cms_SC
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31 rows where "inspection_date" is on date 2015-03-05
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Suggested facets: facility_name, facility_id, address, city, zip, deficiency_tag, scope_severity, eventid, filedate, filedate (date)
| Link | rowid ▼ | facility_name | facility_id | address | city | state | zip | inspection_date | deficiency_tag | scope_severity | complaint | standard | eventid | inspection_text | filedate |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 5726 | 5726 | DR RONALD E MCNAIR NURSING & REHABILITATION CENTER | 425309 | 56 GENESIS DRIVE | LAKE CITY | SC | 29560 | 2015-03-05 | 156 | E | 0 | 1 | HFE711 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of the Liability Notices, and interview, the facility failed to use the Center for Medicare and Medicaid (CMS) designated Form CMS NOMNC (Notice of Medicare Non-Coverage) for 3 of 3 liability notices reviewed. In addition, the documented dated of notification was not 48 hours prior to termination of services. The findings included: On [DATE] at 5:10 PM, review of the liability notices provided to residents when medicare services were terminated revealed Form CMS- was provided instead of the CMS- -NOMNC. Form CMS expired [DATE] and was replaced with Form CMS- NOMNC. Resident B's last covered day for Medicare services was [DATE]. The resident was provided a CMS- . The form indicated the resident was notified by telephone on [DATE]. Resident C was discharged home on [DATE] and was provided the Form CMS- . Resident D's last covered day for Medicare services was [DATE]. The resident was provided a CMS- . The form indicated the resident was notified [DATE]. During an interview on [DATE] at 5:10 PM, the Business Office Manager (BOM) confirmed the facility was using Form CMS- and stated s/he was not aware of the Form NOMNC. The BOM also confirmed the expiration date of the form CMS- was listed on the form as [DATE]. The BOM further stated that she notified Resident B on [DATE] and just documented the wrong date. S/he further stated Resident D was notified on [DATE] and signed the form but the form was lost and the responsible party subsequently signed a new form on [DATE]. | 2018-10-01 |
| 5727 | 5727 | DR RONALD E MCNAIR NURSING & REHABILITATION CENTER | 425309 | 56 GENESIS DRIVE | LAKE CITY | SC | 29560 | 2015-03-05 | 167 | B | 0 | 1 | HFE711 | Based on observation and interview, the facility failed to ensure that the results of the most recent surveys of the facility were readily accessible for 2 of 2 nursing units. The findings included: During a Group interview on 3/4/15, 6 of 6 alert and oriented residents stated they did not know where the survey results were located. Following the conclusion of the interview, observation of the location of the survey results revealed the survey was posted, in a clear plastic sheet protector, on a bulletin board in the common hallway between the 2 nursing units. The survey was posted approximately 6 feet from the floor and the top page in the sheet protector was the DHEC (Department of Health and Environmental Control) cover letter. Observation also revealed the survey was posted with 17 additional pamphlets and notices on the bulletin board. In addition. there was a bulletin board directly to the right with 8 notices/pamphlets and one to the left with 9 notices/pamphlets. During an interview at that time, the Nursing Home Administrator (NHA) confirmed the location of the survey results and stated s/he thought it was a good location, at eye level for anyone walking by. The NHA also confirmed that most of the facility's residents were in wheel chairs. When asked if wheel chair bound residents could see or reach the results without asking a staff member for assistance, the NHA stated I see what you mean. | 2018-10-01 |
| 5728 | 5728 | DR RONALD E MCNAIR NURSING & REHABILITATION CENTER | 425309 | 56 GENESIS DRIVE | LAKE CITY | SC | 29560 | 2015-03-05 | 225 | D | 0 | 1 | HFE711 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to report an injury of unknown origin to the Bureau of Certification for Resident #A, 1 of 3 investigative files reviewed for Abuse Prohibitation. The family of Resident #A reported a potential injury to the right arm, which was not reported to the State Agency as required. The findings included: The facility admitted Resident #A with [DIAGNOSES REDACTED]. During review of 3 [MEDICATION NAME] selected on 3-4-15 at approximately 5:45 PM, review conducted revealed 1 incident of Resident #A's right arm being swollen and warm to touch on 11-17-14, reported by the daughter to the staff nurse. Also record review revealed that the daughter stated, While performing range of motion to right arm, she noticed resident had some facial grimacing as if experiencing pain. Review of the report of the incident dated 11-24-14 by the facility was faxed to the Health Licensing Department instead of the correct department of Bureau of Certification. There was no record of a 24 hour reportable or 5 day follow-up investigation to the Bureau of Certification. The review of the investigative file revealed a letter explaining Resident #A had a warm, swollen, right arm with facial grimacing upon motion, documented witness statements by the staff, and a follow-up X-Ray confirming a fracture. Investigation indicated there was no known cause indicating an injury of unknown origin. During an interview on 3-5-15 at approximately 9:30 AM , the Director of Nurses (DON) stated, We considered the incident as an injury of known origin since the daughter found it and reported it to the staff. We felt like we knew what happened to Resident #A since it was identified by the daughter. The daughter identified the swelling and told the nurse. The daughter is very involved in her care and she repeats the care we give Resident #A when she visits. The daughter reported that Resident #A had pain and swelling along with facial grima… | 2018-10-01 |
| 5729 | 5729 | DR RONALD E MCNAIR NURSING & REHABILITATION CENTER | 425309 | 56 GENESIS DRIVE | LAKE CITY | SC | 29560 | 2015-03-05 | 252 | D | 0 | 1 | HFE711 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to allow Resident #6, 1 of 6 residents interviewed regarding personal property, to keep his personal belongings in his room. The facility removed personal items from the resident's bedside table without permission and while the resident was out of the facility. The findings included: The facility admitted Resident #14 with [DIAGNOSES REDACTED]. On 3/4/15 at 3:00 PM, Resident #14 attended the Group Interview conducted as part of the Quality of Life Assessment. Resident #14 stated that the staff had gone through his/her furniture drawers on 3/3/14 and removed his bar of soap, shaving cream, and alcohol. The resident further stated that he/she was out of the facility at the time and the facility did not have permission to go into the drawers or remove the items. The resident stated it made him/her mad and was upset by the incident. Review of a Concern and/or Compliment Referral Form provided by the Social Services Director revealed the resident had filed a grievance on 3/3/15 that alcohol, Listerine, shaving cream and a bar of soap were removed from his room and that the resident did not feel it was right to have personal belongings taken. The report also indicated the resident stated he understood why the items were removed. In addition, the grievance contained a statement by the nurse stated that while the resident was on Leave of Absence (LOA), s/he had found alcohol shaving cream, air freshener, and a bar of soap in the drawer of night stand (and) TV stand and had removed the items. The statement also indicated the nurse told the resident that he/she must ask the nurse on duty to receive the items when needed. During an interview on 3/5/15 at 1:45 PM, the Nursing Home Administrator (NHA) confirmed the resident was out of the facility when the nurse made random room rounds and removed the personal care items from the resident's drawer. The NHA stated the nurse thought the items were a … | 2018-10-01 |
