rowid,facility_name,facility_id,address,city,state,zip,inspection_date,deficiency_tag,scope_severity,complaint,standard,eventid,inspection_text,filedate
2435,HIDDEN VALLEY CENTER,515147,422  23RD STREET,OAK HILL,WV,25901,2017-06-30,155,D,1,1,45HC11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on record review and staff interview, the facility failed to ensure Resident #133 was afforded the right to request, refuse, and/or discontinue treatment, and to formulate an advance directive. Resident #133 was determined to have capacity to make medical decisions, however; his caregiver had signed all his admission paperwork for admission and treatment at the facility. This was true for one (1) of one (4) residents reviewed for the care area of Choices during Stage 2 of the Quality Indicator Survey. Resident identifier: #133. Facility census: 76. Findings include: a) Resident #133 A review of Resident #133's medical record, at 1:12 p.m. on 06/28/17, found the resident was [AGE] year old resident with an admission date of [DATE]. Consent for treatment and release of information found in medical records was signed by Resident #133's Medical Power of Attorney (MPOA) on 04/07/17. Review of the record found a Physician's Determination of Capacity dated 04/08/17 which indicated Resident #133 was capacitated to make medical decisions. Contained in Resident #133's medical record was a form titled, Resident Representative Designation which allows the representative on behalf of patient to sign the for purposes of nursing facility admission. This form was signed by Resident #133's MPOA on 04/11/17. Resident #133 did not sign this form. Review of Resident #133's admission Minimum Data Set (MDS) with an Assessment Reference Date (ARD) of 04/12/17, found Resident #133's Brief Interview of Mental Status (BIMS) score was 14. This score indicates Resident #133 was cognitively intact. Further review of the record found no evidence to suggest the decisions made by Resident #133's MPOA were ever discussed with Resident #133. An interview with the Admission Director, at 10:26 a.m. on 06/29/17, confirmed she completed the admission form with Resident #133's MPOA on 04/07/17 and 04/08/17. She stated, what typically happens we have an admission meeting and the resident is involved in the process if they have capacity. She then reviewed Resident #133's record and stated, It looks like it was not documented the resident was involved in the decisions and wishes of his care. An interview, on 06/29/17 at 11:30 a.m., with Acting Administrator, when the medical records for Resident #133 was reviewed. She confirmed there was no evidence Resident #133 was involved in his medical decisions. No further information was provided.",2020-09-01
2436,HIDDEN VALLEY CENTER,515147,422  23RD STREET,OAK HILL,WV,25901,2017-06-30,157,D,1,1,45HC11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on record review and staff interview, the facility failed to inform the responsible party of one (1) of three (3) residents reviewed for the care area of Nutritional status when a significant weight loss occurred. Resident #75 experienced a 5.5% weight loss fifteen (15) days after admission to the facility. Resident identifier: #75. Facility census 76. Findings include: a) Resident #75 Record review, at 10:56 a.m. on 06/27/17, found the resident triggered the care area of nutritional status due to a 5.5% weight loss fifteen (15) days after his original admission to the facility. The resident was admitted to the facility on [DATE] and was discharged from the facility to his home on 03/10/17. The following weights were available in the resident's electronic medical record: --02/16/17 - 181.6 pounds (lbs) --02/21/17 - 176.6 lbs. --02/28/17 - 173.6 lbs. --03/07/17 - 171.8 lbs. The resident did not have a terminal diagnosis. He was admitted to the facility after a hospital stay where he was treated for [REDACTED]. The resident planned to receive rehabilitation and return to his home. On 02/26/17, the resident was deemed to lack capacity to make medical decisions. The incapacity was expected to be long term due to cognitive loss. Further review of the medical record found no evidence the resident's responsible party had been informed of the weight loss. The Director of Nursing (DON) was interviewed, on 06/28/17 at 2:45 p.m., regarding the resident's weight loss and notification of his responsible party. The DON concluded the electronic medical record only alerts the facility of weight loss after 30 days. The DON said since the resident was here less than 30 days, and his weight loss did not show up on the computer. The DON was unable to provide evidence the resident's responsible party was aware of the weight loss when the facility should have known about the weight loss on 03/07/17.",2020-09-01
2437,HIDDEN VALLEY CENTER,515147,422  23RD STREET,OAK HILL,WV,25901,2017-06-30,272,D,1,1,45HC11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on medical record review and staff interview, the facility failed to ensure the comprehensive Minimum Data Set (MDS) assessments accurately reflected each residents' status. Resident #133's MDS was inaccurate in the area of Prognosis (life expectancy of six months or less). For Resident #47, the MDS was inaccurate in the area of Vision. This was true for two (2) of twenty-one (21) residents reviewed for accuracy of comprehensive assessments during Stage 2 of the Quality Indicator Survey (QIS). Resident identifiers: #133 and #47. Facility Census: 76. Findings include: a) Resident #133 Resident #133 was admitted on [DATE] with pertinent [DIAGNOSES REDACTED]. This resident had multiple admissions over the last two (2) years and had been released the day before ([DATE]) from another acute care hospital prior to his admission on [DATE] to another acute care facility. During his eight (8) day stay in the acute care hospital Resident #133 showed little to no improvement and as documented in the discharge summary dated [DATE], the hospital physician spoke with the resident concerning his grave condition and poor prognosis and Hospice services was consulted to see him in the nursing home. According to the medical record, the resident expired at the local emergency roiagnom on [DATE]. On [DATE], the attending physician also spoke with Resident #133 concerning his grave condition and poor prognosis. He agreed he wanted Hospice services consulted. Further review of the medical records indicated the resident refused hospice services on [DATE]. The admission MDS with an ARD of [DATE], did not indicate the resident had a condition or terminal illness which would result in a life expectancy of less than six (6) months. An interview, on [DATE] at 11:00 a.m., with the MDS coordinator. She verified the MDS with ARD date [DATE] was inaccurate. She confirmed the resident had a terminal illness that may result in a life expectancy of less than six (6) months. She further verified the resident had declined hospice but understood his poor prognosis and grave condition. The MDS with ARD of [DATE] was immediately corrected and submitted. b) Resident #47 Medical record review for this discharged resident began on [DATE] at 8:29 a.m. The resident's significant change minimum data sets (MDS), with assessment reference dates (ARD) of [DATE] and [DATE], assessed this resident with impaired vision. Per the assessments, she could see large print, but was unable to see regular print. Section B1200 asked if corrective lenses (contacts, glasses, or magnifying glass) were used. The answer was no for both assessments An interview was conducted with MDS Registered Nurse (RN) #40 on [DATE] at 8:17 a.m. She said this resident had glasses and typically wore them. She said she marked section B1200 as no, because she refused to wear the glasses at the time of the vision assessment in (MONTH) of (YEAR). She said time was running out to do the vision assessment during the look back period, as it was quite hectic during that period of time. Therefore, she did not return at a different time or date to try and re-assess her vision while wearing the glasses. She said there was no option on the MDS to indicate the resident was not cooperative. She said she felt if it were marked not assessed, it meant that they did not even try to assess her vision. She admitted she did not write a clarification note and/or progress note to explain her rationale the resident wore glasses, but just not during the assessment. She said a former MDS nurse who no longer works at the facility, completed the significant change MDS with ARD of [DATE]. The former nurse also assessed the resident with impaired vision, and that corrective lenses were not used. RN #40 reviewed the MDS and progress notes, and found no documentation related as to how the former nurse came to the conclusion that the resident had impaired vision, but did not wear corrective lenses. During an interview with the director of nursing on [DATE] at 8:09 a.m., no further information was provided.",2020-09-01
2438,HIDDEN VALLEY CENTER,515147,422  23RD STREET,OAK HILL,WV,25901,2017-06-30,278,D,1,1,45HC11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on record review and staff interview the facility failed to ensure a complete and accurate Minimum Data Set (MDS) for two (2) of twenty-one (21) residents whose MDS's were reviewed during Stage 2 of the Quality Indicator Survey (QIS). Resident #75's MDS was incorrect for the care area of Swallowing/Nutritional Status and Resident #26's MDS was incorrect in the care area of Medications. Resident identifiers: #75 and #26. Facility census: 76. Findings include: a) Resident #75 Record review, at 10:56 a.m. on 06/27/17, found the resident triggered the care area of nutritional status due to a 5.5% weight loss fifteen (15) days after his original admission to the facility. The resident was admitted to the facility on [DATE], and was discharged from the facility to his home on 03/10/17. The following weights were available in the resident's electronic medical record: --02/16/17 - 181.6 pounds (lbs) --02/21/17 - 176.6 lbs --02/28/17 - 173.6 lbs --03/07/17 - 171.8 lbs The following formula determines percentage of weight loss: % of body weight loss = (usual weight -181.6) - actual weight- 171.8) / (usual weight-181.6) x 100. Review of the resident's discharge MDS with an assessment reference date (ARD) of 03/10/17 found Section K, did not code the resident as having a loss of 5% or more in the last month or loss of 10% or more in the last 6 months. At 12:01 p.m. on 06/27/17, the dietary manager (DM) #10 said she did not complete the discharge MDS because she was not employed at the time of completion. DM #10 said the MDS was completed by the dietician who is not at the facility, at this time, for interview. At 12:10 p.m. on 06/27/17 DM #10 and the facility's chef, #17 confirmed the discharge MDS was incorrect. Both employees verified the resident had a 5.5% weight loss which was not captured on the discharge MDS. b) Resident #26 A review of Resident #26's medical record, on 06/29/17 at 8:30 a.m., found a quarterly MDS with an assessment reference date (ARD) of 05/19/17. Review of the MDS found Section N0410 (Medication Received: A) Antipsychotic) was marked with a two (2) to indicate Resident #26 received an antipsychotic medication two (2) of the seven (7) days during the seven (7) look back period. Review of Resident #26's Medication Administration Record [REDACTED]. Resident #26 received this medication on 05/13/17, 05/14/17, 05/16/17 and 05/18/17. A review of the RAI manual, at 11:30 a.m. on 06/29/17, found the following coding instructions pertaining to section N0410 A, Antipsychotic: Record the number of days an antipsychotic medication was received by the resident at any time during the 7-day look back period (or since admission/entry if less than 7 days). An interview with the MDS Assessment, at 1:15 p.m. on 06/29/17, confirmed the MDS with the ARD of 05/19/17 was inaccurate.",2020-09-01
2439,HIDDEN VALLEY CENTER,515147,422  23RD STREET,OAK HILL,WV,25901,2017-06-30,279,D,1,1,45HC11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on medical record review and staff interview, the facility failed to develop a care plan for a resident who declined in urinary continence status. This was evident for one (1) of three (3) residents reviewed for urinary incontinence. Resident identifier: #84. Facility census: 76. Findings include: a) Resident #84 Review of the medical record for this discharged resident began on 06/27/17 at 10:57 a.m. [DIAGNOSES REDACTED]. She resided on the facility's Alzheimer's unit. Review of the 5-day admission MDS with assessment reference date (ARD) 11/24/16, and the 14-day MDS with ARD 12/01/16, assessed that she was always continent of urine. A significant change MDS with ARD 02/15/17, assessed that she was frequently incontinent of urine. Another significant change MDS with ARD 04/11/7, assessed that she was always incontinent of urine. Review of the care plan found it was not developed to include the assessed decline in urinary continence. An individualized goal related to urinary incontinence was not developed until 04/12/17. An interview was conducted with MDS registered nurse #40 on 06/27/17 at 11:58 a.m. She said this resident resided in the facility's Alzheimer's unit. However, due to an overall decline in her [MEDICAL CONDITION], she no longer met the criteria for the locked unit. She transferred to another facility closer to her family on 04/14/17. She explained that a significant change MDS was completed in (MONTH) (YEAR) by a nurse who formerly worked at the facility. She said at that time, the resident sustained [REDACTED]. After first reviewing the care plan, she agreed that the care plan was not developed with measurable goals related to the decline in urinary incontinence until 04/12/17. She agreed that it should have been done at the time of the 02/15/17 significant change MDS, and it was not.",2020-09-01
2440,HIDDEN VALLEY CENTER,515147,422  23RD STREET,OAK HILL,WV,25901,2017-06-30,280,D,1,1,45HC11,"> Based on observation, record review and staff interview, the facility failed to ensure the resident's care plan was revised to reflect the information on the most recent Minimum Data Set (MDS) for one (1) of three (3) residents reviewed for the care area of Vision during Stage 2 of the Quality Indicator Survey (QIS). Resident identifier: #22. Facility census: 76. Findings include: a) Resident #22 Review of the residents last minimum data set (MDS), a significant change, with an assessment reference date (ARD) of 4/7/17 found Section B, entitled vision, coded the resident as having impaired vision but no corrective lenses. Observation of resident at 12:15 p.m. on 06/27/17, found she was not wearing glasses. At 12:35 p.m. on 06/27/17, the residents Nurse Aide (NA) #65 said, I have been here for 3 years and she doesn't wear glasses or have any glasses. NA #65 searched the resident's room and found no glasses, only an empty glasses case in the night stand drawer. Review of the resident's current care plan found the problem: --(Name of resident) has vision impairment: wears eyeglasses. The goal associated with the problem was: --(Name of resident) will remain free from falls without major injury requiring hospitalization through next review. Interventions included: --Encourage resident to utilize her eyeglasses, resident frequently refuses to wear glasses. At 9:45 a.m. on 6/28/17, the Registered Nurse (RN), clinical reimburse coordination (CRC), #40 accompanied the surveyor to the resident's room. CRC #40 was also unable to find any glasses in the resident's room. CRC #40 verified the resident was care planned to wear glasses and the significant change MDS completed on 04/07/17 noted the resident did not have any glasses.",2020-09-01
2441,HIDDEN VALLEY CENTER,515147,422  23RD STREET,OAK HILL,WV,25901,2017-06-30,282,D,1,1,45HC11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on record review and staff interview, the facility failed to implement the care plan for one (1) of three (3) residents reviewed for the care area of Nutritional status. Resident #75 experienced a 5.5% weight loss within fifteen (15) days after being admitted to the facility. The care plan directed the facility to monitor the resident's intake at all meals. The resident was ordered a nutritional supplement to be provided at all meals. The facility did not record the amount of the nutritional supplement consumed by the resident during meal times to determine if the supplement was effective for the resident's weight loss. Resident identifier: #75. Facility census: 76. Findings include: a) Resident #75 Record review at 10:56 a.m. on 06/27/17, found the resident triggered the care area of nutritional status due to a 5.5% weight loss fifteen (15) days after his original admission to the facility. The resident was admitted to the facility on [DATE] and was discharged from the facility to his home on 03/10/17. The following weights were available in the resident's electronic medical record: --02/16/17 - 181.6 pounds (lbs) --02/21/17 - 176.6 lbs --02/28/17 - 173.6 lbs --03/07/17 - 171.8 lbs The following formula determines percentage of weight loss: % of body weight loss = (usual weight -181.6) - actual weight- 171.8) / (usual weight-181.6) x 100 The resident did not have a terminal diagnosis. He was admitted to the facility after a hospital stay where he was treated for [REDACTED]. The resident planned to receive rehabilitation and return to his home. Review of the current care plan, dated 02/21/17, noted the following problem: --(Name of resident) is at nutritional risk: related to requires mechanically altered diet, skin breakdown present, and [DIAGNOSES REDACTED]. The goal associated with this problem was: --The resident will have no significant changes thru next review date. Interventions included: --Monitor intake at all meals, offer alternate choices as needed, alert dietician and physician to any decline in intake. On 02/18/17, the physician ordered Glucerna, a nutritional supplement, 237 milliliters to be given with each meal. The Glucerna was added to the residents Medication Administration Record [REDACTED] Review of the MAR found daily documentation the Glucerna was provided as directed but the MAR indicated [REDACTED]. The director of nursing (DON) was interviewed on 06/28/17 at 2:45 p.m. regarding the resident's weight loss. The DON confirmed the facility staff should document the percentage of nutritional supplements consumed by residents. She was asked how the facility would be able to monitor the effectiveness of a supplement if the percent was not recorded by the facility. In addition, how would the facility notify the dietician and physician of a decline in intake as directed by the care plan. She was unable to provide evidence the percentage of the supplement consumed was documented. Only the percentage of the resident's actual meal intake was documented by the nursing assistants. At 2:59 p.m. on 06/28/17, Licensed Practical Nurse (LPN) #59 said that when she initialed the MAR indicated [REDACTED]. She said, We normally record the percentage consumed by the resident, I don't know why we didn't do it this time.",2020-09-01
2442,HIDDEN VALLEY CENTER,515147,422  23RD STREET,OAK HILL,WV,25901,2017-06-30,309,E,1,1,45HC11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on medical record review, staff interview, observation, physician interview and policy review, the faciliy failed to ensure it had accurate and clear physician orders [REDACTED]. This was evident for one (1) of five (5) residents observed during mediction pass observation. Resident identifier: #33. Facility census: 76. Findings include: a) Resident #33 On 06/27/17 at 9:15 a.m., Licensed Practical Nurse (LPN) #54 said she went on lunch break at 11:30 a.m. today, but would be back at noon or shortly after noon to do a fingerstick blood sugar check and administration of insulin for Resident #33. During medication pass observation, on 06/27/17 at 12:22 p.m., LPN #54 administered twelve (12) units of [MEDICATION NAME]subcutaneously following a fingerstick blood glucose result of 401 milligrams per deciliters (mg/dl). The resident's lunch tray which he had finished eating, sat on his overbed tray. According to the medication administration record (MAR), the sliding scale insulin coverage with [MEDICATION NAME]was scheduled daily at 7:00 a.m., 11:00 a.m., 5:00 p.m., and 9:00 p.m. daily. Upon inquiry as to whether the physician wanted to do the fingerstick blood sugar and insulin coverage prior to meals, she replied in the negative. The nurse said the lunch trays do not arrive on this hall until noon. She said he receives the insulin coverage after he eats in order to bring down the blood sugar. She said his blood sugars are like a roller coaster. A physician's orders [REDACTED]. The order gave directives of how much insulin to give for certain blood sugar parameters. However, the order did not direct the number of times per day to obtain the blood sugar readings and insulin coverage. The order also did not specify the timing of the blood sugars and insulin coverage as related to the meals serves. The physician signed the telephone order on 06/21/17. Review of the MAR found his fingerstick blood sugars were tested daily at 7:00 a.m., 11:00 a.m., 5:00 p.m., and 9:00 p.m. from 11:00 a.m. on 06/20/17 through 11:00 a.m. on 06/2717. He received insulin coverage for elevated blood sugars on twenty-two (22) out of twenty-nine (29) opportunities. Review of the medical record found previous orders for fingerstick (accucheck) blood sugar checks and [MEDICATION NAME]per sliding scale orders as follows: --On 06/08/17 through 06/18/17, the physician ordered blood sugars and [MEDICATION NAME] sliding scale insulin four (4) times daily, at 6:30 a.m., 11:30 a.m., 4:30 p.m., and 9:00 p.m. each day. --On 06/19/17 the physicain ordered fingerstick (accucheck) bloods sugars twice daily at 7:00 a.m. and 5:00 p.m. daily with no coverage. On 06/27/17 at 1:00 p.m., registered nurse #40 provided a copy of the facility's policy for standing orders for blood sugar coverage. Policy 15.0 Fingerstick Glucose Measurement, with effective date 12/01/06 stated, Diabetic residents will have blood glucose levels measured by fingerstick according to physician ordered schedule. At 3:00 p.m. on 06/27/17, an interview was conducted with the Director of Nursing (DON). Upon inquiry as to whether the fancily has any standing orders for sliding scale insulin administration, she provided a document found on her bulletin board titled, Sliding scale blood sugar coverage with [MEDICATION NAME] R. It listed parameters of how many units of insulin to give for specific blood sugar results. However, it did not specify if the blood sugars were to be checked before meals and bedtime, with meals, after meals, or the number of times per day. An interview was conducted with the resident's physician on 06/27/17 at 3:15 p.m. Upon inquiry as to when she wanted blood sugars checked on this resident, she at first said before meals. She then said she definitely wanted the blood sugar in the morning before the meal, but perhaps the lunch and dinner blood sugar checks should be after meals. She said bedtime is just bedtime. She said that in general she does not like sliding scales, but this resident needed it. She said she used sliding scales generally to determine daily dosages. She was informed that today the nurse documented on the MAR at 11:00 a.m. that the blood sugar was 401 mg/dl. However, the resident actually had ingested his meal at noon, and his blood sugar was checked after he ate. She agreed that if the physician thought the premeal blood sugar was 401, and did not realize it was a postmeal blood sugar, that it had the potential to erroneously impact her assessment of his blood sugar status. She said she would clarify the orders for sliding scale insulin coverage for this resident. An interview was conducted with the DON on 06/27/17 at 4:01 p.m. She agreed that the nurse who transcribed the order on 06/20/17 should have clarified the order with the physician as to the times of day, and the number of times per day, for the blood sugar checks and insulin coverage. On 06/29/17, an interview was conducted with the acting administrator at 2:34 p.m It was discussed that nursing wrote a telephone order at noon on 06/20/17 for sliding scale insulin cover and the parameters, but failed to ensure orders for the scheduling of the blood sugars and coverage. Following surveyor intervention, the physician on 06/27/17 wrote new orders for sliding scale coverage for four (4) times daily, and specified the morningas fasting, after lunch, after dinner, and at bedtime. The acting administrator provided no further information.",2020-09-01
