Garden Terrace Healthcare Center of Federal Way

Inspectors wroteBased on interview and record review, the facility failed to ensure residents received care and treatment in accordance with their assessed needs and professional standards of practice for 1 of 5 residents (Resident 1) reviewed for bowel care. The failure to assess a resident's change in condition, address identified signs and symptoms of distress, and notify the physician when residents present with diarrhea (multiple episodes of loose bowel movement) placed residents at risk for nutrition and hydration problems and a decreased quality of life.

Inspectors wroteBased observation, interview, and record review, the facility failed to ensure the provision of skin care for residents with skin impairments for 1 of 4 residents (Residents 113) reviewed for non-pressure skin; provide bowel/constipation care for 2 of 4 residents (Residents 3 & 166) reviewed for constipation. These failures placed residents at risk for avoidable discomfort, skin breakdown, pain, and infection.

Inspectors wroteBased on observation, interview, and record review the facility failed to prepare food under sanitary conditions for 1 of 1 facility kitchens. The failure to ensure cooking surface sanitizer was available at a suitable concentration and ensure exhaust fans were clean placed residents at risk for contaminated food and food-borne illness.

Inspectors wroteBased on observation, interview, and record review the facility failed to maintain an infection prevention and control program designed to provide a sanitary environment to help prevent the transmission of communicable diseases. The facility: failed to follow Contact Precautions signs for 3 of 5 residents (Residents 167, 265, & 270) and 2 supplemental residents (Resident 47, & 44) reviewed for Transmission-Based Precautions (TBP - airborne, contact, and droplet precautions used to prevent the spread of transmissible diseases); failed to follow Enhanced Barrier Precautions (EBP) for 1 of 1 residents (Resident 44) reviewed for EBP; failed to ensure the ice scoop was only used by staff on 1 of 4 units (Lily Garden). [...]

Inspectors wroteBased on interview and record review, the facility failed to provide required liability notices for 1 of 3 residents (Resident 117) reviewed for liability notices. Failure of the facility to issue a Notification of Medicare Non-Coverage (NOMNC - a document informing Medicare beneficiaries that their covered services will be terminated and providing information on their appeal rights) before discharge from the facility placed Resident 117 at risk for not fully understanding their Medicare benefits and appeal rights.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure walls and baseboard in resident rooms were maintained in a homelike condition for 5 of 17 rooms sampled (Rooms 111, 112, 113, 116 & 120) and failed to ensure a privacy curtain was maintained in a clean sanitary condition (room [ROOM NUMBER]). These failures left residents at risk for a less than homelike environment and a diminished quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to initiate, investigate, and resolve grievances for 2 of 17 sampled residents (Resident 44 & 45) reviewed for grievances and 1 supplementary resident (Resident 55). This failure placed residents at risk for emotional distress, unresolved frustration, and a diminished quality of life.

Inspectors wroteBased on interview and record review, the facility failed to ensure an allegation of drug diversion was thoroughly investigated for 1 of 1 supplemental resident (Resident 55) reviewed for grievances. This failure placed residents at risk for uncontrolled pain and a diminished quality of life.

Inspectors wroteBased on interview, observation, and record review the facility failed to develop and/or implement comprehensive Care Plans (CPs) for 3 (Residents 15, 36, & 167) of 17 sample residents whose CPs were reviewed. The failure to develop comprehensive, individualized CPs to address residents' care needs placed residents at risk for unmet care needs, frustration, and other negative health outcomes.

Inspectors wroteBased on observation, interview, and record review the facility: failed to ensure physician ordered parameters for medications were followed for 3 of 17 (Resident 114 & 264) sampled residents; failed to ensure orders were clarified as needed for 2 of 5 residents (residents 18 & 166) whose medication regimens were reviewed; failed to ensure weights were monitored as ordered for 1 of 4 residents (Resident 115) reviewed for nutrition. These failures placed residents at risk for unmet needs, and ineffective and/or delayed treatments.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure residents who were dependent on facility staff for assistance with Activities of Daily Living (ADLs - personal hygiene, grooming, and bathing) received the assistance they were assessed to require for 4 of 9 residents (Residents 36, 45, 166, & 167) reviewed for ADLs. The failure to provide ADL assistance to dependent residents as required left residents at risk for poor hygiene, diminished feelings of self-worth, and other negative health outcomes.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure activity programs met the needs of each resident for 3 of 3 residents (Resident 264, 265 & 270) reviewed for activities. The failure to provide meaningful activities left residents at risk of boredom and a diminished quality of life.

