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The Honorable Mary Jo Hesten Chapter 11
PCO’S FIRST REPORT - 1
FREEMAN LAW OFFICE 1725 NW Market St. #219
Seattle, WA 98108 (206) 491-8843
UNITED STATES BANKRUPTCY COURT FOR THE WESTERN DISTRICT OF WASHINGTON
In re:
PNW HEALTHCARE HOLDINGS, LLC, et al.1
Debtors.
Chapter 11 Lead Case No. 19-43754-MJH (Jointly Administered) PATIENT CARE OMBUDSMAN’S FIRST REPORT
Pursuant 11 U.S.C. § 333(b)(2), Patricia Hunter, the Washington State Long-Term Care
Ombudsman, in her capacity as the Patient Care Ombudsman (PCO) for this matter, hereby files
the PCO’s First Report.
1 The debtors and debtors-in-possession in the above-captioned, jointly administered chapter 11 bankruptcy proceedings, along with the last four digits of each Debtor’s federal tax identification number, are: PNW Healthcare Holdings, LLC (9801); North Auburn Health, LLC dba North Auburn Rehabilitation & Health Center (3159); Sequim Health, LLC dba Sequim Health & Rehabilitation (7737); Bremerton Health, LLC dba Bremerton Convalescent & Rehabilitation Center (3188); Crestwood Convalescent-Port Angeles, LLC dba Crestwood Health & Rehabilitation Center (6565); Fir Lane Health-Shelton, LLC dba Fir Lane Health & Rehabilitation Center (7798); Forest Ridge Health-Bremerton, LLC dba Forest Ridge Health & Rehabilitation Center (4019); Meadow Park Health-St Helen, LLC dba Meadow Park Health & Specialty Care Center (9109); Cherrywood Place-Spokane, LLC dba Cherrywood Place (7776); Riverside Nursing-Centralia, LLC dba Riverside Nursing & Rehabilitation Center (3792); PNW Master Tenant I, LLC (9824); Franklin Hills Health-Spokane, LLC dba Franklin Hills Health & Rehabilitation Center (1763); Aldercrest Health-Edmonds, LLC dba Aldercrest Health & Rehabilitation Center (3827); PNW Master Tenant II, LLC (5319); Gardens on University-Spokane Valley, LLC dba The Gardens on University (1917); Puget Sound Healthcare-Olympia, LLC dba Puget Sound Healthcare Center (4419); Care Center East Health-Portland, LLC dba Care Center East Health & Specialty Care Center (8950); LaCrosse Health-Coeur d’Alene, LLC dba LaCrosse Health & Rehabilitation Center (8594); Ivy Court-Coeur d’Alene, LLC dba Ivy Court C (1265); and CRN Pool, LLC (9083) (collectively, “debtors”).
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PCO’S FIRST REPORT - 2
FREEMAN LAW OFFICE 1725 NW Market St. #219
Seattle, WA 98108 (206) 491-8843
I. GENERAL INFORMATION REGARDING ALL FACILITIES
A. Primary Goals of First Reporting Period
As PCO, the primary goal during this period was to conduct at least one in-person
monitoring visit in each facility. This goal included observing the physical structures, meeting
leadership and staff, and hearing from residents and residents’ representatives, including family
members and other visitors, and legal decision-makers. Additional monitoring activities
included interviewing major department heads, observing meals, including both lunch and dinner
in all facilities except three, reviewing nursing staffing levels, reviewing resident and family
council meeting minutes, and reviewing state enforcement records.
B. Sources of Information
Information for this report was obtained from a variety of individuals and documents
with an eye toward providing consistent information across facilities wherever possible.
However, it is important to know what the “work day” (or night) looks like in a nursing facility.
Administrative staff who have offices are, understandably, not necessarily in that office all day.
Individuals may or may not be present in the facility on the day of a monitoring visit. Schedules
and availability can easily change based on a variety of factors, including the needs of residents.
Shifts change regularly and staff are on the go. Moreover, as with any complex operation, no
one person “knows everything.”
Interactions with non-employees in facilities also vary depending on the day or time. A
resident may want to speak with you at that moment, or not. A family member may demand
your attention on an unplanned basis. All interactions can lead to greater understanding of the
quality of care for residents, but the information is, by nature, not available all at once and not
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PCO’S FIRST REPORT - 3
FREEMAN LAW OFFICE 1725 NW Market St. #219
Seattle, WA 98108 (206) 491-8843
available consistently across facilities. This explanation is provided to explain any gaps that may
appear when information appears to be provided about one facility and not another.
C. Confidentiality Measures
Throughout this report, certain terms are used somewhat interchangeably, such as
“issues,” “concerns,” and “grievances.” These terms pertain to information usually shared with
the PCO verbally, whether by residents, resident representatives, staff, administrators, managers,
or local LTC Ombudsmen. The term “complaint” as used in this report2 refers to complaints
received by the relevant LTC Ombudsman Program, which has duties under state and federal
laws to identify, investigate, and resolve “complaints” brought by or on behalf of long-term care
residents with regard to the resident’s health, safety, welfare, or rights.
As with any operation with high stakes, such as health and safety, many individuals fear
retaliation for speaking out. Therefore, the information provided in this report with regard to
issues, concerns, grievances, and complaints are not attributed to any one person. I share
information in this report that I have a good faith belief to be true. In this first reporting period,
there was no need to review confidential documents and none were reviewed.
D. Areas of PCO Concern
The PCO and the state licensing entity are aware of concerns involving vendors, utilities,
and external support factors that may affect resident care during bankruptcy. Based on this first
reporting period, three areas are of particular concern are set forth below.
2 The term complaint is also used occasionally throughout this report to discuss government complaint investigation and enforcement, which is an entirely separate process from the complaint processing done by LTC Ombudsman Programs.
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PCO’S FIRST REPORT - 4
FREEMAN LAW OFFICE 1725 NW Market St. #219
Seattle, WA 98108 (206) 491-8843
1. Nursing staffing
Monitoring activities have given rise to concerns about nursing staffing levels, and
training and supervision of nursing staff as it relates to resident care.
2. Recommendation re dietary and food services
Monitoring activities have revealed that several of the facilities do not consistently have
appropriate and adequately functioning kitchen equipment and tools, which are particular
important for residents who have missing or false teeth or special diets. This resource issue
negatively impacts the quality and quantity of food available to residents, in turn potentially
impacting the nutrition and dietary needs of residents as well as their overall quality of life and
of care in the facilities.
The PCO recommends the debtor facilities conduct a needs assessment of facility
kitchens and develop a plan to address faulty, broken, or missing equipment and fixtures needed
to meet the needs of all residents, and to provide nutritious, quality meals, beverages, and snacks
including special diets.
