Not rated by CMS — ratings are suppressed for new or low-volume facilities.
The next survey window likely opens around April 2027
Estimate from public CMS data, current as of June 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Paradise Creek Health And Rehab Of Cascadia during CMS and state inspections, most recent first.
Surveyors found that the facility did not maintain sanitary conditions in the walk-in freezer and ice machine area. Ice buildup on freezer lines was encroaching on a box of burritos, and an ice scoop holder attached to the ice machine contained standing water with two scoops resting in it and no visible drainage. The Dietary Manager acknowledged the recurring ice buildup and reported that the standing water issue had not previously been raised. These practices did not follow the facility’s policies for food safety, storage, and ice machine preventative maintenance and had the potential to affect 46 residents who consumed food from the kitchen.
A resident with dementia, malnutrition, anemia, CKD3, and other comorbidities was care planned as at risk for nutritional decline and dehydration, with weekly weights and RD review ordered. An RD later documented poor PO intake averaging about 31%, fluid intake around 612 ml with meals, and no routine supplements in place, and recommended starting 2 oz Med Pass BID between meals with nursing to document consumption. No Med Pass order was entered into the EMR, and the resident did not receive the supplement, while experiencing a 10‑lb (6.8%) weight loss over several months. Interviews showed the RD typically communicated recommendations via email and NAR meetings, but NAR meetings had not been held consistently and no email or other system ensured the recommendation was received or implemented; requested policies on RD recommendations/supplement orders and weight loss were not provided.
A resident with multiple cardiopulmonary diagnoses received continuous O2 at 1.5 LPM via nasal cannula without a physician order or corresponding MAR documentation, despite the care plan and MDS indicating a need for and receipt of oxygen therapy. Surveyors observed the resident on oxygen on several occasions, initially without humidification and later with humidification. An LPN and the DON both confirmed at the bedside that the resident had been on oxygen since admission without a provider order, and that no monitoring was documented, contrary to facility policy requiring verification of a provider order before initiating or changing oxygen therapy.
Two residents in a facility experienced deficiencies in care. One resident suffered a fall resulting in a forehead laceration that was not treated promptly, leading to further complications. Neurological checks were not completed as required. Another resident's hospice orders for pain and anxiety management were delayed, affecting their care. Interviews revealed lapses in communication and documentation, with the DON acknowledging the need for immediate implementation of hospice orders and the importance of neuro checks.
The facility failed to ensure food safety and proper sanitation in its kitchen, affecting 41 residents. Observations revealed expired food items in the refrigerator and dry storage, and a freezer with fluctuating temperatures. Improper sanitation practices were noted during food preparation, with a thermometer being inadequately sanitized, risking chemical contamination. The Culinary Manager confirmed these deficiencies.
The facility did not complete annual performance reviews for CNAs, with none of the five CNAs receiving a review within 12 months. Additionally, three CNAs did not receive the required 12 hours of training per year, with CNA1 receiving 2.35 hours, CNA3 receiving seven hours, and CNA4 receiving 8.6 hours. The DON confirmed that no performance reviews were conducted for CNAs employed for over 12 months, potentially affecting care for 43 residents.
The facility failed to provide meals that were palatable and at safe temperatures, affecting several residents. Observations showed improper food temperatures, with hot meals not reaching the required 130°F and cold items exceeding 50°F. Residents reported issues like lack of flavor and cold food, indicating non-compliance with the facility's food preparation policy.
A resident's grievance about inadequate incontinence briefs was not documented or resolved in a timely manner. Despite expressing dissatisfaction with the wrap-around briefs provided, which led to frequent soiling, the facility failed to ensure the resident received the preferred pull-up briefs. Interviews revealed a lack of follow-through in addressing the grievance, resulting in the issue remaining unresolved.
The facility failed to implement and follow fall prevention interventions for three residents, leading to multiple falls. A resident with cognitive impairment did not have a chair alarm as ordered. Another resident, dependent on staff for transfers, fell multiple times due to missing Dycem pads and cushions. A third resident, with impaired mobility, experienced several unwitnessed falls due to inadequate supervision and improper use of assistive devices.
