cms_SC
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35 rows where "inspection_date" is on date 2015-06-11
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Suggested facets: facility_name, facility_id, address, city, zip, deficiency_tag, scope_severity, complaint, standard, 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 5197 | 5197 | HEARTLAND OF WEST ASHLEY REHAB AND NURSING CENTER | 425362 | 1137 SAM RITTENBURG BLVD | CHARLESTON | SC | 29407 | 2015-06-11 | 156 | C | 0 | 1 | T7PS11 | Based on review of the facility's records and interview, the facility failed to utilize the CMS form or 1 of the 5 approved Liability Notices for Resident #8 and #11, who stayed in the facility after Medicare coverage ended, 2 of 2 residents reviewed for Liability Notices. In addition, the facility failed to offer Residents #8 and #11 the option of receiving services and submitting a Demand Bill to the intermediary for a Medicare decision. The findings included: On 6/10/15 at approximately 4:00 PM, review of the liability notices revealed the facility was not using the CMS or 1 of the other 5 approved generic letters. Further review revealed the request for intermediary review was blank on both forms. At 4:20 PM, the Social Services Director confirmed the request for a demand bill was blank and stated I never get the residents to choose whether or not to submit a demand bill. The SSD further confirmed the denial letters used by the facility was not one of the 5 generic denial letters | 2019-03-01 |
| 5198 | 5198 | HEARTLAND OF WEST ASHLEY REHAB AND NURSING CENTER | 425362 | 1137 SAM RITTENBURG BLVD | CHARLESTON | SC | 29407 | 2015-06-11 | 160 | C | 0 | 1 | T7PS11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of the facility's records and interview, the facility failed convey within 30 days the resident's funds, and a final accounting of those funds, to the individual or probate jurisdiction administering the resident's estate for 4 of 4 residents reviewed for conveyance of funds. Residents A, B, C, and D's funds were not conveyed within 30 days and Resident A's balance was conveyed to the resident, not to the estate. The findings included: On [DATE] at approximately 4:30 PM, review of conveyance of funds revealed Residents A expired on [DATE]. The balance of the trust fund account, $43.35, was conveyed on [DATE] and the payee on the check was the resident, in care of the responsible party. Resident B expired on [DATE] and the balance of the trust fund account, $103.82, was conveyed on [DATE]. Resident C expired on [DATE] and the balance of the trust fund account, $221.81, was conveyed on [DATE]. Resident D expired on [DATE] and the balance of the trust fund account, $1,496.57, was conveyed on [DATE]. During an interview at the time of the review, the Business Office Manager (BOM) stated that Resident B's conveyance was late due to attempts to contact the resident's son to confirm to whom the check should be written. The BOM also stated that s/he did not know why the check for Resident A was written to the resident and not to the estate. In addition, the BOM stated that the corporate office wrote the checks and that s/he sent the notice to the corporate office within 30 days. | 2019-03-01 |
| 5199 | 5199 | HEARTLAND OF WEST ASHLEY REHAB AND NURSING CENTER | 425362 | 1137 SAM RITTENBURG BLVD | CHARLESTON | SC | 29407 | 2015-06-11 | 281 | D | 0 | 1 | T7PS11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview the facility failed to obtain clarification orders for medications for Resident #7 and #8, 2 of 10 residents reviewed for medications. Resident #7 had an order for [REDACTED]. The findings included: Resident #7 was admitted with [DIAGNOSES REDACTED]. On 6/9/15 at 12:48 PM, review of the monthly physician orders [REDACTED]. Further review revealed a second order dated 5/21/15 for [MEDICATION NAME] nebulizer treatment every 6 hours as needed for shortness of breath. On 6/10/15 at 9:30 AM, review of the Medication Administration Records (MAR) revealed both orders remained on the (MONTH) and June, (YEAR) MARs and were both active orders. Continued review of the interdisciplinary Progress Notes revealed a note dated 5/21/15 at 18:00 stating the resident had returned from the hospital with .2 additional orders for [MEDICATION NAME] prn and to be on [MEDICATION NAME] 500 mg (milligrams) for 5days (sic). A medication administration progress note was reviewed dated 5/23/15 at 20:47 .[MEDICATION NAME] inhalation PRN q (every) 4 hours for wheezing and shortness of breath. There was no documentation that a clarification order was obtained as to the frequency of the nebulizer treatments or that the physician had verified the orders upon return from the hospital. During an interview on 6/10/15 at 10:22 AM, Registered Nurse (RN) #1 stated if a resident was out of the facility less that 24 hours then the previous orders were resumed. The RN further stated that the physician should have been called for clarification and one of the orders discontinued. The RN verified there was no documentation the physician was called to verify the orders and no clarification order in the record. During an interview on 6/10/15 at 11:45 AM, the Director of Nursing (DON) stated that the orders remain in the system when a resident goes out to the hospital and that they should be confirmed with the physician upon return. The DON further stated… | 2019-03-01 |
| 5200 | 5200 | HEARTLAND OF WEST ASHLEY REHAB AND NURSING CENTER | 425362 | 1137 SAM RITTENBURG BLVD | CHARLESTON | SC | 29407 | 2015-06-11 | 312 | D | 0 | 1 | T7PS11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview Resident #5 did not receive scheduled showers per facility policy. ( 1 of 11 residents reviewed for Activities of Daily Living.) The findings included: The facility admitted Resident #5 with [DIAGNOSES REDACTED]. During an interview with the resident 6/9/15 at 9:15 AM, the resident stated the staff assisted her/ him with baths but she only got bed baths. Review of the Activity Of Daily Living (ADL) sheet for this resident revealed that since Admission on 4/25/15, the resident had received bed baths on 4/28, 5/1, 5/5, 5/8, 5/13, 5/15, 5/19, 5/26, 6/2, and 6/5 noted out of facility. Showers given were documented for 5/22 and 6/9. Interview with the resident's Certified Nursing Assistant (CNA) #1 revealed that the resident was scheduled to receive showers on Tuesdays and Fridays per the shower schedule. The resident to [MEDICAL TREATMENT] early on Fridays and doesn't return until about 4 PM in the afternoon. The CNA, DON ( Director of Nursing) and the ADON (Assistant Director of Nursing). all stated, The resident is given the option of getting his/her shower after he/she returns. At that time the question was asked by this surveyor Are [MEDICAL TREATMENT] patients usually wiped out ant tired after they return from [MEDICAL TREATMENT]? The answer given by the staff, Well, most of the time. The staff had not considered changing the resident's shower time to another day in order for him/her to obtain his/her two showers per week. | 2019-03-01 |
| 5201 | 5201 | HEARTLAND OF WEST ASHLEY REHAB AND NURSING CENTER | 425362 | 1137 SAM RITTENBURG BLVD | CHARLESTON | SC | 29407 | 2015-06-11 | 322 | D | 0 | 1 | T7PS11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation of enteral tube medication administration and flush, and interview, the nurse failed to practice infection control and follow facility policy or practice in doing the procedure for Resident #2. ( 1 of 1 gastrostomy tube flush observed.) The findings included: The facility admitted Resident #2 with [DIAGNOSES REDACTED]. On 6/9/15 at 4:05 PM an observation was made of Registered Nurse #2 (RN) doing a medication administration and tube flush for Resident #2. The nurse prepared the table and equipment to perform the procedure, washed hands and applied gloves. While trying to administer the first 30 cc (cubic centimeters) of water, the water would not flow in the tube. The water was removed from the tube, tube clamped, resident re-positioned, and head of bed elevated. Without changing gloves or washing hands, the nurse reinserted the syringe, added 30 cc of water, administered the medication mixed with water, flushed with another 30 cc of water, clamped the tube, and removed gloves. The nurse washed his/her hands, picked up the soiled towel in hand, went into the hall, charted the medication, went back into the resident's room without knocking, placed soiled linen into a plastic bag, lowered the bed, picked up bags, and left the room without washing his/her hands. The ADON (Assistant Director of Nursing) who was observing the procedure confirmed all of the above observations. | 2019-03-01 |
