SPRINGS AT PACIFIC REGENT, THE

Nursing Home Inspector

919-109TH AVENUE NORTHEAST
BELLEVUE, WA 98004
King County
Phone: 425-646-3993
Provider Number: 505371
Last Inspection: 08/24/2016

About the Nursing Home

Number of Beds: 54
Number of Residents: 23
Beds Available: 31
Percent Occupancy: 43%
Insurance Accepted: Medicare
Types of Councils: Resident
Ownership: For profit - Corporation
Within Hospital?: NO

About State Inspection Deficiencies

Nursing Homes that are Medicare and/or Medicaid certified are licensed by the state and are required to comply with rigid standards enforced by regular facility inspections and extensive evaluations.

The state inspection deficiencies provided here are accounts reported by state inspectors of every discrepancy found where the home failed to meet the minimum standards set forth by state and federal regulations. If a home does not show any deficiencies, it has met the minimum standards required.

Please note: Findings in these inspections do not present a complete picture of the quality of care provided. Information in this database should be interpreted carefully and used in conjunction with other sources, as well as a visit to the nursing home.


Deficiency Ratings

Our nursing home inspector tool compares the severity of deficiences rather than the number of deficiences. We calculate the severity of each deficiency using the formula:

Severity Rating = Scope + Level of Harm.

Deficiency Rating= Sum of ALL Severity Ratings

Severity Scope Level of Harm
2 1-Isolated 1-Potential for minimal harm
3 2-Pattern 1-Potential for minimal harm
3 1-Isolated 2-Minimal harm or potential for actual harm
4 3-Widespread 1-Potential for minimal harm
4 2-Pattern 2-Minimal harm or potential for actual harm
4 1-Isolated 3-Actual harm
5 3-Widespread 2-Minimal harm or potential for actual harm
5 2-Pattern 3-Actual harm
5 1-Isolated 4-Immediate jeopardy to resident health or safety
6 3-Widespread 3-Actual harm
6 2-Pattern 4-Immediate jeopardy to resident health or safety
7 3-Widespread 4-Immediate jeopardy to resident health or safety

Deficiency Ratings
By Region

Lower Numbers Are Better

 

12

Facility
43

County
36

WA
20

USA

Deficiency Ratings
By Year

Lower Numbers Are Better

 

12

2016
30

2015
38

2014

Medicare Ratings

Overall Rating: Overall Rating
Health Rating: Health Rating
Staff Rating: Staff Rating
Quality Rating: Quality Rating

 

Details by Inspection Date

8/24/2016 Inspection

 
Deficiency Description Scope : Level of Harm 1 -- Rating -- 7 Corrected
Failed To: Keep residents' personal and medical records private and confidential. Isolated : Minimal 3 9/30/2016
 
Failed To: Develop and implement policies for 1) screening and training employees; and the 2) prevention, identification, investigation, and reporting of any abuse, neglect, mistreatment and misappropriation of property. Isolated : Minimal 3 9/30/2016
 
Failed To: Give residents proper treatment to prevent new bed (pressure) sores or heal existing bed sores. Isolated : Minimal 3 9/30/2016
 
Failed To: Store, cook, and serve food in a safe and clean way. Isolated : Minimal 3 9/30/2016
 

7/15/2015 Inspection

 
Deficiency Description Scope : Level of Harm 1 -- Rating -- 7 Corrected
Failed To: Provide care for residents in a way that maintains or improves their dignity and respect in full recognition of their individuality. Isolated : Minimal 3 9/4/2015
 
Failed To: Ensure residents have the right to have a choice over activities, their schedules, and health care according to their interests, assessments, and plans of care. Isolated : Minimal 3 9/4/2015
 
Failed To: Conduct initial and periodic assessments of each resident's functional capacity. Isolated : Minimal 3 9/4/2015
 
Failed To: Ensure that each resident's 1) entire drug/medication regimen is free from unnecessary drugs; and 2) is managed and monitored to achieve highest level of well-being. Pattern : Minimal 4 9/4/2015
 
Failed To: Store, cook, and serve food in a safe and clean way. Pattern : Minimal 4 9/4/2015
 
Failed To: Maintain drug records and properly mark/label drugs and other similar products according to accepted professional standards. Isolated : Minimal 3 9/4/2015
 
Failed To: 1) Receive registry verification that a nurse aide has met the required training and skills that the State requires; and 2) ensure nurse aides receive the required retraining after 24 months if nursing related services were not provided for monetary compe Pattern : Minimal 4 9/4/2015
 
