cms_GA: 143
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 143 | BROWN HEALTH AND REHABILITATION | 115090 | 545 COOK STREET | ROYSTON | GA | 30662 | 2018-08-09 | 679 | D | 1 | 1 | ST5L11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on observations, interviews, and record reviews, the facility failed to provide an ongoing program of activities for three residents (R) (R #82, R#15, and R#74). The sample size was 34 residents. Findings include: 1. Review of R#82 care plan included one developed on 11/23/16 for psychosocial well-being with Interventions that included involving the resident in 1:1 activities or visits daily and in room visits for social stimulation if resident cannot attend activities. Observation on 8/7/18 at 11:00 a.m., the resident is observed in bed. He has not attended any scheduled activities in the facility. On 8/8/18 at 11:12 a.m., R#82 was observed lying in bed with the room lights on, awake with his eyes open looking at the ceiling. The resident does not have a television or radio on. R#82 observed lying in bed with his eyes open on 8/8/18 at 3:33 p.m. He is looking up at the ceiling. No visitors or 1:1 activities being performed. Record review revealed an Activity Quarterly assessment dated [DATE], that revealed that R#82 participates in two activities each week. The types of activities that the resident participates in are social/sensory activities. For participation level, the Assessment identified that R#82 requires assistance to attend activities. Per the Assessment, information for completion of the Activity Assessment was gathered from care plans, family interview, patient observation, and progress notes. An interview with the Activity Director (AD) on 8/9/18 at 1:33 p.m. revealed that she performs an activity assessment on residents when they are first admitted to the facility and then each quarter. If residents are not able to communicate, she contacts their family and/or friends for information. If the resident has a change in condition, she finds out this information in the morning meeting. She stated that occasionally staff will bring R#82 out of his room for group activities. She stated that she performs 1:1 activities with the R#82 in his room. Activities she performs with the resident are applying lotion to R#82's hands and playing music tapes. The AD stated that the resident really doesn't respond to her working with him, but later said that sometimes the resident will look relaxed while she is interacting with him. The AD provided R#82 Activity Logs for June, July, and (MONTH) of (YEAR). The Activity Logs had documentation for R#82 1:1 music/video activity on 6/13/18 and 1:1 activity on 6/21/18 of soft touch/lotion and music/video. There was no other documentation of R#82 activities on the Activity Logs. The AD stated she was unsure why the Activity Logs were not completed for R#82. She was not sure how often the resident participated in Activities at the facility. 2. Review of R (resident) #15's clinical record revealed that she had [DIAGNOSES REDACTED]. Review of R#15's Quarterly Minimum Data Set ((MDS) dated [DATE] revealed that she had short- and long-term memory problems; severely impaired decision making; did not walk; and was dependent on staff for locomotion on and off the unit. Review of her Annual MDS dated [DATE] revealed the staff assessment for activity preferences included listening to music, doing things with groups of people, and participating in religious activities. Review of R#15's care plan for needs assistance to participate in activities due to cognitive impairment, with an onset date of 5/24/18, revealed interventions that included the following: -Provide one on one interventions to include: music, reading, spiritual support, reminiscence, sensory stimulation. -Provide reminiscing using retained long term memory during activities. -Provide sensory stimulation during activities. -Provide shortened activities to accommodate patient's attention span. Review of R#15's Activity Quarterly assessment dated [DATE] revealed the following: Activity environment preferences: Day room/activity room, indoor, inside center, one to one. Frequency of participation in activities: Participated in 2 activities/week. Types of activities patient participates in: (R#15) participates during devotional on Wednesdays and music relaxation, Activities Department provides 1:1 social visits/sensory. Participation level in activities: Behavior in activities is appropriate, is a passive participant, participates in activities with assistance, requires assistance to attend activities, responsive in one to one visits. Comments about participation level: During church services, (R#15) shows active participation by clapping her hands. During 1:1 and sensory, she will smile, talk, and reach out to hold your hand. Activity care plan considerations: Activities Department will continue to remind, invite and assist resident to church services. AD (Activity Director) will also continue to provide 1:1 social visits and sensory. Observation on 8/6/18 at 11:50 a.m. revealed that R#15 was in a reclining gerichair in her room. Further observation revealed that there was no television, radio, CD (compact disc) player, or any other form of stimulation in the room, and her roommate was not in the room. Observation of the resident's room revealed that it was located on a back hall at the end of the hall, with very little foot traffic outside her room. Continued observation of R#15 at this time revealed that her eyes were open and she was alert, but she had a dull, flat expression on her face. Review of the activity calendar revealed that