| 5202 | 5202 | HEARTLAND OF WEST ASHLEY REHAB AND NURSING CENTER | 425362 | 1137 SAM RITTENBURG BLVD | CHARLESTON | SC | 29407 | 2015-06-11 | 328 | E | 0 | 1 | T7PS11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, interview, and review of the facility's policy, Respiratory: Oxygen Administration, the facility failed to administer oxygen as ordered to Resident #4, 1 of 2 residents reviewed with oxygen. The findings included: The facility admitted Resident #4 with [DIAGNOSES REDACTED]. During the initial tour of the facility on 6/8/15, Resident #4 was observed in bed with oxygen infusing via nasal cannula at 2 lpm (liters per minute). At 3:16 PM on 6/8/15, review of the monthly physician orders [REDACTED]. The resident was also observed at 3:12 PM on 6/8/15 with oxygen at 2 lpm. On 6/9/15 the resident was again observed in bed with oxygen infusing at 2 lpm. At 11:08 AM review of the MAR indicated [REDACTED]. Further review of the Progress notes revealed multiple documentation entries that the oxygen was infusing at 2 lpm: 3/11 at 01:28 AM, 3/11 at 22:57 PM, 3/13 at 00:33 AM, 4/7 at 02:20 Am, 4/8 at 00:41 AM, 4/8 at 04:30 AM, 4/8 at 19:43 PM, 4/9 at 21:29 PM, and 4/11/15 at 02:21 AM. Comparison of the Progress Notes to the Treatment Record revealed the nurses had signed off that the resident was receiving 3 lpm of oxygen on all of the shifts that the progress notes stated the oxygen was infusing at 2 lpm. Review of the facilities policy, Respiratory: Oxygen Administration, page 1, revealed under the heading Procedure: Verify physician's orders [REDACTED].flow rate of oxygen . Record oxygen administration on Treatment Administration Record. | 2019-03-01 |
| 5203 | 5203 | HEARTLAND OF WEST ASHLEY REHAB AND NURSING CENTER | 425362 | 1137 SAM RITTENBURG BLVD | CHARLESTON | SC | 29407 | 2015-06-11 | 329 | E | 0 | 1 | T7PS11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview the staff did not administer [MEDICATION NAME] per physicians orders on multiple days for Resident #5, ( 1 of 3 sampled residents reviewed for [MEDICATION NAME] administration.) The findings included: The facility admitted Resident #5 with [DIAGNOSES REDACTED]. Record review on 6/8/15 revealed the resident was receiving [MEDICATION NAME] daily with physician's orders [REDACTED]. Tracking was done to correlate PT/INR's with physician order [REDACTED]. PT/INR done on 5/11/15; 4mg increase to 5mg.(milligram); not given NN(Nurses note stated waiting on result of PT/INR. Documentation of administration of med not present after lab result returned) PT/INR on 5/14/15; resident on 5mg increase to 6mg.; Not given Review of MAR (Medication Administration Sheet) for 5/20/15; Not given- out of facility but not given on return from [MEDICAL TREATMENT]. 5/22/15- blank- note out of facility, not given after resident returned from [MEDICAL TREATMENT] PT/INR 5/27/15 and 5/28/15 - on 9 mg and increased to 10 mg. per physician - resident received 9mg on 5/27/15 and 5/28/15. Findings were reviewed with the DON who confirmed these items. | 2019-03-01 |
| 5331 | 5331 | MCCOY MEMORIAL NURSING CENTER | 425174 | 207 CHAPPELL DRIVE | BISHOPVILLE | SC | 29010 | 2015-06-11 | 157 | D | 0 | 1 | 6INV11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record reviews, interview and review of the facility policy titled, Notification of Families/Responsible Parties, the facility failed to notify Resident #12's responsible party of a change in condition and need for evaluation at the hospital emergency room for 1 of 2 residents reviewed for hospitalization . The findings included: The facility admitted Resident #12 with a [DIAGNOSES REDACTED]. Record review on 6/11/2015 at approximately 4:00 PM revealed a nurse's note dated 1/9/2015 written at 9:15 AM which states, reported by nurse manager, resident needs to be sent to ER (emergency room ), in to assess, informed resident having [MEDICAL CONDITION] activity, not responding to verbal stimuli. HOB (Head of Bed) elevated 45 degrees. VS (Vital Signs) 100/70, 68, 99.6, 18, B/S (blood sugar) 98. Respirations even, unlabored, pupils nonreactive, head slumped at this time. EMS (Emergency Medical Service) notified. Further review on 6/11/2015 at approximately 4:00 PM revealed the next nurse's note dated 1/9//2015 written at 9:30 AM which states,transported X 2 attendants to Mcleod ER. No mention in the notes that the family/responsible party was notified. The next documented nurse's note was dated 1/16/15 and written at 4:00 PM which states, Resident readmitted to the facility from Mcleod, arrived via ambulance Review of the physicians telephone orders on 6/11/2015 at approximately 4:00 PM revealed an order dated 1/9/2015 at 10:45 AM which states, Send to ER for eval. No mention on the order that the family nor the responsible party was notified of the change in condition or the need to be hospitalized . During an interview on 6/11/2015 at approximately 4:05 PM with LPN (Licensed Practical Nurse) #2 confirmed that the family/responsible party had not been notified of resident #12's change in condition nor the need to go to the ER. Review on 6/11/2015 at approximately 4:15 PM of the facility policy titled, Notification of Families/Responsible … | 2019-01-01 |
| 5332 | 5332 | MCCOY MEMORIAL NURSING CENTER | 425174 | 207 CHAPPELL DRIVE | BISHOPVILLE | SC | 29010 | 2015-06-11 | 164 | D | 0 | 1 | 6INV11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and review of the facility policy titled Dressing Change the facility failed to provide privacy during pressure ulcer treatment for 1 of 2 pressure ulcer treatments observed.(Resident #50) The findings included: The facility admitted Resident #50 with [DIAGNOSES REDACTED]. Observation of pressure ulcer treatment on 6/10/15 at 10:25 AM revealed Licensed Practical Nurse(LPN) #2, prior to starting the procedure, did not close the blind or pull the privacy curtain around the resident. During an interview with LPN #2 on 6/10/15 at 10:50 AM, he/she confirmed the privacy curtain had not been pulled and the blinds had not been closed. Review of the facility policy titled Dressing Change revealed under the Policy Interpretation and Implementation #5 the following: Provide privacy by closing the room door and bathroom door(if the bathroom is shared by two rooms), pulling the cubicle curtain around the bed, and closing the blinds. | 2019-01-01 |
| 5333 | 5333 | MCCOY MEMORIAL NURSING CENTER | 425174 | 207 CHAPPELL DRIVE | BISHOPVILLE | SC | 29010 | 2015-06-11 | 241 | E | 0 | 1 | 6INV11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and interview, the facility failed to provide an environment to promote the dignity of residents during the dining experience. Residents had milk cartons on their trays in 2 of 3 dining rooms and were not offered cups for their milk. The findings included: Dining room observation on 6/8/15 at 12:51pm revealed 11 residents who received lunch trays were not offered cups to drink their milk. Observation on 6/10/15 at 8:55 am revealed 2 residents in room [ROOM NUMBER] were not offered or provided cups to drink their milk. During an interview with the Certified Dietary Manager (CDM) on 6/11/15 at 7:30 pm, the CMD admitted the State conducted a survey a while back and only 4 residents wanted a cup for their milk while the other residents who could not respond were served cartons. Main dining room observation on 6/10/15 at 9:10 am revealed 17 residents in the dining area with no cups to drink their milk. A total of 21 trays were observed without glasses for drinking milk. During an interview with the Certified Dietary Manager on 6/11/15, s/he stated that previously residents were care planned for their preference related to having milk served in cartons or glasses. S/he continued by stating residents newly admitted probably had not had their preference documented. During the survey, no facility policy was provided related to the dining experience and resident preferences. | 2019-01-01 |