| 5730 | 5730 | DR RONALD E MCNAIR NURSING & REHABILITATION CENTER | 425309 | 56 GENESIS DRIVE | LAKE CITY | SC | 29560 | 2015-03-05 | 272 | E | 0 | 1 | HFE711 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to provide a summary of the clinical data analysis of findings for the CAA(Care Area Assessment) in the MDS(Minimum Data Set) for approximately 5 months for Residents #2, #4, #6, #8, and #9, 5 of 10 sampled residents. The residents failed to have a detailed summary of clinical data analysis of findings under the supporting documentation of each triggered CAA. The findings included: The facility admitted Resident #6 with [DIAGNOSES REDACTED]. Based on record review 3-4-15, Resident #6 did not have a detailed description of the supporting documentation of which CAA has been triggered, and documentation of assessment information in support of clinical decision making relevant to the CAAs. The facility admitted Resident #2 with [DIAGNOSES REDACTED]. On 3/4/15 at 9:10 AM, review of the Minimum Data Set (MDS) CAAs (Care Area Assessments) revealed indicator for each of the Care Areas were checked in the appropriate boxes. Review of the Analysis of Findings revealed there was no documentation of summary information regarding the indicators for the triggered areas necessary for clinical decision making. The facility admitted Resident #4 with [DIAGNOSES REDACTED]. On 3/4/15 at 9:45 AM, review of the 3/1/15 Annual Minimum Data Set (MDS) CAAs (Care Area Assessments) revealed indicators for each of the Care Areas were checked in the appropriate boxes. Review of the Analysis of Findings revealed there was no documentation of summary information regarding the indicators for the triggered areas necessary for clinical decision making. The facility admitted Resident #8 with [DIAGNOSES REDACTED]. On 3/4/15 at 11:18 AM, review of the 10/1/14 Annual Minimum Data Set (MDS) CAAs (Care Area Assessments) revealed indicators for each of the Care Areas were checked in the appropriate boxes. Review of the Analysis of Findings revealed there was no documentation of summary information regarding the indicators for … | 2018-10-01 |
| 5731 | 5731 | DR RONALD E MCNAIR NURSING & REHABILITATION CENTER | 425309 | 56 GENESIS DRIVE | LAKE CITY | SC | 29560 | 2015-03-05 | 278 | D | 0 | 1 | HFE711 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to accurately assess the mental, mood, behavior and/or functional status of Residents # 2, #8 and #9, 3 of 10 residents reviewed for accuracy of assessments. The findings included: The facility admitted Resident #2 with [DIAGNOSES REDACTED]. On 3/4/15 at 9:10 AM, review of the Minimum Data Set (MDS) assessments dated 1/2/15 and 11/2/14 revealed the resident was coded as Sometimes understood. Further review revealed the question Should Brief Interview for Mental Status be Conducted was answered Yes but all questions of the interview were filled with a dash. The Summary Score did not indicate the resident was unable to complete the interview and a staff assessment of mental status was conducted instead on both assessments. In addition, on the 1/2/15 MDS assessment, in Section D for Mood, the question of whether the resident had poor appetite or overeating was completed with a dash and verbal behaviors symptoms in Section E was also completed with a dash. The facility admitted Resident #8 with [DIAGNOSES REDACTED]. On 3/4/15 at 11:18 AM, review of the Minimum Data Set (MDS) assessments dated 10/1/14 and 1/1/15 revealed the resident was coded as independent for eating which includes intake of nourishment by other means on both assessments. The resident was also coded as receiving less than or equal to 25% of total nutrition via the PEG tube which was administered by the nursing staff. The facility admitted Resident #9 with [DIAGNOSES REDACTED]. On 3/4/15 at 10:58 AM, review of the Significant Change in Status Minimum Data Set (MDS) assessments dated 1/14/15 revealed the resident was coded as independent with eating which includes intake of nourishment by other means. The resident was also coded as receiving greater than or equal to 51% of total nutrition via the PEG tube which was administered by the nursing staff. The physicians orders stated the resident was to have nothing by mouth. In … | 2018-10-01 |
| 5732 | 5732 | DR RONALD E MCNAIR NURSING & REHABILITATION CENTER | 425309 | 56 GENESIS DRIVE | LAKE CITY | SC | 29560 | 2015-03-05 | 371 | D | 0 | 1 | HFE711 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations and interviews the facility failed to ensure that expired nutritional supplements were not stored in 1 of 2 medication rooms. There were no residents receiving the nutritional supplements. The findings include: On 3/3/15 at approximately 9:42 AM inspection of the Hall 100 medication room revealed 11 cans of [MEDICATION NAME] 1 CAL by Abbott Nutrition Lot RE 1227, expiration 2/1/15. During an interview on 3/3/15 at approximately 9:48 AM LPN (Licensed Practical Nurse) # 1 and LPN # 2 verified that the [MEDICATION NAME] 1 CAL was expired and LPN # 2 stated that the product should have been removed. During an interview on 3/4/15 at approximately 6:55 AM the Administrator and the Director of Nursing stated that it is the responsibility of the nurse to check for expired products at least two times monthly and to remove any expired product from active storage. | 2018-10-01 |
| 5807 | 5807 | COVENANT PLACE NURSING CENTER | 425402 | 2825 CARTER ROAD | SUMTER | SC | 29150 | 2015-03-05 | 156 | C | 0 | 1 | EZTI11 | Based on review of residents' funds and interview, the facility failed to complete the required Centers for Medicare and Medicaid Services (CMS) -Notice of Medicare Non-Coverage (NOMNC) Form, the Medicare Liability Notices and Beneficiary Appeal Rights, on the correct form for 3 of 3 sampled residents discharged from Medicare A and discharged from the facility. The facility staff completed the CMS- instead of the required CMS- NOMNC for Resident #2, Resident #12 and Resident #42. The findings included: On 03-04-15 at approximately 12:10 PM, review of Resident #2's, Resident #12's and Resident #42's funds revealed the residents were discharged from Medicare A with days remaining and discharged from the facility. Further review of Resident #2's, Resident #12's and Resident #42's funds revealed the facility had completed the Medicare Liability Notices and Beneficiary Appeal Rights on the incorrect form, CMS- , instead of the correct form of CMS- -NOMNC. During an interview on 03-04-15 at approximately 12:10 PM with the Admissions Coordinator, he/she revealed he/she had been unaware of the correct CMS- NOMNC form. | 2018-09-01 |
