The Cottages of Spokane.

Statement of Deficiencies License #: 2591 Compliance Determination # 49509 Plan of Correction The Cottages of Spokane 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 11/01/2024, 11/04/2024 and 11/05/2024 of: The Cottages of Spokane 6930 N Nevada St Spokane, WA 99208 This document references the following complaint numbers: 151569, 145460. The following sample was selected for review during the unannounced on-site visit: 10 of 74 current residents and 0 former residents. The department staff that inspected the Assisted Living Facility: Joy Pipgras, LTC Surveyor Tethra Wales, Assisted Living Facility Licensor Patricia Eddy, Community Licensor From: DSHS, Aging and Long-Term Support Administration 8517 E Trent Ave, Ste 102 Spokane Valley, WA 99212 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. . Statement of Deficiencies License #: 2591 Compliance Determination # 49509 Plan of Correction The Cottages of Spokane Completion 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. 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 : (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 medications were administered to residents as ordered by the medical provider for 2 of 10 residents (Resident 2 and 5) and failed to monitor a resident’s blood pressure daily to determine if a medication should be administered or held for 1 of 10 residents (Resident 5). This failure resulted in Resident 2 not receiving needed medication and Resident 5 receiving medication that should not have been given, and placed the residents at risk for health complications. Findings included… < Resident 2> Review of Resident 2’s Negotiated Service Agreement (NSA), dated 11/27/2023, showed diagnoses of ( ), ( ), ( ), and ( ). Review of the NSA showed that the facility staff were to administer medications as per physicians’ orders. Further review showed that Resident 2 “will pretend to be asleep when it’s time to take meds,” and that when Resident 2 resisted or declined care, staff were to provide space and reapproach later. Review of Resident 2’s September 2024 and October 2024 Medication Administration . Statement of Deficiencies License #: 2591 Compliance Determination # 49509 Plan of Correction The Cottages of Spokane Completion Date Records (MARs) showed that Resident 2 was to receive one tablet of divalproex (a medication used to treat seizures) once a day. The MARs showed that the resident did not receive the medication on 09/19/2024, 10/02/2024, 10/23/2024, 10/24/2024, 10/29/2024, 10/30/2024, and 10/31/2024. The MAR listed the reason the medication was not given as, “resident sleeping.” Review of Resident 2’s September 2024 and October 2024 MARs showed that Resident 2 was to receive one tablet of furosemide (a medication that helps rid the body of excess water) once a day. The MARs showed that the resident did not receive the medication on 09/19/2024, 10/02/2024, 10/23/2024, 10/24/2024, 10/29/2024, 10/30/2024, and 10/31/2024. The MAR listed the reason the medication was not given as, “resident sleeping.” Review of Resident 2’s September and October 2024 MARs showed that Resident 2 was to receive one tablet of potassium chloride (a supplement that increases the level of potassium) twice a day. The MARs showed that the resident did not receive their morning does of the medication on 09/19/2024, 10/02/2024, 10/23/2024, 10/24/2024, 10/29/2024 and 10/30/2024, and 10/31/2024. The MAR listed the reason the medication was not given as, “resident sleeping.” Review of Resident 2’s September and October 2024 progress notes showed no documentation of reapproach or attempts to administer the medications when the resident was no longer sleeping for the medications not given on 09/19/2024, 10/02/2024, 10/23/2024, 10/24/2024, 10/29/2024 and 10/30/2024, and 10/31/2024. In an interview on 11/04/2024 at 10:32 AM, Staff G, Director of Nursing, confirmed that the medications were not given and that re-attempts should have been made. <Resident 5> Review of Resident 5’s NSA, dated 10/10/2024, showed diagnoses of and . Further review showed that facility staff were to administer medications as per physicians’ orders. Review of Resident 5’s August 2024 MAR showed that Resident 5 was to take one tab of midodrine (medication that treats low blood pressure that causes severe dizziness and fainting) twice daily and to hold the medication if the resident’s systolic (top number) blood pressure (BP) was greater than 130. The MAR showed that on 08/01/2024, Resident 5’s systolic BP was 139 and on 08/02/2024 was 144 and that the midodrine was documented as given. Further review showed that that on 08/06/2024 Resident 5’s order for the midodrine was decreased to a half a tab with the same directions to hold if their systolic BP was greater than 130. The MAR did not show documentation of blood pressure readings from 08/06/2024 until 08/27/2024 (19 days). . Statement of Deficiencies License #: 2591 Compliance Determination # 49509 Plan of Correction The Cottages of Spokane Completion Date In an interview on 11/04/2024 at 10:32 AM, Staff G confirmed that the parameters had not been followed as ordered and no blood pressure readings had been documented after 08/06/2024 to note if the midodrine needed to be held. 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 Cottages of Spokane 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 WAC 388-78A-2474 Training and home care aide certification requirements. (2) The assisted living facility must ensure all assisted living facility administrators, or their designees, and caregivers hired on or after January 7, 2012 meet the long-term care worker training requirements of chapter 388-112A WAC, including but not limited to: (c) Specialty for dementia, mental illness and/or developmental disabilities when serving residents with any of those primary special needs; This requirement was not met as evidenced by: Based on interview and record review, the facility failed to ensure specialty training for dementia and mental health was completed by 2 of 5 sampled staff (Staff A and B). This failure placed residents at risk of receiving care from untrained staff. Findings included… Review of the facility's Characteristic Roster showed that all 76 residents residing in the facility had a diagnosis of . Review of an undated personnel file for Staff A, Caregiver, showed they were hired on 06/24/2024. Further review showed that they had not completed specialty training for dementia. Review of an undated personnel file for Staff B, Caregiver, showed they were hired on 03/25/2024. Further review showed that they had not completed specialty training for dementia. . Statement of Deficiencies License #: 2591 Compliance Determination # 49509 Plan of Correction The Cottages of Spokane Completion Date In an interview on 11/04/2024 at 9:25 AM, Staff F, Executive Director, stated that Staff A and Staff B had not completed the required specialty training certification within 120 days of hire. 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 Cottages of Spokane 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 .

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