A list of the most recent deficiencies for Washington Veteran Home-Retsil. The list is based on the information provided by CMS from both standard inspections and from complaints filed by residents.
| Deficiency | Type of Deficiency | Deficiency Date | Date Corrected | Resulted from a Complaint? |
|---|---|---|---|---|
| Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. | Health | 2023-11-09 | 2023-12-11 | Y |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2023-11-09 | 2023-12-11 | Y |
| Provide the appropriate treatment and services to a resident who displays or is diagnosed with dementia. | Health | 2023-09-14 | 2023-10-31 | Y |
| Conduct risk assessment and an All-Hazards approach. | Fire Safety | 2023-06-26 | 2023-07-30 | N |
| Include a process for Emergency Preparedness collaboration. | Fire Safety | 2023-06-26 | 2023-07-30 | N |
| Address subsistence needs for staff and patients. | Fire Safety | 2023-06-26 | 2023-07-30 | N |
| Establish policies and procedures for medical documentation. | Fire Safety | 2023-06-26 | 2023-07-30 | N |
| Establish policies and procedures for volunteers. | Fire Safety | 2023-06-26 | 2023-07-30 | N |
| Establish roles under a Waiver declared by secretary. | Fire Safety | 2023-06-26 | 2023-07-30 | N |
| Provide primary/alternate means for communication. | Fire Safety | 2023-06-26 | 2023-07-30 | N |
| Provide a means of sharing information on occupancy/needs. | Fire Safety | 2023-06-26 | 2023-07-30 | N |
| Provide family notifications of emergency plan. | Fire Safety | 2023-06-26 | 2023-07-30 | N |
| Establish emergency prep training and testing. | Fire Safety | 2023-06-26 | 2023-07-30 | N |
| Establish staff and initial training requirements. | Fire Safety | 2023-06-26 | 2023-07-30 | N |
| Conduct testing and exercise requirements. | Fire Safety | 2023-06-26 | 2023-07-30 | N |
| Keep aisles, corridors, and exits free of obstruction in case of emergency. | Fire Safety | 2023-06-26 | 2023-07-30 | N |
| Have properly located and lighted "Exit" signs. | Fire Safety | 2023-06-26 | 2023-07-30 | N |
| Meet other general requirements that are deficient. | Fire Safety | 2023-06-26 | 2023-07-30 | N |
| Provide properly protected cooking facilities. | Fire Safety | 2023-06-26 | 2023-07-30 | N |
| Install a fire alarm system that can be heard throughout the facility. | Fire Safety | 2023-06-26 | 2023-07-30 | N |
| Have approved installation, maintenance and testing program for fire alarm systems. | Fire Safety | 2023-06-26 | 2023-07-30 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2023-06-26 | 2023-07-30 | N |
| Properly select, install, inspect, or maintain portable fire extinguishes. | Fire Safety | 2023-06-26 | 2023-07-30 | N |
| Ensure smoke barriers are constructed to a 1 hour fire resistance rating. | Fire Safety | 2023-06-26 | 2023-07-30 | N |
| Meet other general requirements that are deficient. | Fire Safety | 2023-06-26 | 2023-07-30 | N |
| Have properly installed electrical wiring and gas equipment. | Fire Safety | 2023-06-26 | 2023-07-30 | N |
| Have simulated fire drills held at unexpected times. | Fire Safety | 2023-06-26 | 2023-07-30 | N |
| To conduct inspection, testing and maintenance of fire doors by qualified individuals. | Fire Safety | 2023-06-26 | 2023-07-30 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2023-06-26 | 2023-07-30 | N |
| Ensure proper usage of power strips and extension cords. | Fire Safety | 2023-06-26 | 2023-07-30 | N |
| Ensure that testing and maintenance of electrical equipment is performed. | Fire Safety | 2023-06-26 | 2023-07-30 | N |
| Ensure that personnel concerned with handling of medical gases and cylinders are trained on the risk. | Fire Safety | 2023-06-26 | 2023-07-30 | N |
| Have proper fire barriers, ventilation and signs for the transfilling of oxygen. | Fire Safety | 2023-06-26 | 2023-07-30 | N |
| Ensure each resident receives an accurate assessment. | Health | 2023-06-23 | 2023-07-19 | N |
| Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. | Health | 2023-06-23 | 2023-07-19 | N |
| Ensure services provided by the nursing facility meet professional standards of quality. | Health | 2023-06-23 | 2023-07-19 | N |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2023-06-23 | 2023-07-19 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2023-06-23 | 2023-07-19 | N |
| Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. | Health | 2023-06-23 | 2023-07-19 | N |
| Provide and implement an infection prevention and control program. | Health | 2023-06-23 | 2023-07-19 | N |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2023-06-01 | 2023-07-12 | Y |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2023-01-30 | 2023-02-28 | Y |
| Ensure the resident's doctor reviews the resident's care, writes, signs and dates progress notes and orders, at each required visit. | Health | 2023-01-30 | 2023-02-28 | Y |
| Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Health | 2023-01-05 | 2023-02-10 | Y |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2023-01-05 | 2023-02-10 | Y |
| Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | Health | 2022-10-10 | 2022-11-11 | Y |
| Ensure services provided by the nursing facility meet professional standards of quality. | Health | 2022-10-03 | 2022-11-01 | Y |
| Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. | Health | 2022-07-27 | 2022-09-02 | Y |
| Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Health | 2022-06-02 | 2022-06-30 | Y |
| Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | Health | 2022-05-12 | 2022-06-30 | Y |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2022-05-12 | 2022-06-30 | Y |
| Meet other general requirements. | Fire Safety | 2022-03-23 | 2022-05-11 | N |
| Keep aisles, corridors, and exits free of obstruction in case of emergency. | Fire Safety | 2022-03-23 | 2022-05-11 | N |
| Have exits that are accessible at all times. | Fire Safety | 2022-03-23 | 2022-05-11 | N |
| Install corridor and hallway doors that block smoke. | Fire Safety | 2022-03-23 | 2022-05-11 | N |
| Ensure smoke barriers are constructed to a 1 hour fire resistance rating. | Fire Safety | 2022-03-23 | 2022-05-11 | N |
| Have properly installed electrical wiring and gas equipment. | Fire Safety | 2022-03-23 | 2022-05-11 | N |
| Have elevators that firefighters can control in the event of a fire. | Fire Safety | 2022-03-23 | 2022-05-11 | N |
| Provide a written emergency evacuation plan. | Fire Safety | 2022-03-23 | 2022-05-11 | N |
| Have restrictions on the use of flammable curtains. | Fire Safety | 2022-03-23 | 2022-05-11 | N |
| Allow residents to self-administer drugs if determined clinically appropriate. | Health | 2022-03-25 | 2022-05-03 | N |
| Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. | Health | 2022-03-25 | 2022-05-03 | N |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2022-03-25 | 2022-05-03 | N |
| Assist a resident in gaining access to vision and hearing services. | Health | 2022-03-25 | 2022-05-03 | N |
| Provide safe and appropriate respiratory care for a resident when needed. | Health | 2022-03-25 | 2022-05-03 | N |
| Ensure each resident?s drug regimen must be free from unnecessary drugs. | Health | 2022-03-25 | 2022-05-03 | N |
| Provide routine and 24-hour emergency dental care for each resident. | Health | 2022-03-25 | 2022-05-03 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2022-03-25 | 2022-05-03 | N |
| Provide and implement an infection prevention and control program. | Health | 2022-03-25 | 2022-05-03 | N |
| Designate a qualified infection preventionist to be responsible for the infection prevent and control program in the nursing home. | Health | 2022-03-25 | 2022-05-03 | N |
| Perform COVID19 testing on residents and staff. | Health | 2022-03-25 | 2022-05-03 | N |
| Provide and implement an infection prevention and control program. | Health | 2021-08-31 | 2021-10-08 | Y |
| Respond appropriately to all alleged violations. | Health | 2021-07-14 | 2021-08-27 | Y |
| Allow residents to self-administer drugs if determined clinically appropriate. | Health | 2019-06-10 | 2019-07-23 | N |
| Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. | Health | 2019-06-10 | 2019-07-23 | N |
| Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances. | Health | 2019-06-10 | 2019-07-23 | N |
| Respond appropriately to all alleged violations. | Health | 2019-06-10 | 2019-07-23 | N |
| Ensure each resident receives an accurate assessment. | Health | 2019-06-10 | 2019-07-23 | N |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2019-06-10 | 2019-07-23 | N |
| Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. | Health | 2019-06-10 | 2019-07-23 | N |
| Ensure services provided by the nursing facility meet professional standards of quality. | Health | 2019-06-10 | 2019-07-23 | N |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2019-06-10 | 2019-07-23 | N |
| Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Health | 2019-06-10 | 2019-07-23 | N |
| Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. | Health | 2019-06-10 | 2019-07-23 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2019-06-10 | 2019-07-23 | N |
| Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. | Health | 2019-06-10 | 2019-07-23 | N |
| Post nurse staffing information every day. | Health | 2019-06-10 | 2019-07-23 | N |
| Provide and implement an infection prevention and control program. | Health | 2019-06-10 | 2019-07-23 | N |
| Implement a program that monitors antibiotic use. | Health | 2019-06-10 | 2019-07-23 | N |
| Develop and implement policies and procedures for flu and pneumonia vaccinations. | Health | 2019-06-10 | 2019-07-23 | N |
| Provide exit doors that are held open by devices that will automatically close on the activation of a fire alarm or smoke detector. | Fire Safety | 2019-05-30 | 2019-06-28 | N |
| Install proper backup exit lighting. | Fire Safety | 2019-05-30 | 2019-06-24 | N |