3. Adequate resources
The PCO understands that bankruptcy is intended to allow the debtors to reorganize their
business operations and resources. Care must be taken to ensure that resources are adequately
available and used to address building operations, needed repairs, daily operations, and safety
concerns and equipment.
4. New leadership
As I understand, residents and staff at these facilities have gone through two sales and
one bankruptcy already. New leadership is in place in many of the facilities. Many positions
have been newly filled in the last eight months. While turnover is a natural part of any business
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PCO’S FIRST REPORT - 5
FREEMAN LAW OFFICE 1725 NW Market St. #219
Seattle, WA 98108 (206) 491-8843
operation, changes in personnel that are too frequent or regularly ongoing can have a particularly
negative impact on the healthy, safety, welfare, and rights of vulnerable adults who live in long-
term care facilities.
5. Closure process and impacts
The PCO is aware of legal disputes among the debtors and creditors regarding the
likelihood of new operators or owners for the facilities. While the PCO is not currently in a
position to opine on this legal dispute, it is important to at least briefly highlight what is needed
when a long-term facility closes. Facility closure requires communication and coordination with
numerous individuals and agencies, including state and federal regulatory bodies, residents and
their representatives, unions, vendors, providers, attorneys, and other advocates. Months of
preparation and planning are needed. Vulnerable residents—along with their personal
belongings, funds kept with the facility, social and medical records, and any specialized medical
equipment— must be appropriately transferred to new locations that are safe and appropriate.
The phenomenon of “transfer trauma” is a real threat for residents who may have serious
difficulty in relocating due to disability or disease and loss of relationships and familiar
surroundings.
Closures can be particularly difficult for Medicaid-funded residents. Locating a
“Medicaid” bed can be challenging because Medicaid contracted providers are not required to
accept potential residents. At current, Washington State is experiencing a number of nursing
homes that are closing for various reasons with one common reason being that Washington State
Medicaid reimbursement rates being historically too low, and not meeting provider costs.
Additionally, workforce labor issues in Washington State make it difficult to find adequate
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PCO’S FIRST REPORT - 6
FREEMAN LAW OFFICE 1725 NW Market St. #219
Seattle, WA 98108 (206) 491-8843
skilled labor to meet the needs of residents. This is not strictly a regional problem as urban and
rural providers have experienced difficulty in obtaining qualified workers.
II. FACILITY OVERVIEWS
With the exception of Cherrywood Assisted Living, all facilities listed below are skilled
nursing facilities.
A. Explanation of Information in this Section
The bulk of this report is dedicated to providing an individual overview for each facility,
including the dates of the PCO’s monitoring visits and any additional monitoring visit by
certified long-term care ombudsmen who then reported to or shared information with the PCO.
Below is a general explanation of the information provided for each facility listed in this section.
1. Population and Payment
Information is provided for the total number of beds in each facility, the “census” at the
monitoring visit, which means the number of residents living in the facility on the date of the
visit, and the major sources of payment if known. Two government programs pay for the
majority of care in nursing facilities—Medicare and Medicaid. The Medicare program pays at
higher rates than Medicaid, but Medicare is generally available for a shorter amount of time,
such as for rehabilitation after a hospital stay. Medicaid pays at a lower rate but is available for
“long-term” extended stays in nursing facilities. Medicaid is a needs-based program, meaning
that income and resource limits apply to anyone seeking Medicaid-funded nursing facility
services.
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PCO’S FIRST REPORT - 7
FREEMAN LAW OFFICE 1725 NW Market St. #219
Seattle, WA 98108 (206) 491-8843
2. Facility and Environment
The information provided in this subsection pertains to observations and information
obtained about the facility’s physical appearance, general environment, and equipment or
supplies.
3. Resident Care
The subsections on resident care provide an overview of grievances and concerns from
residents or their representatives, whether shared with the PCO directly, or reviewed in
documents such as the minutes of resident or family council meetings. The subsections on
staffing draw upon interviews with administrators and other employees, as well as publicly
posted information regarding nursing staffing levels.
Of note, the debtors did recently hire their own pool of Physical Therapists and Rehab
specialists across the state for all facilities. The debtor facilities also contract with Healthcare
Services Group (HCSG) to provide food, laundry, and housekeeping services.
4. Staffing
The subsections on staffing draw upon interviews with administrators and other
employees, as well as documents including department head rosters, and publicly posted
information regarding nursing staffing levels.
5. CMS Ratings, Licensing, and Enforcement—including the CMS “Red Abuse Icon”
CMS offers a website called Nursing Home Compare, which uses a “Five-Star Quality
Rating System” to provide consumers information about nursing facilities around the country.3
3 Individual nursing facilities can be searched at https://www.medicare.gov/nursinghomecompare/search.html. Information on the data used in the rating system can be found on the Nursing Home Compare website at https://www.medicare.gov/NursingHomeCompare/About/howcannhchelp.html. A technical user’s guide is also available at https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/downloads/usersguide.pdf.
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PCO’S FIRST REPORT - 8
FREEMAN LAW OFFICE 1725 NW Market St. #219
Seattle, WA 98108 (206) 491-8843
This report provides the current star ratings for each facility in the main star-rating areas used on
the Nursing Home Compare website: Overall, Staffing, Health Inspection, and Quality
Measures.
Several facilities in this matter have received CMS’s “red alert icon.” As stated in
relevant part on the CMS website:
As you know, nursing home quality can vary. That’s why we added a new feature on Nursing Home Compare to allow you to tell if a nursing home has been cited for issues related to nursing home abuse or neglect.
Now when you use Nursing Home Compare, you’ll see a red alert icon if a facility has been cited for nursing home abuse that led to harm within the last year, or potential harm of a resident within the last two years. Each month, we’ll review nursing home inspection reports and will update the alert icons to make sure you have the most recent information on nursing home abuse.4
It should be noted that over sixty percent of all nursing facilities in Washington have this
relatively new icon from CMS. This icon does not mean that the debtor facilities are worse or
better than other Washington nursing facilities. Nor does it mean that Washington state nursing
homes are worse than other states’ facilities when it comes to abuse. Washington State has a
robust program for nursing facility licensing, surveillance, and enforcement.
