Sharon Care Center Assisted Living.

Conclusion / Action: Failed Provider Practice Identified / Citation(s) Written . Failed Provider Practice Not Identified / No Citation Written N/A . □ □ STATE OF WASHINGTON DEPARTMENT OF SOCIAL AND HEALTH SERVICES AGING AND LONG-TERM SUPPORT ADMINISTRATION 800 NE 136th Ave Ste 200, Vancouver, WA 98684 Statement of Deficiencies License #: 1428 Compliance Determination # 51728 Plan of Correction SHARON CARE CENTER ASSISTED LIVING Completion Date You are required to be in compliance at all times with all licensing laws and regulations to maintain your Assisted Living Facility license. The department completed data collection for an unannounced on-site complaint investigation on 12/13/2024 and 01/08/2025 of: SHARON CARE CENTER ASSISTED LIVING 1509 HARRISON AVE CENTRALIA, WA 98531 This document references the following complaint number(s): 158302 The following sample was selected for review during the unannounced on-site visit: 3 of 67 current residents and 0 former residents. The department staff that investigated the Assisted Living Facility: Pamela Horlick, NCI RN Complaint Investigator From: DSHS, Aging and Long-Term Support Administration 800 NE 136th Ave Ste 200 Vancouver, WA 98684 As a result of the on-site visit(s), the department found that you are not in compliance with the licensing laws and regulations as stated in the cited deficiencies in the enclosed report. I understand that to maintain an Assisted Living Facility license, the facility must be in compliance with all the licensing laws and regulations at all times. . Statement of Deficiencies License #: 1428 Compliance Determination # 51728 Plan of Correction SHARON CARE CENTER ASSISTED LIVING Completion Date Administrator (or Representative) Date WAC 388-78A-2210 Medication services. (1) An assisted living facility providing medication service, either directly or indirectly, must: (b) Develop and implement systems that support and promote safe medication service for each resident. (2) The assisted living facility must ensure the following residents receive their medications as prescribed, except as provided for in WAC 388-78A-2230 and 388-78A-2250 : (a) Each resident who requires medication assistance and his or her negotiated service agreement indicates the assisted living facility will provide medication assistance; and (b) If the assisted living facility provides medication administration services, each resident who requires medication administration and his or her negotiated service agreement indicates the assisted living facility will provide medication administration. This requirement was not met as evidenced by: Based on interview and record review the facility failed to ensure prescribed medications were available for 2 of 3 residents (Resident 1 [R1] and Resident 2 [R2]). This failure placed R1 and R2 at risk for medical complications and unmet care needs. Findings included… Record review of Department records showed that a report was submitted on 12/06/2024. The report stated on /2024: -R1 was feeling ill and needed their rescue inhaler and it was not available. R1 requested their nebulizer treatment and was told that it was not in the medication cart. R1 was transported to the hospital due to poor oxygen saturation where they stayed for two days until they were discharged to go back to the facility. -R2’s antibiotic were not available <R1> Review of R1’s face sheet, dated 12/13/2024, showed R1 was admitted to the facility on /2020. Listed on R1’s “Diagnosis Information,” showed, “ . Statement of Deficiencies License #: 1428 Compliance Determination # 51728 Plan of Correction SHARON CARE CENTER ASSISTED LIVING Completion Date and “ .” Record review of R1’s negotiated service agreement, dated 01/15/2024, showed under “medications,” the “goal” showed, “Will be supported to take all medications safely and as ordered.” Under the section, “Interventions,” showed, R1 “requires medication assistance. [R1] are able to self- direct care…Requires assistance with ordering meds…Resident uses inhaler(s).” Record review of R1’s Medication Administration Record (MAR), dated October 2024 and November 2024, showed: -“ProAir HFA Inhalation Aerosol Solution 108 (90 base) MCG/ACT (Albuterol Sulfate) [a medication inhaled to help with breathing] 2 puff inhale orally every 4 hours as needed for Wheezing, Start Date 02/01/2023.” -“Ipratropium Albuterol Inhalation Solution 0.5-2.5 (3) MG/3ML (Ipratropium/Albuterol) [a medication inhaled to help with breathing] 3 milliliter inhale orally every 6 hours as needed for COPD, Start