Home / Washington / Soap Lake
127 Second Avenue Southwest, Soap Lake, WA 98851 · Grant County · (509) 246-1111
42 certified beds, about 38 residents a day · Government - Hospital district · Medicare and Medicaid since 1991
CMS Care Compare ratings, data as of September 1, 2026 · CCN 505390 · See it on Medicare.gov · Compare with other homes
At its most recent standard inspection, on June 4, 2026, inspectors cited 6 health deficiencies (the Washington average is 15.8, the national average 9.2).
Of 38 health citations since February 2024, 1 was rated as actual harm or immediate jeopardy to residents.
CMS lists 1 fine totaling $113,505 in the last three years; the largest was $113,505, and the latest is dated February 9, 2024.
Nurses and nurse aides worked 4.29 hours per resident per day, against 4.36 across Washington and 3.86 nationally. Registered nurses accounted for 0.90 of those hours.
72.9% of nursing staff left within the year CMS measured (Washington average 45.1%).
Federal rules call for a standard inspection at least every 15 months, plus a visit whenever a complaint is filed. Each mark below is one citation, colored by how serious inspectors rated it. How to read a citation.
Under each citation, the quoted text is the inspector's own summary from the federal statement of deficiencies (CMS form 2567), word for word apart from a privacy scrub; CMS removes residents' and staff names before it publishes the text. The full notes are on Medicare.gov.
CMS rates every citation by how much harm it caused (rows) and how many residents it touched (columns). The count in each box is this home's, across all 38 health citations on file.
Inspectors wroteBased on observation, interview and record review, the facility failed to ensure residents consistently received restorative therapy services (movement of joints to maintain range of motion) to maintain range of motion (ROM) for 3 of 12 residents (Residents 24, 1 and 6) reviewed for ROM/mobility. This failure placed residents at risk of decreased joint motion, progressive contractures and a diminished quality of life.
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 1 of 3 residents (Resident 48) 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 interview, record review, and observation, the facility failed to ensure information regarding the grievance process was readily available for residents or resident representatives [RR]) and failed to ensure residents were aware of their right to file grievances anonymously. These concerns were voiced in Resident Council (a formal meeting for facility residents to communicate preferences and concerns) for 3 of 5 residents (Resident 26, 39, and 75) reviewed for grievances. This failure placed residents at risk for overall dissatisfaction with their care and unresolved concerns.
Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure that residents, dependent on staff, received necessary care and services. The facility failed to provide consistent, oral care and personal grooming (nail care) for 2 of 2 residents (Resident 1 and 24) reviewed for Activities of Daily Living (ADLs). This failure placed residents at risk for impaired skin integrity, oral infections, unmet care needs and embarrassment.
Inspectors wroteBased on interview and record review, the facility failed to ensure that specific facility primary provider dialysis (a medical treatment that acts as an artificial kidney, it filters waste, toxins, and extra fluid out of the blood) monitoring orders were implemented and followed for 1 of 1 residents (Resident 18) reviewed for dialysis care. This failure placed the residents at risk for fluid overload, electrolyte imbalances, cardiovascular instability, and missed identification of life-threatening post-dialysis complications.
Inspectors wroteBased on observation and interview, the facility failed to provide a safe and sanitary (relating to the conditions that affect hygiene and health) environment for 1 of 1 Laundry room, reviewed for a functional environment. This failure placed residents and staff at an increased risk of cross-contamination (the harmful spread of diseases).
Inspectors wroteBased on observation, interview and record review, the facility failed to implement the resident elopement protocol for 1 of 3 residents (Resident 1) reviewed for accidents. This failure placed the resident at risk for possible serious injury related to an elopement (the potential danger when a resident, often deemed impaired to make sound decisions, leaves the facility premises or safe area unauthorized, posing immediate threats to their health or safety).
Inspectors wroteBased on observation, interview, and record review, the facility failed to provide care and services in a manner that promoted resident respect and dignity for 3 of 4 residents (Residents 14, 27, and 29) reviewed for resident rights. This failure placed the residents at risk for distress, embarrassment, and an undignified existence.
