Columbia Basin Hospital

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure refrigerated medications were stored at proper temperatures in 1 of 1 medication refrigerator. The failure placed residents at risk of medications that could cause unintended outcomes due to improper storage. Findings Include. Review of the TUBERSOL(R) Tuberculin Purified Protein Derivative ([PPD], a serum used in a skin test to help diagnose tuberculosis infection) manufacturer's package insert showed the medication should be stored as follows: Refrigeration: Store at 2 degrees to 8 degrees Celsius (C) (35degrees to 46 degrees Fahrenheit [F]). No Freezing: Do not freeze; discard if the product has been exposed to freezing temperatures. Light Protection: Always protect from light (e.g., store in a brown paper bag). Opened Vial Stability: Once opened, the vial should be discarded after 30 days. [...]

Inspectors wroteBased on interview and record review, the facility failed to provide the Skilled Nursing Facility Advanced Beneficiary Notice of Non-Coverage (SNF ABN) for 3 of 3 residents (Resident 2. 10, and 12) reviewed for Beneficiary Notices. This failure placed residents and/or their representatives at risk of not having adequate information to make financial decisions related to the residents' stay within the facility.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure a safe, clean, comfortable, and homelike environment was maintained for 3 of 11 resident rooms (rooms [ROOM NUMBER]) reviewed for environment. This failure placed residents at risk for potential injury, diminished quality of life, and a lack of security within their environment.

Inspectors wroteBased on interview and record review, the facility failed to ensure residents were free of unnecessary psychotropic (drugs that change brain chemistry to alter a person's mood, thoughts, behavior, or perceptions) medications by failing to provide a clinically valid and accurate diagnosis to justify medication use for 3 of 5 residents (Residents 1, 3, and 6 ) Reviewed for unnecessary medications. This failure placed residents at an increased risk for falls, medication-related adverse side effects, and unmet care needs.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure restorative nursing services programs were implemented for 1 of 4 residents (Resident 12), reviewed for restorative nursing and limited range of motion [(ROM) the extent the joint can move within the expected (normal) range of values]. This failure placed the residents at risk for loss of ROM, deconditioning, pain, and worsening contractures (a permanent tightening of the muscles, tendons, skin, and surrounding tissues that causes the joints to shorten and stiffen).

Inspectors wroteBased on interview, and record review, the facility failed to ensure a resident who was a trauma survivor received culturally competent, trauma-informed care in accordance with professional standards of practice by not identifying triggers (a stimulus that causes a reaction, often an emotional or physical response) regarding a resident history of Post-Traumatic Stress Disorder (PTSD, a mental health condition triggered by experiencing or witnessing a terrifying, life-threatening or traumatic event) for 1 of 5 residents (Resident 2) reviewed for trauma-informed care . This failure placed the resident at risk for unidentified triggers and re-traumatization.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the nursing staff posting was posted daily and/or reflected the actual nursing staff hours worked during 3 of 5 days (04/20/2026, 04/21/2026, and 04/22/2026) of the survey period. This failed practice prevented residents, family members and visitors from knowing the facility's actual number of available nursing staff.

Inspectors wroteBased on interview and record review, the facility failed to timely investigate and report, as required, an allegation of neglect for 1 of 3 residents (Resident 1) reviewed for abuse and neglect. This deficient practice disallowed the facility from identifying the extent of the allegation and placed residents at risk for unidentified and ongoing abuse/neglect.

Inspectors wroteBased on interview and record review the facility failed to maintain a Quality Assessment and Assurance (QAA) committee that met at least quarterly and included the Infection Preventionist who was a required member of the QAA committee. This failure minimized the effectiveness of the interdisciplinary QAA team ' s ability to identify processes and outcomes related to infection control practices and disease management.

Inspectors wroteBased on observation and interview the facility failed to provide a sanitary environment by not providing scheduled maintenance services for cleaning for 1 of 1 kitchen. This failed practice placed the residents at risk for cross contamination, food borne illness, and negative health outcomes.