| 5808 | 5808 | COVENANT PLACE NURSING CENTER | 425402 | 2825 CARTER ROAD | SUMTER | SC | 29150 | 2015-03-05 | 157 | D | 0 | 1 | EZTI11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interview and review of the facility policy titled Change in a Resident's Condition or Status, the facility failed to, notify the resident's physician when the resident had skin breakdown to sacral area for 1 of 3 residents reviewed for nutrition. Resident #41 was noted to have redness on sacral area which began to show signs of skin breakdown. The findings include: The facility admitted Resident #41 with the [DIAGNOSES REDACTED]. Review of Resident #41's medical record on 3/4/15 at approximately 8:45 AM revealed a Nurse's Noted dated 2/15/15 that noted: Resident does appear to be more alert today. Pass suggestions along regarding sitting up in recliner at all times, may need to think about getting a gel cushion if s/he continues to sit up. Sacral area is red and blanchable, resident complains that it is sore. [MEDICATION NAME] applied. Review of Nurses notes dated 2/28/15 revealed: Resident is alert today, with occasional napping. Pass suggestion along regarding sitting up in recliner at all times, may need to get a gel cushion if s/he continues to sit up. Sacral area is beginning to show signs of breakdown, resident complains that it is sore. [MEDICATION NAME] has been being applied, but does not seem to be improving this. Review of the resident's medical record on 3/4/15 at approximately 9:20 AM did not reveal any evidence where the resident's physician had been notified related to the change in the resident's skin condition. Further review of Resident #41 Nurse's Notes revealed an entry dated 3/1/15 that noted Sacral area continues to show signs of breakdown and has improved some with the use of gel cushion, resident complains that it is sore. Area was cleansed, skin prep applied and moisturized with vaseline, [MEDICATION NAME] border applied. Resident states that it feels much better now. Will recommend [MEDICATION NAME] border for protection and possibly [MEDICATION NAME]. Review of the resident's care plan on 3/… | 2018-09-01 |
| 5809 | 5809 | COVENANT PLACE NURSING CENTER | 425402 | 2825 CARTER ROAD | SUMTER | SC | 29150 | 2015-03-05 | 279 | D | 0 | 1 | EZTI11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record reviews, interviews and review of the facility policy titled, Care Planning/Interdisciplinary Team, the facility failed to develop a Comprehensive Plan of Care in a timely manner for Resident #66 related to medications and pain recognition/management. The facility further failed to develop a Comprehensive Plan of Care for Resident #4 related to weight loss and for Resident #23 related to Antidepressants and Hypnotics. (3 of 13 residents reviewed for Comprehensive Care Plans) The findings included: The facility admitted Resident #66 with [DIAGNOSES REDACTED]. Record review on 03-04-15 at approximately 9:15 AM revealed Resident #66's Minimum Data Set (MDS) had been completed on 02-24-15. Further record review on 03-04-15 at approximately 9:15 AM revealed Resident #66's Comprehensive Plan of Care for Medications and Pain Recognition/Management had not been developed. During an interview on 03-05-15 at approximately 9:30 AM with the MDS Coordinator, h/she revealed h/she had delayed the completion of the Comprehensive Plan of Care for Resident #66 due to the Recertification Survey team arrival. The MDS Coordinator further revealed h/she knew the Comprehensive Plan of Care had not been developed in the required specified time frame. Review of the facility policy titled, Care Planning/Interdisciplinary Team, revealed in Policy Interpretation and Implementation the following, 1. A Comprehensive Care Plan for each resident is developed within seven (7) days of completion of the resident assessment (MDS). The facility admitted Resident # 4 with [DIAGNOSES REDACTED]. Review of Resident #4's medical record on 3/4/2015 at approximately 4:44 PM revealed an admission weight of 154 pounds. On 11/26/2014 weight was 145 pounds. On 12/29/2014 weight was 141 pounds and on 1/20/2015 weight was recorded as 141 pounds. No physician orders were found in the medical record for a weight loss program. Review of Resident #4's Comprehensive Plan of Care o… | 2018-09-01 |
| 5810 | 5810 | COVENANT PLACE NURSING CENTER | 425402 | 2825 CARTER ROAD | SUMTER | SC | 29150 | 2015-03-05 | 325 | D | 0 | 1 | EZTI11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interviews, the facility failed to ensure Resident #4 maintained acceptable parameters of nutrition related to a 13 pound weight loss from 11/10/2014 to 1/20/2015 for 1 of 3 residents reviewed for nutrition. The findings included: The facility admitted Resident # 4 with [DIAGNOSES REDACTED]. Review of Resident #4's medical record on 3/4/2015 at approximately 4:44 PM revealed an admission weight of 154 pounds. On 11/26/2014 weight was 145 pounds. On 12/29/2014 weight was 141 pounds and on 1/20/2015 weight was recorded as 141 pounds. No physician orders were found in the medical record for a weight loss program. Review of Resident #4's Comprehensive Plan of Care on 3/4/2015 at approximately 4:55 PM made no mention of the 13 pound weight loss and no interventions to stabilize the weight and to prevent further weight loss for Resident #4. During an interview on 3/4/2015 at approximately 5:15 PM the Care Plan Coordinator, he/she confirmed the weight had not been addressed on the Comprehensive Plan of Care with interventions to stabilize Resident #4's weight and prevent further weight loss. An interview on 3/5/2015 at approximately 1:52 PM with the Certified Dietary Manager, concerning the 13 pound weight loss from 11/10/2014 (154 pounds) to 12/29/2014 (141 pounds), he/she provided a physician's order dated 1/25/2015 to remove the splint from the right ankle and the splint from the left wrist for showering. The dietary manager stated that the removal of the splints was the reason for the 13 pound weight loss even though the splints were not removed until 1/25/2015. | 2018-09-01 |
| 5811 | 5811 | COVENANT PLACE NURSING CENTER | 425402 | 2825 CARTER ROAD | SUMTER | SC | 29150 | 2015-03-05 | 371 | F | 0 | 1 | EZTI11 | Based on observations, record review, interview, review of the facility policy titled Sanitizer Buckets and Documentation of Compliance effective date (MONTH) 26, 2011 and review of the 2013 Food and Drug Administration (FDA) code, the facility had failed to assure that Dietary staff maintained clean kitchen equipment as evident of 2 of 2 hoods with a heavy accumulation of dust and food debris can opener with a build up of metal shavings, dust build up on ceiling vents and ice machine filter had a heavy accumulation of dust. The facility Dietary staff also failed to ensure 2 of 3 sanitizer buckets maintained the appropriate parts-per-million (ppm). The facility's satellite kitchen was observed with a missing shatterproof light cover and multiple Certified Nursing Assistants (CNA's) entering the refrigerator without washing their hands. This was evident for 2 of 2 kitchens observed which has the potential to effect all residents. The findings include: Initial tour of the main kitchen on 3/3/15 at approximately 8:54 AM revealed an observation of 2 sanitizer buckets which utilized a chlorine disinfectant. The surveyor had the Certified Dietary Manager (CDM) test the chlorine solution with the color coded strips which registered 0 ppm. Further observation of the main kitchen noted the can opener with a build up of metal shavings on the blade which was stored in the holder, 2 of 2 ovens were observed with an accumulation of grease and dust and the ice machine's filter was observed with a build up of dust. Observation of the satellite kitchen on 3/3/15 at approximately 11:32 AM, while observing the lunch trayline service, the surveyor had observed multiple CNA's entering the kitchen after assisting residents in the dining room going into the refrigerator and pouring beverages. Further observation of the satellite kitchen revealed a missing shatterproof light covering which was located above the food service area. Observation on 3/3/15 at approximately 12:00 PM revealed CNA's during multiple task in the dining room such… | 2018-09-01 |
