Coeur D Alene Health of Cascadia

Inspectors wroteBased on observation, interview, review of the food code, and facility policy review, the facility failed to ensure food was dated as to when it expired, food was sealed, frozen food was appropriately thawed, and failed to ensure towels used to clean countertops were not heavily stained for one of one kitchen with the potential to affect 73 out of 80 resident consuming oral food. This failure had the potential to lead to food borne illnesses.

Inspectors wroteBased on observation, interview, record review, and facility policy review, the facility failed to ensure food was not served in disposable dishes for residents receiving cake. The facility also failed to ensure residents seated at the same table ate at the same time for one of one resident (Resident (R)75) reviewed for dignity in dining out of a total sample of 29 residents. This failure had the potential to cause R75 to feel less dignified.

Inspectors wroteBased on observation, menu and recipe review, interview, and facility policy review, the facility failed to ensure the menu, menu extension, and recipes were followed for six of 29 sample residents (Resident (R) 11, R91, R71, R75, R79, and R81) reviewed for menu compliance in one of one kitchen. This failure had the potential to affect nutritional adequacy for 73 of 80 residents consuming oral food.

Inspectors wroteBased on observation, record review, interview, and facility policy review, the facility failed to ensure food was palatable to include proper temperature during food preparation and holding during meal service for nine of 29 sample residents (Resident (R) 14, R9, R6, R75, R11, R91, R71, R79, and R81) reviewed for food palatability. This failure had the potential to affect resident oral intake resulting in potential weight loss.

Inspectors wroteBased on observation, record review, interview, and facility policy review, the facility failed to ensure medical record accuracy to include an updated order to match the Portable Medical Orders (POST) form for one of 29 sample residents (Resident (R) 10) reviewed for advanced directives. This failure had the potential to lead to inaccurate code status guidance.

Inspectors wroteBased on observation, review of the Food, Drug, Administration (FDA) Food Code, and staff interview it was determined the facility failed to provide employee hand hygiene, beard masks, and a cleaned and sanitized kitchen. This was true for 57 of 76 residents who received food prepared by the facilities kitchen. This deficient practice created the potential for harm by placing residents at risk for potential foodborne illnesses and adverse health outcomes.

Inspectors wroteBased on grievance review and staff interview, it was determined the facility failed to ensure residents were free from abuse and neglect. This was true for 2 of 2 residents (Resident #9 and #3) whose records were reviewed for neglect and 1 of 1 resident (Resident #5) reviewed for abuse. The facility's failure to properly investigate grievances alleging neglect and abuse created the potential for physical harm, pain, and emotional distress.

Inspectors wroteBased on incident and accident (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 2 residents, (Resident #79) whose records were reviewed for falls. This resulted in actual harm to Resident #79.

Inspectors wroteBased on observation, CDC recommendation review, policy review, and staff interview, it was determined the facility failed to ensure infection control and prevention practices were maintained. This failure had the potential to impact all residents in the facility by placing them at risk for cross contamination and transmission of infection.

Inspectors wroteBased on record review, resident interview, and staff interview, it was determined the facility failed to ensure residents received physical therapy services as ordered by their physician. This was true for 5 of 18 residents (#19, #33, #37, #67, and #182) whose records were reviewed for rehabilitative services. This failure created the potential for all residents who required physical therapy services to experience decline in their physical functioning and ability to perform activities of daily living (ADL's) when these services were not provided consistently.

Inspectors wroteBased on record review and staff interview, it was determined the facility failed to ensure a resident's representative was notified when they experienced a change in condition. This was true for 1 of 2 residents (Resident #64) whose records were reviewed for notifications. This failure placed Resident #64 at risk when his family was not able to advocate for his needs.

