Regency Wenatchee Rehabiliation & Nursing Center

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure residents health information remained private for 4 of 5 residents (Residents 5, 3, 23, and 41) reviewed for the resident's right to privacy. Additionally, the facility staff referred to Resident 5 by a pet name which did not respect their right to be addressed by their own name when interacting with staff. This failure placed residents at risk for embarrassment and a poor quality of life.

Inspectors wroteBased on interview and record review, the facility failed to ensure notification of the notice of transfers to the representative of the Office of the State Long Term Care (LTC) Ombudsman (a person that advocates for residents in nursing homes) occurred for 2 of 5 residents (Residents 52 and 61) reviewed for discharge. This failure placed the residents at risk for diminished protection, lack of access to an advocate that could inform them of their options and rights, and to ensure the resident advocacy agency was aware of the facility practices and activities related to discharge.

Inspectors wroteBased on observation, interview, and record review, the facility failed to identify the risks and initiate interventions to prevent further accidents for 2 of 3 residents (Residents 35 and 11) reviewed for accidents. Resident 35 experienced harm when hot soup was served on the overbed table and when the resident went to pull the tray closer to them to be within reach, the soup spilt onto their lap causing a third-degree burn to the left thigh. In addition, the facility failed to provide consistent supervision, thoroughly investigate the cause of falls, and ensure interventions were put into place to prevent further falls for Resident 11. These failures placed the residents at risk for injury and/or medical complications and a decreased quality of life.

Inspectors wroteBased on interviews and record reviews, the facility failed to follow up on written notices of bed holds (holding or reserving a resident's bed while the resident was absent from the facility) given at the time of hospital transfers, and/or failed to send a copy of the notice of transfers to the representative of the Office of the State Long Term Care (LTC) Ombudsman (a person that advocates for residents in nursing homes) for four of four residents (Residents 35, 14, 51 and 49) reviewed for discharge process. This failure placed the residents at risk for lack of knowledge regarding their right to hold their bed and any monetary charges associated with the bed hold while in the hospital and disallowed the resident and/or their representative an opportunity to fully understand the rationale/resident rights associated with the discharge. [...]

Inspectors wroteBased on interview and record review, the facility failed to develop a baseline care plan [(BCP) a document outlining initial care goals and necessary healthcare information for a resident], within 48 hours of admission, that included the minimum requirements of resident specific goals, physician orders, dietary orders, treatment plans, and social service needs for 6 of 10 residents (Residents 39, 13, 202, 33, 41, and 32) reviewed for new admissions (residents admitted to the facility in the last 30 days). Failure to develop a BCP placed the residents at risk of not receiving continuity of care and resident centered care needs.

Inspectors wroteBased on interview and record review, the facility failed to identify a designated interdisciplinary [(IDT) a group of healthcare professionals from different disciplines to help people receive the care they need] team member, appointed as the responsible party for coordinating care and communication with hospice, and implement the written agreement that ensured effective communication, collaboration, and coordination of care between the facility and the hospice (a specialized type of care focused on providing comfort and support to individuals nearing the end of life) provider for 2 of 2 residents (Resident 39 and 45) reviewed for hospice services. This failure placed the residents at risk of not receiving necessary care and services at end-of-life.

Inspectors wroteBased on interview and record review, the facility failed to ensure grievances (resident and/or resident representative concerns that can be voiced or written) conveyed to staff underwent prompt resolution and appropriately updated residents on the grievance progress/conclusion for 1 of 2 residents (Resident 46) reviewed for grievances. This failure placed residents at risk for unresolved concerns and unmet care needs.

Inspectors wroteBased on interview and record review, the facility failed to ensure nursing staff reported, witnessed verbal and physical abuse, to the State Agency, immediately, but no later than two hours after the abuse took place, for 1 of 3 residents (Residents 41), reviewed for abuse/neglect. This failure placed the residents at risk for unidentified abuse/neglect, and the potential continued exposure to abuse and/or neglect.

