Not rated by CMS — ratings are suppressed for new or low-volume facilities.
A standard survey is most likely before around December 2026
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 Josephine Caring Community during CMS and state inspections, most recent first.
The facility failed to honor resident bathing preferences and schedules for three residents whose care plans specified twice-weekly showers. One resident with post-stroke hemiplegia and moderate cognitive impairment had documented gaps of up to ten days between showers, with no record of re-offering a shower after a refusal and repeated observations of disheveled appearance. Another cognitively intact resident dependent on staff for showers reported preferring two showers per week but stated they barely received one weekly, with documentation showing extended intervals between showers. A third resident who required substantial assistance for bathing reported going eight days without a shower and being told by family they smelled of urine, despite a care plan for twice-weekly showers. Staff interviews confirmed that bathing preferences were obtained and documented, and that NACs were expected to chart showers and refusals in the EMR, but actual practice did not consistently follow these preferences.
Two residents did not receive appropriate care related to skin treatment, positioning, and meal assistance. One resident with Parkinson’s disease, ataxia, and dermatitis had a painful rash on the feet and toes; staff applied Triamcinolone ointment for months without cleaning the feet beforehand, and the order lacked a defined application site and end date, with no documented monitoring of the skin condition on the MAR or TAR. Another resident with stroke-related hemiplegia, existing PIs on the ankle and heel, and documented need for substantial/maximal assistance and heel-floating was repeatedly observed in bed with heels and an injured ankle resting directly on the mattress and in poor alignment. The same resident, who required supervision or touching assistance with meals, was observed multiple times with an untouched lunch tray and no staff present to assist, despite staff stating they rely on Kardex and nurse communication to guide individualized care.
A resident experienced a significant weight loss due to the facility's failure to accurately obtain and monitor weights, recognize weight loss, and provide necessary assistance during meals. The resident, with a history of malnutrition and advanced dementia, was often left without support during meals, leading to inadequate nutritional intake. Staff inconsistencies in recording and reviewing weights contributed to the oversight of the resident's declining health.
The facility was observed serving uncovered cold foods, including fruit cups and desserts, across multiple units, leading to unsanitary food service practices. The Dietary Manager confirmed that dessert bowls and small cups of condiments were not covered, contributing to the deficiency.
The facility failed to maintain complete and accurate medical records for several residents, including missing weights, shower documentation, and consents for restraints. Additionally, consultant provider notes for wound care and podiatry were not included in the records. Staff interviews revealed issues with documentation processes, leading to delays and omissions in the residents' medical records.
The facility failed to create comprehensive care plans for residents with specific medical needs, including congestive heart failure, hypertension, stroke-related conditions, dementia, dysphagia, and chronic diarrhea. Care plans lacked necessary interventions and guidelines, such as wheelchair positioning and monitoring for weight loss. Staff responsible for updating care plans acknowledged these omissions.
Two residents in an LTC facility did not receive adequate assistance with ADLs. One resident, dependent on staff for bathing, was not offered showers as per their care plan due to staffing shortages. Another resident, requiring assistance with meals, was left unattended, resulting in poor meal consumption. Staff interviews revealed issues with staffing and adherence to care plans.
A resident with severe cognitive impairment and multiple health issues was discharged from physical therapy with a recommendation for restorative nursing services, which were not provided due to a communication breakdown among staff. Despite the resident's willingness to participate in exercises, there was no documentation of restorative care being offered, placing the resident at risk of losing the progress made during therapy.
A resident with severe cognitive impairment was prescribed Quetiapine Fumarate as needed for agitation, but the facility failed to conduct the required 14-day reviews to assess the necessity and rationale for its continued use. Interviews with staff confirmed the absence of documentation for necessary assessments, placing the resident at risk for unnecessary medication use.