| 5812 | 5812 | COVENANT PLACE NURSING CENTER | 425402 | 2825 CARTER ROAD | SUMTER | SC | 29150 | 2015-03-05 | 431 | D | 0 | 1 | EZTI11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and review of the facility policy titled, Storage of Medications, the facility failed to discard expired medication and secure the medication cart when not in use for 1 of 2 medication carts and 1 of 1 medication rooms. The findings included: A random observation of the Long Hall Medication Cart on [DATE] at approximately 12:10 PM revealed the medication cart had been unlocked and unattended for approximately 5 minutes. During an interview on [DATE] at approximately 12:15 PM with Licensed Practical Nurse (LPN) # 1, h/she, after observation of the Long Hall Medication Cart, verified the cart had been left unlocked and unattended. H/she stated, the cart is locked with either the keypad on top of the cart or the actual key. LPN #1 further stated, to be sure the medication cart is locked one needs to pull on the handle. I guess I didn't. During review of Medication Storage in the Medication Room on [DATE] at approximately 5:54 AM, in the presence of the Nursing Supervisor/Unit Manager, observation revealed (1) 1.5 milliliter (ml), 0.05 fluid ounce container of Systane Balance Lubricant Eye Drops, Restorative Formula, Lot # 1F, Alcon Laboratories, had expired as evidenced by an Expiration date of ,[DATE]. During interview on [DATE] at approximately 5:54 AM with the Nursing Supervisor/Unit Manager, h/she revealed the medications are to be checked by all nurses daily for medication expiration dates. Review of the facility policy titled, Storage of Medications, revealed in Policy and Interpretation the following, i.e 4) The facility shall not use discontinued, outdated, or deteriorated drugs or biologicals. All such drugs shall be returned to the dispensing pharmacy or destroyed. Additional review of the Policy and Interpretation revealed the following, i.e 7) Compartments (including, but not limited to, drawers, cabinets, rooms, refrigerators, cart, and boxes) containing drugs and biologicals shall be locked when n… | 2018-09-01 |
| 5813 | 5813 | COVENANT PLACE NURSING CENTER | 425402 | 2825 CARTER ROAD | SUMTER | SC | 29150 | 2015-03-05 | 441 | E | 0 | 1 | EZTI11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews, review of Minimum Data Safety Sheets (MSDS) and review of the facility policy titled, Clostridium Difficile, and Cleaning Isolation Rooms, the facility failed to ensure staff were inserviced on the proper cleaning of infectious isolation areas. Two of 2 housekeeping staff were unaware of the proper cleaning of isolation rooms for residents with Clostridium Difficile. The findings included: During an interview on 3/4/2015 at approximately 9:40 AM with the housekeeping supervisor, he/she stated, when asked about the cleaning of rooms in which the resident had clostridium difficile, we used to clean with Clorox but we stopped when the resident's families complained about the strong smell of Clorox. Review of the MSDS on 3/4/2015 at approximately 4:00 PM for the cleaning agents provided by the housekeeping supervisor included, SC-200, Clean On The Go By Proxy (15), Clean On The Go NABC Concentrate (1) and Clean On The Go Smoke and Odor Eliminator (5). There was no mention on any of these MSDS that indicated that these cleaning agents would kill clostridium difficile spores. An interview on 3/5/2015 at approximately 8:35 AM with a housekeeping worker revealed, that he/she did not know that cleaning a room in which the resident had been diagnosed with [REDACTED]. He/she was not aware of the cleaning of the room with a 1:10 dilution of bleach. During an interview on 3/5/2015 approximately 11:41 AM with the Director of Nursing, Infection Control Coordinator, he/she stated that he/she was not aware of the fact that housekeeping staff were not using the 1:10 bleach solution. Review on 3/5/2015 at approximately 12:00 Noon of the facility policy titled, Clostridium Difficile, under, Policy Interpretation and Implementation, #8 reads, A 1:10 dilution of bleach and water will be used for routine environmental disinfection of rooms for residents with Clostridium Difficile. No inservices or inservice attendance sheets were provided by th… | 2018-09-01 |
| 5814 | 5814 | COVENANT PLACE NURSING CENTER | 425402 | 2825 CARTER ROAD | SUMTER | SC | 29150 | 2015-03-05 | 514 | D | 0 | 1 | EZTI11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interviews and review of the facility policy titled Discharge Summary and Plan, the facility failed to ensure medical records were complete and accurately documented for 3 of 9 resident's medical records reviewed. Resident #23 for conflicting [DIAGNOSES REDACTED].#50 no physician's order for Occupational Therapy and the facility had failed to document a complete recapitulation of stay at the time of discharge. The findings included: The facility admitted Resident #23 with [DIAGNOSES REDACTED]. Review on 3/4/2015 at approximately 9:53 AM of Resident #23's Comprehensive Plan of Care revealed on mention of the [DIAGNOSES REDACTED]. The comprehensive plan of care did not mention interventions for Depression, Anxiety and [MEDICAL CONDITION] or the use of [MEDICATION NAME] or Ambien. An interview on 3/4/2015 at approximately 11:00 AM with the MDS (Minimum Data Set)/Care Plan Coordinator, he she stated, the medical record is confusing, and confirmed the [DIAGNOSES REDACTED].#23 was receiving them. Review of the Medication Administration Record [REDACTED]. No mention of the depression or the anxiety. Review of the Physicians Progress notes on 3/4/2015 at approximately 11:40 AM states, [MEDICATION NAME] added for poor appetite, depression and anxiety. Further review of the medical record for resident #23 on 3/4/2015 at approximately 11:45 AM revealed behavior monitoring sheets for Depression and Anxiety with no behaviors documented. During an interview on 3/4/2015 at approximately 11:45 AM with Registered Nurse (RN) #1 he/she could not find on the MAR indicated [REDACTED]. The facility admitted Resident #75 with [DIAGNOSES REDACTED]. Record review on 03-04-15 at approximately 6:45 AM of the Hospital History and Physical dated 02-08-15 revealed Resident #75 had received [MEDICAL TREATMENT] in the hospital. Record review on 03-04-15 at approximately 6:45 AM of the Discharge Order Medication Profile dated 02-18-15 for Resident #75… | 2018-09-01 |