Inspectors wrote<Resident 115> According to the 04/24/2025 admission MDS, Resident 115 had medical conditions including brain cancer. The MDS showed Resident 115 developed brain abscess (accumulation of pus within the tissues) while recovering from the surgical resection (the process of cutting out tissue or part of an organ) of their brain tumor. The 04/21/2025 pain CP showed Resident 115 expressed discomfort/pain related to their recent brain surgery, back pain, bilateral leg pain from having blood clots, and generalized deconditioning. The CP outlined interventions directing the nursing staff to administer pain medications to Resident 115 as ordered by the physician and to notify the physician if interventions were unsuccessful or if there was a significant change from the resident's past experience of pain. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide behavioral health services for 1 of 3 (Resident 264) residents reviewed for behavioral-emotional health. The failure to provide interventions to Resident 264 behavioral health concerns placed Resident 264 and other residents at risk for not receiving the services necessary to meet their mental health needs and a diminished quality of life.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure residents received timely specialized rehabilitative services for 1 of 4 residents reviewed for therapy services (Resident 113). The failure to timely complete a Speech Language Pathologist (SLP - a speech therapist) evaluation placed Resident 113 at risk for unnecessary diet restrictions, weight loss, and a diminished quality of life.

Inspectors wroteBased on interview and record review, the facility failed to ensure 1 of 3 residents (Resident 1) reviewed for Pressure Ulcer/Pressure Injury (PU/PI) was provided the necessary treatment and services consistent with professional standards of practice to promote wound healing. This failure placed residents at risk for worsening skin conditions, skin breakdown, and a diminished quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to implement their abuse and neglect policies and procedures regarding prevention, identification, investigation, and reporting of abuse and/or neglect. The facility failed to thoroughly investigate the incident and allegation of physical abuse for 1 of 3 residents (Resident 1) reviewed for facility incidents. This failure placed residents at risk for abuse and/or neglect by caregivers, avoidable and unnecessary pain, and a diminished quality of life.

Inspectors wroteBased on interview and record review, the facility failed to provide written transfer/discharge notices as required for 3 of 3 residents (Resident 1, 6, & 7) reviewed for hospitalization. Failure to provide notification to the resident and/or the resident's representative of the reason(s) for the transfer or discharge in writing placed residents at risk for a discharge that did not meet the resident's and/or their representative's stated goals for care and preferences.

Inspectors wroteBased on interview and record review, the facility failed to: Provide an environment that was free from accident hazards; and ensure each resident received adequate supervision and/or assistance to prevent accidents, for 1 of 2 residents (Resident 1) reviewed for falls. These failures placed residents at risk for injuries, avoidable accidents, and a decreased quality of life.

Inspectors wroteBased on observation and interview, the facility failed to ensure the physical environment was kept clean and food stored under sanitary conditions for 1 of 1 kitchen observed. Facility staff failed to: Label and date food; discard damaged/spoiled food; keep kitchen vents free from dirt/dust build-up; and maintain cleanliness of handwashing sinks and garbage bins. The facility failed to ensure 2 of 4 resident refrigerators in the nursing units (Lily Garden & Tea Garden) were monitored for opened and undated food and liquids, partially-eaten and spoiled resident-owned food brought in from outside sources, and cleanliness. These failures contributed to an unsanitary kitchen environment and unsafe storage of food and drinks, and placed residents at risk for food-borne illness.

Inspectors wroteBased on interview and record review the facility failed to provide residents and/or the resident's representative a written notice of the facility's bed hold policy at the time of transfer or within 24 hours, for 1 of 1 closed records (Resident 21) and 2 of 3 residents (Residents 43 & 41) reviewed for hospitalization. This failure placed residents and their representatives at risk of not being informed of their right to, and the cost of, holding the resident's bed while hospitalized .

Inspectors wroteBased on observation, interview, and record review the facility failed to develop comprehensive Care Plans (CP) for 7 (Resident 43, 46, 264, 25, 163, 167, & 2) of 17 sampled residents whose comprehensive CPs were reviewed. Failure to establish individualized CPs with identified goals that accurately reflected the resident's condition, placed residents at risk for unmet care needs.

Inspectors wroteBased on observations, interview, and record review, the facility failed to ensure pain management was provided to residents consistent with professional standards of practice including the failure to offer nonpharmacological interventions, identify parameters for administration of as needed (PRN) pain medications, and identify the location of residents' pain for 4 of 4 residents (Residents 18, 13, 213, & 167) reviewed for pain management. These failures left residents at risk for experiencing untreated pain and a decreased quality of life.

