Clarkston Health and Rehab of Cascadia

Inspectors wroteBased on observation and interview, the facility failed to post survey results in a place readily accessible and frequented by most residents, as required. This failure placed residents at risk of being unable to exercise their resident rights.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure meals were served at palatable temperatures for 2 of 6 sampled residents (Residents 17 and 42) reviewed and 1 of 1 meal test trays sampled. This failure put residents at risk of decreased enjoyment of their meals, and possible reduced dietary intake.

Inspectors wroteBased on observation, interview, and record review, the facility failed to store food in accordance with professional standards for food service safety. Specifically, food was not labeled, dated or discarded when expired for 5 of 5 refrigerators, and 1 of 1 dry storage areas. The facility failed to perform hand hygiene when indicated during the meal service and to maintain a clean cooking environment. These failures placed residents at risk for foodborne illnesses.

Inspectors wroteBased on interview and record review, the facility failed to ensure Pre-admission Screening and Resident Review (PASARR, an assessment completed prior to admission into a skilled nursing facility to determine whether a resident with a diagnosis of a serious mental illness needed specialized mental health services) was accurately completed prior to admission, and if indicated, a referral for a PASARR Level II (a more in-depth screening assessment) was made for 3 of 7 sampled residents (Residents 1, 24, and 70), reviewed for PASARR. Specifically, Resident 1 and 24's PASSAR Level I was inaccurately completed prior to admission. In addition, Resident 1 admitted to the facility with an exempted hospital stay and should have been referred for a Level II evaluation after they remained in the facility for more than 30 days. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to revise comprehensive care plans for 4 of 5 sampled residents (Residents 81, 5, 22 and 9) whose care plans were reviewed for pressure ulcers, restorative nursing programs, dental care, and advanced directives. Additionally, the facility failed to ensure Resident 42 and/or their representative were offered the opportunity to participate in care planning. These failures 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 ensure it implemented its protocol for the management of constipation for 2 of 5 residents (Residents 70 and 83) whose records were reviewed for constipation and to ensure physician orders were in place for specific medication dose administration (Resident 22) and wound dressings (Resident 81). These failures placed the residents at risk for medication errors, deterioration of non-pressure skin conditions, and constipation-associated complications, like fecal impaction (where hardened, dry stool accumulates in the colon or rectum, blocking the passage of waste).

Inspectors wroteBased on interview and record review the facility failed to repeatedly ensure registered nursing assistants (NAR) obtained their nursing assistant certification (NAC) within 120 days of hire and had the required paperwork on file to include a certification of completion of NAC program or Department of Health (DOH) authorization to test, passed skills test score sheet e-mail from Washington State Board of Nursing (WABON), passed online written test sheet from Credentia (a company that provided oversight and scheduling services for nurse aide certification exams), and the completed NAR certification application attestation form to continue to work beyond the 120-day deadline, as required for 6 of 6 sampled staff (Staff K, L, M, N, O, and P), reviewed for staffing. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure complete and accurate medical records for 6 of 25 sampled residents (Residents 1, 5, 8, 9, 22 and 86) whose medical records were reviewed. Specifically, the facility failed to ensure Resident 8 and 5's care conference documents (to include a complete resident identifier for Resident 5), Resident 5's visit summaries from a dental appointment, Resident 9's Psychosocial History Document (to include a complete resident identifier), Resident 22's clinic and lab results from a community provider appointment, Resident 1's smoking assessment, and Resident 86's bed hold notice were present and easily accessible in their medical records. These failures placed the residents at risk for a delay in care or services.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure an allegation of staff- to-resident rough handling was reported to the Administrator or designee and to the State Agency (SA) within the required timeframe for 1 of 1 sampled residents (Resident 81) reviewed for abuse. This failure placed the resident and other residents at risk for potential physical abuse and precluded the SA from being aware of and investigating the circumstances surrounding the resident's allegation.

Inspectors wroteBased on interview and record review the facility failed to ensure the appropriate minimum information to include contact information of the practitioner responsible for the care of the resident, resident representative contact information, advanced directive information, comprehensive care plan goals, any special instructions and/or precautions for ongoing care, and all other necessary information was communicated to hospital at time of transfer, as required for 1 of 3 sampled residents (Resident 86) whose closed records were reviewed. This failure placed residents at risk of potential delays in emergent hospital treatment, potential medical complications, and diminished quality of life.

