Paradise Creek Health and Rehab of Cascadia

Inspectors wroteBased on observations, interviews, and policy review, the facility failed to maintain sanitary conditions in the walk-in freezer and in the ice scoop holder on the side of the ice machine. These failures had the potential to cause contamination which could affect 46 residents who consumed food from the kitchen.

Inspectors wroteBased on record review and interviews, the facility failed to ensure recommendations to address gradual weight loss were implemented for one of four residents (Resident (R) 2) reviewed for nutrition out of a total sample of 18 residents. This failure had the potential to contribute to continued weight loss, skin breakdown, or malnutrition for R2.

Inspectors wroteBased on observation, interview, record review, and facility policy review, the facility failed to obtain a physician's order, in accordance with professional standards of practice, prior to administering oxygen to one of two residents reviewed for respiratory care (Resident (R) 8) out of a sample of 18 residents. This failure had the potential to result in unsafe or inappropriate oxygen administration and inadequate monitoring of the resident's respiratory treatment.

Inspectors wroteBased on interview, observation, record review, and policy review, the facility failed to ensure two out of 20 sampled residents (Residents (R)30 and R43) were provided with adequate and or timely nursing care and services after: 1. R30 experienced a fall in which she sustained a significant laceration to her forehead and 2. R43's hospice orders were not implemented in a timely manner. The failure to send R30 to the emergency department (ED) timely resulted in harm when R30's laceration could not be sutured and then required debridement and continued treatment three weeks after the fall.

Inspectors wroteBased on observation, record review, interview, and policy review, the facility failed to ensure food was not expired, freezer temperatures were of proper parameters and thermometers were properly sanitized. This had the potential to affect food safety for the 41 residents served food from the kitchen.

Inspectors wroteBased on record review, interviews, and policy review, the facility failed to ensure annual performance reviews were completed for every nurse aide at least one review every 12 months for five of five (Certified Nursing Assistants (CNA) 1, CNA2, CNA3, CNA4, and CNA5) and failed to include no less than 12 hours of training per year for three of five (CNA) 1, CNA3, and CNA4) reviewed for education and reviews for 43 census residents. The failure had the ability to affect the current skillset and knowledge level in order to care for the residents.

Inspectors wroteBased on observation, record review, interviews, and facility policy review, the facility failed to ensure residents received meals that were palatable for five of 20 sampled residents (Resident (R) 19, R36, R22, R13, and R35) reviewed for palatability. This failure had the potential to affect resident meal intake.

Inspectors wroteBased on observation, interview, record review, and policy review, the facility failed to ensure a verbal grievance was documented, investigated, and the results were reported back for one out of 20 sampled residents (Resident (R) 8). This failure resulted in R8's grievance not being resolved timely.

Inspectors wroteBased on observations, record review, staff interview, and review of the facility policy, the facility failed to ensure interventions were put in place and followed to prevent additional falls for three of six residents reviewed for falls (Resident (R) 9, R33, and R42) out of a total sample of 20 residents. This failure increased the potential for additional falls and potential injury for residents with a history of falls.

Inspectors wroteBased on interview, record review, and policy review, the facility failed to ensure the pharmacist made a written recommendation to the physician for a gradual dose reduction (GDR) for one of five residents reviewed for unnecessary medications (Resident (R) 16) out of a total sample of 20 residents. This failure increased the potential for R16 to be overmedicated.

Inspectors wroteBased on policy review, record review, review of the State Agency's Long-Term Care Reporting Portal, review of I&A reports, and staff interview, it was determined the facility failed to ensure residents were free from abuse. This was true for 2 of 4 residents (#23 and #39) reviewed for abuse. This failure resulted Resident #39 and Resident #23 not being free from verbal abuse.

Inspectors wroteBased on policy review, record review, I&A review, and staff and resident representative interview, it was determined the facility failed to ensure adequate supervision and interventions for residents to prevent falls. This was true for 2 of 7 residents (#24 and #31) reviewed for falls. This resulted in harm to Resident #31 and created risk of injury to Resident #24.

Inspectors wroteBased on observation, record review, policy review, review of manufacturer disinfection instructions, and staff interview, it was determined the facility failed to ensure infection control and prevention practices were maintained to provide a safe and sanitary environment. This was true when staff failed to perform hand hygiene, blood glucose (BG) machines were not sanitized, and unused tables were visibly dirty. These failures had the potential to impact all 35 residents in the facility by placing them at risk for cross contamination and infection.

Inspectors wroteBased on policy review, review of Resident Council meeting minutes, and resident and staff interview, it was determined the facility failed to ensure Resident Council meetings were held regularly. This deficient practice placed residents at risk of ongoing frustration and decreased sense of self-worth and unmet needs, when residents were unable to voice their concerns.

Inspectors wroteBased on record review, policy review, and resident and staff interview, it was determined the facility failed to ensure resident care was provided in accordance with professional standards of nursing practice. This was true for 6 of 12 residents (Resident #5, #6, #9, #17, #23, and #24) reviewed for quality of care. Specifically: - Resident #5 and Resident #9 were not administered their medications as ordered by the physician. - Resident #6 had no monitoring for her anti-coagulant and had bruising. - Resident #17 was not provided skin treatment. - Resident #23 did not have neurological checks completed after a fall. - Resident #24 was not provided skin treatment and had empty oxygen tanks. These failures created the potential for harm if care was delayed due to lack of assessment, lack of treatment, or medication not being given as ordered.

Inspectors wroteBased on observation, staff interview, and policy review, it was determined the facility failed to monitor, discard outdated food items and maintain the kitchen in a sanitary manner. This had the potential to affect the 33 residents residing in the facility who consumed food prepared by the facility. This placed residents at risk for potential contamination of food and adverse health outcomes, including food-borne illnesses.

Inspectors wroteBased on observation, and resident and staff interview, it was determined the facility failed to ensure residents were treated with dignity and respect. This was true for 1 of 12 residents (Resident #32) reviewed for respect and dignity. This deficient practice placed Resident #32 at risk of embarrassment and diminished sense of self-worth.

Inspectors wroteBased on policy review, observation, record review, and staff interview, it was determined the facility failed to ensure a resident's call light was within reach for 1 of 12 resident (Resident #1) reviewed for residents' rights. This deficient practice had the potential to cause harm if the resident could not call for assistance when needed or experienced an adverse medical event that required attention.

Inspectors wroteBased on record review and staff interview, it was determined the facility failed to ensure residents received information and assistance to exercise their rights to formulate an Advance Directive. This was true for 2 of 12 residents (#24 and #32) whose records were reviewed. This failed practice created the potential for harm or adverse outcome if the resident's wishes were not followed or documented regarding their advanced care planning.

Inspectors wroteBased on policy review, record review, review of the State Agency's Long Term Care Reporting Portal, review of I&A reports, and staff interview, it was determined the facility failed to ensure allegations of abuse were thoroughly investigated for 3 of 4 residents (Residents #20, #23, and #39) reviewed for abuse. This failure created the potential for residents to be subjected to ongoing abuse without detection and protection measures not being implemented by the facility.

Inspectors wroteBased on observation, record review and staff interview, it was determined the facility failed to ensure the MDS assessment accurately reflected the resident's status. This was true for 2 of 12 residents (#5 and #20) whose MDS assessments were reviewed. This deficient practice had the potential for negative outcomes if the resident was not assessed and cared for or monitored due to inaccurate MDS assessments.

Inspectors wroteBased on record review, policy review, and staff interview, it was determined the facility failed to ensure residents' care plans were revised and updated as needed. This was true for 1 of 12 residents (Resident #20) whose care plans were reviewed. This created the potential for harm if care and/or services were not provided appropriately due to inaccurate information in the care plan.

Inspectors wroteBased on observation, policy review, record review, and staff interview, it was determined the facility failed to ensure residents were provided with bathing, consistent with their needs. This was true for 3 of 12 residents (#5, #20, and #28) reviewed for ADLs. This failure created the potential for residents to experience embarrassment, isolation, decreased sense of self-worth, and skin impairment due to a lack of personal hygiene.

Inspectors wroteBased on observation, staff interview, and record review, it was determined the facility failed to provide oxygen therapy according to professional standards of practice. This was true for 2 of 4 (Resident #24 and Resident #32) reviewed for oxygen therapy. This deficient practice created the potential for harm when the appropriate oxygen therapy was not provided.

Inspectors wroteBased on record review and resident and staff interviews, the facility failed to ensure the facility's arbitration agreement (a document that designates a third party to resolve a dispute between others) included the selection of a venue (a location to carry out the arbitration proceedings that was agreed upon by both parties) was convenient to both parties. This was true for 3 of 3 residents (#26, #31 and #135) whose records were reviewed for arbitration agreements. This had the potential to affect all 11 residents in the facility who signed an arbitration agreement.

Inspectors wroteBased on policy review and staff interview it was determined the facility failed to ensure the Infection Preventionist (IP) had specialized training in infection prevention and control. This failure had the potential to negatively impact all 35 residents and all staff in the facility if staff were to receive inadequate training and oversight for infection control and prevention, resulting in resident care inconsistent with current standards of practice for infection prevention and control.

Inspectors wroteBased on record review, and staff interview, it was determined the facility failed to ensure residents' records documented residents were offered, provided education regarding benefits and potential side effects, consented to, and received or refused pneumococcal vaccines. This was true for 2 of 5 residents (#24 and #28) reviewed for immunizations. This failure placed residents at risk of severe illness or death, should they contract pneumococcal (bacterial) pneumonia.