Sunshine Terrace.

Statement of Deficiencies License#: 950 Compliance Determination # 55441 Plan of Correction SUNSHINE TERRACE 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 the unannounced on-site full inspection and complaint investigation on 02/21/2025, 02/24/2025, 02/25/2025, 02/26/2025 and 02/27/2025 of: SUNSHINE TERRACE 10412 E 9th Ave Spokane Valley, WA 99206 This document references the following complaint numbers: 168007. The following sample was selected for review during the unannounced on-site visit: 15 of 133 current residents and O former residents. The department staff that inspected the Assisted Living Facility: Carla Rose, NCI Community Licensor Veronica Jackson, Assisted Living Facility Licensor Jennifer Lee, Assisted Living Facility Licensor Tethra Wales, Assisted Living Facility Licensor From: DSHS, Aging and Long-Term Support Administration 8517 E Trent Ave, Ste 102 Spokane Valley, WA 99212 . Statement of Deficiencies License#: 950 Compliance Determination# 55441 Plan of Correction SUNSHINE TERRACE Completion Date As a result of the on-site visit(s) the dep1artment found that you are not in compliance with the licensing laws and regulations as stated in the cited deficiencies in the enclosed report. 03/12/2025 lia are Services Date 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. WAC 388-78A-2210 Medication services. (1) An assisted living facility providing medication service, either directly or indirectly, must: (a) Meet the requirements of chapter 69.41 RCW Legend drugs Prescription drugs, and other applicable statutes and administrative rules; and (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 This requirement was not met as evidenced by: Based on observation, Interview, and record review, the facility failed to ensure a safe medication administration system was in place to administer medications as ordered for 1 of 15 residents (Resident 15) sampled for medication services. This failure resulted in Resident 15 to miss weeks of breathing treatments to improve lung function and placed them at risk of increased difficulty in breathing. Findings included ... Review of Resident 15's Service Plan Report (the facility's titled negotiated service agreement) dated 03/19/2024 showed that the resident required supervised self-administration assistance with medications. . Statement of Deficiencies License #: 950 Compliance Determination # 55441 Plan of Correction SUNSHINE TERRACE Completion Date Page3 of13 Licensee: SUNSHINE HEAL TH FACILITIES INC 02/27/2025 < lptratropium-Albuterol> Review of Resident 15's MAR for January 2025, showed an order for lptratropium-Albuterol inhalation solution three milliliters to be given twice daily in the morning and evening by oral inhalation started on 01/2412025 for treatment of chronic obstructive pulmonary disease (COPD, an ongoing lung disease that limits airflow in the lungs). Further review showed it was administered eight times and refused seven limes for the period of 01124/2025-01/31/2025. Review of Resident 15's MAR for February 2025, showed from 02/01/2025 through 02/2612025 the order for lptratropium-Albuterol was administered 32 times and was refused by the resident 19 times. An observation on 02127/2025 at 9:30 AM, showed Staff I, Resident Assistant, administering medications to Resident 15. Staff I handed the resident an unopened multi-vial 20 dose package of lptratropium-Albuterol inhalation solution (liquid medication used to improve breathing) for the resident to use in their nebulizer machine (turns liquid medications into an aerosolized solution for inhalation treatment that takes 10-15 minutes) in their room and stated they found it in a bottom drawer in the medication room. Staff I further stated that they had been signing it off as administered in the Medication Administration Record (MAR) because they believed the resident had the medication In their room. (Resident 15 had an order to keep and use an albuterol inhaler in their room when necessary) Resident 15 responded by saying they had been asking their doctor for that albuterol nebulizer treatment for over a month, and they believed the doctor had refused to order it for them since they had not received it yet. in an interview on 02/27/2025 at 9:45 AM, Resident 15 stated they were happy to have the albuterol nebulizer treatments and stated they had been asking for this treatment since they had used it in the hospital, because it had helped improve their breathing so much better than the albuterol inhaler. Resident 15 confirmed that they had not used the medication yet in the facility since it was ordered last month. < Budesonide Inhalation Suspension > Review of a prescription order for Resident 15 showed that the prescription for the budesonide was ordered on 07/12/2024. Review of Resident 15's December 2024 and January 2025 MA Rs, showed an order for budesonide inhalation suspension (medication used for long term management of COPD) with one vial to be given by nebulizer two times a day for COPD. Further review showed that Resident 15 refused the medication 24 times In December and 24 times in January and then discontinued on 01/24/2025. . Statement of Deficiencies License#: 950 Compliance Determination # 55441 Plan of Correction SUNSHINE TERRACE Completion Date In an interview on 02/26/2025 at 12:59 PM, Staff I stated that Resident 15 would not take the budesonide because it did not work. In an interview on 02/26/2025 at 2: 11 PM, Resident 15 stated that they told staff administering medications that the budesonide wasn't working and that they weren't getting any breathing help. Review of Resident 15's December 2024 and January 2025 Progress Notes, showed Resident 15 notified the medication technician that the medication wasn't working on the following dates: 12/08/2024 "Said it doesn't work for him any longer'' 12/09/2024 "Said that he does not take this med because it does not work" 12/16/2024 "Does not work for him" 12/22/2024 "Does not use this because it does not work for him" 12/27/2024 "Does not take this because he says that it does not work for him" 12/29/2024 "Does not use says it does not work for him" 12/30/2024 "Does not use it does not work for him" 01/04/2025 "Does not want to take because it does not work for him" 01/11/2025 "States not working for him" In an interview on 02/27/2025 at 9:37 AM, Staff F, Nurse Manager, stated that Resident 15 hadn't used his budesonide "for months" during which time he saw the provider. Staff F further stated that the facility didn't tell Resident 15's provider that the budesonide wasn't working and "neither did the resident." When asked if they had spoken with Resident 15 about how budesonide differs from a rescue medication and that they may not feel immediate improvement, Staff F stated that the prescribing providers explain medications to residents when they order them and that they were confident Resident 15's provider did so when it was ordered. 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, SUNSl;l\ 1\~~1-\Ty E:R; RACE. is or will U be in compliance with this law and I or regulation on (Date) 1 In addition, I will implement a system to monitor and ensure continued compliance with --~~-e)_ __ _ this requirement. WAC 38B-78A-2230 Medication refusal. (1) When a resid.ent who is receiving medication assistance or medication administration services from the assisted living facility chooses to not take his or her . Statement of Deficiencies License #: 950 Compliance Determination# 55441 Plan of Correction SUNSHINE TERRACE Completion Date medications, the assisted living facility must: (c) Notify the physician of the refusal and follow any Instructions provided, unless there is a staff person available who, acting within his or her scope of practice, is able to evaluate the significance of the resident not getting his or her medication, and such staff person; (i) Conducts an evaluation; and (ii) Takes the appropriate action, including notifying the prescriber or primary care practitioner when there is a consistent pattern of the resident choosing to not take his or her medications.

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.