A facility failed to ensure a pharmacist made a written recommendation for a gradual dose reduction (GDR) for a resident on Seroquel, an antipsychotic medication. Despite the facility's policy requiring documentation of irregularities, no formal recommendation was made, and no GDR was attempted for the resident with dementia and mood disturbance. The DON confirmed the lack of documentation from both the pharmacist and psychiatric physician regarding the GDR.
Unsanitary Walk-In Freezer and Ice Scoop Storage Practices
Penalty
Summary
Surveyors observed that the facility failed to maintain sanitary conditions in food storage and ice handling areas. During an initial kitchen tour, the walk-in freezer was found to have ice buildup on the freezer lines that extended far enough to encroach on the upper stacked box of burritos. The Dietary Manager acknowledged during interview that this ice buildup had occurred before. At the end of the tour, inspection of the ice machine revealed an ice scoop holder mounted on the side of the machine containing two ice scoops, with approximately 20 milliliters of standing water in the bottom of the holder and the scoops in direct contact with the water, and no visible way for the water to drain. The Dietary Manager stated that no one had ever mentioned the standing water in the scoop holder before. These conditions were inconsistent with the facility’s written policies on food safety and storage and on ice machine preventative maintenance, which require that food and supplies be stored and handled to ensure safety and sanitation and that exterior surfaces, including the catch basin, be wiped down with a clean cloth and food-safe sanitizer. The deficiency had the potential to affect 46 residents who consumed food from the kitchen.
Failure to Implement RD Supplement Recommendation for Resident With Weight Loss
Penalty
Summary
The facility failed to implement a registered dietician’s (RD) recommendation to address gradual weight loss for one resident. The resident was admitted with dementia with behavioral disturbance, malnutrition, anemia, osteoporosis, B vitamin deficiency, history of alcohol abuse, peripheral vascular disease, hypertension, and stage 3 chronic kidney disease. Her care plan identified her as at risk for nutritional decline and dehydration or potential fluid deficit, with approaches including weekly weights, completion of a Mini Nutritional Assessment, provision of meals per physician diet order with intake documentation, and RD review as indicated. A quarterly MDS showed severely impaired cognition, risk for pressure ulcers, receipt of a therapeutic diet, and a need for set-up or clean-up assistance with eating. On a nutritional review, the RD documented that the resident’s average intake was about 31%, average fluid intake with meals was about 612 ml, and that there were no routine supplements in place, although the RD felt she would benefit from additional support. The RD recommended initiating 2 oz Med Pass BID between meals and directed nursing to document the amount consumed. However, there was no corresponding Med Pass order in the EMR, and the resident did not receive the supplement. The resident experienced a 10‑lb (6.8%) weight loss over four months, with a low of 128.4 lbs. Interviews revealed that the RD expected recommendations to be implemented within 48 hours and typically communicated them via email to nursing and through Nutrition At Risk (NAR) meetings, but there had been no consistent NAR meetings and no email or other system in place to ensure the RD’s recommendation for Med Pass was communicated and implemented. Requested policies on RD recommendations/supplement orders and weight loss were not provided before survey exit.
Oxygen Therapy Administered Without Physician Order or Documentation
Penalty
Summary
The deficiency involves the facility’s failure to obtain a physician’s order, in accordance with professional standards of practice and facility policy, before administering oxygen to a resident. The resident was admitted with diagnoses including pulmonary hypertension, malignant neoplasm of the cardia and lower third of the esophagus, abnormal lung findings, and chronic systolic congestive heart failure. The resident’s care plan documented a potential for altered respiratory status and the need for oxygen therapy via nasal cannula, and the admission MDS indicated the resident received oxygen while in the facility. However, review of the electronic medical record, including the Order Recap Report, MAR, and progress notes for the relevant period, revealed no physician order for oxygen and no documentation that oxygen was being administered or monitored. Surveyor observations on multiple dates showed the resident receiving oxygen via nasal cannula at 1.5 LPM, initially without humidification and later with humidification. During interviews at the bedside, an LPN confirmed the resident was receiving oxygen at 1.5 LPM, acknowledged there was no physician’s order for oxygen, and stated the resident had been on oxygen since admission, with no MAR documentation of monitoring. The DON also confirmed the resident was receiving oxygen at 1.5 LPM without a corresponding physician’s order and stated that an order should have been obtained before oxygen was administered. Review of the facility’s “Oxygen Administration, Safety, Storage & Maintenance” policy showed that staff were required to verify a provider order prior to initiating or changing oxygen therapy, which was not followed in this case.
