Bothell Health Care

Inspectors wroteBased on interview and record review, the facility failed to prevent physical abuse for 1 of 3 residents (Resident 1), reviewed for abuse investigations. Resident 2 entered Resident 1's room and hit them on the right side of their face with a closed fist. This failure placed residents at increased risk of injury, emotional distress, and a diminished quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide supervision of two staff assistance and use of a mechanical lift (Hoyer) device to prevent an avoidable accident during a transfer for 1 of 3 residents (Resident 1), reviewed for accident hazards. Resident 1 experienced harm when they had an assisted fall while being transferred by one staff person without the use of the care planned Hoyer lift device, sustained a broken distal fibula (calf bone), and required transfer to the emergency room. This failure placed residents that require mechanical lift transfer or two staff extensive assistance at risk for injury, adverse outcomes, functional decline, and diminished quality of life.

Inspectors wroteBased on interview and record review, the facility failed to provide necessary services to maintain personal hygiene for 1 of 4 residents (Resident 1), reviewed for Activities of Daily Living (ADL). The failure to provide bath/shower for a resident who was dependent on staff for assistance placed the resident at risk for poor hygiene, unmet care needs and a diminished quality of life.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure a therapeutic diet was provided as ordered for 1 of 3 residents (Resident 1), reviewed for therapeutic diets. This failure had the potential to cause unwanted weight gain, a decline in medical condition, and a diminished quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure residents were evaluated, assessed, received physician orders for self-medication administration, and educated to keep medications in a lockable storage for 4 of 15 residents (Residents 50, 7, 76 & 90), reviewed for self-medication administration. The failure to complete a self-administration of medication assessment and store medications in a lockable unit placed the residents at risk for medication errors, adverse reactions, and related complications.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide the website address of the Washington State Long-Term Care Ombudsman (an advocacy group for residents in a nursing home) on the posted contact information in 4 of 4 facility areas (100-Wing, 400-Wing, across the conference room, and the library), reviewed for residents' rights. This failure placed the residents at risk of not being able to report their concerns online to the State Long-Term Care Ombudsman.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide a homelike environment when residents were served their meals on trays for 2 of 2 residents (Residents 34 & 70) and signage of medical information were posted in residents' rooms for 2 of 15 residents (Residents 70 & 301), reviewed for homelike environment. These failures placed the residents at risk for a less than homelike environment and a diminished quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure staff document medications in accordance with professional standards of practice for 3 of 10 residents (Residents 148, 28 & 8), failed to ensure medications were not handled with bare hands for 1 of 10 residents (Resident 2), and failed to ensure insulin (medication that works by lowering levels of sugar in the blood) pens were wiped with alcohol pads before use and the skin was pinched prior to insulin administration for 2 of 2 residents (Residents 20 & 19), reviewed for medication administrations. In addition, the facility failed to ensure feeding tube (enteral tube - a medical device used to provide nutrition to people who cannot obtain nutrition by mouth or need nutritional supplementation) was checked for placement or patency prior to administering medications for 1 of 1 resident (Resident 16). [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure foods items were handled appropriately in accordance with professional standards of food safety for 1 of 3 refrigerators (Walk-In Refrigerator) and 1 of 1 Shelf (Shelf below steamer table), reviewed for food services. Additionally, the facility failed to ensure 1 of 5 kitchen staff (Staff W) was wearing a beard net. These failures placed the residents at risk for food borne illness (caused by the ingestion of contaminated food or beverages), cross contamination, and a diminished quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure glucometer (device that measures the concentration of sugar in the blood) control testing reading numbers were documented accurately for 5 of 5 residents (Residents 20, 19, 92, 24 & 47), reviewed for resident records. This failure placed the residents at risk of medical complications, unmet care needs, and diminished quality of life.

Inspectors wroteBased on observation, interview and record review, the facility failed to establish and maintain an infection prevention and control program designed to provide a safe and sanitary environment to help prevent the transmission of communicable diseases by: 1. Not having a water management program that assessed the potential growth of Legionella (a waterborne bacteria that can cause pneumonia [a lung infection]) or other waterborne pathogens (an organism that can cause disease) was completed for the decorative water fountain. 2. Touching medications with bare hands during medication administration for 1 of 10 residents (Resident 2), reviewed medication administration. 3. Not performing hand hygiene and disinfection of glucometers (device used to check blood sugar levels) for 3 of 3 residents (Residents 20, 92 & 19), reviewed for blood glucose (blood sugar) monitoring. 4. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain glucometer (a device for measuring the concentration of sugar in the blood) disinfection per manufacturers' recommendations for 4 of 4 glucometers in Wing 300, reviewed for safe operating condition. This failure placed residents at risk of inaccurate blood sugar readings and potential negative outcomes.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure staff provided care and services in a manner that maintained and promoted dignity while providing meal assistance for 1 of 2 residents (Resident 70), reviewed for meal observations. This failure placed the resident at risk for a diminished self-worth and overall well-being.