Inspectors wroteBased on interview and record review the facility failed to develop and implement a comprehensive person-centered care plan with measurable objectives and services to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being for 1 of 3 sampled residents (Resident 1), reviewed for smoking. This failure placed residents at risk of potentially avoidable accidents, unmet care needs, and diminished quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the periodic review and monitoring of splint and/or brace wear and effectively address refusals of the Restorative Nursing Program (RNP) for 2 of 2 sampled residents (Residents 22 and 81) reviewed for limited range of motion (ROM, the full movement potential of a joint or series of joints). These failures placed the resident at risk of worsening contractures (a medical condition where muscle, tendon, or other soft tissue becomes abnormally tight and shortened, limiting the ROM at a joint) and diminished quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure residents received appropriate care and services to minimize the risk of associated urinary tract infections for 1 of 1 sampled residents (Resident 8), reviewed for catheter (a flexible tube inserted into the bladder to drain urine) care. This failure placed the resident at risk for urinary tract infections.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure residents were given their medications as ordered for 1 of 5 sampled residents (Resident 70) reviewed for medication management. This failure placed residents at risk of exacerbations of their chronic health conditions, and unintended consequences when doses of their medications were omitted.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure it coordinated follow-up appointments with the denturist (a person who made dentures) for 1 of 1 sampled resident (Resident 5) reviewed for dental needs. This failure placed Resident 5 at risk of discomfort or pain from ill-fitting dentures, weight loss and decreased self-esteem.

Inspectors wroteBased on observation, interview, and record review, the facility failed to perform hand hygiene when indicated during 2 of 3 medication administration observations. Additionally, the facility failed to ensure enhanced barrier precautions (EBP, use of personal protective equipment such as disposable gowns and gloves when providing high contact types of care for residents with drains, tubes, or colonized with antibiotic resistant bacteria) were implemented and followed when indicated or ensure PPE was readily available for 2 of 3 sampled residents (Residents 1 and 6), reviewed for infection control. This failure placed residents at risk for potential unintended health consequences, the potential spread of infectious diseases or organisms resistant to antibiotics, and diminished quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the use of an indwelling urinary catheter (a tube which drains urine from the bladder into a collection bag) was properly monitored to ensure it was functioning for 2 of 2 sampled residents (Residents 1 & 3), reviewed for urinary catheters. This failure placed the residents at risk for complications, prolonged therapy, and unmet care needs.

Inspectors wroteBased on interview and record review, the facility failed to ensure 1 of 3 sample residents (Resident 1), reviewed for medication administration, received medications appropriately, in accordance with the physician's order. This failure resulted in a pattern of significant medication errors which placed the resident at risk for medical decline, discomfort, and a diminished quality of life.

Inspectors wroteBased on interview and record review, the facility failed to implement their Abuse and Neglect Prohibition Policies and Procedures to include, not reporting allegations of abuse to the State Agency (SA) within the required timeframe and completing thorough investigations for 1 of 3 sampled residents (Resident 1), reviewed for abuse/misappropriation. This failure placed the resident and other residents at risk for abuse/misappropriation.

Inspectors wroteBased on interview and record review, the facility failed to inform the Resident Representative (RR) of changes to the resident's weight, treatments, wound status, medication changes, refusals of treatments, and changes in condition for one (1) of 4 residents reviewed for the right to be informed of care for a span of five months. This failure precluded the RR from the opportunity to contribute to help Resident 1 make an informed decision related to medication and treatment changes and move forward with the treatment options being proposed.

Inspectors wroteBased on interview and record review, the facility failed to ensure 1 of 4 residents (Resident 1) reviewed for dental services received adequate pain management and timely dental services for an impacted wisdom tooth and abscess. This failure placed residents at increased risk of pain, unmet dental needs, and a diminished quality of life.

Inspectors wroteBased on observation and interview, the facility failed to monitor the temperature of food being served, failed to ensure a resident's meal tray (9) was discarded timely, and failed to prepare food in a sanitary manner. These failures placed the residents at risk for food borne illnesses and decreased quality of life.

Inspectors wroteBased on interview and record review, the facility failed to ensure 4 of 5 sampled residents (117, 53, 2, and 55), reviewed for unnecessary medications, were informed of the potential risks and benefits associated with the use of psychotropic medications (medications that can affect the mind, emotions, and behaviors). Failure to obtain the informed consents and/or include necessary information about the medication such as reasons for taking and benefits resulted in the resident and/or representative not being fully informed.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure 1 of 5 sample residents (56), reviewed for medication management, received adequate monitoring to ensure appropriate administration of a high-risk medication. Failure to monitor edema (excess fluid in the tissues) placed the residents at risk for compromised heart health. In addition, the facility failed to ensure timely bowel care was provided for 3 of 3 sample residents (9,10, and 55) reviewed for constipation which placed the residents at risk for constipation and unmet care needs.