The red alert icon, however, is a helpful tool meant to prod consumers into doing their
own research. Unfortunately, this research can be incredibly time-consuming. To truly get to
the bottom of a red alert icon, in order to make an independent assessment, one must make a
deep dive into licensing records. While no type of “abuse” is acceptable, a red abuse icon might
4 Medicare.gov Blog, New Feature Helps You Compare Nursing Home Safety, Oct. 23, 2019, https://www.medicare.gov/blog/nursing-home-abuse (last visited Feb. 11. 2020). For additional information on the red alert icon, see The Center for Medicare Advocacy, Nursing Home Compare’s Abuse Icon is Now Live https://www.medicareadvocacy.org/nursing-home-compares-abuse-icon-is-now-live/ (last visited Feb. 11, 2020) (stating in part that “the absence of an abuse icon . . .does not necessarily indicate the absence of abuse”).
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PCO’S FIRST REPORT - 9
FREEMAN LAW OFFICE 1725 NW Market St. #219
Seattle, WA 98108 (206) 491-8843
indicate an isolated event of “resident to resident aggression.” For any given investigation by a
licensing authority, multiple documents must be analyzed and compared against one another
with regard to specific dates and individual findings. An event might occur outside the reporting
period but not investigated until much later, or resolved even later still. If specifically ordered by
the Court, the PCO would investigate the underlying basis for the red alert icon at each facility
monitored. Without specific court direction, however, the PCO does not believe it a prudent use
of time to do so.
Where available, information is also provided regarding deficiencies found by regulatory
bodies, including information on severity and scope.5
6. Complaints to PCO/LTC Ombudsman Program
This subsection provides basic information on the number and types of complaints
received by the PCO or the applicable LTC Ombudsman Program, whether in Washington,
Idaho, or Oregon. Because complaint resolution and investigation are the functions of a LTC
Ombudsman and not a Patient Care Ombudsman, the PCO did not attempt to investigate or
resolve complaints that were received in the course of fulfilling PCO duties. Instead, the PCO
referred any such complaints to the relevant LTC Ombudsman Program, whether a Regional
Program in Washington or the State LTC Ombudsman Programs in Idaho and Oregon,
respectively. Still, in receiving any such complaint, the PCO was able to communicate with
residents, their representatives, and others to get a sense of the quality of care in the facilities.
As needed, the PCO seeks and obtains follow-up information from the relevant LTC
5 The severity and scope of deficiencies is explained WAC 388-97-4500. Severity and scope is also explained in A technical user’s guide to the Five-Star Quality Rating System, which is available at https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/downloads/usersguide.pdf.
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PCO’S FIRST REPORT - 10
FREEMAN LAW OFFICE 1725 NW Market St. #219
Seattle, WA 98108 (206) 491-8843
Ombudsman Program handling the complaint. The PCO did bring some concerns, none
egregious, to the attention of administrators and executive leadership.
B. Aldercrest Health & Rehabilitation Center
Aldercrest Health & Rehabilitation Center (“Aldercrest”) is located at 21400 72nd Ave
W, Edmonds, WA 98026. The PCO monitoring visit took place on January 2, 2020. Additional
monitoring visits were conducted by a Regional LTC Ombuds who reports directly to the PCO.
1. Population and Payment at Aldercrest
Aldercrest has 128 beds. The census on the monitoring visit was 70. The majority
payment source is Medicaid.
2. Facility and Environment of Aldercrest
Aldercrest is situated in an older building. The Aldercrest facility has gone through
several changes in operators over the past five years or so. Aldercrest’s van appears to have been
out of order since the beginning of summer 2019. No additional information is available at this
time as to possible repair or replacement. Once shower was out of order on the date of the
monitoring visit, but has since been fixed.
3. Resident Care at Aldercrest
Aldercrest has limited access to activities outside of the building due to the facility’s van
being out of order since the beginning of summer 2019. Other concerns at Aldercrest include
lack of showering/bathing due to staff being too busy and one shower being out of order;
however, the shower was reported to be fixed as of the date of this report.
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PCO’S FIRST REPORT - 11
FREEMAN LAW OFFICE 1725 NW Market St. #219
Seattle, WA 98108 (206) 491-8843
The food choices made by residents at Aldercrest were not always provided on the trays
given to residents. The quantity of snacks available throughout the day and night at Aldercrest
was insufficient.
4. Staffing at Aldercrest
Aldercrest’s management positions are not fully staffed. The director of nursing is an
interim placement. Most mangers at Aldercrest have been in place less than six months.
Staffing seems to be improving slowly, though it is fluctuating. The Aldercrest administrator
presents as being very vested in making the needed improvements to ensure quality of care and
life for all of its residents.
The interim Director of Nursing at Aldercrest was called to work as a Cornerstone “pool
nurse” at another facility from January 6-9, 2020 during that facility’s state survey inspection.
This left Aldercrest with just one Resident Care Manager (RCM), whereas there are usually two
to three RCMs. Aldercrest is also reported to be down one or two staff registered nurses. The
administration, staff, and residents reported a history of nurse staffing problems. However, all
report that staffing levels at Aldercrest are improving and not worsening since the bankruptcy
filing.
5. CMS Ratings, Licensing, and Enforcement at Aldercrest
Aldercrest has a “red alert icon” on the Nursing Home Compare website. In addition,
Aldercrest has the following CMS star ratings: Overall is one star; Health inspection is one star;
Staffing is three star; and Quality measures is two star.
A review of the state’s licensing enforcement records available to the LTC Ombudsman
Program, show two level G citations and one level D citation at Aldercrest during the last year.
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PCO’S FIRST REPORT - 12
FREEMAN LAW OFFICE 1725 NW Market St. #219
Seattle, WA 98108 (206) 491-8843
There were no new reports from the regulatory agency in the public file during this first reporting
period known to the PCO or to the LTC Ombudsman Program.
6. Complaints to PCO/LTC Ombudsman Program regarding Aldercrest
Four complaint investigations were received into the local ombudsman program during
the reporting period and remain open at current time. Complaint types are related to telephone
access, nurse staffing levels, quality of care, and safety of residents. Three of these complaints
are also being investigated by the state licensing entity.
7. Recommendations for Aldercrest
The PCO recommends that Aldercrest develop a plan to: address the fluctuations in
nurse staffing levels; obtain a full time Director of Nursing and Resident Care Manager to meet
the needs of residents; allow for use of contracted agency staff when needed; and provide
adequate training for agency and new hires. If Aldercrest’s staffing issues cannot be stabilized, it
is paramount that potential residents are carefully reviewed and approved by skilled clinical staff
and in collaboration with the Aldercrest Administrator.
C. Bremerton Convalescent & Rehabilitation Center
Bremerton Convalescent & Rehabilitation Center (“Bremerton”) is located at 2701 Clare
Ave, Bremerton, WA 98310. The PCO monitoring visit took place on January 21, 2020.