Inspectors wroteBased on interview and record review, the facility failed to ensure residents retained the right to exercise self-determination regarding their dining experience for 1 of 2 residents (Resident 14) reviewed for choices. This failure placed the residents at risk for dissatisfaction in their dining experience and decreased self-worth.
Inspectors wroteBased on interview and record review, the facility failed to review and validate the Preadmission Screening and Resident Reviews ([PASARR], an assessment to ensure individuals with serious mental illness [SMI] or intellectual/developmental disabilities [ID/DD] are not inappropriately placed in nursing homes for long term care) were corrected on admission and had the required Level 2 referral sent for a positive Level 1 PASARR for 2 of 3 residents (Residents 31 and 26) reviewed for PASARR. This failure placed the residents at risk for not receiving the care and services appropriate for their needs.
Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure a resident that experienced past trauma received care and services directed at avoiding re-traumatization and promoting healing and recovery, in accordance with professional standards of practice for 1 of 3 residents (Resident 29), reviewed for trauma informed care. This failure placed the resident at risk for unidentified trauma triggers and re-traumatization.
Inspectors wroteBased on interview and record review, the facility failed to ensure residents were free of significant medication errors for 1 of 5 residents (Resident 2) reviewed for unnecessary medications. The failure to administer an anti-depressant medication as ordered placed the resident at risk for less than an optimal therapeutic effect and/or a potential negative health outcome.
Inspectors wroteBased on observation, interview, and record review, the facility failed to obtain a current hospice written agreement and develop and implement a process that ensured effective communication, collaboration, and coordination of care between the facility and hospice provider for 1 of 2 residents (Resident 14) reviewed for hospice services. This failure placed the resident at risk for not receiving necessary care and services at end-of-life.
Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure 4 of 5 (Staff C, D, E and F) sampled agency (contracted) staff whose personnel files were reviewed, showed established proficiency with the operation of mechanical lift transfers prior to or at the time of assignment to the facility. This failure placed the residents at risk for falls and their associated injuries.
Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the staff implemented safe transfer technique during the operation of a mechanical lift for 1 of 3 (Resident 1) sampled residents reviewed for accidents. This resulted in Resident 1 experiencing a fall from a mechanical lift and a transfer to the hospital for further evaluation.
Inspectors wroteBased on interview and record review, the facility failed to provide care in a dignified manner related to bathing frequency for 2 of 3 residents (Resident 1 and 2) reviewed for dignity. This deficient practice placed the residents at risk for distress, embarrassment, and an undignified existence.
Inspectors wroteBased on interview and record review, the facility failed to monitor the effectiveness of medications that affect blood pressure (BP [the force of blood against the walls of the arteries]) for 2 of 3 residents (Resident 1 and 3) reviewed for unnecessary medications. This deficient practice placed the resident at risk of developing abnormal vital signs (body temperature, heart rate, respiration rate, and BP), experiencing adverse side effects, and the potential of receiving medications unnecessarily.
Inspectors wroteBased on observation, interview, and record review the facility failed to ensure a severely cognitively impaired resident was free from non-consensual sexual abuse for 1 of 4 residents (Resident 2) reviewed for sexual abuse. Resident 1 was observed interacting with Resident 2 in a nonconsensual sexually inappropriate manner. The failure to adequately supervise Resident 1 with their known pattern of inappropriate sexual behaviors toward female residents placed Resident 2 at risk for continued sexual abuse.
Inspectors wroteBased on interview, and record review, the facility failed to ensure an allegation of neglect was reported to the State Survey Agency, as required, for one of three sampled residents (Resident 1), reviewed for abuse. Failure to report alleged neglect placed Resident 1 and additional residents in the facility at risk for continued neglect and poor quality of life.
