Avista Nursing and Rehabilitation

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain best practices in the food service area resulting in the potential to spread food borne illness to all residents who consume food from the kitchen.

Inspectors wroteBased on observations, interviews and record review, the facility failed to 1) Ensure that hand hygiene was practiced between residents while serving food in the dining room, 2) Ensure the sanitary handling of clean food plates during transporting from the kitchen to the dining room, 3) Ensure urinary catheters for 2 residents (Resident #2 and Resident #3) were not on the floor, 4) Ensure that the multi-use shower bed was cleaned and sanitized between residents' use, 5) Ensure that contact precautions were followed for 1 resident (Resident #94), 6) Ensure that a barrier was used and sanitation was done with use of a Glucometer for one resident (Resident #50), and 7) Ensure that appropriate Personal Protective Equipment (PPE) was worn during care for 1 resident (Resident #2) of 32 residents reviewed for infection control practices. Findings Include: Resident #3: [...]

Inspectors wroteThe facility failed to ensure a safe and sanitary shower room for 1 of 2 shower rooms and that shower curtains were maintained without holes.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure that residents were treated in a respectful and dignified manner for 12 residents (#2, #3, #6, #7, #9, #10, #13, #17, #30, #46, #50 and #69) of 12 residents reviewed, resulting in call lights not being in reach, residents wandering and sleeping in other residents' beds, lack of timely assistance with care, uncovered urinary catheter drainage bags, and Resident #6 being told to urinate in their brief.

Inspectors wroteBased on observation and interview, the facility failed to ensure that the results of the most recent federal or state survey were kept in an area that was readily accessible for review to residents, family members and resident representatives for a confidential group of residents reviewed.

Inspectors wroteBased on interview and record review, the facility failed to ensure that a Registered Nurse was on duty for eight consecutive hours a day, seven days a week, resulting in the potential for inadequate coordination of routine or emergent care. Findings Include: Staffing: A record review of the daily posted nurse staffing data sheets from June 2025 to June 2026 indicated there were 15 days with documented 0 for Total Number of Staff and Total Scheduled Hours for RN/Registered Nurse hours: 9/15/2025, 10/8/2025, 12/30/2025, 3/16/2026, 4/10/2026, 4/20/2026, 4/21/2026, 4/26/2026, 5/20/2026, 6/2/2026, 6/5/2026, 6/6/2026, 6/7/2026, 6/20/2026, and 6/21/2026. Upon further review of the Nursing Hours posted document, the facility did not identify 8 hours of RN coverage in a 24 hour period for the identified days. The resident Census for the identified days ranged from 81- 90. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to 1) Ensure that medications were secured, including a pill on the floor for Resident #79 and that opened medications were properly labeled and dated, and 2) Maintain medication and treatment carts in a clean and sanitary condition, identified for two of four medication carts and two of four treatment carts reviewed for medication storage.

Inspectors wroteBased on interview and record review, the facility failed to 1) Provide and document education on vaccine side effects for influenza (flu) and pneumovax (pneumonia) immunizations, and 2) Provide current vaccine education sheets for 4 residents (Resident'#2, Resident #9, Resident #10 and Resident #94) of 4 residents reviewed for vaccine education, resulting in misinformation and lack of full disclosure regarding influenza and pneumovax vaccines. Findings Include:Resident Vaccine Consent Review: Resident #2: Review of facility Electronic Medical Record/EMR revealed, Resident #2 was [AGE] years old, alert and was admitted to the facility on [DATE]. [...]

Inspectors wroteBased on interview and record review, the facility failed to 1) Provide and document education on vaccine side effects for Coronavirus Disease (COVID-19) immunization, and 2) Provide current COVID-19 vaccine education sheet for 4 residents (Resident #2, Resident #9, Resident #10 and Resident #94) of 4 residents reviewed for vaccine education, resulting in misinformation and a lack of full disclosure regarding the COVID-19 vaccine. Findings Include:Resident COVID-19 Vaccine Consent Review: Resident #2: Review of facility Electronic Medical Record/EMR revealed, Resident #2 was [AGE] years old, alert and was admitted to the facility on [DATE]. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure that accurate and comprehensive informed consent was provided prior to initiation of psychotropic medications for one resident (Resident #12) of five residents reviewed for unnecessary medications.

