cms_GA: 10032
Data source: Big Local News · About: big-local-datasette
rowid | facility_name | facility_id | address | city | state | zip | inspection_date | deficiency_tag | scope_severity | complaint | standard | eventid | inspection_text | filedate |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
10032 | GATEWAY HEALTH AND REHAB | 115560 | 3201 WESTMORELAND ROAD | CLEVELAND | GA | 30528 | 2011-11-03 | 328 | D | 1 | 0 | EL2111 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, Emergency Medical Services document review, and family interview, the facility failed to clarify the respiratory care needs, related to oxygen administration, for one (1) resident ("A"), who was a new admission to the facility, from a survey sample of four (4) residents. Findings include: Record review for Resident "A" revealed a Skilled Nursing Progress Note of 08/12/2011 at 4:30 p.m. which documented the resident's admission to the facility, having been transported via ambulance. This Note documented that at the time of admission, the resident's oxygen saturation level was ninety-two (92) percent. The resident's admission physician's orders [REDACTED]. The admission orders [REDACTED]. Review of the admission Skilled Nursing Note of 08/12/2011 at 4:30 p.m. documented the respiratory concern that the resident needed oxygen per cannula as-needed. However, as indicated above, there was no admission order for oxygen administration, and there was no evidence to indicate that nursing staff made an attempt to clarify if the resident needed oxygen on an as-needed basis or on a continuous basis. A Skilled Nursing Progress Notes entry of 08/12/2011 at 6:30 p.m., two hours after the resident's admission to the facility, documented that a family member of Resident "A" came to the facility and informed facility staff that the resident had been on oxygen for the past five years, and documented that oxygen was started at that time at the family's request. This Note also documented that the family member called Emergency Medical Services (EMS) at that time. A Telephone Orders sheet of 08/12/2011 at 6:45 p.m. specified a physician's orders [REDACTED]. The Emergency Medical Services Prehospital Care Report dated 08/12/2011 documented that upon arrival at the nursing facility, at 18:35 p.m. the resident's oxygen saturation was documented at eighty (80) percent and that the resident was placed on oxygen at 3 liters per minute, and then increased to four (4) Liters per minute at that time. The resident was transferred back to the hospital at that time. During an interview with the family member of Resident "A" conducted on 11/03/2011 at 9:30 a.m., this family member stated that the resident had been on continuous home oxygen for years due to [MEDICAL CONDITION] and [MEDICAL CONDITION]. | 2015-03-01 |