Paradigm Northwest

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to ensure that residents received care, consistent with professional standards of care to prevent development of pressure ulcers for 3 of 8 (Resident #2. Resident #1, and Resident #3) reviewed for pressure ulcers. The facility failed to turn/re-position Resident #2 every 2hrs and PRN on 4/9/26 and 4/10/26, to help heal his severe sacrum and L thigh pressure ulcers. The facility failed to turn/reposition Resident #1 every 2hrs and PRN on 4/9/26 and 4/10/26, causing the resident to develop redness to her tailbone. The facility failed to turn/reposition Resident #3 every 2hrs and PRN on 4/9/26 and 4/10/26, to help prevent pressure ulcers. This failure could place residents at risk for developing a pressure ulcer or worsening of a pressure ulcer, which could cause pain and infection.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure residents who were unable to carry out activities of daily living received necessary services to maintain grooming and personal hygiene for 2 out of 8 residents (Resident #3 and Resident #4) reviewed for ADLs. The facility failed to check and/or change Resident #3 for more than six hours on 4/9/26 and for more than seven hours on 4/10/26. The facility failed to check and/or change Resident #4 for more than five hours on 4/9/26. This failure could place residents at risk of skin breakdown, infection, and reduced feelings of self-worth.

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to establish and maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for 1 out of 8 residents (Resident #2) reviewed for infection control. The following occurred on 4/9/26 during wound care to Resident #2: RN O failed to wash/sanitize her hands after changing gloves. RN O failed to change gloves after wound care was finished between each wound. RN O failed to clean the wounds with one gauze at a time and used the gauze more than once. RN O failed to change her gloves after cleaning the wound and prior to putting clean treatment on the wound. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure the timeliness of each resident's person-centered, comprehensive care plan, and to ensure that the comprehensive care plan was reviewed and revised by an interdisciplinary team composed of individuals who have knowledge of the resident and his/her needs, and that each resident and resident representative, if applicable, was involved in developing the care plan and making decisions about his or her care for 1 (Resident #1) of 12 resident reviewed for person centered care plans. The facility failed to revise Resident #1's care plan to address ongoing refusals of medication, ADLs, meals, and wound care. This failure could place residents at risk for not receiving individualized responsive care and a decline in wellbeing.

Inspectors wroteBased on interview and record review, the facility failed to ensure all residents had the right to formulate an advance directive for 1 of 21 residents (Resident #10) reviewed for advance directives. The facility failed to ensure Resident #10's Out of Hospital Do Not Resuscitate (OOH-DNR) form was signed and dated by two witnesses and failed to ensure all persons who signed the form acknowledged that the document was properly completed. This failure could place residents at risk for not having their end of life wishes honored and having incomplete records.

Inspectors wroteBased on interview and record review the facility failed to refer all residents with newly evident or possible serious mental disorder, intellectual disability, or a related condition for level II resident review upon a significant change in status assessment for 1 (Resident #3) of 5 residents reviewed for PASRR.- The facility failed to perform a new PASRR level 1 assessment on Resident #3 due to diagnoses of Schizoaffective Disorder and Bipolar Disorder. This failure could place residents at risk of not receiving needed services and support for mental illness and a decrease in quality of life. Findings Included:Record review of Resident #3's undated face sheet revealed he was a [AGE] year old male admitted to the facility on [DATE], with the most recent admission date of 10/29/25. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to develop and implement a comprehensive person-centered care plan for each resident, consistent with resident rights, that included measurable objectives and time frames to meet a residents' medical, nursing and mental and psychosocial needs that were identified in the comprehensive assessment for 1 of 21 Residents (Resident #10) reviewed for care plans. The facility failed to ensure Resident #10 had a plan of care to address a diagnosis and symptoms of major depressive disorder, including tearfulness and sadness. These failures could place residents at risk of not having their needs met or a decline in psychological health.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure residents maintain acceptable parameters of nutritional status, such as usual body weight or desirable body weight range and electrolyte balance, unless the resident's clinical condition demonstrates that this was not possible or resident preferences indicate otherwise for 2 of 21 residents (Residents #3, #9) reviewed for nutritional status. The facility failed to ensure Resident #9's enteral feeding (a form of nutrition that was delivered into the digestive system as a liquid form via the feeding tube) was administered as ordered by the physician on 12/9/25 and 12/10/25. The facility failed to ensure Resident #3's enteral feeding was administered as ordered by the physician on 12/10/25. This failure could place residents at risk for malnourishment, illness, skin breakdown, and decreased quality of life.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure that the medication error rate was not five percent or greater. The facility had a medication error rate of 16%, based on 4 errors out of 25 opportunities, which involved 1 (Resident #71) of 8 residents reviewed for medication errors. -LVN W administered Escitalopram 5 mg to Resident #71 instead of Escitalopram 10 mg and administered Multivitamin with minerals instead of Multivitamins without minerals according to Physician orders on 12/10/25. (Escitalopram is used to treat depression and generalized anxiety disorder). -LVN W crushed and administered Lansoprazole delayed release ODT and Potassium micro extended release via g-tube to Resident #71 on 12/10/25 when it should not have been crushed according to the pharmacy label. These failures could place residents at risk of inadequate therapeutic outcomes.

