Cascadia of Lewiston

Inspectors wroteBased on record review, review of the facility's policy and procedure, review of Incidents and Accidents (I&A's) reports, and staff interview, it was determined the facility failed to ensure residents were free from significant medication errors. This was true for 2 of 2 residents (#133 and #134) reviewed for medication errors. Resident #134 was harmed when his J-tube had to be surgically replaced after being administered medications through it instead of by mouth per the physician's order and Resident #133 was potentially harmed when he was found to have 2 Fentanyl patches on his body instead of the ordered one patch.

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 all 27 residents who received meals from the facility kitchen served in the dining room and resident rooms. This placed residents at risk for potential contamination and use of spoiled foods, and adverse health outcomes, including food-borne illnesses.

Inspectors wroteBased on observation, record review, policy review, and staff interview, it was determined the facility failed to ensure staff rinsed and stored the nebulizer mouthpiece appropriately after each use. This was true for 5 of 5 residents (#7, #13, #15, #78, and #80). This failure placed residents at risk of respiratory infection due to growth of pathogens (organism that cause illnesses) in the respiratory equipment.

Inspectors wroteBased on observation, record review, resident interview, test tray evaluation, and staff interview, it was determined the facility failed to ensure palatable food was served. This affected 5 of 16 residents (#2, #14, #16, #17, and #127) who were reviewed for dietary concerns. This failed practice created the potential to negatively affect residents' nutritional status and psychosocial well-being.

Inspectors wroteBased on observation, record review, policy review, and resident and staff interviews, it was determine the facility failed to ensure residents were assessed to determined if they were safe to self-administer medication. This was true for 2 of 2 residents (#5 and #7) reviewed for self-administration of medication. This failure created the potential for adverse outcomes if Resident #5 and #7 self-administered their inhaler inappropriately.

Inspectors wroteBased on observation, record review, policy review, and resident and staff interview, it was determined the facility failed to promote and facilitate a resident's ability to make food choices. This was true for 1 of 16 residents (Resident #24) reviewed for accommodation of food choices. This deficient practice placed Resident # 24 at risk for decreased sense of wellbeing and self-worth, and frustration when her food preferences were not accommodated.

Inspectors wroteBased on policy review, record review, review of facility's Grievances, and staff interview, it was determined the facility failed to ensure residents grievances were thoroughly investigated for 1 of 1 resident (Resident #77) whose grievance was reviewed. This failure created the potential for Resident #77 to be subjected for ongoing abuse without detection and intervention.

Inspectors wroteBased on record review, policy review, and interview, it was determined the facility failed to ensure information was provided to the receiving hospital for 1 of 2 residents (Resident #13) reviewed for transfers. This deficient practice had the potential to cause harm if residents were not treated in a timely manner due to lack of information.

Inspectors wroteBased on record review, policy review, and staff interview, the facility failed to ensure a licensed pharmacist reviewed each residents' medications at least monthly, and the physician/prescriber addressed the medications irregularities identified by the pharmacist. This was true for 2 of 5 residents (#3 and #17) whose medications were reviewed. These deficient practices created the potential for harm if residents' medications were administered without a clinical rationale.

Inspectors wroteBased on record review, policy review, observation, and staff interview, the facility failed to ensure that 5 of 13 diabetic residents ( #8, #15, #18, #26, and #85) with insulin medications kits located in their rooms were locked; 1 of 2 medication carts were locked; and daily medication refrigerator temperatures were documented. These deficient practices created the potential for harm if residents and unauthorized personnel accessed medications and they became missing or were administered incorrectly, needles were improperly used, or residents received medications with decreased efficacy from not being stored at the correct temperature.