date 02/01/2023, D/C [discontinue] date 12/02/2024” In an interview on 12/13/2024 at 10:31 AM, R1 was asked to explain what happened when they went to the hospital recently, they stated, they went to the hospital that day and was diagnosed with . R1 stated the facility was to already have their rescue inhaler available on the medication cart. R1 stated that evening they had trouble breathing, were coughing and was not able to catch their breath. R1 stated they asked for their rescue inhaler and was told by the medication technician on shift, Staff D, that they didn’t have it. R1 stated they asked for their nebulizer treatment and was told they didn’t have the treatments either. R1 stated they were taken to the hospital where they stayed for a few days. R1 was asked if the facility handled ordering their medications, they stated yes. R1 was asked how that made them feel when the facility didn’t have their medication, they stated, “it scared me.” Record review of the facility staff working schedule, dated November 2024, showed on /2024, Staff D, Medication Technician, was on shift. In an interview on 12/13/2024 at 1:40 PM, Staff D, was asked if they were aware of an incident regarding R1 needing to go to the hospital recently, they stated, R1 was coughing. Staff D stated they looked for their inhaler and couldn’t find it. The coughing was severe so Staff D called 911 . In an interview on 12/13/2024 at 1:56PM, Staff B, Director of Nursing, was asked, if the order was on the MAR (Medication Administration Order), should the medication have been on the medication cart for use, they stated, yes, I was aware that they tried to look for it and was not able to find it. Staff B was asked where R1’s nebulizer was, they stated it was on the shelf in the medication room and should have been in the cart. . Statement of Deficiencies License #: 1428 Compliance Determination # 51728 Plan of Correction SHARON CARE CENTER ASSISTED LIVING Completion Date In an interview on 12/13/2024 at 2:52 PM, Staff B, stated they need to come up with a process, if the medication was on the MAR, we had a valid order for it and we should have had it in the cart. In an interview on 12/18/2024 at 2:56 PM, Staff A, Executive Director, stated that they don’t have a policy on reordering medications. They stated they were told they don’t need a policy but they do need to have a process in place. Staff A was asked what the process was for reordering PRN (as needed) medications, they stated they didn’t have one but moving forward they will. <R2> Review of R2’s face sheet, dated 12/13/2024, showed that R2 was admitted to the facility on /2020. Listed on R2’s “Diagnosis Information,” showed, “ ” Record review of R2’s negotiated service agreement, dated 01/11/2024, showed under “medications,” the “goal” showed, “Will be supported to take all medications safely and as ordered.” Under the section, “Interventions,” showed, R2 required medication assistance related to cognitive changes related to history of TBI (Traumatic Brain Injury). Record review of R2’s MAR, dated November 2024, showed, “Doxycycline Monohydrate [an antibiotic] Oral Tablet 100MG (Doxycycline Monohydrate) Give 1 capsule by mouth one time a day for folliculitis. Start date 06/13/2024.” On 11/14/2024, the number “9” was listed in the box. On the MAR, the number “9” meant “other/see progress notes.” Record review of R2’s progress notes, dated 11/01/2024 through 12/13/2024 showed: -11/06/2024: the pharmacy was called to order R2’s doxycycline. The pharmacy stated the resident was out of refills. A fax was sent to R2’s PCP (primary care provider). -11/14/2024: showed Doxycycline was unavailable -11/14/2024: Pharmacy was called regarding R2’s Doxycycline. R2 currently out of this medication. Pharmacy stated that they have sent faxes to PCP requesting refills. “Facility staff called PCP regarding staff and pharmacy reaching out to refill with no response from PCP.” -11/14/2024: Dermatology office contacted for refill of doxycycline. . Statement of Deficiencies License #: 1428 Compliance Determination # 51728 Plan of Correction SHARON CARE CENTER ASSISTED LIVING Completion Date -11/15/2024: Doxycycline medication arrived to the facility.

Conclusion / Action: . Failed Provider Practice Identified / Citation(s) Written Failed Provider Practice Not Identified / No Citation Written N/A . . . . .

Conclusion / Action: . Failed Provider Practice Identified / Citation(s) Written Failed Provider Practice Not Identified / No Citation Written N/A .

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