2443,HIDDEN VALLEY CENTER,515147,422  23RD STREET,OAK HILL,WV,25901,2017-06-30,313,E,1,1,45HC11,"> Based on record review, observation and staff interview, the facility failed to ensure one (1) of three (3) residents reviewed for the care area of Vision during Stage 2 of the Quality Indicator Survey (QIS) received assistive devices to maintain vision. The resident's glasses were not available for use. Resident identifier: #22. Facility census: 76. Findings include: a) Resident #22 Review of the residents last Minimum Data Set (MDS), a significant change, with an assessment reference date (ARD) of 04/07/17 found Section B, entitled vision, coded the resident as having impaired vision but no corrective lenses. Observation of resident, at 12:15 p.m. on 06/27/17, found she was not wearing glasses. At 12:35 p.m. on 06/27/17, the residents Nurse Aide (NA) #65 said, I have been here for 3 years and she doesn't wear glasses or have any glasses. NA #65 searched the resident's room and found no glasses, only an empty glasses case in the night stand drawer. Review of the resident's current care plan found the problem: --(Name of resident) has vision impairment: wears eyeglasses. The goal associated with the problem was: --(Name of resident) will remain free from falls without major injury requiring hospitalization through next review. Interventions included: --Encourage resident to utilize her eyeglasses, resident frequently refuses to wear glasses. At 9:45 a.m. on 6/28/17, the Registered Nurse (RN), clinical reimburse coordination (CRC), #40 accompanied the surveyor to the resident's room. CRC #40 was also unable to find any glasses in the residents room. At 12:10 p.m. on 06/28/17, the social worker (SW), #96 said she talked to the residents son who said the glasses have been missing for 2 or 3 months. At approximately 3:00 p.m. on 06/28/17, SW #96 said she had located the resident's glasses in a drawer at the nurses station and she would be returning them to the resident.",2020-09-01
2444,HIDDEN VALLEY CENTER,515147,422  23RD STREET,OAK HILL,WV,25901,2017-06-30,333,E,1,1,45HC11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on observation, medical record review, staff interview, physician interview, and policy review, the facility failed to ensure that it was free of any significant medication errors. The facility administered sliding scale insulin coverage four (4) times daily for seven (7) days in the absence of physician's orders [REDACTED]. This was evident for one of five (5) residents observed during medication pass administration. Resident identifier: #33. Facility census: 76. Findings include: a) Resident #33 During medication pass observation, on 06/27/17 at 12:22 p.m., Licensed Practical Nurse (LPN) #54 administered twelve (12) units of [MEDICATION NAME]subcutaneously following a fingerstick blood glucose result of 401 milligrams per deciliters (mg/dl). The resident's lunch tray which he had finished eating, sat on his overbed tray. According to the medication administration record (MAR), the sliding scale insulin coverage with [MEDICATION NAME]was scheduled daily at 7:00 a.m., 11:00 a.m., 5:00 p.m., and 9:00 p.m daily. Upon inquiry as to whether the physician wanted to do the fingerstick blood sugar and insulin coverage prior to meals, she replied in the negative. The nurse said the lunch trays do not arrive on this hall until noon. She said he receives the insulin coverage after he eats in order to bring down the blood sugar. She said his blood sugars are like a roller coaster. A physician's orders [REDACTED]. The order gave directives of how much insulin to give for certain blood sugar parameters. However, the order did not direct the number of times per day to obtain the blood sugar readings and insulin coverage. The order also did not specify the timing of the blood sugars and insulin coverage as related to the meals serves. The physician signed the telephone order on 06/21/17. Review of the MAR found that his fingerstick blood sugars were documented as tested daily at 7:00 a.m., 11:00 a.m., 5:00 p.m., and 9:00 p.m. from 11:00 a.m. on 06/20/17 through 11:00 a.m. on 06/27/17. He received insulin coverage for elevated blood sugars on twenty-two (22) out of twenty-nine (29) opportunities. On 06/27/17 at 1:00 p.m., registered nurse #40 provided a copy of the facility's policy for standing orders for blood sugar coverage. Policy 15.0 Fingerstick Glucose Measurement, with effective date 12/01/06 stated, Diabetic residents will have blood glucose levels measured by fingerstick according to physician ordered schedule. At 3:00 p.m. on 06/27/17, an interview was conducted with the director of nursing (DON). Upon inquiry as to whether the fancily has any standing orders for sliding scale insulin administration, she provided a document found on her bulletin board titled Sliding scale blood sugar coverage with [MEDICATION NAME] R. It listed parameters of how many units of insulin to give for specific blood sugar results. However, it did not specify if the blood sugars were to be checked before meals and bedtime, with meals, after meals, or the number of times per day. An interview was conducted with the resident's physician, on 06/27/17 at 3:15 p.m. Upon inquiry as to when she wanted blood sugars checked on this resident, she at first said before meals. She then said she definitely wanted the blood sugar in the morning before the meal, but perhaps the lunch and dinner blood sugar checks should be after meals. She said bedtime is just bedtime. She said that in general she does not like sliding scales, but this resident needed it. She said she used sliding scales generally to determine daily dosages. She was informed that today the nurse documented on the MAR at 11:00 a.m. that the blood sugar was 401 mg/dl. However, the resident actually had ingested his meal at noon, and his blood sugar was checked after he ate. She agreed that if the physician thought the premeal blood sugar was 401, and did not realize it was a postmeal blood sugar, that it had the potential to erroneously impact her assessment of his blood sugar status. She said she would clarify the orders for sliding scale insulin coverage for this resident. An interview was conducted with the DON, on 06/27/17 at 4:01 p.m. She agreed that the nurse who transcribed the order on 06/20/17 should have clarified the order with the physician as to the times of day, and the number of times per day, for the blood sugar checks and insulin coverage. On 06/29/17, an interview was conducted with the acting administrator at 2:34 p.m. It was discussed that nursing wrote a telephone order at noon on 06/20/17 for sliding scale insulin cover and the parameters, but failed to ensure orders for the scheduling of the blood sugars and coverage. Following surveyor intervention, the physician on 06/27/17 wrote new orders for sliding scale coverage for four (4) times daily, and specified the morning fasting, after lunch, after dinner, and at bedtime. The acting administrator provided no further information.",2020-09-01
2445,HIDDEN VALLEY CENTER,515147,422  23RD STREET,OAK HILL,WV,25901,2017-06-30,371,E,0,1,45HC11,"Based on observation and staff interview the facility failed to ensure food was stored in a safe and sanitary manner to prevent the spread of food borne illnesses. In the walk in cooler there was opened and undated cheese and Opened and dated cheese which should discarded, but was still available for use. In the A - Hall nutrition pantry there was opened and undated thickened liquids. This practice had the potential to affect more than an isolated number of residents. Facility Census: 76. Findings Include: a) Kitchen An initial tour of the kitchen at 8:45 a.m. on 06/26/17 with the Certified Dietary Manager (CDM) found the following concerns in the walk in cooler: --Sliced American Cheese which was opened and not dated. --Shredded Mozzarella Cheese 5 lb bag which was opened and not dated. --Two bags of Grated Parmesan Cheese. One bag was dated 06/15/17 and one bag was dated 05/2(illegible)/17 (the number behind the 2 was illegible). The CDM stated someone had to date that wrong there is no way we have had that in there that long. When asked how long to keep cheese after it is opened she stated it should be 7 days. b) A - Hall Nutrition Pantry Tour of the A hall Nutrition pantry with the CDM at approximately 9:00 a.m. on 06/26/17 found the following concerns in the refrigerator: --A 46 ounce container of thickened apple juice which was opened and not dated. --A 48 ounce container of Hydralyte Thickened water was opened and not dated. The CDM stated, I even put a place on there for them to put the date they opened it and they did not do it.",2020-09-01
2446,HIDDEN VALLEY CENTER,515147,422  23RD STREET,OAK HILL,WV,25901,2017-06-30,431,D,1,1,45HC11,"> Based on observation, policy review and staff interview, the facility failed, in collaboration with the pharmacist, to ensure the safe and effective use of medications. Two (2) multi-dose vials of insulin on the A hall medication cart contained opened and partially used vials of insulin which contained no date to indicate when they had first been opened. This had the potential to negatively impact the safety and/or potency of the medication. This was found for one (1) of two (2) medication carts checked, and most directly affected Residents #145 and #68. Resident identifiers: #145, #68. Facility census: 76. Findings include: a) Observation of the A hall medication cart on 06/28/17 at 7:56 a.m., accompanied by licensed nurse #51, found two (2) opened and partially used vials of insulin. A three (3) milliliter (ml) vial of Humulin-R insulin for Resident #145 was opened and over half gone. A three (3) ml. vial of Humulin-R insulin for Resident #68 was opened and over half gone. Neither vial, or their storage boxes, contained the dates they were initially opened for use. Nurse #51 said both of the vials should have been dated when initially opened. She produced, and reviewed, the facility's insulin storage policy at this time, which stated that all insulin vials must be dated when first opened. It further stated that Humulin-R insulin may be used for only thirty-one (31) days after initially opened. She agreed that by not knowing the initial date of opening, it could not be determined when to discard the vial at thirty-one (31) days. She discarded those two (2) vials in question. On 06/30/17 at 8:08 a.m., an interview was conducted with the director of nursing (DON). She said staff informed her of those two (2) insulin vials which were not dated when initially opened. She said their policy dictates that staff must date the vials when initially opened for the first time, and discard the vials at times prescribed by the manufacturer.",2020-09-01
2447,HIDDEN VALLEY CENTER,515147,422  23RD STREET,OAK HILL,WV,25901,2017-06-30,441,F,1,1,45HC11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on observation and staff interview, the facility failed to ensure soiled linens/laundry were handled properly to prevent the spread of infection. The facility failed to ensure proper cleaning and sanitizing supplies were available for staff usage in a room identified as an isolation room for Resident #127. In addition, an ice scoop was not sanitized after touching the rim of Resident #80's personal drinking glass. This practice had the potential to affect more than an isolated number of residents. Resident identifiers: #127 and #80. Facility census: 76. Findings include: a) Resident #127 Resident #127 was admitted to the facility on [DATE] at 10:29 p.m. The resident's hospital discharge summary noted the final [DIAGNOSES REDACTED]. At 2:01 p.m. on 06/27/17, observation found two (2) housekeeping carts parked in the hallway outside Resident #127's room. Signage on the resident's door instructed visitors to please see the nurse before entering the room. A three drawer cart, containing personal equipment (PPE), and other items was also parked outside the residents room door, in the hallway. Employee #24, a housekeeper, was inside the residents room, wearing gloves and a gown. She was cleaning the resident's floor with a mop. Employee #23, also a housekeeper, was standing outside the resident's room when [NAME] #24 rolled a covered laundry cart outside the door of the resident's room to [NAME] #23. [NAME] #23's only PPE was gloves. Continued observation, found [NAME] #23 took the cart down the hallway to the laundry room. When asked what she intended to do with the soiled laundry, she stated, the laundry is in a disintegrating bag and it needed to be washed alone. She stated, I am working second shift as the laundry person so I am going to go ahead and start the washer. [NAME] #23 opened the cart and said, Someone put this stuff in a garbage bag, not a disintegrating laundry bag. [NAME] #23 opened the washing machine door and dumped the laundry from a clear garbage bag into the washer. [NAME] #23 did not put on a gown before putting the laundry into the washer. E#23 removed her gloves, washed her hands and returned to the floor. The surveyor returned to the hallway outside Resident #127's room. [NAME] #24 had just finished cleaning Resident #127's room and was outside the room standing beside her cleaning cart. [NAME] #24 had already removed her PPE. [NAME] #24 was asked how she cleaned the resident's room. [NAME] #24 said she had cleaned the resident's room with Clorox. When asked if she had Clorox on her cleaning cart, she produced a bottle of Comet cleaner with bleach and then said this was what she used to clean the resident's room. [NAME] #24 said this was the last room she cleaned for the day as her mop head had to be bagged and could not be used again in any other resident's room. Conflicting information occurred when [NAME] #24 related how she cleaned the resident's room to the surveyor and the hand written statement she provided to facility staff regarding the cleaning of the room. As the surveyor did not visualize the actual cleaning of the room, [NAME] #24's statements could not be confirmed or denied. Employee #24 said the three drawer isolation cart contained wipes that could be used for wiping down surfaces in the resident's room. She opened the middle drawer of the cart and showed the surveyor a canister of CaviWipes which she said she had used. Later when E#24 provided a hand written statement she denied using the CaviWipes and said she wiped the surfaces in the room down with the Comet cleaner. The isolation cart also contained several disintegrating laundry bags. At 3:00 p.m. on 06/27/17, the above issues were discussed with the acting administrator, a Registered Nurse (RN), and the Director of Nursing (DON). Both employees viewed the canister of CaviWipes in the isolation cart. The labeling on the canister, as to the organisms the wipes were effective against, did not include[DIAGNOSES REDACTED]. The DON said wipes with bleach should have been on the isolation cart. The DON did not know who had stocked the isolation cart. Both employees also viewed the disintegrating laundry bags in the isolation cart. At 8:45 a.m. on 06/28/17, the DON provided a copy of, Linen Handling, Infection Control Policies and Procedures, revised on 11/28/17. The DON said policy did not require the use of disintegrating laundry bags. She did verify the bags were on the isolation cart. The policy instructs staff to: .7.3 Use Standard Precautions: 7.3.1 Wear gloves, 7.3.2 Wear gown/apron if linen is visibly soiled and may come in contact with uniform/clothes . The facility has a contracted housekeeping company that provides the housekeeping and laundry services. This company employees [NAME] #23 and E#24. A copy of an in-service was provided for, Contaminated Isolation Room Cleaning[DIAGNOSES REDACTED] spores used by the housekeeping services group at 9:10 a.m. on 06/29/17. The in-service directed: 1. Before entering the room-identify that there is a sign posted regarding an isolation room and check with the Nursing staff to be informed of any open infections and universal precautions that need to be taken prior to entering. a. Wash hands and arms using the proper hand washing technique. b. Dress in isolation clothes provided by nursing staff outside of isolation room, this includes but not limited to gloves, gown, and mask . 4. b. Double bag bed linens and identify them as isolation room contents for laundry personnel. Place inside room until you exit . On 06/29/17 at 9:10 a.m. the administrator, DON, and and the regional vice president of operations, [NAME] #107, provided information from the manufacturer noting the Comet was effective in killing[DIAGNOSES REDACTED]. The DON said the CaviWipes had been replaced with Clorox wipes in the isolation cart. The DON said there was no evidence the CaviWipes had been used to clean the resident's room before discovered on the evening of 06/27/17 at 3:00 p.m. as the resident had only been at the facility for less than 24 hours. The DON did verify the CAviWipes were the only cleaning wipes in the isolation cart and were available for use by the staff. The DON confirmed [NAME] #23 should have worn a gown when she placed the soiled linens in the washing machine. The conflicting information regarding the facility's policy for handling linens and the housekeeping/laundry contracted services in-service for handling linens was discussed with the above staff. No comment was provided by facility staff. The guidance to surveyors for F 441 provides the following guidance: C. difficile is a bacterial species of the genus clostridium, which are gram-positive, spore-forming rods (bacilli). The organism normally lives benignly in the colon in spore form. When antibiotic use eradicates normal intestinal flora, the organism may become active and produce a toxin that causes symptoms such as diarrhea, abdominal pain, and fever. More severe cases can lead to additional complications such as intestinal damage and severe fluid loss. Treatment options include stopping antibiotics and starting specific anticlostridial antibiotics, e.g., [MEDICATION NAME] or oral [MEDICATION NAME]. If a resident has diarrhea due to [DIAGNOSES REDACTED]icile, large numbers of [DIAGNOSES REDACTED]icile organisms will be released from the intestine into the environment and may be transferred to other individuals, causing additional infections. Contact precautions are instituted for residents with symptomatic [DIAGNOSES REDACTED]icile infection. Contact Precautions require the use of appropriate PPE, including a gown and gloves upon entering the contact precaution room. Prior to leaving the contact precaution room the PPE is removed and hand hygiene is performed. C. difficile can survive in the environment (e.g., on floors, bed rails or around toilet seats) in its spore form for up to six months. Rigorously cleaning the environment removes [DIAGNOSES REDACTED]icile spores, and can help prevent transmission of the organism. Cleaning equipment used for residents with [DIAGNOSES REDACTED]icile with a 1:10 dilution of sodium hypochlorite (one part bleach to nine parts water) will also reduce the spread of the organism. Once mixed, the solution is effective for 24 hours. c) Resident #80 During the A hall lunch meal serve observation on 06/26/17, staff pushed a cart down the hallway which contained a bucket of ice. Staff obtained ice with a metal scoop to fill clean glasses sent from dietary, to serve to those residents who desired cold drinks with their meals. At 11:28 a.m. on 06/26/17, nursing assistant (NA) #68 picked up a used, red and white colored personal cup from Resident #80's room. Resident #80's room was located mid-way down the hall. She proceeded to fill the resident's personal cup with ice from the ice bucket. In the process, she touched the rim of the metal scoop to the rim of the resident's personal cup. This contaminated the ice scoop used for other residents down the hall. Upon inquiry as to whether this was Resident #80's personal cup, NA #68 replied in the affirmative. During an interview with the director of nursing on 06/30/17 at 8:09 a.m., she said that staff should know better than to touch any used, inanimate object with the clean ice scoop.",2020-09-01
2448,HIDDEN VALLEY CENTER,515147,422  23RD STREET,OAK HILL,WV,25901,2017-06-30,514,E,0,1,45HC11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview the facility failed to ensure Resident #138's medical record was accurate. This was true for one (1) of one (1) residents reviewed for the care area of [MEDICAL TREATMENT] during Stage 2 of the Quality Indicator Survey. Resident Identifier: #138. Facility Census: 76. Findings Include: a) Resident #138 A review of Resident #138's medical record at 10:36 a.m. on 06/27/17, found Resident #138 had an arteriovenous (AV) graft for [MEDICAL TREATMENT] access in his left upper arm. Review of Resident #138's physician orders [REDACTED]. A review of Resident #138's Blood Pressure Summary in the electronic medical record found on the following dates and times Resident #138's blood pressure was documented as being obtained in his left arm: --05/13/17 at 12:33 p.m. --05/14/17 at 12:40 p.m. --05/18/17 at 7:53 a.m. --05/24/17 at 3:00 a.m. --05/28/17 at 8:06 a.m. --06/03/17 at 3:20 p.m. --06/04/17 at 3:29 p.m. --06/06/17 at 4:31 a.m. --06/07/17 at 3:01 a.m. --06/09/17 at 10:13 a.m. --06/21/17 at 5:41 p.m. --06/22/17 at 12:49 p.m. --06/24/17 at 12:42 p.m. --06/26/17 at 12:07 a.m. --06/26/17 at 1:09 p.m. During an interview with Resident #138 at 1:30 p.m. on 06/27/17, he stated that staff never takes his blood pressure in his left arm. He stated, They know not to take my blood pressure in my left arm they always use my right arm. He further stated if they tried to take it in my left arm I would not let them. An interview with Licensed Practical Nurse (LPN) #56 at 2:46 p.m. on 06/27/17, confirmed that on the above mentioned dates the residents blood pressure was documented as being obtained in the his left arm. He confirmed the record must be inaccurate based on what Resident #138 stated during his interview.",2020-09-01
3434,FAIRMONT HEALTHCARE AND REHABILITATION CENTER,515189,130 KAUFMAN DRIVE,FAIRMONT,WV,26554,2017-06-30,166,E,1,0,25Q611,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on observation, record review, concern/grievance form review, policy review, family interview and staff interview, the facility failed to ensure prompt efforts to address and resolve concerns/grievances from residents and their families in a timely manner. The facility did not resolve expressed concerns about hydration and a clean comfortable homelike environment for Resident #1, as documented in the Resident Council's group meeting minutes, and expressed concerns regarding missing glasses for Resident #52. Resident identifiers: #1 and #52. Facility census: 115. Findings include: a) Resident #1 The review of Resident #1's record began on 06/21/17 at 10:04 a.m. Resident #1 is [AGE] years of age. She was admitted to the facility on [DATE]. Her [DIAGNOSES REDACTED]. She was determined by a physician to lack the capacity to make informed medical decisions. A family member was acting as her responsible party. Resident #1 had a care plan in place for nutrition, hydration, elimination related to weight loss, and consistency of food and liquids. She had a care plan for multiple signs in her room as reminders for resident/staff per the family's request. One of the reminders was for two (2) large insulated cups of ice and water to be within her reach at all times. On 06/22/17 at 11:38 a.m., the resident's responsible party was interviewed in the resident's room. She was surprised her mother was still in bed. She had the two large cups for the resident's water, which were not filled. She was taking the cups to the administrator to make a complaint. Updated complaint/grievance forms were requested regularly as the survey progressed. As of the final day of the survey on 06/30/17, there was no complaint form regarding the lack of water for hydration. On 06/27/17 at 9:10 a.m., a visit was again made to Resident #1's room. Nurse Aide #64 was in the room cleaning an area of the floor between the bed and the bathroom door. She said she had been called to the room by the responsible party. She said there was feces on the washcloth and the floor. She said she was not the one who had left it there, but she was cleaning it up. The responsible party entered the room and said she had found the mess on the floor when she arrived for her visit and since there was no one around, she had gone in search of someone to clean it up. On 06/29/17 at 10:00 a.m., Resident #1's responsible party was interviewed in the resident's room. She said she had gone to interrupt the management morning meeting on 06/27/17 to make a complaint about the feces filled washcloth on the floor. Updated complaint/grievance forms were requested regularly as the survey progressed. As of the final day of the survey on 06/30/17, there was no complaint form regarding the feces on the washcloth on the floor. She held the large cups in her hands. They had some ice in them but no water. She said she had complained about the water just a few days ago but it does no good. b) Resident council meeting minutes for the previous six (6) months were reviewed, on 06/21/17 at 4:00 p.m. The record of the meetings began with a form called Resident Council Quality of Life Assessment - Group Interview. Some of the months, the form had two pages, and for others, there were three. Not all the questions had responses noted. For those that did, some negative responses were found as follows: --For the 06/05/17 meeting, for the question Does the group have input into the rules of the facility? the response was No, because they always give you reason for the rules. The question Does the facility listen to your suggestions? was answered Sometimes. The question Are there places you can go when you want to be with other residents? was answered Not really, need more places. --For the 05/05/17 meeting, for the question Does the group have input into the