pain to the side and pointed to the left stomach area.

Staff T then asked the Surveyor, Do we need to get rid of that [the hot pad]? Staff T stated they knew of no other residents that used a hot pad and confirmed they were aware Resident 78 used the hot pad prior to 02/28/2025.

Staff T stated, I thought it was just for comfort to be honest.

Staff T stated that some of the risks of using heating pads without monitoring included, They get too hot if they turn it up too high.

Burns from not checking it often.

Staff T stated they, Usually make sure the aides are aware of [the hot pad] and check on it a lot make sure it's not too hot.

Find out if [Resident 78] is physically able to manage it.

Staff T again asked the Surveyor, Should I get rid of it? I'll double check with my boss.

505383

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 505383 B.

Wing 03/06/2025

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

Sullivan Park Care Center 14820 East Fourth Spokane, WA 99216

Findings included .

<Resident 52>

The 12/26/2024 admission assessment documented Resident 52 had diagnoses that included empyema (pockets of infection that build up in the space between the lung and the chest wall) and fractured ribs.

The resident was cognitively intact and required substantial assistance of 1 to 2 staff for showering.

The 12/28/24 care plan revised on 01/30/2025 documented Resident 52 was at risk for skin breakdown related to incontinence.

Staff were instructed to keep the skin clean and dry, and minimize exposure to moisture from incontinence, wounds, and perspiration.

Nursing Assistance shower task documentation reviewed on 03/04/2025 documented the resident received showers on 02/06/2025, 02/08/20258, then not again until 02/15/2025; then again 02/19/2025, 02/22/2025, 02/26/2025 and 02/28/2025.

There were no showers documented after 02/28/2025.

During an interview on 02/24/2025 at 10:18 AM, Resident 52 stated that ever since their admission they had not received their showers twice weekly as scheduled and preferred.

They stated many times, the shower aide was removed from shower duties and given assignments on a different unit. Resident 52 stated their showers were scheduled on the evening shift when there was less staff and they were often told there was no one to give them their shower.

On 02/26/2025 at 1:25 PM, Resident 52 stated they had not been given their shower the previous evening.

They stated they asked for one and was told there was not enough staff. At this time, Resident 52 notified the nurse and was told they would work it in for the resident.

On 02/27/2025 at 8:31 AM, Staff P, Licensed Practical Nurse stated Resident 52 was provided their shower on 02/26/2025 as they had requested.

During an interview on 03/04/2025 at 9:40 AM, Staff Y, Nursing Assistant, stated there were two shower aides for the 100, 200 and 300 units that worked on the day shift.

Staff Y stated the shower aides were frequently pulled from shower duties to cover staff that had called in.

Staff Y stated the shower aides were also pulled to accompany residents on appointments if an escort was needed.

Staff Y stated residents that had showers scheduled on evening shifts usually did not get them.

Staff Y stated if there was no shower aide scheduled, they worked with the other aide on their unit to try to get them done but that took them away from other care.

505383

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 505383 B.

Wing 03/06/2025

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

Sullivan Park Care Center 14820 East Fourth Spokane, WA 99216

Findings included .

<Resident 6>

Review of an admission assessment showed Resident 6 admitted to the facility on [DATE].

The medical record showed the resident was treated with medications for heart failure, high blood pressure, and atrial fibrillation (an irregular and often very rapid heart rhythm).

Additionally, the resident was diagnosed as legally blind.

Review of the resident's baseline care plan showed no goals or interventions to address the provider orders for the management of the cardiovascular diagnoses or the vision impairment.

<Resident 411>

Review of the medical record showed Resident 411 admitted to the facility on [DATE].

The medical record showed the resident was treated with medications for chronic obstructive pulmonary disease (lung diseases that lead to breathing difficulties) and asthma.

Review of the resident's baseline care plan showed no goals or interventions to address the provider orders for the management of the lung diseases.

The above information was shared with Staff G, Resident Care Manager, on 03/04/2025 at 10:43 AM.

Staff G acknowledged Resident 6's and 411's baseline care plans did not identify the residents' nursing needs, interventions, or goals related to the active or treated diagnoses, and should have been included.

Reference WAC 388-97-1020 (3).

505383

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 505383 B.

Wing 03/06/2025

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

Sullivan Park Care Center 14820 East Fourth Spokane, WA 99216

Findings included .

Review of the facility policy titled, Abuse, Neglect, Exploitation and Misappropriation Prevention Program revised April 2021, documented the facility would develop and implement policies to prevent and identify abuse or mistreatment of residents; neglect of residents; and/or theft, exploitation or misappropriation of resident property.

Staff would be provided orientation and training on abuse prevention, incident identification and reporting.

The policy further showed all potential allegations of abuse, neglect, mistreatment, or misappropriation of resident property would be identified, reported within the required timeframes, investigated, and residents protected from potential harm during the investigation process.

<Resident 20>

The 01/10/2025 quarterly assessment documented Resident 20 was cognitively intact and made their needs known.

In an interview on 02/24/2025 at 10:46 AM, Resident 20 stated there was a resident on the same hall that entered their room and yelled at them and wandered into their room often. Resident 20 stated three staff members removed the resident from their room.

The incident for 02/05/2025 was written on a single piece of paper that stated Staff A, Administrator, spoke to Resident 20 regarding their interaction with Resident 89 on 02/05/2025 at 5:00 PM. Resident 20 stated Resident 89 was trying to enter their room, and Resident 20 blocked them from coming in with their wheelchair. Resident 20 stated Resident 89 placed their hand on their left arm to support themselves when they turned around.

Staff A stated they had asked Resident 20 if Resident 89 had squeezed their arm, and Resident 20 said no. Resident 20 stated they told Resident 89 to leave their room, staff came and redirected the resident.

Staff A stated Resident 20 reassured them several times that nothing happened, Resident 89 did not hit them, and they were not afraid of them.

Review of the February 2025 incident log had no documentation that Resident 20 was involved in a resident-to-resident altercation and the State Survey Agency was not notified as required.

In a follow-up interview on 02/28/2025 at 8:19 AM, Resident 20 stated Resident 89 had wheeled themselves into my room, they were angry and held my arm. Resident 20 stated they yelled at me, and this was the worst experience I had with them. Resident 20 stated you never knew how Resident 89 was going to act.

505383

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 505383 B.

Wing 03/06/2025

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

Sullivan Park Care Center 14820 East Fourth Spokane, WA 99216