Cascadia of Nampa

Inspectors wroteBased on record review, interview, review of the facility's neglect investigation, and clinical guidance, the facility failed to ensure 1 resident (#60), out of 1 resident reviewed, received treatment and care in accordance with professional standards of practice when they: 1) failed to document regular assessment of the resident's surgical wound; 2) failed to immediately implement provider orders when sepsis was diagnosed; and 3) failed to transfer the resident to a higher level of care when the resident's condition met the facility's change of condition criteria. [...]

Inspectors wroteBased on observation, the 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 all facility residents who consumed food or ice 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 the review of the Facility's Arbitration agreement and staff interview, it was determined the facility failed to ensure the facility's arbitration agreement provides the selection of a venue that is convenient to both parties. This was true for all residents who reside in the facility. This failure created the potential for residents to be inconvenienced or the inability to participate during the arbitration process.

Inspectors wroteBased on observation, interview, and policy review, it was determined the facility failed to ensure infection control measures were consistently implemented. This was true for 5 of 5 residents (#2, #16, #39, #49, and #61) when staff failed to perform effective hand hygiene during medication preparation, and for all resident's using the facility's laundry services. The facility failed to practice standard based precautions when preparing medications and handle, store, process, and transport linens to prevent the spread of infection. These failures created the potential for the spread of infection among all residents.

Inspectors wroteBased on policy review, observation, record review, and resident and staff interview, it was determined the facility failed to serve palatable food to facility residents who were interviewed about food temperature and taste. This was true for all residents who consumed food and coffee prepared by the kitchen and facility staff. This had the potential to create dissatisfaction with meals and decrease residents' quality of life.

Inspectors wroteBased on observation, record review, policy review, and interviews, it was determined the facility failed to ensure residents were assessed for safety to self-administer medication. This was true for 3 of 19 residents (#49, #52 and #87) whose medications were observed at bedside. This failure created the potential for adverse outcome if residents were to administer their medication inappropriately.

Inspectors wroteBased on record review, observation and interview, it was determined the facility failed to ensure residents received services in the facility with reasonable accommodation of resident needs and preferences when they were denied access to the call light system while left alone in their room. This was true for 2 of 19 residents (#28 and #89) whose call lights were observed. This deficient practice had the potential for harm if residents could not alert staff for assistance when needed.

Inspectors wroteBased on observation, record review, and staff interview it was determined the facility failed to ensure accurate MDS Assessments. This was true for 1 of 5 residents (Resident #1) reviewed for accuracy of assessments. This deficient practice had the potential to create harm if residents did not have an accurate MDS assessment.

Inspectors wroteBased on record review and staff interviews, the facility failed to ensure coordination of assessments with the PASARR program for 1 of 2 residents (Resident #9) reviewed for PASARR coordination. This failure created the potential for residents with a mental disorders or intellectual disabilities to miss care and services in the most integrated care setting appropriate to their needs.

Inspectors wroteBased on policy review, record review, and staff interview, it was determined the facility failed to ensure a PASARR was accurately completed for 1 of 2 residents (Resident #44) reviewed for PASARR screenings. This deficient practice created the potential for harm if Resident #44 required, but did not receive, specialized services for mental health while residing in the facility.

Inspectors wroteBased on observation, record review, and staff interview, it was determined the facility failed to provide accurate and quarterly smoking evaluations and did not follow the care plan. This was true for 1 of 2 residents (Resident #90) reviewed for smoking. This deficient practice had the potential for harm if smoking assessment evaluation safety procedures were not followed.

Inspectors wroteBased on observation, record review, and staff interview, it was determined the facility failed to ensure residents received respiratory services consistent with physician's order and/or their care plan. This was true for 1 of 3 residents (Resident #1) reviewed for oxygen use. This deficient practice created the potential for harm if Resident #1's respiratory needs were not met.

Inspectors wroteBased on policy review, review of McGeer's Criteria Surveillance for Infection, and staff interviews, it was determined the facility failed to ensure antibiotic stewardship was implemented and residents had appropriate clinical indications for the use of antibiotic. This was true for 1 of 1 resident (Resident #1) whose record was reviewed for antibiotic use. This deficient practice created the potential for Resident #1 to receive unnecessary treatment for a suspected urinary tract infection and/or develop multi-drug-resistant organism.

Inspectors wroteBased on observation, policy review, and staff interview, it was determined the facility failed to ensure waste was properly contained with lids or otherwise covered. This created the potential for insect and pest infestation of the facility's premises and had the potential to adversely affect all 90 residents residing in the facility.

Inspectors wroteBased on facility document review, record review, observation, and resident and staff interview, it was determined the facility failed to ensure residents' rights for self-determination was honored. This was true for 3 of 3 residents (#5, #35, and #49) reviewed for choices. This deficient practice had the potential for Resident #5, #35, and #49 to experience a decreased sense of well-being, lack of self-worth, and frustration when their preference for having the television (TV) on in the dining room during meals was not accommodated.

Inspectors wroteBased on observation, record review, policy review, and staff interview, it was determined the facility failed to ensure a fall prevention intervention was implemented following a fall. This was true for 1 of 3 residents (Resident #10) whose records were reviewed. This had the potential for harm if the resident sustained an injury from a fall.