rules of the facility? the response was No. The question Does the facility listen to your suggestions? was answered Sometimes. The question Are there places you can go when you want to be with other residents? was answered No. The question Are the temperatures of your foods ok? was answered Sometimes. The question How did staff react? (to a voiced grievance/concern) was answered They listened, but it depends on who it is. --For the (MONTH) meeting (no specific date was on the minutes), for the question Does the group have input into the rules of the facility? the response was No. The question Are meals generally on time? was answered No. --For the 03/01/17 meeting, the question Is there enough staff to take care of everyone? the answer was No. There was no list of attendees for the May, June, or (MONTH) meetings. For the January, February, and (MONTH) meetings, the average attendance was twenty-two (22) residents. There was no evidence of any attempts by the facility to address these negative responses. There was no follow up noted in the meeting minutes, and there were no complaint/grievance forms corresponding to the dates the concerns were stated by the council. An interview was conducted with the Activity Director, on 06/29/17 at 10:00 a.m. She agreed there was no record of any resolution or any attempt to address the concerns attributed to the council. On the afternoon of 06/28/17, the Administrator said the facility had a Concierge Program to compliment the complaint/grievance policy and procedure. She said residents and families were told about the program upon admission. She said management staff were assigned a group of resident rooms, and were charged with completing rounds at least weekly which were to be documented on a form entitled Concierge Program Rounds. Review of the policy and procedure found the concierge was charged with assisting the resident to complete a complaint/grievance form if needed. Review of some of the completed rounds found a form dated 06/12/17 in which an assigned management person for room [ROOM NUMBER]-1 checked the box on the form Concern Completed: Resident is making a statement which indicates his/her needs are not met. As of the final day of the survey, there was no completed complaint/grievance form found to document the concern. The responsible party for Resident #1 was asked about the concierge program as a possible means of resolving grievances on 06/29/17 at 9:30 a.m. She said she had never heard of it. c) Resident #52 On 06/26/17 at 12:16 p.m., during a Stage 1 family interview Resident #52's daughter was asked the question, Has (resident's name) had any missing personal items? the daughter answered Yes, they have lost my Mother's glasses months ago. A review of the concern/grievance reports, on 06//28/17 at 2:30 p.m., found a concern/grievance report dated 04/04/17 by Resident #52's daughter was reported to Referral Manager/Social Worker (RW/SW). Under title of Documentation of Grievance/Complaint, the concern was described as (typed as written): Said her mothers glasses have been missing and no one followed up with her about this. Also (first name of Resident #52) hair was dirty and a dirty blanket on dresser and teeth not clean, commode not flushed. Under the title of Documentation of Facility Follow-up, with Individual designated to take action on this concern: (name of Assistant Director of Nursing (ADON), and a date resolved by of 04/06/17. Under the title of (typed as written), Involved staff members were in-serviced on above concern. Follow-up reveals compliance with care concerns. Under the title of Resolution of Grievance/complaint, was grievance/complaint a check mark was placed before yes was written documentation states (typed as written), NHA (Nursing Home Administrator) on porch discussing with daughter and when staff came to get her to clean her up better and do her teeth, the daughter refused and said not now. Staff did complete after daughter left. This form was signed by the NHA on 04/24/17. During an interview and after reviewing the concern/grievance form for Resident #52, on 06/28/17 at 3:38 p.m., with RM/SW, she explained, I just took the concern and the NHA follows up on that and determines whether it is resolved or not. On 06/28/17 at 3:42 p.m., after reviewing the concern/grievance form for Resident #52 the NHA agreed that it was not resolved. She stated, I just spoke with the daughter about this and she said her mother has not had her glasses for over 2 months but I told her I thought they were found because I just put a pair of glasses on her last week. I remember because I had to fix her bangs when I put the glasses on. When inquired about the time frame for resolution of concerns--she stated it takes more than 1 or 2 days because we look through laundry and everything. When further inquired if it should take more than two (2) and a half (1/2) months to resolve a concern since this concern was voiced on 04/04/17 and Resident #52's glasses are still missing, she stated, Well they might be in the nurses cart. On 06/28/17 at 3:52 p.m., the NHA showed a glasses case containing a pair of glasses. She reported, These are the glasses that were in the drawer at the nurses station that she (Resident #52) wore last week but they aren't hers (Resident #52). The daughter described hers (Resident #52) as black with gold squiggly things at the temple and these are just plain brown. So we will have to just keep looking. Again inquired about a time frame for resolution of a resident or family member concern/grievance and the NHA did not reply.",2020-09-01
3435,FAIRMONT HEALTHCARE AND REHABILITATION CENTER,515189,130 KAUFMAN DRIVE,FAIRMONT,WV,26554,2017-06-30,313,D,1,0,25Q611,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on family interview, record review, concern/grievance form review, and staff interview, the facility failed to ensure that a resident with impaired vision was provided with the care and services to maintain the resident's optimal vision. This affected one (1) of twenty-eight (28) residents reviewed during Stage 2 of the Quality Indicator Survey (QIS). Resident identifier: #52. Facility census: 115 Findings include: a) Resident #52 Resident #52's daughter reported during a Stage 1 family interview on 06/26/17 at 12:16, that her Mother had poor vision and wore glasses, but the facility lost them two (2) months ago. On 06/28/17 at 10:31 a.m., medical record review revealed Resident #52 had [DIAGNOSES REDACTED]. Review of the resident's minimum data set (MDS) with an assessment reference date of (ARD) of 09/09/16 , found her vision assessed as impaired. The quarterly MDS with an ARD of 12/09/16 identified her vision as impaired. Review of the care plan revealed, Has impaired vision was circled indicating this was a problem. Other problems marked with an x include [MEDICAL CONDITION] repaired and dry eyes. Interventions marked with an x include, Vision consult as needed. A review of the concern/grievance reports on 06//28/17 at 2:30 p.m. found a concern/grievance report dated 04/04/17 by Resident #52's daughter that was reported to Referral Manager/Social Worker (SW) #143. Under Documentation of Grievance/Complaint, the concern was described as (typed as written), Said her mothers glasses have been missing and no one followed up with her about this . On 06/28/17 at 3:42 p.m. after reviewing the concern/grievance form for Resident #52, the administrator agreed that it was not resolved. She stated, I just spoke with the daughter about this and she said her mother has not had her glasses for over 2 months, but I told her I thought they were found because I just put a pair of glasses on her last week. I remember because I had to fix her bangs when I put the glasses on. On 06/28/17 at 3:52 p.m. the NHA showed a pair of glasses and said, These are the glasses that were in the drawer at the nurses' station that she (Resident #52) wore last week, but they aren't hers (Resident #52). The daughter described hers (Resident #52) as black with gold squiggly things at the temple and these are just plain brown. So we will have to just keep looking. After review of the care plan for Resident #52 on 06/29/17 at 1:19 p.m., Minimum Data Set (MDS) Nurse #117 stated, Yes, there is an intervention for a vision consult as needed. I agree (name of Resident #52) has not had her glasses for over two (2) months from what I am hearing. Yes, during that time she could have had an appointment with her eye doctor to check her vision . or have her eye glasses replaced. Guess someone dropped the ball on that one.",2020-09-01
3436,FAIRMONT HEALTHCARE AND REHABILITATION CENTER,515189,130 KAUFMAN DRIVE,FAIRMONT,WV,26554,2017-06-30,323,E,1,0,25Q611,"> Based on observation and staff interview, the facility failed to ensure the residents' environment remained as free of accident hazards as is possible. Electric baseboard heaters in the main hallways had sharp corner edges where they were mangled and bent. The main hallways on the North and South sides were utilized as main thoroughfares by residents. This finding had the potential to affect more than an isolated number of residents. Facility census: 115. Findings include: a) Observations during the initial tour of the facility on 06/21/17 at 4:30 p.m., found the electric baseboard heaters in the main hallways were mangled and bent with sharp corner edges. There were three (3) baseboard heaters on the 200 hall, two (2) on the 100 hallway, three (3) on the 300 hallway, and two (2) on the 400 hallway. When observed on 06/21/17 at 5:00 p.m. accompanied by the Maintenance Director, he stated, Those baseboard heaters are not used. I just need to remove them and repair the baseboards. Yes, the baseboard heaters look bad in the hallways and with those sharp edges could certainly be an accident hazard because someone could scratch or cut themselves on those corners.",2020-09-01
3965,FAIRMONT HEALTHCARE AND REHABILITATION CENTER,515189,130 KAUFMAN DRIVE,FAIRMONT,WV,26554,2017-06-30,161,E,0,1,25Q611,"Based upon review of facility documents and staff interview, the facility failed to have an approved surety bond to ensure the security of the residents' personal funds. This failed practice had the potential to affect one-hundred-six (106) residents having personal funds deposited in the care of the facility, and so had the potential to affect more than a limited number of residents. Facility census: 115. Findings include: a) The review of the facility's surety bond began on 06/28/17 at 9:30 a.m. A copy of the surety bond had been requested upon entrance. The facility provided a certificate listing the names of persons appointed as attorneys-in-fact to act to provide surety up to an amount of $2,000,000.00. There was no mention of the facility or its relationship to all or any portion of the amount specified. Clarification was requested from the Administrator on 06/28/17 at 10:00 a.m. She provided a second document entitled continuation certificate which stated a bond was in force in the amount of $76,000.00 for the facility's resident funds account for the period from 07/01/17 to 07/01/18. An approval of the bond, or a continuation approval of the facility's bond, by the West Virginia Attorney General was requested from the Administrator. She said the facility did not have such a document. She offered to contact the Office of Health Facility Licensure and Certification, the agency which facilitates the process of obtaining the required approval documentation of West Virginia nursing facilities from the Attorney General's office to find out the status of the facility's surety bond. She reported there was no approved surety bond in effect as required by statute due to the fact the bond was not submitted by the parent corporation in accordance with the provisions of the law.",2020-04-01
3966,FAIRMONT HEALTHCARE AND REHABILITATION CENTER,515189,130 KAUFMAN DRIVE,FAIRMONT,WV,26554,2017-06-30,223,D,0,1,25Q611,"Based on observation, staff interview, family interview, and policy review, the facility failed to ensure residents were free from verbal abuse. Resident #44, a mentally challenged individual with documented communication deficits demonstrated increased agitation and fearful facial expressions after a nurse aide yelled at him in the hall. Resident identifier: #44. Facility census: 115. Findings include: a) Resident #44 A random observation on 06/27/17 at 9:38 a.m., found Nurse Aide (NA) #61 in the hall across from the nurses' station, loudly say, Don't punch me! as she backed away from Resident #44. Resident #44, who sat in his wheelchair, exhibited tight facial muscles, clenched fists, and held his right arm across his at chest as though to strike out. Licensed Practical Nurse (LPN) #142 was standing near the nurses' desk during this incident. When interviewed on 06/27/17 at 9:40 a.m., he agreed NA #61 raised her voice at Resident #44. When asked if he would consider this verbal abuse he stated, I will talk to her. LPN #142 reported this incident to the Risk Manager after this interview. During an interview on 06/27/17 at 9:45 a.m., NA #61 stated, I am a loud talker, and denied raising her voice or yelling at Resident #44. Review of the resident's medical record on 06/27/17 at 2:10 p.m., revealed Resident #44 was alert, mentally challenged individual with a severe intellectual disability since birth, and had unclear speech with limited verbalization skills. He resided in an assisted living home for several years, but after a hospitalization , he was not eligible to return to his previous home because of his need for total care. The resident's care plan, dated 05/03/17, identified behaviors as a problem and included verbal outbursts and Potential/shows aggression towards staff and other residents. The care plan for mood, depression, and anxiety included the interventions of, Speak softly, clearly & stand/sit directly in front when communicating (Don't want misinterpretation). In an interview on 06/29/17 at 10:28 a.m., the staff development coordinator Registered Nurse (RN) #110 reported she just reviewed verbal abuse with the staff last month. She said verbal abuse was talking in an unkind manner, screaming, raising your voice, or yelling at the resident. Anything that made him feel threatened was considered verbal abuse.",2020-04-01
3967,FAIRMONT HEALTHCARE AND REHABILITATION CENTER,515189,130 KAUFMAN DRIVE,FAIRMONT,WV,26554,2017-06-30,241,D,0,1,25Q611,"Based on observation and staff interview, the facility failed to assist and promote care for each resident in a manner that maintained or enhanced dignity and respect by ensuring a Resident #115 was seated in a manner to allow her to eat in a dignified manner. This practice had the potential to affect an isolated number of residents. Resident identifer: #115. Facility census: 115. Findings include: a) Resident #115 A dining observation on 06/27/17 at 12:12 p.m. noted Resident #115 sat at a table with three (3) other residents. When asked about the height of the table and if it was suitable for meal service, Resident #115 stated, I have a problem with the table, I can't reach it. I am too far back. Additional observations on Thursday 06/22/17 and Monday 06/26/17 during lunch, noted th resident sitting in the same position. She stated, I am too far back from the table, it is hard to get something to drink even though they have not brought my food yet. Resident #115 was seated in a high back wheelchair with front facing leg rests preventing her from being close up to the table due to the table having a metal middle pole with four legs extending for balance and stability. Resident #115 asked if the surveyor could find someone to fix the situation. She stated, They just park me here and never ask if I can reach anything. The Referral Manager/Social Worker (RM/SW) who was near by, was asked if if she was able to assist Resident #115 to be closer to the table to enable her to reach her drinks. The RM/SW asked the Social Worker (SW #127) for assistance to move the table. RM/SW asked Scheduler (Employee #131) to assist when she was called away for a telephone call. Employee #131 asked, Why are you moving the table when all you need to do is swing her leg rests to the side and she (Resident #115) will then be up to the table? Employee #131 proceeded to swing Resident #115's wheelchair leg rests to either side and she was able to reach her drinks without difficulty. SW #127 was asked why Resident #115 had not been positioned at her table. SW #127 stated, Well her tray isn't even here yet and they probably would have done it later. When asked why this was not done on previous dining observations when Resident #115 was not seated close to her table for her meal, SW #127 replied, Well it is your word against mine that it was not done. When asked if she was in the dining room on Thursday 06/22/17 and Monday 06/26/17 for lunch meal service, SW #127 proceeded to walk away. Immediately following this encounter, Resident #115 stated, They do swing the leg rests back sometimes so I can be closer, but it is not a permanent thing. I saw you in here yesterday and last week and was going to ask you about it because you were watching and writing things down so I thought you were someone important. Resident #41 (who was also seated at the table) stated, (Resident #115's first name) just sits like that sometimes because she gets tired of asking them to move her up to the table because everyone acts like it is huge chore. Residents #26 and #53 (who were also seated at the table) both nodded their heads in agreement, but did not reply. During a confidential interview, Employee #Z stated, She (Resident #115) should not have to ask to be moved up to the table. It should be the person who brought her to the dining room to adjust her chair so she can drink and eat comfortably without having to lean over so much to reach things, or whoever is in the dining room to ensure she is comfortable. Yes I saw you in there on Thursday (06/22/17) and yesterday (Monday 06/26/17) and admit that I either told someone to fix her or went myself because we were afraid you would see it and hoped that you didn't. But I guess I underestimated your observation skills.",2020-04-01
3968,FAIRMONT HEALTHCARE AND REHABILITATION CENTER,515189,130 KAUFMAN DRIVE,FAIRMONT,WV,26554,2017-06-30,244,E,0,1,25Q611,"Based upon review of resident council meeting minutes, review of complaints and grievances, and staff interview, the facility failed to consider the views of a resident or family group and act promptly upon the grievances voiced by the Resident Council concerning issues of resident care and life in the facility. The facility was not able to demonstrate its responses and rationale for such responses. This had the potential to affect more than a limited number of residents residing in the facility. Facility census: 115. Findings include: a) Review of the Resident Council Meeting Minutes for the previous six (6) months on 06/21/17 at 4:00 p.m. found the record of the meetings began with a form called Resident Council Quality of Life Assessment - Group Interview. For some of the months, the form had two (2) pages, and for others, there were three (3). Not all the issues had responses noted. For those that did, some negative responses were found as follows: -- For the 06/05/17 meeting, for the question, Does the group have input into the rules of the facility? the response was No, because they always give you reason for the rules. The question Does the facility listen to your suggestions? was answered Sometimes. The question Are there places you can go when you want to be with other residents? was answered Not really, need more places. -- For the 05/05/17 meeting, for the question Does the group have input into the rules of the facility? the response was No. The question Does the facility listen to your suggestions? was answered Sometimes. The question Are there places you can go when you want to be with other residents? was answered No. The question Are the temperatures of your foods ok? was answered Sometimes. The question How did staff react? (to a voiced grievance/concern) was answered They listened, but it depends on who it is. -- For the (MONTH) (YEAR) meeting (no specific date was on the minutes), for the question Does the group have input into the rules of the facility? the response was No. The question Are meals generally on time? was answered No. -- For the 03/01/17 meeting, the question Is there enough staff to take care of everyone? the answer was No. There was no list of attendees for the May, June, or (MONTH) (YEAR) meetings. For the January, February, and (MONTH) (YEAR) meetings, the average attendance was twenty-two (22) residents. There was no evidence of any attempts by the facility to address these negative responses. There was no follow up noted in the meeting minutes, and there were no complaint/grievance forms corresponding to the dates the concerns were voiced by the council. b) During an interview with Activities Director #140 on 6/29/17 at 10:00 a.m., she agreed there was no record of any resolution or any attempt to address the concerns attributed to the council.",2020-04-01
3969,FAIRMONT HEALTHCARE AND REHABILITATION CENTER,515189,130 KAUFMAN DRIVE,FAIRMONT,WV,26554,2017-06-30,252,E,0,1,25Q611,"Based on observation and staff interview, the facility failed to provide a homelike environment for residents who were served their meals in the dining room where floor tiles and cove molding were in disrepair and for a resident who had a feces covered washcloth laying on the floor in her room. This had the potential to affect more than an isolated number of residents. Resident identifier: #1. Facility census: 115. Findings include: a) Dining room Observations of dining for the lunch meal on 06/22/17 at 11:57 a.m., found cracked and missing floor tiles around the back wall of the dining room and cove molding that was not attached to the wall. Residents were seated at tables located around this area. At 12:21 p.m. on 06/22/17, when shown the area, the Director of Nursing (DON) stated, Oh my, I will have them fix it. The shower room on the other side of this wall has just been repaired and remodeled and maybe that caused it. On 06/26/17 at 10:30 a.m. the Maintenance Director reported, I have replaced those tiles in the dining room, so it looks better. b) Resident #1 On 06/27/17 at 9:10 a.m., a visit to Resident #1's room found Nurse Aide #64 in the room cleaning an area of the floor between the resident's bed and the bathroom door. She said she had been called to the room by the resident's responsible party because there was feces on the washcloth and the floor. She said she was not the one who had left it there, but she was cleaning it up. The responsible party entered the room and said she had found the mess on the floor when she arrived for her visit and since there was no one around, she had gone in search of someone to clean it up.",2020-04-01
