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The next survey window likely opens around January 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 North Valley Hospital during CMS and state inspections, most recent first.
A resident with atrial fibrillation was receiving Eliquis daily and was later started on Naproxen 250 mg BID for pain, ordered by the MD as a two-week short course. The RCM entered the Naproxen order into the MAR without an end date, and the medication continued to be administered BID until the resident was discharged. Staff later identified extensive bruising to the resident’s inner thighs, buttocks, and perineal area, and the DON acknowledged that the ongoing concurrent use of Eliquis and Naproxen, despite the intended time-limited order, could have contributed to the bruising.
Improper Hand Hygiene During Meal Service: Two dietary staff were observed preparing lunch without performing hand hygiene when changing gloves or after touching non-food surfaces. A Dietary Aide plated food, opened the heated food cart and cooler doors, and resumed plating with the same gloves, while a Cook handled cheesecake, touched the cooler handle, removed items, and continued food prep without hand hygiene during glove changes. The RD stated staff were expected to wash hands or use hand sanitizer with every glove change and change gloves after touching other surfaces.
A resident with Parkinson’s disease was prescribed Carbidopa-Levodopa, and pharmacy review noted it was being given during flexible med times instead of at specific times. The MAR showed the medication continued on flexible timing for months, with no documentation that the MD was informed of the pharmacy recommendation until the administration time was later changed.
The facility failed to adhere to food safety standards, with expired and undated food items found in storage areas. Staff transported uncovered food without proper hand hygiene, and food temperatures were not consistently monitored. These actions were acknowledged by staff, highlighting risks of food-borne illnesses.
The facility did not repair damaged paint and drywall from a water leak over a year ago, leaving large sections of puffed-up paint and sagging drywall near dining rooms. Additionally, hazardous chemicals were found unsecured in a shower room, posing a risk to residents. Staff interviews confirmed the need for timely repairs and securing of chemicals.
The facility failed to conduct required Level II PASRR evaluations for two residents with serious mental illness indicators. One resident was prescribed antipsychotic and antidepressant medications for hallucinations and depression, while another had severe cognitive impairment and depression. Despite these conditions, no referrals for Level II evaluations were made, as acknowledged by the Social Service Director.
The facility failed to maintain standard precautions and proper hand hygiene during medication administration. An LPN did not perform hand hygiene before entering a resident's room and administered medications without cleansing hands. Another instance involved a nurse administering an insulin injection without cleansing the site or wearing gloves. Staff interviews confirmed these actions violated infection prevention policies.
A facility failed to accurately document a resident's dental status in the MDS, despite the resident having severe cognitive impairment and being dependent on staff for oral hygiene. Observations showed poor dental condition, which was not reflected in the MDS, as confirmed by the DON and Resident Care Manager.
A resident with Alzheimer's and dementia experienced a decline in physical abilities, requiring total assistance for ADLs and a mechanical lift for transfers. Despite these changes, the facility failed to conduct a significant change assessment or update the care plan, as confirmed by staff observations and interviews.
A facility failed to develop a comprehensive care plan for a resident's dental needs, despite the resident's dependency on staff for oral hygiene and a diagnosis of periodontal disease. The care plan lacked documentation of the resident's dentation status, and staff interviews confirmed the oversight.
A resident with impaired vision required assistance with ADLs, including personal hygiene. Despite needing supervision, the resident's nails were observed to be unclean with a brown substance, as staff failed to clean under the nails after meals. Interviews with staff confirmed that nail care was not consistently provided after meals, which is crucial to prevent bacteria. The DON acknowledged the importance of this practice.
A facility failed to adequately monitor a resident's use of psychotropic medications, leading to unnecessary drug administration. The resident, with diagnoses including dementia and bipolar disorder, was on antidepressant and antipsychotic medications. Despite policy requirements, there was insufficient documentation of behaviors or symptoms of depression. Medication adjustments were made without proper documentation, and staff acknowledged the lack of detailed behavior records.