Inspectors wroteBased on observation, interview and record review the facility failed to obtain informed consent regarding the potential risks and benefits associated with the use of a psychotropic medication (medications that affects behavior and alter mental thought processes) for 3 of 5 residents (Residents 2, 7, and 11) reviewed for psychotropic medications. This failure placed residents and/or the legal representative at risk of not being fully informed about the medication prior to administration or discontinuation.

Inspectors wroteBased on observation, interview, and record review the facility failed to comprehensively assess and identify side rails attached to resident beds as a physical restraint for 2 of 2 residents (Residents 8 and 7) reviewed for physical restraints. This failure placed the residents at risk for injury and poor quality of life.

Inspectors wroteBased on interview and record review the facility failed to notify the Office of the State Long-Term Care Ombudsman of the discharge of 1 of 1 resident (Resident 5) reviewed for transfer/discharge notifications. This failure placed the residents at risk for decreased protection from being inappropriately discharged and lack of access to an advocacy group whom could inform them of their rights and options.

Inspectors wroteBased on interview and record review the facility failed to ensure a system was in place to provide a written notice of a bed-hold at the time of discharge to the hospital prior to a hospital transfer for 1 of 1 resident (Resident 5) reviewed for hospitalization. This failure placed the resident at risk for lack of knowledge regarding their right to hold their bed on the long-term care unit while in the hospital.

Inspectors wroteBased on interview and record review the facility failed to implement an effective and individualized Infection Prevention and Control Program (IPC) for long-term care (LTC) residents that met the Center for Medicaid and Medicare Services federal regulatory requirements included monthly surveillance, monitoring/tracking of infectious diseases. This failure disallowed the designated Infection Preventionist (IP) the ability to identify trends and implement interventions. The failure placed residents at risk for infectious diseases and deterioration in their health status.

Inspectors wroteBased on interview and record review the facility failed to ensure the designated Infection Preventionist (IP) responsible for the facility's Infection Control Program met the education qualifications for certification prior to accepting the role as the IP in a long-term care facility. This failure placed residents at risk for not having an adequate oversight of infection control issues specific to long-term care.

Inspectors wroteBased on interview and record review, the facility failed to perform an annual review of the Facility Assessment (FA, an evaluation that determine what resources are required to meet each resident's care/service needs with the facility's resident population) and did not include a representative of the governing body or medical director in the development of the FA. Additionally, the FA failed to address the staffing competencies necessary to provide the level and types of care needed for the resident population. These failures placed all residents at risk of unidentified and/or unmet care and service needs.

Inspectors wroteBased on interview and record review the facility failed to; 1) maintain a Quality Assessment and Assurance (QAA) committee that included the medical director, or their designee, to participate in the committee's effort for 3 of 3 quarterly (Q, every three months) meetings (Q1, Q2, Q3 2023) reviewed for the QAA process, and 2) ensure that a thorough analysis of the high risk/adverse events were acted upon, and, a good faith attempt was made (once the facility had become aware of the adverse event) to correct quality deficiency and care concerns identified by the facility's infection control committee (which information was submitted to the facility's QAPI committee) for 2 of 3 quarterly meetings (Q2 and Q3 2023), reviewed for QAPI and infection control concerns identified on survey. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure infection control interventions intended to mitigate the risk of exposure and transmission of COVID-19 (an infectious disease-causing respiratory illness with symptoms including cough, fever, new or worsening malaise, headache, dizziness, nausea, vomiting, diarrhea, loss of taste or smell, and in severe cases, difficulty breathing, that could result in severe impairment or death) were consistently implemented during a COVID-19 outbreak [two or more facility-acquired cases with epi-linkage (an overlap on the same unit or other patient location, or having the potential to have been cared for by common healthcare professionals (HCP) within a seven day time period of each other)]. The facility failed to implement infection control interventions for: [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to develop and implement a person-centered comprehensive care plan that addressed the resident's medical, physical, mental, and psychosocial needs for 5 of 7 residents (Resident 3, 2, 112, 6, and 7) reviewed for urinary catheter (a flexible tube used to empty the bladder and collect urine in a drainage bag) use, medication use, and transfers. These failures placed the residents at risk for not receiving care and services to meet their individualized needs.