Inspectors wrote<TBP> <Resident 167> According to the 04/01/2024 admission MDS, Resident 167 had medical conditions including a bladder infection and was administered antibiotics during the assessment period. The MDS showed Resident 167 was frequently incontinent of their urine and was assessed to require substantial/maximal assistance from staff for their toileting hygiene. In an observation and interview on 04/09/2024 at 10:13 AM, a Contact Precaution sign was observed posted outside Resident 167's door and instructed all staff to perform HH and wear PPE at all times. Staff T (Registered Nurse - RN) confirmed Resident 167 had a contagious infection in their urine. At 10:15 AM, the TBP sign was observed different; it was replaced with Enhanced Barrier Precaution (EBP) and instructed staff to only wear PPE during high-contact resident activities. Staff T stated they did not know why the TBP was changed. [...]

Inspectors wroteBased on interview and record review, the facility failed to encode and transmit resident assessment data to the Centers for Medicare & Medicaid Services (CMS) within the required timeframe, for 1 of 1 residents (Resident 9) reviewed for timeliness in transmission. This failure placed residents at risk for inaccurate monitoring of decline or progress over time, untimely comprehensive review of residents' health data/information, and a diminished quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the Minimum Data Set (MDS - an assessment tool) of 2 of 17 residents (Residents 28 & 166) were completed accurately to reflect the resident's condition and overall health status. The facility failed to identify Resident 28's poor dental status and failed to capture Resident 166's active diagnosis of dementia (a memory problem). These failures placed Residents 28 and 166 and other residents at risk for unidentified and/or unmet care needs.

Inspectors wrote<Resident 32> Review of the 03/07/2024 admission MDS showed Resident 32 was admitted to the facility following a hip fracture. This MDS showed Resident 32 was totally dependent on staff for personal hygiene and bathing needs. This MDS showed Resident 32 did not reject care during the look back period of the assessment. Review of Resident 32's March 2024 task documentation showed on 03/07/2024 staff documented bathing did not occur. The task documentation showed Resident 32 was not offered or provided a bath from 03/07/2024 to 03/31/2024, indicating the resident went 24 days without bathing. Review of a 04/10/2024 [NAME] (directions to care staff) showed Resident 32 preferred bathing on Monday and Wednesday evenings. In an observation and interview on 04/09/2024 at 11:55 AM, Resident 32 was lying in bed and had short facial hair stubble. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to identify and provide care and services in accordance with the resident's goals and professional standards of practice for 1 of 2 residents (Resident 163) reviewed for Anticoagulation (AC - blood thinner) use and monitoring. This failure placed residents at risk for unidentified and/or worsening bleeding and a decreased quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide care and services consistent with professional standards of practice to prevent weight loss for 2 of 3 sampled residents (Residents 163 & 264) reviewed for nutrition. The facility failed to timely assess the residents' nutritional status after facility admission and failed to develop and implement a nutrition Care Plan (CP) with person-centered interventions. These failures placed residents at risk for unidentified nutritional needs and concerns, unplanned weight loss, and a decreased quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to implement care for 1 (Resident 43) of 1 resident reviewed for Tube Feeding (TF - nutrition delivered into the stomach by tube) management including documenting and tracking the rate of the TF orders, documenting the amount of TF nutrition and water infused. These failures placed Resident 43 at risk for inadequate calorie or protein intake and/or inadequate hydration.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure 2 of 2 residents (Residents 167 & 31) reviewed for respiratory care were provided care consistent with professional standards of practice. Failure to provide deep breathing treatments as ordered (Resident 167) and obtain Physician Orders (POs) for supplemental oxygen (Resident 31) left residents at risk for over or under oxygenation, respiratory discomfort, infections, and a decreased quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide appropriate treatment and services for residents diagnosed with dementia to attain and/or maintain their highest practicable physical, mental, and psychosocial well-being for 1 of 3 residents (Resident 166) reviewed for dementia (a memory problem) care. Failure of the facility to identify, develop, and implement a person-centered Care Plan (CP) that addressed residents' dementia diagnosis and behaviors placed the residents at risk for having unidentified and/or unmet care needs, avoidable decline, and a diminished quality of life.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure 2 (Resident 18 & 13) of 5 residents reviewed for unnecessary medications were free from unnecessary psychotropic medications. Facility staff failed to: provide non-pharmacological interventions prior to administering an as needed Antipsychotic (AP) medication, re-evaluate and document the specific condition being treated with the as needed AP medication, obtain consent prior to administering psychotropics, and identify target behaviors. These failures placed residents at risk to receive unnecessary psychotropic medications, experience adverse side effects, and detracted from the resident/resident representative's ability to exercise their right to decline treatment/therapies.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure 1 of 2 garbage dumpsters and 1 of 1 recycling dumpster reviewed and inspected for outdoor garbage and refuse disposal were properly covered and the surrounding areas were kept clean as required. These failures placed the facility at risk of attracting bugs, rodents, and other disease-carrying germs/bacteria that could reproduce, grow, and place the residents at risk for acquiring these diseases.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure specialized rehabilitative services were provided as assessed to be required for 1 of 2 sample residents (Residents 265) reviewed for rehabilitation with skilled therapy services. This failure prevented residents from attaining, maintaining, or restoring their highest practicable level of physical, mental, functional, and psycho-social well-being.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure resident medical records were accurate and consistent for 2 of 17 sample residents (Residents 166 & 167) whose resident records were reviewed. The facility failed to ensure the correct type of active diagnosis was identified (Resident 166) and the correct Advance Directives (AD) status was represented (Resident 167) in the resident's records. These failures placed residents at risk for unidentified and/or unmet care needs, missed opportunities for care planning, and inaccessible health care instructions if/when needed.