Failed To: Keep accurate, complete and organized clinical records on each resident that meet professional standards. Isolated : Minimal 3 9/4/2015
 
Failed To: Develop a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Isolated : Minimal 3 9/4/2015
 

8/6/2014 Inspection

 
Deficiency Description Scope : Level of Harm 1 -- Rating -- 7 Corrected
Failed To: Give residents a notice of rights, rules, services and charges. Pattern : Potential 3 9/14/2014
 
Failed To: Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. Isolated : Minimal 3 9/14/2014
 
Failed To: Allow residents to easily view the results of the nursing home's most recent inspection. Pattern : Potential 3 9/14/2014
 
Failed To: Ensure each resident receives an accurate assessment by a qualified health professional. Isolated : Minimal 3 9/14/2014
 
Failed To: Develop a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Pattern : Minimal 4 9/14/2014
 
Failed To: Provide care by qualified persons according to each resident's written plan of care. Pattern : Minimal 4 9/14/2014
 
Failed To: Make sure that residents receive treatments/services to maintain or improve their ability to care for themselves. Isolated : Actual 4 9/14/2014
 
Failed To: Assist those residents who need help with eating/drinking, grooming and personal and oral hygiene. Isolated : Minimal 3 9/14/2014
 
Failed To: Prevent a loss in range of motion among residents who entered the nursing home with a full range of motion, unless it is unavoidable due to resident’s clinical condition. Isolated : Minimal 3 9/14/2014
 
Failed To: Have enough nurses to care for every resident in a way that maximizes the resident's well being. Pattern : Minimal 4 9/14/2014
 
Failed To: Have a program that investigates, controls and keeps infection from spreading. Pattern : Minimal 4 9/14/2014
 

Complaint Investigation Deficiencies

These deficiencies resulted from complaints investigated by the state inspectors and substantiated.

1/26/2017 Investigation

 
Deficiency Description Scope : Level of Harm 1 -- Rating -- 7 Corrected
Failed To: Ensure that a nursing home area is free from accident hazards and provide adequate supervision to prevent avoidable accidents. Isolated : Actual 4 3/6/2017
 

3/1/2016 Investigation

 
Deficiency Description Scope : Level of Harm 1 -- Rating -- 7 Corrected
Failed To: Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. Isolated : Actual 4 4/25/2016
 
Failed To: 1) Hire only people with no legal history of abusing, neglecting or mistreating residents; or 2) report and investigate any acts or reports of abuse, neglect or mistreatment of residents. Isolated : Minimal 3 4/25/2016
 
Failed To: Ensure services provided by the nursing facility meet professional standards of quality. Isolated : Actual 4 4/25/2016
 
Failed To: Provide care by qualified persons according to each resident's written plan of care. Isolated : Minimal 3 4/25/2016
 
Failed To: Provide necessary care and services to maintain or improve the highest well being of each resident . Isolated : Immediate 5 4/11/2016
 
Failed To: Give each resident enough fluids to keep them healthy and prevent dehydration. Isolated : Actual 4 4/25/2016
 
Failed To: Properly care for residents needing special services, including: injections, colostomy, ureostomy, ileostomy, tracheostomy care, tracheal suctioning, respiratory care, foot care, and prostheses. Isolated : Minimal 3 4/25/2016
 
Failed To: Ensure that each resident's 1) entire drug/medication regimen is free from unnecessary drugs; and 2) is managed and monitored to achieve highest level of well-being. Isolated : Minimal 3 4/25/2016
 
Failed To: Ensure that residents are safe from serious medication errors. Isolated : Minimal 3 4/25/2016
 
Failed To: Have enough nurses to care for every resident in a way that maximizes the resident's well being. Isolated : Immediate 5 4/11/2016
 
Failed To: Provide routine and 24-hour emergency dental care for each resident. Isolated : Minimal 3 4/25/2016
 
Failed To: Have a program that investigates, controls and keeps infection from spreading. Widespread : Minimal 5 4/11/2016
 
Failed To: Make sure that the facility is administered in an acceptable way that maintains the well-being of each resident . Pattern : Actual 5 4/25/2016
 
Failed To: 1) Review the work of each nurse aide every year; and 2) give regular in-service training based upon these reviews. Widespread : Minimal 5 4/25/2016
 
Failed To: Choose a doctor to serve as the medical director to create resident care policies and coordinate medical care in the facility. Widespread : Minimal 5 4/25/2016
 
