Average — CMS composite of the measures below.
A standard survey is most likely before around August 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 Brookfield Health And Rehab Of Cascadia during CMS and state inspections, most recent first.
A resident with liver and kidney disease ingested another resident's 10mg Zyprexa after a nurse left the medication unattended on the cart. The resident became unresponsive, required ICU care, and was placed on a ventilator. Staff interviews confirmed that medications were supposed to be secured and not left unattended, but this protocol was not followed in this incident.
A resident with significant medical conditions ingested a 10 mg dose of Zyprexa that was not prescribed, became unresponsive, and required hospitalization with ventilator support. The facility did not report this medication error to the State Survey Agency as required, and key staff were either advised not to report or were unaware of the incident.
Three residents with moderate cognitive impairment or mobility issues were found with bed rails or beds placed against the wall without required assessments, physician orders, or informed consent. Staff confirmed that these steps were not completed, despite facility policy requiring them for the use of restraints and bedrails.
Three medication carts were found unlocked and unattended in two hallways, with drawers accessible and no staff present. Nursing staff confirmed that carts are required to be locked when not in use, but failed to do so during the survey.
A resident who was alert and oriented was admitted without a privacy curtain in her room, and multiple observations confirmed the curtain was missing. The resident expressed ongoing concerns about her privacy, especially when using a bed pan, and reported that her requests for a curtain had not been addressed. Staff were unaware of the missing curtain and acknowledged that one should have been installed.
A resident who was alert and oriented did not have a privacy curtain installed in her room since admission, despite requesting one. She was unable to close the door herself during personal care, and staff were unaware of the missing curtain until notified during the survey.
A resident with severe cognitive impairment experienced a fall despite fall risk precautions being in place. The facility's incident investigation lacked a root cause analysis and did not determine if further interventions were needed. The CNO acknowledged that the investigation should have addressed the root cause and ruled out abuse or neglect, but this was not done.
A resident with moderate cognitive impairment had a care plan stating the bed should be against the wall with a full side rail, but repeated observations showed the bed was not against the wall and only a quarter rail was present. The care plan was not updated to reflect these changes, and staff confirmed the care plan did not match the resident's current needs.
The facility did not consistently follow physician orders for two residents: one resident was not weighed weekly as ordered, with missed and incorrect documentation, and another resident's IV bags and tubing were not labeled with the required date, time, and nurse initials during antibiotic administration, as confirmed by staff and observations.
A resident's bed was found positioned against a wall with a baseboard heater, with linens touching the heater and a plastic tub nearby, despite clear markings and signage requiring a 12-inch clearance due to fire risk. Staff interviews revealed a lack of awareness and adherence to safety protocols, and the bed's placement blocked access to the heater's controls.
A resident with COPD and acute respiratory failure was observed receiving supplemental oxygen at various flow rates, but the facility failed to document oxygen use, SPO2 measurements without oxygen, and timely tubing changes in the EHR. Staff interviews confirmed that required documentation and weekly tubing changes were not completed according to physician orders and facility protocol.
Staff did not properly don PPE when entering the room of a resident on contact precautions for conjunctivitis. Despite clear signage and physician orders, two staff members entered the room and assisted the resident without gloves or gowns, believing PPE was only needed for personal care. This misunderstanding was shared by another LPN, while the Chief Nursing Officer stated that PPE should be worn at the door for all entries.
A resident who was alert and oriented did not receive a pneumococcal vaccine despite having provided consent and having a physician's order in place. The vaccine was not documented as administered, and staff confirmed it was missed because it was not entered on the MAR as required.
The facility failed to ensure residents were free from significant medication errors, as multiple residents did not receive medications and treatments as ordered, including missed doses, late administration, and incomplete wound care, pain monitoring, and behavioral assessments. Staff confirmed that blank spaces on the MAR and TAR indicated missed or incomplete tasks.
A resident with multiple health conditions required two-person assistance for bed mobility, as per their care plan. However, only one staff member assisted, leading to the resident falling and fracturing their femur. The incident required medical intervention, and the staff member involved was no longer employed at the facility.
