Below average — CMS composite of the measures below.
The next survey window likely opens around November 2026
Estimate from public CMS data, current as of July 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Orchards Of Cascadia, The during CMS and state inspections, most recent first.
A cognitively intact resident with chronic respiratory failure and depression reported that a roommate threatened to "kick" him, leading staff to move the resident to another room for the night. Documentation showed there was a verbal altercation with no physical contact, and the resident later stated he felt safe and not threatened. The facility’s policy required a timely, thorough abuse investigation and follow-up report, but the Administrator, though notified and having spoken with the resident, did not ensure the incident was reported or fully investigated. The CRN confirmed that a thorough investigation was not completed, resulting in a failure to properly respond to an alleged resident-to-resident abuse incident.
Multiple residents reported ongoing issues with excessive nighttime noise from staff activities and roommate televisions, as well as concerns about staff conduct, but their grievances were not investigated or resolved in a timely manner. The facility failed to document or follow up on several complaints, including those related to verbal abuse, and did not communicate outcomes to the affected residents.
A resident with Parkinson's disease reported that a CNA caused pain by pulling a shirt that caught on the resident's hernia, and the incident was not reported to the Administrator or State within the required timeframe. The delay occurred because the Administrator was not informed immediately and only learned of the allegation after receiving a grievance form several days later, resulting in late reporting of the suspected abuse.
A resident with a history of surgical amputation and end stage renal disease received a whole 4 mg hydromorphone tablet on 14 occasions instead of the prescribed 2 mg dose after a physician's order was changed. The error was not detected due to failures in communication between the pharmacy and facility, lack of proper auditing, and staff not following the updated order, resulting in significant medication errors.
Surveyors found that medication and vaccine storage practices were not followed, including an open and undated vial of Tuberculin Skin Testing Solution in a medication room refrigerator and missing temperature logs for both medication and immunization refrigerators. The DON confirmed that required monitoring and labeling procedures were not in place.
Staff failed to follow enhanced barrier precautions and hand hygiene protocols while providing care to a resident with a nephrostomy and other complex conditions. An LPN did not wear a gown or perform hand hygiene after glove removal when emptying a nephrostomy bag, and a CNA did not change gloves or perform hand hygiene between cleaning the resident and handling clean supplies. Both staff acknowledged the lapses, and the Infection Preventionist confirmed the expected procedures.
A resident with ESRD and a central venous catheter for hemodialysis experienced a bleeding emergency when her catheter began leaking blood. An LPN clamped the line but left to get a cap, during which time the clamp became unclipped and bleeding resumed. The resident was escorted by a CNA without continuous licensed nurse supervision, and was later found unresponsive with ongoing bleeding. CPR was initiated, but the resident was pronounced deceased at the hospital. The facility lacked evidence of staff training or competency in managing dialysis access emergencies, and staff did not follow best practices or facility policy.
A resident, identified as a fall risk, fell during a transfer due to inadequate supervision by a CNA, resulting in a hematoma and chest pain. The resident was on anticoagulants, raising concerns about internal bleeding. The incident was not immediately reported, and discrepancies were noted in the accounts of the fall. The facility failed to follow the care plan and provide timely notification.
A resident's right to self-determination was not honored when a CNA repositioned the resident's bed without consent, despite the resident's preference for the bed to be against the wall. The resident, who was cognitively intact and had multiple health issues, felt insecure about falling out of bed in its new position. Interviews with staff, including an LPN, SSD, and DON, confirmed that residents have the right to determine their personal space arrangement, and staff should not alter it without consent.
The facility failed to adhere to its smoking policy, which prohibited storing smoking materials in resident rooms. Two residents were found with smoking materials in their rooms, contrary to their care plans. Staff interviews revealed inconsistencies in policy understanding, and the newly hired Administrator and DON were unfamiliar with the policy.