Failed To: Keep accurate, complete and organized clinical records on each resident that meet professional standards. Isolated : Minimal 3 4/25/2016
 
Failed To: Set up an ongoing quality assessment and assurance group to review quality deficiencies quarterly, and develop corrective plans of action. Widespread : Minimal 5 4/25/2016
 

6/19/2015 Investigation

 
Deficiency Description Scope : Level of Harm 1 -- Rating -- 7 Corrected
Failed To: 1) Hire only people with no legal history of abusing, neglecting or mistreating residents; or 2) report and investigate any acts or reports of abuse, neglect or mistreatment of residents. Isolated : Minimal 3 9/8/2015
 
Failed To: Provide necessary care and services to maintain or improve the highest well being of each resident . Isolated : Minimal 3 9/8/2015
 

3/24/2015 Investigation

 
Deficiency Description Scope : Level of Harm 1 -- Rating -- 7 Corrected
Failed To: Ensure that residents are fully informed and understand their health status, care and treatments. Isolated : Minimal 3 4/27/2015
 
Failed To: Provide necessary care and services to maintain or improve the highest well being of each resident . Isolated : Minimal 3 4/27/2015
 

1/7/2015 Investigation

 
Deficiency Description Scope : Level of Harm 1 -- Rating -- 7 Corrected
Failed To: Encode each resident’s assessment data and transmit these data to the State within 7 days of assessment. Pattern : Minimal 4 2/18/2015
 

12/17/2014 Investigation

 
Deficiency Description Scope : Level of Harm 1 -- Rating -- 7 Corrected
Failed To: Ensure that residents are fully informed and understand their health status, care and treatments. Isolated : Minimal 3 2/18/2015
 
Failed To: Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. Isolated : Minimal 3 2/18/2015
 
Failed To: 1) Hire only people with no legal history of abusing, neglecting or mistreating residents; or 2) report and investigate any acts or reports of abuse, neglect or mistreatment of residents. Isolated : Minimal 3 2/18/2015
 
Failed To: Provide medically-related social services to help each resident achieve the highest possible quality of life. Isolated : Minimal 3 2/18/2015
 
Failed To: Provide necessary care and services to maintain or improve the highest well being of each resident . Isolated : Actual 4 2/18/2015
 
Failed To: Keep accurate, complete and organized clinical records on each resident that meet professional standards. Isolated : Minimal 3 2/18/2015
 

About The Staff

(Higher Numbers Are Better)

Staffing Hours Per Day Per Resident... This Facility County Avg WA State Avg
Number of Residents 23 81.23 74.34
Registered Nurses Not Available 1.14 1.07
Licensed Practical / Vocational Nurses Not Available 0.65 0.66
Certified Nursing Assistants Not Available 2.60 2.50
Total Staff Hours Not Available 4.40 4.23

 


About the Residents

(Lower Numbers Are Better)

Percent of Residents... This Facility% County Avg% WA State Avg%
of high risk long-stay residents with pressure ulcers 6 4 4
of long-stay residents assessed and appropriately given the pneumococcal vaccine 97 95 94
of long-stay residents assessed and appropriately given the seasonal influenza vaccine 92 95 95
of long-stay residents experiencing one or more falls with major injury 3 2 2
of long-stay residents who have depressive symptoms 0 10 9
of long-stay residents who lose too much weight 3 6 6
of long-stay residents who received an antianxiety or hypnotic medication 0 12 15
of long-stay residents who received an antipsychotic medication 0 13 15
of long-stay residents who self-report moderate to severe pain 0 5 7
of long-stay residents who were physically restrained 0 1 0
of long-stay residents whose ability to move independently worsened 8 16 17
of long-stay residents whose need for help with daily activities has increased 8 12 13
of long-stay residents with a catheter inserted and left in their bladder 3 2 2
of long-stay residents with a urinary tract infection 3 3 3
of short-stay residents assessed and appropriately given the pneumococcal vaccine 95 55 52
of short-stay residents who had an outpatient emergency department visit 6 88 85
of short-stay residents who made improvements in function 67 10 11
of short-stay residents who newly received an antipsychotic medication 0 67 70
of short-stay residents who self-report moderate to severe pain 15 0 1
of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine 92 13 16
of short-stay residents who were rehospitalized after a nursing home admission 19 87 84
of short-stay residents who were successfully discharged to the community 70 16 16
of short-stay residents with pressure ulcers that are new or worsened 1 61 60