A resident with multiple health conditions fell from their bed and was taken to the ER. The family was not notified until over five hours later, contrary to the facility's policy. The delay was due to an LPN's failure to inform the necessary parties promptly.
The facility failed to provide timely and complete SNF ABN and NOMNC notifications to three residents, risking inadequate information for financial decisions. Notices were either issued on the last covered day, incomplete, or missing, with staff acknowledging errors and confusion in documentation processes.
A resident with severe cognitive impairment was repeatedly observed with unkempt facial hair and a dirty beard, despite being assisted with showers. Staff acknowledged the resident was supposed to be shaved on shower days and did not often refuse care, indicating a failure in providing necessary grooming assistance.
The facility failed to ensure accurate documentation and communication of residents' code status, leading to discrepancies between POLST forms and physician orders. For several residents, the POLST indicated a DNR status, but room stickers suggested a Full Code status, causing confusion among staff about the appropriate response in emergencies.
The facility failed to follow physician orders for labeling IV and TF bags and tubing for a resident, and did not implement the bowel protocol for two residents experiencing constipation. Staff acknowledged the oversight in labeling and the lapse in following the prescribed bowel management orders.
Resident Harm from Unattended Medication Error
Penalty
Summary
A significant medication error occurred when a resident with liver cirrhosis and stage 3 kidney disease ingested a 10mg Zyprexa pill that was not prescribed to them. The medication, intended for another resident, was left unattended in a cup on top of the medication cart by a licensed nurse who had stepped away. The resident took the medication while at the cart for their own bedtime medications. Shortly after, the resident became unresponsive, began mumbling incoherently, and was transferred to the emergency room, where they required intensive care and mechanical ventilation for several days. Interviews with staff revealed that standard procedures required medications to be kept locked in the cart and not left unattended, and resident identification was to be verified before administration. However, in this incident, the medication was left accessible, and the nurse provided inconsistent accounts of the event. The facility's medication error report identified the root cause as the medication cup being left on the cart. The incident was not immediately communicated to the facility's CEO, and the resident's family was notified only after the resident was found unresponsive.
Failure to Report Serious Medication Error Resulting in Hospitalization
Penalty
Summary
The facility failed to report a significant medication error to the State Survey Agency as required. A resident with liver cirrhosis and stage 3 kidney disease, who was unable to participate in their assessment, ingested a 10 mg tablet of Zyprexa that was not prescribed to them while receiving medications at the medication cart. The resident subsequently became unresponsive and began to mumble incoherently, prompting the nurse to notify the physician, who ordered a transfer to the emergency room. The resident was hospitalized and required ventilator support in the intensive care unit for three days. The facility's incident log confirmed the event and documented that the state hotline was not notified. During interviews, the Interim DNS stated that regional staff advised the incident did not require reporting, so it was not reported. A newly appointed Interim DNS later stated that the medication error should have been reported, and the CEO was unaware of the incident. The failure to report the serious medication error delayed appropriate oversight and investigation.
Failure to Assess and Document Use of Bed Rails and Bed Placement as Restraints
Penalty
Summary
The facility failed to ensure that bed placement and the use of bed side rails were properly assessed, physician ordered, and accompanied by informed consent for three residents who were reviewed for physical restraints. Specifically, for one resident with moderate cognitive impairment, a quarter rail was observed on the bed during multiple observations, but there was no evaluation assessment, consent, or physician's order documented in the electronic health record. For another resident with hemiplegia and hemiparesis following a stroke, the bed was consistently observed with one side against the wall, yet there was no related assessment, consent, or physician's order. A third resident, also moderately cognitively impaired, was found with the bed against the wall and was unaware of the reason; again, no evaluation, consent, or physician's order was found in the record. Staff interviews confirmed that the expected process was not followed, as both the Resident Care Manager (LPN) and the Chief Nursing Officer (RN) acknowledged that evaluation assessments, consents, physician orders, and care plans should have been in place for the use of bed rails or beds placed against the wall. The facility's own policy requires these steps for the use of restraints and bedrails, including assessment, care planning, physician order, and informed consent, none of which were documented for the affected residents.