A resident with severe cognitive impairment and diagnosed with periodontal disease did not receive necessary dental care due to the facility's failure to follow up on a provider's referral for a dental evaluation. Despite being dependent on staff for oral hygiene, the resident had not been seen by a dentist since admission, leading to poor oral health conditions observed by surveyors.
The facility failed to maintain the stove hood in a safe and clean condition, with a section falling and grease buildup observed. The Dietary Manager was unaware of the issue until the surveyor's observation, and maintenance was only notified afterward. The stove hood was previously cleaned quarterly but had shifted to twice a year, and the issue might have occurred during the last cleaning.
Failure to Discontinue Naproxen Ordered as Short Course in Resident on Eliquis
Penalty
Summary
The facility failed to ensure a resident’s drug regimen was free from unnecessary drugs when an anti-inflammatory medication, Naproxen, ordered for a limited duration, was entered and administered without an end date while the resident was also receiving the anticoagulant Eliquis. The resident had been admitted with atrial fibrillation and was taking Eliquis daily to reduce the risk of stroke or heart attack. On 12/02/2025, the physician documented that the resident had knee and shoulder pain and could start Naproxen 250 mg twice daily for two weeks, as a short course if renal and gastrointestinal status allowed. The resident care manager (Staff B) reviewed this note and entered the Naproxen order into the MAR on the same date but omitted the two-week stop date, resulting in an open-ended order. The MAR showed that Eliquis was ordered once daily to continue until discharge, and Naproxen, entered on 12/02/2025 without an end date, was administered twice daily through the resident’s discharge on 02/25/2026. On 02/23/2026, staff identified significant dark blue/purple bruising on the resident’s inner thighs, buttocks, and perineal region, which was documented in a skin check and subsequent skin assessment with measurements of multiple bruised areas. During interviews, Staff B confirmed they had entered the Naproxen order without an end date despite the physician’s two-week limitation and could not recall why the end date was omitted. The DON (Staff A) confirmed the resident had been on Eliquis since admission and that Naproxen, intended as a two-week course, continued until discharge, and stated that the interaction between Eliquis and Naproxen could have caused the bruising identified on 02/23/2026.
Improper Hand Hygiene During Meal Service
Penalty
Summary
The facility failed to follow food code regulations during lunch meal service by not correctly performing hand hygiene when indicated for 2 of 2 dietary staff observed. On 02/26/2026, Staff D, a Dietary Aide, plated the main dish while wearing gloves, then unlatching and opening the heated food cart door twice and opening the cooler door to remove needed items without changing gloves, washing hands, or using hand sanitizer before resuming food plating with the same gloves. During the same meal service, Staff E, a Cook, plated cheesecake with caramel drizzle and apple topping, then touched the cooler handle, removed items from the cooler, touched the cheesecake to nudge it to the center of the plate, and squeezed the caramel bottle while wearing the same gloves. Staff E changed gloves during food service, but did not perform hand hygiene with the glove changes. Neither Staff D nor Staff E washed their hands at the sink until food service was completed or used hand sanitizer during any glove changes. Staff E stated gloves should be changed after touching anything other than serving utensils, Staff D agreed they should have changed gloves after touching cooler handles, and both stated hand hygiene should have been done whenever gloves were changed. Staff C, Registered Dietician, stated dietary staff were expected to perform hand hygiene with every glove change and change gloves after touching other surfaces during meal preparation.
Delayed Follow-Up on Pharmacy Recommendation for Parkinson’s Medication
Penalty
Summary
The facility failed to ensure that pharmacy recommendations were followed up on for one sampled resident who was reviewed for unnecessary medication. The resident had diagnoses including Parkinson’s disease, a progressive brain disorder that causes problems with movement, balance, and coordination, and was prescribed Carbidopa-Levodopa for symptoms of the disease. A pharmacy consultation report dated 09/29/2025 documented that the resident was receiving Carbidopa-Levodopa during flexible medication times, and recommended that it be administered at specific times instead. Review of the MAR showed that the Carbidopa-Levodopa continued to be given during flexible medication times through October 2025 and November 2025. No documentation was found showing that the physician had been informed of the pharmacy recommendation. A later pharmacy consultation report dated 11/24/2025 repeated the recommendation to change the medication to a specific administration time, and the December 2025 MAR showed the administration time was changed on 12/26/2025, almost three months after the initial recommendation. In interview, the Resident Care Manager stated the facility had identified issues with timely follow-up on pharmacy recommendations.