| 5334 | 5334 | MCCOY MEMORIAL NURSING CENTER | 425174 | 207 CHAPPELL DRIVE | BISHOPVILLE | SC | 29010 | 2015-06-11 | 253 | E | 0 | 1 | 6INV11 | Based on record review and interview, the facility failed to ensure housekeeping and maintenance maintained a clean interior and in good repair for 3 of 4 halls. Halls 2, 3, and 4 were observed with damaged walls, scuffed furniture and wax build-up on floors. The findings included: During initial room reviews on 6/8/15 and random observations, the following was observed: Room 203-bedside tables worn, bathroom wall and door scuffed, bathroom floor with dark substance observed Room 207-scuffed, chipped room wall, worn bedside tables Room 210-bathroom door scuffed, wall damage noted near commode Room 213-baseboards dirty Room 216-damaged wall behind bed, scuffed bathroom door Room 221-scuffed bedside table Room 225-wardrobe scuffed Room 301-bathroom door scuffed Room 302-wax build-up noted on floor, scuffed bathroom door and bedside table Room 303-damaged wall behind bed Room 403-damaged wall behind bed Room 406-room chair torn Room 410-scuffed wall. Environmental rounds were made with the Administrator on 6/11/15 at approximately 3:30 PM. No cleaning schedules were provided during the survey. The Administrator presented a renovation memo which stated a number of resident rooms had been renovated which included new paint, baseboards, replacement of stained tiles and bathroom fixture repair/replacement. This will be an ongoing program whereas each resident room will receive this same upgrade. In addition, walls behind the beds are in the process of being replaced and currently this was being identified through priority. | 2019-01-01 |
| 5335 | 5335 | MCCOY MEMORIAL NURSING CENTER | 425174 | 207 CHAPPELL DRIVE | BISHOPVILLE | SC | 29010 | 2015-06-11 | 274 | D | 0 | 1 | 6INV11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to ensure a significant change assessment was completed in a timely manner for 1 of 1 resident reviewed for a significant change. Resident #117 had a decline in 2 areas of Activities of Daily Living. The findings included: The facility admitted Resident #117 with [DIAGNOSES REDACTED]. Review of the medical record on 6/10/2015 at approximately 1:41 PM revealed a MDS (Minimum Data Set) assessment dated [DATE] Section G Functional Status under H. reads, Eating - how resident eats and drinks regardless of skill, is coded as (1) for supervision and oversight and a (1) for setup help only. Further review of the MDS on 6/10/2015 at approximately 1:41 PM dated 2/15/2015 revealed section H, Bowel and Bladder. Section H0300 for Urinary Continence and section H0400 is coded (1) as Occasionally incontinent of bowel Review of the MDS assessment dated [DATE] on 6/10/2015 at approximately 1:45 PM revealed Section H. Bowel and Bladder coded H0300 a (2) for Urinary Incontinence which reads, Frequently incontinent of bladder and H0400 a (1) for Occasionally incontinent of bowel. Further review of the MDS assessment revealed under section H - Functional Status revealed section H. Eating coded as (4) for total dependence - full staff performance every time during entire 7 day period. Resident #117 had a significant decline in bowel and bladder continence and eating. No significant change assessment was completed for resident #117's decline in a timely manner. During an interview on 6/11/2015 at approximately 6:40 PM with the MDS/Care Plan Coordinator, he/she confirmed that a significant change assessment had not been completed. | 2019-01-01 |
| 5336 | 5336 | MCCOY MEMORIAL NURSING CENTER | 425174 | 207 CHAPPELL DRIVE | BISHOPVILLE | SC | 29010 | 2015-06-11 | 280 | D | 0 | 1 | 6INV11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, and interview, the facility failed to revise Care Plan interventions for 2 of 18 sampled residents reviewed for review and revision of Care Plan. Resident #50's Care Plan was not updated to reflect a change in use of a pressure ulcer prevention device. Resident #10's Care Plan was not updated to reflect inappropriate sexual behaviors, impotence, and consultation with the mental health clinic. The findings included: The facility admitted Resident #10 with [DIAGNOSES REDACTED]. Review of Resident #10's Admission Minimum Data Set (MDS) assessment dated [DATE] confirmed that the resident's speech was coded as clear. Further observation of Resident #10 revealed s/he does have slurred speech which indicated the MDS as inaccurate. Record review on 6/11/15 at 12:35 PM revealed behaviors listed for Resident #10 on the Behavior Psychoactive Flow Record as depression and anxiety, that are not known behaviors. Social Services Notes reviewed on 6/11/15 at 2:53 PM revealed inappropriate sexual comments towards staff and impotency. Record review of Resident # 10's care plan on 6/11/15 did not reveal any mental health appointments or notes. During an interview with the Minimum Data Set (MDS) Coordinator and the Director of Nursing (DON) on 6/11/15 @ 3:38 PM, they confirmed that Social Service's Notes revealed inappropriate sexual behavior towards staff and that Resident #10 was seen at the Mental Health Clinic. During an interview on 6/11/15 at 5:50 PM with the DON and the MDS Coordinator, it was confirmed that Resident #10's record revealed the resident had a mental health appointment on 3/2/15 with no notes documented. The MDS Coordinator verified that there were no mental health reports in the resident's chart and was unaware the resident was seen at mental health. The MDS Coordinator confirmed that notes should be under consultation. The facility admitted Resident #50 with [DIAGNOSES REDACTED]. Record review of the ca… | 2019-01-01 |
| 5337 | 5337 | MCCOY MEMORIAL NURSING CENTER | 425174 | 207 CHAPPELL DRIVE | BISHOPVILLE | SC | 29010 | 2015-06-11 | 282 | D | 0 | 1 | 6INV11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interviews, the facility failed to ensure services were provided in accordance with the written Comprehensive Plan of Care for 2 of 15 residents reviewed for care plans. Resident #117's written plan of care not followed related to a toileting program and Resident #50's written plan of care not followed related to an alternating pressure mattress. The findings included: The facility admitted Resident #117 with [DIAGNOSES REDACTED]. Review on 6/10/2015 at approximately 3:00 PM of Resident #117's comprehensive plan of care revealed an intervention dated 3/26/2015 for staff to toilet resident every 2 hours and as needed with the assistance of one. No documentation could be found in resident #117's medical record where this resident was toileted by staff. Resident #117's plan of care had not been followed. An interview on 6/10/2015 at approximately 3:00 PM with Licensed Practical Nurse (LPN) #3 revealed Resident #117 had not been toileted. LPN #3 went on to say that this resident was not on a toileting program and had not been on a toileting program. An interview on 6/10/2015 at approximately 3:05 PM with CNA (Certified Nursing Assistant ) #1 stated resident #117 will let you know when he/she needs to use the restroom but could not produce any documentation that resident #117 had been assisted to the restroom. The facility admitted Resident #50 with [DIAGNOSES REDACTED]. Review of the care plan on 6/10/15 revealed the resident was care planned to have an air mattress which was to be checked every shift with the setting on the alternating mode. Observation of the resident's air mattress on 6/10/15 at 10:25 AM and 4:00 PM and on 6/11/15 at 9:56 AM and 12:05 PM revealed the air mattress was on the static pressure mode. On 6/11/15 at 4:45 PM, the resident's mattress was observed with the Director of Nursing (DON). At the time of the observation, the DON confirmed the mattress was on static mode. | 2019-01-01 |