1. Population and Payment at Bremerton
Bremerton has 125 certified beds. The census on the monitoring visit was 94. The
majority payment source is unknown at this time.
2. Facility and Environment of Bremerton:
The Bremerton facility is situated in an older building with uneven terrain and a steep
driveway.
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PCO’S FIRST REPORT - 13
FREEMAN LAW OFFICE 1725 NW Market St. #219
Seattle, WA 98108 (206) 491-8843
3. Resident Care at Bremerton
The PCO received several grievances about the quality and quantity of food available to
the residents, and the accuracy of resident choices and preferences. The residents would like to
have more communication with the administrator to hear their concerns and have them
addressed. No hydration stations such as coffee, tea and ice water were seen available for the
residents to access independently. Residents report being hungry at night and not having access
to enough snacks. All of these concerns were brought to the administrator at the end of the
monitoring visit. No concerns were expressed about direct care or nursing care.
4. Staffing at Bremerton
The administrator at the time shared that finding nursing assistants (NAC) is challenging
and that she has several positions open on the day of the visit. The administrator (who was hired
about one year ago has since been replaced and is no longer at Bremerton Convalescent) shared
that she offers pay incentives and recruitment bonuses. The facility also offers nursing assistant
certification classes. On the day of the visit the nursing staffing is: RN-60 hours; LPN/LVN-48;
and NACs-217.5 hours.
5. CMS Ratings, Licensing, and Enforcement at Bremerton
Bremerton has the following CMS star ratings: Overall is one star; Health inspections is
one star; Staffing is two star; and Quality Measures is three star. The state licensing entity public
file shows a full health survey inspection ended on November 25, 2019. Two deficiencies were
found at levels F and K scope and severity.
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PCO’S FIRST REPORT - 14
FREEMAN LAW OFFICE 1725 NW Market St. #219
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6. Complaints to PCO/LTC Ombudsman Program regarding Bremerton
The PCO will make a referral to the Kitsap Long-Term Care Ombudsman Program
regarding food service, quality and quantity and resident choice and preferences. No other
complaints received into the long-term care ombudsman program during the reporting period.
7. Recommendations for Bremerton
The PCO recommends that the new administrator review Quality Assurance and
Performance Improvement (QAPI) goals to include concerns about food and snacks. Also
suggest that administrator assure that grievance procedures are in place.
D. Cherrywood Place
Cherrywood Place (“Cherrywood”) is located at 100 East Dalke Ave, Spokane, WA
99208. The PCO monitoring visit took place on January 29, 2020.
1. Population and Payment at Cherrywood
Cherrywood has 52 beds. The census on the monitoring visit was 44. The majority
payment source is Medicaid.
2. Facility and Environment of Cherrywood
Cherrywood is licensed as an assisted living facility (ALF) and is the only assisted living
facility in the bankruptcy.
3. Resident Care at Cherrywood
The PCO received concerns and grievances regarding the lack of activities being offered
and lack of outdoor group activities. Additionally, concerns were expressed about damaged and
missing clothes. Multiple concerns were expressed about a lack of attention, respect, dignity and
poor attitudes about residents by facility staff.
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PCO’S FIRST REPORT - 15
FREEMAN LAW OFFICE 1725 NW Market St. #219
Seattle, WA 98108 (206) 491-8843
4. Staffing at Cherrywood
At time of the monitoring visit, the administrator has been in her role for about two years.
Total number of employees is fourteen. The facility relies on one part-time RN nurse delegator.
The Administrator does most of the care planning and some of the care assessments. The
activities director is full time but only does activities part time-as has other job responsibilities
related to management and operations.
5. Licensing and Enforcement at Cherrywood
As an assisted living facility there is no federal oversight or certification by CMS.
During this reporting period the state licensing entity identified failed provider practice during a
survey of the facility. No harm to residents was found.
6. Complaints to PCO/LTC Ombudsman Program regarding Cherrywood
There were seven complaints received into the Spokane long-term care ombudsman
Program. Complaint types are Autonomy, Choice and Rights; Financial Property; Care and
Environmental. All but one complaint remains open and still active. The PCO brought
concerns about laundry and activities to the administrator on the day of the visit. The
administrator shared that a faulty dryer was the cause of the damaged clothing and a new dryer
had been ordered.
The PCO has made a referral to the local ombudsman program to investigate concerns
regarding food quality, care services, and unresponsiveness to resident requests.
7. Recommendations for Cherrywood
The PCO recommends additional staffing be hired and more nurse delegation hours to
meet the needs of residents.
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PCO’S FIRST REPORT - 16
FREEMAN LAW OFFICE 1725 NW Market St. #219
Seattle, WA 98108 (206) 491-8843
E. Crestwood Health & Rehabilitation Center
Crestwood Health & Rehabilitation Center (“Crestwood”) is located at 1116 E Lauridsen
Blvd, Port Angeles, WA 98362. The PCO monitoring visit took place on January 3, 2020.
1. Population and Payment at Crestwood
Crestwood has 101 beds. The census on the monitoring visit was 82. The majority
payment source is Medicaid.
2. Facility and Environment of Crestwood
Crestwood is set in a spacious older building from the 1960s or 70s with lots of light. It
appeared well organized and clean during the monitoring visit.
3. Resident Care at Crestwood
The PCO observed some residents appearing disheveled. The residents were in clothing
that was ill-fitting and not clean. One resident using a wheelchair went most of the day without
socks or shoes. Concerns pertained to staffing levels.
The PCO observed that lunch was served approximately 30 minutes late. Residents
waiting in the dining room received proper attention, including the offer of beverages while they
waited. Late meal service is not unusual but improving on service times, per staff and residents.
It was reported that the administration and the director of nursing are working to resolve late
meal delivery, which is due to a lack of staff.
4. Staffing at Crestwood
At time of the monitoring visit, the interim director of nursing was transitioning out of the
facility. The new director of nursing was in training and waiting for state licensure. Otherwise,
all management positions were fully staffed. The administrator was hired one week before the
bankruptcy was announced in 2019. As of the day of filing this report, the PCO was informed
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FREEMAN LAW OFFICE 1725 NW Market St. #219
Seattle, WA 98108 (206) 491-8843
that the Administrator is no longer with Crestwood and possibly has transferred to another debtor
facility. The new administrator at Crestwood was previously an assistant administrator at Sequim
Health and Rehabilitation Center.
5. CMS Ratings, Licensing, and Enforcement at Crestwood
Crestwood has a red alert icon on the CMS website. In addition, Crestwood has the
following CMS star ratings: Overall is one star; Health inspections is one star; Staffing is three
star; and Quality measures is two star. A review of the state’s licensing enforcement records
available to the LTC Ombudsman Program, show that investigation was conducted during the
reporting period, and a level D deficiency was identified. Crestwood also had a full
unannounced health survey by state licensing during the reporting period. The results are not yet
known to the PCO.
