Avalon Healthcare Bellingham

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide the necessary care and services related to restorative nursing programs (RNPs) for 3 of 5 residents (Resident 47, 65, and 67) reviewed for positioning, mobility, and range of motion. The failed practice placed residents at risk for a decline in function, contractures (shortening and hardening of muscles, tendons leading to deformity and rigidity of joints), pain and increased dependency on caregivers.

Inspectors wroteBased on interview and record review the facility failed to ensure residents were free from unnecessary psychotropic medications for 1 of 5 residents (Resident 5) sampled for medication review. This failure placed residents at risk for unrecognized adverse effects of psychotropic medications.

Inspectors wroteBased on interview and record review the facility failed to ensure the baseline care plan included the minimum healthcare information necessary to properly care for the residents for 2 of 5 residents (Residents 5 and 77) reviewed for baseline care plan. These failures placed residents at risk for clinical complications, not receiving person centered care and being at risk of unmet care needs.

Inspectors wroteBased on interview and record review, the facility failed to follow physician's orders to obtain monthly weights for 1 of 2 residents (Resident 11) reviewed for nutrition. This failed practice placed residents at risk of not receiving adequate care and services and a decline in health and/or mobility.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure interventions to prevent pressure ulcers were implemented for one of one residents (Resident 67) reviewed for house acquired pressure ulcers. Failure to ensure preventative measures were implemented resulted in Resident 67 developing a stage 2 pressure injury and placed the resident at risk for delay in healing or additional pressure ulcers.

Inspectors wroteBased on observation, interview and record review, the facility failed to provide adequate supervision to prevent accidents for one of one residents (Resident 5) reviewed for smoking. Failure to comprehensively assess and care plan the resident's smoking history and behaviors placed Resident 5 at risk for burns or injury related to unsupervised smoking and placed other residents at risk for injury related to unsecured smoking materials in the facility.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure that two (44 and 49) of three residents reviewed for respiratory care, were provided care consistent with professional standards of practice. Failure of the facility to maintain respiratory equipment, including Continuous Positive Airway Pressure (CPAP), placed residents at risk for unmet needs and potential negative outcomes for sleep deprivation, respiratory distress, discomfort or skin breakdown of the ears/nostrils/face.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure that all drugs and biologicals were labeled in accordance with professional standards for 1 of 2 medication carts (Cart 2 B-wing) reviewed for medication storage. The failure to remove expired items from the medication carts placed residents at risk to receive expired or ineffective medications and a decreased quality of life.

Inspectors wroteBased on interview and record review, the facility failed to ensure influenza and pneumococcal immunizations were offered, up to date and risks and benefits of the immunizations were provided to 3 of 6 residents (Resident 67, 54 and 80) reviewed for immunization and infection control. This failure placed the residents at risk for illness, lack of knowledge to make medical decisions, and spread of communicable diseases.

Inspectors wroteBased on interview and record review, the facility failed to ensure COVID-19 (a viral illness that caused fever, difficulty breathing or possibly death) immunizations were offered, up to date and risks and benefits of the immunizations were provided to 2 of 6 residents (Resident 54 and 80) reviewed for immunization and infection control. This failure placed the residents at risk for illness, lack of knowledge to make medical decisions, and spread of communicable diseases.

Inspectors wroteBased on interviews and record reviews, the facility failed to consistently reposition, assess and monitor skin integrity timely & implement pressure offloading interventions to prevent the occurrences of avoidable pressure ulcers (PU) for 1 of 3 residents (Resident 1) reviewed for pressure ulcers. Resident 1 experienced harm when they developed unstageable PU (later diagnosed as Stage 4 pressure ulcer) to their sacrum that became infected and required hospitalization.

Inspectors wroteBased on interviews and record review, the facility failed to ensure that notification of changes had been communicated to the resident and/or resident representative for 1 of 3 (Resident 1) residents reviewed for notifications of change. These failures placed residents and/or representatives at risk of not being informed of resident changes in health status or transfers out of the facility.

Inspectors wroteBased on record review and interview, the facility failed to ensure the facility's activity program was directed by a trained and qualified activities professional for the ongoing assessment, development, and/or revision of individualized activity programs for the current activities scheduled in the facility for 1 of 1 Recreation/Activity Directors (Staff S) reviewed for activities professional qualifications. This failure placed residents at risk for unmet recreation needs, boredom, and decreased quality of life.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure 5 of 6 resident's (Resident 6, 23, 24, 29 and 53) received care and treatment in accordance with professional standards of practice and received the necessary care and services to attain or maintain their highest practicable level of well-being. This placed residents at increased risk of unmet care needs, medical complications and decreased quality of life.

Inspectors wroteBased on interview and record review the facility failed to ensure an appropriate delegation of resident rights for decision making and informed consent was completed and followed for 1 of 4 residents (Resident 53) reviewed for Advance Directives. This failure placed Resident 53 and their representative at risk for lack of knowledge related to risks, benefits and alternatives to proposed health care and for financial or other exploitation related to lack of capacity to make informed decisions.

