Spokane Valley Health and Rehabilitation of Cascad

Inspectors wroteBased on interview and record review, the facility failed to ensure that direct care staffing information, including information for agency and contract staff, was electronically submitted correctly to the Centers for Medicare and Medicaid Services (CMS), for Quarter 2 of 2025, reviewed for Payroll Based Journal (PBJ - mandatory reporting of staffing information based on payroll data) submission. This failure resulted in CMS receiving inaccurate data related to nursing home staffing levels and had the potential to impact resident care and services.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure the consistent and required provision of Restorative Nursing Programs (RNP, a formal, planned and organized program of care which is intended to restore a lost ability or maintain a potentially deteriorating function for a particular resident), including periodic reviews of the RNP, for 4 of 4 sampled residents (Residents 49, 68, 82, and 88) reviewed for limited range of motion and mobility. These failures placed the residents at risk of development or worsening of contractures (a medical condition where muscle, tendon, or other soft tissue becomes abnormally tight and shortened, limiting the range of motion at a joint) and a diminished quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure sufficient staff were available to meet the care needs for 3 of 6 sampled residents (Residents 4, 68, 88) reviewed for activities of daily living for dependent residents, and 4 of 4 sampled residents (Residents 49, 68, 82, and 88) reviewed for restorative nursing (interventions that promote a resident's ability to adapt and adjust to living as independently and safely as possible). Failure to ensure there was adequate nursing staff available to provide bathing and restorative services placed the residents at risk for unmet care needs, a diminished quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to consistently provide bathing/showers for 3 of 6 sampled residents (4, 68, 88) reviewed for activities of daily living (ADLS). This failure placed the residents at risk for a diminished quality of life and unmet care needs.

Inspectors wroteBased on interview and record review, the facility failed to fully assess and implement orders and interventions, monitored a change in condition for 4 of 9 sampled residents (Residents 7, 24, 6 and 51) whose records were reviewed for quality of care. This failure placed residents at risk of medical complications, discomfort and a decreased quality of life.

Inspectors wroteBased on observation, interview, and record review the facility failed to assess a resident's smoking abilities, appropriately care plan, and implement safety interventions as needed for 1 of 5 sampled residents (Resident 81), reviewed for accidents. This failure placed residents at risk of potentially avoidable accidents, unmet care needs, and diminished quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure consistent, ongoing communication and collaboration with the dialysis (a treatment that removes waste products and excess fluid from the blood when the kidneys are unable to do so) center regarding dialysis care and services for 1 of 1 sampled resident (Resident 24) reviewed for dialysis. Failure to ensure accurate and complete communication to and from the dialysis center, address dietitian communication, and ensure administration and disposition of medications on dialysis days, placed the resident at risk for unmet care needs and dialysis complications.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure expired medications were disposed of timely, in accordance with currently accepted professional standards, in 2 of 4 medication storage rooms and 2 of 4 medication carts were not maintained in a sanitary manner. This failure placed residents at risk for receiving compromised or ineffective medication.

Inspectors wroteBased on interview and record review, the facility failed to ensure resident records were complete and accurate for 2 of 3 sampled residents (Resident 6 and 17) reviewed for advance directives (a legal document that outlined a resident's wishes for medical treatment if they could not make decisions for themselves) and 2 of 6 sampled residents (Resident 2 and 3) reviewed for admission. This failure placed the residents at risk of delay in care, inaccurate medical records, and decreased quality of life.

Inspectors wroteBased on observation and interview, the facility failed to perform hand hygiene when indicated during 2 of 3 medication administration observations. This failure placed residents at risk for potential unintended health consequences and diminished quality of life.

Inspectors wroteBased on interview and record review, the facility failed to ensure a complete and thorough investigation of an allegation of abuse for 1 of 3 sampled residents (Resident 3) whose records were reviewed for accident hazards. This failure placed the residents at risk for continued abuse or neglect.

Inspectors wroteBased on observation, interview, and record review, the facility failed to develop and implement interventions to prevent falls and associated injuries and injury during transfers or bed mobility for 3 of 3 sampled residents (Residents 1, 2 and 3) whose records were reviewed for accident hazards. This failure placed the residents at risk for falls, physical injury, and pain.