Inspectors wroteBased on interview and record review, the facility failed to inform the resident and/or their representative before administering psychotropic (mind altering) medications for 1 of 5 residents (Resident 34), reviewed for unnecessary medications. This failure placed the resident and/or their representative at risk of not being fully informed of the risks and benefits before making decisions about their medications.

Inspectors wroteBased on interview and record review, the facility failed to ensure an advance directive (a written instruction, such as a living will or Durable Power of Attorney [DPOA] for health care [a document delegating to an agent the authority to make health care decisions in case the individual delegating the authority subsequently becomes incapable to do so]) was obtained and completed for 1 of 3 residents (Resident 70), reviewed for advance directives. This failure placed the resident and/or their representative at risk for losing their right to have their preferences honored to receive or refuse/discontinue care according to their choice.

Inspectors wroteBased on interview and record review, the facility failed to issue Skilled Nursing Facility (SNF) Advanced Beneficiary Notice of Non-coverage (SNF ABN) and Notification of Medicare (federal health insurance program for people age [AGE] or older) Non-Coverage (NOMNC- a required form notifying the resident that their skilled services coverage was ending and would no longer be covered by their Medicare A benefits) at least two calendar days before the Medicare coverage ended for 2 of 3 residents (Resident 25 & 73), reviewed for beneficiary notification. These failures placed the residents and/or their representatives at risk of not being fully informed and losing their right to an appeals process.

Inspectors wroteBased on interview and record review, the facility failed to transmit the resident Minimum Data Set (MDS - an assessment tool) to the Centers for Medicare & Medicaid Service (CMS) within the required timeframe for 1 of 22 residents (Resident 69), reviewed for transmitting MDS assessments. This failure placed the residents at risk for unmet care needs and diminished quality of life.

Inspectors wroteBased on interview and record review, the facility failed to ensure Preadmission Screening and Resident Review (PASARR-an assessment used to identify people referred to nursing facilities with Serious Mental Illness [SMI], Intellectual Disabilities [ID]; or related conditions are not inappropriately placed in nursing homes for long-term care) Level I form was completed accurately and Level II PASARR referrals were made for 2 of 5 residents (Residents 55 & 34), reviewed for PASARR screening. In addition, the facility failed to complete Level I PASARR screening form for an exempted hospital discharge resident who remained in the facility for more than 30 days for 1 of 5 residents (Resident 2). [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure a resident centered discharge plan was in place for 1 of 1 resident (Resident 96), reviewed for discharge planning. The failure to begin the discharge planning process at admission placed the resident at risk for delayed discharge, unmet care needs, and a diminished quality of life.

Inspectors wroteBased on interview and record review, the facility failed to ensure the discharge summary was completed and included a recapitulation (overview) of the resident's stay for 1 of 1 resident (Resident 96), reviewed for discharge summary. This failure placed the resident at risk for unsafe discharge, complications and a diminished quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to implement and/or provide activity plan for 1 of 1 resident (Resident 45), reviewed for activities. This failure placed the resident at risk of boredom, decreased mood, and a diminished quality of life.

Inspectors wroteBased on interview and record review, the facility failed to ensure consistent communication and collaboration of care occurred between the facility and hospice care for 1 of 1 resident (Resident 15), reviewed for hospice services. This failure placed the resident at risk of not receiving the necessary hospice care services, unmet care needs, and a diminished quality of life.

Inspectors wroteBased on interview and record review, the facility failed to ensure residents who were trauma survivors and diagnosed with Post Traumatic Stress Disorder (PTSD - a mental health condition triggered by a terrifying event that was either experienced or witnessed) received trauma informed care, trigger assessment, and trauma-informed care assessment in accordance with professional standards of practice for 3 of 4 residents (Residents 8, 34 & 76), reviewed for mood/behavior. These failures placed residents at risk for unidentified triggers, re-traumatization, and a decreased quality of life.

