Grangeville Health & Rehabilitation of Cascadia

Inspectors wroteBased on observation, Food Drug Administration (FDA) Food Code review, record review, and staff interview, it was determined the facility failed to ensure kitchen equipment was maintained, cleaned, and sanitized. These deficiencies had the potential to affect the 42 residents who consumed food prepared by the facility. This placed residents at risk for potential foodborne illnesses and adverse health outcomes.

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) Assessments included correct assessment information. This was true for 1 of 2 residents (#5 and #26) whose MDS 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, staff interview, and record review, it was determined the facility failed to ensure a licensed nurse had the specific skill set necessary to appropriately administer an insulin injection. This was true for RN #1, when she was observed administering an insulin injection. This failure created the potential for adverse effects if the resident did not receive the complete dose of their insulin.

Inspectors wroteBased on observation, staff interview, and record review, it was determined the facility failed to ensure infection prevention standards of practice were maintained during insulin administration. This was true for RN #1 when she was observed administering an insulin injection. This failure created the potential for harm to all residents in the facility by placing them at risk for cross contamination and infection.

Inspectors wroteBased on record review, CDC guidance, policy review and staff interviews, it was determined the facility failed to ensure residents were offered and/or administered the appropriate pneumococcal vaccine as indicated. This was true for 2 of 5 residents (#5 and #13) reviewed for pneumococcal immunizations. This deficient practice placed residents at risk of developing pneumococcal pneumonia, a potentially life-threatening condition.

Inspectors wroteBased on record review, CDC guidance, and staff interview, it was determined the facility failed to ensure COVID-19 vaccinations were offered and administered to the residents. This was true for 1 of 5 residents (Resident #17) whose COVID-19 vaccinations were reviewed. This deficient practice placed residents at risk of severe illness, hospitalization, and death due to SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus - the virus that causes the COVID-19 illness) and had the potential to affect all residents in the facility.

Inspectors wroteBased on review of the Payroll Based Journal (PBJ) Staffing Data Report, record review, and staff interview, it was determined the facility failed to ensure an RN was on-site for 8 consecutive hours, 7 days a week. This failure created the potential for harm if routine and/or emergency nursing needs were unmet and had the potential to affect the 46 residents living at the facility.

Inspectors wroteBased on record review and staff interview, it was determined the facility failed to ensure a Pre-admission Screening and Resident Review (PASARR), was completed within the required timeframe for 1 of 5 residents (Resident #40) reviewed for PASARR screenings. This failure created the potential for harm if residents required, but did not receive, specialized services for mental health while residing in the facility.

Inspectors wroteBased on observation, policy review, and staff interview, it was determined the facility failed to ensure food was prepared and served under sanitary conditions when staff members' hair was observed not properly restrained in a hairnet. This failure created the potential for each of the 38 residents residing at the facility to be exposed to food contamination and potential disease-causing pathogens.

Inspectors wroteBased on observation, staff interview, and policy review, it was determined the facility failed to ensure staff performed proper hand hygiene and appropriate peri-care during resident cares. This was true for 1 of 4 residents (Resident #3) who was observed during resident cares. The deficient practice placed residents at risk of infection from cross-contamination.

Inspectors wroteBased on record review and staff interview, it was determined the facility failed to ensure informed consent was obtained prior to initiation of medications for 2 of 5 residents (#5 and #32) who were reviewed for unnecessary medications. This deficient practice placed residents at risk of receiving medications without knowledge of the risks and benefits associated with the medications and the right to refuse the medications.

Inspectors wroteBased on record review, policy review and staff interview, it was determined the facility failed to ensure professional standards of practice were followed when a) blood pressure medications were held when a resident's pulse was outside of ordered parameters for 1 of 5 residents (Resident #12) reviewed for unnecessary medications; and b) staff failed to dispose controlled medications consistent with the facility's policy to prevent drug diversion for 2 of 2 licensed nurses (LPN #1 and LPN #2) who were interviewed during medication cart inspection. These failed practices placed Resident #12 at risk of dangerously low blood pressure, and created the potential for harm for each of the 38 residents residing in the facility if controlled medications were diverted and residents did not receive medications as ordered.

Inspectors wroteBased on staff interview and record review, it was determined the facility failed to ensure residents receiving psychotropic medications had clear indications for use of the medications and clinical rationale supporting the continued use of the medications. This was true for 1 of 5 residents (Resident #12) whose records were reviewed for unnecessary medications. This deficient practice had the potential for harm if residents received psychotropic medications that were unwarranted and used for excessive duration.