Inspectors wroteBased on interview and record review, the facility failed to ensure adequate staffing was maintained to provide consistent and required assistance during bed mobility and use of a mechanical lift (a device that uses mechanical means, like gears, chains, or cables driven by a motor, to raise and lower persons and moving individuals with limited mobility safely) for 1 of 3 sampled residents (Resident 3) reviewed for accident. In addition, the facility failed to ensure the Director of Nursing maintained a license that authorized them to work as a Registered Nurse (RN) in the State of [NAME]. These failures placed the resident at risk for unmet care needs.

Inspectors wroteBased on interview and record review, the facility failed to ensure 1 of 3 sampled residents (Resident 6), reviewed for medication administration, received medication as ordered by the physician. This failure resulted in a pattern of significant medication errors which placed the resident at risk for medical complications, unintended health consequences and diminished quality of life.

Inspectors wroteBased on interview and record review, the facility failed to notify the resident representative of an incident requiring transfer to the hospital experienced by 1 of 4 sampled residents (Resident 1), reviewed for accident hazards. This failure placed the resident at risk for delayed decisions for treatment by the legal representative.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure 1 of 4 sampled residents (Resident 1), reviewed for accident hazards, received adequate supervision while at an appointment with an external provider. This failure placed the resident at risk of injury and unmet needs.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure 1 of 8 sample residents (Resident 1) reviewed for abuse, was free from sexual abuse from another resident (Resident 2). This failure placed Resident 1 and other residents at risk for psychosocial harm and a diminished quality of life.

Inspectors wroteBased on interview and record review, the facility failed to ensure that direct care staffing information was accurate upon submission to the Centers for Medicare and Medicaid Services (CMS) for Quarter 1 of 2024 (January 1, 2024 through March 31, 2024) reviewed for Payroll Based Journal (PBJ - mandatory reporting of staffing information based on payroll data) submission. This failure caused CMS to have inaccurate data related to facility staffing levels and had the potential to impact resident care and services.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide appetizing and palatable food for 6 of 7 sampled residents (48, 59, 8, 41, 1, 43) reviewed for food. This failure placed the residents at risk for decreased nutritional intake, and a diminished quality of life.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure enhanced barrier precautions (EBP, an infection control intervention to reduce transmission of multi-drug resistant organisms) were implemented when indicated for 4 of 4 sampled residents (69, 7, 73, 1) reviewed, and that hand hygiene was completed when indicated during 1 medication pass observed and 2 wound treatments observed. Additionally, the water management plan was not developed and implemented as required, Infection Prevention Program policies and procedures were not reviewed annually, and appropriate follow-up measures were not completed timely when one resident screened for Tuberculosis exposure (TB, a bacterical infection that mainly affected the lungs) had a positive skin test. [...]

Inspectors wroteBased on record review and interview, the facility failed to ensure residents were provided education regarding the risks and benefits of influenza and pneumococcal immunizations, and received the immunizations or did not receive them due to contraindications or refusals for 4 of 5 sampled residents (36, 48, 66, 69) reviewed. This failure put residents at risk of being unable to participate in aspects of their care, and at risk of acquiring viral and bacterial diseases.

Inspectors wroteBased on record review and interview, the facility failed to ensure resident records included evidence of the resident's vaccination status for COVID-19 (a viral illness that caused difficulty breathing, fever, or other severe symptoms that included possible death), that the residents had been offered education regarding the risks or potential side effects of the vaccine, had been offered the vaccine if available, refusals, contraindications, or administrations if given, for 4 of 5 sampled residents (36, 48, 66, 69) reviewed. This failure placed residents at risk of not being informed of their choices to receive immunizations, and at risk for acquiring serious viral illnesses.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure residents were provided care in a dignified manner for 3 of 4 sampled residents (4, 58, 67) reviewed for resident rights. Specifically, Resident 4 was referred to as a feeder, and Residents 58 and 67 required use of urinary catheters (a tube inserted into the bladder that allowed urine to drain) and the urine collection bags were not covered and were visible to the public. This failure put the residents at risk for embarassment and decreased quality of life.

Inspectors wroteBased on interview and record review, the facility failed to investigate a fall for 1 of 3 sampled residents (285), reviewed for falls. This failure placed the resident at risk of further falls, injury, and a diminished quality of life.

