The Orchards at Grandview.

. Statement of Deficiencies License #: 2503 Compliance Determination # 68992 Plan of Correction The Orchards at Grandview Completion Date Plan/Attestation Statement I hereby certify that I have reviewed this report and have taken or will take active measures to correct this deficiency. By taking this action, The Orchards at Grandview is or will be in compliance with this law and / or regulation on (Date)________________ . In addition, I will implement a system to monitor and ensure continued compliance with this requirement. Administrator (or Representative) Date .

This document was prepared by Residential Care Services for the Locator website.

This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website.

Conclusion / Action: Failed Provider Practice Identified / Citation(s) Written . Failed Provider Practice Not Identified / No Citation Written N/A . Investigation Summary Report Provider/Facility: The Orchards at Grandview Provider Type: Assisted Living Facility License/Cert.#: 2503 Intake ID: 83944 Compliance Determination #: 24832 Region/Unit #: RCS Region 1 / Unit G Investigator: Gwin Kaercher Investigation Date(s): 06/05/2023 through 07/06/2023 Complainant Contact Date(s): Allegation(s): 1. Residents who need assistance with eating were not getting help, they were left in soiled brief for hours, beds were not being made, linens were dirty and soiled. 2. Staff were not repositioning residents like they were supposed to. 3. When the reporter went to check and change residents, they were not cleaned properly and would have feces stuck on them. 4. Medications were not given properly. 5. Staff were not certified to do medication pass, the nurse was not there most of the time, and the facility allows the staff to do the medication pass. 6. Non-certified staff administering medications without training and or medication delegation. 7. A staff member smokes dabs (Marijuana). 8. The staff member who smoked went into resident rooms to smoke, does their Tik-Tok videos, and residents were left alone. 9. A couple of months ago, the reporter walked into a resident's room and found three staff members holding the named resident down, pretty aggressively. 10. Reporter felt they were harassed, traumatized, and blamed for something every day by the administrator and human resources. 11. The named resident was hospice and their pain medication was not given and staff said to give the named resident Motrin for pain because family did not want the Morphine given. 12. The named resident was screaming in pain for awhile that day. 13. There was not communication from the nurse to the night shift staff. 14. Facility staff hide things, pretend like no one knows anything , and do not take responsibility for anything. 15. Some staff make fun of residents, do not know how to care for dementia residents, yell and bully residents when they get frustrated. 16. Residents complain about the food and sometimes get diarrhea after eating. Investigation Methods: Sample: Total residents: 40 Resident sample size: 6 Closed records sample size: 2 Observations: The facility's common areas, resident to staff, resident to resident interactions, facility laundry room, and a morning meal serve out were observed. . Interviews: Sampled residents, facility staff, and others not associated with the facility. Record Reviews: Resident characteristic roster, resident records (Negotiated Service Agreement (NSA), NSA updates, progress notes, Medication Administration Records (MAR), incident investigations, facility policies, activity calendar, staff roster, staff work schedule, facility training booklet for behaviors, and resident medical supply invoices. Investigation Summary: 1. 2. 3. Observations on 06/05, 06/07, 06/20 and 06/27/2023 showed residents in clean clothes, no odors in sampled resident rooms or common areas. Observations on 06/20/2023 showed three facility staff provided resident checks between 5 AM to 6:30 AM. Two of the three staff removed dirty linen from the resident rooms in hall 2 and 3. Two of three staff changed resident undergarments for residents on hall 2 and 3. The staff member on hall 1 changed 2 resident's briefs. Observations on 06/20 and 06/27/2023 showed staff assisting residents with eating. Interview with the facility administrator stated that staff had to walk by their office in order to take out the bags of soiled garbage. In addition, the facility had placed a camera in the laundry room to ensure staff were doing laundry. Interview with the facility administrator stated that staff were to do resident checks every two hours. 4. Review of sampled resident MARs showed medications given as prescribed. Interview with the facility nurse stated that an investigation was completed, and the MT was terminated. 5. 6. Staff record review showed staff who were Medication Technicians (MT) were nurse delegated and had the required training. Observations on 06/05, 06/07, 06/20, and 06/27/2023 showed the facility nurse to be in the facility. 