{"rowid": 101, "facility_name": "HUNTINGTON HEALTH AND REHABILITATION CENTER", "facility_id": 515007, "address": "1720 17TH STREET", "city": "HUNTINGTON", "state": "WV", "zip": 25701, "inspection_date": "2018-08-23", "deficiency_tag": 695, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "TKSO11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to ensure that one resident's oxygen therapy was monitored for the need and effectiveness of oxygen therapy and failed to document respiratory signs and symptoms, changes in oxygen administration, and/or results of oxygen therapy. This affected one of one resident reviewed for oxygen therapy in the sample of 28. Resident identifier: #92. Facility census: 176. Findings included: a) Resident #92 Resident #92's medical record was reviewed on 08/22/18 at 02:17 PM. Resident #92 is severely cognitively impaired according to the Minimum Data Assessment, dated 05/24/18. Resident #92 had [DIAGNOSES REDACTED]. Resident #92 had a physician's orders [REDACTED]. The order further stated that the oxygen should be titrated to keep oxygen levels above 92%. There were no oxygen saturation levels documented in the medical record. There were no progress notes regarding the resident's respiratory signs and symptoms, the time or reason oxygen was administered, or the result of oxygen therapy. Resident #92's care plan, target date 08/21/18, listed interventions to observe for signs and symptoms of acute respiratory insufficiency such as anxiety, confusion, restlessness, shortness of breath at rest, cyanosis, and somnolence. Resident #92 was observed in bed receiving oxygen therapy via nasal canula on 08/20/18 at 11:35 AM, 08/21/18 at 01:39 PM, 08/21/18 at 5:45 PM, and 08/22/18 at 10:10 AM at 2 L/M. On 08/22/18 at 02:49 PM Resident #92 was observed receiving oxygen at 3.5 L/M via the nasal canula. On 08/22/18 at 02:49 the Unit Coordinator/Licensed Practical Nurse (LPN) #55 confirmed that Resident #92's oxygen level was set at 3.5 L/M. LPN #55 stated that the order is for 2 L/M as needed, but that the oxygen can be titrated up to keep saturation levels greater than 92% per the physician's orders [REDACTED]. LPN #55 said, There should be oxygen saturation levels for her. LPN #55 obtained Resident #92's oxygen saturation level and reported it was 95 - 96%. On 08/22/18 at 03:01 PM LPN #75 was interviewed. LPN #75 confirmed that she was the nurse caring for Resident #92 on that day. LPN #75 said she checked Resident #92's oxygen concentrator a couple hours ago and it was on 2 L/M. LPN #75 said she checked Resident #92's oxygen saturation level at that time and it was 97%. LPN #75 said she did not record the result in the medical record. On 08/22/18 at 03:14 PM the Director of Nursing (DON) was interviewed. The DON said that oxygen saturation levels should be checked as needed depending on what symptoms the resident is displaying. The DON said, They should not put oxygen on her unless she is displaying signs and symptoms, or her saturation levels are below 92%. The facility's Oxygen Administration Policy, revised (MONTH) 2010, was reviewed on 08/22/18 at 03:30 PM. The policy stated in part, D[NAME]UMENTATION: In the Nurse's notes and Treatment Administration Record (TAR) and/or Medication Administration Record [REDACTED].", "filedate": "2020-09-01"}
{"rowid": 102, "facility_name": "HUNTINGTON HEALTH AND REHABILITATION CENTER", "facility_id": 515007, "address": "1720 17TH STREET", "city": "HUNTINGTON", "state": "WV", "zip": 25701, "inspection_date": "2018-08-23", "deficiency_tag": 698, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "TKSO11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to maintain effective communication with the [MEDICAL TREATMENT] center and failed to follow-up on communication related to the resident's blood pressure dropping during [MEDICAL TREATMENT]. This affected one of one resident reviewed for [MEDICAL TREATMENT] care in the sample of 28. Resident identifier: #32. Facility census: 176. Findings included: a) Resident #32 On 08/20/18 at 10:39 AM Resident #32 was interviewed in his room. Resident #32 stated that sometimes his blood pressure is low during [MEDICAL TREATMENT] and that he was instructed by the [MEDICAL TREATMENT] clinic not to take his morning blood pressure medication before [MEDICAL TREATMENT]. Resident #32 said he leaves for [MEDICAL TREATMENT] around 06:00 AM and he takes his morning medications before he leaves, but was under the impression that he was not getting his blood pressure medication before he goes to [MEDICAL TREATMENT]. On 08/21/18 at 03:55 PM Resident #32's medical record was reviewed. Resident #32 has intact cognition according to the Minimum Data Sets (MDS), dated [DATE]. Resident #32 had [DIAGNOSES