Medication Carts Left Unlocked and Unattended
Penalty
Summary
Surveyors observed that three out of four medication carts on the 200 Hall and 300 Hall were left unlocked and unattended, allowing drawers to be opened without staff supervision. At the time of observation, no staff were present in the hallway, and the carts contained medications, including controlled substances. Staff members, including a Registered Nurse and an LPN, acknowledged that medication carts are supposed to be locked when unattended, confirming that the carts should not have been left unsecured. These findings were based on direct observation and staff interviews during the survey.
Failure to Provide Privacy Curtain for Resident
Penalty
Summary
A resident who was alert and oriented was admitted to the facility and, upon admission, did not have a privacy curtain installed in her room. Observations on multiple occasions confirmed the absence of a privacy curtain. The resident reported that she had been without a privacy curtain since admission and was unable to close the door herself when using a bed pan, resulting in concerns about her privacy for over two weeks. She stated that she had requested the installation of a privacy curtain, but it had not been addressed. Staff interviews revealed that both the Maintenance Manager and the Chief Nursing Officer were unaware of the missing privacy curtain and confirmed that a privacy curtain should have been installed for every resident prior to admission.
Failure to Provide Privacy Curtain for Resident
Penalty
Summary
The facility failed to maintain personal privacy for a resident by not having a privacy curtain installed in the resident's room. The resident, who was alert and oriented, reported that there had not been a privacy curtain since admission and that she was unable to close the door herself when using a bed pan, despite having requested the curtain be installed. Observations on multiple occasions confirmed the absence of a privacy curtain in the room. Both the Maintenance Manager and the Chief Nursing Officer were unaware of the missing curtain prior to being informed during the survey.
Failure to Conduct Thorough Post-Fall Investigation
Penalty
Summary
The facility failed to conduct a thorough investigation following an incident involving a resident who was found fallen in their room, face down and with their head positioned between the bedside table and bed. The resident was identified as being severely cognitively impaired, and fall risk precautions such as a low bed and floor mat were in place, with the call light within reach at the time of the incident. Documentation of the incident investigation did not include a root cause analysis or indicate whether additional interventions were necessary. The Chief Nursing Officer confirmed that the investigation should have addressed the root cause of the fall and ruled out abuse or neglect, but this was not completed as required.
Failure to Update Care Plan to Reflect Current Bed Placement and Side Rail Use
Penalty
Summary
The facility failed to ensure that a resident's care plan was revised to accurately reflect current care needs. The resident, who was moderately cognitively impaired, had a care plan indicating the bed should be placed against the wall for increased living space and that a full side rail should be used for ease of mobility and transfers. However, multiple observations over several days showed that the resident's bed was not against the wall and only a quarter rail was present on the middle right side of the bed. The care plan did not document the use of a quarter rail, nor did it reflect the actual bed placement. Staff interviews confirmed that the care plan was outdated and did not match the resident's current environment or equipment in use. The Resident Care Manager and LPN acknowledged that the care plan was not updated to reflect the use of a quarter rail or the change in bed placement, and the Chief Nursing Officer stated that it was her expectation that care plans should be updated to reflect current care needs. This discrepancy was identified through observation, interview, and record review.
Failure to Follow Physician Orders for Weights and IV Labeling
Penalty
Summary
The facility failed to follow physician orders and care plans for two residents regarding weight monitoring and intravenous (IV) medication administration. For one resident with severe cognitive impairment, the care plan required weekly weights every Wednesday as ordered by the physician. However, electronic health records showed inconsistent documentation, including missed weights, incorrect entries, and a lack of follow-up when weights were recorded as incorrect. Staff interviews confirmed that weights were typically done monthly unless otherwise directed, and that incorrect weights should have been rechecked by the next day, which was not consistently done. For another resident with moderate cognitive impairment receiving IV antibiotics via a PICC line, physician orders and the care plan required that IV bags and tubing be labeled with the date, time, and nurse's initials, and that administration sets be changed every 24 hours. Observations on multiple occasions found empty IV bags and tubing hanging without the required labeling. Staff confirmed that labeling was expected per orders, but the required information was not present on the used IV sets and bags.
