Emerald Care

F 0607

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

Level of Harm - Minimal harm or potential for actual harm

Based on interview and record review, the facility failed to implement 4 of 8 components (identify, protect, report, and investigate), of their abuse/neglect policy/procedure for 3 of 3 residents (Residents 9, 35, and 40) reviewed for allegations of abuse/neglect. This failure placed the residents at risk for unrecognized abuse and unmet care needs. Findings included .Review of a 01/2026 policy titled Abuse, Neglect and Exploitation, showed the facility would prohibit and prevent abuse, neglect, and.of residents. with ongoing oversight and supervision of staff to ensure policies were being implemented. Review of the grievance (a formal or informal complaint about care or living conditions) log, dated 07/01/2025 through 01/25/2026, showed allegations of abuse and/or neglect that had not been identified, reported, or investigated as allegations of abuse and/or neglect, nor were the resident's provided protection from further abuse and/or neglect. The logs showed: On 12/23/2025 a staff concern issue was logged for Resident 9 regarding lack of assistance/care was provided from Staff M, Licensed Practical Nurse when asked. The log showed a completed date of 01/30/2026 (seven days after concern was reported). On 12/15/2025 a staff concern issue was logged for Resident 40 regarding a verbal confrontation with Staff N, Nursing Assistant. The log showed a completed date of 12/22/2025 (seven days after concern was reported). On 12/22/2025 a staff concern issue was logged for Resident 35; the concern was made by the Resident's Representative (RR).

The issue showed Resident 35 was left with a soiled face, clothing, and their brief was so wet with urine that they dripped urine all the way down the hallway. The log showed no completion date. Review of the reporting log (a record used to document incidents that may involve abuse, neglect, or mistreatment of residents), dated 07/01/2025 through 01/25/2026, showed none of the grievances for Residents 9, 35, and 40 had been logged or thoroughly investigated to rule out abuse or neglect. Therefore, Residents 9, 35, and 40 were not protected from the possibility of ongoing abuse or neglect. During an interview on 01/30/2026, Staff A, Administrator, along with Staff B, Director of Nursing Services, stated there was some confusion with what concerns should be put on the grievance log versus the Reporting log and the policies needed updated. Staff A stated the nursing staff should have been logging allegations of not receiving appropriate care concerns on the incident log, and not on the grievance log. Staff A and Staff B both stated the grievance log concerns of Residents 9, 35, and 40 were not identified as allegations of abuse and/or neglect and should have been thoroughly investigated as allegations of abuse and neglect. Reference: WAC 388-97-0640 (2)(a)(b)

Residents Affected - Some

Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date

these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.

LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE

TITLE

(X6) DATE

FORM CMS-2567 (02/99) Previous Versions Obsolete

Facility ID:

If continuation sheet

Event ID:

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

01/30/2026

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Emerald Care

209 North Ahtanum Avenue Wapato, WA 98951

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0609

Reference: WAC 388-97-0640 (5)(a)

Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

01/30/2026

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Emerald Care

209 North Ahtanum Avenue Wapato, WA 98951

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

member (later identified as Staff N, NA), and how they spoke to them. The grievance showed the resident was upset and said Staff N entered their room and told them, Would you stop locking the dang door.

Resident 40 stated they did not like how Staff N talked to them or blamed them for locking the shared bathroom door. The grievance investigation showed the resident stated the way the Staff N spoke to them was unprofessional and unnecessary. The grievance conclusion was Staff N was removed from the scheduled room and on 12/16/2025 was removed off the routine schedule to that unit. The grievance showed continued education was provided about sharing info on other residents (even though the grievance did not reflect anything about sharing information about other residents). There was no root cause or analysis completed to rule out abuse or neglect, nor were other residents interviewed regarding

the interactions they had with Staff N were of a professional manner, no care plan changes, no alert charting to continue to monitor any adverse reactions the resident may have had over the incident.

During an interview on 01/28/2026 at 11:13 AM, Resident 40 stated they reported an incident involving Staff N. The resident stated Staff N accused them of locking the shared bathroom door when they last used

the bathroom and didn't unlock it when they were finished. The resident, who became tearful during this interview, stated it upset them because Staff N had spoken to them as if they were being scolded and when

they attempted to explain to staff N that they had not used the restroom that day, Staff N made them feel as if they were lying, threw their hands up in the air, and walked out of the room while they were talking to them. Resident 40 stated Staff N was removed from their room but then a few days later came back in their room again, where they had an exchange of words again.

Review of the Reporting Incident Log from 07/01/2025 through 01/25/2026 showed no allegations of abuse or neglect had been reported for Resident 9, 35 or Resident 40's allegations.

During an interview on 01/30/2026 at 2:09 PM, Staff A, Administrator, along with Staff B, stated there was some staff confusion with what should be reported on the grievance log and what should be on the reporting log. Staff A stated they needed to review and revise the grievance policy to ensure they were protecting the residents involved right away and thoroughly investigating allegations of abuse and/or neglect.

Reference: WAC 388-97-0640 (6)(a)(b)

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet