Payette Healthcare of Cascadia

Inspectors wroteBased on staff interview, record review, and review of the State Long Term Care Reporting System, it was determined the facility failed to ensure residents were free from abuse. This was true for 1 of 3 residents (Resident #24) reviewed for abuse, neglect, misappropriation of resident property and exploitation. The facility failed to protect Resident #24 when she experienced abuse from CNA #1 during a shower and created the potential for all residents in the facility to experience abuse.

Inspectors wroteBased on record review and staff interview, it was determined the facility failed to provide hospital transfer documents for 3 of 5 residents (#3, #5, and #59) whose records were reviewed for hospitalization. This deficient practice created the potential for the residents to experience harm if the residents were not treated in a timely manner due to lack of information.

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 reflected the residents' status. This was true for 2 of 13 residents (#2 and #27) whose MDS assessments were reviewed for accuracy. This deficient practice created the potential for negative outcomes if residents' were not assessed and/or monitored due to inaccurate assessments.

Inspectors wroteBased on record review and staff interview, it was determined the facility failed to ensure residents' care plans were revised to reflect current needs and interventions. This was true for 1 of 13 residents (Resident #9) whose care plans were reviewed. This deficient practice created the risk of adverse outcomes if care and services were not provided due to care plans not being revised as resident needs changed.

Inspectors wroteBased on record review and staff interview, it was determined the facility failed to ensure services provided met professional standards. This was true for 1 of 13 residents (Resident #2) whose records were reviewed. This failure placed Resident #2 at risk for harm from obstruction or over medication when her bowel medication administration was not documented in the medication administration record (MAR).

Inspectors wroteBased on observations, staff interview and record review, it was determined the facility failed to ensure physician's orders were clarified for bowel medications and respiratory treatment. This was true for 2 of 13 residents (#8 and #28) whose records were reviewed for quality of care. This deficient practice had the potential for adverse effects and harm for residents whose care and services were not delivered according to accepted standards of practice.

Inspectors wroteBased on observation, record review and staff interview, it was determined the facility failed to ensure residents' oxygen tubing were changed per physician's orders. This was true for 2 of 3 residents (#41 and #53) reviewed for oxygen therapy. This failure created the potential for harm from respiratory infections due to growth of pathogens (organisms that cause illnesses) in oxygen tubing.

Inspectors wroteBased on observation, record review, and staff interview, it was determined the facility failed to ensure residents were free from unnecessary medications. This was true for 2 of 7 residents (#28 and #53) whose medications were reviewed. Resident #28 had duplicate bowel medication orders and Resident #53 had medications at her bedside with no physician's order. This failure created the potential for harm and adverse reactions if Resident #28 and Resident #53 were to receive their medications inappropriately.

Inspectors wroteBased on observation and staff interview, it was determined the facility failed to ensure medications carts were secured and house stock medications were labeled when opened. This deficient practice created the potential for harm if the medications were left unsecured and if the medications administered were expired.

Inspectors wroteBased on observation, CDC recommendation review, and staff interview, it was determined the facility failed to ensure infection control and prevention practices were maintained. This failure had the potential to impact all residents in the facility by placing them at risk for cross contamination and transmission of infection.

Inspectors wroteBased on observation, policy review, and staff interview, it was determined the facility failed to ensure residents were provided with a safe, clean, homelike environment. This was true for 1 of 4 residents (Resident #36) who were observed in power wheelchairs, and for all 44 residents who resided in the facility whose overall environment was observed. This deficient practice created the potential for harm if: a) residents were injured when the privacy curtains in the resident's rooms prevented the resident from moving around in their room safely and the holes in the floors caused a resident to fall, b) residents were embarrassed by dirty equipment and/or felt the lack of cleanliness in the facility was unacceptable, disrespectful, or undignified, and c) cross-contamination from spread of microorganisms.

Inspectors wroteBased on observation and staff interviews, the facility failed to ensure adherence to infection control and prevention practices to provide a safe and sanitary environment, when staff did not follow hand hygiene protocols, properly clean Hoyer lift equipment, and follow proper protocol during tube feeding. These failures had the potential to impact 4 of 4 residents (Residents #8, #15, #16, and #21) for hand hygiene, Hoyer lift use for transfers, and 1 of 1 resident (Resident #156) during G-tube feeding, placing them all at risk for cross-contamination and infection.