6. Complaints to PCO/LTC Ombudsman Program regarding Crestwood
No complaints were received during the monitoring visit and there are no open
complaints with the local long-term care ombudsman program.
7. Recommendations for Crestwood
The PCO makes no recommendations at this time.
F. Fir Lane Health & Rehabilitation Center
Fir Lane Health & Rehabilitation Center (“Fir Lane”) is located at 2430 North 13th St,
Shelton, WA 98584. The PCO monitoring visit took place on January 10, 2020.
1. Population and Payment at Fir Lane
Fir Lane has 135 beds. The census on the monitoring visit was 92. The majority
payment source is unknown at this time.
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FREEMAN LAW OFFICE 1725 NW Market St. #219
Seattle, WA 98108 (206) 491-8843
2. Facility and Environment of Fir Lane
During this visit the state licensing entity was conducting a full health survey inspection.
Surveyors discovered what appeared to be mold in the facility on two walls in the main dining
room. The main dining room was closed off and remains closed as of the time of this report.
Testing of the mold and air quality were ordered. A level I-J deficiency was made by state
licensing.
Flooring was also noted to have warping in parts of two hallways, a long standing issue
possibly caused by past flooding in the area per employees and the facility administrator. The
warped areas are not necessarily visible to the eye. One entire wing is “semi” closed in the
facility for renovations of the flooring but it has not yet happened.
Additionally, a storage room roof caved in. Repair of the storage room was also stopped
due to a lack of permits.
3. Resident Care at Fir Lane
The PCO was unable to interview staff and residents during this visit because the visit
was ended due to concerns about alleged mold in the building.
4. Staffing at Fir Lane
At the time of the monitoring visit, the administrator reported that all department head
positions are filled. The administrator has been in his role for less than a year. He reported to
the PCO that recruitment of staff is challenging.
5. CMS Ratings, Licensing, and Enforcement at Fir Lane
Fir Lane has the following CMS star ratings: Overall is one star; Health inspections is
one star; Staffing is two star; and Quality measures is three star.
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PCO’S FIRST REPORT - 19
FREEMAN LAW OFFICE 1725 NW Market St. #219
Seattle, WA 98108 (206) 491-8843
6. Complaints to PCO/LTC Ombudsman Program regarding Fir Lane
The PCO referred to the local Long-Term Care Ombudsman Program for complaint
resolution regarding condition of building and safety of residents. A conversation was had with
Cornerstone leadership and state licensing. Testing has since been done and there is mold in the
dining room which has since been removed and treated. The dining room remains closed for
permitting for repairs. Additionally, air testing was also done and the air is reported to be safe.
7. Recommendations for Fir Lane
The PCO recommends that the building be repaired and renovated so that all residents are
living in a safe, secure, homelike environment.
G. Forest Ridge Health & Rehabilitation Center
Forest Ridge Health & Rehabilitation Center (“Forest Ridge”) is located at 140 Marion
Ave South, Bremerton, WA 98312. The PCO monitoring visit took place on January 22, 2020
1. Population and Payment at Forest Ridge
Forest Ridge has 98 beds. The census on the monitoring visit was 83. The majority
payment source is unknown.
2. Facility and Environment of Forest Ridge
The Forest Ridge facility is an older facility.
3. Resident Care at Forest Ridge
No comments regarding resident care at this time.
4. Staffing at Forest Ridge
At the time of the monitoring visit, the Administrator reports that the Director of Nursing
position is vacant but he has recruited a new employee who will begin February 3, 2020. A
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FREEMAN LAW OFFICE 1725 NW Market St. #219
Seattle, WA 98108 (206) 491-8843
Residential care manager position is open in the “C” Wing of the building. There are four nurse
manager positions in total. The facility offers training for certified nursing assistants. The
administrator is authorized to utilize agency staff if needed.
5. CMS Ratings, Licensing, and Enforcement at Forest Ridge
Forest Ridge has the following CMS star ratings: Overall two star; health inspection is
two star; Staffing is two star; and Quality measures is two star.
6. Complaints to PCO/LTC Ombudsman Program regarding Forest Ridge
There are no open complaints with the Regional LTC Ombudsman Program at current.
Three complaints were open since November 1, 2019 with one complaint being received in
December of 2019. Complaint types are Admission, Transfer, Discharge and Eviction
(discharge) and Autonomy, Choice and Rights (Other rights and preferences).
7. Recommendations for Forest Ridge
The PCO has no recommendations at this time.
H. Franklin Hills Health & Rehabilitation Center
Franklin Hills Health & Rehabilitation Center (“Franklin Hills”) is located at 6021 North
Lidgerwood St., Spokane, WA 99208. The PCO monitoring visit took place on January 27,
2020.
1. Population and Payment at Franklin Hills
Franklin Hills has 100 beds. The census on the monitoring visit was 71 . The majority
payment source is Medicaid.
2. Facility and Environment of Franklin Hills
The Franklin Hills facility is an older, larger building.
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PCO’S FIRST REPORT - 21
FREEMAN LAW OFFICE 1725 NW Market St. #219
Seattle, WA 98108 (206) 491-8843
3. Resident Care at Franklin Hills
The PCO attended the resident council meeting and sat in on the food committee meeting
during this visit. Staffing was historically poor but has been improving over the recent months
with some issues from time to time. The majority of concerns received were about food quality,
choice, accuracy of diets and preferences, late tray service, and cold food. Concerns expressed
about the new kitchen services vendor not setting up trays correctly according to resident’s needs
and requests.
4. Staffing at Franklin Hills
At the time of the monitoring visit, the administrator had been in her position less than
three months but she was previously an assistant executive director there. All department head
positions are fully staffed. The facility has two resident care managers. Nurse staffing on the
day of visit was as follows: RNs- 44 hours; LPNs/LVNs-8 hours; and NACs- 152 hours.
5. CMS Ratings, Licensing, and Enforcement at Franklin Hills
Franklin Hills has the following CMS star ratings: Overall is two star; Health inspection
is one star; Staffing is four star; and Quality measures is three star.
6. Complaints to PCO/LTC Ombudsman Program regarding Franklin Hills
No open cases with Spokane LTC Ombudsman Program are in existence during this
reporting time.
7. Recommendations for Franklin Hills
The PCO has no recommendations at this time.