Food Safety and Sanitation Deficiencies
Penalty
Summary
The facility failed to store food in accordance with professional standards for food service safety, as observed during a tour of the kitchen and storage areas. Expired and undated food items were found in three refrigerators and one dry storage area. Items such as nut mix, trail mix, brown rice, instant mashed potatoes, and toasted seeds were either expired or lacked open or expiration dates. Similarly, the refrigerator and freezer contained undated cheese, grapes, bacon, crescent rolls, and various other food items. Staff I, the Dietary Manager, acknowledged the need for food to be dated for quality and safety. During dining room observations, Staff M, a Dietary Aide, was seen transporting uncovered plates of food across a common hall without removing gloves or performing hand hygiene. This practice was repeated multiple times, and food was not covered during transport, which was acknowledged by Staff N, an LPN, and Staff C, a Resident Care Manager, as a potential risk for bacterial contamination. Staff B, the Director of Nursing, noted that the common hall was considered part of the dining room area, which led to the oversight. The facility also failed to consistently monitor food and equipment temperatures. During a tray line observation, Staff O, a Cook, attempted to serve a chicken breast that did not meet the required temperature of 165 degrees. Cold food items were also found to be above the required temperature of 41 degrees. Additionally, refrigerator and dishwasher temperature logs showed multiple omissions, with no corrective actions documented for out-of-range temperatures. Staff I emphasized the importance of monitoring temperatures to ensure food safety and sanitation.
Facility Fails to Repair Water Damage and Secure Hazardous Chemicals
Penalty
Summary
The facility failed to ensure the timely repair of damaged paint and drywall following a water leak in one of the halls. Observations revealed large sections of puffed-up paint and sagging drywall near the dining rooms, with dried brown discolored drip streaks and bubbled wallpaper. Staff interviews indicated that the damage was a result of a water leak that occurred over a year ago, yet the necessary repairs had not been completed. Staff members, including a Licensed Practical Nurse, a Registered Nurse, and a Maintenance Assistant, were unsure of the duration of the disrepair, but acknowledged the damage and its origins. Additionally, the facility did not secure hazardous chemicals in a shower room, posing a risk to residents. During observations, an unlocked cabinet containing disinfectant cleansers was found in the shower room on the east hall. Staff interviews confirmed that the chemicals should have been locked to prevent potential harm to residents, particularly those who are cognitively impaired. The Director of Nursing acknowledged the importance of securing these chemicals to avoid potential ingestion by residents.
Failure to Conduct Required PASRR Level II Evaluations
Penalty
Summary
The facility failed to ensure that the Level I Preadmission Screening and Resident Review (PASRR) was accurately completed for Resident 6, who was admitted with diagnoses including chronic pain. Despite the initial assessment indicating no serious mental illness, subsequent documentation revealed that Resident 6 was prescribed antipsychotic and antidepressant medications for visual hallucinations and moderate recurrent major depression. The facility did not conduct a Level II PASRR evaluation, which is required when a resident shows signs of serious mental illness. This oversight was evident in the quarterly assessment, which noted Resident 6 felt down, depressed, or hopeless, yet no referral for a Level II evaluation was made. Similarly, Resident 31, who was admitted with depression and a psychotic disorder, was not referred for a Level II PASRR evaluation despite having severe cognitive impairment and experiencing feelings of depression. The facility's Social Service Director acknowledged that no referrals for Level II evaluations had been made in several years, even though the process requires it when a positive Level I PASRR is identified. The Director of Nursing expected staff to follow the appropriate PASRR process, but the lack of referrals indicates a failure in adhering to these requirements.