Inspectors wroteBased on review of the Resident Assessment Instrument (RAI) Manual, record review, and staff interview, it was determined the facility failed to ensure residents' Minimum Data Set (MDS- standardized assessment tool used in nursing facilities to assess residents' health and functional status) assessments included correct information. This was true for 3 of 18 residents (#11, #20, and #44) whose records were reviewed for accuracy. This deficient practice had the potential for negative outcomes if residents were not assessed and/or monitored due to inaccurate assessments.

Inspectors wroteBased on observation, record review, policy review, and staff interview, it was determined the facility failed to ensure resident care plans were revised to reflect current needs and interventions. This was true for 3 of 18 residents (Resident #60, #64, #182) whose care plans were reviewed. This placed residents at risk for adverse outcomes when care plans were not revised to reflect their updated needs.

Inspectors wroteBased on record review and staff interview, it was determined the facility failed to ensure bathing was provided to residents who required assistance. This was true for 1 of 6 residents, (Resident #60) whose records were reviewed for bathing. This failure had the potential for embarrassment and compromised skin integrity due to lack of hygiene.

Inspectors wroteBased on record review and staff interview, it was determined the facility failed to ensure quality care was provided to 1 of 18 residents whose bowel records were reviewed. This was true for Resident #49 when his physician orders were not followed placing him at increased risk for harm.

Inspectors wroteBased on observation, resident interview, staff interview, and record review, it was determined the facility failed to ensure residents are free from pain. This was true for 1 of 2 residents, (Resident #60) whose records were reviewed for pain management. This failure placed Resident #60 at risk of psychosocial harm and functional decline related to unrelieved pain, and not being offered effective pain management.

Inspectors wroteBased on record review and staff interview, it was determined the facility failed to ensure a registered nurse (RN) was on-site for 8 consecutive hours a day, 7 days a week, to provide care to the residents. This was true for 2 of 21 days reviewed for sufficient staffing. This failure placed all residents at risk for harm if their routine and/or emergency needs could not be met without the care of a registered nurse.

Inspectors wroteBased on observation, record review, and staff interview it was determined the facility failed to ensure nurse staffing data was completed accurately, posted daily, and the records were maintained for a minimum of 18 months. This failed practice had the potential to affect the 76 residents residing in the facility, their representatives, and any visitors who would like to review staffing data and census information.

Inspectors wroteBased on observation, policy review, United States Food and Drug Administration (FDA) food code review, and staff interview, it was determined the facility failed to ensure sanitation of nutrition rooms and equipment. This failure had the potential to affect all residents who consumed food or ice from the nutrition rooms and increased the risk for transmission of food born illnesses.

Inspectors wroteBased on observation, policy review, resident interview, food test tray evaluation, and staff interview, it was determined the facility failed to ensure palatable food was served. This was true for 4 of 4 residents (#1, #9, #19 and #35) reviewed for food concerns, and had the potential to affect all residents in the facility who ate food from the kitchen. This failed practice had the potential to negatively affect residents' nutritional status and psychosocial well-being.

Inspectors wroteBased on record review, policy review, review of the Facility Assessment, and staff interview, it was determined the facility failed to ensure the Facility Assessment identified how staffing levels and competencies met resident needs. This had the potential to affect all residents residing in the facility, and created the potential for harm if the facility did not have sufficient and competent staff to provide the necessary care and services for the residents.

Inspectors wroteBased on observation, policy review, and staff interview, it was determined the facility failed to ensure: a) clean laundry was covered appropriately when transported throughout the facility which had the potential to affect all residents in the facility b) Staff performed hand hygiene in between contact with residents in the dining room which was true for 4 residents (#31, #32, #36, and #42) who were observed in the main dining room and required assistance with their meals. These deficient practices created the potential for harm if residents experienced infections from cross contamination.

Inspectors wroteBased on record review, policy review, and staff interview, it was determined the facility failed to ensure residents received information and assistance to exercise their rights to formulate an advance directive. This was true for 3 of 8 residents (#19, #23, and #100) whose records were reviewed for advance directives. This failed practice created the potential for harm if residents' wishes regarding end of life or emergent care were not honored if they became incapacitated.