Inspectors wroteBased on interview and record review, the facility failed to immediately implement effective measures in the protection of a resident from further abuse/neglect, nor conduct a thorough investigation into an allegation of abuse for 2 of 3 residents (Residents 41 and 11), reviewed for abuse and neglect. This failure placed the residents at risk for unidentified abuse, unmet care needs, and the potential for continued exposure to abuse and/or neglect.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure a Preadmission Screening and Resident Review [(PASARR) a process to determine if a potential nursing home resident had mental health/intellectual disability needs which required further assessment/treatment] accurately reflected residents' mental health conditions for 1 of 5 residents (Resident 39) reviewed for PASARR accuracy. This failure placed the residents at risk for inappropriate nursing home placement and/or not receiving timely and necessary services to meet their mental health needs. Findings including . Review of a policy titled, Pre-admission Screening and Resident Review, revised 06/2024, showed prior to admitting a resident, the admission coordinator or designee would request a PASARR Level I screening. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure services provided met professional standards of practice regarding, A) a residents Central Vascular Access Device (CVAD, also known as a central line, is a thin, soft tube that is inserted into a main vein in the arm, leg, or neck for long-term administration of antibiotics, medication, nutrition, and/or blood draws) dressing change and medication administration after nursing staff noted the central line migration (movement of the tubing from its original position) for 1 of 4 residents (Residents 32) reviewed for central lines, B) nursing staff failing to process, initiate, and follow physician orders with residents wound care for 1 of 4 residents (Resident 41) reviewed for wound care orders. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to follow the Centers for Disease Control [(CDC) a public agency that protects the public's health and well-being] guidance for temperature monitoring of vaccines in 1 of 1 medication storage refrigerators (Refrigerator 1) reviewed for medication storage. This failure placed the residents at risk of receiving compromised or ineffective vaccines and negative outcomes.

Inspectors wroteBased on interview and record review, the facility failed to ensure residents were offered the pneumococcal immunizations (a vaccine that protects against pneumococcal infections that can lead to serious lung infections) nor documentation of the resident refusal or acceptance of the vaccine along with education on the risk/benefits of the vaccine for 1 of 5 residents (Resident 29) residents reviewed for pneumococcal immunizations. This failure placed the resident at an increased risk for a contagious disease without the opportunity to make an informed decision in the refusal or acceptance of the pneumococcal vaccine.

Inspectors wroteBased on observation and interview the facility failed to ensure the resident environment was free from accident hazards, due to the placement of a 1500-[NAME] oil filled indoor electric space heater in 1 of 1 resident room (room [ROOM NUMBER]), reviewed for accident hazards. This failure placed the residents at risk for avoidable accidents and/or injury.

Inspectors wroteBased on interview and record review, the facility failed to address required documentation for Advanced Directives [(ADs) a legal document in which a person specifies what actions should be taken for their health if they are no longer able to make decisions for themselves because of illness or incapacity] including incorporating ADs into the care planning process for 3 of 5 residents (Residents 6, 15, and 16) reviewed for ADs. These failures placed the residents at risk of losing their right to have their preferences and/or decisions followed regarding their end-of-life care.

Inspectors wroteBased on interview and record review, the facility failed to implement two components of their abuse policy when they did not verify licensure for 1 of 2 staff (Staff AA) for screening and did not provide abuse training for 5 of 8 staff (Staff O, T, U, V, and R) reviewed for abuse and neglect. This failure placed the residents at risk for unrecognized abuse, and unmet care needs.

Inspectors wroteBased on interview and record review, the facility failed to ensure interdisciplinary team [(IDT) a group of healthcare providers from different fields who work together for the best outcome for residents] care conferences were completed for 2 of 2 residents (Residents 18 and 6) reviewed for comprehensive care planning. Additionally, the facility failed to ensure the IDT care conference meetings included the required team members for 2 of 2 residents (Residents 14 and 25) reviewed for comprehensive care planning. These failures disallowed the resident and/or their representative the involvement in planning resident care and placed the residents at risk for unmet care needs.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure restorative therapy services including the consistent use of braces/splints were implemented for 4 of 4 residents (Resident 6, 16, 17, and 23), reviewed for restorative therapy and limited range of motion [(ROM) the extent the joint can move within the expected (normal) range of values]. This failure placed the residents at risk for loss of ROM, deconditioning, and contractures (a permanent tightening of the muscles, tendons, skin, and surrounding tissues that causes the joints to shorten and stiffen).

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure appropriate administration and documentation of enteral feedings (delivery of nutrition directly to your stomach or small intestine through a tube) and fluid intake via gastrostomy tube [(g-tube) a device inserted into the stomach through the abdomen that provides nutrition when you are unable to eat on your own] feedings for 1 of 2 residents (Resident 16) reviewed for enteral feeding. This failed practice put Resident 16 at risk for dehydration, fluid overload, and weight loss/gain.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure a medication error rate of less than five percent. Eight medication errors were identified for 3 of 11 residents (Residents 9, 5 and 13) observed during 28 medication administration opportunities, that resulted in an error rate of 28.57%. Errors in medication administration placed the residents at risk for side effects and/or reduced or increased medication effectiveness due to improper administration.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure a clinically appropriate self-administration of medications assessment was completed by the interdisciplinary team [(IDT) a group of healthcare providers from different fields who work together for the best outcome for residents] for 1 of 1 resident (Resident 14) reviewed for safe self-administration of medications. Failure to complete a self-administration assessment placed the resident at risk for inaccurate and unsafe medication administration, adverse side effects, and medical complications.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide a comfortable, appropriate length bed for 1 of 1 resident (Resident 33) reviewed for accommodations. This failed practice placed the resident at risk for discomfort and skin issues.