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PCO’S FIRST REPORT - 22
FREEMAN LAW OFFICE 1725 NW Market St. #219
Seattle, WA 98108 (206) 491-8843
I. Ivy Court
Ivy Court (“Ivy Court”) is located at 2200 Ironwood Pl, Coeur d’Alene, ID 83814. The
PCO monitoring visit took place on January 31, 2020. An additional monitoring visit was
conducted by a local LTC Ombudsman in Idaho who provided information to the PCO.
1. Population and Payment at Ivy Court.
Ivy Court has 80 certified beds. The census on the monitoring visit was 72. The majority
payment source is unknown at this time.
2. Facility and Environment of Ivy Court
The facility is an older building that has gone through several changes in operators over
the last five years. The building is undergoing renovation of the hallway flooring and nursing
stations.
3. Resident Care at Ivy Court
The most consistent concerns are the need to: change bed linens after resident bathes,
maintain shower schedules, and provide drinking water by the residents’ beds. Additional
concerns pertained to slow response to call lights. All of these issues are being audited internally
by the administrator and management.
4. Staffing at Ivy Court
Management positions at Ivy Court are fully staffed. During this visit nursing staffing total is
RNs-16 hours; LPN/LVNs-72 hours; and NACs 157.5 hours. The facility utilizes existing staff
first to fill call-ins or short staffing in order to give staff an opportunity to earn extra pay. The
facility also utilizes the Cornerstone pool of workers and just recently contracted with a staffing
agency.
5. CMS Ratings, Licensing, and Enforcement at Ivy Court
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PCO’S FIRST REPORT - 23
FREEMAN LAW OFFICE 1725 NW Market St. #219
Seattle, WA 98108 (206) 491-8843
On the CMS website, Ivy Court is marked with a “red alert icon.” In addition, Ivy Court
has the following CMS star ratings: Overall is two star; Health inspections is one star; Staffing
is four star; and Quality measures is three star. There are no licensing reports from the
regulatory agency in the public file during this first reporting period known to the PCO or to the
LTC Ombudsman Program.
6. Complaints to PCO/LTC Ombudsman Program regarding Ivy Court
The local long-term care ombudsman reports no complaints received or open during the
reporting period.
7. Recommendations for Ivy Court
The PCO has no recommendations at this time.
J. LaCrosse Health & Rehabilitation Center
LaCrosse Health & Rehabilitation Center (“LaCrosse”) is located at 210 West LaCrosse
Ave, Coeur d’Alene, ID 83814. The PCO monitoring visit took place on January 30, 2020.
1. Population and Payment at LaCrosse
LaCrosse has 100 beds. The census on the monitoring visit was 94. The majority
payment source is unknown at this time. An additional monitoring visit was conducted by a
local LTC Ombudsman in Idaho who provided information to the PCO.
2. Facility and Environment of LaCrosse
The facility is an older building that has gone through several changes in operators over
the last five years. LaCrosse offers special services to residents with significant respiratory
needs including ventilator care. The wing has capacity for 24 residents and on this visit 10
residents were utilizing ventilators. The remaining residents on the wing are described as having
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PCO’S FIRST REPORT - 24
FREEMAN LAW OFFICE 1725 NW Market St. #219
Seattle, WA 98108 (206) 491-8843
high respiratory needs such as tracheostomy care, per the Director of Nursing. LaCrosse is one
of only two nursing homes in the state that care for residents who use ventilators.
3. Resident Care at LaCrosse
The most consistent concern reported is staffing levels as the census number increases.
LaCrosse utilizes Cornerstone’s pool of workers. The director of nursing and department
managers seem committed to improving care outcomes for the residents. The director of nursing
explained the facility quality assurance and performance improvement management system. She
also noted the facility’s “Stop and Watch, Early Warning Tool” which is a form posted for
anyone to report changes while caring for or observing a resident. Initial impressions are that
this facility appears to function well and progress is being made.
4. Staffing at LaCrosse
Management positions are fully staffed. During the monitoring visit, the nursing staffing
totals were: RNs–20 hours; LPN/LVNs–92 hours; and NACs– 225 hours.
5. CMS Ratings, Licensing, and Enforcement at LaCrosse
LaCrosse has the following CMS star ratings: Overall is one star; Health inspections is
one star; Staffing is three star; and Quality measures is two star.
There are no licensing reports from the regulatory agency in the public file during this
first reporting period known to the PCO or to the LTC Ombudsman Program.
The last full survey inspection occurred in June 2019 of which there were six citations
with highest level being an “F”. Complaint investigations since the last full survey have all been
determined “unsubstantiated” according to Idaho’s nursing home licensing public file.
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PCO’S FIRST REPORT - 25
FREEMAN LAW OFFICE 1725 NW Market St. #219
Seattle, WA 98108 (206) 491-8843
6. Complaints to PCO/LTC Ombudsman Program regarding LaCrosse
No complaints were received and there are no open complaints with the local long-term care
ombudsman program.
7. Recommendations for LaCrosse
The PCO recommends that LaCrosse have detailed transition plans in place if there is any
chance of a change in ownership or operators. Any new operator must have the proven ability
and resources to meet the needs of all residents, but especially the residents on the respiratory
wing. If this facility were to close, the options to transfer residents to another facility in Idaho
may very limited, given that there are only two nursing facilities in Idaho that specialize in
respiratory services.
K. Meadow Park Health & Specialty Care Center
Meadow Park Health & Specialty Care Center (“Meadow Park”) is located at 75 Shore
Dr, St Helens, OR 97051. The PCO monitoring visit took place on February 4, 2020.
1. Population and Payment at Meadow Park
Meadow Park has 92 certified beds. The census on the monitoring visit was 36. The
majority payment source is unknown.
2. Facility and Environment of Meadow Park
The Meadow Park facility is an older facility that needs repair and upkeep of the grounds
and building. Staff report that the water in the kitchen is slow to heat and maintenance replied
that the water reaches higher temperatures but that it takes time due to age of the building.
Facility appears clean and odor free during visit.
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PCO’S FIRST REPORT - 26
FREEMAN LAW OFFICE 1725 NW Market St. #219
Seattle, WA 98108 (206) 491-8843
3. Resident Care at Meadow Park
No concerns received about care during visit. Residents would, however, like resident
care meetings to not be held in public areas with doctors and state workers.
4. Staffing at Meadow Park
Director of Nursing shared that they have been overstaffing at times. Today, they are
using one Cornerstone pool nursing assistant.
5. CMS Ratings, Licensing, and Enforcement at Meadow Park
Meadow Park has the following CMS star ratings: Overall rating is two star; Health
inspections is one star; Staffing is four star; and Quality measures is five star.