Inspectors wroteBased on observation, record review, and staff interview, it was determined the facility failed to ensure blood pressure medications were held when the resident's pulse was outside of ordered parameters. This was true for 1 of 5 residents (Resident #9) reviewed for unnecessary medications. This failure created the potential for harm if residents experienced adverse effects from blood pressure medications.

Inspectors wroteBased on staff interview, policy review, and facility training documentation, it was determined the facility failed to ensure each CNA completed the required hours of yearly education. This was true for 3 of 3 CNAs (Staff A, B, and C), who worked at the facility for 1 year or longer. This failure created the potential for incompetent CNAs providing care and increased the risk for harm for 53 of 53 residents living in the facility.

Inspectors wroteBased on record review, policy review, and staff interview, it was determined the facility failed to ensure pertinent information was provided to the receiving facility when a resident was transferred to the hospital. This was true for 1 of 1 resident (Resident #36) who was reviewed for transfer to the hospital. This deficient practice had the potential to cause harm if the resident was not treated appropriately or in a timely manner due to a lack of information.

Inspectors wroteBased on record review, policy review, and staff interview, it was determined the facility failed to ensure a written notice of transfer was provided to the resident and the State Long Term Care ombudsman when a resident was transferred to the hospital. This was true for 1 of 1 resident (Resident #36) who was reviewed for transfer to the hospital. This deficient practice had the potential to cause 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 ensure a bed hold notice was provided to the resident and/or their representative when a resident was transferred to the hospital. This was true for 1 of 1 resident (Resident #36) who was reviewed for transfer to the hospital. 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 wroteBased on observation, staff and resident interview, and record review, it was determined the facility failed to ensure a resident's bed safety assessments were documented accurately. This was true for 1 of 1 resident (Resident #35) whose bed safety assessments were reviewed. This failure created the potential for harm if residents received an injury due to inaccurate resident assessments.

Inspectors wroteBased on record review, policy review, and resident and staff interview, it was determined the facility failed to ensure care conferences were held regularly and included the resident when possible. This was true for 2 of 14 residents (#9 and #35) whose care plans were reviewed. This failure created the potential for inappropriate care and services which did not meet the resident's current needs.

Inspectors wroteBased on observation, record review, policy review, and resident and staff interview, it was determined the facility failed to ensure residents' hygiene and grooming were appropriately maintained. This was true for 1 of 14 residents (Resident #28) who were reviewed for ADLs. This failure had the potential to cause psychosocial distress if residents experienced embarrassment, isolation, decreased sense of self-worth, and/or decreased sense of well-being.

Inspectors wroteBased on record review, policy review, and staff interview, it was determined the facility failed to ensure residents were consistently provided adequate nutritional interventions to prevent significant unplanned weight loss. This was true for 1 of 1 resident (Resident #27) who was reviewed for weight loss. This failure created the potential for harm if residents experienced a loss in functional ADLs due to muscle loss and/or weakness.

Inspectors wroteBased on observation, staff and resident interview, and record review, it was determined the facility failed to ensure a resident was appropriately assessed and a physician's order was obtained prior to installing side rails. This was true for 1 of 1 resident (Resident #35) who was reviewed for side rails. This created the potential for harm from entrapment or injury related to the use of side rails.

Inspectors wroteBased on record review and staff interview, it was determined the facility failed to ensure residents were monitored appropriately while receiving anti-diabetic medications. This was true for 1 of 5 residents (Resident #101) reviewed for unnecessary medications. This failure created the potential for harm if residents experienced adverse reactions due to a lack of appropriate monitoring.

Inspectors wroteBased on record review, policy review, and staff interview, it was determined the facility failed to ensure hospice documentation included a physician statement of terminal illness. This was true for 1 of 1 resident (Resident #7) reviewed for hospice care. This failure created the potential for harm if residents received inappropriate hospice care.