| 5871 | 5871 | GOLDEN AGE - INMAN | 425316 | 82 N MAIN STREET | INMAN | SC | 29349 | 2015-03-05 | 155 | D | 0 | 1 | YNC111 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interviews, review of the facility policy entitled Advance Directives, and review of the South Carolina Adult Healthcare Consent Act, the facility failed to ensure that 1 of 15 sampled residents reviewed had the opportunity to develop their own advance directive. There was no documentation in the record to indicate Resident #23 desired a Do Not Resuscitate DNR status. An Emergency Medical Services EMS order for DNR was signed by the resident's Responsible Party. Two physicians had not determined that Resident #23 was unable to make his/her own healthcare decisions. The findings included: The facility admitted Resident #23 with [DIAGNOSES REDACTED]. Record review on 3/4/15 at 3:18 PM revealed current Physician's Orders for a DNR code status for Resident #23. Further review revealed a Physician's Telephone Order dated 8/13/13 stating Res(ident) is DNR since 8-8-13. A Progress Note Addressing Decisional Capacity dated 8/15/13 revealed one physician had signed that the resident was not able to make healthcare decisions for him/herself. A Nurse Practitioner's Progress Note dated 7/31/13 documented This patient lacks decision-making capacity. There was no documentation noted that a second physician had certified that the resident lacked decisional capacity. There was nothing noted in the record to indicate that facility staff had spoken with the resident about his/her code status and that a DNR status was what the resident desired. There was nothing noted in the record to indicate the resident was on hospice. During an interview on 3/4/15 at 3:40 PM, the Director of Nursing (DON) reviewed the documentation in the medical record and verified there was no evidence that 2 physicians had determined that Resident #23 was unable to make his/her own healthcare decisions. The DON stated s/he would check the thinned records to see if additional documentation could be found. During an interview on 3/5/15 at 11:27 AM, the Social Servic… | 2018-08-01 |
| 5872 | 5872 | GOLDEN AGE - INMAN | 425316 | 82 N MAIN STREET | INMAN | SC | 29349 | 2015-03-05 | 279 | D | 0 | 1 | YNC111 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to develop a care plan related to the use and monitoring of psychoactive medications for 1 of 5 sampled residents reviewed for unnecessary medications. Resident #24 was receiving multiple psychoactive medications but had no care plan related to their use, monitoring, or managing of risk factors. Also, based on observations, record review, and interviews, the facility failed to develop a behavioral care plan for 1 of 2 sampled residents reviewed for respiratory care. Resident #30 was observed multiple times with no oxygen on or with 2 liters of oxygen infusing when physician's orders [REDACTED]. The Comprehensive Care Plan for Resident #30 did not include behaviors of removing the oxygen and/or changing the oxygen settings. The findings included: Cross Refer to F-329 The facility admitted Resident #24 with [DIAGNOSES REDACTED]. On 3/4/15, review of the physician's orders [REDACTED].#24 was receiving multiple psychoactive medications including [MEDICATION NAME] Oxalate once daily for Depression, [MEDICATION NAME] Sprinkles two times a day for Senile Dementia with Depressive Features, [MEDICATION NAME] three times daily for Anxiety, and [MEDICATION NAME] every 24 hours as needed for Anxiety. A review of the Comprehensive Care Plan on 3/4/15 revealed that it did not include a focus area for psychoactive medications. There were no goals or interventions listed to direct nursing staff as to the care and monitoring required for Resident #24 related to his/her psychoactive medication use. During an interview on 3/4/15 at approximately 4:00 PM, the Director of Nursing verified a care plan had not been developed relative to Resident #24's psychoactive medications. Cross Refer to F-328 The facility admitted Resident #30 with [DIAGNOSES REDACTED]. The resident was admitted to hospice care on 2/9/15 with [DIAGNOSES REDACTED]. Review of the 2-18-15 Readmission Minimum Data Set Assessment revealed th… | 2018-08-01 |
| 5873 | 5873 | GOLDEN AGE - INMAN | 425316 | 82 N MAIN STREET | INMAN | SC | 29349 | 2015-03-05 | 282 | G | 0 | 1 | YNC111 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to implement the Care Plan for 1 of 1 sampled resident reviewed for pressure ulcers. Skin care and pressure ulcer treatments were not provided per the Care Plan for Resident #37, resulting in a Stage IV pressure ulcer. The findings included: The facility admitted Resident #37 with [DIAGNOSES REDACTED]. Review of the 2/25/2015 Weekly Pressure Ulcer Record on 3/4/2015 at 12:06 PM revealed that Resident #37 acquired a new pressure ulcer to the sacrum with an onset date of 2/20/2015. The Pressure Ulcer was identified as a Stage IV Pressure Ulcer. Review of the Care Plan on 3/4/2014 at 11:30 AM revealed an intervention for the Pressure Ulcer to: Administer treatments as ordered and observe for effectiveness. Another problem area on the Care Plan was the potential for impaired skin integrity r/t (related to) incontinence episodes, catheter, [MEDICAL CONDITION], and decreased mobility. A listed intervention for this problem was tx (treatment)/care of cyst per physicians orders. Review of the physician's orders [REDACTED]. Pack with normal saline gauze and apply [MEDICATION NAME] adhesive. Change qd (daily) and prn (as needed). Further review of the physician's orders [REDACTED]. Apply dry dressing over area on sacrum everyday and prn soiling one time a day for cyst. This treatment started 11/6/2014. 2. Apply Calazyyme cream to area on buttocks below the coccyx every night shift for irritation (of the skin). This treatment started 9/1/2014. The Calazyme cream treatment was not listed as an intervention on the Care Plan. Review of the Treatment Administration Record (TAR) on 3/4/2015 at 11:05 AM revealed that pressure ulcer treatments (start date 2/20/2015) were not documented as done daily as ordered on (MONTH) 20, 23, 24, 26, 27, and 28, (YEAR). The treatment for [REDACTED]. Eighteen of 28 daily treatments for the cyst were not done in February, (YEAR). Three daily treatments for the cyst to … | 2018-08-01 |
| 5874 | 5874 | GOLDEN AGE - INMAN | 425316 | 82 N MAIN STREET | INMAN | SC | 29349 | 2015-03-05 | 309 | D | 0 | 1 | YNC111 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interviews, the facility failed to ensure that 1 of 1 sampled resident reviewed with a pacemaker received the necessary care and services. Resident #4 had no physician's orders for pacemaker checks and there was no documentation to determine the type of pacemaker the resident had or how often the pacemaker should be checked/monitored. The findings included: The facility admitted Resident #4 with a [DIAGNOSES REDACTED]. Record review on 3/05/15 at approximately 10 AM revealed a radiology report dated 10/25/14 and 12/30/14 that indicated the resident had a pacemaker. There was an Electrocardiogram (EKG) dated 5/29/14 that indicated the physician was notified with no new orders. There was no documentation in the chart to indicate the type of pacemaker the resident had or how often the pacemaker should be checked/monitored. Review of the February, (YEAR) cumulative physician's orders and treatment sheets and review of the resident's care plan revealed no reference to a pacemaker. During an interview on 3/05/15, the Director of Nursing (DON) confirmed that Resident #4 had a pacemaker and stated the pacemaker checks were to be done yearly. The surveyor requested documentation to confirm the pacemaker should be checked yearly. The DON reviewed the resident's medical record and stated s/he was unable to find the verification in the chart. During an interview on 3/05/15 at approximately 11:31 AM, the Care Plan Coordinator (CPC) stated that residents with pacemakers would be care planned for monitoring/precautions and how often the pacemaker would be checked. The CPC confirmed Resident #4 was not care planned for the pacemaker care and services. During an interview on 3/05/15 at approximately 11:39 AM, the DON stated s/he had spoken with the resident's cardiologist and was informed that the type of pacemaker the resident had required checks every 6 months. | 2018-08-01 |