Inspectors wroteBased on observation and interview, the facility failed to ensure medication boxes/kits which contained controlled medications (medications that have a high risk for abuse such as narcotics, anti-anxiety, hypnotic and hallucinogenic) and stored in the medication refrigerators were affixed as required for 2 of 2 medication rooms reviewed for medication storage. In addition, the facility failed to consistently monitor the medication refrigerator temperatures to ensure they were at safe storage levels. These failures placed residents at risk for receiving compromised or ineffective medication and placed the facility at risk for potential diversion or misappropriation of narcotic medications.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure resident medical records were complete and accurate, in accordance with accepted professional standards and practices, for 2 of 2 sampled residents (1, 50) reviewed for abuse, 1 of 1 sampled resident reviewed for activities (2), and 1 of 1 sampled resident (12) reviewed for care planning. Failure to document pertinent resident information placed the residents at risk for unmet care needs, decreased continuity of care, and diminished quality of life. In addition, the facility failed to provide access timely to resident records for 15 of 17 sampled residents (169, 62, 1, 16, 2, 53, 167, 33, 55, 58, 3, 117, 25, 18, and 56) reviewed for Advance Directives, and failed to timely provide the facility staffing documentation that had been requested for review of the sufficient staffing task.

Inspectors wroteBased on observation and interview, the facility failed to ensure appropriate hand hygiene was performed during the meal service for 1 of 3 dining rooms, and during wound care for 1 of 1 sampled residents (58) reviewed for non-pressure wounds. These failures placed the residents at risk for infections and unmet care needs.

Inspectors wroteBased on interview and record review, the facility failed to ensure investigations related to allegations of abuse/neglect were initiated, thorough, and completed timely for 2 of 2 sampled residents (1, 50), reviewed for abuse. These failures placed the residents at risk for repeated incidents and potential abuse.

Inspectors wroteBased on interview and record review, the facility failed to ensure a Pre-admission Screening and Resident Review (PASARR) [an assessment used to identify people referred to nursing facilities with mental illness, intellectual disabilities, or related conditions], was completed for 2 of 5 sampled residents (50, 55), reviewed for PASARR services. This failure placed the residents at risk for inappropriate placement, and/or not receiving timely and necessary services to meet mental health care needs.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure 2 of 3 sampled residents (53, 12) reviewed for activities of daily living, received assistance with grooming and maintaining clean glasses. These failures placed residents at risk for poor hygiene and impaired vision.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure 1 of 1 sampled residents (2) reviewed for activities, received an ongoing program of activities that met their interests. Failure to assess the resident's activity preferences placed the resident at risk for boredom and diminished quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure nutritional supplements were offered as ordered for 1 of 5 sampled residents (9), reviewed for nutrition. This failure placed the resident, who had experienced significant weight loss, at risk for further loss.

Inspectors wroteBased on interview and record review, the facility failed to complete performance reviews at least once every 12 months, and provide in-service education based on the outcome of the reviews as required, for 1 of 5 sampled staff (L), whose records were reviewed. This failure placed residents at risk for receiving care from inadequately trained staff.

Inspectors wrote<Resident 16> Per the 12/26/2023 quarterly assessment, Resident 16 had diagnoses including kidney failure and diabetes (a disease in which your body does not make enough insulin). Review of the physciain orders showed on 07/03/2023, Resident 16 was presecribed Lispro (sliding scale insulin, a hormone used to treat diabetes and given based on blood glucose levels). The July, August, and September 2023 Monthly Medication Review (MMR) documented a recommendation to discontinue the sliding scale insulin as mentioned above and no response was obtained. The October 2023 MMR documented a recommendation to discontinue the Lispro insulin sliding scale and the physician responded on 11/10/23, nearly four months since the recommendation was first made. Reference: [...]

Inspectors wroteBased on interview, and record review, the facility failed to ensure that orders for as needed (PRN) psychotropic medication (a type of medication used to affect mood, behavior, and perceptions) was limited to14 days, and was given for an appropriate diagnosis for 1 of 5 sampled residents (55). These failures placed the residents at risk for unintended medication side effects and a decreased quality of life.

Inspectors wroteBased on interview and record review, the facility failed to employ sufficient staff with the appropriate licensing necessary to carry out the functions of the nutritional services for 68 residents. Failure to ensure Staff J, Registered Dietician (RD) had a license to practice in Washington State placed residents at risk for unmet nutritional needs and possible unintended weight loss or gain.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure dietary staff had the required qualifications (current Food Worker Cards) for one dietary staff (W). This failed practice had the potential risk for unsafe food handling practices and placed all residents at risk for developing foodborne illness.

Inspectors wroteBased on interview and record review, the facility failed to ensure an injury of unknown origin was reported to the State Survey Agency as required, for 1 of 3 sampled residents (Resident 1), reviewed for abuse. Failure to report potential abuse placed Resident 1 and additional residents in the facility at risk for uninvestigated abuse, mistreatment, and poor quality of life.