Failure to Thoroughly Investigate Resident-to-Resident Abuse Allegation
Penalty
Summary
The facility failed to ensure a thorough investigation was completed following an allegation of resident-to-resident abuse involving one cognitively intact resident with chronic respiratory failure and depression. According to the facility’s abuse policy, a follow-up report summarizing investigation findings and corrective actions must be submitted within five working days of an incident, including any new or revised information. In this case, a resident reported to the nurse’s station during the night that he "can't take it anymore" and that his roommate was "threatening to kick my ass." The resident was offered a temporary room change for the night, initially declined due to concern about losing his room, but later agreed after further discussion and slept peacefully in another room. Progress notes documented that the resident reported there was no physical altercation, that both individuals remained on their own sides of the room during the verbal altercation, and that although the roommate stated, "once I get out of bed, I am going to kick your ass," the resident indicated he did not feel threatened and felt safe in the facility. During an interview, the Administrator stated he was notified of the situation by phone, was informed the residents were separated, and that he personally spoke with the resident and ruled out physical and psychosocial harm. When asked by surveyors why the incident was not reported and whether an investigation was conducted, the Administrator stated he ruled out harm and did not answer regarding an investigation, and the CRN acknowledged that the facility did not complete a thorough investigation, resulting in a failure to respond appropriately to the alleged abuse in accordance with facility policy.
Failure to Timely Investigate and Resolve Resident Grievances
Penalty
Summary
The facility failed to investigate and resolve resident grievances in a timely manner for multiple residents, as evidenced by interviews, record reviews, and policy review. Residents repeatedly raised concerns about excessive noise at night, particularly from staff activities and roommate televisions, during several resident council meetings. Despite these ongoing complaints, residents reported that no resolution had been communicated to them, and the noise disturbances persisted. The facility's grievance log did not reflect timely documentation or follow-up on these issues, and some grievances were not logged until months after the initial complaint. Several residents with varying cognitive abilities, including those with moderate impairment and those who were cognitively intact, described being disturbed at night by staff entering rooms, knocking loudly, turning on lights, and offering services such as ice water or trash removal during early morning hours. Residents also reported that staff responses to their complaints were inadequate, with some staff members being described as rude or dismissive. In cases where residents complained about roommate behavior, such as loud televisions, staff acknowledged the issue but did not provide a timely or effective resolution, and the facility lacked a clear policy regarding television use at night. Additionally, the facility did not complete or document grievances related to allegations of verbal abuse by staff, as identified during a facility-reported incident investigation. Residents reported instances of staff yelling, using negative language, and making inappropriate comments, but these grievances were not entered into the grievance log or investigated according to facility policy. Interviews with the Social Services Director and Administrator confirmed that some grievances had not been completed or addressed, and there was a lack of consistent follow-up and communication with residents regarding the outcomes of their complaints.
Failure to Timely Report Alleged Physical Abuse
Penalty
Summary
The facility failed to ensure that an allegation of physical abuse involving a resident was reported in a timely manner to both the Administrator and the State, as required by facility policy. The policy specifies that allegations of abuse or serious bodily injury must be reported to the CEO and the state agency within two hours, and within 24 hours if the event did not involve abuse or serious bodily injury. In this case, a resident with Parkinson's disease and impaired upper extremity range of motion reported to the Unit Manager that a CNA caused pain by pulling a shirt that caught on the resident's umbilical hernia. The resident stated that the CNA continued to pull on the shirt despite being told to stop, causing further discomfort. The incident was initially reported by the resident to the Unit Manager, who documented the event as a late entry in the medical record. The resident also submitted a grievance form describing the incident and alleged that attempts to report the event to other CNAs were unsuccessful. The Administrator became aware of the incident only after the grievance form was placed under his door and did not see it until several days after the initial report. The Administrator stated that the initial report did not meet the threshold for abuse and therefore was not reported immediately. The facility did not report the allegation to the State until four days after the resident's initial report, exceeding the required reporting timeframe. The Administrator confirmed that staff are expected to report abuse allegations to him immediately, but this did not occur in this instance. The delay in reporting the incident constituted a failure to follow the facility's abuse reporting policy and regulatory requirements.
Resident Received Incorrect Dose of Hydromorphone
Penalty
Summary
A resident with a history of surgical amputation and end stage renal disease was admitted to the facility and had a physician's order for hydromorphone oral tablets. Initially, the order was for four milligrams (mg) every six hours for pain, but it was later changed to 0.5 tablet (2 mg) every six hours. Despite this change, review of the controlled drug record revealed that the resident received a whole 4 mg tablet on 14 occasions instead of the prescribed 2 mg dose. This error was confirmed through interviews with facility staff, including a registered pharmacist and an LPN, both of whom acknowledged that the medication was administered at the incorrect dose and that the physician's order was not followed. The facility's policy required regular audits of controlled substance inventory records, but the error was not detected until after multiple incorrect doses had been administered. The pharmacist noted that the interface between the pharmacy and the facility did not communicate narcotic orders effectively, and that a hard copy of the order was required. The LPN involved confirmed that she had given a whole pill instead of half, and the DON agreed that the medication was not administered as ordered. The failure to follow the physician's order resulted in significant medication errors for the resident.