Inspectors wroteBased on record review, observation, policy review, and staff interview, it was determined the facility failed to ensure infection control prevention practices were maintained to provide a safe and sanitary environment. This was true for 9 of 9 residents (#2, #5, #26, #81, #83, #84, #133, #135, and #137) observed for enhanced barrier precautions. 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 record review, policy review, and staff interview, it was determined the facility failed to ensure newly admitted residents were provided education for pneumococcal vaccines prior to refusing the vaccine. This was true for 5 of 5 residents (#2, #7, #14, #15, and #16) reviewed for pneumococcal immunizations. This failure created the potential for harm should residents contract Pneumococcal pneumonia and experience illness from pneumonia.

Inspectors wroteBased on record review, policy review, grievance review, and resident and staff interview, the facility failed to ensure grievance concerns and/or complaints were thoroughly investigated and resolved to the satisfaction of the complainant without fear of reprisal. This was true for 2 of 4 residents (#7 and #143 ) whose grievances were reviewed. This deficiency had the potential for harm should residents experience a loss of self-worth and psychosocial distress.

Inspectors wroteBased on review of the State Agency's Long Term Care Reporting Portal, record review, grievance report review, and resident and staff interview, it was determined the facility failed to ensure allegations of resident abuse were reported to the State Survey Agency within 2 to 24 hours. This affected 1 of 3 residents (Resident #7) who were reviewed for abuse. This failure created the potential for residents to be subjected to ongoing abuse without detection and protective measures implemented by the facility.

Inspectors wroteBased on record review, policy review, and staff interview, the facility failed to ensure abuse allegations documented on grievance forms were recognized, reported, and investigated for 1 of 3 residents (Resident #7) reviewed for abuse. This failure created the potential for residents to be subjected to ongoing abuse without detection and protective measures implemented by the facility.

Inspectors wroteBased on record review, policy review, and staff interview, it was determined the facility failed to ensure a transfer notice was provided in writing to a resident, their representative, and the Office of the State Long-Term Care Ombudsman prior to transfer. This was true for 1 of 1 residents (Resident #30) reviewed for transfers. The deficient practice created the potential for psychosocial distress if residents and their representatives were not made aware of or able to exercise their rights related to transfer from the facility.

Inspectors wroteBased on record review, policy review, and staff interview, it was determined the facility failed to ensure a bed hold notice was provided to a resident or their representative upon transfer to the hospital. This was true for 1 of 1 resident (Resident #30) reviewed for transfers. This deficient practice created the potential for harm if residents were not informed of their right to return to their former bed/room at the facility within a specified time.

Inspectors wrote2. Resident #26 was admitted to the facility on [DATE], with multiple diagnoses including End Stage Renal Failure. An admission physician order, dated 4/11/24, documented Resident #26 was to receive dialysis every evening on Monday, Wednesday, and Friday for End Stage Renal Disease. Resident #26's Baseline Care Plan, dated 4/12/24, did not include baseline care development for her dialysis. During an interview on 5/2/24 at 2:05 PM, LPN #1 reviewed the process for Resident #26 for dialysis and confirmed the 48-hour care plan did not include dialysis care. During an interview on 5/2/24 at 3:32 PM, the CNO and the CRN reviewed the 48-hour care plan for Resident #26 and confirmed there was no focus or plan of care for dialysis and said there should have been a plan of care for dialysis in place upon admission. [...]

Inspectors wroteBased on record review, policy review, and staff interview, it was determined the facility failed to ensure comprehensive resident-centered care plans were developed and implemented. This was true for 1 of 12 residents (Resident # 26) whose care plans were reviewed. This failure placed Resident #26 at risk of negative outcomes if services were not provided or provided incorrectly due to lack of information in the care plan.

Inspectors wroteBased on record review, protocol review, and resident and staff interview, the facility failed to ensure physician orders for bowel care were followed for a resident. This was true for 1 of 1 resident (Resident #7) reviewed for bowel care. This deficient practice placed Resident #7 at risk for constipation or bowel obstruction.

Inspectors wroteBased on record review, policy review, observation, and staff interview, it was determined the facility failed to ensure to keep accurate and complete clinical records for each resident. This was true for 1 of 12 residents (Resident #7) whose records were reviewed. This deficient practice created the potential for harm if inappropriate care and/or treatment was provided.