3970,FAIRMONT HEALTHCARE AND REHABILITATION CENTER,515189,130 KAUFMAN DRIVE,FAIRMONT,WV,26554,2017-06-30,253,F,0,1,25Q611,"Based on observation and staff interview the facility failed to provide housekeeping and maintenance services necessary to maintain a sanitary, orderly, clean and comfortable homelike interior. Bathroom sink cabinets were chipped and broken and the interiors were stained and discolored. Faucets were dripping and sink drains were rusted or broken. Insulation was hanging below the front sink edge and caulking was cracked or missing around the sinks and toilets. Cove molding was loose and damaged in the bathrooms and vinyl bathroom floors were cracked. Bathroom mirror facings were chipped along the bottom edge. The central bathrooms on the 200 and 300 halls were cluttered with resident equipment and supplies. Wall heaters on the North and South ends of the building were rusted and floor base heaters on the 100, 200, and 300 halls were in disrepair with mangled sharp edges, loose parts, and large dust particles inside. These findings had the potential to affect all residents in the facility. Facility census: 115. Findings include: a) Observation of the facility during Stage 1 and Stage 2 of the Quality Indicator Survey revealed the following rooms had environmental concerns and cosmetic imperfections. 1. Room 103 The sink faucet was constantly dripping, the cove molding on the side of the commode was easily pushed in and there was dirt and grime accumulation in the corner of the bathroom door. 2. Room 104 The caulking was stained and discolored around the commode and the cove molding was not secured to the wall on the right side of the toilet. 3. Room 105 The sink cabinet was chipped and in disrepair and the floor was stained and discolored around the toilet base. 4. Room 202 The left side of the board on the bottom of the sink cabinet was dislodged and resting on the floor. The right cabinet face panel was loose and slid easily to the side. The plaster was off the exterior wall corner next to the sink exposing the metal support which was leaning out. 5. Room 205 The bathroom mirror facing was missing along the edge. The sink faucet was dripping and the cabinet had multiple areas of chipped particle board. The caulking was cracked around the sink top and missing around the commode, and the cove molding was loose and leaning outward below the sink. 6. Room 210 The foam insulation was hanging out the front edge of the bathroom sink. The edges of the particle board sink cabinet were rough and bare and the inside bottom shelf was stained and discolored. 7. Room 211 The bathroom sink cabinet was chipped along the lower edges of the doors and there was no caulking around the commode. 8. Room 213 The bathroom sink caulking was cracked, the cabinet doors were chipped, and the bottom shelf on the inside of the cabinet was split, swollen and in disrepair. 9. Room 402 The bathroom sink drain plug was rusted and there were holes in the cabinet from improper assembly of the front panel coverings. 10. Room 406 The bathroom sink cabinet was missing a front panel leaving a large square hole and the inside bottom shelf was wavy from moisture damage. 11. Room 409 The bottom shelf inside the bathroom sink was wavy and discolored and the vinyl floor was cracked on both sides of the toilet. 12. Room 412 The inside bottom of the bathroom sink was wavy and the vinyl floor contained a linear crack on the left side of the commode. 13. Room 417 The bathroom sink drain top was broken off. During a tour of the facility with the maintenance supervisor on 06/28/17 at 10:35 a.m., he agreed all of these items were in need of repair and/or replacement. He stated he could easily fix the dripping faucets and the drain plug, but did not have the supplies to replace the sink cabinets or replace the bathroom floors. b) Central bathrooms Observations of the central bathrooms on the 200 and 300 halls during the initial tour on 06/21/17 at 4:30 p.m., and randomly throughout the survey found both restrooms were used by residents while stocked with supplies and equipment. The North restroom located on the 300 hall contained a sink by the door and a commode in the far corner across from the door. Next to the commode was a curtain touching an empty chart rack. Beside the chart rack in the far left corner were 180 gallons of water in plastic jugs with an open plastic cover across the top and sides. Beside the water along the wall were shelves stocked with briefs and other supplies. In addition, two (2) wound carts with treatment records, a suction machine, the emergency crash cart, a wheelchair scale, and multiple supplies including a mattress. Licensed Practical Nurse (LPN) #112 accompanied the surveyor into the restroom during the initial tour and acknowledged the residents use both the 300 hall and 400 hall restrooms. LPN #112, reported the facility used the water for emergency situations, the chart rack next to the toilet was used by the facility, and the mattress and other supplies near the door were waiting to be returned to someone. The south restroom located on the 200 hall was also used by the residents and storage of resident equipment and supplies. A tour of the 200 hall restroom on 06/28/17 at 10:35 a.m. found the following items: a wheelchair scale and a stand up scale, two (2) unlocked wound care carts with the treatment records on top, a mop and bucket of water, a chart rack, 180 gallons of water in plastic jugs, several packages of briefs, a crash cart, and several lift blankets. On 06/21/17 at 4:50 p.m., during the initial tour, Unit Manager/RN #97 reported there was no other place to store the carts and acknowledged this could be an infection control issue since the bathroom was used by the residents on all three (3) shifts. Confidential interviews with Employee A and Employee B during the survey confirmed the central restrooms on the 200 and 300 halls were used by the residents on all three (3) shifts. The employees stated that independent residents were left unattended in the restroom/storage space on the 200 and 300 halls. b) The initial tour of the facility on 06/21/17 at 4:30 p.m. discovered in the main hallways by exit doors on 100, 200, 300 and 400 hallways, wall heating units with rusted vents. Electric baseboard heaters in the main hallways were mangled and bent, with sharp corner edges. These halls were utilized as a main thoroughfare by residents. There were three (3) baseboard heaters on the 200 hall, two (2) on the 100 hallway, three (3) on the 300 hallway, and two (2) on the 400 hallway. On 06/21/17 at 5:00 p.m., accompanied by the Maintenance Director, the baseboard heaters were viewed again. He stated, Those baseboard heaters are not used I just need to remove them and repair the baseboards. The wall unit vents need painted. Yes, the baseboard heaters look bad in the hallways and with those sharp edges could certainly an accident hazard.",2020-04-01
3971,FAIRMONT HEALTHCARE AND REHABILITATION CENTER,515189,130 KAUFMAN DRIVE,FAIRMONT,WV,26554,2017-06-30,278,D,0,1,25Q611,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the individual assessing and certifying the accuracy of Section B of Resident #52's quarterly Minimum Data Set (MDS), failed to ensure the assessment was accurate regarding a resident's vision. This was found for one (1) of twenty-eight (28) Stage 2 sample residents whose MDS was reviewed during the Quality Indicator Survey (QIS). Resident identifier: #52. Facility census: 115. Findings include: a) Resident #52 On 06/28/17 at 10:31 a.m., a medical record review revealed Resident #52 was originally admitted to the facility on [DATE] with her most recent re-admission on 12/04/17. Her [DIAGNOSES REDACTED]. Review of the MDS with an assessment reference date (ARD) of 09/09/16 found the resident's vision coded as impaired. Review of the quarterly MDS with an ARD of 12/09/16 found her vision coded as impaired. Review of the quarterly MDS with an ARD of 03/01/17 found her vision coded as adequate. Review of the quarterly MDS with an ARD of 05/29/17 found her vision coded as adequate. After reviewing the quarterly MDSs with ARD of 09/09/16 to 05/29/17 on 06/29/17 at 1:04 p.m., MDS Nurse #117 stated, I coded those two (2) MDSs wrong (quarterly MDS with ARD of 03/01/17 and 05/29/17) for her (Resident #52) vision. It should be coded as impaired and guess I will be sending in corrections for that.",2020-04-01
3972,FAIRMONT HEALTHCARE AND REHABILITATION CENTER,515189,130 KAUFMAN DRIVE,FAIRMONT,WV,26554,2017-06-30,279,D,0,1,25Q611,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility failed to develop a care plan that addressed the use of an an antiplatelet medication ([MEDICATION NAME]). This was found for one (1) of twenty-eight (28) Stage 2 sample residents whose care plans were reviewed during the Quality Indicator Survey (QIS). Resident identifier: #42. Facility census: 115. Findings include: a) Resident #42 On 06/28/17 at 4:33 p.m., medical record review revealed Resident #42 was admitted on [DATE]. Her [DIAGNOSES REDACTED]. Her medications included [MEDICATION NAME] 75 mg po (by mouth) daily. The care plan was silent for interventions and possible side effects related to the antiplatelet medication [MEDICATION NAME]. Serious side effects of the medication [MEDICATION NAME] include, bruising, nosebleeds, bloody or tarry stools, coughing up blood, unusual bleeding in the mouth, vagina or rectum, purple or pinpoint spots under the skin, and vomiting that looks like coffee grounds. After review of the care plan for Resident #42 on 06/28/17 at 5:09 p.m., Registered Nurse (RN)/Unit Manager #109 verified there were interventions and side effects related to the use of an anti-platelet medication. He stated, It (care plan) should have something there regarding bleeding and bruising precautions and what to watch for.)",2020-04-01
3973,FAIRMONT HEALTHCARE AND REHABILITATION CENTER,515189,130 KAUFMAN DRIVE,FAIRMONT,WV,26554,2017-06-30,280,D,0,1,25Q611,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, family interview, and staff interview, the facility failed to revise the care plans for two (2) of twenty-eight (28) sample residents whose care plans were reviewed during Stage 2 of the Quality Indicator Survey (QIS). Resident #52's care plan was not revised to reflect the use of glasses for impaired vision and Resident #44's care plan was not revised to reflect his current behaviors. Resident identifiers: #52 and #44. Facility census: 115. Findings include: a) Resident #52 Resident #52's daughter reported during a Stage 1 family interview on 06/26/17 at 12:16, that her Mother had poor vision and wore glasses, but the facility lost them two (2) months ago. On 06/28/17 at 10:31 a.m., medical record review revealed Resident #52's quarterly minimum data set (MDS) assessments with assessment reference dates (ARD) of 09/09/16 and 12/09/16 identified the resident had impaired vision. The resident's care plan had, Has impaired vision circled indicating that was a problem. Other problems marked with an x included, [MEDICAL CONDITION] repaired and dry eyes. An x by a handwritten note (typed as written), Glasses are worn (then a word crossed out with error written above it) often-are at home. After reviewing the care plan for Resident #52 on 06/29/17 at 1:19 p.m., MDS Nurse #117 stated, The original admission date of [DATE] was when it was handwritten on there (care plan) that her glasses were at home and it was not updated when her daughter brought the glasses to the facility a few days later. Also, it should be checked on the care plan that she forgets to wear her glasses. So, the care plan was incorrect and was not revised. Additionally, the resident's care plan was not revised to reflect the loss of her glasses 2 months ago and any adaptations/interventions that might be required to help her compensate for the additional visual impairment. b) Resident #44 Review of the resident's medical record on 06/27/17 at 2:10 p.m., revealed Resident #44 was alert, mentally challenged with a severe intellectual disability since birth, and had unclear speech with limited verbalization skills. He resided in an assisted living home for several years until he was hospitalized and was not eligible to return to his prior home because of his need for total care. He was admitted to the facility on [DATE]. Resident #44's mood behavior medications were adjusted during his hospitalization because of questionable symptoms of drug toxicity to [MEDICATION NAME]. His medical discharge Medication Reconciliation Report (MRR) dated 04/26/17 noted the following medications changes: -- [MEDICATION NAME] 1 mg three times a day for impulse control disorder, -- [MEDICATION NAME] ER 1000 mg twice a day discontinued, -- [MEDICATION NAME] 50 mg three times a day as needed for increased agitation and anxiety, -- [MEDICATION NAME] 2 mg two times a day for impulse control disorder, and -- [MEDICATION NAME] 50 mg at bedtime for tremors. The nurse progress notes identified the following behaviors: --5/09/17 - Therapist reported Resident #44 struck therapist in the head with his hand --5/11/17 - Combative with staff intermittent through shift --5/23/17 - Combative with staff hits staff without any apparent reason --5/26/17 - Randomly hits staff in the back --5/27/17 - Yells out Sissy or Bubby. Randomly strikes out at staff --5/28/17 - Yelling at staff States he's mad. Combative with staff --5/30/17 - Resident disruptive with noon meal. Refused to eat. Picked up glass of milk threw glass at staff --6/06/17 - Combative with staff during care --6/07/17 - Combative with staff with ADLS (activities of daily living) and transfers --6/11/17 - Combative with nurse aide during routine care --6/20/17 - Resident was in the lounge and started yelling at another resident. Started crying when other resident yelled back --6/22/17 - Nurse aide reported resident was combative during morning care, crying --6/25/17 - Resident was in north lounge listening to music he grabbed a female resident's hair and jerked her head backwards --6/26/17 - Refused throughout the shift to allow nurse aides to shave --6/27/17 - 3:00 a.m. In hall way spitting and hitting at people (staff and residents) threw his slipper and hit the nurse and a resident's daughter --6/27/17 - 4:45 p.m. Trying to hit other residents and hitting activity staff in activity room. Nurse Aide approached resident and he punched her and later punched nurse .Resident throughout the day has been swinging at other residents and staff as they go by him in the hall. --6/28/17 - threw his shoes at roommate The behavior monitoring sheets for (MONTH) (YEAR) noted an increase of physical aggression since 06/20/17. The following documentation were made on the (MONTH) (YEAR) behavior monitoring sheet: --6/20/17 - 5 episodes of aggressive behavior - treated with redirection, one to one, and activity - outcome worsened --6/22/17 - 1 aggressive behavior episode - treated with redirection, one to one, and returned to room - outcome unchanged --6/23/17 - 2 aggressive episodes - treated with redirection and one to one - outcome worsened --6/24/17 - 1 aggressive episodes - treated with redirection and one to one - outcome worsened --6/25/17 - 1 aggressive behavior - treated with redirection and one to one - outcome worsened The care plan dated 05/03/17 identified behaviors as a problem and included verbal outbursts, Potential/shows aggression towards staff (when) h/o (history of) and current punching, hitting, elbowing and kicking, and Potential/shows aggression to other residents (when) h/o within personal space. Interventions include report missed or refused [MEDICAL CONDITION] medications, diversional activities - music, TV Westerns, outside, music via headphones, playing guitar or musical instrument. Allow extra time to communicate, do not corner if agitated, and routine monitoring. The care plan for mood, depression, and anxiety under interventions included, Speak softly, clearly & stand/sit directly in front when communicating (Don't want misinterpretation). Licensed Social Worker (LSW) #139 reviewed the resident's medical records during an interview on 06/28/17 at 10:00 a.m. LSW #139 reported Resident #44 did not have behaviors when he first arrived at the facility. According to the nurse progress notes, his behaviors began on 05/10/17 when he first struck someone in the therapy room. LSW #139 reviewed the behavior monitoring sheets for (MONTH) (YEAR) and reported his behaviors had increased since 06/20/17 and the outcomes documented indicate the behaviors either worsened or were unchanged with the interventions. She reviewed the care plan and acknowledged the sections related to behaviors, [MEDICAL CONDITION] meds, cognitive loss and mood, depression or anxiety had not been updated or changed since initiated on 05/02/17 and agreed the care plan should have been revised when he started demonstrating behaviors towards others and the established interventions were not effective. .",2020-04-01
3974,FAIRMONT HEALTHCARE AND REHABILITATION CENTER,515189,130 KAUFMAN DRIVE,FAIRMONT,WV,26554,2017-06-30,282,D,0,1,25Q611,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, family interview, and staff interview, the facility failed to follow the comprehensive care plan for two (2) of twenty-eight (28) Stage 2 residents reviewed during the Annual Quality Indicator Survey. The facility failed to implement Resident #80's care plan for drawing labs as ordered and Resident #52's care plan was not implemented when a vision consult was not obtained after her glasses were lost. Resident identifiers: #80 and #52. Facility census: 115. Findings include: a) Resident #80 Medical record review on 06/29/17 at 8:15 a.m. revealed Resident #80 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. On 06/28/16, the physician ordered (typed as written), FBS (fasting blood sugar) every month. Her care plan included an intervention of, Labs (laboratory tests) as ordered Review of the resident's medical record found no laboratory results for a FBS in (MONTH) (YEAR). During an interview on 06/29/17 at 10:30 a.m., Registered Nurse (RN)/Nurse Educator #110 reported, There is no laboratory result for a FBS in (MONTH) (YEAR) because it was not done. After reviewing the care plan RN/Nurse Educator #110 agreed, The care plan was not followed, for the intervention Labs as ordered. On 06/29/17 at 11:10 a.m., the Assistant Director of Nursing (ADON) provided copies of the physician's orders [REDACTED]. After review of the care plan, she verified the services for monthly laboratory testing were not provided according to the care plan. b) Resident #52 Resident #52's daughter reported during a Stage 1 family interview on 06/26/17 at 12:16 p.m. that her Mother had poor vision and wore glasses, but the facility had lost them two (2) months ago. On 06/28/17 at 10:31 a.m., medical record review revealed Resident #52 had a history of [REDACTED]. Review of the quarterly minimum data set assessment (MDS) with an assessment reference date (ARD) of 09/09/16 found the resident's vision coded as impaired. The quarterly MDS with an ARD of 12/09/16 also identified the resident's vision as impaired. Review of the resident's care plan revealed Has impaired vision was circled indicating this was a problem. Other problems marked with an x included, [MEDICAL CONDITION] repaired and dry eyes. Interventions marked with an x included, Vision consult as needed. A review of the concern/grievance reports on 06//28/17 at 2:30 p.m. found a concern/grievance report dated 04/04/17 by Resident #52's daughter that was reported to Referral Manager/Social Worker (SW) #143. The concern was described as (typed as written), Said her mothers glasses have been missing and no one followed up with her about this . On 06/28/17 at 3:42 p.m. after reviewing the concern/grievance form for Resident #52 the NHA agreed that it was not resolved. She stated, I just spoke with the daughter about this and she said her mother has not had her glasses for over 2 months, but I told her I thought they were found because I just put a pair of glasses on her last week. I remember because I had to fix her bangs when I put the glasses on. On 06/28/17 at 3:52 p.m. the NHA showed a pair of glasses and said, These are the glasses that were in the drawer at the nurses' station that she (Resident #52) wore last week, but they aren't hers (Resident #52). The daughter described hers (Resident #52's) as black with gold squiggly things at the temple and these are just plain brown. So, we will have to just keep looking. After review of the care plan for Resident #52 on 06/29/17 at 1:19 p.m. minimum data set (MDS) Nurse #117 stated, Yes, there is an intervention for vision consult as needed. I agree (name of Resident #52) has not had her glasses for over two (2) months from what I am hearing. Yes, during that time she could have had an appointment with her eye doctor to check her vision, which isn't good or have her eye glasses replaced. Guess someone dropped the ball on that one.",2020-04-01
3975,FAIRMONT HEALTHCARE AND REHABILITATION CENTER,515189,130 KAUFMAN DRIVE,FAIRMONT,WV,26554,2017-06-30,315,D,0,1,25Q611,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, resident interview, and staff interview, the facility failed to ensure a resident who was incontinent of bladder received appropriate treatment and services to maintain and/or restore continence to the extent possible. There was no evidence the resident was provided with any type of toileting program. This was found for one (1) of three (3) residents' reviewed for urinary incontinence during Stage 2 of the Quality Indicator Survey (QIS). Resident identifier: #14. Facility census: 115. Findings include: a) Resident #14 During an interview with Resident #14 on 06/27/17 at 10:48 a.m., he stated, No they never have taken me to the bathroom since I have been here, maybe a few times in the beginning now they just change my diaper. Doesn't do any good to ask to go to the bathroom because they just tell me it takes two (2) people and they are too busy. Review of the minimum data set (MDS) for Resident #14, on 06/27/17 at 11:08 a.m., found his admission MDS with an assessment reference date (ARD) of 02/15/17 identified he was frequently incontinent (7 or more episodes of urinary incontinence, but at least one episode of continent voiding). The 14-day MDS with an ARD of 03/09/17 also indicated he was frequently incontinent and that he was not on a current toileting program or trial. The 30-day MDS with an ARD of 03/23/17 again identified he was frequently incontinent and that he was not on a toileting program. The Quarterly MDS with ARD of 05/15/17 assessed him as always incontinent (no episodes of continent voiding). A continuing review of the medical record revealed Resident #14 was admitted on [DATE]. His [DIAGNOSES REDACTED]. He was admitted on an antibiotic for UTI, required another dose of antibiotics on 03/02/17 for UTI and another dose of antibiotics for UTI on 03/16/17 for UTI. The resident's care plan included a problem of bladder incontinence. The plan noted he was not not a candidate for a toileting program due to immobility with a handwritten note -[MEDICAL CONDITION] assist with (illegible word) ambulation. Interventions included, .Check for incontinence upon arising, before & after mealtimes, at bedtime and as needed during care . and Toilet upon request. The care plan did not include a toileting program. MDS Coordinator #117 reported on 06/27/17 at 3:15 p.m. that Resident #14, .did have a decline in urinary continence and I'm not sure if he was on a toileting program but don't think so, just checked every two (2) hours and his brief changed. On 06/27/17 at 3:25 p.m. MDS Coordinator #117 provided a copy of a toileting program. She stated, it (toileting) was not done every two (2) hours just a brief check. There is not enough staff here to toilet everyone every two (2) hours so it wasn't done. So according to everything he (Resident #14) did decline in urinary continence and, no, we did not meet his toileting needs. We did nothing to prevent his decline in urinary continence which could cause continued UTIs and no evidence that we did anything in that area. Not sure if it would have helped, but guess we should have at least tried a toileting program.",2020-04-01