Inspectors wroteBased on interview and record review, the facility failed to 1) Ensure the resident's right to formulate an Advanced Directive for one resident (Resident #3) and 2) Ensure that a resident was competent to sign an advance directive/Code Status for one resident (Resident #43), of 3 reviewed for Advance Directives, resulting in the potential for the residents' lack of informed knowledge related to options for code status and miscommunication of code status. Findings Include: Resident #3: Record review revealed Resident #3 was most recently admitted on [DATE] with diagnoses which included diabetes mellites, chronic respiratory failure, bipolar disorder, anxiety, chronic kidney disease (CKD), Bardet-Biedl syndrome (BBS- rare genetic disorder characterized by obesity, kidney abnormalities, and vision loss), and urinary retention. [...]

Inspectors wroteBased on observation, interview and record review the facility failed to develop and implement a comprehensive care plan for one resident (Resident #43) of 23 residents reviewed, resulting in Resident #43 lacking Care Plan interventions related to wandering into other residents' rooms. Findings Include: Resident #43: A record review of the Face sheet and Minimum Data Set/MDS indicated Resident #43 was admitted to the facility on [DATE] with diagnoses: History of a stroke, history of a myocardial infarction (heart attack), weakness right lower leg, diabetes, liver disease, history of liver transplant, lung disease, dementia, depression, anxiety, chronic kidney disease, and gout. The MDS assessment dated [DATE] revealed the resident had moderate cognitive loss with a Brief Interview for Mental Status/BIMS score of 8/15, and the resident needed some assistance with care. [...]

Inspectors wroteThe facility failed to provide adequate supervision, and develop, enact and evaluate interventions for repeated wandering into other residents' rooms for one resident (Resident #43).

Inspectors wroteBased on interview and record review the facility failed to ensure that nurses completed yearly competencies and training for one nurse (Nurse A) of 1 nurse reviewed for education and competencies. Findings Include: On 06/25/2026 at 9:30 AM, Regional Human Resources/HR Director T was interviewed about staff education. She said the completed education documents were stored in the staff files in the HR office. A yearly competency was requested to be reviewed for Nurse A. On 6/25/2026 at 11:29 AM, the HR Director T was interviewed, and she said she did not have a competency evaluation for Nurse A. A review of the Facility Assessment dated March 2026 identified the following: Training, Competencies- Annual and on hire, in person and Show me. On 6/25/2026 at 2:40 PM, the Administrator was interviewed about the absence of a competency for Nurse A and said the staff were looking into it.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure clinical staff postings were accurately completed for several days in 2025 and 2026, resulting in several missed days and incomplete documents. Findings Include: On 6/24/2026 at 10:20 AM, the Director of Nursing was interviewed and staffing documents were requested. She said the facility Scheduler kept the documents in her office. A record review of the daily posted nurse staffing data sheets from June 2025 to June 2026 indicated there were several days that the documents were missing: 5/21/2026 and 6/16/2026. In addition, there were 2 documents for 5/29/2026 and none for 5/30/2026. There was also a staffing document dated January but did not include a day or year. There were several days with missing information on the form including 12/30/2025; [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure that the drug/medication regimen reviews were completed, dated and in the medical record monthly, for 3 residents (Resident #8, Resident #12 and Resident #84) of five residents reviewed for medications, resulting in the potential for each resident to receive unnecessary medications and develop adverse effects. Findings Include: Medication Regimen Review Resident #8: A record review of the Face sheet and Minimum Data Set/MDS assessment indicated Resident #8 was admitted to the facility on [DATE] with diagnoses: Dementia, Pulmonary hypertension, diabetes, history of falls, back pain, history of a stroke, auditory hallucinations, depression, peripheral vascular disease, cataracts, and hypertension. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure that the communication process was implemented, and documentation was readily available reflecting coordination of a resident's care, for one resident (Resident #13) of one resident reviewed for hospice services.