Failure to Honor Resident Bathing Preferences and Schedules
Penalty
Summary
The deficiency involves the facility’s failure to honor residents’ stated bathing preferences and schedules, as required for resident choice and self-determination. For Resident 2, who had a history of stroke with right-sided hemiplegia and hemiparesis, the quarterly MDS documented moderate cognitive impairment and dependence on staff for bathing and shower transfers. The resident’s preference care plan indicated a desire for showers twice a week before breakfast. However, v2 documentation showed inconsistent intervals between showers, including gaps of seven, eight, nine, and ten days between showers, and there was no documentation that a shower was re-offered after a refusal on one date. Observations over two days showed the resident repeatedly lying in bed in a hospital gown with disheveled hair. Resident 3, a long-term care resident with no cognitive impairment and dependent on staff for showers, had a care plan preference for two showers per week. Documentation for November and December showed some weeks where the interval between showers extended to six or seven days. In late December, showers were documented on two dates only. In January, the v2 report showed showers on three dates with seven and eight days between some showers. During an interview and observation, the resident, seated in a wheelchair and dressed, stated a preference for twice-weekly showers and reported they “barely get one a week.” Resident 4, also a long-term care resident, had an annual MDS indicating they could make their needs known and required substantial assistance for bathing. Their preference care plan documented a preference for two showers per week. In an interview, the resident reported they were bathed on Tuesdays and Fridays but stated it had been eight days since their last shower. The resident also reported that during a recent doctor’s appointment, a family member told them they smelled like urine, which the resident described as embarrassing, noting their limitations from using a wheelchair. Staff interviews confirmed that resident bathing preferences were obtained on admission and placed on care plans, and that NACs and shower aides were expected to document showers and refusals in the EMR and notify licensed nurses of refusals, but the documented shower frequencies did not consistently align with the residents’ stated preferences.
Failure to Provide Ordered Skin Care, Positioning, and Meal Assistance for Two Residents
Penalty
Summary
The deficiency involves the facility’s failure to provide appropriate skin care and treatment according to physician orders and resident needs for a resident with Parkinson’s disease, cerebellar ataxia, dementia, and muscle weakness. The resident, who had no documented cognitive impairment on a recent MDS, reported to a collateral contact that a rash on their toes and feet had worsened and was painful, and that staff did not clean their feet before applying prescribed ointment. The collateral contact observed the resident’s toes and feet as red, discolored, and with skin breakdown. The resident’s care plan documented chronic dermatitis to the lower extremities and later a fungal rash to both toes, and there was a long-standing order for Triamcinolone 0.1% ointment to be applied twice daily for rash, but the order lacked a specific application site and end date. Review of the MAR and TAR over several months showed no documentation of monitoring the skin condition of the feet/toes or cleaning the skin prior to ointment application. Nursing staff confirmed the ointment was applied to both feet and that the feet had not been cleaned prior to application until a specific date, and the DON acknowledged the order lacked a specific site and end date and could not clearly describe expectations for documenting and monitoring skin issues. The deficiency also involves the facility’s failure to follow care plan interventions for positioning and pressure injury prevention for a resident with a history of stroke, right-sided hemiplegia/hemiparesis, and existing pressure injuries to the right outer ankle and left heel. The resident’s MDS documented moderate cognitive impairment, a need for substantial/maximal assistance with bed mobility, supervision or touching assistance with meals, and risk for pressure ulcers. The care plan directed staff to provide substantial/maximal assistance with two staff for bed mobility and to float the resident’s heels when in bed as they allowed. Multiple observations showed the resident in bed with heels and feet lying directly on the mattress surface, including times when the lower legs were uncovered and when a pillow under the calves still left one heel resting directly on the bed. At another time, the resident was positioned on their side with their torso leaning toward the edge of the bed, knees hanging over the mattress edge, and the right outer ankle lying directly on the mattress. In addition, the facility failed to ensure appropriate assistance with meals for this same resident, who required supervision or touching assistance and only occasional monitoring and cueing after setup. Surveyors observed an untouched lunch tray on the overbed table within reach of the resident on multiple occasions over several hours, with no staff present to assist or supervise. Later observations showed the resident in the same position with the lunch tray still untouched, and when asked, the resident inaccurately reported having eaten lunch. Nursing assistants interviewed described relying on Kardex information in the closet or EMR and communication from licensed nurses or nurse managers for care directions, but the observed lack of meal assistance and positioning did not align with the resident’s documented needs and care plan requirements.