Inspectors wroteBased on interview and record review, the facility failed to ensure adequate monitoring was conducted for use of anticoagulants (medication that prevent blood clot) for 2 of 5 residents (Residents 55 & 45), reviewed for unnecessary medications. This failure placed the residents at risk for receiving unnecessary medications, adverse side effects, and related complications.

Inspectors wroteBased on observation, interview, and record review, the facility failed to appropriately label and store drugs and/or biologicals (diverse group of medicines made from natural sources) for 1 of 2 refrigerators (Medication Storage A), reviewed for medication storage. This failure placed the residents at risk of receiving compromised and ineffective medications.

Inspectors wroteBased on interview and record review, the facility failed to ensure Certified Nursing Assistants (CNAs) had the required dementia (memory loss) management training upon hire for 2 of 5 staff (Staff U & Staff V), reviewed for sufficient and competent Nurse staffing. This failure placed the residents at risk for potential negative outcomes and unmet care needs.

Inspectors wroteBased on interview and record review, the facility failed to ensure the facility assessment (document describing resident population and needs to determine staff and other resources necessary to competently care for residents) was updated to include and consider specific staffing needs for each resident unit/each shift and to identify contracts or agreements with third parties such as Hospice (specialized care for residents requiring comfort care) and Hemodialysis (treatment for residents whose kidneys are failing) services. These failures placed the residents at risk for unmet care needs and a diminished quality of life.

Inspectors wroteBased on interview and record review, the facility failed to provide timely information about medical appointment for 1 of 1 resident (Resident 1), reviewed for planning and implementation of care. The failure to notify the resident's representative of Resident 1's medical appointment led to the cancellation of the medical procedure and prevented the resident's representative the ability to exercise their right to make an informed decision.

Inspectors wroteBased on interview and record review, the facility failed to provide a summary/copy of the baseline care plan to the residents and/or their representatives for 4 of 4 residents (Residents 334, 32, 57 & 183), reviewed for baseline care plan. This failure resulted in the residents not being informed of their initial plan for delivery of care services and placed the residents at risk for unmet care needs.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the daily nurse staffing form was accurately completed with the census, actual number of staff and the hours worked for each shift for 4 of 5 days reviewed for sufficient and competent staffing. This failure placed the residents and residents' representatives at risk of not being fully informed of the current staffing levels.

Inspectors wroteBased on observation, interview, and record review, the facility failed to appropriately label and store drugs and/or biologicals (diverse group of medicines made from natural sources) and failed to ensure expired medications were disposed of timely in accordance with current accepted professional standards for 2 of 4 medication carts (300 & 400 Hall Medication Carts), reviewed for medication storage. In addition, the facility failed to maintain proper temperature for 2 of 2 refrigerators in the medication storage room (Medication Storage Room Refrigerator A & B). These failures placed the residents at risk for receiving compromised, ineffective, and expired medications.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure infection control practices for hand hygiene and/or proper use of gloves were followed during peri-care (cleaning of private areas), wound care, and medication administration for 3 of 3 residents (Residents 42, 23 & 48), and failed to do hand hygiene during meal observations for 2 of 2 staff (Staff M & T), reviewed for infection control. These failures placed the residents at risk for facility acquired or healthcare-associated infections and related complications. Findings Included . Review of the facility's policy titled, Hand Hygiene, revised in May 2023, showed that the use of towelettes (antimicrobial-impregnated wipes) are not a substitute for using an Alcohol-Based Hand Rub (ABHR) or antimicrobial soap. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to conduct routine maintenance to ensure bed rails/side rails were safe to use for 4 of 4 residents (Residents 42, 47, 5 & 1), reviewed for accident hazards. This failure placed the residents at risk for injury and/or entrapment.

Inspectors wroteBased on interview and record review, the facility failed to ensure resident's personal clothing were kept safe from loss/theft and failed to follow their process for missing/lost items for 1 of 1 resident (Resident 18), reviewed for personal property. This failure placed the resident at risk for decreased sense of security and a diminished quality of life.

Inspectors wroteBased on interview and record review, the facility failed to ensure allegation of abuse was reported to the State Agency within the required time frame for 1 of 1 resident (Resident 44), reviewed for abuse allegation. This failure placed the resident at risk for potential unidentified mistreatment and lack of protection due to unrecognized abuse.