6. Complaints to PCO/LTC Ombudsman Program regarding Meadow Park
The PCO received complaints about the quality of food and missing clothing from the
laundry service. Information about complaints in the Oregon State LTC Ombudsman Program is
not yet available.
7. Recommendations for Meadow Park
The PCO has no recommendations at this time.
L. North Auburn Rehabilitation & Health Center
North Auburn Rehabilitation & Health Center (“North Auburn”) is located at 2830 I
Street NE, Auburn, WA 98002. The PCO monitoring visit took place on January 20, 2020.
1. Population and Payment at North Auburn
North Auburn has 125 beds. The census on the monitoring visit was 79. The majority
payment source is Medicaid.
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FREEMAN LAW OFFICE 1725 NW Market St. #219
Seattle, WA 98108 (206) 491-8843
2. Facility and Environment of North Auburn
North Auburn is located in an older spacious building. There was a strong smell of bleach
in hallways and in the dining room area.
3. Resident Care at North Auburn
On the day of the monitoring visit, the Administrator and very few department heads
were in the building. Multiple concerns reported regarding food services, poor staffing and new
nurses. Allegations were made that nurses sometimes use harsh tones with residents; loudness in
hallways while people are sleeping; staff cannot be found when needed at night; staff sleeping;
call lights don’t get answered or slow to answer at night; dirty meal trays left in rooms until next
meal; snacks passed out too late; nurses arguing with residents about medications; and nurses not
listening to residents’ needs. Other concerns were expressed about security, including a large
group of homeless people in the parking lot at night and a visitor with a dog.
Multiple grievances and concerns were reported regarding food services and quality of
food including “horrible” on weekends, late delivery, wrong food on trays, and dirty trays left
too long in rooms.
4. Staffing at North Auburn
The current management positions are vacant: Dietary Manager, Housekeeping
Manager, and Life Enrichment Director. A new Social Services Director was expected to start
the day of the monitoring visit. The Administrator was not available for an interview on the day
of the monitoring visit.
5. CMS Ratings, Licensing, and Enforcement at North Auburn
North Auburn has a red alert icon on the CMS website. In addition, North Auburn has
the following CMS star ratings: Overall is two star; Health inspection is two star; Staffing is
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FREEMAN LAW OFFICE 1725 NW Market St. #219
Seattle, WA 98108 (206) 491-8843
three star; and Quality measures is four star. A full standard health survey and complaint
investigation during the monitoring period identified the most serious deficiency at level G. The
facility had a full unannounced survey during the reporting period. Complete results are not yet
known to the PCO.
6. Complaints to PCO/LTC Ombudsman Program for North Auburn
During the reporting period, sixteen complaints were received and are still open. The
complaints involve: Access to Information (language and communication barriers); Admission,
Transfer, Discharge, Eviction (discharge or eviction); Autonomy, Choice, Rights (dignity and
respect, retaliation, response to complaints, live in less restrictive setting, privacy, dignity and
respect); Personal Property; Care (assistive devices or equipment, medications, care planning);
Activities, Community Integration and Social Services (conflict resolution); Environment
(housekeeping, laundry and pest abatement); and Facility Policies, Procedures and Practices
(staffing).
7. Recommendations for North Auburn
The PCO recommends management observe food service delivery on weekends, make
unannounced visits at different shifts and provide retraining for all staff on resident rights, abuse
and neglect, and job performance expectations when working with vulnerable adults. Facility
management should also address security concerns.
M. Puget Sound Healthcare Center
Puget Sound Healthcare Center (“Puget Sound”) is located at 4001 Capitol Mall Dr SW,
Olympia, WA 98502. The PCO monitoring visit took place on January 13, 2020. Additional
monitoring visits were conducted by a Regional LTC Ombuds who reports directly to the PCO.
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PCO’S FIRST REPORT - 29
FREEMAN LAW OFFICE 1725 NW Market St. #219
Seattle, WA 98108 (206) 491-8843
1. Population and Payment at Puget Sound
Puget Sound has 108 beds. The census on the monitoring visit was 97. The majority
payment source is unknown at this time.
2. Facility and Environment of Puget Sound
Puget Sound is an older building that has gone through several changes in operators over
the last five years. It appears clean and orderly.
3. Resident Care at Puget Sound
Puget Sound’s food was reported to be cold at times. Puget Sound holds a resident “food
committee” in partnership with the kitchen manager and residents to resolve issues.
4. Staffing at Puget Sound
Management positions at Puget Sound are fully staffed. The Administrator has been in
place for over three years.
5. CMS Ratings, Licensing, and Enforcement at Puget Sound
Puget Sounds has the following CMS star ratings: Overall is four star; Health inspection is four
star; Staffing is four star; and Quality Measures is four star.
6. Complaints to PCO/LTC Ombudsman Program regarding Puget Sound
PCO will be referring a complaint to the local long-term care ombudsman about
temperature and texture of food (too tough, dry).
7. Recommendations for Puget Sound
The PCO has no recommendations at this time.
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PCO’S FIRST REPORT - 30
FREEMAN LAW OFFICE 1725 NW Market St. #219
Seattle, WA 98108 (206) 491-8843
N. Riverside Nursing & Rehabilitation Center
Riverside Nursing & Rehabilitation Center (“Riverside”) is located at 1305 Alexander St,
Centralia, WA 98531. The PCO monitoring visit took place on January 17, 2020.
1. Population and Payment at Riverside
Riverside has 91 beds. The census on the monitoring visit was 66. The majority
payment source is Medicaid.
2. Facility and Environment of Riverside
The facility is an older building that has gone through several changes in operators over
the last five years.
3. Resident Care at Riverside
Concerns included lack of showering/bathing due to staffing being too busy and one
shower room being down, quality of food viewed as poor, and not enough snacks available.
Linens not being changed after resident showers. Issues identified during the visit have been
resolved or are currently being remedied by administration.
4. Staffing at Riverside
Management positions at Riverside are fully staffed, with the exception of the
Maintenance Director position. The Administrator has been in place less than four months. The
administration, staff and residents report history of nurse staffing problems and all report that
staffing levels are improving and not worsening since the bankruptcy filing as of January 31,
2020.
5. CMS Ratings, Licensing, and Enforcement at Riverside
Riverside has the following CMS star ratings: Overall is two star; Health inspection is
three star; Nurse Staffing is three star; and Quality measures is one star.
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PCO’S FIRST REPORT - 31
FREEMAN LAW OFFICE 1725 NW Market St. #219
Seattle, WA 98108 (206) 491-8843
There was one new report from the regulatory agency in the public file during this first
reporting period, known to the PCO or to the LTC Ombudsman Program. A review of the state’s
licensing enforcement records available to the LTC Ombudsman Program, show one level L and
one level D citations. The level L was corrected the following day, per the state licensing entity.