Failure to Monitor and Address Resident's Nutritional Needs
Penalty
Summary
The facility failed to consistently and accurately obtain weights, recognize significant weight loss, and provide consistent assistance with eating and cueing for Resident 33, who was reviewed for nutrition. Resident 33 experienced a significant 14.6% weight loss over a period of approximately six weeks. The facility's policy required weekly weights for new admissions, but there was a discrepancy in the recorded weights, and the facility did not document or address this discrepancy. The initial weight recorded at the facility was 140 lbs., which was inconsistent with the hospital's weight of 114 lbs. prior to admission. This discrepancy was not reviewed or corrected until much later. Observations revealed that Resident 33 was not receiving adequate assistance during meals. On multiple occasions, the resident was left alone with their meal tray, and staff did not provide necessary cueing or encouragement to eat. The resident, who had a history of protein calorie malnutrition, fractured hip, fractured left arm, and advanced dementia, struggled to consume meals independently. The resident's meal intake records showed that they consumed 50% or more of their meals only 31 times out of 137 meals, indicating a lack of adequate nutritional intake. Interviews with staff revealed inconsistencies in the process of obtaining and recording weights. Weights were recorded on worksheets by shower aides, but these were not entered into the electronic medical record or reviewed by nurses. The facility's Director of Nursing and Assistant Director of Nursing were unaware of the weight loss and the inaccuracies in weight documentation. The facility's failure to accurately monitor and address Resident 33's nutritional needs and weight loss was a significant deficiency, as it placed the resident at risk for further decline in health and quality of life.
Unsanitary Food Service Practices
Penalty
Summary
The facility failed to transport and serve food in a sanitary manner across three units: East, West, and North. Observations revealed that trays with uncovered cold foods, such as mandarin oranges, fruit cups with melon, apricots, and desserts like cake with whipped cream, were served to residents. These incidents occurred on multiple occasions, with specific observations noted on July 8th, 9th, 10th, and 15th, 2024. During an interview, the Dietary Manager, identified as Staff T, admitted that dessert bowls and small cups of condiments were not covered, which contributed to the deficiency.
Incomplete and Inaccurate Medical Records in LTC Facility
Penalty
Summary
The facility failed to maintain complete, accurate, and accessible medical records for several residents, leading to potential risks for medical complications and unmet care needs. For Resident 33, the facility did not document weights consistently, with only one weight recorded in the clinical record over a period of time. Similarly, Resident 49's records showed only three showers documented over two months, despite additional showers being noted on handwritten worksheets that were not part of the official medical record. This lack of systematic organization and accessibility of records was acknowledged by the Assistant Director of Nursing, who admitted that the worksheets were not considered part of the medical record. Resident 92's records were incomplete regarding the use of a tilt n space wheelchair, classified as a restraint, as there was no documentation of a Physical Restraint Informed Consent form at the time of the survey. Additionally, there were multiple missing entries for meal tray monitoring, which were supposed to be documented by CNAs. The consent form was eventually found, but it was dated two weeks after the restraint was initiated, indicating a delay in obtaining necessary consents. Staff interviews revealed that the documentation process was not being followed correctly, leading to these omissions. For Residents 78 and 103, the facility failed to include consultant provider notes in their medical records. Resident 78's records lacked documentation from an outside wound clinic, despite the resident attending weekly appointments. Similarly, Resident 103's records did not contain podiatry notes, even though the resident had been seen by a podiatrist for an infection. Staff interviews indicated that documentation was not being scanned into the electronic medical record in a timely manner, with case managers holding onto documents before they were scanned, leading to significant delays in record updates.
Deficiencies in Resident Care Plans
Penalty
Summary
The facility failed to develop and implement comprehensive, person-centered care plans for several residents, leading to deficiencies in meeting their specific needs and preferences. Resident 7, who was admitted with congestive heart failure and hypertension, did not have a care plan addressing these conditions. Staff F, an LPN/Case Manager, confirmed the absence of a care plan for these diagnoses. Similarly, Resident 87, who used a tilt n space wheelchair due to stroke-related conditions, lacked a care plan detailing proper wheelchair positioning. Staff M, responsible for updating the care plan, acknowledged this omission. Resident 92, diagnosed with dementia, dysphagia, and muscle weakness, also used a tilt n space wheelchair and was at risk for weight loss. However, their care plan did not include guidelines for wheelchair positioning or monitoring for weight loss. Staff M admitted that these interventions were missing from the care plan. Additionally, Resident 73, who had been experiencing chronic diarrhea for 17 weeks, did not have a care plan addressing this issue despite a diagnosis of functional diarrhea and a referral to a GI physician. Staff B, the Director of Nursing, indicated that case managers were responsible for care plan updates, yet these deficiencies persisted.