Failure to Properly Store and Monitor Medications and Vaccines
Penalty
Summary
The facility failed to ensure proper storage and labeling of medications and vaccine supplies in one of its medication rooms. During an observation with the DON, an open and undated vial of Tuberculin Skin Testing Solution was found in one of the medication room refrigerators. The packaging indicated the solution had been dispensed from the pharmacy, but there was no indication of when it was opened, as required by the manufacturer's instructions and facility policy. The instructions specified that the solution must be discarded 30 days after opening or by the expiration date, whichever comes first, and must be stored refrigerated and protected from light. Additionally, temperature logs for both refrigerators in the medication room, one used for medications and the other for immunization materials, could not be located at the time of the survey. The facility's policy required daily monitoring of medication refrigerator temperatures and twice-daily monitoring for vaccine storage. When a log was later provided, it was unclear which refrigerator it pertained to, and the logs were not posted on the refrigerator doors as expected. The DON confirmed that both refrigerators were supposed to be monitored and labeled appropriately, but this was not being done at the time of the survey.
Failure to Follow Enhanced Barrier Precautions and Hand Hygiene During Resident Care
Penalty
Summary
The facility failed to ensure proper infection prevention and control practices were followed for a resident with a nephrostomy and other complex medical conditions. During care, an LPN emptied the resident's nephrostomy bag while wearing only gloves, without donning a gown as required under enhanced barrier precautions (EBP) for residents with indwelling medical devices. After emptying the bag and disposing of the contents, the LPN removed her gloves and immediately donned a new pair without performing hand hygiene, contrary to facility policy and physician orders that specify hand hygiene before and after glove use. Additionally, a CNA providing incontinence care to the same resident did not change gloves or perform hand hygiene between cleaning the resident and handling clean supplies, such as picking up clean incontinence briefs. Both staff members acknowledged during interviews that they should have performed hand hygiene and changed gloves as required. The Infection Preventionist confirmed that the expectation is for staff to wash hands before starting care and to use gowns and gloves appropriately when providing high-contact care to residents on EBP.
Failure to Provide Appropriate Emergency Response for Dialysis Catheter Bleed
Penalty
Summary
The facility failed to provide appropriate monitoring, emergency response, and staff intervention for a resident receiving hemodialysis, resulting in actual harm. The resident, who had end stage renal disease and a central venous catheter (CVC) for dialysis, was found by an LPN with her catheter leaking blood from the red port, with blood flowing onto the floor and down her chest. The LPN clamped the line but left to obtain a cap, during which time the clamp became unclipped and bleeding resumed. The resident was then escorted down the hallway by a CNA without continuous licensed nurse supervision of the access site. Subsequently, the resident was found in her room slumped on the bed, with blood continuing to leak from the catheter, followed by loss of consciousness, absent respirations, and pulse. CPR was initiated, and EMS was called, but the resident was later pronounced deceased at the hospital after extensive interventions. The investigation revealed that the facility did not provide evidence of staff training or competency in responding to dialysis access emergencies. The Director of Clinical Services confirmed that no such training had been provided and that staff were expected to rely on their initial licensing preparation. The nurse involved did not apply a hemostat when the clamp failed and did not replace the cap on the CVC, contrary to best practices and facility policy. These failures were inconsistent with professional standards of practice, the resident's care plan, and the facility's own policies regarding monitoring and responding to changes in condition.
Inadequate Supervision During Transfer Leads to Resident Fall
Penalty
Summary
The facility failed to provide adequate supervision and intervention during a resident's transfer, resulting in a fall and subsequent injury. The resident, who was cognitively intact and required extensive assistance for transfers, was identified as a fall risk due to multiple factors including impaired mobility and medication use. On the day of the incident, a CNA was assisting the resident when she began to slide out of bed. The CNA attempted to assist, but the resident fell forward, sustaining a hematoma on her face and experiencing chest pain. The incident report noted discrepancies in the accounts of the fall between the CNA and the resident. The resident's husband reported a delay in the notification of the fall, and the resident was sent to the hospital due to concerns about internal bleeding from anticoagulant use. A CT scan revealed a hematoma and soft tissue swelling, but no fractures. Interviews with staff indicated that the CNA did not immediately report the fall, and the resident was seen with facial bruising when brought to the dining room. The facility's response included educating the CNA on proper procedures, but the report highlights the initial failure to follow the care plan and provide timely notification of the incident.