Inspectors wroteBased on policy review, record review and staff interview, it was determined the facility failed to ensure residents were offered a pneumococcal vaccine they were eligible to receive. This was true for 2 of 5 residents (#31 and #52) whose records were reviewed for pneumococcal vaccinations. This failure created the potential for residents to have an increased risk of pneumococcal (bacterial) pneumonia and the potential for severe illness or death.

Inspectors wroteBased on observation, record review, staff interview, resident interview, and review of facility policies, it was determined the facility failed to implement interventions to prevent the worsening of pressure ulcers and ensure pressure ulcer prevention interventions were followed. This was true for 2 of 2 resident (Resident #1 and #318) reviewed for pressure ulcers. This deficient practice caused harm to Resident #318 when she developed Stage 2 pressure ulcers on her buttocks and placed Resident #1 at risk of developing pressure ulcers.

Inspectors wroteBased on observation, staff interview, and record review, the facility failed to ensure the dishwasher was maintained at an appropriate rinse temperature to ensure the dishes and utensils were sanitized, and failed to ensure food was placed on and held at a safe temperature on the steam table. These deficient practices placed the 79 of 79 residents who resided in the facility (each consumed food prepared by the facility) at risk of contracting foodborne illnesses.

Inspectors wroteBased on resident and staff interview, policy review, review of meeting minutes, and record review, it was determined the facility failed to provide guidance to assist the Resident Council group with agenda items to address and discuss facility policies/rules, concerns and grievances, and requests that resulted from the group meetings, and failed to act promptly to resolve and respond to requests from the group meetings. This was true for 13 of 13 (#3, #4, #7, #15, #16, #19, #28, #32, #36, #38, #41, #50, and #53) residents who attended the Resident Group Meeting. These negative practices placed residents at risk of ongoing frustration and decreased sense of self-worth, as well as, unmet care needs, when issues of concern to them were not promptly addressed by the facility.

Inspectors wrote5. Resident #43 was admitted to the facility on [DATE], with multiple diagnosis including type II diabetes and cerebrovascular (related to blood vessels of the brain) disease. Resident #43's POST, dated 12/18/18, documented a code status of Full Code. The POST section for Advance Directives to identify a Living Will was blank. Resident #43's care conference note, dated 12/27/18, documented the Advance Directive was reviewed and continued. On 1/30/19 at 10:41 AM, Resident #43 said he had a living will. On 1/30/19 at 4:12 PM, Resident #43's spouse said she was unsure if a copy of the living had been provided to the facility, and said she had a copy of the living will in the car, if the facility needed it. On 1/31/19 at 10:04 AM, the Social Worker said she knew Resident #43 had a living will, and did not see a copy of it in his chart. 4. [...]

Inspectors wroteBased on record review, policy review, review of meeting minutes, and resident, family member, and staff interview, it was determined the facility failed to ensure grievances were responded to, investigated, and prompt corrective action taken to resolve the grievances. This was true for 4 of 21 residents (#1, #24, #41, and #64) reviewed for grievances and 13 of 13 residents (#3, #4, #7, #15, #16, #19, #28, #32, #36, #38, #41, #50, and #53) who participated in the Resident Group Interview. This failure created the potential for harm if residents' grievances, both verbal and written, were not acted upon and residents did not receive appropriate care or were at risk for abuse or neglect.

Inspectors wroteBased on resident, family, and staff interview and record review, it was determined the facility failed to ensure care plans were reviewed and/or revised, and failed to ensure residents and/or resident representatives were involved in the development of the care plan for 9 of 22 residents (Residents #1, #7, #14, #15, #32, #54, #64, #267, and #318) whose care plans were reviewed. This failure created the potential for harm should residents receive inappropriate care due to inaccurate information on their care plan and should residents' input not be considered on the care plan.

Inspectors wrote4. Resident #7 was admitted to the facility on [DATE], with multiple diagnoses including history of falls, cognitive communication deficit, difficulty walking, and generalized muscle weakness. Resident #7's admission MDS assessment, dated 6/28/18, documented she was cognitively intact, family involvement in discussions about her care was very important, and she required the assistance of one person for bathing. Resident #7's care plan, dated 1/6/19, directed staff to provide Resident #7 with one shower a week. Resident #7's bathing/shower flowsheets and nurses' progress notes, dated 10/1/18 through 1/26/19, documented missing shower entries. The flowsheets documented if Resident #7 refused, to please call her daughter and notify social services. Showers should have been provided for Resident #7 on Sundays and Thursdays. Resident #7 did not receive baths/showers as follows: [...]

Inspectors wrote2. Resident #1 was admitted to the facility on [DATE] with multiple diagnoses, including difficulty in walking, generalized muscle weakness, history of falls, and unspecified dementia without behavioral disturbances. Resident #1's admission MDS, dated [DATE], and quarterly MDS, dated [DATE], documented he had severe cognitive impairment. He required extensive assistance of staff for bed mobility, transfers, dressing, personal hygiene, and toileting, was totally dependent on staff for bathing, and required limited assistance to walk in room and eat. He was not steady or able to balance with transfers. Resident #1's care plan for falls, revised on 12/24/18, documented he was at risk for falls due to having actual falls with no injuries and due to having dementia with poor safety awareness, poor balance, confusion, vision/hearing problems, and having an unsteady gait. [...]