| 5338 | 5338 | MCCOY MEMORIAL NURSING CENTER | 425174 | 207 CHAPPELL DRIVE | BISHOPVILLE | SC | 29010 | 2015-06-11 | 309 | E | 0 | 1 | 6INV11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interviews and the facility agreement with [MEDICAL TREATMENT] titled, Long-Term Care Facility Outpatient [MEDICAL TREATMENT] Services Agreement, the facility failed to ensure coordination of care for 1 of 1 resident reviewed for [MEDICAL TREATMENT] care and services. Resident #128. The facility further failed to ensure Trazadone was given as ordered by the physician for 1 of 6 residents reviewed for unnecessary medications. Resident #160. The findings included: The facility admitted Resident #128 with [DIAGNOSES REDACTED]. Review of Resident #128's medical record on 6/10/2015 at approximately 10:59 AM revealed no communication sheets with the facility and the [MEDICAL TREATMENT] center. Registered Nurse (RN) #1 produced a communication sheet dated 6/9/2015 from the [MEDICAL TREATMENT] center that the [MEDICAL TREATMENT] center had filled out and returned to the facility. The facility had not filled out any of their portion of the form to communicate with the [MEDICAL TREATMENT] center. During an interview on 6/10/2015 at approximately 10:59 AM with RN #1, he/she verified that the communication sheet dated 6/9/2015 was the only one the facility had. RN #1 went on to say that the facility would send one with the resident to [MEDICAL TREATMENT] but the [MEDICAL TREATMENT] center would not send one back to them to let the facility know of any labs, new orders or basically how the resident tolerated the [MEDICAL TREATMENT] treatment. Review on 6/10/2015 at approximately 11:15 AM of the facility's agreement with [MEDICAL TREATMENT] center titled, Long-Term Care Facility Outpatient [MEDICAL TREATMENT] Services Agreement, under Section A. #2 states, Interchange of Information. The nursing facility shall provide for the interchange of information useful or necessary for the care of the [MEDICAL CONDITION] residents, including a Registered Nurse as a contact person at the Nursing Facility whose responsibilities include oversigh… | 2019-01-01 |
| 5339 | 5339 | MCCOY MEMORIAL NURSING CENTER | 425174 | 207 CHAPPELL DRIVE | BISHOPVILLE | SC | 29010 | 2015-06-11 | 314 | D | 0 | 1 | 6INV11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observation, interview, and review of the facility policy titled Dressing Change and Wound Irrigation, the facility failed to prevent pressure ulcer development and failed to follow infection control techniques for 1 of 2 pressure ulcer treatments observed.(Resident #50) In addition, the facility failed to follow ordered interventions or care planned interventions for 2 of 4 residents reviewed for pressure ulcers. Resident #50's bed was on static pressure and a roho cushion was not in use and Resident #160 an air mattress and heel protectors were not in place as ordered. The findings included: The facility admitted Resident #50 with [DIAGNOSES REDACTED]. Record review on 6/10/15 revealed Resident #50 developed a pressure wound to the left hip which was documented as a Stage III. Further review of the incident report revealed on 3/21/15 two open areas were noted on the upper left thigh area caused by rivets in the resident's wheelchair. Further review revealed the cushion for the wheelchair was very worn and thin and did not function properly which caused the wounds. Review of the approaches on the resident's care plan dated 4/24/15 revealed the resident had been care planned for a roho cushion in the wheelchair and the resident's bed was to be in the alternating mode. Further review of the Treatment Record for (MONTH) (YEAR) revealed an Air Mattress -check function every shift alternating function. Staff initials were noted each shift related to the air mattress on the alternating function. Current physician orders revealed an order for [REDACTED]. Observation of the pressure ulcer treatment on 6/10/15 at 10:25 AM revealed the Unit Manager in preparing the items for the procedure obtained a bottle of Normal Saline from the treatment cart which had an open date of 6/9/15 at 9:40 AM. At the time of the observation, the Unit Manager was asked how long the Normal Saline was good for once opened. S/he stated s/he did not kn… | 2019-01-01 |
| 5340 | 5340 | MCCOY MEMORIAL NURSING CENTER | 425174 | 207 CHAPPELL DRIVE | BISHOPVILLE | SC | 29010 | 2015-06-11 | 315 | D | 0 | 1 | 6INV11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interviews the facility failed to provide care and services to improve and or to prevent decline in normal bladder function for 1 of 3 residents reviewed for urinary incontinence. Resident #117 The findings included: The facility admitted Resident #117 with [DIAGNOSES REDACTED]. Review of Resident #117's medical record on 6/10/2015 at approximately 2:24 PM revealed an Admission Nursing assessment dated [DATE]. The assessment included bowel and bladder and was checked as continent of bowel and bladder. Review on 6/10/2015 at approximately 2:24 PM of a form titled, Bowel and Bladder Incontinence Management dated 3/26/2015 included a total score of 7. A scale of 6 to 9 points states,resident is likely to benefit from a retraining program or consideration program or adult briefs. Candidate was checked as yes with an intervention for staff to toilet resident every 2 hours and as needed with the assistance of one. A form titled, Candidate for Adult Briefs states, wears briefs for incontinent episodes. A progress note on the form, Candidate for Adult Briefs read, Resident is frequently incontinent of bladder and occasionally incontinent of bowel. Resident is usually continent on days with the assistance of one with toileting. Staff to toilet resident every 2 hours and as needed. Staff to offer incontinent care as needed. Review on 6/10/2015 at approximately 3:00 PM of Resident #117's comprehensive plan of care revealed an intervention dated 3/26/2015 for staff to toilet resident every 2 hours and as needed with the assistance of one. No documentation could be found in resident #117's medical record where this resident was toileted by staff. An interview on 6/10/2015 at approximately 3:05 PM with CNA (Certified Nursing Assistant ) #1 stated resident #117 will let you know when he/she needs to use the restroom but could not produce any documentation that resident #117 had been assisted to the restroom. An interview on 6/10/2… | 2019-01-01 |
| 5341 | 5341 | MCCOY MEMORIAL NURSING CENTER | 425174 | 207 CHAPPELL DRIVE | BISHOPVILLE | SC | 29010 | 2015-06-11 | 329 | E | 0 | 1 | 6INV11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interviews, the facility failed to ensure that medications were adequately monitored for effectiveness and had specific indications for use for 2 of 6 sampled reviewed residents for unnecessary medications. Resident #146's blood pressure (bp) was not monitored prior to administering [MEDICATION NAME] as required. Resident # 10's behavior monitoring addressed anxiety and depression as behaviors with Social Service notes referencing inappropriate sexual comments to staff, but no documentation in the clinical record of the activity or interventions implemented prior to the use of medication. The findings included: The facility admitted Resident #10 with [DIAGNOSES REDACTED]. Record review of the Behavior Monitoring Psychoactive Flow Record on 6/11/15 at 12:35 PM revealed anxiety and depression as behaviors. Record review of the Social Services Notes on 6/11/15 at 2:53 PM revealed inappropriate sexual comments to staff and impotency concerns by Resident #10. Review of Resident #10's Care Plan on 6/11/15 at 3 PM did not reveal any documentation regarding inappropriate behaviors towards staff or interventions. Record review of Nurses Notes on 6/11/15 at 2:50 PM revealed mental health appointment on 3/2/15 with prescribed medications: [REDACTED] [MEDICATION NAME] E.R. 500 milligrams (mg) 4 tabs daily at bedtime for [MEDICAL CONDITION], [MEDICATION NAME] 20 milligrams (mg) 1 tab at bedtime for [MEDICAL CONDITION], and Klonopin 1mg 1 twice daily for Anxiety. During an interview with the Director of Nursing (DON) on 6/11/15 at 6:35 PM, s/he confirmed mental health appointments on 1/26/15, 3/2/15, 4/21/15,and 5/15/15. The DON reviewed the Nursing Progress Notes and confirmed no documented interventions had been provided to the resident prior to administering of the medications. The facility admitted Resident #146 with [DIAGNOSES REDACTED]. On 6-10-15 at approximately 9:00AM, record review of (MONTH) through (MONTH) (YEAR) Medi… | 2019-01-01 |