| 5875 | 5875 | GOLDEN AGE - INMAN | 425316 | 82 N MAIN STREET | INMAN | SC | 29349 | 2015-03-05 | 314 | G | 0 | 1 | YNC111 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interview and review of the facility policy entitled Skin Management Program, the facility failed to provide treatments and services to prevent development of a Stage IV pressure ulcer for 1 of 1 sampled resident reviewed for pressure ulcers. The facility failed to complete weekly skin audits and provide skin treatments as ordered for Resident #37, resulting in the Stage IV ulcer. The findings included: The facility admitted Resident #37 with [DIAGNOSES REDACTED]. Review of the 2/25/2015 Weekly Pressure Ulcer Record on 3/4/2015 at 12:06 PM revealed that Resident #37 acquired a new pressure ulcer to the sacrum on 2/20/2015. The pressure ulcer was identified as Stage IV. Review of the Physician's Orders on 3/4/2015 at 10:43 AM revealed a 2/20/2015 treatment order to: Clean open areas to buttocks. Pack with normal saline gauze and apply [MEDICATION NAME] adhesive. Change qd (daily) and prn (as needed). Further review of the Physician's Orders revealed the following treatment orders: 1.Apply calazyyme cream (a skin protectant) to area on buttocks below the coccyx (tail bone area) every night shift for irritation (of the skin). This treatment started 9/1/2014. 2. Apply dry dressing over area on sacrum everyday and prn soiling one time a day for cyst. This treatment started 11/6/2014. Review of the Care Plan on 3/4/2014 at 11:30 AM revealed a problem of (Resident #37) has pressure ulcer (to) buttocks or potential for pressure development r/t (related to) Immobility, poor nutrition. Interventions included: 1. Administer treatments as ordered and observe for effectiveness. 2. Complete a full body check weekly and document. Another problem on the Care Plan for this resident was the potential for impaired skin integrity r/t incontinence episodes, catheter, [MEDICAL CONDITION], and decreased mobility. A listed intervention for this problem was for tx (treatment)/care of cyst per physicians orders. Calazyme cream to the buttocks w… | 2018-08-01 |
| 5876 | 5876 | GOLDEN AGE - INMAN | 425316 | 82 N MAIN STREET | INMAN | SC | 29349 | 2015-03-05 | 323 | E | 0 | 1 | YNC111 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, and interviews, the facility failed to ensure the safety of 1 of 1 sampled resident on aspiration precautions during meal service. Resident #41 was served an incorrect diet during one of one meal observed. Based on observations and interview, the facility failed to ensure there was a safe and systematic method of identifying residents for 4 of 4 residents observed during the medication (med pass). There was no picture or wrist band information available for nursing staff to use to ensure proper identification of residents. The findings included: During med pass observations of 4 residents on 3/3/15 at approximately 4:00 PM and on 3/4/15 between 10:00 AM and 10:30 AM, the surveyor noted that nursing staff were not identifying residents through the use of wrist bands or through the use of pictures. During med pass observation on 3/3/15 at approximately 4:00 PM, Registered Nurse (RN) #1 was not observed to check a wrist identification band prior to giving Resident #28 his/her medications. (Review of the 1-13-15 Annual Minimum Data Set (MDS) Assessment revealed that Resident #28 had a Brief Interview for Mental Status (BIMS) score of 15, indicating the resident was cognitively intact.) During a med pass observation on 3/4/15 at 10:11 AM, Licensed Practical Nurse (LPN) #1 was asked how s/he identified residents in order to administer their medications. LPN #1 was asked to check for a wrist band for Resident #20 but found none. According to the nurse, the resident was oriented to his/her name and would answer if his/her name was called. (Review of the 2-14-15 5-Day MDS revealed that Resident #20 had a BIMS score of 1, indicating severe cognitive impairment.) During med pass observation on 03/04/2015 at 10:26 AM, LPN #1 stated Resident #7 answered to his/her name and was alert and oriented. (Review of the 1-13-15 Quarterly MDS Assessment revealed that Resident #28 had a BIMS score of 15, indicating the resident w… | 2018-08-01 |
| 5877 | 5877 | GOLDEN AGE - INMAN | 425316 | 82 N MAIN STREET | INMAN | SC | 29349 | 2015-03-05 | 325 | D | 0 | 1 | YNC111 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview the facility failed to obtain weekly weights due to significant weight loss per the recommendation of the Registered Dietician (RD) for Resident # 26, 1 of 3 sampled residents reviewed for nutrition. The findings included: The facility admitted Resident #26 with [DIAGNOSES REDACTED]. Record review of the residents Weights and Vitals Summary on 3/5/2015 at 8:39 AM revealed a 9% weight loss in 30 days. The resident's weight on 1/8/2015 was 157.8 pounds. The resident's weight on 2/11/2015 was 145.4 pounds. The last weight documented for the resident was on 2/17/2015 with a result of 95 pounds. Review of a Nutrition Note at approximately 8:39 AM revealed that the RD had identified a significant weight loss on 2/12/2015. Review of the physician's orders [REDACTED]. During an interview on 3/5/2015 at 8:20 AM, the RD stated that after identifying the significant weight loss s/he implemented multiple interventions, including weekly weights. The RD was interviewed again at 9:06 AM and confirmed there was no order for weekly weights and that weekly weights were not noted on the Care Plan. In addition, the RD stated the weight for 2/17/2015 (95 pounds) was incorrect and confirmed the last accurate weight for the resident had been on 2/11/2015. The RD confirmed s/he recommended weekly weights for the resident, but the weekly weights had not been done. When asked how the staff would know to weigh the resident weekly, the RD stated s/he gave the Director of Nursing a list of residents s/he recommended for weekly weights. When asked if s/he could show documentation of this list the RD produced a photocopy of a sticky note at 9:25 AM. Written on the sticky note was Weekly Weights and 3 residents' names (including Resident #26 due to significant weight loss). The note did not indicate the author, nor was it signed or dated. During another interview at 9:38 AM, the RD stated Resident #26 had been weighed that morning (3/5/2… | 2018-08-01 |