Inspectors wroteBased on interview and record review, the facility failed to ensure allegation of abuse was thoroughly investigated for 1 of 1 resident (Resident 44), reviewed for abuse investigation. This failure placed the resident at risk for repeated incidents, unidentified abuse, and inappropriate corrective actions.

Inspectors wroteBased on interview and record review, the facility failed to provide a written transfer/discharge notice to the residents/representatives describing the reason for transfers for 2 of 5 residents (Residents 63 & 21), reviewed for hospitalization. This failure placed the residents at risk for not having an opportunity to make informed decision about transfers/discharge.

Inspectors wroteBased on interview and record review, the facility failed to ensure bed-hold notices were provided at the time of transfer to the hospital for 2 of 5 residents (Residents 63 & 21), reviewed for hospitalization. This failure placed the residents at risk of lack of knowledge regarding their right to hold their bed while in the hospital.

Inspectors wroteBased on observation, interview, and record review, the facility failed to develop and/or implement care plans for 2 of 17 residents (Residents 23 & 53), reviewed for comprehensive care plans. The failure to develop and/or implement care plans for dental care, dentures, and incontinence care placed the residents at risk for unmet care needs and a diminished quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to consistently provide nail care and denture care for 2 of 3 residents (Residents 44 & 53), reviewed for Activities of Daily Living (ADL). This failure placed the residents at risk for poor hygiene, decreased self-esteem, and a diminished quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to assess and provide risks and benefits for bed rail/side rail use to meet the needs of 1 of 4 residents (Resident 5), reviewed for accident hazards. This failure placed the resident at risk for injury and a diminished quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to coordinate services for 1 of 2 residents (Resident 23) who had identified dental needs. The failure to follow through and coordinate dental services placed the resident at risk for dental pain, dental complications, and a diminished quality of life.

Inspectors wroteBased on interview and record review, the facility failed to ensure appropriate use of antibiotic medication (used to treat infection) was followed for 1 of 4 residents (Resident 280), and failed to ensure standardized tools and criteria were utilized for antibiotic stewardship program (such as Loeb Minimum Criteria [minimum set of signs/symptoms used to determine whether to treat an infection with antibiotics] and/or SBAR [Situation, Background, Assessment, and Recommendation - a toolkit that helps staff/prescribing clinicians communicate about suspected UTIs [Urinary Tract Infections-bladder infection] and facilitates appropriate antibiotic prescribing) to promote appropriate use of antibiotics, reduce the risk of unnecessary antibiotic use, and decrease the development of adverse side effects and antibiotic resistance. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure residents were free of physical abuse when the facility failed to implement their abuse policy and procedures to conduct an immediate investigation that included resident interviews for potential abuse for 2 of 3 residents (Residents 2 & 1). In addition, the facility failed to protect Resident 2 and other residents from potential abuse when an identified nursing assistant (NA) remained in the facility after Resident 1 reported to staff that the same NA hit them on the right upper arm causing bruise, and mental anguish. These failures caused Resident 1 harm and had the potential to cause further abuse, pain, and fear for Resident 2 and other residents.

Inspectors wroteBased on interview and record review, the facility failed to ensure reported concerns were addressed and investigated timely for 3 of 8 residents (Residents 5, 7 & 9), reviewed for grievances. This failure placed the resident at risk for unmet care needs, and a diminished quality of life.

Inspectors wroteBased on interview and record review, the facility failed to ensure possible allegations of abuse and/or neglect were investigated for 1 of 8 residents (Resident 10), reviewed for abuse/neglect investigations. This failure placed the resident at risk for unidentified abuse and/or neglect, and a diminished quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure foods stored in the refrigerator, freezer, and dry storage, were labeled, dated when opened, and closed shut. The facility also failed to separate clean work areas from soiled work areas and keep the kitchen clean from debris and garbage. These failures had the potential to affect all 81 residents in the facility who consumed food from the kitchen.

Inspectors wroteBased on observation and interview, the facility failed to ensure expired medications and laboratory supplies were properly discarded to prevent the potential use of the medications and supplies in 1 of 2 medication storage rooms observed. This failure placed the residents at risk to receive ineffective medications, use compromised laboratory supplies, and possibly experience adverse side effects.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the oxygen (O2) nasal canula (a thin tube inserted into the nose to deliver O2) was dated and in a plastic bag when not in use for 1 of 1 resident (Resident 66) reviewed for respiratory care. This failure placed the resident at risk for infection and related complications.