Deficiencies in Timely Care and Documentation for Two Residents
Penalty
Summary
The facility failed to provide adequate and timely nursing care for two residents, resulting in significant deficiencies. Resident 30 experienced a fall that resulted in a significant laceration to her forehead. Despite the severity of the injury, the resident was not sent to the emergency department in a timely manner. The hospice nurse advised against sending the resident to the hospital, and the facility staff did not follow up adequately. As a result, the wound could not be sutured and required debridement and continued treatment weeks after the fall. Additionally, neurological checks were not completed as required, which could have helped detect any changes in the resident's condition. Resident 43's hospice orders were not implemented in a timely manner, which affected the resident's pain management. The hospice orders were faxed to the facility, but they were not documented into the medical record until several days later. This delay meant that the resident did not receive the updated medication orders for pain and anxiety management promptly. The facility staff found the hospice orders on the nursing manager's desk days after they were sent, indicating a lapse in communication and documentation processes. Interviews with family members and facility staff revealed that there was a lack of coordination and follow-up regarding the residents' care. The Director of Nursing acknowledged that the hospice orders should have been implemented immediately and that the neuro checks for Resident 30 were crucial for monitoring potential changes in mental status. These deficiencies highlight the need for improved communication and adherence to care protocols to ensure residents receive timely and appropriate care.
Food Safety and Sanitation Deficiencies in Kitchen
Penalty
Summary
The facility failed to ensure food safety and proper sanitation practices in its kitchen, which had the potential to affect the 41 residents served food from the kitchen. During observations, it was found that the walk-in refrigerator contained expired food items, including sour cream and potato salad, which were confirmed by the Culinary Manager (CM) and subsequently disposed of. Additionally, the freezer was observed to have food that was not fully frozen, with the temperature recorded at 28 degrees Fahrenheit, which is above the recommended range. The CM acknowledged that the freezer temperatures had been fluctuating and that affected food had been discarded. Furthermore, the dry storage area contained expired honey thickened dairy liquids and chicken noodle soup, which were also confirmed by the CM. Improper sanitation practices were observed during food preparation. Cook1 was seen using a thermometer to check the temperature of lasagna, but instead of using thermometer wipes, he used a bucket of sanitizer water and a rag, which could lead to chemical contamination. The CM confirmed that the proper procedure was not followed, and the pan of lasagna tested with the improperly sanitized thermometer was discarded. The Registered Dietitian (RD) and the CM confirmed the presence of expired foods and stated that the freezer was currently functioning properly.
Deficiency in CNA Performance Reviews and Training
Penalty
Summary
The facility failed to ensure that annual performance reviews were completed for every nurse aide, with none of the five Certified Nursing Assistants (CNAs) having received a performance review within 12 months. Additionally, the facility did not provide the required minimum of 12 hours of training per year for three of the five CNAs reviewed. Specifically, CNA1 received 2.35 hours, CNA3 received seven hours, and CNA4 received 8.6 hours of training over the past year. The training provided did include abuse and dementia training. During an interview, the Director of Nursing (DON) confirmed that no performance reviews had been conducted for the CNAs who had worked at the facility for over 12 months. This deficiency had the potential to impact the current skillset and knowledge level necessary for the care of 43 census residents.
Deficiency in Meal Palatability and Temperature
Penalty
Summary
The facility failed to ensure that meals provided to residents were palatable, attractive, and served at safe and appetizing temperatures. This deficiency was identified through observations, record reviews, interviews, and a review of facility policies. Five residents expressed dissatisfaction with the meals, citing issues such as lack of flavor, inadequate seasoning, and improper temperatures. For instance, one resident mentioned that the food had no flavor and lacked salt, while another described the food as cold and unseasoned. Additionally, a resident noted that the water was not hot enough for cocoa, and there were no condiments available. Observations revealed that the food temperatures were not maintained appropriately. During a test tray evaluation, the lasagna was found to be 118 degrees Fahrenheit, the salad was 89 degrees Fahrenheit, and the custard was 54 degrees Fahrenheit, all of which were outside the recommended temperature ranges. The Registered Dietitian confirmed these findings and noted that the hot food should have been around 130 degrees Fahrenheit, and the cold food should have been around 50 degrees Fahrenheit. The improper placement of the salad on the same plate as the lasagna was identified as a contributing factor to the temperature issues. The facility's policy on food preparation emphasized the importance of conserving nutritive value, flavor, and appearance, which was not adhered to in this instance.