REDACTED]. Resident #32 received [MEDICAL TREATMENT] every Tuesday, Thursday and Saturday, according to the current [MEDICAL TREATMENT] care plan, initiated 05/24/18. The care plan intervention stated, [MEDICAL TREATMENT] Communication Record is sent to the [MEDICAL TREATMENT] center with each appointment and return of form is ensured after appointment is completed. Resident #32 had physician's orders [REDACTED]. [REDACTED]. Resident #32 was scheduled to receive his first doses of [MEDICATION NAME] and [MEDICATION NAME] ER at 0600 (06:00 AM) according to the Medication Administration Record (MAR), dated 08/01/2018 - 08/31/18. Resident #32's progress note, dated 08/5/18, 06:29 read, RES STATED THAT [MEDICAL TREATMENT] NURSE STATES HIS BP IS DROPPING TOO LOW AND NOT TO TAKE HIS BP MEDS PRIOR TO [MEDICAL TREATMENT]. HELD BP MEDS, INFORMED SUPERVISOR AND SIALYSIS PER PROGRESS NOTE. SENT ORDER SHEET W/RES TO [MEDICAL TREATMENT] FOR ORDERS TO BE WRITTEN REGARDING BP MEDS. The progress note was signed by Licensed Practical Nurse (LPN) #70. Resident #32's corresponding [MEDICAL TREATMENT] Communication Record form (Briggs), dated 08/05/18, and completed by LPN #70 read, Res stated that you wanted his blood pressure meds held prior to [MEDICAL TREATMENT]. [MEDICATION NAME] and [MEDICATION NAME] held today. We can change time of BP meds if needed. Pls respond below. There was no response documented from the [MEDICAL TREATMENT] center on the 08/05/18 [MEDICAL TREATMENT] Communication form. The only information completed on the form by the [MEDICAL TREATMENT] center was the resident's pre- and post-[MEDICAL TREATMENT] weights. The following sections where left blank: [MEDICAL TREATMENT] completed without incident?; Problem with access graft/catheter?; Lab work completed?; Medications given at [MEDICAL TREATMENT]; Recommendations/Follow-up. Resident #32's MAR and progress notes were reviewed on 08/23/18 at 10:00 AM. There was no follow-up regarding whether Resident #32's blood pressure medication should be held prior to [MEDICAL TREATMENT] according to review of the progress notes dated 08/05 - 08/23/18 in the medical record. Resident #32's pre-[MEDICAL TREATMENT] blood pressure medications, [MEDICATION NAME] and [MEDICATION NAME] ER, were held on 08/05/18 due to the resident self-report of his blood pressure dropping during [MEDICAL TREATMENT], per documentation in the MAR and progress note dated 08/05/18. Resident #32's blood pressure medications were also held on 08/09/18 and 08/11/18 due to the resident's refusal per documentation in the MAR. Resident #32 received his blood pressure medications on all other pre-[MEDICAL TREATMENT] days including 08/07, 08/14, 08/16, 08/18, 08/21, and 08/23/18 per the MAR. On 08/23/18 at 10:05 AM Registered Nurse (RN) #34 confirmed there was no follow-up documented regarding the 08/05/18 communication to the [MEDICAL TREATMENT] center about the resident's blood pressure medication. RN #34 said Resident #32 continued to receive his blood pressure medications prior to [MEDICAL TREATMENT]. There were no [MEDICAL TREATMENT] Communication Record forms for Resident #32's [MEDICAL TREATMENT] visits of 08/11/18, 08/14/18, and 08/16/18. Resident #32's [MEDICAL TREATMENT] Communication Record forms dated 08/02/18 and 08/21/18 were also incomplete in the section to be completed by the [MEDICAL TREATMENT] center. An interview was conducted with the Director of Nursing (DON) on 08/21/18 at 04:09 PM. The DON stated the nurse should verify that the [MEDICAL TREATMENT] Communication form is completed upon the resident's return to the facility. The DON said if it's not completed they should fax it back to the [MEDICAL TREATMENT] center and request that it be completed. The DON also stated that if the [MEDICAL TREATMENT] center does not send back the [MEDICAL TREATMENT] Communication form the nurse should call the [MEDICAL TREATMENT] center and request the form. The DON confirmed that the [MEDICAL TREATMENT] Communication Record forms for 08/11/18, 08/14/18 and 08/16/18 were not in the record or in the facility. The facility policy titled [MEDICAL TREATMENT], Care of Residents, revised (MONTH) (YEAR), stated in part, 3. A [MEDICAL TREATMENT] Communication Record (Briggs) is initiated and sent to the [MEDICAL TREATMENT] center for each appointment. Ensure it is received upon return.", "filedate": "2020-09-01"}
