Weiser Care of Cascadia

Inspectors wroteBased on observation, policy review, and staff interviews, it was determined the facility failed to ensure infection control practices were followed for hand hygiene during housekeeping tasks, hand hygiene during medication administration, and safe infection control practices in the laundry room. This failure affected all residents who receive medications and laundry services and created the potential for adverse outcomes related to cross contamination.

Inspectors wroteBased on observation, policy review, resident and staff interview, it was determined the facility failed to provide a clean, comfortable, sanitary, and homelike environment when trash and laundry services were not provided. This was true for 2 of 15 residents (#5 and #7) reviewed for frequency of laundry and housekeeping services. This deficient practice created the potential for psychosocial harm if residents' laundry and trash were not cleaned creating an unwelcome and unsanitary environment for residents and/or their visitors.

Inspectors wroteBased on record review, policy review, and staff interviews, it was determined the facility failed to provide a required 30 day written notice of discharge for 1 of 1 residents (Resident #58) reviewed for discharge process. This failure created the potential for psychosocial harm when Resident #58 received a verbal notice and subsequently chose to leave the facility against medical advice.

Inspectors wroteBased on observation, policy review, and staff interviews, it was determined the facility failed to provide a PASRR level II to the designated state agency. This was true for 1 of 1 residents (Resident #7) whose record was reviewed for PASRR documentation. This deficient practice created the potential for harm if Resident #7's coordination of care was not completed between the facility and the designated state agency, with interventions appropriately documented in Resident #7's care plan.

Inspectors wroteBased on record review, policy review, and staff interview, it was determined the facility failed to implement the comprehensive person centered care plan according to the resident's identified needs. This was true for 1 of 15 residents (Resident #42) reviewed for comprehensive care planning. This failure created the potential for harm when Resident #42 was not monitored for signs and symptoms of withdrawal as directed in the care plan.

Inspectors wroteBased on observation, record review and staff interview, it was determined the facility failed to ensure a medication was administered according to professional standards of practice. This was true for 1 of 8 residents (Resident #29) observed during medication administration. This deficient practice created the potential for Resident #29 to develop Candida albicans infection in her mouth (oral thrush - a fungal infection characterized by painful, creamy white, cottage cheese-like patches on the tongue, inner cheeks or throat) when she did not rinse her mouth with water after inhaling her steroid medication.

Inspectors wroteBased on record review, observation, policy review, and staff interview, it was determined the facility failed to ensure smoking paraphernalia was stored in a safe location for 2 of 3 residents (#6 and #42) reviewed for smoking. This failure created the potential for harm when Resident #6's smoking assessment was not accurate and when Resident #42 was observed sleeping in her bed while holding a vape device.

Inspectors wroteBased on record review, policy review, and staff interview, it was determined the facility failed to ensure the physician responded to the pharmacists' recommendation. This was true for 1 of 6 residents (Resident #48) reviewed for unnecessary medications. This created the potential for Resident #48 to develop Candida albicans infection in his mouth (oral thrush - a fungal infection characterized by painful, creamy white, cottage cheese-like patches on the tongue, inner cheeks or throat).

Inspectors wroteBased on record review and staff interview, it was determined the facility failed to ensure a resident's medication regimen was free from unnecessary medications. This was true for 1 of 6 residents (Resident #8) whose medication regimens were reviewed for unnecessary medications. This failure placed Resident #8 at risk for adverse outcomes from overmedication when he was receiving nicotine patches, had an order for nicotine gum, and was smoking cigarettes.

Inspectors wroteBased on observation, policy review, and resident and staff interviews, it was determined the facility failed to ensure medications were safely stored when unattended by staff. This was true for 1 of 1 resident (Resident #18) whose medications were observed in his room. This deficient practice created the potential for harm if the medications were taken by another resident.

Inspectors wroteBased on record review and staff interview, the facility failed to ensure the facility's Arbitration Agreement signed by the residents included the selection of venue that was convenient to both parties. This was true for 2 of 3 residents (#40 and #48) whose arbitration agreements were reviewed. This deficient practice created the potential for residents not to attend the arbitration process to resolve the dispute due to inconvenience of the venue.

Inspectors wroteBased on record review, policy review, and staff interview, it was determined the facility failed to ensure its Antibiotic Stewardship practices were followed by initiating antibiotic therapy without obtaining culture and sensitivity results to guide appropriate treatment. This was true for 1 of 1 residents (Resident #17) reviewed for antibiotic stewardship. This failure created the potential for inappropriate antibiotic use and development of antibiotic resistant organisms.