Inspectors wroteBased on interview and record review, the facility failed to ensure that 4 of 5 Certified Nursing Assistants (CNA), reviewed for the mandatory 12 hours of yearly training, had the required training. Findings Include: On 06/25/2026 at 9:30 AM, Regional Human Resources/HR Director T was interviewed about staff education. She said the completed education documents were stored in the staff files in the HR office and the 12 hour Certified Nursing Assistant/CNA training was able to be downloaded from the training cite on the computer. At that time the HR Director T was asked to see the 12 hour CNA training for 4 CNA's I, V, X, and Y. The HR Director was not able to locate the proof of training. On 6/25/2026 at 11:29 AM, the HR Director T was interviewed and she provided several pages of training documents for CNA X equaling 10.91 hours. [...]

Inspectors wrotebased on interview and record review, the facility staff failed to follow and update timely a fall care plan for one resident (Resident #101) resulting in missed interventions necessary for care and services not being care planned with a likelihood of unmet care needs.

Inspectors wrotebased on observation, interview and record review, the facility failed to prevent a fall/accident and ensure that a left foot Ankle Foot Orthosis (AFO) device and gait belt were applied prior to standing for one resident (Resident #101) of 4 sampled residents, resulting a fall with likelihood for repeat falls, pain and serious injury.

Inspectors wroteBased on observation, interview and record review the facility failed to 1). Maintain food service equipment (steam table lids, food trays, plate warmers and refrigerator, 2) Ensure kitchen cookware was sanitary and dry; and 3). Maintain the walk- in freezer to be free of ice/snow buildup, resulting in an increased potential for cross-contamination and foodborne illness for all residents who consume meals from the kitchen.

Inspectors wroteBased on observation, interview and record review, the facility failed to store and discard medications for 4 of 4 medication carts reviewed, resulting in a lack of dating of multi-dose medications, opened and undated medications, and the potential for residents to receive medications with altered efficiency.

Inspectors wroteBased on observation, interview and record review, the facility failed to 1) Ensure that one resident's (Resident #38), who was on isolation precautions, room was free of soiled linen, 2) Ensure two residents (Residents #15, Resident #64) of 2 residents observed for wound care were free of cross-contamination, and 3) Ensure that kitchen staff wore hair nets properly (covering all hair) and that no artificial finger nails were allowed on kitchen staff while preparing foods, resulting in the potential for cross contamination, resident illness, and increased risk for infection during wound care. Findings Include: During the initial tour of the facility kitchen, Dietary Manager Q was had a hair net on, however on the right and left side of her face were long tendrils of hair that were not covered by the hair net. Dietary Manger Q also had long artificial nails at the time. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to assess, monitor and document wound care timely for two residents (Resident #46, Resident #337) of three residents reviewed for wound care, resulting in missed treatments with the likelihood of worsening wounds.

Inspectors wroteBased on observation, interview and record review, the facility failed to 1) Implement one resident's (Resident #17) preventive pressure ulcer measure (air mattress), and 2) Prevent an erosion to the penis area for one resident (Resident #74) of 4 residents reviewed for pressure ulcers, resulting in the potential for pressure ulcer development, increased discomfort and pain with hospitalization.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure one resident's (Resident #24) trapeze (bed mobility device) was within reach out of five residents reviewed for assistive devices. Findings Include: Resident #24: On 5/13/2025 at approximately 2:20 PM, Resident #24 was laying in bed and her trapeze was not hanging in a place that was accessible to her as it was flipped over the stabilization bar its connected too. Resident #24 was asked if she was able to reach the trapeze and she stated she was unable to and attempted to reach for it but was unable to access it. On 5/14/2025 at 10:55 AM, Resident #24 was observed sleeping peacefully in bed. Her trapeze was not accessible to the resident as it was flipped over the bar. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure that one resident (Resident #25) of 2 residents observed had their dry nebulizer mask stored in a storage bag when not in use, resulting in the potential for cross contamination with respiratory infection, and increased antibiotic usage. Findings Include: Resident #25: Review of the Face Sheet, care plans dated 2/25 through 4/25, orders and electronic medication admission record/EMAR dated 4/25 and 5/25, revealed Resident #25 was [AGE] years old, admitted to the facility on [DATE], alert with a Guardian in place, and required staff assistance with all Activities of Daily Living. [...]

Inspectors wroteBased on observation, interview, and record review the facility failed to maintain cold holding refrigeration temperatures of potentially hazardous food in the kitchen resulting in an increased potential for foodborne illness, potentially affecting the facility's total census of 79 residents who receive meal services.