Bed and Linens Placed Against Baseboard Heater Creates Fire Hazard
Penalty
Summary
A deficiency was identified when a resident's bed was observed positioned against a wall with a baseboard heater, with bed linens hanging down and touching the heater. A plastic tub was also found under the bed near the heater. The area around the heater was marked with red tape indicating a 12-inch clearance zone, and a warning sign was posted stating that no items should be within 12 inches of the baseboard heater due to fire risk. The heater was off at the time of observation. The resident, who was moderately cognitively impaired, stated that the bed was not supposed to be against the wall and acknowledged the fire hazard, but noted the heater had not been on while the bed was in that position. Staff interviews revealed a lack of awareness and adherence to safety protocols regarding the required clearance around baseboard heaters. A housekeeper indicated that the bed blocked access to the heater's temperature control, and a LPN confirmed that regulations required beds to be a certain distance from heaters. Upon inspection, the LPN moved the bed away from the heater, acknowledging it should not have been placed there. The Chief Nursing Officer also confirmed that nothing should be within a 12-inch radius of the heater and that the bed placement was inappropriate.
Failure to Document and Manage Supplemental Oxygen Therapy
Penalty
Summary
The facility failed to ensure accurate documentation and proper management of supplemental oxygen therapy for a resident with chronic obstructive pulmonary disease and acute respiratory failure with hypoxia. Observations revealed that the resident was receiving oxygen via nasal cannula at varying flow rates, but the oxygen tubing was undated on multiple occasions, both in the resident's room and on a portable tank attached to the resident's wheelchair. Additionally, there was no documentation in the electronic medication or treatment administration records of the resident's supplemental oxygen use on the observed dates. The resident's electronic health record also lacked documentation of oxygen saturation (SPO2) measurements without oxygen and did not indicate that the oxygen tubing had been changed as required. Interviews with facility staff confirmed that the physician's order required supplemental oxygen to be administered if the resident's SPO2 was below 90, and that oxygen tubing should be changed weekly with corresponding documentation. Staff were unable to locate documentation of the resident's oxygen use, SPO2 assessments without oxygen, or evidence that the tubing had been changed according to protocol. The Chief Nursing Officer acknowledged that documentation of SPO2 assessment and effectiveness of oxygen therapy was not completed, and that the standard for changing oxygen tubing was not met.
Failure to Don PPE for Resident on Contact Precautions
Penalty
Summary
Staff failed to properly don personal protective equipment (PPE) when entering the room of a resident who was on contact precautions for conjunctivitis. The resident, who was severely cognitively impaired, had physician orders for contact isolation and was being treated with Ofloxacin Ophthalmic Solution for a bacterial eye infection. A sign was posted on the resident's door instructing staff to gown and glove at the door before entry. Despite these instructions, two staff members, a CNA and a Staffing Coordinator/CNA, entered the resident's room and assisted the resident in bed without wearing gloves or gowns. Upon interview, both staff members indicated they believed PPE was only required when performing personal care or handling urine, not for all room entry. Another staff member, an LPN, echoed this misunderstanding, stating PPE was only necessary when treating the specific problem. However, the Chief Nursing Officer clarified that staff were expected to don gloves and gowns at the door prior to entering the room for any resident on contact precautions. This discrepancy in understanding and practice led to the failure to implement proper infection prevention and control measures.
Failure to Administer Pneumococcal Vaccine After Consent and Order
Penalty
Summary
The facility failed to ensure that a pneumococcal vaccine was administered to one of five sampled residents reviewed for immunizations. The resident was admitted to the facility and was found to be alert and oriented, with documentation indicating that the pneumococcal vaccination was not up to date. The resident signed an acknowledgement form indicating receipt of the vaccine information sheet and consented to receive any needed vaccines. A physician's order was present, authorizing the administration of the pneumococcal vaccine if indicated. The electronic health record showed the vaccine status as pending, with consent confirmed by the infection preventionist. Despite the presence of consent and a physician's order, there was no documentation in the resident's record that the pneumococcal vaccine was administered. The infection preventionist confirmed that the vaccine had not been given and that it was not entered on the Medication Administration Record as required. The Chief Nursing Officer stated that the expectation was for vaccinations to be administered after obtaining orders and consents, but this process was not followed in this instance.