3976,FAIRMONT HEALTHCARE AND REHABILITATION CENTER,515189,130 KAUFMAN DRIVE,FAIRMONT,WV,26554,2017-06-30,319,D,0,1,25Q611,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, family interview, and staff interview, the facility failed to ensure that a resident who displayed and/or was diagnosed with [REDACTED]. Resident #44 was admitted to the facility with a history of outpatient psychiatric treatment for [REDACTED]. His next scheduled psychiatric appointment was missed because the facility failed to obtain a complete medical and psychiatric history from his previous home and family. Staff's lack of knowledge of Resident #44's previous drug regimen and recent changes, and the failure to identify previously defined nonpharmacological interventions, along with mental and psychosocial adjustment difficulties related to a change in his living environment caused the resident to act out towards others in an aggressive nature. Arrangements for psychiatric services were not made until the resident's behaviors towards others continued all day with no response to listed nonpharmacological interventions and isolation. These failures had the potential to cause harm to the resident and potential to cause harm and affect other residents and staff. Resident identifier: #44. Facility census: 115. Findings include: a) Resident #44 Review of the medical record on 06/27/17 at 2:10 p.m., revealed this alert, mentally challenged individual had had a severe intellectual disability since birth and had unclear speech with limited verbalization skills. He resided in an assisted living type home for several years until he became ill and required hospitalization . He was unable to return to his previous residence because of his increased care needs for all of his activities of daily living (ADLS) and was admitted to the facility on [DATE]. Resident #44's medications were adjusted during his hospitalization because of questionable symptoms of drug toxicity to [MEDICATION NAME]. His medical discharge Medication Reconciliation Report (MRR) dated 04/26/17 noted the following medications changes: -- [MEDICATION NAME] 1 mg three times a day for impulse control disorder -- [MEDICATION NAME] ER 1000 mg twice a day - discontinued -- [MEDICATION NAME] 50 mg three times a day as needed for increased agitation and anxiety -- [MEDICATION NAME] 2 mg two times a day for impulse control disorder -- [MEDICATION NAME] 50 mg at bedtime for tremors The physician's admission history and physical signed 04/27/17 included under the Medical Conditions section, metabolic enceph ([MEDICAL CONDITION]), [MEDICATION NAME] toxic, [MEDICAL CONDITION], Tremors, acute [MEDICAL CONDITION], and [MEDICAL CONDITION]. The medications list included, [MEDICATION NAME] 50 mg tid prn (three times a day as needed), [MEDICATION NAME] 400 mg BID (twice a day), and multiple other medications with no indications for the use of the medications documented on the physician's admission form and the form lacked any information related to [MEDICATION NAME] 2 mg twice a day for impulse control. The Medication Administration Record [REDACTED] -- [MEDICATION NAME] 1 mg three times a day for [MEDICAL CONDITION] - the MRR noted this was for impulse control disorder -- [MEDICATION NAME] 10 mg daily for depression started 05/04/17 -- [MEDICATION NAME] 50 mg at bedtime for [MEDICAL CONDITION] - the MRR noted this was for tremors -- [MEDICATION NAME] 2 mg twice a day for [MEDICAL CONDITION] - the MRR noted this was for impulse control The physician's orders [REDACTED]. The original order was, [MEDICATION NAME] 50 mg . 1 CAP (capsule) by mouth three times a day for itching. The rewritten order at the end of the monthly order sheet dated 05/18/17 stated, [MEDICATION NAME] 25 mg po (by mouth) q (every) eight hours prn tid (as needed three times a day) itching The MRR noted Resident #44 was receiving [MEDICATION NAME] 50 mg three times a day for increased agitation and anxiety and the medication at discharge was written as an as needed drug. No clarification on this order was identified in the records. The physician's progress note dated 05/04/14 stated, Staff feels pt (patient) is depressed will start [MEDICATION NAME] . The medical record contained two (2) Informed Consents for Psychoactive Medications dated 05/01/17. -- Risperidal for the treatment of [REDACTED]. -- Klonopin for [MEDICAL CONDITION] (this was prescribed as a replacement for [MEDICATION NAME] for impulse control) There was no information related to [MEDICATION NAME] for anxiety. The records the surveyor received via fax machine from Resident #44's previous home on 06/27/17 at 1:08 p.m. and 3:23 p.m. indicated Resident #44 was on the following medications prior to his admission to the hospital: [MEDICATION NAME] 1000 milligrams (mg) Extended Release (ER) twice a day for aggression mood disorder, [MEDICATION NAME] 1 mg three times a day for impulse control behaviors, [MEDICATION NAME] 50 mg three times a day for anxiety behaviors, and [MEDICATION NAME] 2 mg twice a day for impulse control. Resident #44 was last seen by his psychiatric team on 03/08/17 and his next scheduled appointment was on 06/08/17. His [DIAGNOSES REDACTED]. The Nurse progress notes identified the following behaviors: -- 05/09/17 Therapist reported Resident #44 struck therapist in the head with his hand -- 05/11/17 Combative with staff intermittent through shift -- 05/23/17 Combative with staff hits staff without any apparent reason -- 05/26/17 Randomly hits staff in the back -- 05/27/17 Yells out Sissy or Bubby. Randomly strikes out at staff -- 05/28/17 Yelling at staff States he's mad. Combative with staff -- 05/30/17 Resident disruptive with noon meal. Refused to eat. Picked up glass of milk threw glass at staff -- 06/06/17 Combative with staff during care -- 06/07/17 Combative with staff with ADLS (activities of daily living) and transfers -- 06/11/17 Combative with nurse aide during routine care -- 06/20/17 Resident was in the lounge and started yelling at another resident. Started crying when other resident yelled back -- 06/22/17 Nurse aide reported resident was combative during morning care, crying -- 06/25/17 Resident was in north lounge listening to music he grabbed a female resident's hair and jerked her head backwards -- 06/26/17 Refused throughout the shift to allow nurse aides to shave -- 06/27/17 3:00 a.m. In hall way spitting and hitting at people (staff and residents) threw his slipper and hit the nurse and a resident's daughter -- 06/27/17 4:45 p.m. at 1645 (4:45 p.m.) states . Around 1300 (1:00 p.m.) Res hit another resident's w/c (wheel chair) and threw his shoe at staff. Attempted separating Res from others with limited success; Res continues trying to hit anyone nearby. 1500 (3:00 p.m.) called Dr. (name) regarding Res behavior, received order for neuropsyche eval, called (facility name), appt (appointment) for 07/02/17 at 1430 (2:30 p.m.) with Dr. (name). Dr. (name) again called d/t Res continuing to be combative, ordered out to (name) ER (emergency room ) Because of his continued agitation two (2) Policemen were called to assist the Emergency Medical Squad (EMS) with transferring Resident #44 to the emergency room . After the surveyor informed staff that the resident calmed down when he spoke with his sister, the resident was allowed to talk to his sister by telephone. After he spoke with his sister, he did calm down and was transferred to the ER without exhibiting further behaviors. The behavior monitoring sheets for (MONTH) (YEAR) note an increase of physical aggression since 06/20/17. The following documentation were made on the (MONTH) (YEAR) behavior monitoring sheet: -- 06/20/17 - 5 episodes of aggressive behavior - treated with redirection, one to one, and activity - outcome worsened -- 06/22/17 - 1 aggressive behavior episode - treated with redirection, one to one, and returned to room - outcome unchanged -- 06/23/17 - 2 aggressive episodes - treated with redirection and one to one - outcome worsened -- 06/24/17 - 1 aggressive episodes - treated with redirection and one to one - outcome worsened -- 06/25/17 - 1 aggressive behavior - treated with redirection and one to one - outcome worsened Resident #44's sister/health care surrogate (HCS) was contacted by telephone on 06/27/17 at 12:15 p.m. She reported Resident #44 was born mentally challenged and required assistance with all activities of daily living (ADLS). He had communication difficulties and at times could talk and respond to questions. He was physically abused by one of his brothers growing up, and became upset when a certain song was playing on the radio. He had lived in an assisted living type of home for several years until he became sick and was transferred to the hospital. Resident #44 was admitted to the nursing home facility following his discharge from the hospital and he was not close enough to home for the family to visit. The sister reported Resident #44 could get mad at times and start cussing and hitting, but he calmed down when he talked to his sister/ HCS over the telephone or he listened to country music, played his guitar, played with cars, or talked about buses and trains. At 12:30 p.m. on 06/27/17, Home Care Manager #148 was contacted as recommended by Resident #44's sister/HCS. Manager #148 reported Resident #44 use to be fairly independent and able to walk around the home until he became ill and required hospitalization . His behaviors had increased with his illness and he did become agitated at times. He responded to redirection, asking him what his problem was, and talking to his sister on the phone. He had been seeing (name) an assistant to a psychiatrist Dr. (name) every three (3) months and was scheduled to return to the psychiatrist office on 06/08/17. During an interview on 06/28/17 at 8:45 a.m., Registered Nurse (RN) #109 reported he was not working the day Resident #44 was admitted , but he had talked to his sister/HCS over the phone. Resident #44 could be calm and pleasant at times and at times would be crying and seeking attention. The current care plan interventions for Resident #44's behaviors include talking to him, country music, and his guitar. RN#109 stated a Resident's history was obtained through the hospital discharge summary and family when available. He acknowledged the facility was unaware of Resident #44's routine psychiatric visits and his missed appointment on 06/08/17 and was unaware that the recently discontinued [MEDICATION NAME] medication was for aggression and mood disorder and not [MEDICAL CONDITION]. RN #109 agreed it would be good to contact Resident #44's prior home for further information related to his psychiatric and medication history, as well as successful nonpharmacological interventions for behaviors. During an interview on 06/28/17 at 10:00 a.m., Licensed Social Worker (LSW) #139 reviewed the resident's medical record and acknowledged she was unaware of Resident #44's history of physical abuse by his brother or his increased agitation when a certain country music song was played. In addition, she acknowledged there was no information about Resident #44's psychiatric visits every three (3) months or his missed appointment that was scheduled for 06/08/17. She agreed it would be good to contact the resident's previous home to identify previous medication regimens, behaviors and interventions. Resident #44 had lived at an assisted living home since 2009. He began to decline, was no longer independent with his ADLS, and was admitted to the hospital, where he was weaned off of [MEDICATION NAME], a drug he was receiving for aggression mood disorder, because of suspected toxicity. The [MEDICATION NAME] was replaced with [MEDICATION NAME] and the MRR noted it was for impulse control. The facility order sheet stated the [MEDICATION NAME] was for [MEDICAL CONDITION]. The records the surveyor obtained from Resident #44's previous home stated he did not have a [MEDICAL CONDITION] disorder. Resident #44 was also receiving [MEDICATION NAME] 50 mg three times a day for anxiety and agitation when he was admitted to the hospital. The hospital discharge MRR changed it to as needed at discharge. This change was not identified or clarified. The facility failed to obtain a complete history of Resident #44 from his previous home and from his sister/HCS. Facility staff were unaware of his history of being physically abused by a brother, or that he had increased agitation when a certain country song was played (his sister could not remember the song during our conversation). The facility was unaware of the resident's psychiatric needs, including his psychiatric visits every three months and his scheduled appointment which he missed on (MONTH) 8th. The facility was unaware of what interventions worked when he became stressed, which included letting him talk to his sister on the telephone and talking about trains and cars. Resident #44's behaviors began 05/09/17 and had increased to the point he was sent to the ER for evaluation. At that time, an appointment was made at a different psychiatric center for July. Staff were unaware of any of these findings until the Surveyor pointed them out after brief telephone interviews with the manager of the home and the HCS. RN #109 acknowledged the resident had some psychiatric issues they need to address and agreed they should have obtained more information from Resident #44's previous home. LSW #139 agreed the interventions the facility was using did not meet Resident #44's needs and acknowledged they were unaware of his routine psychiatric visits or his missed appointment.",2020-04-01
3977,FAIRMONT HEALTHCARE AND REHABILITATION CENTER,515189,130 KAUFMAN DRIVE,FAIRMONT,WV,26554,2017-06-30,334,E,0,1,25Q611,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, staff interview, policy review, and review of the Centers for Disease Control and Prevention (CDC) guidelines, the facility failed to educate each resident and/or the resident's legal representative on the benefits and potential side effects of the influenza vaccine prior to administering the vaccine during the current (YEAR)-2017 flu season. In addition, the consent forms presented on admission were not updated to reflect the CDC's current vaccine information statement. This was found for four (4) of five (5) Stage 1 sampled residents reviewed during the annual Quality Indicator Survey (QIS). Resident identifiers: #79, #124, #34, and #26. Facility census: 115. Findings include: a) Residents #79, #124, #34, and #26 Review of the medical records for these residents on 06/28/17 at 2:00 p.m., revealed all four (4) medical records lacked documentation indicating the resident and/or the resident's legal representative received education regarding the current benefits and potential side effects of the influenza vaccine prior to administration during the current flu season. Resident #124 received the [MEDICATION NAME] flu vaccine on 10/11/16 and Residents #79, #34, and #26 received the [MEDICATION NAME] vaccine on 10/12/16. Licensed Practical Nurse (LPN) #119 reviewed the medical records during an interview on 06/28/17 at 2:40 p.m. and confirmed the records lacked any information related to consents and/or education regarding the benefits and potential side effects of the influenza vaccine. LPN #119 contacted Social Worker #143, the admissions person, and reported the only resident/family education provided was on the Pneumococcal & Annual Influenza Vaccination Information & Request form which was signed on admission and contained a revision date of 02/2007. During an interview at 3:00 p.m. on 06/28/17 the Assistant Director of Nursing (ADON) provided copies of the Influenza (flu) consents for Residents #79, #124, #34, and #26 on the form titled Pneumococcal & Annual Influenza Vaccination Information & Request with a revision date of 02/2007. The ADON reported the consent forms were not kept in the medical records. Resident #79's consent was not dated or signed. Resident #124's consent was signed on 10/05/16 with no identification of the person signing. Resident #34's consent was signed on 09/15/15 and Resident #26's consent was signed 09/18/15 with no identification of the family member signing. The ADON acknowledged there were no other consents or annual education provided to the resident and/or family prior to the yearly administration of the flu vaccine. The facility policy titled Immunizations - Pneumococcal & Annual Influenza stated under #3 of the guidelines on page 92: Counsel resident and/or family on the benefits and adverse effects by providing educational materials of each vaccine prior to administration of the vaccines. Section 4 of the guidelines states: Provide the resident and/or family with a copy of the applicable VIS (Vaccine Information Statement) .a. On an annual basis, the person administering the vaccine will Document the review of the VIS in the Nurse Progress Notes and include whom the VIS was given too. The Centers for Disease Control and Prevention (CDC) updates its recommendations regarding the influenza vaccine annually based on information from the World Health Organzation (WHO) regarding the projected [MEDICAL CONDITION]. For example, For the (YEAR)-17 season, CDC recommends use of the flu shot (inactivated influenza vaccine or IIV) and the recombinant influenza vaccine (RIV). The nasal spray flu vaccine (live attenuated influenza vaccine or LAIV) should not be used during (YEAR)-17. The CDC also makes recommendations for certain populations such as the elderly, those who are immunocompromised, etc. The facility's influenza information was last updated in 2007. Registered Nurse (RN) #109 and LPN #96 reviewed the consents for Residents #79, #124, #34, and #26 during an interview on 06/28/17 at 3:20 p.m. and confirmed the Pneumococcal & Annual Influenza Vaccination Information & Request form with a revision date was 02/2007 could not contain the current information from CDC related to the benefits and potential side effects of the influenza vaccine.",2020-04-01
3978,FAIRMONT HEALTHCARE AND REHABILITATION CENTER,515189,130 KAUFMAN DRIVE,FAIRMONT,WV,26554,2017-06-30,371,F,0,1,25Q611,"Based on observation and staff interview, the facility failed to ensure food was served under sanitary conditions. While taking food temperatures, an employee failed to wash her hands after brushing her nose with her hand. Additionally, the drain pipes of an ice machine did not have a gap between the pipes and the drain, and a refrigerator in a nutrition room was in disrepair and was not clean. This practice had the potential to affect all residents. Facility census: 115. Findings include: a) On 06/26/17 at 11:30 a.m., staff obtained food temperatures in the presence of the Dietary Manager (DM). After obtaining the food temperature on the prepared rice and writing down the food temperature, Cook #93 swiped her nose with the back of her ungloved hand then proceeded to continue to take temperatures of other foods. When this was brought to her attention, she stopped and performed hand hygiene. Immediately following this observation, Cook #93 stated, This is my usual routine to stop after each food temperature was taken and find a pen then write it down on the temperature log. Yes, I did swipe my nose and did not wash my hands after that before going back to taking temperatures. The DM agreed that Cook #93 should have washed her hands after wiping her nose during an interview on 06/26/17 at 2:35 p.m. She added, Yes I saw that the same as you did standing there. b) Ice machine An observation of the North hall nutrition room with Licensed Practical Nurse (LPN) #112 on 06/21/17 at 4:30 p.m., revealed three (3) drain pipes from the North hall ice machine running into the floor drain. Two of the drain pipes were in direct physical contact with the floor drain cap. There was no gap between the drip lines and floor drain to back-siphonage. During an interview on 06/21/17 at 4:44 p.m., Maintenance Supervisor #133 acknowledged the ends of the ice machine drains were in direct contact with the floor drain and stated he could easily repair this by cutting off the ends of the pipes. c) North hall refrigerator An observation of the North hall nutrition room with Licensed Practical Nurse (LPN) #112 on 06/21/17 at 4:30 p.m., found the following: -- the gasket on the bottom of the refrigerator door was cracked and broken, exposing the magnet inside the gasket. -- The refrigerator drawer was cracked with a large hole on the right corner -- Inside bottom of the refrigerator was dirty and sticky to touch The Maintenance Supervisor viewed the North hall refrigerator on 06/21/17 at 4:44 p.m., and agreed the refrigerator was in disrepair and needed cleaned.",2020-04-01
3979,FAIRMONT HEALTHCARE AND REHABILITATION CENTER,515189,130 KAUFMAN DRIVE,FAIRMONT,WV,26554,2017-06-30,425,D,0,1,25Q612,". Based on observation, staff interview, and review of manufacturer's recommendations, the facility failed, in collaboration with the pharmacist, to ensure the safe and effective use of medications. Two (2) insulin pens and one (1) insulin vial were open for greater than the time allowed per manufacturer's recommendations. Use of medication from a multi-dose vial or pen which was open for a time period greater than that recommended by the manufacturer, had the potential to negatively impact the safety and/or potency of the medication. This practice was evident for both of the facility's medication storage room refrigerators, and affected a limited number of residents. Resident identifiers: #54, #99, #115. Facility census: 112. Findings include: a) North hall medication storage room refrigerator. On 09/25/17 at 10:30 a.m., the North hall medication storage room was observed, in the presence of Registered Nurse (RN) #1. 1. The medication storage room refrigerator contained a Humalog insulin pen which belonged to Resident #54. It had been opened and partially used. The expiration date of 09/22/17 was inscribed (hand-written) on the pen. RN #1 said this vial should have been discarded on 09/22/17, and it was not. He said the date it was initially opened for use must have been twenty-eight (28) days prior . He acknowledged that the date of first opening was not inscribed on the vial. He disposed of the vial. 2. The medication storage room refrigerator contained a multi-dose vial of Lantus insulin which belonged to Resident #99. It had been opened and partially used. The expiration date of 09/23/17 was inscribed (hand-written) on the vial. Registered Nurse (RN) #1 it should have been discarded on 09/23/17, and it was not. He said it is their policy to discard multi-dose vials twenty-eight days after initially opened. He said he would dispose of this vial. b) South hall medication storage room refrigerator On 09/25/17 at 11:00 a.m. the South hall medication storage room was observed, in the presence of Licensed Practical Nurse (LPN) #2. In the refrigerator was a Novolog insulin pen which belonged to Resident #115. The expiration date of 09/24/17 was inscribed (hand-written) on the pen.Registered Nurse (RN) #2 said this insulin pen should have been discarded on 09/24/17, and it was not. He said he would discard it right away. c) Manufacturer's guidelines Review of manufacturer's guidelines for drug storage requirements of insulin were as follows: 1. Humalog insulin - When refrigerated when not in use, it may be used for twenty-eight (28) days after first opened. 2. Lantus insulin - When refrigerated when not in use, it may be used for twenty-eight (28) days after first opened. 3. Novolog insulin - When refrigerated when not in use, it may be used for twenty-eight (28) days after first opened. An interview was conducted with the Director of Nursing (DON) on 09/27/17 at 10:00 a.m. We reviewed the above issues with insulin vials and/or insulin pens stored and available for use in both of the medication room refrigerators after their expiration dates. It was communicated that RN #1 and LPN #2 said they would dispose of the expired insulins the day of discovery on 09/25/17. The DON said the nurses made her aware of the insulins. It was clarified that the term expiration referred to the greatest amount of time, based on manufacturer's recommendations, that the insulin should be used after the insulin container was initially opened for use.",2020-04-01
3980,FAIRMONT HEALTHCARE AND REHABILITATION CENTER,515189,130 KAUFMAN DRIVE,FAIRMONT,WV,26554,2017-06-30,431,E,0,1,25Q611,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, controlled medication sheet review, policy review, and staff interview, the facility failed to store medications, alcoholic beverages and biological's in accordance with professional guidelines. A liter (33.8 ounces) bottle of Lord Calvert 80% Canadian Whiskey sitting on the counter in the North unit medication room not labeled and no procedure to mark the remaining amount of liquid after administering a dose, one (1) of two (2) medication room refrigerators contained expired medication and opened medication which was not labeled and/or dated, two (2) of four (4) medication carts contained opened unlabeled and/or undated multi-dose medications. In addition the facility failed to ensure controlled substance records contained information to show complete reconciliation by on-coming and off-going nurses. This was found for two (2) of four (4) narcotic books reviewed. This practice has the potential to affect more than an isolated number of residents. Resident identifiers: #28. Facility census: 115. Findings include: a) North unit medication room 1. Observation of the North unit medication room accompanied by Licensed Practical Nurse (LPN) #104 on [DATE] at 2:50 p.m. revealed a liter (33.8 ounces) bottle of Lord Calvert 80% Canadian Whiskey sitting on the counter not labeled with a resident name. Above hanging on the cabinet door was a progress note with resident #28's name, times and dates of administration of 30 ml (milliliters) by mouth. Upon inquiry if this should be stored in a different area and how to determine how much liquor/liquid if left in the bottle, LPN #104 stated, It always just sits on the counter since _________ (first name of Resident #28) was admitted back in (MONTH) (2017). His wife just brings in a new bottle when he needs it. LPN #104 verified that the bottle was not labeled with a resident name or dated when opened. LPN #104 further stated, No there is now way to know if the correct amount is left in the bottle because there is no marking or nothing there to show how much is left. I guess it is possible that any nurse with a key could come in her and have a drink without anyone ever knowing because no one knows how much is supposed to be left in the bottle. 2. Immediately following an observation of the medication refrigerator utilized for 300 and 400 contained two (2) opened ten (10) test multi-dose vials of Tubersol purified protein derivative (PPD). One (1) vial was not dated when opened, and one (1) vial was dated [DATE]. LPN #104 voiced the vial dated [DATE] should have been discarded because it could not be used after 30 days, and the second vial should have been dated when opened. The nurse confirmed no information was available to indicate when the vial had been opened. Manufacturer's guidelines noted, A vial of TUBERSOL which has been entered and in use for 30 days should be discarded. b) North unit Medication carts (for 300 and 400 halls) On [DATE] at 3:00 p.m. accompanied by LPN #104 an observation of the 400 hall medication cart revealed opened unlabeled multi-dose bottles of the following: ---a 16 fl (fluid) oz (ounce) liquid bottle of Pink bismuth (a diarrhea medication used to treat diarrhea, heartburn, nausea and upset stomach). ---a 16 fl/oz liquid bottle of Milk of magnesia (an antacid and laxative medication). ---a 12 fl/oz liquid bottle of Advanced antacid (a heartburn and upset stomach medication). An observation of the 300 hall medication cart revealed opened unlabeled multi-dose bottles of the following: ---a 17.9 oz liquid bottle labeled Laxative ---a 16 oz bottle of Polyethylene glycol powder 3350 Immediately following this observation LPN #104 stated, All of the bottles are to be dated with the date they were opened. He verified that no date of opening were on the open bottles of medications. c) Controlled substance inventory logs Review of the four (4) shift change controlled substance inventory logs dated [DATE] through [DATE] at 3:15 p.m. on [DATE], found there were twenty (20) blank signature spaces for reconciliation of the controlled medication counts at the change of shifts identified. After review of the controlled substance inventory logs LPN #96 verified there were blank signature spaces. She stated, No there should not be any blanks, it is supposed to be signed by each on-coming and off -going nurse at the end of each shift to ensure the narcotic count is accurate. Regional Nurse Consultant #147 provided copies of the facility/pharmacy policy on [DATE] at 4:00 p.m. The policy titled, 5.4 Inventory Control of controlled Substances with an effective date of [DATE] and most recent revision date of [DATE] revealed under title: Procedure: .1.2 Facility should ensure that the incoming and outgoing nurses count all Schedule II controlled substances and other medications with a risk of abuse or diversion at the change of each shift or at least once daily and document the results on the controlled Substance count Verification/Shift Count Sheet . .1.2.1 Reconcile the total number number of controlled medications on hand . The Assistant Director of Nursing (ADON) reported on [DATE] at 4:20 p.m., there should not be any blank signatures from the on-coming and off -going nurses on the narcotic sheets. They are supposed to sign each day at the end of and beginning of each shift to ensure the narcotic count is correct. I was not aware that we needed to keep the whiskey in a more secured place other than the counter and agree there is not way of knowing if there is any diversion of the contents by staff. On [DATE] at 11:35 a.m. Regional Nurse Consultant #147 reported that the Physician was notified regarding the whiskey and changed the dosage to 50 ml which is in the small bottles which can be easily dispensed and counted on the narcotic sheet at the end of each shift. Resident #28's wife is taking the big bottle home and will bring in the small 50 ml bottles. Resident #28 was happy to receive a larger dose of the whiskey ordered and we will be able to keep track of the dosage and monitor the remaining amount of the whiskey. Review of the Pharmacist Quality Assurance (QA) review on [DATE] addressed to the Nursing Home Administrator (NHA) and Director of Nursing (DON) at 8:45 a.m. on [DATE] revealed under the title, Medication Cart Check with sub title of Controlled Substance with an x placed for 200 hall, Signatures are not present for each shift.",2020-04-01