Inspectors wroteBased on observation, interview and record review, the facility failed to act upon grievances reported in Resident Council meetings and provide responses to grievances as reported during Resident Council with the potential to affect all residents that attend the council meetings, resulting in, unresolved resident concerns and a decreased quality of life. Findings Include: During Resident Council on June 4,2024 at 3:30 PM, the four residents in attendance were asked if their concerns voiced in the meetings were followed up on and resolution/update provided at the next scheduled meeting. The attendees reported staff will ask generalized questions regarding if their issues have been resolved but there is no other discussion past issues or how the facility will resolve them. On 6/5/2024 at approximately 9:00 AM, a review was completed of Resident Council Notes from June 2023 to May 2024. [...]

Inspectors wroteThis Citation pertains to Intake Number MI000144366. Based on observation, interview and record review, the facility failed to that ensure residents' food choices were honored, food was palatable (with temperature maintained), and an adequate amount of food was offered to one resident (Resident #47), and 4 of 4 residents in the Resident Council Meeting on 06/04/24 at 3:20 PM, resulting in anger, frustration and verbalizations of being hungry. Findings Include: Observation done on 6/3/24 at the noon meal revealed chili, a salad and beverages were served in the main dining room. The facility menu dated 6/3/24, revealed lunch was to include Texas toast. The resident's were not offered any toast, bread nor crackers to go with the chili. During an interview done on 6/3/24 at 1:50 p.m., Dietary Manager E stated (food company name given) makes our menu's; we follow the menu. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure assessment and documentation of incompetency prior to enacting a Durable Power of Attorney (DPOA) and accurate documentation of advance directive forms for one resident (Resident #28) of two residents reviewed for Advance Directives, resulting in DPOA enactment prior to incompetency determination, medical decisions being made for the resident without legal documentation of determination of incompetency, including consent for psychoactive medications and the likelihood for the resident's care wishes to not be followed.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure that hygiene care was provided to two residents (Resident #23 and Resident #28) of four residents reviewed, resulting in a lack of comprehensive documentation and provision of daily care, long, visible facial hair on a female resident, and the likelihood for feelings of psychosocial distress utilizing the reasonable person concept.

Inspectors wroteBased on observation, interview, and record review, the facility failed to implement and operationalize a comprehensive Restorative Nursing program to ensure appropriate assessment, services, and treatment to maintain or improve Range of Motion (ROM) for two residents (Resident #36 and Resident #44) of two residents reviewed, resulting in a lack of ongoing and accurate assessment and documentation of Range of Motion (ROM) and contractures, a lack of implementation of Restorative Nursing services and residents with known contractures and limitations in ROM, and the likelihood for further decline in ROM, functional decline, and avoidable pain.

Inspectors wroteBased on observation, interview and record review, the facility failed to implement and operationalize policies and procedures to ensure adequate staff training, equipment monitoring, prevention, reporting, investigation, and a thorough analysis of accidents for one resident (Resident #44) of four residents reviewed for falls, resulting in a lack of reporting, thorough investigation, comprehensive procedures to prevent accidents, Resident #44 experiencing a fractured tibia and fibula bones (both bones in lower leg) necessitating emergency medical treatment, unnecessary pain, and the likelihood for decline in overall functioning and health status.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure assessment, maintenance and care of an indwelling urinary catheter, per professional standards of practice, for one resident (Resident #39), and failed to complete treatment of a Urinary Tract Infection (UTI) for one resident (Resident#18) of four residents reviewed, resulting in an indwelling urinary catheter being maintained in an unsanitary manner, a lack of a urinary catheter securement device, delayed, and incomplete antibiotic therapy with the likelihood of ongoing UTI's with continued and increased Multi-Drug Resistant Organisms (MDRO- infections caused by microorganisms that are resistant to treatment), difficulty in treatment, and a decline in overall health. Resident #18: [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure Peripherally Inserted Central Catheter (PICC line - catheter inserted in the body through the arm that extends to the heart and is utilized for long term administration of intravenous [IV] medications) care was provided, per professional standards of practice and health care provider's order, for one resident (Resident #37) of one resident reviewed, resulting in a lack of dressing change completion, a lack of sterile technique during dressing change, resident verbalizations of concerns related to a lack of care, and the likelihood for infection and alteration in overall health status.