7. 8. Interviews with facility staff showed that there was a staff member who smoked in the break room and blew the smoke out the exterior door. Staff interviewed denied smoking dabs (Marijuana). Staff denied smoking in resident rooms, doing Tik-Tok videos, or leaving resident's unattended. 9. Staff interviewed denied knowing about an incident where a resident was held down by staff. Record review showed that the facility had not investigated incidents or reported to the State hotline. Failed practice identified in reporting and investigations. 10. Interview with the facility administrator showed that if staff had concerns they would talk to the Resident Care Coordinator (RCC) and or the nurse to discuss the concern. The administrator also stated that most staff get along and do their job. 11. 12. Record review showed that family requested that the narcotic pain medication not be given to the named resident. Review of the MAR showed that the named resident had other pain medication prescribed and given that was not a narcotic. Interview with the resident's representative stated that they did not want the narcotic given. 13. Interview with the facility nurse and facility administrator showed that there was shift to shift communication and that the shift coming on arrived and walked the hall with the outgoing shift staff member. Interview with the facility nurse showed that an NSA update form would be completed for all shift communications. 14. Onsite observations and interviews showed staff to be approachable and answered questions the licensors had. Record review did find the facility was not doing investigations or reporting to the State hotline. Facility failed practice identified for investigations and reporting. 15. Observations showed staff to resident interactions were respectful. Interview with the facility administrator denied knowing or witnessing staff making fun of residents, not caring for residents, or yelling/bullying residents. The administrator stated they would not tolerate that and staff would be fired if that happened. The administrator . also stated a recent training for all staff on how to care for resident's with dementia and behaviors. 16.Observations on 06/05, 06/07, 06/20, and 06/27/2023 showed residents eating their meals, no reported complaints about the food. Interview with the facility administrator and facility nurse denied having resident's complain or have diarrhea after eating at the facility. Failed practice identified WAC 388-78A-2371, WAC 388-78A-2630 and 388-78A- 2660, reference Statement of Deficiencies dated 07/12/2023. Conclusion / Action: Failed Provider Practice Identified / Citation(s) Written Failed Provider Practice Not Identified / No Citation Written N/A . Investigation Summary Report Provider/Facility: The Orchards at Grandview Provider Type: Assisted Living Facility License/Cert.#: 2503 Intake ID: 85401 Compliance Determination #: 24832 Region/Unit #: RCS Region 1 / Unit G Investigator: Gwin Kaercher Investigation Date(s): 06/05/2023 through 07/06/2023 Complainant Contact Date(s): Allegation(s): 1. A named resident prior to their death, was bleeding from their eyes and suffocating. 2. Residents were neglected due to no communication between staff. 3. Another named resident had wounds on their legs, no treatment occurred, and we were told to leave it alone. 4. A Medication Technician (MT) during the night shift was not changing their residents, smoked in the laundry room or outside, slept on shift, and sometimes slept in resident rooms or the living room. 5. Another named resident had fallen, had a gash on their leg, wounds were not reported even though the MT was aware of the wounds. 6. Residents complained of not getting enough food. 7. Residents were over medicated. Investigation Methods: Sample: Total residents: 40 Resident sample size: 6 Closed records sample size: 2 Observations: The facility's common areas, resident to staff, resident to resident interactions, facility laundry room, and a morning meal serve out were observed. Interviews: Sampled resident, facility staff, and others not associated with the facility. Record Reviews: Resident characteristic roster, resident records (Negotiated Service Agreement (NSA), NSA updates, progress notes, Medication Administration Records (MAR), incident investigations, facility policies, activity calendar, staff roster, staff work schedule, facility training booklet for behaviors, and resident medical supply invoices. Investigation Summary: 1. Record review showed that the named resident had chronic obstructive pulmonary disease (lung disease), refused treatment for the disease, and refused to be taken to the hospital or to have end of life services. Review of the progress notes showed . facility communication with the named resident's family which respected the named resident's wishes. 2.