Failure to Ensure Residents Are Free from Significant Medication Errors
Penalty
Summary
The facility failed to ensure that residents were free from significant medication errors, as evidenced by the administration of medications at incorrect times and the omission of prescribed medications and treatments for all five sampled residents. For example, one resident with multiple sclerosis, sepsis, and osteomyelitis did not receive several medications, such as Tramadol, Vancomycin, and Ciprofloxacin, at the times ordered by the provider. Additionally, this resident missed multiple wound care treatments, skin inspections, hygiene care, weight monitoring, and other essential interventions as documented in the Medication Administration Record (MAR) and Treatment Administration Record (TAR). Another resident with an intracranial injury and paraplegia experienced omissions in the administration of catheter care, wound care, and education regarding anticoagulant therapy. Similarly, a resident with Parkinson's disease and a catatonic disorder did not receive several prescribed treatments, including hand splint application, edema monitoring, pain assessments, and specialty mattress checks. These omissions were consistently documented as blank spaces on the MAR and TAR, indicating that the tasks were incomplete or not performed. Further review revealed that residents with complex medical needs, such as those with multiple sclerosis, respiratory failure, hemiplegia, sepsis, and cellulitis, also experienced missed medication doses and treatments. These included failures to administer pain medications, perform wound care, monitor vital signs, and provide behavioral and psychotropic medication monitoring. Staff interviews confirmed that blank spaces on the MAR and TAR signified missed tasks or medications, and that the facility's policy allowed for a specific window of time for medication administration, which was not adhered to in these cases.
Failure to Provide Adequate Bed Mobility Assistance
Penalty
Summary
The facility failed to ensure that residents were free from avoidable accidents during bed mobility assistance, resulting in harm to a resident. The resident, who had a history of asthma, diabetes mellitus type 2, hypertension, and chronic heart failure, required maximum assistance for bed mobility as per their care plan. The care plan specifically indicated the need for two-person assistance for repositioning. However, on the night of the incident, only one staff member provided assistance, leading to the resident falling from the bed and sustaining a fractured femur. The incident occurred during personal care at approximately 2:00 AM, and the resulting injury required medical intervention. A hospital orthopedic surgery consult confirmed the femur fracture and discussed the limited options for treatment, focusing on comfort care due to the significant risks associated with surgery. The staff member involved in the incident was no longer employed at the facility following the failure to adhere to the care plan, which resulted in the resident's injury.
Failure to Notify Resident's Family of Significant Change
Penalty
Summary
The facility failed to ensure timely notification of a resident's representative following a significant change in the resident's condition. Specifically, a resident with a history of asthma, diabetes mellitus type 2, hypertension, and chronic heart failure was involved in an incident where they fell from their bed and were subsequently transported to the emergency room. Despite the facility's policy requiring immediate notification of a resident's representative in such cases, the family was not informed until over five hours after the incident occurred. The incident took place at approximately 2:30 AM, and the family was not notified until 7:45 AM. The delay in communication was attributed to Staff C, an LPN, who was responsible for the resident's care at the time of the incident. The Director of Nursing Services confirmed that neither the administrator nor the family was informed in a timely manner, which was a breach of the facility's policy on resident change of condition.
Failure to Provide Timely Medicare Coverage Notices
Penalty
Summary
The facility failed to provide timely and complete notifications regarding Medicare coverage and potential liability for services not covered, specifically the Skilled Nursing Facility Advanced Beneficiary Notice of Non-coverage (SNF ABN) and the Notice of Medicare Non-Coverage (NOMNC). For three residents, the facility did not issue these notices at least two calendar days before the end of Medicare services, as required. Resident 33 received both the SNF ABN and NOMNC on the last covered day of services, and the SNF ABN was incomplete, lacking details on what Medicare may not pay for, the reason, estimated cost, and the resident's chosen option. Similarly, Resident 49's SNF ABN was undated and incomplete, and the NOMNC lacked a documented date. Resident 214 was not provided with a NOMNC at all. Staff G, the Social Service Director, acknowledged the errors, stating that the notices were not properly filled out or dated, and there was confusion about whether to keep original documents after scanning them into the Electronic Health Record. The Chief Executive Officer expected that SNF ABNs and NOMNCs be filled out completely, signed, and dated with at least two days' notice before non-coverage. The lack of proper documentation and timely notification placed residents at risk of not having adequate information to make informed financial decisions regarding their continued stay in the facility.