| 5878 | 5878 | GOLDEN AGE - INMAN | 425316 | 82 N MAIN STREET | INMAN | SC | 29349 | 2015-03-05 | 328 | D | 0 | 1 | YNC111 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, record review, and interviews, the facility failed to provide oxygen (O2) as ordered for 1 of 2 sampled residents reviewed for respiratory care. Resident #30 was observed with no oxygen on or with 2 liters of oxygen infusing when physician's orders [REDACTED]. The Comprehensive Care Plan for Resident #30 was not updated to include behaviors of removing the Oxygen and/or changing the Oxygen settings. The findings included: The facility admitted Resident #30 with [DIAGNOSES REDACTED]. The resident was admitted to hospice care on 2/9/15 with [DIAGNOSES REDACTED]. Review of the 2-18-15 Readmission Minimum Data Set Assessment revealed that the resident had a Brief Interview for Mental Status Score of 8, indicating moderate cognitive impairment. No rejection of care was documented under the behavior section of the assessment. Record review on 3/5/15 at 10:25 AM revealed 2/9/15 physician's orders [REDACTED]. Observation on 3/3/15 from 10:40 AM to 10:50 AM revealed the resident sitting in his/her wheelchair in the room with Oxygen infusing via nasal cannula at 2 liters per minute by Oxygen concentrator. Observation on 3/4/15 at 8:46 AM revealed the resident sitting at the dining room table feeding her/himself. The resident was on room air. There was no oxygen tank or concentrator present for the 15 minute meal observation. Observation with the Director of Nursing (DON) on 3/5/15 at 10:30 AM revealed Resident #30 sitting in his/her wheelchair in the room with oxygen infusing via nasal cannula by concentrator at 2 liters per minute. According to the DON, hospice had ordered the oxygen at 5 liters upon return from the hospital in early February. S/he stated Resident #30 did not like to wear the oxygen at times, and turned the oxygen down or took it off. Review of the Care Plan with the DON revealed the resident had not been care planned for removing or turning down the oxygen. The DON was informed of previous surveyor observations… | 2018-08-01 |
| 5879 | 5879 | GOLDEN AGE - INMAN | 425316 | 82 N MAIN STREET | INMAN | SC | 29349 | 2015-03-05 | 329 | E | 0 | 1 | YNC111 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interview, and a review of the facility policy entitled [MEDICAL CONDITION] Management, the facility failed to appropriately monitor the use of psychoactive medications for 1 of 5 sampled residents reviewed for unnecessary medications. Facility nursing staff failed to adequately document behaviors and interventions used prior to the administration of As Needed (PRN) [MEDICATION NAME] to justify its use for Resident #24. There were multiple blanks in Behavior Monthly Flow Sheets and there was no Behavior Monthly Flow Sheet in the record for March, (YEAR). where the nursing staff failed to document whether the resident did or did not have behaviors and/or to indicate what interventions had been used for Resident #24 related to the use of antidepressant and anti-anxiety medications. The findings included: The facility admitted Resident #24 with [DIAGNOSES REDACTED]. A review of the record on 3/4/15 revealed Resident #24 had orders for and/or had received the following psychoactive medications in (MONTH) 2014, and in January, February, and (MONTH) of (YEAR). The medications included [MEDICATION NAME] Oxalate once daily for Depression, [MEDICATION NAME] sprinkles two times a day for Senile Dementia with Depressive Features, [MEDICATION NAME] three times daily for Anxiety, and [MEDICATION NAME] every 24 hours as needed for Anxiety. On 3/4/15, a review of the Behavior Monthly Flow Sheets for (MONTH) 2014, (MONTH) (YEAR), and (MONTH) (YEAR) revealed multiple blanks where facility nursing staff had failed to document whether the resident had exhibited behaviors relative to the administration of antidepressant or anti-anxiety medications. The facility was unable to provide a (MONTH) (YEAR) Behavior Flow Sheet. A review of the (MONTH) (YEAR) Medication Administration Record [REDACTED]. A review of Nursing Progress Notes revealed the PRN doses of [MEDICATION NAME] had been administered for anxiety or agitation. A note dated 2/16/1… | 2018-08-01 |
| 6029 | 6029 | STILL HOPES EPISCOPAL RETIREMENT COMMUNITY | 425401 | 1 STILL HOPES DRIVE | WEST COLUMBIA | SC | 29169 | 2015-03-05 | 157 | D | 0 | 1 | 4QMD11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to notify the physician of changes in a resident' s condition potentially requiring physician intervention for 1 of 5 residents reviewed for unnecessary medications. The facility failed to notify the physician when insulin was not administered to Resident #27 according to order. The findings included: The facility admitted Resident #27 with [DIAGNOSES REDACTED]. Record review revealed a physician's orders [REDACTED]. Review of the MAR indicated [REDACTED]. This blood sugar required the resident to receive 4 units of [MEDICATION NAME] SSI (sliding scale insulin) via Flex Pen. The MAR indicated [REDACTED]. During an interview on 3/4/15 at approximately 9 AM, the Unit Manager confirmed that the physician had not been notified of the omission. | 2018-07-01 |
| 6030 | 6030 | STILL HOPES EPISCOPAL RETIREMENT COMMUNITY | 425401 | 1 STILL HOPES DRIVE | WEST COLUMBIA | SC | 29169 | 2015-03-05 | 282 | E | 0 | 1 | 4QMD11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observation, and interview, the facility failed to ensure that the care plan was correctly implemented for 1 of 1 resident reviewed for hydration, 1 of 4 residents reviewed for accidents, and 1 of 1 resident reviewed for urinary catheter. Resident #27's care plan was not followed related to a fluid restriction/monitoring fluid intake. Resident #120's care plan was not followed related to implementation of fall prevention measures. Resident #117's care plan was not followed related to recording output from a urinary catheter. The findings included: The facility admitted Resident #120 with [DIAGNOSES REDACTED]. Record review on 3/4/15 at 4:52 PM revealed physician admission orders [REDACTED]. Interventions included a bed/chair alarm. Observation of the resident on 3/5/15 at 3:47 PM with the Unit Manager and Registered Nurse (RN) #1 revealed the resident did not have a bed or chair alarm in place. At the time of the observation, RN #1 confirmed the resident did not have a bed/chair alarm per the physician orders [REDACTED]. The facility admitted Resident #117 with [DIAGNOSES REDACTED]. Record review on 3/5/15 at approximately 2:00 PM revealed a 2/26/15 physician's admission order to measure output from the indwelling catheter every shift. Review of the Initial Care Plan for potential for complications related to incontinence due to Foley catheter revealed an intervention to record output. Review of the Total Intake and Output Record revealed the resident's output had not been measured/documented as ordered on [DATE] for all three shifts, on 3/1/15 for the 11-7 shift, and on 3/2/15 for the 11-7 shift. During an interview on 3/5/15 at 3:03 PM, the Unit Manager confirmed that the urinary output from the Foley catheter had not been documented as ordered. The facility admitted Resident #27 on 2-3-15 with [DIAGNOSES REDACTED]. Record review on 3-4-15 revealed a physician's orders [REDACTED]. Review of the 2-3-15 Care Plan revea… | 2018-07-01 |
| 6031 | 6031 | STILL HOPES EPISCOPAL RETIREMENT COMMUNITY | 425401 | 1 STILL HOPES DRIVE | WEST COLUMBIA | SC | 29169 | 2015-03-05 | 323 | E | 0 | 1 | 4QMD11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observation, and interview, the facility failed to ensure that 1 of 4 residents reviewed for accidents had fall prevention measures in place as required. Resident #120 was observed without a bed/chair alarm in place as ordered by the physician. The findings included: The facility admitted Resident #120 with [DIAGNOSES REDACTED]. Record review on 3/4/15 at 4:52 PM revealed a physician's admission order for a bed/chair alarm. Further review of the chart revealed a 3/2/15 Fall Risk Assessment with a score of 14, indicating the resident was a high risk for falls. Review of the Certified Nursing Assistant (CNA) Care Plan revealed no instruction for application of a bed/chair alarm. Observation of the resident on 3/5/15 at 3:47 PM with the Unit Manager and Registered Nurse (RN) #1 revealed the resident did not have a bed or chair alarm in place. At the time of the observation, RN #1 confirmed the resident did not have a bed/chair alarm per the physician orders [REDACTED]. S/he stated the facility protocol was to place a bed/chair alarm on the resident if s/he was a high risk for falls. RN #1 stated that a CNA had been instructed to place the alarm but s/he had not done so. | 2018-07-01 |
