Caldwell Care of Cascadia

Inspectors wroteBased on observation, record and policy review, and resident and staff interview, it was determined the facility failed to ensure a grievance process was available for residents. This deficient practice created the potential for psychosocial harm if residents' concerns were not identified and addressed in a timely manner.

Inspectors wroteBased on observation, review of FDA Food Code, and staff interview, it was determined the facility failed to ensure employees were not wearing jewelry during food preparation and service, and cutting boards were not cleaned properly. These deficiencies had the potential to affect the 59 residents who consumed food prepared by the facility. This placed residents at risk for potential contamination of food and adverse health outcomes, including food-borne illnesses.

Inspectors wroteBased on record review, policy review, and staff interviews it was determined the facility failed to provide quarterly care conferences for 8 of 8 residents (#5, #6, #7, #9, #13, #25, #38 and #47), and for 2 of 16 residents (#5 and #34) whose care plans were not revised. This deficient practice created the potential for harm when the care conferences were not conducted, and when their care plans were not revised.

Inspectors wroteBased on observation, interviews and American Health Care Association (AHCA)/National Center for Assisted Living (NCAL) and CDC guidance, the facility failed to ensure an infection control prevention and practices were implemented during medication administration and cleaning of a urine spill. These deficient practices created the potential for the spread of infectious diseases which could harm the residents in the facility.

Inspectors wroteBased on record review, resident and staff interview, it was determined the facility failed to respect the right of residents when they did not provide written notification prior to moving a resident to a new room. This was true for 1 of 1 resident (Resident #13) who was moved prior to receiving written notification. This deficient practice created the potential for psychosocial harm if Resident #13 was not provided an opportunity to see the new location, meet a new roommate, or have questions answered related to the move.

Inspectors wroteBased on record review and staff interview, it was determined resident rights were not honored. This was true for 1 of 16 residents (Resident #9) whose records were reviewed for physician notification. This failure placed Resident #9 at risk for harm when abnormal vital signs were not reported to her physician.

Inspectors wroteBased on observation, record review, policy review, and resident and staff interview it was determined the facility failed to provide a homelike environment when resident's walls were left unrepaired and/or with visible patch work. This was true for 2 of 16 residents (#13 and #53) whose rooms were observed. This created the potential for psychosocial harm and embarrassment if residents did not have a homelike environment if their walls were not repaired and did not have consistent wall paint covering the white patchwork.

Inspectors wroteBased on observation, record review, and staff interview, it was determined the facility failed to accurately report which resident was the victim and aggressor in an abuse investigation submitted to the Idaho BFS LTC Reporting System. This was true for 1 of 3 residents (Resident #13) reviewed for abuse. This deficient practice created the potential for psychosocial harm as Resident #13 was identified as the victim on the report and this was reported to Resident #13 and her family member, and to the State of Idaho, contradicting witness statements which identified Resident #13 as the aggressor.

Inspectors wroteBased on record review and staff interviews, it was determined the facility failed to ensure required transfer and discharge documentation was included in the resident's medical record to support the communication of essential information to the receiving healthcare provider. This was true for 1 of 2 residents (Resident #1) reviewed for discharge processes. This failure created the potential to result in delayed or inappropriate treatment. Findings Include:Resident #1 was admitted to the facility on [DATE] with multiple diagnoses including acute respiratory failure, pneumonia, and chronic obstructive pulmonary disease. Resident #1's care plan initiated 6/19/23, documented he had altered respiratory status and directed staff to monitor and report to physician if signs of compromised airway occurred. [...]

Inspectors wroteBased on record review, and staff interview, it was determined the facility failed to ensure Residents' Preadmission Screening and Resident Review (PASRR) accurately reflected the resident's primary diagnosis. This was true for 1 of 3 residents (Resident #34) reviewed for accuracy of PASRR's. This failure resulted in incorrect PASRR Level I determination.

Inspectors wroteBased on observation, record review, and staff interview, it was determined the facility failed to ensure services provided met accepted professional standards of clinical practice This was true for 2 of 6 residents (#47 and #56) who were observed during medication administration and for 1 of 1 resident (Resident #3) who received hemodialysis services. These failures placed Resident's #47 and #56 at risk for harm when their medications were not administered appropriately, and placed Resident #3 at risk for harm when staff took his blood pressure on the arm with his hemodialysis access.

Inspectors wroteBased on observations, record review, and staff interviews, it was determined the facility failed to implement and follow resident centered comprehensive care plan interventions and physician ordered treatments for 3 of 16 residents (Residents #9, #47, and #64) reviewed for quality of care. The facility failed to apply physician ordered interventions for Resident #47, failed to implement fall prevention interventions for Resident #64, and failed to complete reassessment of blood pressures for Resident #9. These failures created the potential for harm when required care plan interventions, treatments, and reassessments were not carried out.