Failure to Honor Resident's Right to Self-Determination
Penalty
Summary
The facility failed to honor a resident's right to self-determination, specifically regarding the resident's preference for bed placement. Resident #63, who was cognitively intact and had multiple diagnoses including morbid obesity, a pressure ulcer, spinal disc degeneration, and major depressive disorder, expressed a preference for her bed to be positioned against the wall. This preference was not honored by CNA #1, who repositioned the bed without the resident's consent, citing ease of care as the reason. The resident reported feeling insecure about potentially falling out of bed due to the new position and communicated her concerns to another CNA. Interviews with facility staff, including an LPN, the SSD, and the DON, confirmed that residents have the right to determine the arrangement of their personal space, and staff should not alter it without consent. The LPN was unaware of the reason for the bed's repositioning and stated that it should be returned to the resident's preferred position. The SSD and DON both acknowledged the resident's right to self-determination and emphasized the importance of staff explaining any risks to the resident and their family.
Failure to Implement Smoking Material Storage Policy
Penalty
Summary
The facility failed to implement proper storage of resident smoking materials as directed by the residents' care plans, which was identified during a survey. The facility's Smoking Policy, dated 10/15/22, clearly stated that smoking paraphernalia, including e-cigarettes and vaping devices/materials, was not permitted to be stored in the resident's room. However, for two residents whose care plans were reviewed, this policy was not followed. Resident #57, who was cognitively intact, had his smoking materials stored in his room, contrary to the care plan that stated they should be stored in the nurse's cart. Similarly, Resident #67, who was moderately cognitively impaired, kept his smoking materials in his room, despite his care plan indicating they should be stored at the nursing station or in a locked box outdoors. Interviews with various staff members revealed inconsistencies in the understanding and implementation of the smoking policy. Some staff members believed residents could keep smoking materials in their rooms if deemed safe, while others stated that smoking materials were not allowed in resident rooms and should be stored at the nurses' station. The facility Administrator and DON, both recently hired, were not familiar with the facility's smoking policy, acknowledging that the policy and residents' care plans should be adhered to. This lack of adherence to the smoking policy placed residents at risk of negative outcomes due to unsafe storage of smoking materials.
What surveyors are citing around you — mapped
All 10 risk areas, ranked with evidence
Repeat citations, what's rising near you, and quality measures — ranked so department heads know exactly where to look first.
Illustrative
What surveyors actually found near you
We read the 229 citations issued within 25 miles in the last 12 months — including the 1 immediate-jeopardy cases — and tell you exactly what happened, in plain English, matched to your record.
Resident with a documented fall history left unattended on the patio; found on the ground with a hip fracture.
Walk-in cooler logs missing for 12 days; expired supplements in the medication room fridge.
Illustrative
A prioritized, do-first checklist
Every risk area becomes concrete audit steps drawn from real citations at facilities like yours — run them this week, before your window opens.
Illustrative
Risk indicators are statistical estimates from public CMS data — not predictions, findings, or compliance advice.
Nursing homes near Nampa
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Meadow View Nursing And Rehabilitation | 0.5 mi | ★★★★★ | 13 | 0 |
| Karcher Post Acute | 1 mi | ★★★★★ | 21 | 0 |
| Sunny Ridge | 3.1 mi | ★★★★★ | 16 | 0 |
| Wellspring Health & Rehabilitation Of Cascadia | 3.9 mi | ★★★★★ | 3 | 0 |
| Cascadia Of Nampa | 4 mi | ★★★★★ | 16 | 1 |
Every risk area ranked, a do-first checklist, and your local survey patterns
Built specifically for Orchards Of Cascadia, The.
100% money-back within 48 hours.
Trusted data, never guesswork. Every citation, penalty, rating and Plan of Correction on this page is sourced from public CMS records (latest release July 2026) and official state health department websites.