Inspectors wroteBased on observation, interview and record review, the facility failed to develop and implement a comprehensive person-centered care plan for 2 of 3 residents (Residents 51 and 215) reviewed for discharge planning, 1 of 1 resident reviewed for Rehab and Restorative Services (Resident 54) and 1 of 2 residents (Resident 6) reviewed for skin issues. Failure to develop and implement individualized goals or approaches placed residents at risk for decreased quality of care and unmet care needs. Findings Included . [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to assist 1 of 3 dependent residents (Resident 6) with routine activities of daily living. Failure to provide routine grooming and clothing changes placed residents at risk for poor hygiene, discomfort, dignity issues, and diminished quality of life.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure 1 of 1 resident (Resident 49) reviewed for incontinence, received the care and services necessary to maintain and avoid loss of bowel and bladder functions. This failure placed the resident at risk for continued decline in bowel and bladder function, skin issues, and feelings of frustration and embarrassment.

Inspectors wroteBased on observation, interview and record review, the facility failed to provide supervision to ensure residents were free from avoidable accidents for 2 of 3 residents (Resident 1 and 2) reviewed for accident hazards. Resident 1 experienced harm when they fell from bed and sustained a head injury that required sutures and hospitalization when facility staff did not follow the resident's individualized care plan (CP) that required two staff assistance/supervision for incontinence care. This failed practice placed Resident 2 at risk for injury when they wandered outside the facility without staff supervision.

Inspectors wroteBased on interview and record review, the facility failed to ensure a resident's right to privacy, security, and confidentiality when a staff member relayed confidential information to a visiting family member for 1 of 1 resident (Resident 1) reviewed for personal privacy/confidentiality of records. This failed practice placed residents at risk for the loss of confidentiality and privacy and the right to have their preferences honored.

Inspectors wroteBased on interview and record review, the facility failed to conduct a thorough investigation for 2 of 3 residents (Resident 1 and 2) reviewed for complete and thorough investigations. The facility failed to thoroughly investigate a fall with significant injury and hospitalization for Resident 1, and to thoroughly investigate an incident of elopement for Resident 2. This failure placed residents at risk for continued or uninvestigated potential abuse or neglect. <RESIDENT 1> Resident 1 admitted to the facility on [DATE] with diagnoses that included a history of a stroke with left sided hemiparesis (weakness or partial paralysis affecting one side of the body) and generalized weakness. Review of Resident 1's clinical record showed the resident had a fall out of bed on 08/13/2024. [...]

Inspectors wroteBased on observation, and interview, the facility failed to ensure resident rooms were routinely cleaned and maintained in good condition for 1 of 3 sampled residents (Resident 1) reviewed for homelike environment. This failure placed residents at risk of not having rooms clean, sanitary, and maintained with a comfortable interior and a decreased quality of life.

Inspectors wroteBased on interview, and record review, the facility failed to ensure the designated Infection Preventionist (IP) met the qualifications for experience, education, and training or certification for the role to assume responsibility for the facility's Infection Prevention Control Program (IPCP). This failure placed residents, family members, and staff at risk of contracting communicable diseases.

Inspectors wroteBased on interview, and record review, the facility failed to ensure a resident record was provided for review in a timely manner to the legal representative for 2 of 2 sampled residents (Resident 24 and 34) reviewed for requested medical records. This failure placed the legal representative at risk for not having full clinical information about the resident to best represent the resident and make informed decisions.

Inspectors wroteBased on interview, and record review, the facility failed to ensure the Resident Assessment Instrument (RAI), an assessment of a resident's needs, strengths, goals, and preferences, included thorough summaries of the Care Area Assessments (CAA - a systematic process to interpret the triggered information from the Minimum Data Set assessment to assess the potential problem and determine if the area should be care planned), to holistically analyze the plan of care for 2 of 4 residents (Residents 2 and 39) reviewed for comprehensive assessments. This failure placed the residents at risk of not having appropriate services provided based on the resident's individualized needs.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure professional standards were met for 1of 1 sampled residents (Resident 1) sampled for intravenous (IV - into the vein) medication administration. The facility failed to ensure a blood specimen taken from a peripherally inserted central catheter [(PICC) form of IV that is centrally located, longer in length and goes directly to the heart] was acquired by a nurse that had the appropriate training. The facility failed to ensure the resident's antibiotic (medication to treat an infection) IV medication was administered by a nurse that had the appropriate training to manage and administer medication through an IV line. This failure placed the resident at risk for complications, a worsened infection, delay in healing, and adverse outcomes.

Inspectors wroteBased on interview, and record review, the facility failed to provide person-centered pain management for 1 of 2 sampled residents (Resident 39). Resident 39 requested, was evaluated, and care planned for nonpharmacological pain interventions which were not initiated or obtained. This failure placed residents at risk for increased pain, and a decreased quality of life.

Inspectors wroteBased on interview, and record review the facility failed to ensure residents were free from unnecessary medications for 1 of 5 sampled residents (Resident 3) reviewed for unnecessary medications. Failure to follow pharmacy recommendations for an as needed headache pain reliever placed residents at potential risk for use of unnecessary medications and/or have adverse side effects.

Inspectors wroteBased on interview, and record review the facility failed to ensure specialized rehabilitative services were provided as determined by the Physician's Order (PO) for 1 of 2 sampled residents (Resident 44) reviewed for rehabilitation with skilled therapy services. This failure placed residents at risk from attaining, maintaining, or restoring their highest practicable level of cognitive function and psycho-social well-being.