| 422 |
MITCHELL COUNTY NURSING HOMES |
115266 |
37 SOUTH ELLIS STREET |
CAMILLA |
GA |
31730 |
2019-09-20 |
658 |
J |
1 |
0 |
5G2B11 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on observations, staff interviews, record review, and review of the Georgia Nurse Practice Act, Facility #2 failed to ensure that accepted standards of clinical practice were followed to ensure that a newly recognized pressure ulcer received follow up care and ensure that treatment was provided timely for one of 12 (R#1) residents reviewed for pressure ulcers. On (MONTH) 17, 2019 a determination was made that a situation in which the facility's noncompliance with one or more requirements of participation had caused or had the likelihood to cause serious injury, harm, impairment or death to residents. The facility's Administrator and Director of Nursing for both Facility #1 and Facility #2, and the System Administrator were informed of the Immediate Jeopardy on (MONTH) 17, 2019 at 2:51 p.m. The noncompliance related to the Immediate Jeopardy was identified to have existed on (MONTH) 1, 2019. The Immediate Jeopardy is outlined as follows: During the complaint investigation it was identified that R#1, which resided in Facility #2, was identified as having an open area to her sacrum on (MONTH) 1, 2019; however, treatment was not provided for this wound until (MONTH) 10, 2019. The Physician was not notified of the wound until (MONTH) 24, 2019. The Physician ordered for R#1 to have a wound consultation on (MONTH) 27, 2019. R#1 was seen at the Wound Clinic on (MONTH) 12, 2019, at which time it was observed that the wound was infected, and the resident's wound treatment was changed to Dakin's solution. On (MONTH) 15, 2019, R#1 was sent to the hospital and was admitted to the hospital. The resident's primary admitting [DIAGNOSES REDACTED]. R#1 had to have a central line placed to receive antibiotic treatment. In addition, on (MONTH) 17, 2019, R#1 had to undergo surgical debridement of the Stage IV pressure ulcer on her sacrum and the resident had to have surgery to have a diverting loop [MEDICAL CONDITION]. The Immediate Jeopardy was related to the facility's noncompliance with the program requirements at 42 C.F.R. F580 -- S/S: J -- 483.10(g)(14)(i)-(iv)(15) -- Notify Of Changes (injury/decline/room, Etc.); F657 -- S/S: J -- 483.21(b)(2)(i)-(iii) -- Care Plan Timing And Revision; F658 -- S/S: J -- 483.21(b)(3)(i) -- Services Provided Meet Professional Standards; F686 -- S/S: J -- 483.25(b)(1)(i)(ii) -- Treatment/svcs To Prevent/heal Pressure Ulcer; F867 -- S/S: J -- 483.75(g)(2)(ii) -- Qapi/qaa Improvement Activities Additionally, Substandard Quality of Care was identified with the requirements at F686 -- S/S: J -- 483.25(b)(1)(i)(ii) -- Treatment/svcs To Prevent/heal Pressure Ulcers. At the time of exit on (MONTH) 20, 2019, an acceptable Immediate Jeopardy Removal Plan had not been accepted therefore the Immediate Jeopardy remains ongoing. Findings include: Review of the Rules and Regulations of the State of Georgia, Rule 410-10-.01 Standards of Practice for Registered Professional Nurse addressed Rule 410-10-.01 (1) The Georgia Board of Nursing defines the minimal standards of acceptable and prevailing nursing practice as including, but not limited to the following enumerated standards of competent practice. (2) The Board recognizes that assessment, nursing diagnosis, planning, intervention, evaluation, teaching, and supervision are the major responsibilities of the registered nurse in the practice of nursing. The Standards of Practice for Registered Professional Nurses delineate the quality of nursing care which a patient/client should receive regardless of whether it is provided solely by a registered nurse in collaboration with other licensed or unlicensed personnel. The Standards are based on the premise that the registered nurse is responsible for and accountable to the patient/client for the quality of nursing care rendered. The Standards of Practice for Registered Professional Nurses shall establish a baseline for quality nursing care; be derived from the Georgia Nurse Practice Act; apply to the registered nurse [MEDICATION NAME] in any setting; and, govern the practice of the licensee at all levels of competency. (a) Standards related to the registered nurse's responsibility to apply the nursing process (adapted from American Nurses Association Code for Nurses and Standards of Practice). The registered nurse shall: 1. Assess the patient/client in a systematic, organized manner; 2. Formulate a nursing [DIAGNOSES REDACTED]. systematic and continuous manner); 3. Plan care which includes goals and prioritized nursing approaches, or measures derived from the nursing diagnoses; 4. Implement strategies to provide for patient/client participation in health promotion, maintenance and restoration; 5. Initiate nursing