Inspectors wroteBased on observation, interview, and record review, the facility failed to identify the risk of hot liquids, adequately supervise, and initiate interventions for the safe use of hot liquids for a resident who required staff assistance with drinking fluids for 1 of 3 residents (Resident 6), reviewed for accidents. Resident 6 experienced harm as they sustained a second degree burn to their right thigh. Additionally, the facility failed to safeguard the residents' environment by securing cleaning chemicals for 2 of 3 common resident bathrooms (bathrooms [ROOM NUMBERS] on hall D ) and 2 of 2 shower rooms (shower rooms [ROOM NUMBERS] on hall D), reviewed for environment. These failures placed the residents at risk for injury and/or medical complications secondary to hot liquid spills and the ingestion of harmful chemicals.
Inspectors wroteBased on observation, interview, and record review, the facility failed to provide dietary information for staff to follow that recognized the resident's diet type, consistency, allergies, intolerances, and preferences for 34 of 34 residents living in the facility reviewed for dining. This failure placed the residents at risk of receiving food or drink that decreased their quality of life and had the potential to cause harm.
Inspectors wroteBased on interview and record review, the facility failed to address required documentation for Advanced Directives (AD), a legal document in which a person specifies what actions should be taken for their health if they are no longer are able to make decisions for themselves because of illness or incapacity) including incorporating ADs into the care planning process for 3 of 5 residents (Resident 3, 14, and 17) reviewed for ADs. These failures placed the residents at risk of losing their right of having their preferences and/or decisions followed regarding their end-of-life care.
Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure allegations of abuse/neglect involving unwitnessed or unsupervised events with substantial injuries was reported to the state agency, as required for 2 of 2 residents (Residents 28 and 6), reviewed for accidents. The failure to report to the state agency resulted in the inability to recognize patterns of potential abuse and/or neglect.
Inspectors wroteBased on interview and record review, the facility failed to ensure timely follow-up on a pharmacist recommendation for a gradual dose reduction (GDR- a stepwise tapering of a dose to determine if symptoms, conditions, or risks could be managed by a lower dose or if the dose or medication could be discontinued) of an anti-depressant medication and an anti-psychotic medication for 3 of 6 residents (Resident 3, 17 and 24) reviewed for unnecessary medication. The failure to act timely on the recommendation placed the resident at risk for health complications related to potential adverse consequences of the psychotropic medications.
Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure 1) consistent monitoring of individualized targeted behaviors for 4 of 6 residents (Residents 3, 17, 24 and 25), 2) as needed (PRN) psychotropic medications (medications capable of affecting the mind, emotions, and/or behavior) were limited to 14-days or had a documented rationale for their extended use for 3 of 6 residents (Resident 4, 24, and 25), 3) the consistent attempt of non-pharmacological (non-medication) interventions prior to psychotropic medication administration for 1 of 6 residents (Resident 3), 4) completion of abnormal involuntary movement scale (AIMS, the assessment of the presence and severity of abnormal movements of the face, limbs, and body in patients with tardive dyskinesia [abnormal and uncontrollable movements caused by anti-psychotic medications]) prior to starting a psychotropic [...]
Inspectors wroteBased on observation, interview, and record review the facility failed to 1) provide prompt routine dental services for 2 of 3 residents (Resident 3 and 7) and 2) Failed to replace lost dentures for 1 of 1 resident (Resident 17) reviewed for dental services. This failure placed residents at increased risk for dental impairment/nutritional needs, altered self-imagery and weight loss.
Inspectors wroteBased on observation, interview and record review, the facility failed to maintain infection control practices for 4 of 4 residents (Residents 4, 6, 24, and 35), by not wearing the proper Personal Protection Equipment (PPE, equipment worn to minimize exposure to hazards that cause serious workplace injuries and illnesses) during 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) testing, perform hand hygiene and glove changes between dirty and clean tasks (after touching the resident and/or the resident's environment and during wound care dressing changes), or ongoing surveillance of communicable diseases and infections within the facility for 3 of 12 [...]
Inspectors wroteBased on interview and record review, the facility failed to ensure personal funds were reimbursed within 30 days of a residents death for 1 of 4 residents (Resident 191) reviewed for personal funds. This failed practice caused delay in the reconciliation of Resident 191's account within a 30-day period as required.