Inspectors wroteBased on record review, policy review, and staff interview, it was determined the facility failed to prevent a fall when a fall intervention was not updated in the resident's care plan. This was true for 1 of 5 residents (Resident #5) reviewed for accident prevention. This deficient practice created the potential for harm when Resident #5 fell from her wheelchair when she was left unsupervised in the dining room.

Inspectors wroteBased on record review, pharmacy review, and staff interview, it was determined the facility failed to ensure recommended monitoring for adverse effects of antipsychotic medication was completed for 1 of 5 residents (Resident #38) reviewed for psychoactive medication monitoring. This created the potential for side effects to go undetected when the facility did not complete a current AIMS (an abnormal involuntary movement scale) or DISCUS (dyskinesia identification system condensed user scale) assessment as recommended by the consulting pharmacist.

Inspectors wroteBased on record review and staff interview, it was determined the facility failed to ensure residents receiving anticonvulsant medications were monitored for potential side effects as required by their comprehensive person-centered care plans. This was true for 2 of 5 residents (#34 and #41) whose records were reviewed for unnecessary medications. This failure created the potential for harm if side effects were undetected.

Inspectors wroteBased on observation and interview, it was determined the facility failed to ensure expired medications were removed from the medication storage room and not available for administration to residents. This was true for 1 of 1 medication room observed. This failed practice created the potential for adverse effects if residents received expired medications with decreased efficacy.

Inspectors wroteBased on record review, policy review, and staff interview, it was determined the facility failed to ensure its Antibiotic Stewardship practices were followed by initiating antibiotic therapy without obtaining culture and sensitivity results to guide appropriate treatment. This was true for 1 of 1 residents (Resident #64) reviewed for antibiotic stewardship. This failure created the potential for inappropriate antibiotic use and development of antibiotic resistant organisms.

Inspectors wroteBased on observation and staff interview, it was determined the facility failed to ensure resident rights were honored when past survey results were not posted in an area readily accessible to residents and their representatives. This failure created the potential for misinformation about the facility's prior 3 years of survey results and plans of correction.

Inspectors wroteBased on review of facility staffing records and staff interview, it was determined the facility failed to ensure an RN was on duty at least 8 consecutive hours per day, 7 days a week. This was true for 1 of 38 days reviewed for RN staffing coverage. The failure created the potential for harm if routine and/or emergency nursing needs went unmet and had the potential to affect all residents living in the facility.

Inspectors wroteBased on observation, interview, policy review, and review of the Idaho Food Code, the facility failed to appropriately store, label, and serve foods. This deficient practice had the potential to affect the 59 residents who received meals in the dining room and eat snacks that had been stored in the snack refrigerators. This placed residents at risk for the potential for consuming contaminated and spoiled foods, and adverse health outcomes related to food-borne illnesses.

Inspectors wroteBased on observation, interview, record review, and policy review, the facility failed to ensure 2 of 5 resident's (#32 and #47) records reviewed for oxygen use had complete orders, and 2 of 2 residents (#5 and #47) were using oxygen per physician orders. This created the potential for residents to experience harm, respiratory difficulties, and adverse outcomes.

Inspectors wroteBased on record review and interview, it was determined the facility failed to ensure residents received a written notice prior to a change in their room for 1 of 1 resident (Resident #110) who was reviewed for a room change. This resulted in a lack of information being provided to a resident necessary to make an informed decision.

Inspectors wroteBased on observation and staff interview, it was determined the facility failed to ensure residents were provided with a safe, clean, comfortable, and homelike environment. This was true for 1 of 3 shower rooms observed. This deficient practice created the potential for diminished quality of life for all residents that use the east shower room.

Inspectors wroteBased on review of medical records, the State Survey Agency's Long-Term Care Reporting Portal, and staff interviews, it was determined the facility failed to ensure residents' rights were protected to be free from abuse. This was true for 1 of 6 residents (Resident #32) reviewed for abuse. This failure placed all residents at risk of ongoing abuse, potential physical, and psychosocial harm.

Inspectors wroteBased on record review and staff interview, it was determined the facility failed to ensure a bed-hold notice was provided to residents or their representatives upon transfer to the hospital. This was true for 1 of 4 residents (Resident #110) reviewed for hospitalizations. This deficient practice created the potential for harm if residents were not informed of their right to return to their former bed at the facility within a specified time.