| 5342 | 5342 | MCCOY MEMORIAL NURSING CENTER | 425174 | 207 CHAPPELL DRIVE | BISHOPVILLE | SC | 29010 | 2015-06-11 | 431 | D | 0 | 1 | 6INV11 | Based on observation, interview, review of the Controlled Drug Accountability Record, and review of the facility's Pharmacy Services Policy, the facility failed to follow procedures to ensure proper labeling of external medications on 1 of 2 treatment carts to ensure that controlled drugs were handled appropriately. The Controlled Drug Accountability Record did not match the actual drug count on 1 of 2 med carts on the 100-400 hall. The findings included: Observation on 6/11/15 @ 9:18 AM revealed the treatment cart on 200-300 hall contained 3 opened tubes of external medications that did not have appropriate labeling with residents names. Medication included: Preparation H 1 oz (ounce), SAF Gel Wound Dressing 3 oz., and Hemorrhoidal Ointment 2 oz. During an interview on 6/11/15 at 9:18 AM, Licensed Practical Nurse (LPN) #2 verified that the external medications should have been labeled. Observation on 6/11/15 at 4:56 PM revealed that the controlled drug count on medication cart 1 on the 100-400 hall for Resident # 32's Clorazepate 3.75 (milligrams) mg did not match the Controlled Drug Accountability Record and the Medication Administration Record [REDACTED] During an interview with Licensed Practical Nurse (LPN) # 1 on 6/11/15 at 5:15 PM, s/he admitted that the Medication Administration Record [REDACTED]. | 2019-01-01 |
| 5343 | 5343 | MCCOY MEMORIAL NURSING CENTER | 425174 | 207 CHAPPELL DRIVE | BISHOPVILLE | SC | 29010 | 2015-06-11 | 441 | D | 0 | 1 | 6INV11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and review of the facility policy titled, Hand Washing, and the facility policy titled, Perineal Care, the facility failed to ensure proper handwashing technique was followed prior to urinary incontinent care for 1 of 1 resident observed for incontinent care. (Resident #117) The findings included: The facility admitted Resident #117 with [DIAGNOSES REDACTED]. Observation on 6/10/2015 at approximately 2:40 PM of urinary incontinence care for Resident #117 revealed CNA (Certified Nursing Assistant) #1 donning gloves and proceeding with incontinent care. CNA #1 did not wash his/her hands prior to starting incontinent care for Resident #117. During an interview on 6/10/2015 at approximately 2:58 PM, CNA #1 confirmed that he/she had not washed his/her hands prior to starting incontinent care. Review on 6/10/2015 at approximately 3:00 PM of the facility policy titled, Hand Washing, states, Staff shall wash their hands or use hand sanitizer to help prevent the transmission of infection. Review on 6/10/2015 at approximately 3:00 PM of the facility policy titled, Perineal Care, states, Perineal care shall be performed to assist in the prevention or elimination of infection and odor, promote healing, remove secretions, and provide comfort. Review on 6/10/2015 at approximately 3:15 PM of the facility inservices dated 3/2/2015 included, Proper Handwashing and the attendance sheet included CNA #1. Review of another inservice dated 4/15/2015 included, Handwashing. The inservice dated 4/15/2015 states, Each employee was inserviced during check offs on the importance of handwashing and times when hands should be washed. CNA #1 was in attendance for the inservice. | 2019-01-01 |
| 5344 | 5344 | MCCOY MEMORIAL NURSING CENTER | 425174 | 207 CHAPPELL DRIVE | BISHOPVILLE | SC | 29010 | 2015-06-11 | 467 | E | 0 | 1 | 6INV11 | Based on observation and interview, the facility failed to maintain an adequate outside ventilation system for 2 of 4 halls. The findings included: During room reviews on 6/8/15, odors were noted in several resident restrooms. Upon further observation, the exhaust fan in the restrooms could not be heard. On 6/11/15 at approximately 4:39 PM, the Maintenance Director tested a restroom shared by Rooms 201 and 203 and confirmed the exhaust was not working. He/she continued by stating the 100 and 200 halls only had an open ventilation with no exhaust. On 6/11/15 at 5:45 PM, after testing resident restrooms, the Maintenance Director provided information which stated the 100 and 200 Halls only had an open ventilation system. In addition, the exhaust fans for shared restrooms for rooms 301/303, 403/405, 402/404, and a private restroom for room 410 were not functioning. | 2019-01-01 |
| 5345 | 5345 | MCCOY MEMORIAL NURSING CENTER | 425174 | 207 CHAPPELL DRIVE | BISHOPVILLE | SC | 29010 | 2015-06-11 | 514 | E | 0 | 1 | 6INV11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to maintain clinical records on each resident in accordance with accepted professional standards and practices that are complete; accurately documented; readily accessible; and systematically organized for 4 of 19 residents reviewed for accuracy of clinical records. Resident #10 had 4 mental health appointments and no evidence of the appointments or results listed in the chart, Resident #126 with an incorrect time for tube feeding listed on the physician orders and Medication Administration Record [REDACTED]. In addition, Resident #146 was given [MEDICATION NAME] not signed out on the MAR. The findings included: The facility admitted Resident #126 with [DIAGNOSES REDACTED]. On 6-10-15 at approximately 11:00AM, record review of the Physician's Orders revealed [MEDICATION NAME] 1.5 cal (calories) liquid at 80ml/hr (milliliter/hour) via percutaneous enteral gastrostomy( peg) x 12 hours from 8AM to 8 PM and flush peg with 60 ml. water x 12 hours from 8AM to 8PM. Under the section listed Medications the hour listed was 8PM ON and 8AM OFF for (MONTH) 1 through (MONTH) 30, (YEAR). Flush peg with 60 ml water times 12 hours from 8PM to 8AM. On the (MONTH) 1-31, (YEAR) Physician's Orders record review revealed the following physician order, [MEDICATION NAME] 1.5 at 80ml/hr via peg x 12 hrs from 8AM to 8PM. Flush peg with 60 ml. water x 12 hrs. from 8AM to 8PM. On the Physician's Orders for (MONTH) 1 through (MONTH) 30 revealed the following order [MEDICATION NAME] 1.5 cal bolus-one can at hs with 100 ml water flush at 10PM. [MEDICATION NAME] 1.5 cal-one can if po intake is During an interview on 6-10-15 at approximately 11:15AM with LPN#5 verified that the times were not correct on the physician orders from 8AM to 8PM but the resident was getting the tube feeding correctly from 8PM to 8AM as noted on the Medication Administration Record [REDACTED]. The facility admitted Resident #14… | 2019-01-01 |
| 6146 | 6146 | PRUITTHEALTH- RIDGEWAY | 425288 | 213 TANGLEWOOD COURT | RIDGEWAY | SC | 29130 | 2015-06-11 | 244 | D | 1 | 0 | NH5611 | Based on record review, observations and interviews, the facility failed to follow up on grievances. The findings included: On 6/8/15 at approximately 9:00 AM the Resident Council Minutes were reviewed by the surveyor. On 4/14/15: The Resident Council expressed concerns regarding showers. Showers- some residents would like to wear clothes/pjs when transporting to showers. Wondering why some don't use the showers in their own rooms. Hall 2- no curtain so if door opens you are exposed. Resident Council Minutes for 5/12/15 stated, Showers in rooms are ok for some, not for some. Safety concerns. Shower curtains being looked in to. On 6/9/15 at approximately 11:30 AM the Maintenance Director was interviewed by the surveyor. The residents were taken to other halls to get their showers. No shower curtains in the showers. There is only one stall, only one resident at a time. One resident and one staff member. On 6/9/15 at approximately 11:55 AM the Housekeeping Supervisor was interviewed by the surveyor. No shower curtains. When patient care is happening, bathing, showers, doors to be closed. None of the showers have curtains. The resident should be behind the wall when taking showers. On 6/9/15 the shower room on unit 2 was observed at approximately 12:25 PM with the Housekeeping Supervisor. The Hall 2 shower room was observed without a privacy curtain; the shower room had only one shower stall. When residents were removed from shower stall to dry off and dress, the resident would be visible when the door opened. A group meeting was conducted by the surveyor on 6/10/15 at approximately 11:00 AM. Resident C stated that the shower room on units 2 and 4 had no privacy curtain. When they open the door you are exposed. | 2018-05-01 |