Inspectors wroteBased on interview and record review, the facility failed to ensure intravenous (IV) services were provided in accordance with professional standards of practice for 1 of 1 sample residents (Resident 2) reviewed for IV therapy. The facility failed to provide Peripherally Inserted Central Catheter (PICC, a long, thin tube that's inserted through a vein in the arm and passed through to the larger veins near the heart) care, maintenance and monitoring to include changing needleless injection caps, flushes, dressing changes, monitoring the external length to verify the line had not migrated, and monitoring insertion site for signs and symptoms of infection. These failures placed the resident at risk for loss of vascular access, infection, and other potential negative outcomes.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure anticoagulant (AC) medication (medication that stops blood from clotting) side effects were consistently monitored for 3 of 4 sampled residents (Residents 1, 5 and 6), reviewed for unnecessary medications. This failure caused Resident 1 re-hospitalization and treatment to reverse blood thinning and placed additional residents at risk of experiencing medication side-effects and a diminished quality of life.

Inspectors wroteBased on interview and record review, the facility failed to ensure the resident and/or the resident's representative was informed of and consented to a new medication for 1 of 3 residents (Resident 1), reviewed for care planning. This failure disallowed the resident and/or the resident representative to make an informed decision regarding treatment, and placed the resident at risk of diminished quality of life.

Inspectors wroteBased on interview and record review the facility failed to provide the necessary care and services for 1 of 2 residents (Resident 6), reviewed for non-pressure skin wounds. Failure to perform wound treatments as ordered placed the resident at risk for delayed wound healing, worsening of wounds, and/or potential infection and a diminished quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to accurately assess and document pain levels and administer pain medication timely as ordered/needed for 1 of 3 sampled residents (267), reviewed for pain. These failures caused actual harm to the resident, who experienced inadequate pain control and a diminished quality of life.

Inspectors wroteBased on observation and interview, the facility failed to ensure multiple food items in the kitchen were properly labeled, and that out-of-date foods were identified and discarded. In addition, the facility failed to ensure unpasteurized eggs were not used for foods not fully cooked. The failure to properly label foods, ensure the visibility of Best By dates, and use pasteurized eggs, placed residents at risk for consuming expired/spoiled foods and exposure to food borne illness.

Inspectors wroteBased on interview and record review, the facility failed to ensure residents' records had complete and readily accessible Advance Directives and Vaccination Consents for 6 residents (6, 12, 25, 26, 33, and 47) of 15 residents whose records were reviewed for Advance Directives and immunizations. This failure placed the residents at risk for unmet care needs.

Inspectors wroteBased on observation, interview, and record review, the facility failed to develop thorough policies, and implement abuse and neglect prevention policies and procedures including, identifying, reporting, and investigating abuse, and protection of residents after verbal reports of rough handling during care were made, for 2 of 4 sampled residents (39, 31), reviewed for abuse. This failure placed the residents at risk for potential abuse, neglect, and unmet care needs.

Inspectors wroteBased on interview and record review, the facility failed to report resident verbal reports of rough handling during care as an allegations of abuse for 2 of 4 sampled residents (39, 31), reviewed for abuse. This failure placed the residents at risk for potential abuse, neglect, and unmet care needs.

Inspectors wroteBased on interview and record review, the facility failed to thoroughly investigate resident verbal reports of rough handling during care as allegations of abuse for 2 residents of 4 sampled residents (39, 31), reviewed for abuse. This failure placed the residents at risk for potential abuse, neglect, and unmet care needs.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide grooming for 1 of 3 sampled residents (40), reviewed for activities of daily living. This failure placed the resident at risk for poor personal hygiene and a diminished quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to implement bowel protocol orders as instructed for 1 of 5 sampled residents (25), reviewed for unnecessary medications. In addition, the facility failed to ensure care and services were provided for 2 of 4 sampled residents (43, 267) reviewed for non-pressure skin conditions. Failure to treat Resident 25's constipation, consistently monitor blood pressure for Resident 43, and obtain wound care orders for Resident 267 placed the residents at risk for clinical complications and unmet care needs.

Inspectors wroteBased on interview and record review, the facility failed to show adequate indication for the use of a seizure medication for 1 of 5 sampled residents (25), reviewed for unnecessary medications. This failure placed the resident at risk for receiving an unnecessary medication, and its adverse outcomes.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure a medication error rate of less than 5 percent. Three medication errors were identified for 2 of 3 sampled residents (78,16), observed during 29 medication opportunities, resulting in a medication error rate of 10.34 percent. Errors in medication administration had the potential to place residents at risk for not receiving the full therapeutic effect of the medication.

Inspectors wroteBased on observation and interview, the facility failed to maintain a clean, comfortable, homelike, and safe environment for 3 of 17 rooms (211, 213, 106), sampled for a safe and sanitary environment. Failure to ensure that the facility was free from damaged walls and a broken door, placed the residents (25, 33, 38) at risk for injury and a decreased quality of life.