Inspectors wroteBased on policy review, record review, and staff interview, it was determined the facility failed to refer residents for further evaluation when residents were diagnosed with a major mental illness. This was true for 2 of 4 residents (#42 and #46) reviewed for Pre-admission Screening and Resident Review (PASARR) level 2 evaluations. This deficient practice had the potential to cause harm if residents' specialized services for mental health needs were not evaluated by an appropriate state-designated authority.

Inspectors wroteBased on policy review, record review, and staff interview, it was determined the facility failed to ensure a Pre-admission Screening and Resident Review (PASARR), was completed within the required timeframe for 2 of 4 residents (#42 and #46) reviewed for PASARR screenings. This failure created the potential for harm if residents required, but did not receive, specialized services for mental health while residing in the facility.

Inspectors wroteBased on interview and record review, the facility failed to revise a comprehensive person-centered care plan related to a fall intervention of 30-minute checks for 1 of 22 Residents (#52). This deficient practice had the potential to affect residents health and wellbeing.

Inspectors wroteBased on observation, interview, policy and record review, the facility failed to follow standard of practice during resident transfers for 1 of 2 residents (Resident #8), and follow a comprehensive person-centered care plan to maintain resident body weight for 1 of 22 residents (Resident #26). This deficient practice created the potential for harm or adverse outcomes.

Inspectors wroteBased on observation and interviews, it was determined the facility failed to ensure all residents had access to their call lights while in their beds. This issue was observed in 1 of 22 resident's (Resident #5) observed for call light access. This failure had the potential for harm if residents were not able to summon staff assistance by activating the call light.

Inspectors wroteBased on observation and interview, the facility failed to provide safe shower floors for all residents that use the east shower room. This deficient practice had the potential to cause harm due to slips or falls and distress for residents that use the east side shower.

Inspectors wroteBased on staff interview and policy review, it was determined the facility failed to ensure staff disposed of controlled medications consistent with the facility's policies to prevent possible diversion. This was true for 2 of 2 licensed nurses (RN #1 and LPN #2) interviewed during medication cart inspection. This had the potential to negatively impact each of the 79 residents residing in the facility. This failed practice created the potential for harm if controlled medications were diverted and residents did not receive the medications as ordered.

Inspectors wroteBased on observations, record review, staff interview, and review of the facility's guidelines, the facility failed to ensure the tubing for respiratory equipment included the date it was last changed. This was true for 4 of 6 residents (#5, #32, #35, and #51) reviewed for oxygen therapy. This placed residents at risk of respiratory infections due to the growth of pathogens (organisms that cause illness) in the tubing of respiratory equipment.

Inspectors wroteBased on observation, record review, resident and staff interviews, it was determined the facility failed to ensure rooms with multiple residents had at least 80 square feet space per resident. This was true for 3 of 32 resident rooms (rooms 111, 112 and 114) which did not meet the requirement of 80 square feet per resident. This was true for 6 of 6 residents (#15, #17, #18, #24, #35 and #51) whose rooms did not have 80 square feet of living space. This failure created the potential for residents to experience a loss of well-being due to lack of living space.

Inspectors wroteBased on observation, record review, and staff interview, it was determined the facility failed to ensure comprehensive resident-centered care plans included the use of oxygen. This was true for 1 of 6 residents (Resident #47) whose comprehensive care plans were reviewed. This deficient practice created the potential for Resident #47 to receive inadequate care or treatment due to missing information in her care plan.

Inspectors wroteBased on observation, staff interview, and record review, it was determined the facility failed to ensure the medication error rate was less than 5%. This was true for 2 of 26 medications (11.5%) which affected 1 of 2 residents (Resident #45) whose medication administration was observed during medication pass. This failure created the potential for subtherapeutic effect when Resident #45's Mucinex (an expectorant, helps loosen congestion) was crushed, not administered as ordered, and she was not instructed to rinse her mouth after receiving the inhaled medications.

Inspectors wroteBased on observation, record review, staff interview, and policy review, it was determined the facility failed to ensure staff performed proper hand hygiene during resident cares. This was true for 1 of 15 resident (Resident #30) observed during resident cares. The deficient practice placed residents at risk of infection from cross-contamination.

Inspectors wroteBased on record review, policy review, and staff interview, it was determined the facility failed to ensure residents were offered the pneumococcal vaccine and received information and education consistent with the current Center for Disease Control (CDC) recommendations. This was true for 1 of 5 residents (#20) reviewed for pneumococcal immunizations. This failure created the potential for harm to residents should they acquire, transmit, or experience complications from pneumococcal pneumonia.