Inspectors wroteBased on interview and record review, the facility failed to ensure nursing staff had the appropriate competencies (a series of knowledge, abilities, skills, experiences and behaviors, which leads to effective performance of staff regarding resident cares), and skill sets, which included an assessment of the staff's demonstration of competency in the skills needed to provide care and services for the facility's resident population, for 5 of 5 nursing staff (Staff I, K, O, P and Q) reviewed for staff competencies. This failure placed residents at an increased risk of adverse effects regarding the quality of care provided to the residents and unmet care needs.

Inspectors wroteBased on interview and record review, the facility failed to ensure residents were given the opportunity to formulate an Advanced Directive (AD) and/or periodically reviewed/notified residents of their right to formulate an AD for 1 of 4 residents (Resident 2) reviewed for ADs. This failure denied residents the right to make an informed decision regarding formulation of an AD and placed residents at risk for losing the right to have their preferences and choices honored regarding emergent/end-of-life care.

Inspectors wroteBased on interview and record review the facility failed to develop an abuse prohibition policy and procedures regarding the incorporation of Quality Assurance and Performance Improvement program (QAPI). This failure disallowed the QAPI committee determination regarding abuse investigations.

Inspectors wroteBased on interview and record review, the facility failed to report alleged violations related to abuse to include injuries of unknown source within the required time frame to the State Agency (SA) for 1 of 1 resident (Resident 10), reviewed for abuse and neglect. This failure placed residents at risk for unidentified abuse and neglect and the continued exposure to abuse and neglect.

Inspectors wroteBased on interview and record review the facility failed to conduct a thorough investigation regarding allegations of abuse and/or neglect for 1 of 1 resident (Resident 10) reviewed for investigations. The failure to complete a thorough investigation placed residents at risk for abuse, neglect, and unmet care needs.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure 1 of 1 resident (Resident 3), reviewed for care and use of a urinary catheter (a hollow, partially flexible tube that collects urine from the bladder and leads to a drainage bag) received appropriate care and services by positioning the catheter drainage bag below the level of the bladder to prevent infection. This failure placed the resident at risk for additional urinary tract infections (UTI) and serious medical complications.

Inspectors wroteBased on interview and record review, the facility failed to ensure residents who were trauma survivors received culturally competent, trauma-informed care in accordance with professional standards of practice for 2 of 2 residents (Resident 2 and 9) reviewed for trauma informed care. The facility failed to assess, monitor, and care plan residents' experiences and preferences regarding potential triggers (a stimulus that could prompt a recall of a previous traumatic event even if the stimulus itself is not traumatic or frightening) that may cause re-traumatization (a reliving of the traumatic experience). This failure placed the resident at risk for unidentified triggers and re-traumatization.

Inspectors wroteBased on interview, and record review, the facility failed to consistently offer substantial nutritional snacks in the evening for 6 of 9 residents (Residents 112, 8, 9, 3, 6, and 7) reviewed for evening snacks. This failure placed the residents at risk for hunger and unmet nutritional needs.

Inspectors wroteBased on observation and interview, the facility failed to ensure the proper disposal of trash for 1 of 1 dumpster (Dumpster 1) reviewed for outdoor refuse storage. The failure to ensure Dumpster 1 was covered, placed the facility at risk of attracting bugs, rodents, and an unsanitary environment.

Inspectors wroteBased on interview and record review, the facility failed to conduct a Performance Improvement Project (PIP) that focused on a high risk or problem prone areas of the resident population annually for 3 of 3 quarterly (Q, every three months) meetings (Q1, Q2 and Q3) reviewed for the Quality Assurance and Performance Improvement (QAPI) process. This failure placed residents at risk regarding quality care improvement, unidentified complications, and prompt corrective action towards high-risk/problem prone areas.

Inspectors wroteBased on interview and record review, the facility failed to offer and/or provide an influenza (a common viral infection that attacks the lungs, nose, and throat) immunization (a vaccine that protects against infection by influenza viruses) for 2 of 5 residents (Resident 1 and 3) reviewed for immunizations. This failure placed the residents at risk for illness and transmission of a communicable disease.