Failure to Provide Grooming Assistance for Cognitively Impaired Resident
Penalty
Summary
The facility failed to provide grooming assistance for a resident, identified as Resident 44, who was severely cognitively impaired. The resident was admitted to the facility and had an annual Minimum Data Set assessment indicating severe cognitive impairment. On multiple occasions, Resident 44 was observed with unkempt facial hair and a brown-colored substance on his face, despite being assisted out of the shower by a certified nursing assistant (CNA). The resident's son expressed concern about the resident's consistently dirty beard. Staff members, including a Resident Care Manager and a CNA, acknowledged that Resident 44 was supposed to be shaved on shower days and noted that the resident did not often refuse care. These observations and interviews indicate a failure to ensure proper grooming assistance, as required by the facility's care standards.
Discrepancies in Code Status Documentation and Communication
Penalty
Summary
The facility failed to ensure that policies and procedures were in place to accurately reflect residents' choices regarding their code status, leading to discrepancies in the documentation and communication of these preferences. For four residents, there were inconsistencies between the Physician Order for Life Sustaining Treatment (POLST) forms and the physician orders in the electronic health records (EHR). Specifically, Resident 10's POLST indicated a Do Not Resuscitate (DNR) status, while the physician order in the EHR showed a Full Code status. This discrepancy was not addressed by the staff, as evidenced by the heart sticker outside Resident 10's room, which incorrectly indicated a Full Code status. Similar issues were observed with Residents 8, 11, and 36, whose POLST forms indicated a DNR status, but the stickers outside their rooms suggested otherwise. Staff members, including the Chief Nursing Officer and other nursing staff, were unaware of these discrepancies and relied on the stickers to determine the residents' code status. This lack of accurate communication and documentation placed residents at risk for receiving care that was not aligned with their documented wishes.
Failure to Follow Physician Orders for IV/TF Labeling and Bowel Protocol
Penalty
Summary
The facility failed to adhere to physician's orders and care plans for labeling intravenous (IV) and tube feeding (TF) bags and tubing for a resident. The resident, who was moderately cognitively impaired, was receiving vancomycin IV and Jevity enteral nutrition. Despite physician orders requiring the labeling of IV and TF bags and tubing with date, time, and initials, observations on multiple occasions revealed that these items were not labeled. Staff members acknowledged the oversight, confirming that the labeling was necessary to ensure compliance with physician orders and care plans. Additionally, the facility did not follow the bowel protocol for two residents experiencing constipation. One resident did not have a bowel movement for five days, and the electronic medication administration record (EMAR) showed that PRN bowel medications were not administered as per physician orders. The orders included a sequence of administering Miralax, milk of magnesia (MOM), Dulcolax suppository, and Fleet enema if necessary, but this protocol was not initiated. Staff confirmed the protocol was not followed. For the second resident, the bowel management orders required MOM to be given if no bowel movement occurred for two days, followed by a Dulcolax suppository if there were no results within 24 hours. However, the Dulcolax suppository was administered four days after the MOM, not within the required 24-hour period. This failure to implement the bowel protocol as ordered by the physician was acknowledged by the staff, indicating a lapse in following the prescribed treatment plan.
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Illustrative
What surveyors actually found near you
We read the 455 citations issued within 25 miles in the last 12 months — 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
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Illustrative
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Nursing homes near Battle Ground
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Salmon Creek Post Acute & Rehabilitation | 6.5 mi | ★★★★★ | 27 | 0 |
| Bridge Crest Post Acute | 10.7 mi | ★★★★★ | 29 | 0 |
| Vancouver Specialty And Rehab Care | 11.1 mi | ★★★★★ | 29 | 0 |
| Hudson Bay Health And Rehabilitation | 11.2 mi | ★★★★★ | 14 | 0 |
| The Oaks At Timberline | 11.5 mi | ★★★★★ | 15 | 0 |
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