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to establish and maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for 1 out of 5 resident rooms (Resident #5) reviewed for infection control. - CNA D failed to wear appropriate PPE during incontinence care with Resident #5, when she was on Enhanced Barrier Precautions.- CNA D threw Resident #5's dirty brief on the floor instead of in the trash can. These failures could place residents and staff at risk of cross contamination and risk for infection.

Inspectors wroteBased on observation, interview, and record review, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for 1 of 1 kitchen reviewed for food service safety. The facility failed to obtain the food temperatures of the lunch meal prior to serving residents on 10/4/25. The facility failed to ensure a storage bag of peaches, and a container of rice were properly labeled and dated. These failures could place residents at risk of food-borne illness. Findings Include:Record review of the facility's Production Sheet dated 10/4/25 revealed there were no food temperatures documented for the lunch meal which consisted of golden-brown oven fried chicken, black eyed peas, seasoned broccoli, buttered cabbage, chilled peaches, and a biscuit. In an interview on 10/7/25 at 10:00 a.m. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure that a resident who needs respiratory care was provided such care, consistent with professional standards of practice for 1 of 2 residents (Resident #1) reviewed for oxygen.- The facility failed to ensure Residents #1 had an order for oxygen, when she was on 2L O2 via NC.This failure could place residents at risk for inadequate or inappropriate amounts of oxygen delivery and ineffective treatment.

Inspectors wroteBased on observation, interview, and record review the facility failed to consult with the resident's physician when there was a significant change in the resident's physical, mental, or psychosocial status (that is, a deterioration in health, mental, or psychosocial status in either life-threatening conditions or clinical complications) for 1 (Resident #1) of 5 residents reviewed for notification of changes. The facility failed to establish contact with the NP after Resident#1 had an unwitnessed fall where he was found lying face down on the floor on 8/13/25 at 11am. LVN A sent the NP a text at 11:40 am but she was not aware until she received a second text notification at 12:44 pm. Resident #1 was transported to the hospital at 1:30 pm, after an induration formed above his left brow. An IJ was identified on 8/15/25 at 6:05 pm. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure based on the comprehensive assessment of a resident, that resident received treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the resident's choices for 1 (Resident #1) of 5 residents reviewed for quality of care. The facility failed to contact 911 after Resident#1 was found laying face down on the floor after an unwitnessed fall on 8/13/25 at 11am. Resident was transported to hospital at 1:30pm, after an induration began to form above his left brow. An IJ was identified on 8/15/25 at 6:05 pm. The IJ template was provided to the facility on 8/15/25 at 7:10 pm. [...]

Inspectors wroteBased on observation, interview and record review the facility failed to ensure each resident received adequate supervision and assistive devices to prevent accidents for 1 of 5 (CR#1) residents reviewed for accidents and supervision. 1. The facility failed to ensure CR#1 received adequate supervision and assistance devices to prevent accidents resulting in CR#1 sliding out of bed to the floor sustaining a cut to the right eye and left thalamic bleed (a type of intracerebral hemorrhage) without intraventricular (inside the brain's ventricles) involvement. 2. CNA A failed to ensure two-person assistance was used to provide care to CR #1, who required total assistance with all ADLs, and resulted in CR#1 sliding out of bed to the floor. The noncompliance was identified as PNC. The IJ began on 08/11/2025 and ended on 08/12/2025. [...]