3981,FAIRMONT HEALTHCARE AND REHABILITATION CENTER,515189,130 KAUFMAN DRIVE,FAIRMONT,WV,26554,2017-06-30,441,F,0,1,25Q611,"Based on observation, confidential staff interviews, a family member's comment, and staff interviews, the facility failed to maintain an Infection Control Program designed to provide a safe and sanitary environment and to help prevent the development and transmission of disease and infection. A random observation found staff did not clean a mechanical lift removed from the soiled utility room (where it was stored) before or after use to transfer a resident. An uncovered toilet plunger sat on the floor beside the toilet in a common resident bathroom. In addition, a washcloth with feces lay on the floor in a resident's room. These findings had the potential to affect more than a limited number of residents. Resident identifiers: #71 and #1. Facility census: 115. Findings include: a) Resident #71 Observations on 06/29/17 at 9:09 a.m. noted Employee #R removed a mechanical lift (Hoyer lift) from the soiled utility room on the North unit - 400 hall without sanitizing the equipment. She proceeded down the hallway to Resident #71's room and with the assistance of Employee #O, utilized the mechanical lift to transfer Resident #71 from his bed to his wheelchair. The mechanical lift was taken back to the soiled utility room without sanitizing the equipment. Immediately following this observation during a confidential interview with Employee #R, she verified the mechanical lift was not properly sanitized before or after the transfer of Resident #71. Employee #R stated, The lifts are always kept in soiled utility room and they (mechanical lift) are never cleaned by any staff before or after used to transfer residents. I didn't know we were supposed to clean them and even if we wanted to there is nothing to clean them with. (First name of Housekeeping Supervisor) never leaves us anything to clean them with. Employee #O, present during the previous confidential interview verified the lift was not cleaned after removing from soiled utility room or before the transfer of Resident #71. She stated, No we have never cleaned anything before or after we use it nobody does, even if we wanted to there is nothing for us to clean it with. I can tell you none of the staff in this facility on any shift ever clean the lift. Infection Control Nurse #102 reported on 06/29/17 at 11:00 a.m., There are cleaning wipes stored in the medication room and the nurses have the keys, but had to look for a while to find them. We keep them under lock and key now because of the last survey, and no, the aides don't have access unless they ask the nurse for them. We are limited with storage areas, but the soiled utility room is the worst place to store the mechanical lifts and they should be sanitized before and after using as is our policy and standards of care. b) The initial tour on 06/21/17 at 4:30 p.m., accompanied by Unit Manager #97, found an uncovered toilet plunger sitting beside the toilet of the common restroom utilized by residents on South unit-200 hall. She stated, The plunger is supposed to be covered not sitting directly on the floor. Yes, it is an infection control issue because it is used to unplug the toilet. c) Resident #1 On 06/27/17 at 9:10 a.m., a visit to Resident #1's room found Nurse Aide #64 in the room cleaning an area of the floor between the resident's bed and the bathroom door. She said she had been called to the room by the responsible party because there was feces on a washcloth and the floor. She said she was not the one who had left it there, but she was cleaning it up. The responsible party entered the room and said she had found the mess on the floor when she arrived for her visit and since there was no one around, she had gone in search of someone to clean it up.",2020-04-01
3982,FAIRMONT HEALTHCARE AND REHABILITATION CENTER,515189,130 KAUFMAN DRIVE,FAIRMONT,WV,26554,2017-06-30,490,F,0,1,25Q611,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based upon observation, resident interview, family interview, staff interview, policy review, and record review, the facility was not administered in a manner that enabled it to use its resources effectively and efficiently to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident. The survey found the facility did not have an approved surety bond to safeguard residents' personal funds entrusted to the facility, failed to address and respond promptly to complaints and grievances voiced by residents, family members, and the resident council, failed to provide appropriate care and treatment for [REDACTED]. The systemic nature of some of the deficient practices identified substandard quality of care and required an extended survey. Facility census: 115. Findings include: a) The review of the facility's surety bond on 06/28/17 at 9:30 a.m. The facility provided a certificate listing the names of persons appointed as attorneys-in-fact to act to provide surety, but there was no mention of the facility or it relationship to all or any portion of the amount specified. Upon request, the Administrator provided a second document entitled continuation certificate which stated that a bond was in force in the amount of $76,000.00 for the facility's resident funds account for the period from 07/01/17 to 07/01/18. An approval of the bond, or a continuation approval of the facility's bond by the West Virginia Attorney General was requested. The administrator said the facility did not have such a document. She offered to contact the Office of Health Facility Licensure and certification, the agency which facilitates the process of obtaining the required approval documentation of West Virginia Nursing Facilities from the Attorney general's office to find out the status of the facility's surety bond. She reported there was no approved surety bond in effect as required by statute due to the fact the bond was not submitted by the parent corporation in accordance with the provisions of the law. b) Resolution of concerns/grievances 1. Resident #1 On 06/22/17 at 11:38 a.m., Resident #1's responsible party was interviewed in the resident's room. She was surprised her mother was still in bed. She had two large cups for the resident's water, which were not filled. She was taking the cups to the administrator to make a complaint. Updated complaint/grievance forms were requested regularly as the survey progressed. As of the final day of the survey on 6/30/17, there was no complaint form regarding the lack of water for hydration. On 06/27/17 at 9:10 a.m., a visit was again made to Resident #1's room. Nurse Aide #64 was in the room cleaning an area of the floor between the bed and the bathroom door. She said she had been called to the room by the resident's responsible party because there was feces on the washcloth and the floor. She said she was not the one who had left it there, but she was cleaning it up. The responsible party entered the room and said she had found the mess on the floor when she arrived for her visit and since there was no one around, she had gone in search of someone to clean it up. On 6/29/17 at 10:00 a.m., Resident #1's responsible party was interviewed in the resident's room. She said she had gone to interrupt the management morning meeting on 06/27/17 to make a complaint about the feces filled washcloth on the floor. Updated complaint/grievance forms were requested regularly as the survey progressed. As of the final day of the survey on 6/30/17, there was no complaint form regarding the feces on the washcloth on the floor. She again held the large cups in her hands. The cups contained some ice in them, but no water. She said she had complained about the water just a few days ago, but it did no good. Review of the Resident council meeting minutes for the previous six (6) months on 06/21/17 at 4:00 p.m. found the minutes recorded on a form called Resident Council Quality of Life Assessment - Group Interview. Some of the months, the form had two pages, and for others, there were three. Not all the questions had responses noted. For those that did, some negative responses were found as follows: -- For the 06/05/17 meeting, for the question, Does the group have input into the rules of the facility? the response was No, because they always give you reason for the rules. The question Does the facility listen to your suggestions? was answered Sometimes. The question Are there places you can go when you want to be with other residents? was answered Not really, need more places. -- For the 05/05/17 meeting, for the question Does the group have input into the rules of the facility? the response was No. The question Does the facility listen to your suggestions? was answered Sometimes. The question Are there places you can go when you want to be with other residents? was answered No. The question Are the temperatures of your foods ok? was answered Sometimes. The question How did staff react? (to a voiced grievance/concern) was answered They listened, but it depends on who it is. -- For the (MONTH) (YEAR) meeting (no specific date was on the minutes), for the question Does the group have input into the rules of the facility? the response was No. The question Are meals generally on time? was answered No. -- For the 03/01/17 meeting, the question Is there enough staff to take care of everyone? the answer was No. There was no list of attendees for the May, June, or (MONTH) (YEAR) meetings. For the January, February, and (MONTH) (YEAR) meetings, the average attendance was twenty-two (22) residents. There was no evidence of any attempts by the facility to address these negative responses. There was no follow up noted in the meeting minutes, and there were no complaint/grievance forms corresponding to the dates the concerns were stated by the council. On 06/29/17 at 10:00 a.m., during an interview, Activities Director #140 agreed there was no record of any resolution or any attempt to address the concerns voiced by the council. On the afternoon of 06/28/17, Administrator #135 said the facility had a Concierge Program to compliment the complaint/grievance policy and procedure. She said residents and families were told about the program upon admission. The administrator said management staff were assigned a group of resident rooms and were charged with completing rounds at least weekly which were to be documented on a form entitled Concierge Program Rounds. Review of the policy and procedure found the concierge was charged with assisting the resident to complete a complaint/grievance form if needed. Review of some of the completed rounds found a form dated 06/12/17 in which an assigned management person for room [ROOM NUMBER]-1 checked the box on the form that Concern Completed: Resident is making a statement which indicates his/her needs are not met. As of the final day of the survey, there was no completed complaint/grievance form found to document the concern. The responsible party for Resident #1 was asked about the concierge program as a possible means of resolving grievances on 06/29/17 at 9:30 a.m., she said she had never heard of it. 2. Resident #52 On 06/26/17 at 12:16 p.m., during a Stage 1 family interview, when asked, Has (resident's name) had any missing personal items? the resident's daughter answered Yes, they have lost my Mother's glasses months ago. A review of the concern/grievance reports, on 06/28/17 at 2:30 p.m., found a concern/grievance report dated 04/04/17 by Resident #52's daughter was reported to Referral Manager/Social Worker (RM/SW). Under title of Documentation of Grievance/Complaint, the concern was described as (typed as written): Said her mothers glasses have been missing and no one followed up with her about this. Also (first name of Resident #52) hair was dirty and a dirty blanket on dresser and teeth not clean, commode not flushed. Under Documentation of Facility Follow-up, was Individual designated to take action on this concern: (name of Assistant Director of Nursing (ADON)), and a date resolved by of 04/06/17. Also noted was, Involved staff members were in-serviced on above concern. Follow-up reveals compliance with care concerns. Under Resolution of Grievance/complaint, a check mark was placed before Yes and written documentation stated (typed as written), NHA (Nursing Home Administrator) on porch discussing with daughter and when staff came to get her to clean her up better and do her teeth, the daughter refused and said not now. Staff did complete after daughter left. This form was signed by the NHA on 04/24/17. During an interview, and after reviewing the concern/grievance form for Resident #52, on 06/28/17 at 3:38 p.m., RM/SW explained, I just took the concern and the NHA follows up on that and determines whether it is resolved or not. On 06/28/17 at 3:42 p.m., after reviewing the concern/grievance form for Resident #52, the NHA agreed that it was not resolved. She stated, I just spoke with the daughter about this and she said her mother has not had her glasses for over 2 months, but I told her I thought they were found because I just put a pair of glasses on her last week. I remember because I had to fix her bangs when I put the glasses on. When asked about the time frame for resolution of concerns, she stated it took more than 1 or 2 days because they look through laundry and everything. When further inquired whether it should take more than two (2) and a half (1/2) months to resolve a concern since this concern was voiced on 04/04/17 and Resident #52's glasses were still missing, she stated, Well they might be in the nurses' cart. On 06/28/17 at 3:52 p.m., the NHA, with a glasses case in her hand, showed a pair of glasses reported, These are the glasses that were in the drawer at the nurses' station that she (Resident #52) wore last week, but they aren't hers (Resident #52). The daughter described hers (Resident #52) as black with gold squiggly things at the temple and these are just plain brown. So, we will have to just keep looking. When asked again about a time frame for resolution of a resident's or family member's concern/grievance, the NHA did not reply. c) Mental/Psychosocial Difficulties 1. Resident #44 The facility failed to ensure Resident #44 who was admitted to the facility with a history of outpatient psychiatric treatment for [REDACTED]. Staff's lack of knowledge of Resident #44's previous drug regimen and recent changes, and the failure to identify previously defined nonpharmacological interventions, along with mental and psychosocial adjustment difficulties related to a change in his living environment caused the resident to act out towards others in an aggressive nature. Arrangements for psychiatric services were not made until the resident's behaviors towards others continued all day with no response to listed nonpharmacological interventions and isolation. Review of the medical record on 06/27/17 at 2:10 p.m., revealed this alert, mentally challenged individual had had a severe intellectual disability since birth and had unclear speech with limited verbalization skills. He resided in an assisted living type home for several years until he became ill and required hospitalization . He was unable to return to his previous residence because of his increased care needs for all his activities of daily living (ADLS) and was admitted to the facility on [DATE]. Resident #44's medications were adjusted during his hospitalization because of questionable symptoms of drug toxicity to [MEDICATION NAME]. His medical discharge Medication Reconciliation Report (MRR) dated 04/26/17 noted the following medications changes: -- [MEDICATION NAME] 1 mg three times a day for impulse control disorder -- [MEDICATION NAME] ER 1000 mg twice a day - discontinued -- [MEDICATION NAME] 50 mg three times a day as needed for increased agitation and anxiety -- [MEDICATION NAME] 2 mg two times a day for impulse control disorder -- [MEDICATION NAME] 50 mg at bedtime for tremors The physician's admission history and physical signed 04/27/17 included under the Medical Conditions section, metabolic enceph ([MEDICAL CONDITION]), [MEDICATION NAME] toxic, [MEDICAL CONDITION], Tremors, acute [MEDICAL CONDITION], and [MEDICAL CONDITION]. The medications list included, [MEDICATION NAME] 50 mg tid prn (three times a day as needed), [MEDICATION NAME] 400 mg BID (twice a day), and multiple other medications with no indications for the use of the medications documented on the physician's admission form and the form lacked any information related to [MEDICATION NAME] 2 mg twice a day for impulse control. The Medication Administration Record [REDACTED] -- [MEDICATION NAME] 1 mg three times a day for [MEDICAL CONDITION] - the MRR noted this was for impulse control disorder -- [MEDICATION NAME] 10 mg daily for depression started 05/04/17 -- [MEDICATION NAME] 50 mg at bedtime for [MEDICAL CONDITION] - the MRR noted this was for tremors -- [MEDICATION NAME] 2 mg twice a day for [MEDICAL CONDITION] - the MRR noted this was for impulse control The physician's orders [REDACTED]. The original order was, [MEDICATION NAME] 50 mg . 1 CAP (capsule) by mouth three times a day for itching. The rewritten order at the end of the monthly order sheet dated 05/18/17 stated, [MEDICATION NAME] 25 mg po (by mouth) q (every) eight hours prn tid (as needed three times a day) itching The MRR noted Resident #44 was receiving [MEDICATION NAME] 50 mg three times a day for increased agitation and anxiety and the medication at discharge was written as an as needed drug. No clarification on this order was identified in the records. The physician's progress note dated 05/04/14 stated, Staff feels pt (patient) is depressed will start [MEDICATION NAME] . The medical record contained two (2) Informed Consents for Psychoactive Medications dated 05/01/17. -- [MEDICATION NAME] for the treatment of [REDACTED]. -- Klonopin for [MEDICAL CONDITION] (this was prescribed as a replacement for [MEDICATION NAME] for impulse control) There was no information related to [MEDICATION NAME] for anxiety. The records the surveyor received via fax machine from Resident #44's previous home on 06/27/17 at 1:08 p.m. and 3:23 p.m. indicated Resident #44 was on the following medications prior to his admission to the hospital: [MEDICATION NAME] 1000 milligrams (mg) Extended Release (ER) twice a day for aggression mood disorder, [MEDICATION NAME] 1 mg three times a day for impulse control behaviors, [MEDICATION NAME] 50 mg three times a day for anxiety behaviors, and [MEDICATION NAME] 2 mg twice a day for impulse control. Resident #44 was last seen by his psychiatric team on 03/08/17 and his next scheduled appointment was on 06/08/17. His [DIAGNOSES REDACTED]. The Nurse progress notes identified the following behaviors: -- 05/09/17 Therapist reported Resident #44 struck therapist in the head with his hand -- 05/11/17 Combative with staff intermittent through shift -- 05/23/17 Combative with staff hits staff without any apparent reason -- 05/26/17 Randomly hits staff in the back -- 05/27/17 Yells out Sissy or Bubby. Randomly strikes out at staff -- 05/28/17 Yelling at staff States he's mad. Combative with staff -- 05/30/17 Resident disruptive with noon meal. Refused to eat. Picked up glass of milk threw glass at staff -- 06/06/17 Combative with staff during care -- 06/07/17 Combative with staff with ADLS (activities of daily living) and transfers -- 06/11/17 Combative with nurse aide during routine care -- 06/20/17 Resident was in the lounge and started yelling at another resident. Started crying when other resident yelled back -- 06/22/17 Nurse aide reported resident was combative during morning care, crying -- 06/25/17 Resident was in north lounge listening to music he grabbed a female resident's hair and jerked her head backwards -- 06/26/17 Refused throughout the shift to allow nurse aides to shave -- 06/27/17 3:00 a.m. In hall way spitting and hitting at people (staff and residents) threw his slipper and hit the nurse and a resident's daughter -- 06/27/17 4:45 p.m. at 1645 (4:45 p.m.) states . Around 1300 (1:00 p.m.) Res hit another resident's w/c (wheel chair) and threw his shoe at staff. Attempted separating Res from others with limited success; Res continues trying to hit anyone nearby. 