Inspectors wroteBased on observation, interview, and record review, the facility failed to assess a resident's need for the use of a postural support/safety harness (a device used to support impaired posture), that restricts a resident's freedom of movement for 1 of 1 resident (Resident 4) reviewed for physical restraints. Additionally, the documentation lacked least restrictive alternatives interventions were attempted, periodic removal of the device, and ongoing monitoring while in use. This failed practice placed the resident at risk for decline in physical function, restriction of movements, risk of injury, and loss of dignity.
Inspectors wroteBased on interview and record review, the facility failed to thoroughly investigate for allegations of abuse and/or neglect for 1 of 2 residents (Resident 28), reviewed for accidents. Resident 28 had an unwitnessed fall that resulted in a fractured nasal bone and a concussion (a traumatic brain injury caused by a blow to the head). This failed practice placed the resident at risk for unidentified abuse and neglect.
Inspectors wroteBased on observation, interview, and record review the facility failed to recognize a significant change in a resident's activities of daily living (ADLs) due to their disease progression for 1 of 1 resident (Resident 16) reviewed for ADL decline. This failed practice placed the resident at risk for unmet needs due to changes.
Inspectors wroteBased on interview and record review, the facility failed to develop a baseline care plan within 48 hours of admission that documented resident specific initial goals, physician orders and treatment plans for 1 of 1 resident (Resident 241), reviewed for recent admissions. The failure to develop and provide a summary of the care plan to the resident and/or family representative placed the resident at risk of not receiving continuity of care and resident centered care needs.
Inspectors wroteBased on interview and record review, the facility failed to develop comprehensive care plans prepared by the required members of the interdisciplinary team (IDT a group of healthcare providers from different fields who work together for the best outcome for residents), including the residents and Resident Representatives (RRs) for 2 of 2 residents (Residents 18, and 3), reviewed for comprehensive care planning. This failure placed the residents at risk of unmet care needs.
Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure residents received care and services in accordance with professional standards of practice regarding ongoing skin assessments for 2 of 2 residents (Residents 14 and 16) reviewed for skin impairment. The facility's failure to provide the care and services required related to non-pressure skin issues placed residents at risk for unidentified and/or avoidable decline, delay in treatment, pain/discomfort, and unmet care needs.
Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure restorative therapy services were implemented for 1 of 3 sampled residents (Resident 32), reviewed for restorative therapy. This failure placed the resident at risk for loss of range of motion, deconditioning, and contractures.
Inspectors wroteBased on observation, interview, and record review the facility failed to ensure a resident who was continent of bowel and bladder on admission received services and assistance to maintain their continence status for one of one resident (Resident 241) assessed for bowel and bladder function. This failure left the resident with feelings of embarrassment and a loss of independence.
Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure a medication error rate of less than five percent (%). During observation of (4) medication passes, 2 of 3 Licensed Nurses (Staff K and V) administered 16 medications in error, out of 25 medications opportunities observed, resulting in an error rate of 64%. This failure placed the residents at risk for inaccurate and/or ineffective medication dosing and adverse side effects.
Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure residents were free from significant medication errors for 2 of 2 residents (Resident 18, and 35) reviewed for medication administration. This failed practice placed the residents at risk for medication adverse side effects.
78 fire safety citations on file: 25 on June 4, 2026, 20 on March 21, 2025, 33 on February 9, 2024.
| Date | Penalty | Amount or length |
|---|---|---|
| February 9, 2024 | Fine | $113,505 |
A payment denial means Medicare and Medicaid stopped paying for new admissions for that period.
Hours of care per resident per day, from the payroll records every home sends CMS. Higher means more staff time with each resident.
| Measure | This home | Washington | United States |
|---|---|---|---|
| All nursing staff (RN, LPN and aides) | 4.29 | 4.36 | 3.86 |
| Registered nurses | 0.90 | 0.94 | 0.69 |
| All nursing staff on weekends | 3.67 | 3.80 | 3.42 |
| Nurse aides | 2.67 | ||
| Licensed practical nurses | 0.72 | ||
| Nursing staff turnover (share who left in a year) | 72.9% | 45.1% | 45.8% |
| Registered nurse turnover | 70.0% | 45.4% | 42.9% |
| Administrators who left | 1 |
CMS expects 3.91 hours a day for residents as sick as this home's (its case-mix figure). The staffing star compares the two.
