Cascadia of Boise

Inspectors wroteBased on resident interviews, representative interviews, staff interviews, observations, review of grievances, and review of the three-week nursing schedule, it was determined the facility failed to ensure sufficient staffing was available to meet resident needs according to their plan of care. This failure had the potential to affect all residents residing in the facility if staff were not available to ensure resident needs and safety measures were provided.

Inspectors wroteBased on record review, policy review, and staff interviews, it was determined the facility failed to notify a resident's representative of an accident. This was true for 1 of 3 residents (Resident #20) reviewed for notifications. This deficient practice had the potential to prevent Resident #20 and/or their representative from making timely and informed decisions regarding the resident's medical care.

Inspectors wroteBased on record review and staff interview, it was determined the facility failed to follow the physician's order to monitor urinary output. This was true for 1 of 3 residents (Resident #4) whose bowel and bladder records were reviewed. This deficient practice had the potential to affect Resident #4's hydration status when physician ordered monitoring was not completed.

Inspectors wroteBased on observation, the Food Drug Administration (FDA) Food Code, and staff interview, it was determined the facility failed to ensure ice machines were cleaned, and resident freezers were not contaminated by non-food items, or undated, opened food. These deficiencies had the potential to affect the 70 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 and staff interview, it was determined the facility failed to ensure residents' Minimum Data Set (MDS a standardized assessment tool that measures health status in nursing home residents) Assessments were accurate. This was true for 3 of 6 residents (#5, #16, and #59) whose MDS assessment records were reviewed for accuracy. This deficient practice created the potential for negative outcomes if residents were not assessed and/or monitored due to assessment inaccuracies'.

Inspectors wroteBased on record review and staff interview it was determined the facility failed to ensure residents' care plans were revised according to their post fall needs. This was true for 1 of 22 residents (Resident #33) whose records were reviewed for care plan timing and revision. This deficient practice created the potential for harm when residents' needs were not identified and or met.

Inspectors wroteBased on observation, record review, interview and Insulin Lispro website, it was determined the facility failed to ensure residents' medications were administered according to professional standards of practice. This was true for 1 of 2 residents (Resident #36) whose insulin administration was observed. This failed practice created the potential for Resident #36 experience low or high blood sugar if she receives an incorrect amount of insulin.

Inspectors wroteBased on record review and staff interview it was determined the facility failed to ensure professional standards of practiced were followed. This was true for 3 of 22 residents (#6, #7, and #58) reviewed for following physician's orders. This deficient practice created the potential for harm if the facility failed to follow physician's orders and if resident's experienced complications related to catheter placement and care, and hypoglycemia (a condition in which blood glucose (BG, sugar) falls below normal.)

Inspectors wroteBased on record review and staff interview, it was determined the facility failed to ensure medication orders were clarified. This was true for 1 of 6 residents (Resident #87) whose records were reviewed for unnecessary medications. This failure placed Resident #87 at risk for over medication when her rescue seizure medication orders did not clearly direct their use.

Inspectors wroteBased on record review and staff interview it was determined the facility failed to ensure resident's records contained accurate documentation related to their vital signs. This was true for 1of 22 residents (Resident #7) whose record was reviewed for accurate documentation. This deficient practice had the potential for adverse outcomes and harm if Resident #7's blood pressure was taken in an unsafe manner.

Inspectors wroteBased on observation, staff interviews, and review of Centers for Disease Control and Prevention (CDC) guidance, it was determined the facility failed to implement infection prevention and control practices to prevent cross-contamination for 2 of 2 Residents (Resident #85 and Resident #59) reviewed for infection control. This failure created the potential for adverse health outcomes, including infection.

Inspectors wroteBased on record review, policy review, and staff interview, it was determined the facility failed develop a comprehensive resident-centered care plan. This was true for 1 of 21 residents (Resident #18) whose care plans were reviewed. This failure placed Resident #18 at risk of unmet care needs when he did not have a care plan for pneumonitis.

Inspectors wroteBased on record review, policy review and interview, it was determined the facility failed to ensure medication orders were written accurately per current standards of practice. This was true for 2 of 21 residents (#52 and #710) whose physician's orders were reviewed. This failure created the potential for residents to receive the wrong dosage or receive the medication via the wrong route.

Inspectors wroteBased on observations, staff interviews, and record review, it was determined the facility failed to ensure physician's order was followed regarding dressing changes for 1 of 2 residents (Resident #84). This failure created the potential for infection to spread to Resident #84's open areas to his left arm if it was not covered as ordered by the physician.

Inspectors wroteBased on staff interview, and record review, it was determined the facility failed to obtain physician ordered laboratory testing. This was true for 1 of 21 residents (Resident #18) whose records were reviewed. This failure created the potential for a physician to inaccurately diagnose and/or treat a resident appropriately due to lack of information.

Inspectors wrote2. The facility's policy titled, Documentation of Resident Health Status Needs and Services, dated 10/14/22, documented directions to document services provided after the encounter has concluded and do not document in advance or prior to providing treatments. Resident #84 was admitted to the facility on [DATE] with multiple diagnoses including acute respiratory failure with hypoxia (lack of oxygen in the blood and body tissues), hypertension, heart disease, and stroke. Resident #84 was severely cognitively impaired. Resident #84's record contained a physician order, dated 8/6/24, that directed staff to cleanse the open rash on his left arm with wound cleanser, cover with bordered gauze, and change two times per week and as needed. On 8/7/24 at 11:30 AM, Resident #84 was observed in his room, he did not have a dressing on his left arm. [...]