1500 (3:00 p.m.) called Dr. (name) regarding Res behavior, received order for neuropsyche eval, called (facility name), appt (appointment) for 07/02/17 at 1430 (2:30 p.m.) with Dr. (name). Dr. (name) again called d/t Res continuing to be combative, ordered out to (name) ER (emergency room ) Because of his continued agitation two (2) Policemen were called to assist the Emergency Medical Squad (EMS) with transferring Resident #44 to the emergency room . After the surveyor informed staff that the resident calmed down when he spoke with his sister, the resident was allowed to talk to his sister by telephone. After he spoke with his sister, he did calm down and was transferred to the ER without exhibiting further behaviors. The behavior monitoring sheets for (MONTH) (YEAR) note an increase of physical aggression since 06/20/17. The following documentation were made on the (MONTH) (YEAR) behavior monitoring sheet: -- 06/20/17 - 5 episodes of aggressive behavior - treated with redirection, one to one, and activity - outcome worsened -- 06/22/17 - 1 aggressive behavior episode - treated with redirection, one to one, and returned to room - outcome unchanged -- 06/23/17 - 2 aggressive episodes - treated with redirection and one to one - outcome worsened -- 06/24/17 - 1 aggressive episodes - treated with redirection and one to one - outcome worsened -- 06/25/17 - 1 aggressive behavior - treated with redirection and one to one - outcome worsened Resident #44's sister/health care surrogate (HCS) was contacted by telephone on 06/27/17 at 12:15 p.m. She reported Resident #44 was born mentally challenged and required assistance with all activities of daily living (ADLS). He had communication difficulties and at times could talk and respond to questions. He was physically abused by one of his brothers growing up, and became upset when a certain song was playing on the radio. He had lived in an assisted living type of home for several years until he became sick and was transferred to the hospital. Resident #44 was admitted to the nursing home facility following his discharge from the hospital and he was not close enough to home for the family to visit. The sister reported Resident #44 could get mad at times and start cussing and hitting, but he calmed down when he talked to his sister/ HCS over the telephone or he listened to country music, played his guitar, played with cars, or talked about buses and trains. At 12:30 p.m. on 06/27/17, Home Care Manager #148 was contacted as recommended by Resident #44's sister/HCS. Manager #148 reported Resident #44 use to be fairly independent and able to walk around the home until he became ill and required hospitalization . His behaviors had increased with his illness and he did become agitated at times. He responded to redirection, asking him what his problem was, and talking to his sister on the phone. He had been seeing (name) an assistant to a psychiatrist Dr. (name) every three (3) months and was scheduled to return to the psychiatrist office on 06/08/17. During an interview on 06/28/17 at 8:45 a.m., Registered Nurse (RN) #109 reported he was not working the day Resident #44 was admitted , but he had talked to his sister/HCS over the phone. Resident #44 could be calm and pleasant at times and at times would be crying and seeking attention. The current care plan interventions for Resident #44's behaviors include talking to him, country music, and his guitar. RN#109 stated a Resident's history was obtained through the hospital discharge summary and family when available. He acknowledged the facility was unaware of Resident #44's routine psychiatric visits and his missed appointment on 06/08/17 and was unaware that the recently discontinued [MEDICATION NAME] medication was for aggression and mood disorder and not [MEDICAL CONDITION]. RN #109 agreed it would be good to contact Resident #44's prior home for further information related to his psychiatric and medication history, as well as successful nonpharmacological interventions for behaviors. During an interview on 06/28/17 at 10:00 a.m., Licensed Social Worker (LSW) #139 reviewed the resident's medical record and acknowledged she was unaware of Resident #44's history of physical abuse by his brother or his increased agitation when a certain country music song was played. In addition, she acknowledged there was no information about Resident #44's psychiatric visits every three (3) months or his missed appointment that was scheduled for 06/08/17. She agreed it would be good to contact the resident's previous home to identify previous medication regimens, behaviors and interventions. Resident #44 had lived at an assisted living home since 2009. He began to decline, was no longer independent with his ADLS, and was admitted to the hospital, where he was weaned off [MEDICATION NAME], a drug he was receiving for aggression mood disorder, because of suspected toxicity. The [MEDICATION NAME] was replaced with [MEDICATION NAME] and the MRR noted it was for impulse control. The facility order sheet stated the [MEDICATION NAME] was for [MEDICAL CONDITION]. The records the surveyor obtained from Resident #44's previous home stated he did not have a [MEDICAL CONDITION] disorder. Resident #44 was also receiving [MEDICATION NAME] 50 mg three times a day for anxiety and agitation when he was admitted to the hospital. The hospital discharge MRR changed it to as needed at discharge. This change was not identified or clarified. The facility failed to obtain a complete history of Resident #44 from his previous home and from his sister/HCS. Facility staff were unaware of his history of being physically abused by a brother, or that he had increased agitation when a certain country song was played (his sister could not remember the song during our conversation). The facility was unaware of the resident's psychiatric needs, including his psychiatric visits every three months and his scheduled appointment which he missed on (MONTH) 8th. The facility was unaware of what interventions worked when he became stressed, which included letting him talk to his sister on the telephone and talking about trains and cars. Resident #44's behaviors began 05/09/17 and had increased to the point he was sent to the ER for evaluation. At that time, an appointment was made at a different psychiatric center for July. Staff were unaware of any of these findings until the Surveyor pointed them out after brief telephone interviews with the manager of the home and the HCS. RN #109 acknowledged the resident had some psychiatric issues they need to address and agreed they should have obtained more information from Resident #44's previous home. LSW #139 agreed the interventions the facility was using did not meet Resident #44's needs and acknowledged they were unaware of his routine psychiatric visits or his missed appointment. d) The facility failed to maintain an Infection Control Program designed to provide a safe and sanitary environment and to help prevent the development and transmission of disease and infection. A random observation found staff did not clean a mechanical lift removed from the soiled utility room (where it was stored) before or after use to transfer a resident. An uncovered toilet plunger sat on the floor beside the toilet in a common resident bathroom. In addition, a washcloth with feces lay on the floor in a resident's room. 1. Resident #71 Observations on 06/29/17 at 9:09 a.m. noted Employee #R removed a mechanical lift (Hoyer lift) from the soiled utility room on the North unit - 400 hall without sanitizing the equipment. She proceeded down the hallway to Resident #71's room and with the assistance of Employee #O, utilized the mechanical lift to transfer Resident #71 from his bed to his wheelchair. The mechanical lift was taken back to the soiled utility room without sanitizing the equipment. Immediately following this observation during a confidential interview with Employee #R, she verified the mechanical lift was not properly sanitized before or after the transfer of Resident #71. Employee #R stated, The lifts are always kept in soiled utility room and they (mechanical lift) are never cleaned by any staff before or after used to transfer residents. I didn't know we were supposed to clean them and even if we wanted to there is nothing to clean them with. (First name of Housekeeping Supervisor) never leaves us anything to clean them with. Employee #O, present during the previous confidential interview verified the lift was not cleaned after removing from soiled utility room or before the transfer of Resident #71. She stated, No we have never cleaned anything before or after we use it nobody does, even if we wanted to there is nothing for us to clean it with. I can tell you none of the staff in this facility on any shift ever clean the lift. Infection Control Nurse #102 reported on 06/29/17 at 11:00 a.m., There are cleaning wipes stored in the medication room and the nurses have the keys, but had to look for a while to find them. We keep them under lock and key now because of the last survey, and no, the aides don't have access unless they ask the nurse for them. We are limited with storage areas, but the soiled utility room is the worst place to store the mechanical lifts and they should be sanitized before and after using as is our policy and standards of care. 2. The initial tour on 06/21/17 at 4:30 p.m., accompanied by Unit Manager #97, found an uncovered toilet plunger sitting beside the toilet of the common restroom utilized by residents on South unit-200 hall. She stated, The plunger is supposed to be covered not sitting directly on the floor. Yes, it is an infection control issue because it is used to unplug the toilet. 3. Resident #1 On 06/27/17 at 9:10 a.m., a visit to Resident #1's room found Nurse Aide #64 in the room cleaning an area of the floor between the resident's bed and the bathroom door. She said she had been called to the room by the responsible party because there was feces on a washcloth and the floor. She said she was not the one who had left it there, but she was cleaning it up. The responsible party entered the room and said she had found the mess on the floor when she arrived for her visit and since there was no one around, she had gone in search of someone to clean it up. e) The facility failed to ensure the residents' environment remained as free of accident hazards as is possible. Electric baseboard heaters in the main hallways had sharp corner edges where they were mangled and bent. The main hallways on the North and South sides were utilized as main thoroughfares by residents. Observations during the initial tour of the facility on 06/21/17 at 4:30 p.m., found the electric baseboard heaters in the main hallways were mangled and bent with sharp corner edges. There were three (3) baseboard heaters on the 200 hall, two (2) on the 100 hallway, three (3) on the 300 hallway, and two (2) on the 400 hallway. When observed on 06/21/17 at 5:00 p.m. accompanied by the Maintenance Director, he stated, Those baseboard heaters are not used. I just need to remove them and repair the baseboards. Yes, the baseboard heaters look bad in the hallways and with those sharp edges could certainly be an accident hazard because someone could scratch or cut themselves on those corners. f) Housekeeping and Maintenance The facility failed to provide housekeeping and maintenance services necessary to maintain a sanitary, orderly, clean and comfortable homelike interior. Bathroom sink cabinets were chipped and broken and the interiors were stained and discolored. Faucets were dripping and sink drains were rusted or broken. Insulation was hanging below the front sink edge and caulking was cracked or missing around the sinks and toilets. Cove molding was loose and damaged in the bathrooms and vinyl bathroom floors were cracked. Bathroom mirror facings were chipped along the bottom edge. The central bathrooms on the 200 and 300 halls were cluttered with resident equipment and supplies. Wall heaters on the North and South ends of the building were rusted and floor base heaters on the 100, 200, and 300 halls were in disrepair with mangled sharp edges, loose parts, and large dust particles inside. 1. Observation of the facility during Stage 1 and Stage 2 of the Quality Indicator Survey revealed the following rooms had environmental concerns and cosmetic imperfections. a. room [ROOM NUMBER] The sink faucet was constantly dripping, the cove molding on the side of the commode was easily pushed in and there was dirt and grime accumulation in the corner of the bathroom door. b. room [ROOM NUMBER] The caulking was stained and discolored around the commode and the cove molding was not secured to the wall on the right side of the toilet. c. room [ROOM NUMBER] The sink cabinet was chipped and in disrepair and the floor was stained and discolored around the toilet base. d. room [ROOM NUMBER] The left side of the board on the bottom of the sink cabinet was dislodged and resting on the floor. The right cabinet face panel was loose and slid easily to the side. The plaster was off the exterior wall corner next to the sink exposing the metal support which was leaning out. e. room [ROOM NUMBER] The bathroom mirror facing was missing along the edge. The sink faucet was dripping and the cabinet had multiple areas of chipped particle board. The caulking was cracked around the sink top and missing around the commode, and the cove molding was loose and leaning outward below the sink. f. room [ROOM NUMBER] The foam insulation was hanging out the front edge of the bathroom sink. The edges of the particle board sink cabinet were rough and bare and the inside bottom shelf was stained and discolored. g. room [ROOM NUMBER] The bathroom sink cabinet was chipped along the lower edges of the doors and there was no caulking around the commode. h. room [ROOM NUMBER] The bathroom sink caulking was cracked, the cabinet doors were chipped, and the bottom shelf on the inside of the cabinet was split, swollen and in disrepair. i. room [ROOM NUMBER] The bathroom sink drain plug was rusted and there were holes in the cabinet from improper assembly of the front panel coverings. j. room [ROOM NUMBER] The bathroom sink cabinet was missing a front panel leaving a large square hole and the inside bottom shelf was wavy from moisture damage. h. room [ROOM NUMBER] The bottom shelf inside the bathroom sink was wavy and discolored and the vinyl floor was cracked on both sides of the toilet. e. room [ROOM NUMBER] The inside bottom of the bathroom sink was wavy and the vinyl floor contained a linear crack on the left side of the commode. f. room [ROOM NUMBER] The bathroom sink drain top was broken off. During a tour of the facility with the maintenance supervisor on 06/28/17 at 10:35 a.m., he agreed these items needed repaired and/or replaced. He stated he could easily fix the dripping faucets an (TRUNCATED)",2020-04-01
3983,FAIRMONT HEALTHCARE AND REHABILITATION CENTER,515189,130 KAUFMAN DRIVE,FAIRMONT,WV,26554,2017-06-30,502,D,0,1,25Q611,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility failed to obtain laboratory services as ordered by the physician. A fasting blood sugar (FBS) was no obtained as ordered for Resident #80. This affected one (1) of five (5) residents reviewed for unnecessary medications. Resident identifier: #80. Facility census: 115. Findings include: a) Resident #80 Medical record review on 06/29/17 at 8:15 a.m. revealed Resident #80's [DIAGNOSES REDACTED]. Her current medications include, Humalog insulin 8 units subcutaneous (subq) injection three times a day (TID) with meals for DMII and [MEDICATION NAME] 44 units subq at bedtime for DMII. A physician's orders [REDACTED]. The laboratory results for the FBS in (MONTH) (YEAR) were not found in the resident's medical record. During an interview with Registered Nurse (RN)/Nurse Educator #110 on 06/29/17 at 10:30 a.m., she said, There is no laboratory result for a FBS in (MONTH) (YEAR) because it was not done. On 06/29/17 at 11:10 a.m., the Assistant Director of Nursing (ADON) provided copies of the physician's orders [REDACTED]. She stated, The physician's orders [REDACTED]. So, no, the FBS was not monitored as ordered and I admit we did not know this until you asked for April's results.",2020-04-01
3984,FAIRMONT HEALTHCARE AND REHABILITATION CENTER,515189,130 KAUFMAN DRIVE,FAIRMONT,WV,26554,2017-06-30,514,E,0,1,25Q611,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility failed to maintain complete, accurately documented clinical records for each resident. Laboratory test results were absent in the chart for review for one (1) of five (5) Stage 2 sample residents reviewed for unnecessary medications. Inventory of Personal Effects forms were blank and/or incomplete for four (4) of four (4) Stage 2 sample residents whose charts were reviewed during the QIS survey. In addition there were no education sheets for the yearly flu vaccinations and immunization consents for five (5) of five (5) sample residents reviewed for immunizations during the QIS survey. These findings had, the potential to affect more than an isolated number of residents. Resident identifiers: #80, #81, #14, #1, #52, #42, #123, #79, #26, and #34. Facility census: 115. Findings include: a) Resident #80 Medical record review on 06/29/17 at 8:15 a.m. found a physician's orders [REDACTED]. The HGBA1C results for 12/29/16 were not found in the resident's medical record. Registered Nurse (RN)/Nurse Educator #110 provided copies of the HGBA1C results for 12/29/16 on 06/29/17 at 10:30 a.m. She stated, I had to get them off of the computer because they were not in the chart where they are supposed to be located. Yes, they should have been in the chart because we do not have electronic records other than than the minimum data set (MDS). I agree it is an incomplete medical record because only the nurses have access to the chart and may not know to look there for the results. b) Inventory of Personal Effects forms On 06/28/17 at 10:31 a.m., during a medical record review for Resident #52 (who had missing glasses while in the facility) found her Inventory of Personal Effects form lacked signature of employee, signature of relative or resident and dates. Continued medical record reviews on 06/28/17 at 10:40 a.m. of Inventory of Personal Effects forms discovered the following: -- Resident #1's form lacked a signature of an employee, a signature of a relative or the resident, and dates. -- Resident #14's form lacked a signature of a relative or the resident. -- Resident #81's form was blank for personal effects and lacked a signature of a relative or the resident. On 06/28/17 at 2:12 p.m. Employee #28 explained the process for obtaining and completing the Inventory of Personal Effects form for residents. She stated, The nurse will give us the form when we go in to do vitals and weights to be filled out, signed and dated by the employee and the resident or family. After reviewing the Inventory of Personal Effects forms for Residents #52, #1, #14, and #81 on 06/28/17 at 3:15 p.m., the Assistant Director of Nursing (ADON) stated, Yes they are all incomplete medical records because they are to be signed and dated by the employee and signed by either the resident or family. She explained Resident #81's form was blank because she was not admitted with any personal effects, but stated, No one would know that by looking at the form. c) Review of medical records for Residents #79, #124, #34 #26, and #142, on 06/28/17 at 2:00 p.m., revealed all five (5) medical records lacked documentation/consent forms indicating the resident and/or the resident's legal representative consented for the influenza vaccine and/or received education regarding the current benefits and potential side effects prior to administration during the (YEAR)-2017 flu season. Resident #124 received the [MEDICATION NAME] flu vaccine on 10/11/16, Residents #79, #34, and #26 received the [MEDICATION NAME] vaccine on 10/12/16, and Resident #42 refused the vaccine in (YEAR). The Assistant Director of Nursing (ADON) provided copies of the Influenza (flu) consents for Residents #79, #124, #34, and #26 on the form titled Pneumococcal & Annual Influenza Vaccination Information & Request with a revision date of 02/2007, during an interview on 06/28/17 at 3:00 p.m. The ADON reported the consent forms were not kept in the medical records and acknowledged there were no other consents for the influenza vaccine or documentation related to annual education on the risks and benefits of the flu vaccine provided to the resident and/or family prior to the yearly administration of the flu vaccine. The Pneumococcal & Annual Influenza Vaccination Information & Request forms reviewed 06/28/17 at 3:10 p.m. and found to be incomplete were: -- Resident #79's consent was not dated or signed by the resident and/or responsible party or the facility representative. -- Resident #124's consent was signed on 10/05/16, but lacked identification of the person signing and a signature by the facility representative. -- Resident #34's consent was signed on 09/15/15 by a West Virginia Department of Health and Human Resources representative but lacked the signature of the facility's representative. -- Resident #26's consent was signed on 09/18/15 with no identification of the family member signing and lacked a signature of the facility representative. -- Resident #42's consent was signed on 09/14/15 by her daughter/health care surrogate but lacked a facility representative signature. Registered Nurse (RN) #109 and LPN #96 reviewed the consents for Residents #79, #124, #34, and #26 during an interview on 06/28/17 at 3:20 p.m. Both staff acknowledged the forms were incomplete lacking signatures and/or dates. RN #109 and LPN #96 confirmed the Pneumococcal & Annual Influenza Vaccination Information & Request form with a revision date was 02/2007 could not contain the current information from Centers for Disease Control and Prevention related to the benefits and potential side effects of the influenza vaccine. The facility failed to follow its policy titled Immunizations - Pneumococcal & Annual Influenza that stated, Counsel resident and/or family on the benefits and adverse effects by providing educational materials of each vaccine prior to administration of the vaccines. Section 4 of the guidelines included, Provide the resident and/or family with a copy of the applicable VIS (Vaccine Information Statement) .On an annual basis, the person administering the vaccine will Document the review of the VIS in the Nurse Progress Notes and include whom the VIS was given too.",2020-04-01
3985,FAIRMONT HEALTHCARE AND REHABILITATION CENTER,515189,130 KAUFMAN DRIVE,FAIRMONT,WV,26554,2017-06-30,520,F,0,1,25Q611,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, staff interviews, resident interviews, confidential staff interviews, and confidential resident interviews, and review of Quality Assurance and Assessment (QA&A) Committee sign-in sheets, the facility failed to identify and/or correct quality deficiencies of which they were aware, or should have been aware. These deficient practices included failure to ensure prompt efforts to resolve concern/grievances in a timely manner, failure to maintain residents' dignity with proper positions during dining, failure to maintain a clean comfortable homelike environment in the dining room and ensuring used wash cloths with feces are not left in a resident room, failure to provide housekeeping and maintenance services to maintain a sanitary orderly and comfortable interior by repairing and/or replacing cosmetic imperfections in hallways and resident rooms, to maintain hallways that are free of accident hazards by repairing or replacing electric baseboard heaters in main hallways, failure to provide yearly education prior to the administration of the influenza vaccine, to maintain an effective infection control program and to maintain complete and accurate medical records. These practices have the potential to affect all residents residing in the facility. Facility census: 115. Citation Text for Tag 0520, Regulation FF10 [NAME], [NAME] [NAME], [NAME] [NAME] Based on observation, staff interviews, resident interviews, confidential staff interviews, and confidential resident interviews, and review of Quality Assurance and Assessment (QA&A) Committee sign-in sheets, the facility failed to identify and/or correct quality deficiencies of which they were aware, or should have been aware. These deficient practices included failure to ensure prompt efforts to resolve concern/grievances in a timely manner, failure to maintain residents' dignity with proper positions during dining, failure to maintain a clean comfortable homelike environment in the dining room and ensuring used washcloths with feces are not left in a resident room, failure to provide housekeeping and maintenance services to maintain a sanitary orderly and comfortable interior by repairing and/or replacing cosmetic imperfections in hallways and resident rooms, to maintain hallways that are free of accident hazards by repairing or replacing electric baseboard heaters in main hallways, failure to provide yearly education prior to the administration of the influenza vaccine, to maintain an effective infection control program and to maintain complete and accurate medical records. These practices had the potential to affect all residents residing in the facility. Facility census: 115. Findings include: a) Resolution of concerns/grievances 1. Resident #1 On 06/22/17 at 11:38 a.m., Resident #1's responsible party was interviewed in the resident's room. She was surprised her mother was still in bed. She had two large cups for the resident's water, which were not filled. She was taking the cups to the administrator to make a complaint. Updated complaint/grievance forms were requested regularly as the survey progressed. As of the final day of the survey on 6/30/17, there was no complaint form regarding the lack of water for hydration. On 06/27/17 at 9:10 a.m., a visit was again made to Resident #1's room. Nurse Aide #64 was in the room cleaning an area of the floor between the bed and the bathroom door. She said she had been called to the room by the resident's responsible party because there was feces on the washcloth and the floor. She said she was not the one who had left it there, but she was cleaning it up. The responsible party entered the room and said she had found the mess on the floor when she arrived for her visit and since there was no one around, she had gone in search of someone to clean it up. On 6/29/17 at 10:00 a.m., Resident #1's responsible party was interviewed in the resident's room. She said she had gone to interrupt the management morning meeting on 06/27/17 to make a complaint about the feces filled washcloth on the floor. Updated complaint/grievance forms were requested regularly as the survey progressed. As of the final day of the survey on 6/30/17, there was no complaint form regarding the feces on the washcloth on the floor. She again held the large cups in her hands. The cups contained some ice in them, but no water. She said she had complained about the water just a few days ago, but it did no good. Review of the Resident council meeting minutes for the previous six (6) months on 06/21/17 at 4:00 p.m. found the minutes recorded on a form called Resident Council Quality of Life Assessment - Group Interview. Some of the months, the form had two pages, and for others, there were three. Not all the questions had responses noted. For those that did, some negative responses were found as follows: -- For the 06/05/17 meeting, for the question, Does the group have input into the rules of the facility? the response was No, because they always give you reason for the rules. The question Does the facility listen to your suggestions? was answered Sometimes. The question Are there places you can go when you want to be with other residents? was answered Not really, need more places. -- For the 05/05/17 meeting, for the question Does the group have input into the rules of the facility? the response was No. The question Does the facility listen to your suggestions? was answered Sometimes. The question Are there places you can go when you want to be with other residents? was answered No. The question Are the temperatures of your foods ok? was answered Sometimes. The question How did staff react? (to a voiced grievance/concern) was answered They listened, but it depends on who it is. -- For the (MONTH) (YEAR) meeting (no specific date was on the minutes), for the question Does the group have input into the rules of the facility? the response was No. The question Are meals generally on time? was answered No. -- For