Every nursing home sends CMS its staff hours for each day (the Payroll Based Journal). Here they are added up by quarter. The latest quarter is the one behind the figures above. In January to March 2026, nursing staff hours per resident were 4.54 on weekdays and 3.67 on weekends, 19% lower on weekends (nationally, weekends ran 15% lower). Contract or agency staff worked 17.2% of nursing hours, against 5.3% nationally. Total nursing hours per resident went from 4.59 in April to June 2025 to 4.29 in January to March 2026.
| Quarter | All nursing staff | Registered nurses | Weekdays | Weekends | Contract staff share | Days with no RN hours | Residents a day |
|---|---|---|---|---|---|---|---|
| Jan to Mar 2026 | 4.29 | 0.90 | 4.54 | 3.67 | 17.2% | 2 of 90 | 38 |
| Oct to Dec 2025 | 4.23 | 0.76 | 4.40 | 3.78 | 21.1% | 3 of 92 | 38 |
| Jul to Sep 2025 | 4.39 | 0.84 | 4.64 | 3.75 | 14.2% | 3 of 92 | 37 |
| Apr to Jun 2025 | 4.59 | 0.81 | 4.86 | 3.90 | 15.1% | 4 of 91 | 35 |
| United States, Jan to Mar 2026 | 3.75 | 0.62 | 3.92 | 3.33 | 5.3% | 0.5% of days | |
| Washington, Jan to Mar 2026 | 4.21 | 0.90 | 4.44 | 3.66 | 3.7% | 0.1% of days |
Hours per resident per day: staff hours in the quarter divided by resident days (the daily census CMS derives from resident assessments). Registered nurses include the director of nursing and RNs with administrative duties; aides include nurse aides in training and medication aides, as in CMS's own staffing measure. How these are calculated.
Staff pay reports
No staff pay figure for this home has passed review yet. A figure appears only after at least 5 reports from at least 3 different people, sent over at least 60 days, have passed review.
| Job | Median | Middle half | Employed |
|---|---|---|---|
| Washington, all employers | |||
| CNAs (nursing assistants) | $23.65 | $22.59 to $27.85 | 30,270 |
| LPNs and LVNs | $39.98 | $36.98 to $45.18 | 6,780 |
| Registered nurses | $59.71 | $49.57 to $64.54 | 69,260 |
| United States, nursing care facilities | |||
| CNAs (nursing assistants) | $20.67 | $17.91 to $22.55 | 534,270 |
| LPNs and LVNs | $33.86 | $30.05 to $37.40 | 188,210 |
| Registered nurses | $41.11 | $37.85 to $47.68 | 142,270 |
Hourly wages; the middle half runs from the 25th to the 75th percentile. Source: U.S. Bureau of Labor Statistics, Occupational Employment and Wage Statistics, May 2025. BLS has no separate estimate for medication aides. These are survey estimates for whole occupations, not figures for any one home.
The measures CMS uses for the quality star. Lower is better for every one of them.