Inspectors wroteBased on interview and record review, the facility failed to ensure 1 of 5 sampled residents (23) reviewed for Pre-admission Screening and Resident Review (PASARR, an assessment completed to determine whether a resident with a diagnosis of a serious mental illness needed specialized mental health services) was completed accurately and prior to admission as required. In addition, the facility failed to ensure a new PASARR assessment was completed when Resident 23 had changes in their mental health diagnoses. These failures placed the resident at risk for unmet care needs.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure care plan interventions were implemented for 3 of 19 sampled residents (1, 283, 4) reviewed for care planning. Failure to ensure nutritional interventions for Residents 1 and 4, and vascular ulcer interventions for 283 were followed placed the residents at risk for poor nutritional intake, potential skin breakdown, unmet care needs, and a diminished quality of life.

Inspectors wroteBased on interview and record review, the facility failed to complete a discharge summary, including a recapitulation of the resident's stay as required, for 1 of 1 sampled residents (19), reviewed for discharge. This failure placed the resident at risk for having an incomplete medical record.

Inspectors wroteBased on observation, interview, and record review, the facility failed to consistently provide bathing and/or grooming for 3 of 3 sampled residents (1, 43, 5), reviewed for activities of daily living (ADLS). This failure placed the residents at risk for poor personal hygiene, unmet care needs and a diminished quality of life.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure 1 of 1 sampled residents (25) reviewed for activities, received an ongoing program of activities that met their interests. This failure placed the resident at risk for boredom and diminished quality of life.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure pressure relieving interventions were implemented for 1 of 4 sampled residents (4) reviewed. Specifically, Resident 4 did not have their pressure relieving foam boot applied consistently when in bed and an area where the resident had a history of pressure on their left heel reopened. This failure placed the resident at risk of further deterioration of their heel, pain, infection, and decreased quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide consistent, ongoing communication and collaboration with the dialysis facility for 1 of 1 sampled resident (65), reviewed for dialysis. These failures placed the residents at risk for unmet care needs and medical complications.

Inspectors wroteBased on interview and record review, the facility failed to ensure residents were seen by the physician within the required timeframes for 2 of 8 sampled residents (5, 59) reviewed. This failure placed residents at risk for unmet medical needs and decreased quality of care.

Inspectors wroteBased on interview and record review, the facility failed to complete a yearly performance review on 3 of 3 sampled nursing assistants (AA, BB, CC) as required. This failure placed residents at risk of receiving care from inadequately trained staff.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure behavioral health services were provided for 2 of 2 sampled residents (7, 36) reviewed. This failure placed the residents at risk of declining mental health, escalation of their chronic mental health conditions and decreased quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure a medication error rate of less than five percent. Five medication errors were identified for 1 of 8 sampled residents (Resident 73) observed during 40 medication opportunities, which resulted in an error rate of 12.5 percent. The failure to administer medications correctly placed the residents at risk for receiving subtherapeutic effects of their medications and possible adverse side effects.

Inspectors wroteBased on observation and interview, the facility failed to ensure expired medications were disposed of and multi-dose vials were dated when opened in 1 of 2 medication rooms inspected, and that insulin needles were securely stored on a unit that was closed. This failure placed residents at risk of receiving expired medications and potential needlestick injuries. Findings Included . On 08/01/2024 at 8:30 AM, a team of surveyors entered the facility to conduct a recertification survey. The team was provided a workspace in a dining area on a rehabilitation unit that was no longer in use. Across the hall from the dining area, a nursing station no longer in use was located, and contained a small dorm-style refrigerator, a sink area, and multiple unlocked cabinets, and drawers. At 11:01 AM, the nursing station was inspected. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure dietary staff had the required qualifications (current Food Worker Cards) for one of twelve dietary staff reviewed (EE). This failed practice had the potential risk for unsafe food handling practices and placed all residents at risk for developing foodborne illness.

Inspectors wroteBased on observation and interview the facility failed to ensure hand hygiene was completed when indicated during 1 of 4 meals observed during dining. This failure resulted in potential risk of food borne illness and a decreased quality of life for all residents.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure pharmacy services were provided to meet the needs of 3 of 3 sampled residents (Resident 1, 2, and 3) reviewed for medication management. The failure to ensure medications were acquired and administered as ordered, and follow facility processes for medications not available, placed residents at risk for adverse events related to missed medications.