Inspectors wroteBased on interview and record review, the facility failed to administer a pneumococcal vaccine for 1 (Resident 213) of 5 residents reviewed for vaccinations. This failure placed the resident at risk for contracting pneumonia (a potentially life threatening lung infection) and associated complications.

Inspectors wroteResident 9 According to the 03/01/2023 Admissions MDS Resident 9 had diagnoses including metabolic encephalopathy (a brain disease that can cause confusion), Deep Vein Thrombosis (DVT - a blood clotting condition), anemia (low red blood cell count), insomnia, and chronic pain. The MDS showed Resident 9 expected to discharge to the community and active discharge planning was already occurring. Review of the 03/01/2023 Discharge CP showed the goal was to develop and follow full discharge plan with comprehensive and showed Resident 9 wished to return home. The Discharge CP did not include specific and measurable goals for discharge. In an interview on 03/20/23 at 1:29 PM, Staff H (Unit Care Coordinator) stated the Discharge CPs the facility created for residents did not include measurable goals and this was something the facility probably should work on. [...]

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure Care Plans (CP) were maintained, revised, and updated as required for 5 (Residents 26, 37, 20, 39, & 25) of 12 sampled residents. This failure left 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 food was stored and prepared in a sanitary manner and in accordance with professional standards of food safety. The failure to ensure food was stored appropriately, food and trays were free from contaminants, and kitchen staffs' hair was secured as required left residents at risk of food contamination and food-borne illness.

Inspectors wroteBased on interview and record review, the facility failed to develop and implement a system to ensure a copy of the Advance Directive (AD) was obtained from residents/representatives who have an AD in place and make the documentation readily available in the medical records for 2 of 12 residents (Resident 20 & 32) reviewed. The facility failed to perform family/representative follow up after providing AD information for 1 of 12 residents (Resident 39) determined to have cognitive limitations necessary for healthcare decision-making. Failure to have the AD accessible to facility staff and failure to follow up the formulation of an AD placed residents at risk of losing their right to have their stated preferences and decisions honored regarding medical treatment including end-of-life care.

Inspectors wroteBased on interview and record review, the facility failed to provide a Skilled Nursing Facility (SNF) Advance Beneficiary Notices (ABN) for 1 of 2 residents (Resident 26) reviewed for SNF beneficiary protection notification. This failure placed residents at risk of not being informed of their right to make choices about further treatment or services, as required by the Medicare Program.

Inspectors wroteBased on interview and record review, the facility failed to ensure a system by which the office of the State Long-Term Care Ombudsman (LTCO) received required discharge information for 2 (Resident 41 & 25) of 2 residents reviewed for discharge to the hospital. Failure to ensure required notification was completed, prevented the LTCO office the opportunity to educate residents and advocate for them regarding the discharge process.

Inspectors wroteBased on interview and record review, the facility failed to ensure nursing services were provided within professional standards of nursing for 3 of 12 sample residents reviewed (Residents 9, 37 & 32). Facility failure to: ensure pain medications were not given outside parameters (Resident 9); ensure psychotropic medications were monitored for Target Behaviors (TBs - the behaviors the medication was prescribed to treat) and Adverse Side Effects (ASEs) (Resident 9); ensure nurses clarified Physician's Orders (POs) (Resident 37); nurses only sign for tasks completed (Resident 32); ensure dressings were changed timely (Resident 32) left residents at risk for negative health outcomes.

Inspectors wroteBased on interview and record review, the facility failed to ensure resident records were complete and accurate for 3 of 12 (Residents 9, 26, & 17) sample residents whose records were reviewed. Facility failure to document resident refusals and maintain complete and accurate medical records left residents at risk for unidentified patterns of refusals, inaccurate medical records, and other negative outcomes.