| Measure | This home | Washington | US |
|---|---|---|---|
| Percentage of long-stay residents whose need for help with daily activities has increased Long Stay residents, 2025Q2-2026Q1 | 15.1 | 14.2 | 13.9 |
| Percentage of long-stay residents with a catheter inserted and left in their bladder Long Stay residents, 2025Q2-2026Q1 | 1.1 | 1.0 | 0.8 |
| Percentage of long-stay residents with a urinary tract infection Long Stay residents, 2025Q2-2026Q1 | 0.9 | 1.6 | 1.6 |
| Percentage of long-stay residents experiencing one or more falls with major injury Long Stay residents, 2025Q2-2026Q1 | 1.7 | 2.6 | 3.2 |
| Percentage of short-stay residents who newly received an antipsychotic medication Short Stay residents, 2025Q2-2026Q1 | 0.0 | 1.3 | 1.6 |
| Percentage of long-stay residents with pressure ulcers Long Stay residents, 2025Q2-2026Q1 | 1.2 | 4.3 | 4.6 |
| Percentage of long-stay residents who received an antipsychotic medication Long Stay residents, 2025Q2-2026Q1 | 19.8 | 15.1 | 15.4 |
| Number of hospitalizations per 1000 long-stay resident days Long Stay residents, 20250101-20251231 | 0.5 | 1.3 | 1.9 |
| Number of outpatient emergency department visits per 1000 long-stay resident days Long Stay residents, 20250101-20251231 | 2.1 | 1.5 | 1.8 |
For a stay to recover after a hospital visit, these are the results CMS publishes for McKay Healthcare & Rehab Ctr's Medicare short-stay residents. How to read these, and what Medicare pays for.
Not reported
CMS note: The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure.
US median of homes 51.5% · Washington: 71 better, 16 worse
Rate of successful return to home or community from a SNF (risk-standardized discharge to community rate). Higher is better. October 2022 to September 2024. 17 eligible stays.
Not reported
CMS note: The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure.
US median of homes 10.7% · Washington: 7 better, 0 worse
Rate of potentially preventable hospital readmissions 30 days after discharge from a SNF (risk-standardized rate). Lower is better. October 2022 to September 2024. 21 eligible stays.
Not reported
CMS note: The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure.
US median of homes 7.1% · Washington: 4 better, 0 worse
Percentage of infections residents got during their SNF stay that resulted in hospitalization (risk-standardized rate). Lower is better. October 2023 to September 2024. 16 eligible stays.
40.9% this home
Median of homes: Washington61.4% · US 56.6%
Percentage of residents who are at or above an expected ability to care for themselves and move around at discharge. Higher is better. October 2024 to September 2025. 22 residents counted.
4.0% this home
Median of homes: Washington0.0% · US 0.0%
Percentage of SNF residents who experience one or more falls with major injury during their SNF stay. Lower is better. October 2024 to September 2025. 25 residents counted.
2.9% this home
Median of homes: Washington1.4% · US 1.7%
Percentage of residents with pressure ulcers or pressure injuries that are new or worsened (adjusted rate). Lower is better. October 2024 to September 2025. 25 residents counted.
Not reported
CMS note: The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure.
Median of homes: Washington98.3% · US 98.7%
Percentage of residents where the SNF provided a current medication list to the resident, family, and/or caregiver at final discharge. Higher is better. October 2024 to September 2025. 11 residents counted.
Source: CMS Skilled Nursing Facility Quality Reporting Program - Provider Data, released 2026-09-30. Better, no different and worse are CMS's own comparisons with the national rate, after adjusting for how sick residents were. Medians of homes and the state counts are worked out by us from the same file.
Legal business name: PUBLIC HOSPITAL DISTRICT 4 OF GRANT COUNTY.
| Name | Role | Type | Share | Since |
|---|---|---|---|---|
| Gaertner, Erica | W-2 managing employee | Individual | 08/20/2020 | |
| Palmer, Theresa | W-2 managing employee | Individual | 02/04/2019 | |
| Carlson, Barbara | Corporate director | Individual | 01/21/2020 | |
| Dillenburg, Jean | Corporate director | Individual | 01/01/2014 | |
| Rang, Cindi | Corporate director | Individual | 12/15/2021 | |
| Spencer, Judy | Corporate director | Individual | 01/21/2020 | |
| Wellein, Stephen | Corporate director | Individual | 01/01/2014 | |
| Public Hospital District 4 of Grant County | Operational/managerial control | Organization | 05/12/2022 |
As listed in the CMS ownership file, which names owners with a 5% or greater stake and the people and companies with operational or managerial control.
Chosen from this home's own inspection record.
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