Inspectors wroteBased on interview and record review, the facility failed to ensure professional standards of practice were followed when discontinuing medications for 1 of 3 sampled residents (Resident 3) reviewed for medication management. This failure placed the resident at risk of not receiving correct medications, adverse health effects, and diminished quality of life.

Inspectors wroteBased on interview and record review, the facility failed to ensure a system was in place in which residents' records were complete and accurate for 1 of 3 sampled residents (Resident 1) reviewed for accurate and complete medical records. The facility failed to ensure the medical record included consultant provider notes and medications administered during external provider visits. This failure to not maintain complete and accurate medical records placed residents at risk for medical complications, unmet care needs, and diminished quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure 1 of 3 sampled residents (Resident 1), reviewed for food and nutrition services, was served the appropriate diet texture to prevent choking hazards. This failed practice placed the resident at risk for decreased nutritional intake, serious injury, and dimished quality of life.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure staff provided CPR (cardiopulmonary resuscitation) in accordance with national standards for effective CPR to one of two sampled residents (Resident 2), reviewed for death. Additionally, the facility failed to ensure two of three sampled facility staff (Staff B and D), reviewed for CPR certification, had current CPR certification credentials. These failures placed residents at risk for not receiving effective care in accordance with their decision-making if their heart stopped beating or their breathing stopped.

Inspectors wroteBased on interview and record review, the facility failed to take action or evaluate the need for action for 2 of 3 sampled residents (Resident 1 and 2), who experienced significant changes in clinical status. There was a lack of timely interventions, physician notification and adherence to the bowel management program, Resident 1 experienced harm when complaints of stomach pain were not reported or managed, Resident 2 experienced harm when pain and significant weeping edema was not addressed.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure a medication error rate of less than five percent. During observation of medication pass, there were two errors observed out of 25 opportunities, resulting in an 8% error rate. This had the potential to place two sample residents (12, 42) at risk of not receiving the full benefit of their medication therapy.

Inspectors wroteBased on observation, interview, and record review, the facility failed to properly label a medication box for one of four sampled residents (42), observed during a medication pass. This failure placed the resident at risk of receiving an inaccurate dosage of medication. In addition, the facility failed to ensure that there were no expired medications in one of the two medication rooms.

Inspectors wroteBased on observation, interview, and record review, the facility failed to serve food that was at a safe and appetizing temperature for 3 of 5 sampled residents (22, 29, 42), reviewed for food palatability. This failure placed residents at risk for decreased food consumption and decreased enjoyment of their meals.

Inspectors wroteBased on observation, interview, and record review, the facility failed to consistently provide bathing/showers for two of four sampled residents (52, 25) in a total sample of 18, who required extensive assistance from two staff to complete their activities of daily living (ADLs). This failure placed the residents at risk for a diminished quality of life and unmet care needs.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure a program of meaningful activities in accordance with the resident's preferences and current cognitive ability, as identified in the resident assessment, for one of two sampled residents (52), reviewed for activities, in a total sample of 18. This failure placed the resident at risk for a diminished quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to follow the physician orders for parameters set before administering medication for 2 of 5 sampled residents (17, 49), reviewed for medications. These failures placed the residents at risk for adverse side effects and unmet care needs.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide care and services to prevent weight loss and impaired nutritional needs for one of two sampled residents (22), reviewed for nutrition and weight loss in a total sample of 18. This deficient practice caused Resident 22 to have a 7.5% weight loss in a three-month time frame. The facility failed to add additional interventions, failed to notify the provider in a timely manner of the weight loss, and consistently provide fluids as directed on the care plan at meals. These failures placed Resident 22 at risk for additional weight loss and impaired nutrition.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure that orders for as needed (PRN) antipsychotic medications (a type of medication used to treat symptoms of psychosis) were limited to 14 days for 2 of 4 sampled residents (11, 20), reviewed for Hospice (care for a terminal illness) services. In addition, the prescribing practioner had not re-evaluated Resident 11 for the appropriateness of the PRN antipsychotic medication, as required. These failures placed the residents at risk for unintended medication side effects and a decreased quality of life.