| 6147 | 6147 | PRUITTHEALTH- RIDGEWAY | 425288 | 213 TANGLEWOOD COURT | RIDGEWAY | SC | 29130 | 2015-06-11 | 252 | E | 1 | 0 | NH5611 | Based on observations, interviews and review of facility records, the facility failed to maintain a clean, odor free environment for 2 of 4 units. Unit 1 and 3 had elimination odors and resident concerns of cleanliness. The findings included: On 6/7/15 and 6/8/15, the facility was noted to have urine odors on units 1 and 3. Resident Council Minutes revealed concerns expressed by residents related to cleanliness. Floors were noted to be sticky. On 6/8/15 at approximately 9:00 AM, Resident Council Minutes were reviewed: Resident Council Minutes Review: 1/13/15 through 5/12/15 1/13/15: Weekend cleaning and trash not done very well or not collected. 5/12/15: Trash Bags- housekeeping responsible (for replacing). CNAs need to notify. On 6/8/15 at approximately 10:05 AM Resident #4 was observed sitting on the side of the bed, watching TV. The resident's room had a strong smell of urine; a urinal on the floor in front of the air conditioning unit with approximately 200 cc (cubic centimeter) of amber urine. The floor between the bed and the air conditioning unit was sticky as the surveyor walked across the floor. On 6/8/15 at approximately 2:00 PM the resident was observed sitting up in wheelchair at the bedside; dressed appropriately in dress clothes and was wearing a light weight jacket. The resident's bed was unmade and there was a strong urine smell in the room. The floor continued to be sticky. On 6/8/15 at approximately 2:30 PM the surveyor interviewed Certified Nursing Assistant (CNA) #1. S/he stated s/he was responsible for providing care to Resident #4. S/he stated that s/he uses a urinal and goes to the bathroom when s/he has a bowel movement, no incontinent episodes on her/his shift. CNA #1 stated Resident #4 was incontinent at times during the night and that the urine smell came from the urinal. I emptied the urinal and rinsed and it smelled better. Sometimes bed is wet when I come in but sometimes not. S/he wears pull-ups. No problems with him showering or bathing. On 6/9/15 at approximately 10:45 AM the surv… | 2018-05-01 |
| 6148 | 6148 | PRUITTHEALTH- RIDGEWAY | 425288 | 213 TANGLEWOOD COURT | RIDGEWAY | SC | 29130 | 2015-06-11 | 280 | D | 1 | 0 | NH5611 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview the facility failed to review and revise the comprehensive care plan for Resident's #1, #3, #4 and #5 (4 of 6 resident's reviewed for care plans). The findings included: Resident #5 was admitted to the facility on [DATE]. Review of Resident #5's Admission/Nursing Observation Form dated 5/20/15 completed by LPN (Licensed Practical Nurse) #1 indicated there were two small open areas at the top of the buttocks. Review of Resident #5's Body Audit Form dated 5/21/15 completed by LPN #2 indicated there were two small areas at the top of the buttocks. Review of the resident's physician's orders [REDACTED]. Review of Resident #5's Documentation of Wound Observation and Assessment Form dated 6/2/15 revealed the resident had a Stage III pressure ulcer to his/her sacrum that measured 1 x 0.5 x 0.2 centimeters. Review of the physician's orders [REDACTED]. Cover the area with a dry dressing and change every 12 hours and as needed. Review of the resident's care plan revealed potential for alteration in skin integrity was identified as a problem area. Interventions and approaches to this problem area were documented on the care plan and included to report any signs/symptoms of skin alteration to the charge nurse or supervisor. The care plan was not updated to reflect the resident had a Stage III pressure ulcer to the sacrum or the treatment that was ordered. In an interview with the surveyor on 6/9/15 at approximately 1:34 PM, Wound Nurse #1 stated a nurse and CNA were changing Resident #5 and noted the area to his/her sacrum. They told Wound Nurse #1 about the area and that is when s/he ordered a treatment for [REDACTED].#1 stated that the care plan was updated on 6/2/15 to reflect the open area. After reviewing the care plan s/he stated the updated care plan needed to be added. The facility admitted Resident #4 with [DIAGNOSES REDACTED]. Review of the hospital Transfer Summary of 2/17/2014 revealed the resident had a h… | 2018-05-01 |
| 6149 | 6149 | PRUITTHEALTH- RIDGEWAY | 425288 | 213 TANGLEWOOD COURT | RIDGEWAY | SC | 29130 | 2015-06-11 | 314 | G | 1 | 0 | NH5611 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview the facility failed to ensure a resident having a pressure sore received necessary treatment and services to promote healing, prevent infection and prevent new sores from developing. Resident #5 was admitted to the facility on [DATE] with two small open areas on his/her sacrum. There were no orders for treatment to the area until 6/2/15. One of three residents reviewed for pressure ulcers. The findings included: Resident #5 was admitted to the facility on [DATE]. Review of Resident #5's Admission/Nursing Observation Form dated 5/20/15 completed by LPN (Licensed Practical Nurse) #1 indicated there were two small open areas at the top of the buttocks. Review of Resident #5's Body Audit Form dated 5/21/15 completed by LPN #2 indicated there were two small areas at the top of the buttocks. Review of the resident's physician's orders [REDACTED]. Review of Resident #5's Documentation of Wound Observation and Assessment Form dated 6/2/15 revealed the resident had a Stage III pressure ulcer to his/her sacrum that measured 1 x 0.5 x 0.2. Review of the physician's orders [REDACTED]. Cover the area with a dry dressing and change every 12 hours and as needed. Review of the resident's care plan revealed potential for alteration in skin integrity was identified as a problem area. Interventions and approaches to this problem area were documented on the care plan and included to report any signs/symptoms of skin alteration to the charge nurse or supervisor. In an interview with the surveyor on 6/9/15 at approximately 1:34 PM, Wound Nurse #1 stated a nurse and CNA (certified nurse aide) were changing Resident #5 and noted the area to his/her sacrum. They told Wound Nurse #1 about the area and that is when s/he ordered a treatment for [REDACTED].#1 stated that the area was noted on May 20th during admission. The nurses who completed the 5/20/14 and 5/21/14 body audits did not let him/her know about the area. Wound Nurse #1 … | 2018-05-01 |
| 6150 | 6150 | PRUITTHEALTH- RIDGEWAY | 425288 | 213 TANGLEWOOD COURT | RIDGEWAY | SC | 29130 | 2015-06-11 | 323 | D | 1 | 0 | NH5611 | Based on observation and interview, the facility failed to ensure that the resident environment remained as free of accident hazards as possible. Resident #5 was noted to have an IV pole attached to his/her wheelchair. The pole remained attached to the wheelchair while the resident was in bed. One of three resident's reviewed for accident hazards. The findings included: During Initial Tour of the facility on 6/7/15 at approximately 3:00 PM, Resident #5 was observed in his/her bed. The resident's IV pole was attached to the wheelchair with clamps and the wheelchair was next to the resident's bed. During an interview with the surveyor on 6/10/15 at approximately 10:10 AM, the 100/200 Unit Manager observed Resident #5's Total Parenteral Nutrition (TPN) bag to verify the label. The TPN bag was hanging on the IV pole attached to the wheelchair and Resident #5 was lying in bed. The 100/200 Unit Manager touched the TPN bag and the front wheels of the wheelchair tipped up. The 100/200 Unit Manager stated that s/he was going to put the IV pump on a regular pole. S/he stated that pump should be on the wheelchair only when the resident is in the wheelchair. The IV pump should be on a regular pole when Resident #5 is in bed. The 100/200 Unit Manager stated that the resident had a regular IV pole in his/her room. The 100/200 Unit Manager also stated that the pole could fall when on the wheelchair and Resident #5 is in the bed. | 2018-05-01 |