| 6032 | 6032 | STILL HOPES EPISCOPAL RETIREMENT COMMUNITY | 425401 | 1 STILL HOPES DRIVE | WEST COLUMBIA | SC | 29169 | 2015-03-05 | 327 | E | 0 | 1 | 4QMD11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to ensure that fluid intake and/or output were accurately measured for 1 of 1 resident reviewed for hydration and 1 of 1 resident reviewed with a urinary catheter. The facility failed to ensure that Resident #27 received sufficient fluid to maintain hydration while staying within the parameters of the 24 hour fluid restriction ordered for the resident. The facility failed to monitor the fluid intake as required for Resident #27 for 6 of the 9 days the resident was on fluid restriction. The facility also failed to monitor urinary output for 3 of 6 days, 5 of 15 shifts, for Resident #117 since admission. The findings included: The facility admitted Resident #27 on 2-3-15 with [DIAGNOSES REDACTED]. Record review on 3-4-15 revealed a physician's orders [REDACTED]. The fluid intake was not monitored appropriately during the time the restriction was being utilized as demonstrated by the incomplete documentation on the used for this purpose. Review of the Total Intake and Output Records on 3-4-15 revealed that from 2/3/15- 2/12/15 (when the order was discontinued), 12 shifts (on 6 of 9 days) failed to record the resident's intake. The facility admitted Resident #117 with [DIAGNOSES REDACTED]. Record review on 3/5/15 at approximately 2:00 PM revealed a 2/26/15 physician's admission order to measure output from the indwelling catheter every shift. Further review of the Total Intake and Output Record revealed the resident's output had not been measured/documented as ordered on [DATE] for all three shifts, on 3/1/15 for the 11-7 shift, and on 3/2/15 for the 11-7 shift. During an interview on 3/5/15 at 3:03 PM, the Unit Manager confirmed that the urinary output from the Foley catheter had not been documented and should have been done due to the resident's recent surgery. | 2018-07-01 |
| 6033 | 6033 | STILL HOPES EPISCOPAL RETIREMENT COMMUNITY | 425401 | 1 STILL HOPES DRIVE | WEST COLUMBIA | SC | 29169 | 2015-03-05 | 332 | E | 0 | 1 | 4QMD11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and record review, the facility failed to ensure that it was free of a medication error rate of five percent or greater. There were 2 errors out of 27 opportunities, resulting in a medication error rate of 7.4% (percent). The findings included: Error #1: On 3/4/15 at 9:50 AM, during observation of medication pass on A Cart, Licensed Practical Nurses (LPN) #1 applied [MEDICATION NAME] eye ointment to Resident #52's eyes. The first attempt was to the left eye and the medication ended on the upper eyelash rather than the conjunctiva. Gloves were removed and hands washed before making another attempt, however, it was not successful in placing the medication in the affected area as required. Again, appropriate infection control measures were taken and the LPN then attempted to apply the ointment to the right eye. This also required two attempts with ointment still ending up on the upper eye lash rather than in contact with the conjunctiva of the eye. The nurse did not ensure the medication was placed appropriately to ensure the effectiveness of the medication for the [MEDICAL CONDITION] for which the resident was being treated. Error #2: During medication reconciliation record review on 3/5/15 at 2:15 PM, a physician's orders [REDACTED]. During the medication pass on 3/4/15 at approximately 10 AM, this medicine was not administered to Resident #29. | 2018-07-01 |
| 6034 | 6034 | STILL HOPES EPISCOPAL RETIREMENT COMMUNITY | 425401 | 1 STILL HOPES DRIVE | WEST COLUMBIA | SC | 29169 | 2015-03-05 | 425 | D | 0 | 1 | 4QMD11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to obtain medication for administration as ordered for 1 of 5 residents reviewed for unnecessary medication. Resident #27 did not receive insulin as ordered because it was unavailable. The findings included: The facility admitted Resident #27 with [DIAGNOSES REDACTED]. The resident had an order to receive Novolog Insulin according to sliding scale directions based on blood sugars. The first dose was due at 4:30 PM on 2/3/15 at which time the resident's blood sugar was 165. According to the sliding scale, a blood sugar of 165 required 4 units of Novolog SSI Flex Pen to be administered. The Medication Administration Record [REDACTED] During an interview on 3/4/15 at 9:50 AM, the Unit Director indicated that the facility had been reviewing what medications were available in their Pyxsis system and would be adding a number of medications so that they would have them on hand when needed. The interviewee stated the local back up pharmacy had been called on 2/3/15 and the insulin was there in time for the next dose which was the next morning (2/4/15) at 7 AM. | 2018-07-01 |
| 6035 | 6035 | STILL HOPES EPISCOPAL RETIREMENT COMMUNITY | 425401 | 1 STILL HOPES DRIVE | WEST COLUMBIA | SC | 29169 | 2015-03-05 | 514 | D | 0 | 1 | 4QMD11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to ensure the clinical records reflected professional standards and practices for 2 of 2 records reviewed for Discharge Summaries. Both Resident #52 and Resident #27 had a pre-dated Interdisciplinary Discharge Summary in the medical record. The findings included: The facility admitted Resident #52 with [DIAGNOSES REDACTED]. During medical record review on 3/4/15 at 3:15 PM, the Interdisciplinary Discharge Summary form was partially completed with the following information, admitted : 2/2/15. discharge date : 3/9/15. The form contained additional information regarding sensory impairments, mental status, cognitive status, and behavior status. The form was signed by the Social Services Director with the signature dated 3/9/15. During record review on 3-5-15, the Interdisciplinary Discharge Summary for Resident #27 was observed to have been completed. The resident was admitted [DATE] and had a planned discharge date of [DATE]. The Final Summary of the Resident's Status had been signed by the Social Worker, using the date of 3/9/15. During an interview on 3-5-15 at approximately 8:45 AM, the Social Worker (SW) stated that s/he had been doing that so s/he would not get behind with so many discharges happening. The SW also stated s/he was aware s/he should not date and sign the summary before the actual date the resident was discharged . | 2018-07-01 |
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CREATE TABLE [cms_SC] ( [facility_name] TEXT, [facility_id] INTEGER, [address] TEXT, [city] TEXT, [state] TEXT, [zip] INTEGER, [inspection_date] TEXT, [deficiency_tag] INTEGER, [scope_severity] TEXT, [complaint] INTEGER, [standard] INTEGER, [eventid] TEXT, [inspection_text] TEXT, [filedate] TEXT );