there was a sing-a-long activity at 11:00 a.m. Observation on 8/6/18 at 12:40 p.m. revealed that R#15 remained in the gerichair in her room. Further observation revealed that the window curtains in her room were pulled and the lighting was very dim, and the roommate was not in the room. No music or other stimulation was observed to be provided. Observation on 8/6/18 at 2:19 p.m. revealed that R#15 was in a reclining gerichair in her room facing the hallway. Further observation revealed that there was no TV in the room and no music playing, and her roommate was not in the room. Observation on 8/7/18 at 9:21 a.m. revealed that a Certified Nursing Assistant (CNA) had just brought R#15 back to her room from the dining room in her gerichair after eating breakfast, and backed the resident into the space between her bed and the closets so that she could not see outside her room. Further observation revealed that her head was hyperextended and she looking either straight up at the ceiling, or at times to the right toward the window. Continued observation revealed that there was no TV in the room and there was no music playing, and the roommate was not in the room. Observation on 8/7/18 at 10:01 a.m. revealed that R#15 was in the gerichair in her room with her eyes open and head turned to the right. Review of the activity calendar revealed that there was a spiritual activity on 8/7/18 at 10:30 a.m. Observation on 8/7/18 at 11:36 a.m. revealed that R#15 had been brought out to dining room [ROOM NUMBER] in her gerichair. Further observation revealed there was only one other resident in the dining room at this time, and there was no activity in progress. Observation on 8/7/18 at 2:52 p.m. revealed that R#15 was in bed in her room with her eyes closed, no music or other stimulation noted. Review of the activity calendar revealed that there was a religious activity scheduled at 10:30 a.m. on 8/8/18. Observation on 8/8/18 at 2:55 p.m. revealed that R#15 was in a gerichair in her room which had been pulled between the dresser and bed so that she would not be able to see out in the hall. Further observation revealed that she was awake and her head was turned toward the window, but the privacy curtain was pulled between the A- and B-beds, so that she would not be able to see outside, the lights were off, and her roommate was not in the room. Observation on 8/9/18 at 9:08 a.m. revealed that R#15 was in a gerichair that had been backed into the space between her bed and the closets, so that she would not be able to see out in the hallway. Further observation revealed that the window curtains were partially open, and there was no TV and no music playing, and her roommate was not in the room. Observation on 8/9/18 at 10:13 a.m. revealed that R#15 remained in the gerichair in her room, was alert, and had pulled the water pitcher off her overbed table and spilled water on herself. Review of the activity calendar revealed that there was a religious activity offered at 10:30 a.m. During interview with the Activity Director on 8/9/18 at 1:02 p.m., she stated that one on one activities were done for residents not brought out of their rooms for socialization and sensory stimulation once a week and sometimes more. She stated during further interview that one on one activities included music, brushing hair, reading, reminiscing, and giving them a lollipop if they could have it. She stated during continued interview that R#15 liked to have her hair brushed, and would get disruptive in group activities at times and curse. During interview with the Activity Assistant on 8/9/18 at 1:52 p.m., she stated that she had done a social visit with R#15 at the beginning of the week, and verified R#15 had not been had not been out of her room for the church services or any other out-of-room activity this week. She further stated that R#15 would watch the activities and at times rub the staff's arm, and that she was not disruptive in activities. She stated during continued interview that the facility had a CD player to play music and a DVD player to display video that could be used for residents in their rooms. Review of R#15's activity participation records revealed the following: -In June, there was no documentation of activity participation from 6/1/18 to 6/10/18, and it was documented that she attended two out-of-room activities each week of the last three weeks. There was no documentation of any one-on-one activities done. -In July, there were no activities documented from 7/1/18 to 7/10/18. It was documented that R#15 attended two group and one one-on-one activity on 7/11/18 to 7/12/18; one group and one one-on-one activity on 7/18/18; four group and one one-on-one activity the week of 7/22/18; and two one-on-ones and one group activity the week of (MONTH) 29th to (MONTH) 5th. 3. Review of R#74's clinical record revealed that she had [DIAGNOSES REDACTED]. Review of R#74's Quarterly MDS dated [DATE] revealed that she had short- and long-term memory problems, and moderately impaired decision making; walking did not occur; and she was dependent on staff for locomotion on and off the unit. Review of her Annual MDS dated [DATE] revealed staff assessment for activity preferences included listening to music, keeping up with the news, and participating in religious activities or practices. Review of R#74's psychosocial care plan with a revised date of 7/31/18 revealed behavior of being withdrawn and talking less, and she indicated activities that she enjoys are fresh air, religious services and her family. Review of the interventions to this care plan revealed to involve resident in activities or provide 1:1 daily, and