Inspectors wroteBased on interview and record review the facility failed to develop and implement a comprehensive person-centered care plan for each resident, consistent with the resident rights, that included measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that were identified in the comprehensive assessment for 2 of 5 residents (Resident #1 and Resident #2) reviewed for comprehensive care plans. The facility failed to ensure Resident #1 and Resident #2's comprehensive care plans included all care areas triggered on their assessments. This failure could place residents at risk of not receiving care and services specific to their needs.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to maintain an effective pest control program so that the facility was free of pests for 1 of 6 hallways, (Hall 200) and Resident #30's room. The facility had live gnats in areas of the facility including Halls 200, and Resident #30's room. This failure could place residents at risk for decreased resident health, safety and quality of life.

Inspectors wroteBased on observation, interviews, and record reviews, the facility failed to revise the comprehensive care plan for 2 (Resident #1 and CR #2) of 5 residents reviewed for care plan timing and revision. -The facility failed to revise Resident #1's care plan for a suprapubic catheter (tube inserted into bladder through incision in abdomen) after 3/26/25. -The facility failed to revise CR #2's care plan for severe contractures (shortening/hardening of muscles, tendons, and other tissue) after 5/19/25. This failure could place residents at risk of not receiving the appropriate care and services to maintain the highest practical well-being.

Inspectors wroteBased on observation, interview and record review the facility failed to establish and maintain an infection prevention and control program designed to provide a safe, sanitary and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for one of three residents (Resident #1) reviewed for infection control. 1. RT A failed to wash her hands or use hand sanitizer between gloves changes while providing Tracheostomy (Trach) care for Resident #1. 2. RT A failed to ensure she did not double glove in placed of hand hygiene while providing Tracheostomy Care. These failures could place residents at risk for spread of infection.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure personnel provided basic life support, including CPR, to a resident requiring such emergency care prior to the arrival of emergency medical personnel for 1 of 77 residents (CR #1) reviewed for CPR. 1. RN A failed to call a code blue and obtain assistance from available staff when CR #1 was found unresponsive. This led to a delay of approximately 1-2 minutes before CPR was started on CR #1. 2. RN A initiated CPR with improper chest compressions and depth during CPR on CR #1 on [DATE]. 3. LVN A failed to place the mask over the resident's nose and mouth, ensuring a good seal. 4. Staff failed to ensure the crash cart had AED pads and was ready for use during CPR on CR #1. This led to a delay of approximately 1-2 minutes before CPR was started on CR #1. An IJ was identified on [DATE]. [...]

Inspectors wroteBased on observations, interviews, and record review the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety in 1 of 1 kitchen reviewed for food procurement. The facility failed to ensure/prepared food was discarded after 72 hours (3 days) per facility policy. These failures could place residents at risk of food borne illness and disease. Findings Include: Observation of the facility kitchen on 09/24/24 at 8:15 AM revealed the following. 1. A plastic container of Shredded Monterey Cheese, dated 9/20/24. 2. A plastic container of gravy, dated 9/20/24. 3. A plastic bag of green salad, dated 9/15/24. In an interview with the Dietary Food Service Manager on 09/24/24 at 8:30 AM, she stated the leftover food stored in the refrigerator should have been used or discarded prior to the use by date. [...]

Inspectors wroteBased on interviews and record review the facility failed to develop and implement written policies and procedures to prohibit and prevent abuse, neglect, and exploitation of residents and misappropriation of resident property for 2 of 10 staff (Activities Director, and the Dietary Manager) reviewed for developing and implementing abuse and neglect policies. - The facility failed to ensure employee EMR checks were completed at least once every 12 months for the Activities Director and the Dietary Manager. These failures could place residents at risk of abuse, neglect, and misappropriation of property.

Inspectors wroteBased on observation, interview and record review, the facility failed to establish and maintain an infection prevention and control program designed to provide a safe, sanitary and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for 2 of 8 residents (Residents #41 and #48) reviewed for infection control. - RN C failed to wear PPE when he was giving G-tube meds to Resident #41, when the resident was on EBP. - CNA A and CNA B failed to wear PPE during incontinence care with Resident #48, when the resident was on EBP. These failures could place residents at risk for cross contamination and the spread of infection to other residents.