| 6151 | 6151 | PRUITTHEALTH- RIDGEWAY | 425288 | 213 TANGLEWOOD COURT | RIDGEWAY | SC | 29130 | 2015-06-11 | 328 | J | 1 | 0 | NH5611 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and interview the facility failed to ensure that residents receive proper treatment and care for [MEDICATION NAME] fluids. The facility failed to provide quality of care in the management of Resident #5 who was receiving Total [MEDICATION NAME] Nutrition (TPN). The facility staff was not monitoring labs as ordered, assessing the resident, administering the TPN per protocol or adequatly documenting the administration of TPN (1 of 1 resident reviewed receiving TPN). The findings included: Review of the medical record revealed Resident #5 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Resident #5 had an [MEDICAL CONDITION] and mucus fistula. Review of Resident #5's medical record revealed a [MEDICATION NAME] Nutrition Orders (PN) form dated 5/19/15. The 5/19/15 [MEDICATION NAME] Nutrition Order form included information on the Total Nutrient Admixture Base Formula and also the amount of additives per bag. In an interview with the surveyor on 6/10/15 at approximately 10:10 AM, the 100/200 Unit Manager confirmed the 5/19/15 [MEDICATION NAME] Nutrition Order form was the only one on the resident's medical record. The 100/200 Unit Manager stated that the nurse should verify the TPN bag label matches the order dated 5/19/15. The 100/200 Unit Manager stated that [MEDICATION NAME] Nutrition Orders are not kept anywhere other than the resident's medical record. The 100/200 Unit Manager reviewed the label on Resident #5's bag of TPN that was currently infusing. The 100/200 Unit Manager confirmed the label on the bag did not match the 5/19/15 TPN order. Review of the label revealed the TPN Base Formula matched the 5/19/15 order but the amount of additives per bag did not. The Clinical Competency Coordinator provided a [MEDICATION NAME] Nutrition Orders form dated 6/1/15 to the surveyor on 6/9/15 at approximately 3:30 PM. The form was noted to have a fax stamp across the top that indicated 6/9/15 at 12… | 2018-05-01 |
| 6152 | 6152 | PRUITTHEALTH- RIDGEWAY | 425288 | 213 TANGLEWOOD COURT | RIDGEWAY | SC | 29130 | 2015-06-11 | 425 | J | 1 | 0 | NH5611 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to provide pharmaceutical services to meet the needs of each resident. The facility failed to provide pharmaceutical services to meet the needs of Resident #5 who was receiving Total Parenteral Nutrition (TPN) (1 of 1 resident reviewed receiving TPN). The pharmacy failed to monitor labs and medications orders. The findings included: Cross refer to F-328 as it relates to the failure of the facility to ensure that residents receive proper treatment and care for parenteral fluids. The facility failed to provide quality of care in the management of Resident #5 who was receiving Total Parenteral Nutrition (TPN). The facility staff was not monitoring labs as ordered, assessing the resident, administering the TPN per protocol or adequatly documenting the administration of TPN (1 of 1 resident reviewed receiving TPN). Review of the medical record revealed Resident #5 was admitted to the facility on [DATE]. [DIAGNOSES REDACTED]. Resident #5 had an Ileostomy and Mucus Fistula. In an interview with the surveyor on 6/10/15 at approximately 10:10 AM, the 100/200 Unit Manager stated that Resident #5 was on TPN because of a short gut, most of the resident's small intestines were gone. The Clinical Competency Coordinator provided a Parenteral Nutrition Orders form dated 6/1/15 to the surveyor on 6/9/15 at approximately 3:30 PM. The form was noted to have a fax stamp across the top that indicated 6/9/15 at 12:52 PM. There was no Parenteral Nutrition Orders form dated 6/1/15 located on Resident #5's medical record. Review of the form revealed the TPN Base Formula was the same as the 5/19/15 order but the amount of additives per bag was different. Further review of the Parenteral Nutrition Orders form dated 6/1/15 revealed an order for [REDACTED]. Review of Resident #5's medical record revealed no results for the 6/3/15 labs ordered. Review of Resident #5's labs revealed liver function labs were drawn on… | 2018-05-01 |
| 6153 | 6153 | PRUITTHEALTH- RIDGEWAY | 425288 | 213 TANGLEWOOD COURT | RIDGEWAY | SC | 29130 | 2015-06-11 | 441 | F | 1 | 0 | NH5611 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observation and interview, the facility failed to maintain infection control practices related to isolation precautions. Resident #6 was admitted with a condition requiring contact isolation, however the precautions were not in place upon observation. The findings included: The facility admitted Resident #6 with [DIAGNOSES REDACTED]. The resident was a new admit, there were no Minimum Data Set (MDS) available for review. Record review indicated the resident required total assistance from staff for his/her Activity of Daily Living Care (ADLs). During the initial tour of the facility on 6/7/15 at 3:10 PM it was noted that Resident #6 had a 3 drawer bedside table outside of his/her room, but there were no signs on the door indicating precautions were in place. Review of the medical record on 6/9/15 at approximately 2:37 PM, revealed that Resident #6 was admitted to the facility on [DATE] with Clostridium Difficile, however, there were no orders written for precautions until 6/7/15. A review of the order revealed that the unit manager received the order for contact isolation at 7 PM on 6/7/15. During a second observation on 6/9/15 at approximately 2:37 PM, revealed that a sign had been posted on the door indicating all visitors were to report to the nurses station before entering. An interview was conducted with Licensed Practical Nurse (LPN) #1 on 6/10/15 at approximately 10:00 AM, revealed that with isolation precautions they are to write an order for [REDACTED]. We notify dietary and post a sign on the door and this is done on admission. The LPN stated that when they do an admission they (staff) should start with all the steps. In an interview with the surveyor on 6/7/15 at approximately 3:25 PM, the Weekend Supervisor stated that Resident #6 had come in on Friday. Resident #6 had[DIAGNOSES REDACTED] and was on contact precautions. The Weekend Supervisor stated they normally have contact precaution signs up for resident… | 2018-05-01 |
| 6154 | 6154 | PRUITTHEALTH- RIDGEWAY | 425288 | 213 TANGLEWOOD COURT | RIDGEWAY | SC | 29130 | 2015-06-11 | 490 | J | 1 | 0 | NH5611 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to be administered in a manner that enables it to use its resource effectively to maintain the highest practicable physical well-being of each resident. The facility failed to provide quality of care in the management of Resident #5 who was receiving Total [MEDICATION NAME] Nutrition (TPN). The facility staff was not monitoring labs as ordered, assessing the resident, administering the TPN per protocol or adequatly documenting the administration of TPN (1 of 1 resident reviewed receiving TPN). The findings included: Cross refer to F-328 as it relates to the failure of the facility to ensure that residents receive proper treatment and care for [MEDICATION NAME] fluids. The facility failed to provide quality of care in the management of Resident #5 who was receiving Total [MEDICATION NAME] Nutrition (TPN). The facility staff was not monitoring labs as ordered, assessing the resident, administering the TPN per protocol or adequatly documenting the administration of TPN (1 of 1 resident reviewed receiving TPN). Review of the medical record revealed Resident #5 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Resident #5 had an [MEDICAL CONDITION] and Mucus Fistula. Review of Resident #5's medical record revealed a [MEDICATION NAME] Nutrition Orders (PN) form dated 5/19/15. In an interview with the surveyor on 6/10/15 at approximately 10:10 AM, the 100/200 Unit Manager stated that Resident #5 was on TPN because of a short gut, most of the resident's small intestines were gone. The 100/200 Unit Manager reviewed the label on Resident #5's bag of TPN that was currently infusing. The 100/200 Unit Manager confirmed the label on the bag did not match the 5/19/15 TPN order. Review of the label revealed the TPN Base Formula matched the 5/19/15 order but the amount of additives per bag did not. The Clinical Competency Coordinator provided a [MEDICATION NAME] Nutrition Orders form da… | 2018-05-01 |