Inspectors wroteBased on interview and record review, the facility failed to provide a Skilled Nursing Facility (SNF) Advance Beneficiary Notice [(ABN) a notification that provides an estimated cost of continuing services which may no longer be covered by Medicare; beneficiaries may choose to continue services but may be financially liable] as required for 1 of 5 residents (Resident 149) reviewed for beneficiary notification. Resident 149 was not issued the required ABN when they remained in the facility after their Medicare Part A skilled nursing and rehabilitation services (nursing services such as intravenous fluids or medications or therapy services) ended. This failure placed the resident at risk for the inability to make informed financial and care decisions related to their continued stay.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure a quiet, comfortable, and homelike environment for 4 of 10 resident rooms (Rooms 7, 5, 4, and 3) and 2 of 2 residents (Residents 25 and 33) reviewed for homelike environment. Observations showed resident rooms needed physical repairs, storage of nutritional supplies in cardboard boxes, and noisy beds. This failure placed residents at risk for unmet care needs, discomfort, and a non-homelike environment.

Inspectors wroteBased on interview and record review, the facility failed to ensure that prompt efforts were made to resolve a grievance involving a missing hearing aide for 1 of 1 resident (Resident 23) reviewed for grievances. The failure to promptly attempt to resolve a grievance disallowed the resident their right to a timely grievance resolution and placed the resident at risk for hearing difficulties and financial concerns.

Inspectors wroteBased on interview and record review, the facility failed to provide a written notice to the resident and/or resident's representative (RR) of the facility policy for bed hold at the time of transfer to the hospital for 1 of 2 residents (Resident 9) reviewed for hospitalization. This failure placed the resident and/or resident's representative at risk for lack of knowledge regarding their right to hold their bed while in the hospital.

Inspectors wroteBased on interview and record review, the facility failed to ensure Pre-Admissions Screening and Resident Review [(PASARR) a federal required assessment to help ensure that individuals are not inappropriately placed in nursing homes for long term care. Assesses for serious mental illness and intellectual disability, ensures most appropriate setting for their needs, and receive services they need in those settings) assessment was accurately completed upon or prior to admission to the facility for 1 of 6 residents (Resident 33) reviewed for PASARR. This failure placed the resident at risk for inappropriate placement and/or not receiving timely and necessary services to meet their mental health and/or developmentally disability care needs.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure a resident was provided assistance with meals for 1 of 1 resident (Resident 6) reviewed for dining. This failure placed the resident at risk for weight loss and an undignified dining experience.

Inspectors wroteBased on observation, interview, and record review, the facility failed to follow physician orders for bowel and pain management for 1 of 2 residents (Resident 25) reviewed for constipation and pain. This failure placed the resident at risk for unmet care needs and negative health outcomes.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure that pre/post dialysis (a process that uses a machine to filter waste and fluids from the blood when the kidneys no longer function) communication forms and vital signs (reflect essential body functions, including your heart beat, breathing rate, temperature, and blood pressure) were completed for 1 of 1 resident (Resident 17) reviewed for dialysis services. This failure placed the residents at risk for unidentified complications.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure culturally competent, trauma-informed care, related to assessing for trauma and identifying triggers for residents with a history of the loss of a loved one for 1 of 2 residents (Resident 33) reviewed for mood and behavior. This failed practice put residents at risk for re-traumatization, unidentified triggers, and a decline in their psychosocial well-being.

Inspectors wroteBased on interview and record review, the facility failed to serve a nourishing snack at bedtime for 3 of 4 residents (Residents 1, 4, and 17) reviewed for bedtime snacks. This failure placed the residents at risk for hunger, weight loss, and unmet nutritional needs.

Inspectors wroteBased on observation and interview, the facility failed to ensure the proper disposal of trash for 1 of 1 dumpster reviewed for outdoor refuse storage. Failure to ensure the dumpster was covered placed the facility at risk of attracting bugs, rodents, and an unsanitary environment. An observation on 03/26/2024 at 11:17 AM, showed the dumpster located in a walled off area of the parking lot, with two gates enclosing the front side of the wall and one opened gate on the side. There was one dumpster located inside the enclosure that had both lids open; visible trash included trash bags that were not secured to keep trash contained, and a mattress. An observation on 03/27/2024 at 8:15 AM, showed the dumpster in the same area, with additional bags of trash added from the previous observation, and both dumpster lids open. [...]