actions to assist the patient/client to maximize her/his health capabilities; 6. Evaluate with the patient/client the status of goal achievement as a basis for reassessment, reordering of priorities, new goal-setting and revision of the plan of nursing care; 7. Seek educational resources and create learning experiences to enhance and maintain current knowledge and skills appropriate to her/his area of practice. (b) Standards related to the registered nurse's responsibilities as a member of the nursing profession. The registered nurse shall: 3. Communicate, collaborate and function with other members of the health team to provide optimum care. 410-10-.03 Definition of Unprofessional Conduct (1) Nursing conduct failing to meet standards of acceptable and prevailing nursing practice, which could jeopardize the health, safety, and welfare of the public, shall constitute unprofessional conduct. This conduct shall include, but not be limited to, the following: (2) Practice (a) Using inappropriate or unsafe judgement, technical skill, or interpersonal behaviors in providing nursing care; (3) Documentation (a) Failing to maintain a patient record that accurately reflects the nursing assessment, care, treatment, and other nursing services provided to the patient. Review of the undated Standards of Performance Clinical Coordinator - PPNH (Pelham Parkway Nursing Home - effective for Facility #1 and Faciltiy #2) documents that this position requires the following: skill the ability to establish and maintain effective working relation and administrative and medical personnel, employees, the public and other agencies. Must be able to multi-task and meet deadlines and be organized and dependable to monitor and follow through on due dates. Must be highly accountable. Review of the undated Standards of Performance Registered Nurse (PPNH) effective for Facility #1 and Facility #2 revealed the position require the following: skill must possess leadership and supervisory skills and be able to plan, organize, develop, implement and interpret the programs, goals, objectives, policies and procedures that are necessary to providing high quality care. Long Term Care Nurse Core Demonstrate effective clinical skills and utilize the nursing process in planning or providing care for residents of all ages. Review of the 7-3 Assignment Sheet, for Facility #2, dated 6/1/19 through 6/2/19 revealed that Registed Nurse (RN) PP was listed as the RN weekend supervisor and the on call nurse). Review of the Body Check documentation which is completed by the Certified Nurse Aide (CNA) staff dated 5/1/19 through 6/15/19 revealed that on 6/1/19 an entry was documented that R#1 had an abnormal body check for her sacrum. The CNA documented that this finding was reported to a License Practical Nurse (LPN). Further investigation revealed that, due to staff shortage for that shift, that RN PP worked this date as a CNA and performed CNA duties. During an interview on 9/16/19 at 9:36 a.m. with Registered Nurse (RN) PP revealed that on 6/1/19 she worked as a Certified Nursing Assistant (CNA) that day and that she was providing care for R#1, when she saw what looked like an intertriginous lesion, located in the crack of the resident buttocks midway up from the resident's rectum. RN PP described the area as missing skin and looked raw. RN PP stated that she reported this open area to LPN QQ. RN PP stated that normally, she would have informed the treatment nurse but that she could not recall for sure if she had informed the treatment nurse of the skin impairment but that she did tell Licensued Practical Nurse (LPN QQ). Continued interview with RN PP revealed that RN PP emphasized that she worked as a CNA that day, and that it was not her job that day to address the wound, but it was the responsibility of the nurse assigned to the resident to ensure that the opened area was followed up on. A subsequent interview on 9/19/19 at 3:04 p.m. with RN PP revealed that, in addition to working as a CNA, she was the RN supervisor for that weekend, and it was not her job to address the wound, because she had reported the findings to LPN QQ. A subsequent interview on 9/20/19 at 10:05 a.m. with RN PP revealed that the nurse on the hall, should have looked at the wound on R#1's sacrum, taken a picture of the wound, called the family and the doctor. RN PP stated that the Charge Nurse should have followed-up and made sure that this was done. RN PP stated again that she had worked as a CNA and that she reported the wound to the Charge Nurse assigned to that hall. During an interview on 9/20/19 at 10:07 a.m. with the Director of Nursing (DON) revealed that what should have happened, was once the wound was found, a photo should have been taken, the Physician and Family should have been informed, the wound protocol order or physician order [REDACTED]. |
2020-09-01 |