{"rowid": 103, "facility_name": "HUNTINGTON HEALTH AND REHABILITATION CENTER", "facility_id": 515007, "address": "1720 17TH STREET", "city": "HUNTINGTON", "state": "WV", "zip": 25701, "inspection_date": "2018-08-23", "deficiency_tag": 756, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "TKSO11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, staff and Consultant Pharmacist interviews, the facility failed to ensure that the consulting pharmacist identified drug irregularities related to laboratory (lab) testing levels for one of seven sampled who were reviewed for unnecessary medications. Resident identifier: #84. Facility census: 176. Findings included: a) Resident #84 A review of the admission record for Resident #84 was conducted on 08/22/18 at approximately 4:52 PM. The admission record revealed that Resident #84 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. The facility's policy and procedure entitled Monthly Drug Regimen Review, dated (MONTH) (YEAR), was reviewed on 08/24/18 at approximately 10:45 AM. The policy read in part, The facility contracts with a pharmacist to perform a monthly review of each resident's drug regimen to ensure the necessity and safety of each prescribed medication. Under the section entitled procedure the following entries were noted in part: --The pharmacist reviews resident charts monthly and submits a written report of the irregularities to the attending physician, the Director of Nursing and the facility Medical Director. --The pharmacist's report includes resident' names, relevant drug(s) and identified irregularity(ies). A review of the physician's orders [REDACTED]. The order summary note indicated that Resident #84 was scheduled to have a HgbA1C (a measure of average blood sugar over the past 3 months) every 3 three months d/t (due to) DM (Diabetes Mellitus) - Due (MONTH) (YEAR). Upon further review it was determined that the HgbA1C lab results were not found in the clinical record. An interview was conducted with nurse #28 on 08/22/18 at approximately 4:52 PM regarding the missing HgbA1C level for the month of (MONTH) (YEAR). Nurse #28 stated, It's not in the lab book and the lab doesn't have it in their records either. Nurse #28 shared that she had looked in the both the clinical record and well as the South unit's lab (laboratory) book. She explained that the lab book maintains labs that need to be drawn daily. Nurse #28 stated that she had called the lab to see if they had the lab results in their database, but there was no record of the HgbA1C. A review of the admission MDS (Minimum Data Set) assessment was conducted on 08/22/18 at 4:59 PM. The MDS assessment was dated 04/27/18 and had the resident coded as having a [DIAGNOSES REDACTED]. The MDS assessment also indicated that the resident had received insulin injections on 6 occasions within the last 7 days. An interview was conducted with the DON (Director of Nursing) regarding the missing HgbA1C level on 8/22/18 at 5:07 PM. The DON said she would follow-up on the missing HgbA1C level. An interview was conducted with the Consultant Pharmacist (#167) via telephone call on 08/23/18 at 10:32 AM. The DON was present for the call. The Consultant Pharmacist was asked about the monthly drug regimen review for the month of (MONTH) (YEAR) which failed to note the missing HgbA1C that was ordered for the month of (MONTH) (YEAR). The Consultant Pharmacist stated that she was driving at the time of the call and did not have immediate access to her records. The pharmacist went on to explain her process stating that if a lab were missing, she would give the nurses a piece of paper with what she needed to see if it was something they could find immediately. This writer informed the Consultant Pharmacist that the medication regimen review form completed by her for the months of (MONTH) and (MONTH) (YEAR) both indicated that there were no irregularities as evidenced by an X which was placed in the box indicating no irregularities. The box on the same form next to See report for any noted irregularities and or recommendations was left blank. The Consultant Pharmacist #167 stated that she would not necessarily have written a recommendation at that point. She went on to say that when she reviewed the chart again in (MONTH) of (YEAR) and the lab was still missing she would make a written recommendation at that point. As the Consultant Pharmacist was driving at the time of this interview, this writer encouraged her to call back to the facility on ce she had an opportunity to review her records. No further follow-up was provided by the Consultant Pharmacist. The concern regarding the HgbA1C was shared with the administrator on 08/23/18 at approximately 11:10 AM. The administrator acknowledged being aware of the drug irregularity.", "filedate": "2020-09-01"}