| 6155 | 6155 | PRUITTHEALTH- RIDGEWAY | 425288 | 213 TANGLEWOOD COURT | RIDGEWAY | SC | 29130 | 2015-06-11 | 501 | J | 1 | 0 | NH5611 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview the medical director failed to be responsible for the implementation of resident care policies. The medical director failed to be responsible for the implementation of resident care policies in the management of Resident #5 who was receiving Total [MEDICATION NAME] Nutrition (TPN). One of one residents reviewed receiving TPN. The findings included: Cross refer to F-328 as it relates to the failure of the facility to ensure that residents receive proper treatment and care for [MEDICATION NAME] fluids. The facility failed to provide quality of care in the management of Resident #5 who was receiving Total [MEDICATION NAME] Nutrition (TPN). The facility staff was not monitoring labs as ordered, assessing the resident, administering the TPN per protocol or adequatly documenting the administration of TPN (1 of 1 resident reviewed receiving TPN). Review of the medical record revealed Resident #5 was admitted to the facility on [DATE]. [DIAGNOSES REDACTED]. Resident #5 had an [MEDICAL CONDITION] and Mucus Fistula. Review of Resident #5's medical record revealed a [MEDICATION NAME] Nutrition Orders (TPN) form dated 5/19/15. The 5/19/15 [MEDICATION NAME] Nutrition Order form included information on the Total Nutrient Admixture Base Formula and also the amount of additives per bag. In an interview with the surveyor on 6/10/15 at approximately 10:10 AM, the 100/200 Unit Manager confirmed the 5/19/15 [MEDICATION NAME] Nutrition Order form was the only one on the resident's medical record. The 100/200 Unit Manager stated that the nurse should verify the TPN bag label matches the order dated 5/19/15. The 100/200 Unit Manager stated that [MEDICATION NAME] Nutrition Orders are not kept anywhere other than the resident's medical record. The 100/200 Unit Manager reviewed the label on Resident #5's bag of TPN that was currently infusing. The 100/200 Unit Manager confirmed the label on the bag did not match the 5/19/15 TPN ord… | 2018-05-01 |
| 6156 | 6156 | PRUITTHEALTH- RIDGEWAY | 425288 | 213 TANGLEWOOD COURT | RIDGEWAY | SC | 29130 | 2015-06-11 | 502 | J | 1 | 0 | NH5611 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview the facility failed to obtain laboratory services to meet the needs of Resident #5 who was receiving Total [MEDICATION NAME] Nurtition (TPN) (1 of 1 resident reviewed receiving TPN). The findings included: Cross refer to F-328 as it relates to the failure of the facility to ensure that residents receive proper treatment and care for [MEDICATION NAME] fluids. The facility failed to provide quality of care in the management of Resident #5 who was receiving Total [MEDICATION NAME] Nutrition (TPN). The facility staff was not monitoring labs as ordered, assessing the resident, administering the TPN per protocol or adequatly documenting the administration of TPN (1 of 1 resident reviewed receiving TPN). Review of the medical record revealed Resident #5 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Resident #5 had an [MEDICAL CONDITION] and Mucus Fistula. Review of Resident #5's medical record revealed a [MEDICATION NAME] Nutrition Orders (PN) form dated 5/19/15. The 5/19/15 [MEDICATION NAME] Nutrition Order form included information on the Total Nutrient Admixture Base Formula and also the amount of additives per bag. In an interview with the surveyor on 6/10/15 at approximately 10:10 AM, the 100/200 Unit Manager confirmed the 5/19/15 [MEDICATION NAME] Nutrition Order form was the only one on the resident's medical record. The 100/200 Unit Manager stated that the nurse should verify the TPN bag label matches the order dated 5/19/15. The 100/200 Unit Manager stated that [MEDICATION NAME] Nutrition Orders are not kept anywhere other than the resident's medical record. The 100/200 Unit Manager reviewed the label on Resident #5's bag of TPN that was currently infusing. The 100/200 Unit Manager confirmed the label on the bag did not match the 5/19/15 TPN order. Review of the label revealed the TPN Base Formula matched the 5/19/15 order but the amount of additives per bag did not. The Clinical Comp… | 2018-05-01 |
| 6157 | 6157 | PRUITTHEALTH- RIDGEWAY | 425288 | 213 TANGLEWOOD COURT | RIDGEWAY | SC | 29130 | 2015-06-11 | 514 | E | 1 | 0 | NH5611 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interviews, the facility failed to close medical records timely and place in an order that could be followed for 1 of 3 closed records reviewed. Resident #3 had been discharged from the facility in March, the medical record had not been closed out or placed in order. The findings included: On 6/9/15 the surveyor attempted to review Resident #3's discharged medical record from 10:00 AM through 1:00 PM. The medical record was not in any order. The face sheet and discharge nurses notes were not available. At 1:45 PM the Administrator was notified that the medical record was not in order and was returned to Medical Records. On 6/10/15 the medical record was reviewed. Review of the medical record revealed the facility had admitted Resident #3 with [DIAGNOSES REDACTED]. The resident was admitted with an open area on the coccyx. The area was documented as healed on 10/23/15. The next Wound Assessment Form was dated for February. The Wound Nurse was interviewed on 6/11/15 at approximately 8:50 AM. Resident #3's medical record was reviewed with the Wound Nurse. There was no November, December and January wound documentation available in the medical record. The Wound Nurse stated s/he would check the overflow. There is a lot of stuff missing from the chart. The November Treatment sheet is missing, weekly body audits and wound measurements. They may be in the over flow, we have a lot of overflow, I will check for the information in the over-flow. The missing documentation was not available during the survey. Review of the Facility Discharge Record Closure/ Analysis Policy revealed, Discharge records are to be assembled, completed and closed within thirty days of discharge. Discharge records are to be removed from the stations within 24-48 hours after discharge. | 2018-05-01 |
| 6158 | 6158 | PRUITTHEALTH- RIDGEWAY | 425288 | 213 TANGLEWOOD COURT | RIDGEWAY | SC | 29130 | 2015-06-11 | 520 | G | 1 | 0 | NH5611 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview the facility failed to develop and implement appropriate plans of action to correct identified quality deficiencies. Review of documentation provided by the facility revealed pressure ulcers were identified as an area of concern and a Performance Improvement Plan was implemented on 2/17/15. An updated Performance Improvement Plan related to pressure ulcers was created on 5/22/15. Resident #5 was admitted to the facility on [DATE] with two small open areas to his/her sacrum. No treatment was ordered and Wound Nurse #1 was not notified of the area until 6/2/15. One of one quality assessments reviewed. The findings included: Resident #5 was admitted to the facility on [DATE]. Review of Resident #5's Admission/Nursing Observation Form dated 5/20/15 completed by LPN (Licensed Practical Nurse) #1 indicated there were two small open areas at the top of the buttocks. Review of Resident #5's Body Audit Form dated 5/21/15 completed by LPN #2 indicated there were two small areas at the top of the buttocks. Review of the resident's physician's orders [REDACTED]. Review of Resident #5's Documentation of Wound Observation and Assessment Form dated 6/2/15 revealed the resident had a Stage III pressure ulcer to his/her sacrum that measured 1 x 0.5 x 0.2. Review of the physician's orders [REDACTED]. Cover the area with a dry dressing and change every 12 hours and as needed. Review of the resident's care plan revealed potential for alteration in skin integrity was identified as a problem area. Interventions and approaches to this problem area were documented on the care plan and included to report any signs/symptoms of skin alteration to the charge nurse or supervisor. In an interview with the surveyor on 6/9/15 at approximately 1:34 PM, Wound Nurse #1 stated a nurse and CNA (certified nurse aide) were changing Resident #5 and noted the area to his/her sacrum. They told Wound Nurse #1 about the area and that is when s/he or… | 2018-05-01 |
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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 );