Inspectors wroteBased on review of facility staffing records and staff interview, it was determined the facility failed to ensure an RN was on duty at least 8 hours a day, 7 days a week. This was true for 2 of 21 days reviewed. The failure created the potential for harm if routine and/or emergency nursing needs went unmet and had the potential to affect all residents living in the facility.

Inspectors wroteBased on observation, policy review, and staff interview, it was determined the facility failed to ensure nurse staffing information was accurate, posted daily for each shift, and kept for review for 18 months. This failed practice had the potential to affect the 46 residents residing in the facility and their representatives, visitors, and others who wanted to review the facility's staffing levels.

Inspectors wroteBased on observation, staff interview, policy review, and review of the Idaho Food Code, the facility failed to appropriately store and label food . This deficient practice had the potential to affect 25 of 26 residents who received meals in the facility and residents that eat snacks. This placed residents at risk for potential contamination and use of spoiled foods, and adverse health outcomes, including food-borne illnesses.

Inspectors wroteBased on observation and staff interviews, it was determined the facility failed to ensure residents were provided with a safe, clean, and homelike environment. This was true for 2 of 46 Residents (#28, #199) whose rooms were observed. This deficient practice created the potential for diminished quality of life and safety risk.

Inspectors wroteBased on record review and staff interview, it was determined the facility failed to complete a comprehensive MDS assessment when a resident experienced a significant change after developing a pressure ulcer to her right buttock. This was true for 1 of 5 residents (Resident #28) reviewed for pressure ulcers. This failure had the potential for harm if the facility staff did not recognize significant changes in the resident's health status and needs.

Inspectors wroteBased on observation, staff interview, policy and record review, the facility failed to follow comprehensive person-centered care plan for 1 of 4 residents (Resident #199) observed with wounds. This deficient practice created the potential for harm or adverse outcomes related to infection and skin breakdown.

Inspectors wroteBased on observation, review of policy, records review, and interviews, it was determined the facility failed to ensure Nursing Assistants (NAs) performed tasks which they had the knowledge, skills, and competences. This was true for 1 of 6 NAs observed in the facility. This had the potential for adverse effects and potential harm to residents medical and physical status.

Inspectors wroteBased on observation, policy review, and staff interview, it was determined the facility failed to ensure medications available for residents were dated and had not expired. This was true for 2 of 2 medication carts inspected. This failure created the potential for residents to receive expired medications with decreased efficacy.

Inspectors wroteBased on observation and staff interview, the facility failed to ensure adherence to infection control and prevention practices to provide a safe and sanitary environment. This failure had the potential to impact 25 of 26 residents that eat meals prepared in the kitchen, 2 of 2 residents (#35 and #200) for hand hygiene.

Inspectors wroteBased on observation and staff interview, the facility failed to provide a functional environment for residents to meet their physical needs. This was true for 1 of 46 residents (Resident #12). This deficient practice had the potential to cause harm and distress for residents with loss of independence.

Inspectors wroteBased on record review, policy review, and staff interview, it was determined the facility failed to ensure residents' records included an Advanced Directive or documentation of discussion regarding Advance Directives and their decision not to formulate one. This was true for 2 of 12 residents (#1 and #30) reviewed for Advance Directives. The deficient practice created the potential for harm should residents' wishes regarding end of life care not be honored when they are unable to make or communicate their health care preference.

Inspectors wroteBased on record review, policy review and staff interview, it was determined the facility failed to ensure a notice of their bed-hold policy was provided to residents or their representatives upon transfer to the hospital. This was true for 1 of 1 resident (Resident #17) reviewed for transfers. This deficient practice created the potential for harm if residents were not informed of their right to return to their former bed/room at the facility within a specified time and may cause psychosocial distress if not informed they may be charged to reserve their bed/room.

Inspectors wroteBased on observation, record review, and staff interview, it was determined the facility failed to ensure residents were assisted with hand hygiene. This was true for 1 of 12 residents (Resident #40) reviewed for ADL care. This failure created the potential for harm by potentially exposing residents to the risk of infection.

Inspectors wroteBased on observation, record review, policy review, and staff interview, it was determined the facility failed to ensure professional standards of nursing practice were followed for medication administration, bowel care, and skin care. This was true for 3 of 12 residents (#9, #16, and #30) reviewed for quality of care. These failed practices created the potential for harm should residents experience adverse effects from medications, constipation or fecal impaction, and skin breakdown.