Failure to Address Resident's Grievance on Incontinence Products
Penalty
Summary
The facility failed to document, investigate, and resolve a verbal grievance raised by a resident, identified as R8, regarding the type of incontinence briefs provided. R8, who was cognitively intact with a BIMS score of 15, expressed dissatisfaction during a Resident Council Meeting about not receiving the large heavy pull-up briefs ordered by his doctor. Instead, he was provided with wrap-around briefs, which he found inadequate, leading to frequent soiling of his clothing and bedding. Despite the resident's clear communication of his needs and preferences, the grievance was not formally documented or addressed in a timely manner. Interviews with various staff members, including the Activity Manager, Social Services Manager, and Central Supply Specialist, revealed a lack of follow-through in addressing R8's grievance. Although the Central Supply Specialist ordered pull-up briefs for R8, there was no subsequent check to ensure the resident received them. The Director of Nursing acknowledged the issue but could not provide documentation that the pull-up briefs were ordered and provided to R8. This oversight resulted in R8's grievance remaining unresolved for an extended period.
Failure to Implement Fall Prevention Interventions
Penalty
Summary
The facility failed to implement and follow interventions to prevent additional falls for three residents, increasing the risk of further falls and potential injury. Resident 9, who was moderately cognitively impaired and had a history of falls, was ordered to have a bed and chair alarm due to her cognitive history and desire for independence. However, observations revealed that while a bed alarm was in place, a chair alarm was not, contrary to the physician's orders and the resident's care plan. Resident 33, who was severely cognitively impaired and dependent on staff for transfers, experienced multiple falls from his wheelchair. The care plan included interventions such as a Dycem pad and a comfort cushion to prevent falls. However, during incidents where the resident slid out of the wheelchair, it was noted that the Dycem pad was not in place, and the comfort cushion was not used until after subsequent falls, despite being part of the care plan. Resident 42, who had intact cognition but was at risk for falls due to impaired mobility and a terminal prognosis, experienced several unwitnessed falls. The falls were attributed to factors such as the resident being barefoot, using an unsteady commode, and inadequate supervision. Interventions like ensuring proper footwear, using a call light, and placing the bed against the wall were not effectively implemented or documented in the care plan until after multiple falls occurred.
Failure to Document Gradual Dose Reduction for Antipsychotic Medication
Penalty
Summary
The facility failed to ensure that a licensed pharmacist made a written recommendation for a gradual dose reduction (GDR) for a resident prescribed an antipsychotic medication. The facility's Drug Regimen Review policy requires that any irregularities noted by the pharmacist during the monthly drug regimen review be documented and sent to the attending physician and other relevant staff. However, for one resident with dementia and mood disturbance, no such recommendation was made, despite the resident being on Seroquel since January 2024 without a GDR attempt. The resident, who was severely impaired in cognition, was identified as having behavioral symptoms and was administered Seroquel without a GDR. The Director of Nursing confirmed that although a GDR was discussed with the pharmacist and a psychiatric doctor, no formal written recommendation was completed. Additionally, there was no documentation from the pharmacist or psychiatric physician regarding the GDR, and no medication recommendations were made by the pharmacist for the resident over the past 12 months.
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 42 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 Moscow
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Aspen Park Of Cascadia | 1.6 mi | — | 0 | 0 |
| Three Creeks Post Acute | 10.6 mi | — | 32 | 1 |
| Colfax Health And Rehabilitation Of Cascadia | 21 mi | — | 5 | 0 |
| Clarkston Health And Rehab Of Cascadia | 23.3 mi | — | 0 | 0 |
| Idaho State Veterans Home - Lewiston | 23.6 mi | — | 0 | 0 |
Every risk area ranked, a do-first checklist, and your local survey patterns
Built specifically for Paradise Creek Health And Rehab Of Cascadia.
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 August 2026) and official state health department websites.