Inspectors wroteBased on observation, interview, and record review the facility failed to dispose of garbage and refuse properly for 1 of 2 dumpster reviewed for food and nutrition services. -The facility failed to ensure the dumpster door was closed at all times when no one was dumping garbage. This failure could place residents at risk of infection from improperly disposed garbage.

Inspectors wroteBased on observation, interview, and record review, the facility failed to treat each resident with respect and dignity and care for each resident in a manner and in an environment that promoted maintenance or enhancement of his or her quality of life for 1 (Resident #8) of 5 residents reviewed for resident rights. -The facility failed to allow Resident #8 to exercise her right to refuse her soiled linen to be changed. This failure could place residents at risk for decreased feelings of self-worth and dignity.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure a resident who was unable to carry out activities of daily living received necessary services to maintain good personal hygiene for 1 (Resident #1) out of 9 residents reviewed for ADL care. - The facility staff failed to provide timely incontinence care to Resident #1. This failure could place residents who were unable to carry out ADLs independently, at risk of skin breakdown, pain, and infection.

Inspectors wroteBased on observation, interview, and record review, the facility failed to treat each resident with respect and dignity and care for each resident in a manner and in an environment that promotes maintenance or enhancement of his or her quality of life, for 1 of 5 residents (Resident #1) reviewed for dignity. The facility did not change the linen on Resident #1's bed after it had been soiled and stained with dark brown matter for the duration of the 6am-2pm shift on 05/08/24. This failure could put residents who are incontinent and require ADL assistance at risk for a diminished quality of life, loss of dignity, and self-worth.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide routine and emergency drugs and biologicals and pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals) to meet the needs of each resident for 1 (Resident #1) of 5 residents reviewed for pharmacy services. -The facility failed to send Resident #1's insulin medications with him when he went out on pass/leave for two days. Resident returned back to the facility with a blood sugar level of 457.0 mg/dL. -The facility failed to complete the Medication/Release Receipt form for Resident #1 when he went out on pass/leave for two days. On 02/13/24 an Immediate Jeopardy (IJ) was identified. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed develop and implement a comprehensive person-centered care plan for each resident, consistent with the resident rights and that includes measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the comprehensive assessment for 1 of 5 residents (Resident #1) reviewed for care plans, in that: -The facility failed to care plan Resident #1's diagnosis of type 2 diabetes mellitus and use of insulin. This failure placed residents at risk of not having their individual care needs met and cause residents not to receive needed services.

Inspectors wroteBased on observation, interview, record review, the facility failed to ensure that residents were free from accidents for 1 of 6 residents (Resident #76) reviewed for accident, hazards, and supervision. The facility failed to ensure the emergency exit and patio exit in the secured unit were adequately secured which resulted in a resident elopement on 7/2/2023. This failure could place residents at risk of injuries, hospitalization, pain and decreased quality of life.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure that the medication error rate was not five percent or greater. The facility had a medication error rate of 9%, based on 3 errors out of 32 opportunities, which involved 3 (Residents #59, Resident #12, and Resident #101) of 5 residents reviewed for medication errors. -The facility failed to ensure MA A administered one medication scheduled for 8:00 a.m. during Resident #59 medication administration. -The facility failed to ensure MA A administered one medication scheduled for 8:00 a.m. during Resident #12 medication administration. -RN D failed to administer the correct dose for one medication scheduled for 8:00 a.m. during Resident #101 medication administration. This failure could place residents at risk of inadequate therapeutic outcomes, increased negative side effects, and a decline in health.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide a safe, functional, sanitary, and comfortable environment for 1 (Resident #100) of 12 residents reviewed for environmental concerns in that: -Resident #100's room had a pervasive urine odor. These failures could place 21 residents who resided on hall 500 at risk of living in an unsafe, unsanitary, and uncomfortable environment.

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain an effective pest control program for one of one facility for residents, staff, and the public as evidence by: Gnats were observed on 100 hall, 200 hall, 300 hall, 500 hall, the nurse's station, and the conference room. These failures could place 106 residents in the facility at risk of infection and decline in their health.