Infection Control and Hand Hygiene Deficiencies
Penalty
Summary
The facility failed to ensure standard precautions and proper hand hygiene were maintained during medication administration, as observed in two separate instances. In the first instance, an LPN did not perform hand hygiene before entering a resident's room, touched various surfaces, and administered medications without cleansing hands. The LPN only used alcohol-based hand rub upon exiting the room. In the second instance, the same LPN washed hands before applying gloves but failed to change gloves or perform hand hygiene after obtaining a blood sample and before administering an injection. Additionally, a registered nurse administered an insulin injection to another resident without cleansing the injection site with an alcohol wipe and without wearing gloves. Interviews with staff, including the Director of Nursing, confirmed that these actions were against the facility's infection prevention policies, which require hand hygiene before and after resident contact, and the use of gloves and cleansing of injection sites to prevent infection.
Inaccurate MDS Documentation of Resident's Dental Status
Penalty
Summary
The facility failed to ensure the Minimum Data Set (MDS) accurately reflected the status of a resident, specifically regarding their dental condition. Upon admission, the resident was noted to have severe cognitive impairment and was dependent on staff for oral hygiene. However, the admission assessment did not document the status of the resident's own teeth, and the MDS did not accurately reflect the resident's dental status as of the assessment reference date (ARD). This oversight was confirmed by the Director of Nursing and the Resident Care Manager, who acknowledged that the MDS should have accurately reflected the resident's dental condition. Observations and interviews revealed that the resident had a thick layer of white debris along their bottom teeth, missing upper teeth, and jagged discolored front teeth. Staff members, including a Nursing Assistant and a Registered Nurse, were aware of the resident's poor dental condition but did not ensure it was accurately documented in the MDS. The failure to accurately assess and document the resident's dental status placed them at risk of unmet care needs and diminished quality of life.
Failure to Assess Significant Change in Resident's Condition
Penalty
Summary
The facility failed to recognize and assess a significant change in the condition of a resident, identified as Resident 27, who was diagnosed with Alzheimer's disease and dementia with anxiety. Initially, the resident required partial to moderate assistance for eating and substantial to maximum assistance for other activities of daily living (ADLs). However, a later assessment indicated that the resident required substantial to maximum assistance for eating and was totally dependent on staff for ADLs. Despite these changes, a significant change assessment was not completed, and the resident's care plan was not updated to reflect their increased needs. Observations and staff interviews revealed that Resident 27 was being fed by staff and required a mechanical lift for transfers, indicating a decline in their physical abilities. Staff members, including nursing assistants and the Resident Care Manager, acknowledged the resident's increased dependency but did not conduct a significant change assessment. The Director of Nursing admitted that internal audits had identified deficiencies in the comprehensive assessment process, which needed improvement.
Failure to Document and Address Resident's Dental Needs
Penalty
Summary
The facility failed to develop and implement a comprehensive person-centered care plan for a resident, specifically regarding their dentation status and needs. The resident, who was admitted with diagnoses including cancer and muscle wasting, was dependent on staff for oral hygiene. Despite the nursing admission assessment noting the presence of a partial denture and no immediate oral concerns, there was no documentation about the resident's own teeth or their status. The personal hygiene care plan also lacked goals or interventions related to the resident's dentation status. Further review of the resident's medical records revealed that a provider note indicated the resident had periodontal disease and was referred for a dental evaluation, yet this was not reflected in the care plan. Nursing progress notes documented issues with the resident's oral care, such as refusal to remove dentures and difficulty in cleaning food debris. Observations showed poor oral hygiene, with missing and discolored teeth. Interviews with staff confirmed the resident's dependency on staff for oral care and acknowledged the absence of documentation regarding the resident's dental status in the care plan.
