COLLEGE PLACE -- The state Department of Social and Health Services has issued a citation for a city nursing home, and two administrators have lost their jobs as a result.
Regency at the Park was found to have caused harm to a resident through incidents beginning in late summer.
The facility failed to ensure the resident's right to be protected from mental and physical abuse, state officials said. The woman, admitted to Regency in 2000, was coerced into complying with the nursing home's practices and suffered mental anguish as a result, officials said.
The facility's parent corporation, Regency Pacific Inc., fired the administrators from the skilled nursing facility on Myra Road because of the state's findings, state and Regency parent company officials said.
Regency at the Park's administrator, Larry White, and Mary Coates, director of nursing services, were fired Sept. 21. Neither could be reached for comment.
A plan to correct the problems has been put into place at Regency at the Park, as well, officials said.
According David Moon, regional administrator of Aging & Disability Services Administration, a survey team discovered the problems traced back to early June, when the resident began refusing to shower and change out of soiled clothing.
The woman had been assessed June 23 with short- and long-term memory impairments, poor decision-making abilities and as resistant to care. Her body odor "had become very offensive," the report stated.
On July 24, Regency's administration took away the woman's smoking privileges as a penalty for refusing to shower or change her clothing. She was told that she would not get her cigarettes until she complied and being allowed to smoke was a courtesy that had been extended in the past.
She was also told White would no longer allow cigarettes to be purchased with the resident's money, due to the hygiene issue.
When the resident continued to decline to shower, White pushed the resident in her wheelchair to the bathing area and ordered Coates to have two aides shower the resident that day, the state found.
The woman incurred superficial injuries from her struggle then and during two more compulsory showers in August.
Forcing someone to shower against their will is considered abuse, noted Kathy Stevenson of the Eastern Washington regional state ombudsman program for long-term care. Care facility residents are in their home, she said, and staff is "working for them."
Actions from the administration should have been recognized and investigated as abuse and reported to the state. There is no documentation the facility's social service staff had advocated for the resident in an effort to protect her or tried alternative measures to get the woman to cooperate, the report said.
State officials also found that Regency had failed to adequately supervise this same resident when she was smoking. The woman entered the nursing home before it was a smoke-free building and had a legal right to continue to smoke, in order to accommodate her needs.
She had been allowed to smoke independently in a designated area outside. "In a lot of these buildings, they have smoking areas for employees. You can't say you have it for one and not the other," Moon said.
After the July 24 shower incident, the nursing home's maintenance staff removed ashtrays from the resident smoking area.
The woman was seen by staff asking others for cigarettes and smoking after her cigarettes were curtailed by administration. However, no follow up was documented to determine how she was getting the cigarettes or where she was disposing of them, despite information showing her to have problems with memory and in making decisions.
On Aug. 29, a fire started in the only trash can in the area where the woman smoked, putting all residents in potential harm. Investigation showed that a smoking assessment -- scheduled for every three months upon her admission to the nursing home -- had not been done since May 2008.
The woman expressed anger and the opinion she had been lied to, staff told state investigators.
Regency at the Park should have used medically related social services to help resolve the issues, but failed to do so, the state report said. Doing so would have promoted dignity and failure to pursue that option added to the resident's abuse and anguish. The administration also did not devise a plan to help with the patient's objections to self care or to cope with the abuse by staff and loss of smoking privileges, the investigation by DSHS noted.
Corrective action ordered by Moon's department include:
In an official response, Dell Workman, regional director of operations for Regency Pacific, noted the corporation started in the Walla Walla area 32 years ago and there is a strong investment in the community.
"We took swift, corrective action related to the issued cited by DSHS, Workman said. "We were found to be in substantial compliance when the department re-surveyed (Walla Walla) last month.
"This was just a very unfortunate event."