in room visits for social stimulation if resident cannot attend activities. Review of R#74's Activity Quarterly assessment dated [DATE] revealed the following: Activity environment preferences: Day room/activity room, one to one, outdoor, own room, self-directed. Frequency of participation in activities: Participates in 3-5 activities/week. Types of activities patient participates in: Church services, 1:1 social/sensory, outside for fresh air, self directed such as tv in her room, napping, and visiting with family. Participation level in activities: Behavior in activities is appropriate; is an active participant; participates in activities with assistance; requires assistance to attend activities; responsive in one to one visits. Activity care plan considerations: Continue to provide activities of interest. Observation of R#74 on 8/6/18 at 11:36 a.m. revealed that she was in bed and alert. Further observation revealed that her television was off. Observation on 8/7/18 at 9:52 a.m. revealed that R#74 was alert and in the bed turned toward the window, the window blinds were closed, and her television was off. Review of the activity calendar for 8/7/18 at 10:30 a.m. revealed that there was a religious activity offered. Observation on 8/7/18 at 11:37 a.m. revealed that R#74 was in the bed with her eyes closed. Observation on 8/7/18 at 2:51 p.m. revealed that R#74 was in bed turned toward the door. R#74's television was off but her roommate's television was on and tuned to a football game, and the resident nodded yes when asked if she was watching the football game. Observation on 8/8/18 at 8:20 a.m. revealed that R#74 was in the bed with her eyes open, and her television was off. Further observation revealed that the roommate's radio was on at a low volume. Review of the activity calendar for 8/8/18 at 10:30 a.m. revealed that there was a religious activity offered. During a medication administration observation on 8/8/18 at 11:57 a.m., R#74 was in bed and was able to follow simple directions given her by the nurse. Further observation revealed that her television was off, and her roommate's television was tuned to a sports station. On 8/8/18 at 2:09 p.m., R#74 was observed in bed and alert, and smiled when spoken to. Further observation revealed that her television was off, and the privacy curtain was pulled between the two beds so that she would not have been able to see her roommate's television. Observation on 8/9/18 at 8:00 a.m. revealed that R#74 was in her bed with her eyes closed. Further observation revealed that the window blinds were closed, the privacy curtain between the beds was pulled, both televisions were off, and the roommate's radio was on but only static was heard. Observation on 8/9/18 at 9:10 a.m. revealed that R#74 was in bed and alert, one pair of blinds over the two windows was open, and her television was off. During interview with CNA AA on 8/9/18 at 9:16 a.m., she stated that R#74's television worked, and that she had never seen the resident with a radio or CD player in her room. CNA AA further stated that R#74 was totally dependent on staff for everything, and that the CNAs would assist the activity staff to get residents to activities. CNA AA stated during further interview that she had seen R#74 in a group activity maybe eight or nine times a month, and saw the Activity Director in the resident's room maybe once a week. Observation on 8/9/18 at 10:27 a.m. revealed that R#74 was in the bed with her eyes closed, and her television was off. Further observation revealed that the privacy curtain was pulled between the two beds, and R#74 would not be able to see any activity in the hallway outside her room. Continued observation revealed that there was a religious activity in progress at this time in dining room [ROOM NUMBER]. During interview with the Activity Director on 8/9/18 at 1:02 p.m., she stated that R#74 enjoyed television programs like game shows, and liked getting her hair brushed. She stated during further interview that she did not remember the last time that R#74's television was on. She further stated that R#74 would often refuse to come out of her room to an activity, and would nod her head yes or no when she was invited. Review of R#74's psychosocial/activity care plan revealed that there was no mention that she refused out of room activities. During interview with the Activity Assistant on 8/9/18 at 1:52 p.m., she stated that R#74 liked to have her nails painted, but refused when offered on 8/7/18. She further stated that she did not know why R#74's television had not been on, could not remember the last time it was on, and that the resident liked to watch television. Review of R#74's activity participation records revealed documentation that she attended the following activities: The only activities documented as given from 6/1/18 to 6/13/18 was a Move and Groove activity and nail care. From 6/15/18 to 6/30/18 there was documentation that the resident attended a total of seven activities. In July, there were only five activities documented for the entire month. From 8/1/18 to 8/7/18, only one one-on-one activity was documented. Review of the facility's Activities Comprehensive Program policy reviewed (MONTH) (YEAR) revealed: It is the intent of this center to provide an ongoing program of activities that is designed to meet the needs of each patient. The program should be periodically evaluated to promote that it still meets the needs and desires of the patient population. This center's activity program is designed to meet the interests and the physical, mental, and psychosocial well-being of each patient. | 2020-09-01 |