Failure to Provide Adequate Grooming and Hygiene
Penalty
Summary
The facility failed to consistently provide grooming for a resident who was cognitively intact but had impaired vision and required assistance with activities of daily living (ADLs), including personal hygiene. According to the resident's care plan, they needed supervision and set-up assistance for ADLs. Despite this, observations and interviews revealed that the resident's nails were unclean with a brown substance underneath them, indicating a lack of proper grooming. The resident, who used their fingers to eat, reported that staff had not cleaned under their nails after meals, which is a necessary practice to prevent bacteria. Interviews with staff confirmed that nail care was typically completed after showers, but it should have also been provided after meals for residents who ate with their fingers. The Director of Nursing acknowledged the importance of this practice to prevent bacterial harboring under nails. The deficiency was identified through observations and interviews conducted over several days, highlighting the facility's failure to adhere to the resident's care plan and ensure proper hygiene practices.
Failure to Monitor Psychotropic Medication Use
Penalty
Summary
The facility failed to ensure that a resident's drug regimen was free from unnecessary medications, specifically psychotropic drugs. Resident 18, who had diagnoses including dementia, depression, bipolar disorder, and PTSD, was administered antidepressant and antipsychotic medications. Despite the facility's policy requiring documentation of behaviors and monitoring of residents on psychotropic medications, there was no documentation of behaviors or signs of depression for Resident 18 from April to July 2024. The resident's antipsychotic medication was decreased on April 30, 2024, without any observed changes in mood or behavior, and further orders were given to decrease the medication slowly due to the resident's stable bipolar disorder. However, on May 16, 2024, the resident reported feeling unmotivated, leading to an increase in both the antipsychotic and antidepressant medications. Despite this, there was no documentation of behaviors or symptoms of depression. The facility's staff, including the Social Service Director and Resident Care Manager, acknowledged that behaviors should have been documented in more detail. The Director of Nursing also confirmed that the resident's behaviors were inadequately documented, which contributed to the deficiency in monitoring and managing the resident's psychotropic medication regimen.
Failure to Provide Dental Services for a Resident
Penalty
Summary
The facility failed to assist a resident, identified as Resident 31, in obtaining necessary dental care, which was required as part of their routine health services. Resident 31, who was admitted with diagnoses including cancer and muscle wasting, was dependent on staff for oral hygiene due to severe cognitive impairment. Despite a provider's note on April 29, 2024, indicating that Resident 31 had periodontal disease and required a dental evaluation and treatment, there was no follow-up or documentation of a dental evaluation being conducted. The provider's order for a dental evaluation was not found in the records, and nursing progress notes from March to November 2024 did not indicate any dental visits or evaluations. Observations made in November 2024 revealed that Resident 31 had a thick layer of white debris along their lower teeth, and some missing and discolored upper teeth. Interviews with staff, including nursing assistants and resident care managers, confirmed that Resident 31 was dependent on staff for oral care and sometimes refused care. However, there was no record of a dental referral being processed, and the resident's representative confirmed that Resident 31 had not been seen by a dentist since admission. The Director of Nursing acknowledged the expectation for staff to follow up on provider referrals, which was not met in this case.
Failure to Maintain Safe and Clean Kitchen Equipment
Penalty
Summary
The facility failed to maintain kitchen equipment in a safe and clean operating condition, specifically concerning the stove hood. During an initial observation, a section of the stove hood was found to be falling, creating a four-inch gap from the hood to the ceiling, and had grease buildup along the edge of the opening. This condition remained unchanged during a second tour of the kitchen. The Dietary Manager, Staff I, acknowledged that the stove hood should have been closed and mentioned that it was previously cleaned quarterly but had shifted to twice a year. Staff I was unaware of the issue until the surveyor's observation and stated that maintenance should have been notified. The Maintenance Assistant, Staff J, confirmed they were only notified about the issue after the surveyor's observation and explained that maintenance requests are typically communicated through a work request line. Staff J speculated that the issue might have occurred during the last cleaning in October.
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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 Tonasket
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| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Regency Omak | 19.8 mi | — | 4 | 0 |
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