the 03/01/17 meeting, the question Is there enough staff to take care of everyone? the answer was No. There was no list of attendees for the May, June, or (MONTH) (YEAR) meetings. For the January, February, and (MONTH) (YEAR) meetings, the average attendance was twenty-two (22) residents. There was no evidence of any attempts by the facility to address these negative responses. There was no follow up noted in the meeting minutes, and there were no complaint/grievance forms corresponding to the dates the concerns were stated by the council. On 06/29/17 at 10:00 a.m., during an interview, Activities Director #140 agreed there was no record of any resolution or any attempt to address the concerns voiced by the council. On the afternoon of 06/28/17, Administrator #135 said the facility had a Concierge Program to compliment the complaint/grievance policy and procedure. She said residents and families were told about the program upon admission. The administrator said management staff were assigned a group of resident rooms and were charged with completing rounds at least weekly which were to be documented on a form entitled Concierge Program Rounds. Review of the policy and procedure found the concierge was charged with assisting the resident to complete a complaint/grievance form if needed. Review of some of the completed rounds found a form dated 06/12/17 in which an assigned management person for room [ROOM NUMBER]-1 checked the box on the form that Concern Completed: Resident is making a statement which indicates his/her needs are not met. As of the final day of the survey, there was no completed complaint/grievance form found to document the concern. The responsible party for Resident #1 was asked about the concierge program as a possible means of resolving grievances on 06/29/17 at 9:30 a.m., she said she had never heard of it. 2. Resident #52 On 06/26/17 at 12:16 p.m., during a Stage 1 family interview, when asked, Has (resident's name) had any missing personal items? the resident's daughter answered Yes, they have lost my Mother's glasses months ago. A review of the concern/grievance reports, on 06/28/17 at 2:30 p.m., found a concern/grievance report dated 04/04/17 by Resident #52's daughter was reported to Referral Manager/Social Worker (RM/SW). Under title of Documentation of Grievance/Complaint, the concern was described as (typed as written): Said her mothers glasses have been missing and no one followed up with her about this. Also (first name of Resident #52) hair was dirty and a dirty blanket on dresser and teeth not clean, commode not flushed. Under Documentation of Facility Follow-up, was Individual designated to take action on this concern: (name of Assistant Director of Nursing (ADON)), and a date resolved by of 04/06/17. Also noted was, Involved staff members were in-serviced on above concern. Follow-up reveals compliance with care concerns. Under Resolution of Grievance/complaint, a check mark was placed before Yes and written documentation stated (typed as written), NHA (Nursing Home Administrator) on porch discussing with daughter and when staff came to get her to clean her up better and do her teeth, the daughter refused and said not now. Staff did complete after daughter left. This form was signed by the NHA on 04/24/17. During an interview, and after reviewing the concern/grievance form for Resident #52, on 06/28/17 at 3:38 p.m., RM/SW explained, I just took the concern and the NHA follows up on that and determines whether it is resolved or not. On 06/28/17 at 3:42 p.m., after reviewing the concern/grievance form for Resident #52, the NHA agreed that it was not resolved. She stated, I just spoke with the daughter about this and she said her mother has not had her glasses for over 2 months, but I told her I thought they were found because I just put a pair of glasses on her last week. I remember because I had to fix her bangs when I put the glasses on. When asked about the time frame for resolution of concerns, she stated it took more than 1 or 2 days because they look through laundry and everything. When further inquired whether it should take more than two (2) and a half (1/2) months to resolve a concern since this concern was voiced on 04/04/17 and Resident #52's glasses were still missing, she stated, Well they might be in the nurses' cart. On 06/28/17 at 3:52 p.m., the NHA, with a glasses case in her hand, showed a pair of glasses reported, These are the glasses that were in the drawer at the nurses' station that she (Resident #52) wore last week, but they aren't hers (Resident #52). The daughter described hers (Resident #52) as black with gold squiggly things at the temple and these are just plain brown. So, we will have to just keep looking. When asked again about a time frame for resolution of a resident's or family member's concern/grievance, the NHA did not reply. b) The facility failed to maintain an Infection Control Program designed to provide a safe and sanitary environment and to help prevent the development and transmission of disease and infection. A random observation found staff did not clean a mechanical lift removed from the soiled utility room (where it was stored) before or after use to transfer a resident. An uncovered toilet plunger sat on the floor beside the toilet in a common resident bathroom. In addition, a washcloth with feces lay on the floor in a resident's room. 1. Resident #71 Observations on 06/29/17 at 9:09 a.m. noted Employee #R removed a mechanical lift (Hoyer lift) from the soiled utility room on the North unit - 400 hall without sanitizing the equipment. She proceeded down the hallway to Resident #71's room and with the assistance of Employee #O, utilized the mechanical lift to transfer Resident #71 from his bed to his wheelchair. The mechanical lift was taken back to the soiled utility room without sanitizing the equipment. Immediately following this observation during a confidential interview with Employee #R, she verified the mechanical lift was not properly sanitized before or after the transfer of Resident #71. Employee #R stated, The lifts are always kept in soiled utility room and they (mechanical lift) are never cleaned by any staff before or after used to transfer residents. I didn't know we were supposed to clean them and even if we wanted to there is nothing to clean them with. (First name of Housekeeping Supervisor) never leaves us anything to clean them with. Employee #O, present during the previous confidential interview verified the lift was not cleaned after removing from soiled utility room or before the transfer of Resident #71. She stated, No we have never cleaned anything before or after we use it nobody does, even if we wanted to there is nothing for us to clean it with. I can tell you none of the staff in this facility on any shift ever clean the lift. Infection Control Nurse #102 reported on 06/29/17 at 11:00 a.m., There are cleaning wipes stored in the medication room and the nurses have the keys, but had to look for a while to find them. We keep them under lock and key now because of the last survey, and no, the aides don't have access unless they ask the nurse for them. We are limited with storage areas, but the soiled utility room is the worst place to store the mechanical lifts and they should be sanitized before and after using as is our policy and standards of care. 2. The initial tour on 06/21/17 at 4:30 p.m., accompanied by Unit Manager #97, found an uncovered toilet plunger sitting beside the toilet of the common restroom utilized by residents on South unit-200 hall. She stated, The plunger is supposed to be covered not sitting directly on the floor. Yes, it is an infection control issue because it is used to unplug the toilet. 3. Resident #1 On 06/27/17 at 9:10 a.m., a visit to Resident #1's room found Nurse Aide #64 in the room cleaning an area of the floor between the resident's bed and the bathroom door. She said she had been called to the room by the responsible party because there was feces on a washcloth and the floor. She said she was not the one who had left it there, but she was cleaning it up. The responsible party entered the room and said she had found the mess on the floor when she arrived for her visit and since there was no one around, she had gone in search of someone to clean it up. b) The facility failed to ensure the residents' environment remained as free of accident hazards as is possible. Electric baseboard heaters in the main hallways had sharp corner edges where they were mangled and bent. The main hallways on the North and South sides were utilized as main thoroughfares by residents. Observations during the initial tour of the facility on 06/21/17 at 4:30 p.m., found the electric baseboard heaters in the main hallways were mangled and bent with sharp corner edges. There were three (3) baseboard heaters on the 200 hall, two (2) on the 100 hallway, three (3) on the 300 hallway, and two (2) on the 400 hallway. When observed on 06/21/17 at 5:00 p.m. accompanied by the Maintenance Director, he stated, Those baseboard heaters are not used. I just need to remove them and repair the baseboards. Yes, the baseboard heaters look bad in the hallways and with those sharp edges could certainly be an accident hazard because someone could scratch or cut themselves on those corners. c) Housekeeping and Maintenance The facility failed to provide housekeeping and maintenance services necessary to maintain a sanitary, orderly, clean and comfortable homelike interior. Bathroom sink cabinets were chipped and broken and the interiors were stained and discolored. Faucets were dripping and sink drains were rusted or broken. Insulation was hanging below the front sink edge and caulking was cracked or missing around the sinks and toilets. Cove molding was loose and damaged in the bathrooms and vinyl bathroom floors were cracked. Bathroom mirror facings were chipped along the bottom edge. The central bathrooms on the 200 and 300 halls were cluttered with resident equipment and supplies. Wall heaters on the North and South ends of the building were rusted and floor base heaters on the 100, 200, and 300 halls were in disrepair with mangled sharp edges, loose parts, and large dust particles inside. 1. Observation of the facility during Stage 1 and Stage 2 of the Quality Indicator Survey revealed the following rooms had environmental concerns and cosmetic imperfections. a. room [ROOM NUMBER] The sink faucet was constantly dripping, the cove molding on the side of the commode was easily pushed in and there was dirt and grime accumulation in the corner of the bathroom door. b. room [ROOM NUMBER] The caulking was stained and discolored around the commode and the cove molding was not secured to the wall on the right side of the toilet. c. room [ROOM NUMBER] The sink cabinet was chipped and in disrepair and the floor was stained and discolored around the toilet base. d. room [ROOM NUMBER] The left side of the board on the bottom of the sink cabinet was dislodged and resting on the floor. The right cabinet face panel was loose and slid easily to the side. The plaster was off the exterior wall corner next to the sink exposing the metal support which was leaning out. e. room [ROOM NUMBER] The bathroom mirror facing was missing along the edge. The sink faucet was dripping and the cabinet had multiple areas of chipped particle board. The caulking was cracked around the sink top and missing around the commode, and the cove molding was loose and leaning outward below the sink. f. room [ROOM NUMBER] The foam insulation was hanging out the front edge of the bathroom sink. The edges of the particle board sink cabinet were rough and bare and the inside bottom shelf was stained and discolored. g. room [ROOM NUMBER] The bathroom sink cabinet was chipped along the lower edges of the doors and there was no caulking around the commode. h. room [ROOM NUMBER] The bathroom sink caulking was cracked, the cabinet doors were chipped, and the bottom shelf on the inside of the cabinet was split, swollen and in disrepair. i. room [ROOM NUMBER] The bathroom sink drain plug was rusted and there were holes in the cabinet from improper assembly of the front panel coverings. j. room [ROOM NUMBER] The bathroom sink cabinet was missing a front panel leaving a large square hole and the inside bottom shelf was wavy from moisture damage. h. room [ROOM NUMBER] The bottom shelf inside the bathroom sink was wavy and discolored and the vinyl floor was cracked on both sides of the toilet. e. room [ROOM NUMBER] The inside bottom of the bathroom sink was wavy and the vinyl floor contained a linear crack on the left side of the commode. f. room [ROOM NUMBER] The bathroom sink drain top was broken off. During a tour of the facility with the maintenance supervisor on 06/28/17 at 10:35 a.m., he agreed these items needed repaired and/or replaced. He stated he could easily fix the dripping faucets and the drain plug, but did not have the supplies to replace the sink cabinets or replace the bathroom floors. 2. Central bathrooms Observations of the central bathrooms on the 200 and 300 halls during the initial tour on 06/21/17 at 4:30 p.m., and randomly throughout the survey found both restrooms were used by residents while stocked with supplies and equipment. The North restroom located on the 300 hall contained a sink by the door and a commode in the far corner across from the door. Next to the commode was a curtain touching an empty chart rack. Beside the chart rack in the far left corner were 180 gallons of water in plastic jugs with an open plastic cover across the top and sides. Beside the water along the wall were shelves stocked with briefs and other supplies. In addition, two (2) wound carts with treatment records, a suction machine, the emergency crash cart, a wheelchair scale, and multiple supplies including a mattress. Licensed Practical Nurse (LPN) #112 accompanied the surveyor into the restroom during the initial tour and acknowledged the residents use both the 300 hall and 400 hall restrooms. LPN #112, reported the facility used the water for emergency situations, the chart rack next to the toilet was used by the facility, and the mattress and other supplies near the door were waiting to be returned to someone. The south restroom located on the 200 hall was also used by the residents and storage of resident equipment and supplies. A tour of the 200 hall restroom on 06/28/17 at 10:35 a.m. found the following items: a wheelchair scale and a stand-up scale, two (2) unlocked wound care carts with the treatment records on top, a mop and bucket of water, a chart rack, 180 gallons of water in plastic jugs, several packages of briefs, a crash cart, and several lift blankets. On 06/21/17 at 4:50 p.m., during the initial tour, Unit Manager/RN #97 reported there was no other place to store the carts and acknowledged this could be an infection control issue since the bathroom was used by the residents on all three (3) shifts. Confidential interviews with Employee A and Employee B during the survey confirmed the central restrooms on the 200 and 300 halls were used by the residents on all three (3) shifts. The employees stated that independent residents were left unattended in the restroom/storage space on the 200 and 300 halls. 3. The initial tour of the facility on 06/21/17 at 4:30 p.m., discovered in the main hallways by exit doors on 100, 200, 300 and 400 hallways, wall heating units with rusted vents. Electric baseboard heaters in the main hallways were mangled and bent, with sharp corner edges. These halls were utilized as a main thoroughfare by residents. There were three (3) baseboard heaters on the 200 hall, two (2) on the 100 hallway, three (3) on the 300 hallway, and two (2) on the 400 hallway. On 06/21/17 at 5:00 p.m., accompanied by the Maintenance Director, the baseboard heaters were viewed again. He stated, Those baseboard heaters are not used I just need to remove them and repair the baseboards. The wall unit vents need painted. Yes, the baseboard heaters look bad in the hallways and with those sharp edges could certainly an accident hazard. d) The facility failed to educate each resident and/or the resident's legal representative on the benefits and potential side effects of the influenza vaccine prior to administering the vaccine during the current (YEAR)-2017 flu season. In addition, the consent forms presented on admission were not updated to reflect the CDC's current vaccine information statement. 1. Residents #79, #124, #34, and #26 Review of the medical records for these residents on 06/28/17 at 2:00 p.m., revealed all four (4) medical records lacked documentation indicating the resident and/or the resident's legal representative received education regarding the current benefits and potential side effects of the influenza vaccine prior to administration during the current flu season. Resident #124 received the [MEDICATION NAME] flu vaccine on 10/11/16 and Residents #79, #34, and #26 received the [MEDICATION NAME] vaccine on 10/12/16. Licensed Practical Nurse (LPN) #119 reviewed the medical records during an interview on 06/28/17 at 2:40 p.m. and confirmed the records lacked any information related to consents and/or education regarding the benefits and potential side effects of the influenza vaccine. LPN #119 contacted Social Worker #143, the admissions person, and reported the only resident/family education provided was on the Pneumococcal & Annual Influenza Vaccination Information & Request form which was signed on admission and contained a revision date of 02/2007. During an interview at 3:00 p.m. on 06/28/17 the Assistant Director of Nursing (ADON) provided copies of the Influenza (flu) consents for Residents #79, #124, #34, and #26 on the form titled Pneumococcal & Annual Influenza Vaccination Information & Request with a revision date of 02/2007. The ADON reported the consent forms were not kept in the medical records. Resident #79's consent was not dated or signed. Resident #124's consent was signed on 10/05/16 with no identification of the person signing. Resident #34's consent was signed on 09/15/15 and Resident #26's consent was signed 09/18/15 with no identification of the family member signing. The ADON acknowledged there were no other consents or annual education provided to the resident and/or family prior to the yearly administration of the flu vaccine. The facility policy titled Immunizations - Pneumococcal & Annual Influenza stated under #3 of the guidelines on page 92: Counsel resident and/or family on the benefits and adverse effects by providing educational materials of each vaccine prior to administration of the vaccines. Section 4 of the guidelines states: Provide the resident and/or family with a copy of the applicable VIS (Vaccine Information Statement) .a. On an annual basis, the person administering the vaccine will Document the review of the VIS in the Nurse Progress Notes and include whom the VIS was given too. The Centers for Disease Control and Prevention (CDC) updates its recommendations regarding the influenza vaccine annually based on information from the World Health Organzation (WHO) regarding the projected [MEDICAL CONDITION]. For example, For the (YEAR)-17 season, CDC recommends use of the flu shot (inactivated influenza vaccine or IIV) and the recombinant influenza vaccine (RIV). The nasal spray flu vaccine (live attenuated influenza vaccine or LAIV) should not be used during (YEAR)-17. The CDC also makes recommendations for certain populations such as the elderly, those who are immunocompromised, etc. The facility's influenza information was last updated in 2007. Registered Nurse (RN) #109 and LPN #96 reviewed the consents for Residents #79, #124, #34, and #26 during an interview on 06/28/17 at 3:20 p.m. and confirmed the Pneumococcal & Annual Influenza Vaccination Information & Request form with a revision date was 02/2007 could not contain the current information from CDC related to the benefits and potential side effects of the influenza vaccine. e) The facility failed to maintain complete, accurately documented clinical records for each resident. Laboratory test results were absent in the chart for review for one (1) of five (5) Stage 2 sample residents reviewed for unnecessary medications. Inventory of Personal Effects forms were blank and/or incomplete for four (4) of four (4) Stage 2 sample residents whose charts were reviewed during the QIS survey. In addition, the education sheets for the yearly flu vaccinations and immunization consents were incomplete for five (5) of five (5) sample residents reviewed for immunizations during the QIS survey. 1. Resident #80 Medical record review on 06/29/17 at 8:15 a.m. found a physician's orders [REDACTED]. The HGBA1C results for 12/29/16 were not found in the resident's medical record. Registered Nurse (RN)/Nurse Educator #110 provided copies of the HGBA1C results for 12/29/16 on 06/29/17 at 10:30 a.m. She stated, I had to get them off of the computer because they were not in the chart where they are supposed to be located. Yes, they should have been in the chart because we do not have electronic records other than than the minimum data set (MDS). I agree it is an incomplete medical record because only the nurses have access to the chart and may not know to look there for the results. 2. Inventory of Personal Effects forms On 06/28/17 at 10:31 a.m., during a medical record review for Resident #52 (who had missing glasses while in the facility) found her Inventory of Personal Effects form lacked signature of employee, signature of relative or resident and dates. Continued medical record reviews on 06/28/17 at 10:40 a.m. of Inventory of Personal Effects forms discovered the following: -- Resident #1's form lacked a signature of an employee, a signature of a relative or the resident, and dates. -- Resident #14's form lacked a signature of a relative or the resident. -- Resident #81's form was blank for personal effects and lacked a signature of a relative or the resident. On 06/28/17 at 2:12 p.m. Employee #28 explained the process for obtaining and completing the Inventory of Personal Effects form for residents. She stated, The nurse will give us the form when we go in to do vitals and weights to be filled out, signed and dated by the employee and the resident or family. After reviewing the Inventory of Personal Effects forms for Residents #52, #1, #14, and #81 on 06/28/17 at 3:15 p.m., the Assistant Director of Nursing (ADON) stated, Yes they are all incomplete medical records because they are to be signed and dated by the employee and signed by either the resident or family. She explained Resident #81's form was blank because she was not admitted with any personal effects, but stated, No one would know that by looking at the form. 3. Review of medical records for Residents #79, #124, #34 #26, and #142, on 06/28/17 at 2:00 p.m., revealed all five (5) medical records lacked documentation/consent forms indicating the resident and/or the resident's legal representative consented for the influenza vaccine and/or received education regarding the current benefits and potential side effects prior to administration during the (YEAR)-2017 flu season. Resident #124 received the [MEDICATION NAME] flu vaccine on 10/11/16, Residents #79, #34, and #26 received the [MEDICATION NAME] vaccine on 10/12/16, and Resident #42 refused the vaccine in (YEAR). The Assistant Director of Nursing (ADON) provided copies of the Influenza (flu) consents for Residents #79, #124, #34, and #26 on the form titled Pneumococcal & Annual Influenza Vaccination Information & Request with a revision date of 02/2007, during an interview on 06/28/17 at 3:00 p.m. The ADON reported the consent forms were not kept in the medical records and acknowledged there were no other consents for the influenza vaccine or documentation related to annual education on the risks and benefits of the flu vaccine provided to the resident and/or family prior to the yearly administration of the flu vaccine. The Pneumococcal & Annual Influenza Vaccination Information & Request forms reviewed 06/28/17 at 3:10 p.m. and found to be incomplete were: -- Resident #79's consent was not dated or signed by the resident and/or responsible party or the facility representative. -- Resident #124's consent was signed on 10/05/16, but lacked identification of the person signing and a signature by the facility representative. -- Resident #34's consent was signed on 09/15/15 by a West Virginia Department of Health and Human Resources representative but lacked the signature of the facility's representative. -- Resident #26's consent was signed on 09/18/15 with no identification of the family member signing and lacked a signature of the facility representative. -- Resident #42's consent was signed on 09/14/15 by her daughter/health care surrogate but lacked a facility representative signature. Registered Nurse (RN) #109 and LPN #96 reviewed the consents for Residents #79, #124, #34, and #26 during an interview on 06/28/17 at 3:20 p.m. Both staff acknowledged the forms were incomplete lacking signatures and/or dates. RN #109 and LPN #96 confirmed the Pneumococcal & Annual Influenza Vaccination Information & Request form with a revision date was 02/2007 could not contain the current information from Centers for Disease Control and Prevention related to the benefits and potential side effects of the influen (TRUNCATED)",2020-04-01