There are no public records of the inspection available yet.
6. Complaints to PCO/LTC Ombudsman Program regarding Riverside
The PCO is referring a complaint regarding response to requests for assistance and
quality and availability of food choices to the local long-term care ombudsman program for
resolution.
7. Recommendations for Riverside
The PCO recommends a review of the facility’s QAPI system with leadership to
guarantee adequate resources and support are being provided to improve care outcomes and the
quality of life for all residents. The facility’s QAPI system should address staffing levels,
training of nurse leadership (registered nurses, resident care managers), certified nursing
assistants, residents’ rights, and food.
O. Sequim Health
Sequim Health & Rehabilitation (“Sequim Health”) is located at 650 West Hemlock St,
Sequim, WA 98382. The PCO monitoring visit took place on February 5, 2020.
1. Population and Payment at Sequim Health
Sequim Health has 100 beds. The census on the monitoring visit was 91. The majority
payment source is unknown at this time.
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PCO’S FIRST REPORT - 32
FREEMAN LAW OFFICE 1725 NW Market St. #219
Seattle, WA 98108 (206) 491-8843
2. Facility and Environment of Sequim Health
Sequim Health appears to be resourced adequately according to interviews with facility
department managers. It has a van and a bus for transporting residents for social and medical
needs.
3. Resident Care at Sequim Health
Concerns were reported regarding noise in the hallways at night and throughout the day,
showers being missed on scheduled days, phones/access issues, training of newer certified
nursing assistants, housekeeping, nursing staff training, meal times, and being kept informed of
new hires. The Sequim Health administrator responds to and address grievances and concerns
expressed during council meetings. Staff and residents report satisfaction with equipment,
medical supplies, nursing services, activities, social work, rehab services and food/snacks. This
facility also has a new family council that meets monthly
Residents express food quality is improving now that new menus have been instituted.
The PCO observed two meal services in the dining room that were 30-45 minutes later than
posted mealtimes. Very few individuals eat in the dining rooms, which may be by resident
preference. Trays were also late to the floors. The reason given for the delay was that the
facility has a new cook in training.
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PCO’S FIRST REPORT - 33
FREEMAN LAW OFFICE 1725 NW Market St. #219
Seattle, WA 98108 (206) 491-8843
4. Staffing at Sequim Health
Sequim Health’s management positions are fully staffed. The administrator has been in
place since 2008 when the facility opened. Nursing staffing total: RNs-42.5 hours; LPN/LVNs-
59.5 hours; and NACs 96 hours. Residents expressed that staffing levels are improving.
5. CMS Ratings, Licensing, and Enforcement at Sequim Health
Sequim Health has received a “red alert icon” on the CMS website which means it has
been recently cited for resident harm or potential harm for abuse or neglect (the icon is the red
circle with a hand in it.). In addition, Sequim Health has the following CMS star ratings: Overall
is two star; Health inspections is two star; Nurse staffing is three star; and Quality measures is
three star.
There are no licensing reports from the regulatory agency in the public file during this
first reporting period known to the PCO or to the LTC Ombudsman Program.
6. Complaints to PCO/LTC Ombudsman Program regarding Sequim Health
The Olympic Long-Term Care Ombudsman Program has received six complaints since
November 6, 2019. Two of the cases were resolved and one remains open. Complaint types are
financial property (Personal property and billing and charges by the facility) and Care (response
to requests for assistance, symptoms not attended to and access to health related services.
7. Recommendations for Sequim Health
The PCO has no recommendations at this time.
P. The Gardens on University
The Gardens on University (“The Gardens”) is located at 414 S University Rd., Spokane
Valley, WA 99206. The PCO monitoring visit took place on January 28, 2020.
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PCO’S FIRST REPORT - 34
FREEMAN LAW OFFICE 1725 NW Market St. #219
Seattle, WA 98108 (206) 491-8843
1. Population and Payment at The Gardens
North Auburn has 124 beds. The census on the monitoring visit was 111, which included
17 residents in the transitional care unit (“TCU”). The majority payment source is Medicaid.
The payment sources for the TUC are 9 on Managed Care/Managed Medicaid; 6 on Medicare
Part A; 2 on combination of Medicaid, private pay, and HMO.
2. Facility and Environment of The Gardens
The Gardens is set in an older, large building. The TCU is in its own wing and focuses
on shorter term rehabilitation. The TCU’s interiors were updated in the last ten to fifteen years.
3. Resident Care at The Gardens
Per staff interviews, bankruptcy has had little to no impact on residents. Two residents
asked about the facility closing down due to the bankruptcy. PCO responded to the effect that
shutting down is not the goal of the bankruptcy; the goal is to keep facilities operating, but the
Court, the debtors, and the creditors need to work out how to manage the debt.
4. Staffing at The Gardens
Management positions at the Gardens are fully staffed. The Administrator has been in
place less than six months. Nursing levels the time of the visit were RN 88 hrs; LPN 40 hrs;
CNA 224 hrs. Staff appear to be attentive and concerned about the residents’ quality of life and
care. Staffing seems to be improving in the short-term (last several weeks/months).
The PCO expressed concern to the kitchen night manager about the quantity of the food
served and choices offered to the residents. The PCO also brought this issue to the head of
Healthcare Services Group which contracts with debtors to provide all food, laundry and
housekeeping services. Grievances reported were mostly about food (temperature, taste, quality,
and quantity).
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PCO’S FIRST REPORT - 35
FREEMAN LAW OFFICE 1725 NW Market St. #219
Seattle, WA 98108 (206) 491-8843
5. CMS Ratings, Licensing, and Enforcement at The Gardens
The Gardens has the following CMS star ratings: Overall is two star; Health inspections
is one star; Staffing is four star; and Quality measures is four star. The facility has a red “abuse”
icon on the CMS website. In the past year, the facility received citations ranging from Level D
to G, as a result of complaint investigations. There were no serious citations in the past year,
although the facility does have a history of serious violations resulting in fines. For the reporting
period, there were no reports from the regulatory agency in the public file available to the PCO
or LTC Ombudsman Program.
6. Complaints to PCO/LTC Ombudsman Program regarding The Gardens
Complaints regarding food service and quality were referred to the Spokane Long-term
Care Ombudsman Program for investigation and resolution.
7. Recommendations for The Gardens
The PCO has no recommendations at this time.
Dated this 11th day of February, 2020.
/s/ Amy Freeman Amy Freeman, WSBA No. 38801 Attorney for Patient Care Ombudsman
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