Inspection Reports for
Renton Health and Rehabilitation

The facility was found to have multiple deficiencies including failure to obtain informed consent for psychotropic medications and bed rails, failure to notify Medicaid recipients of personal fund balances, failure to provide required Medicare non-coverage notices, inadequate maintenance of resident rooms, inaccurate resident assessments, incomplete care plans, medication administration errors, inadequate assistance with activities of daily living, lapses in infection control practices, unsafe medication storage, and delayed or missed dental care. Despite these deficiencies, the level of harm was generally minimal and residents were placed at risk rather than harmed.

The complaint investigation involved two residents, Resident 1 and Resident 2, who experienced multiple incidents including Resident 2 wearing Resident 1's clothes, sitting on Resident 1's bed and leg, and leaving feces on Resident 1's bed sheets. Staff failed to document or respond adequately to these incidents. Resident 2 was agitated, confused, and exhibited wandering behaviors without a proper care plan or wandering risk assessment. The investigation confirmed these issues and found that Resident 2 was not moved to another room until after Resident 1's concerns were voiced and an x-ray was obtained.

The facility failed to provide adequate supervision to prevent accidents and resident-to-resident altercations involving Residents 1 and 2. Documentation and care planning for Resident 2's wandering behaviors and safety interventions were insufficient, and staff failed to take timely actions to ensure resident safety. Resident 2 was eventually moved to another room after concerns were raised, but prior incidents were not properly documented or addressed.

The facility failed to ensure Physician Orders for Life Sustaining Treatment (POLST) were available and complete for some residents, and failed to initiate timely CPR during medical emergencies for two residents, placing many others at risk. Additionally, the facility did not provide required in-service training for nurse aides. Immediate Jeopardy was identified and later removed after corrective actions.

The complaint investigation focused on falls involving Resident 1 and Resident 2, psychotropic medication use in Residents 1, 3, 4, and 5, and food allergy accommodations for Residents 1 and 6. The investigation found substantiated deficiencies in fall investigations and prevention, psychotropic medication management, and food allergy accommodations.

The facility failed to conduct thorough investigations and implement preventative measures for resident falls, failed to ensure residents were free from unnecessary psychotropic medications and failed to adequately monitor medication effectiveness, and failed to provide meals accommodating resident food allergies and preferences. These failures placed residents at risk of injury, adverse medication effects, allergic reactions, and diminished quality of life.

The inspection was complaint-driven based on multiple grievances and allegations of abuse and neglect involving several residents (Residents 1, 2, 3, 4, 5, 6, 7, 8, and 9). The facility failed to identify these concerns as abuse, did not report or investigate them properly, and allowed alleged perpetrators to continue working with residents. The complaint was substantiated with findings of neglect, failure to protect, and inadequate investigation and reporting.

The facility was found to have failed in multiple areas including identifying and investigating abuse allegations, protecting residents during investigations, providing sufficient staffing, ensuring adequate training on abuse and neglect, and reporting incidents as required. Immediate Jeopardy was cited due to these failures placing residents at serious risk. Some staff were allowed to return to work before investigations were completed, and investigations were incomplete or delayed. The facility also failed to provide adequate supervision and staffing to meet resident needs.

The complaint investigation focused on two main issues: failure to honor resident bathing preferences for Residents 85 and 10, and failure to address resident concerns about the patio area raised at multiple Resident Council meetings. Interviews and record reviews confirmed these issues. The facility lacked a process to document bathing preferences and did not act on patio concerns despite repeated resident requests.

The facility failed to accommodate bathing preferences for 2 residents, placing them at risk for frustration and diminished quality of life. Additionally, the facility did not promptly address resident concerns about the patio area, resulting in restricted access and resident dissatisfaction.

The facility was found to have multiple deficiencies including failure to honor resident bathing preferences, inadequate response to resident council concerns, failure to notify residents of Medicaid personal fund balances, lack of surety bond coverage for resident funds, missing advance directives, unsafe and cluttered environment, failure to provide written bed hold notices, incomplete and untimely resident assessments, inaccurate Minimum Data Set (MDS) assessments, incomplete and outdated care plans, failure to follow physician orders, inadequate assistance with activities of daily living, failure to provide assistive hearing devices, delayed dental care, improper medication storage and labeling, failure to provide therapeutic diets as ordered, inadequate food safety practices, missed therapy services, and infection control lapses including poor hand hygiene and equipment sanitation. These deficiencies placed residents at risk for harm, frustration, and diminished quality of life.

The facility was found to have multiple deficiencies including failure to provide care in a dignified manner, failure to accommodate resident choice, delays in financial and Medicaid notifications, inadequate security of resident funds, incomplete advanced directive documentation, failure to provide required Medicare notices, privacy violations, environmental maintenance issues, incomplete abuse investigations, failure to notify residents of bed hold policies, incomplete and inaccurate resident assessments, failure to coordinate PASRR evaluations, lack of baseline and updated care plans, insufficient nursing and restorative staffing, medication regimen review delays, inadequate pressure ulcer care, incomplete restorative nursing services, insufficient therapy services, food service sanitation failures, dietary service failures including incorrect diet textures and unpalatable food, and incomplete COVID-19 testing documentation. Many residents experienced unmet care needs and risks due to these deficiencies.