Inspectors wroteBased on policy review, observation, record review, and interviews, it was determined the facility failed to ensure a resident was initially assessed to determine if they were safe to self-administer medications for 1 of 2 residents (Resident #36). This failure created the potential for adverse effects if Resident #36 self-administered medications inappropriately.

Inspectors wroteBased on observation, record review, policy review, and staff interview, it was determined the facility failed to ensure adequate care and treatment was provided to 1 of 1 resident (Resident #156) reviewed for feeding tube use. This created the potential for harm if complications developed from improper tube feeding practice.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure 1 of 5 residents (Resident #14) received continuous oxygen via nasal cannula prescribed by the physician. This created the potential for Resident #14 to experience respiratory difficulties/impaired breathing.

Inspectors wroteBased on staff interview and review of annual competency evaluations, it was determined the facility failed to ensure each CNA's performance was evaluated at least once every 12 months and annual evaluations were performed. This was true for 1 of 5 CNAs (CNA #3) whose personnel records were reviewed. This failure created the potential for incompetent CNAs providing care and increased the risk for harm for 44 of 44 residents living in the facility.

Inspectors wroteBased on observation, interviews, and facility policy review, it was determined the facility failed to ensure wound care products and resident prescribed wound care cream were secured in a locked treatment care. This was observed in 1 of 2 treatment carts. This failure created the potential for residents to obtain prescribed wound care cream used for other residents and presented the risk for cross-contamination of wound care products stored in the cart.

Inspectors wroteBased on record review and staff interview, it was determined the facility failed to ensure residents were provided with the pneumococcal vaccine when residents requested it. This was observed in 1 of 5 resident medical records reviewed (Resident #41). This failure created the potential for residents to have an increased risk of pneumococcal (bacterial) pneumonia and the potential for severe illness or death.

Inspectors wroteBased on record review, policy review, and staff interview, it was determined the facility failed to ensure residents and/or their representative received written notification regarding transfer to the hospital, and the state ombudsman was notified of the transfer. This was true for 2 of 3 residents (#31 and #33) reviewed for transfer/discharge. This failure created the potential for harm if residents were unable to exercise their rights related to transfers due to lack of notification.

Inspectors wroteBased on policy review, record review, and staff interview, it was determined the facility failed to notify the resident and their representative of the bed hold policy upon transfer/discharge. This was true for 2 of 3 residents (#31 and #33) reviewed for transfer/discharge. This failure created the potential for harm if residents were not informed of their right to return to their former room at the facility within a specified time.

Inspectors wroteBased on record review, policy review, and resident and staff interview, it was determined the facility failed to ensure residents' MDS assessments accurately reflected their status at the time of the assessment. This was true for 1 of 12 residents (Resident #30) whose MDS assessments were reviewed. This failure created the potential for harm if care decisions were based upon inaccurate information.

Inspectors wroteBased on observation, record review, policy review, and staff interview, it was determined the facility failed to ensure residents' care plans were updated to maintain consistency and accuracy. This was true for 1 of 12 residents (Resident #21) whose care plans were reviewed. This failure created the potential for harm if cares and/or services were not provided due to missing information on the care plan.

Inspectors wroteBased on record review, policy review, review of I&A Reports, and staff interview, it was determined the facility failed to ensure neurological assessments were completed after unwitnessed falls per the facility's policy. This was true for 2 of 4 residents (#30 and #31) reviewed for falls. This failure created the potential for harm should residents experience undetected changes in neurological status.

Inspectors wroteBased on record review, staff interview, and resident family interview, it was determined the facility failed to ensure residents received bowel care in accordance with standard nursing practice and physician orders. This was true for 1 of 1 resident (Resident #27) reviewed for constipation. This failure created the potential for harm should residents experience negative effects from constipation or fecal impaction (a mass of stool that is so hard it cannot be passed).

Inspectors wroteBased on observation, policy review, record review, and resident and staff interviews, it was determined the facility failed to ensure that post-dialysis assessments were consistently completed. This was true for for 2 of 2 residents (Resident #30 and #33) reviewed for dialysis, and created the potential for harm if complications were undetected and untreated.