Inspectors wroteBased on observation, staff interview, record review, and nursing competency review, it was determined the facility failed to observe infection control guidelines during a wound care dressing change for 1 of 2 residents, (Resident #71) whose wound care was observed. This failure placed the resident at increased risk of contracting an infection in their wound.

Inspectors wroteBased on policy review, record review, observation, and resident and staff interview, it was determined the facility failed to ensure residents were assessed for safety and care-planned to self-administer medication. This was true for 2 of 3 residents (#4 and #7) reviewed for self-administration of medication. This failure created the potential for adverse outcomes if residents self-administered medications inaccurately and received too much or too little of the medication.

Inspectors wroteBased on record review, policy review, observation, and staff interview, it was determined the facility failed to ensure a resident's MDS assessment documented his nephrostomy tube (a thin flexible tube surgically placed into a kidney to drain urine). This was true for 1 of 19 residents (Resident #17) reviewed for accuracy of MDS assessments. This failure had the potential for Resident #17 to not receive care and services necessary to prevent infection and damage to her kidney.

Inspectors wroteBased on record review, policy review, observation, and staff interview, it was determined the facility failed to ensure interventions were in place on a resident's care plan for the care of her nephrostomy tube (a thin flexible tube surgically placed into a kidney to drain urine) and biliary tube (a thin flexible tube surgically placed into the bile duct of the liver to drain bile). This was true for 1 of 19 residents (Resident #17) whose care plans were reviewed. This failure had the potential for Resident #17 to not receive care and services necessary to prevent infection and damage to her kidney and liver.

Inspectors wroteBased on record review, policy review and family and staff interview, it was determined the facility failed to provide communication assistance as needed to 1 of 2 residents (Resident #54) reviewed for activities of daily living. This failure placed Resident #54 at risk for decreased quality of life and psychosocial distress related to inability to communicate effectively.

Inspectors wroteBased on record review, policy review, observation, and resident and staff interview, it was determined the facility failed to ensure residents received treatment and services to prevent skin injuries. This was true for 1 of 5 residents (Resident #308) who were reviewed for pressure injuries. This placed residents at risk of adverse outcomes if care and services were not provided due to skin assessments not being completed as ordered.

Inspectors wrote2. Resident #53 was admitted on [DATE], with multiple diagnoses including paraplegia (paralysis of the lower legs and body) and altered mental status. On 3/18/24 at 3:25 PM, a can of Biofreeze (a medication used topically to relieve pain) was observed on Resident #53's bedside table. On 3/18/24 at 3:28 PM, LPN #4 stated medication should not be left at the bedside unless the resident had an order for it to be left at bedside. 3/21/24 at 11:21 AM, the CNO stated medications were allowed at a resident's beside if the resident was approved to self-administer the medication. She stated the can of Biofreeze should have been stored on the medication cart and not left at Resident #53's bedside. Based on policy review, observation, and staff interview, it was determined the facility failed to ensure medications were secured when they were unattended by staff. [...]

Inspectors wroteBased on policy review, I&A review, record review, and staff interview, it was determined the facility failed to ensure adequate supervision for residents to prevent falls. This was true for 1 of 3 residents, (Resident #21) whose records were reviewed for falls. This resulted in harm to Resident #21.

Inspectors wroteBased on observation, record review, policy review, and resident and staff interview, it was determined the facility failed to ensure residents were monitored appropriately and offered non-pharmacological interventions while receiving opioid pain medications. This was true for 4 of 5 residents (#29, #44, #91, and #350) reviewed for unnecessary medications. This failure created the potential for residents to experience adverse reactions due to a lack of appropriate monitoring or increased pain due to not offering non-pharmacological interventions.

Inspectors wroteBased on observation, policy review, and staff interview, it was determined the facility failed to ensure infection control and prevention practices were maintained to provide a safe and sanitary environment when staff did not perform hand hygiene. This was true for 4 of 27 residents (#21, #29, #67, and #83) observed during resident care. These failures had the potential to impact all residents in the facility by placing them at risk for cross contamination and infection.

Inspectors wroteBased on observation, policy review, record review, and staff interview, it was determined the facility failed to ensure a resident was provided an appropriate adaptive call light due to physical limitations or ensure the call light was within reach. This was true for 1 of 27 residents (Resident #21) reviewed for resident rights. This deficient practice had the potential to cause harm if the resident could not call for assistance when needed or experienced an adverse medical event that required attention.

Inspectors wroteBased on record review, policy review, and staff interview, it was determined the facility failed to develop and implement a comprehensive resident-centered care plan when a resident expressed suicidal thoughts. This was true for 1 of 27 residents (Resident #78) whose care plans were reviewed. This deficient practice placed Resident #78 at risk for a negative outcome if his emotional needs were not identified and interventions documented in his care plan.

Inspectors wroteBased on observation, record review, policy review, and resident and staff interview, it was determined the facility failed to ensure residents' care plans were revised to reflect current needs and interventions. This was true for 2 of 27 residents (#1 and #21) whose care plans were reviewed. This placed residents at risk of adverse outcomes if care and services were not provided due to care plans not being revised as residents' needs changed.

Inspectors wroteBased on observation, policy review, and staff interview, it was determined the facility failed to ensure medications available for residents were labeled and dated. This was true for 2 of 3 medication carts inspected. This failure created the potential for residents to receive medication used for another resident presenting a risk for cross-contamination or to receive expired medications with decreased efficacy.