Inspectors wrote3. Resident #1 was admitted to the facility on [DATE], with multiple diagnoses including a history of falls, difficulty walking, muscle weakness, and dementia without behavioral disturbances. Resident #1's admission MDS assessment and the quarterly MDS assessment, dated 09/20/18 and 12/20/18, respectively, documented he was severely cognitively impaired, required extensive assistance of staff for bed mobility, transfers, dressing, and toileting; and required limited assistance to walk in his room and eat; and he was not steady or able to balance with transfers. Resident #1's care plan, revised on 12/24/18, directed staff that he was at risk for falls due to actual falls with no injuries and due to dementia with poor safety awareness, poor balance, poor communication/comprehension, confusion, incontinence, vision/hearing problems, and unsteady gait. [...]

Inspectors wroteBased on observation, resident and staff interview, and record review, it was determined the facility failed to ensure 2 of 2 residents (#15 and #168) reviewed for self-administration of medications were clinically appropriate to do so prior to allowing them to self-administer medications. This had the potential for harm should the residents administer medications contrary to physician orders.

Inspectors wroteBased on record review, policy review, and resident and staff interviews, it was determined the facility failed to ensure a resident's physician and representative were notified of significant changes in the resident's clinical condition in a timely manner. This was true for 1 of 3 residents (Resident #319) reviewed for notification of changes. This failure created the potential for harm when the facility failed to immediately notify Resident #319's physician and family member of his decreased level of consciousness.

Inspectors wroteBased on observation, policy review, and resident and staff interview, it was determined the facility failed to ensure the residents' living environment was homelike. This was true for 4 of 22 residents (#16, #24, #29, and #41) reviewed for homelike environment. This failure created the potential for diminished quality of life and psychosocial harm for those residents with room wall damage.

Inspectors wroteBased on record review, policy review, and staff interview, it was determined the facility failed to ensure the required documentation was completed when a resident was transferred to the hospital. This was true for 1 of 3 residents (#318) reviewed for transfer or discharge, and had the potential for harm if the required documentation was not obtained from the physician and the pertinent information made available to the receiving facility.

Inspectors wroteBased on record review, policy review, and staff interview, it was determined the facility failed to ensure a notice of transfer was provided in writing to a resident and/or her representative when she was transferred to the hospital. This was true for 1 of 3 residents (#318) reviewed for transfer or discharge, and had the potential for harm if residents were not made aware of or able to exercise their rights related to transfers.

Inspectors wroteBased on record review, policy review, and staff interview, it was determined the facility failed to complete a comprehensive assessment when a resident experienced a significant change in health and functional status. This was true for 1 of 1 resident (#65) reviewed for hospice. This had the potential for harm if facility staff did not recognize changes in the resident's health status and needs.

Inspectors wroteBased on observation, record review, policy review, and staff interview, it was determined the facility failed to develop and implement comprehensive resident-centered care plans to include code status and assistance with eating. This was true for 2 of 21 residents (#40 and #43) who were reviewed for care plans. This failure created the potential for harm if residents received inappropriate or inadequate care, and if their resuscitation code status wishes were not honored.

Inspectors wroteBased on record review, policy review, and resident and staff interview, it was determined the facility failed to ensure residents received treatment and services to prevent further decrease in ROM (range of motion). This was true for 1 of 5 residents (#38) reviewed for treatment and services related to ROM. This deficient practice placed residents at risk of experiencing a decrease in mobility and function due to lack of active ROM (AROM) or passive ROM (PROM) services.

Inspectors wroteBased on staff interview, policy review, and record review, it was determined the facility failed to ensure the bowel protocol was followed and implemented for 1 of 2 residents (#267) reviewed for bowel and bladder care. This had the potential to place residents at risk for fecal impaction.

Inspectors wroteBased on staff interview and record review, it was determined the facility failed to ensure residents' weights were monitored in accordance with their nutritional assessment and plan of care. This was true for 1 of of 8 residents (#44) reviewed for weight loss. This failure created the potential for harm if Resident #44 experience further weight loss and interventions were not in place in timely manner.

Inspectors wroteBased on record review, facility policy review, observation, and interviews with staff and a resident, it was determined the facility failed to ensure a physician's order was in place prior to a resident receiving oxygen therapy. This was true for 1 of 1 resident (#318) reviewed for oxygen. This failure created the potential for harm if residents received oxygen inconsistent with physician orders.

Inspectors wroteBased on observation, policy review, record review, and interviews with staff and a resident's family member, it was determined the facility failed to ensure that prior to the placement of bed rails, residents were thoroughly assessed for the risk of entrapment and a consent was in place. This was true for 1 of 4 residents (#54) reviewed for bed rail use, and created the potential for harm from entrapment or injury related to the use of bed rails.