Deficiencies in ADL Assistance for Two Residents
Penalty
Summary
The facility failed to provide adequate assistance with activities of daily living (ADLs) for two residents, leading to deficiencies in care. Resident 10, who was dependent on staff for bathing due to dementia and weakness, did not receive the preferred number of showers per week. Despite having a care plan that required substantial assistance for bathing, the resident was only offered showers five times over a period of six weeks, with no refusals documented. Interviews with staff revealed that the shower aide was often reassigned to other duties due to staffing shortages, resulting in the resident not receiving the necessary care. Resident 33, who required supervision and setup assistance with eating due to advanced dementia and physical impairments, was not provided with the necessary assistance during meals. Documentation showed that the resident consumed less than 50% of their meals in most instances, with only eight meals documented as having received partial or extensive assistance. Observations confirmed that the resident was left unattended during meals, struggling to eat without staff intervention. Interviews with staff indicated a lack of awareness and adherence to the care plan, which required cueing and assistance during meals. The deficiencies in care for both residents were attributed to inadequate staffing and a lack of adherence to established care plans. Staff interviews highlighted issues with staffing call-offs and the reassignment of shower aides, which contributed to the failure to meet the residents' care needs. The facility's policies on providing assistance with ADLs were not consistently followed, resulting in unmet care needs and a diminished quality of life for the affected residents.
Failure to Provide Restorative Nursing Services
Penalty
Summary
The facility failed to provide appropriate services and assistance to maintain or improve mobility and range of motion for a resident, identified as Resident 107, who was reviewed for the restorative nursing program. The facility's policy on the Restorative Nursing Program, dated 12/27/2023, indicated that residents should receive maintenance and restorative services to maintain and improve their abilities to the highest practicable level. Resident 107, who was admitted with multiple facial fractures, iron deficiency anemia, and essential tremors, was discharged from physical therapy on 06/11/2024 with a recommendation for restorative nursing services to maintain the abilities gained during therapy. However, a review of the resident's clinical record from 06/10/2024 to 07/11/2024 showed no documentation of receiving or refusing such services. Interviews conducted with facility staff revealed a breakdown in communication regarding the recommendation for restorative nursing care. Staff R, a CNA, noted that Resident 107 required more care than appeared necessary, while Staff M, an LPN and Restorative Program Manager, stated they had not received a recommendation for restorative care for the resident. CC1, a Physical Therapy Assistant, confirmed they had recommended restorative services for Resident 107 but acknowledged that the resident was not currently receiving the program. Additionally, Resident 107 expressed willingness to engage in exercises and walking with staff, indicating a missed opportunity to maintain their mobility and range of motion.
Failure to Review PRN Psychotropic Medication
Penalty
Summary
The facility failed to ensure that a resident was free from unnecessary psychotropic medications, specifically regarding the extended use of a PRN anti-psychotic medication without proper assessment and documentation. The resident, who had severe cognitive impairment due to Alzheimer's disease and dementia, was prescribed Quetiapine Fumarate 25 mg every four hours as needed for agitation. This medication was initially prescribed by hospice. However, the facility did not conduct the required 14-day reviews to assess the necessity and rationale for the continued use of this PRN medication, nor was there any documentation of a stop date or duration of use. Interviews with facility staff, including a Registered Nurse/Case Manager and the Director of Nursing Services, revealed that the PRN medication had not been reviewed as required. The staff confirmed the absence of documentation for the necessary assessments and rationale for the medication's continued use. This oversight placed the resident at risk for medication-related complications and receiving unnecessary psychotropic medication, as there was no documented justification for the extended use of the anti-psychotic medication.
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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.
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Nursing homes near Stanwood
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Arlington Health And Rehabilitation | 11.7 mi | — | 16 | 0 |
| Life Care Center Of Mount Vernon | 12.3 mi | — | 9 | 0 |
| Mira Vista Care Center | 12.4 mi | — | 25 | 0 |
| Regency Coupeville Rehab And Nursing Center | 14.4 mi | — | 6 | 0 |
| Marysville Care Center | 15.6 mi | — | 22 | 0 |
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