{"rowid": 104, "facility_name": "HUNTINGTON HEALTH AND REHABILITATION CENTER", "facility_id": 515007, "address": "1720 17TH STREET", "city": "HUNTINGTON", "state": "WV", "zip": 25701, "inspection_date": "2018-08-23", "deficiency_tag": 760, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "TKSO11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, policy review, resident and staff interviews, the facility failed to prevent a significant medication error from occurring for one of 12 sampled residents (Resident #120) who was reviewed for medication administration. Resident #120 was administered long acting insulin that was prescribed for another resident. Resident identifier: #120. Facility census: 176. Findings included: a) Resident #120 An interview was conducted with Resident #120 on 08/20/18 at 11:05 AM. Resident #120 stated that a male nurse (Nurse #4), who she referred to as the medicine man had administered insulin to her in her belly (abdomen) although she is not diabetic. She repeated this again stating that, He gave me an insulin needle in my belly. She also stated that Nurse #4 had administered the insulin injection on the day prior to this interview which was Sunday, 08/19/18. Resident #120 went on to say that she had specifically asked Nurse #4 why was she receiving the insulin injection as she was not diabetic. Resident #120 reported that Nurse #4 gave her the insulin injection anyway and stated, Well, you're supposed to get it. Resident #120 also stated that Nurse #4 checked her blood sugar level after he had administered the insulin injection. She said he told her that the blood sugar reading was 108 and showed it to her on the blood sugar monitor. Resident #120 said that Nurse #4 told her it was fine. Resident #120 stated that Nurse #4 did not check her blood sugar level before administering the insulin injection. Additionally, Resident #120 voiced that she did not report the insulin administration incident to any other facility staff but said she did call her family member and informed him of the incident on the same day that the incident occurred, Sunday, 08/19/18. A review of the clinical record was conducted for Resident #120 on 08/20/18 at approximately 12:05 PM. The admission record, which listed the resident's diagnoses, indicated that Resident #120 was admitted to the facility on [DATE] with multiple [DIAGNOSES REDACTED]. Neither the admission record nor any other part of the clinical record indicated that Resident #120 had a [DIAGNOSES REDACTED].#120 and failed to indicate that Resident #120 had a physician's orders [REDACTED]. A review of the admission MDS (Minimum Data Set) assessment was conducted on 08/20/18 at approximately 12:35 AM. The MDS, dated [DATE], had the resident coded as having a BIMS (Brief Interview for Mental Status) summary score of 15 indicating the resident's cognition was intact. Resident #120 was also coded as being oriented to year, month and date as well. Resident #120 was not coded as having a [DIAGNOSES REDACTED]. An interview was conducted with the Unit Manager, Nurse (#34) on 08/20/18 at approximately 12:50 PM. Nurse #34 stated that she was aware of the allegation involving the insulin error as Resident #120's family member came in earlier that morning before lunch and brought it to her attention. Nurse #34 confirmed that Resident #120 did not have a physician's orders [REDACTED]. Nurse #34 also reviewed the daily staffing report with this writer and confirmed that Nurse #4 was on duty the previous day when Resident #120 alleged having received an insulin injection. Nurse #34 also conveyed that Nurse #4 is a PRN (works as necessary) nurse and worked from 7AM -7PM on 08/19/18. Nurse #34 stated that another nurse, Nurse #113 was the unit manager that was on duty at the time of the insulin administration error and that Nurse #113 typically worked a double shift on the weekends from 7AM-11:30 PM. Initial attempts to call Nurse #4 and Nurse #113 were unsuccessful. Voicemail messages were left for each of these nurses. An interview was later conducted with Nurse #4 on 08/20/18 at 3:21 PM. Nurse #4 stated that he came back to the facility at the request of the Director of Nursing (DON). Nurse #4 stated, If you're asking about the insulin, yes, I made a mistake. I'll own up to it. I was supposed to give it to a resident across the hall. This is only the second time that I worked down there (referring to the hallway where Resident #120 resides.) I only have the computer to go by. I don't really know the people. I just made a mistake. Nurse #4 stated, As soon as I gave it to her (Resident#120) she said, But I'm not a diabetic. Why am I getting insulin? Nurse #4 stated that he had administered 30 units of [MEDICATION NAME]to Resident #120. Nurse #4 stated, I went by the name and the picture on the MAR (Medication Administration Record) when asked which identifiers were used to correctly identify Resident #120 as the correct resident to receive the 30 units of [MEDICATION NAME] insulin. Nurse #4 also stated, They are very similar referring to the appearance of Resident #120 and the other resident across the hall who he said was supposed to receive the insulin. Nurse #4 stated, I'm sick to death over it. I've never done anything like this before. During the same interview with Nurse #4 he stated that he knew right away that he had made a mistake and immediately reported the incident to his unit manager (Nurse #113). Nurse #4 shared that he did not call the physician after the incident, but that his unit manager, Nurse #113, had done so. He also stated that Nurse #113 gave him instructions to check Resident #120's blood sugar level three more times as ordered by the physician. Nurse #4 stated that he checked Resident #120's blood sugar levels at least three more times after administering the insulin. Nurse #4 recalled checking Resident #120's blood sugar immediately after administering the insulin and received 108. He acknowledged showing the blood sugar monitor result to Resident #120. He also reported checking the resident's blood sugar level again after lunch which was 103, before dinner, which was 93 and again after dinner around 5:30 PM. At 5:30 PM he stated that the resident's blood sugar level was 91. Nurse #4 voiced that he had written an incident report and pinned it up on the incident board before leaving work. He also recalled reporting the incident to the oncoming nurse that worked the 7PM-7AM shift. An interview was conducted with Nurse #113 on 08/20/18 at approximately 3:38 PM who confirmed that she was on duty at the time of the alleged insulin incident. She stated she worked from 7 AM - 2 AM on Sunday, 08/19/18. Nurse #113 recalled that Nurse #4 came to the desk and informed her that he had administered 30 units of [MEDICATION NAME]to the wrong resident. Nurse #113 also recalled Nurse #4 having notified Resident #120 that he had mistakenly given her insulin that was meant for another resident. Nurse #113 confirmed that she called the physician and notified the physician of the medication error that had occurred with Resident #120. She said she informed the physician that Resident #120 received 30 units of [MEDICATION NAME]and that Resident #120 was not diabetic. Nurse #113 also stated that the physician gave her an order to monitor Resident #120's blood sugar level three more times. Nurse #113 shared with this writer that the peak time for [MEDICATION NAME]was eight hours and Resident #120's blood sugar level never dropped below 91. Nurse #113 also stated that she went down to the room of Resident #120 after the incident had occurred and that Resident #120 reiterated the same story to her that Nurse #4 had previously communicated to her about the insulin error. Nurse #113 also stated that Nurse #4 had apologized to Resident #120. Nurse #113 stated that both she and Nurse #4 were very open with Resident #120 about the incident and that Resident #120 was aware of the incident and what had occurred. Nurse #113 also stated that Resident #120 had eaten all her meals that day and that she was fine (without symptoms of a low blood sugar reaction). Nurse #113 conveyed that nurses are supposed identify residents by checking the name on door check their arm bands and using the pictures on the MAR. Nurse #113 stated, Had Nurse #4 done that, yes, he should have known that it wasn't the right resident. Resident #120 was re-interviewed on 08/20/18 at approximately 4:22 PM to clarify if Nurse # 4 had checked her blood sugar before he administered the insulin. Resident #120 was quite certain that Nurse #4 did not check her blood sugar before giving her the insulin injection. The incident/accident report was reviewed on 08/22/18 at approximately 4:45 PM. The report conveyed that [MEDICATION NAME] 30 units was given in error on 08/19/18. The report also indicated that the physician was notified. Under the section entitled action the report indicated that the blood sugar level was checked immediately, and that snacks were also offered. The incident report also listed blood sugar checks that were conducted at the following times on 08/19/18: 10:00 AM-BS=108 11:00 AM -BS =103 1:30 PM -BS =93 5:00 PM- BS =91 The incident report was signed by Nurse#4 as having prepared the report and was also signed by the DON. The incident report indicated that the physician, unit manager (Nurse #113) and Resident #120 were each notified that [MEDICATION NAME] 30 units was given in error. The medication variance report was also reviewed on 08/22/18 at approximately 4:58 PM. The variance report indicated that [MEDICATION NAME] 30 units SQ (subcutaneous) was given in error and the error type was listed as wrong resident. An interview was conducted with the DON on 08/20/18 at approximately 4:30 PM. The DON stated that she was aware of the medication error involving both Resident #120 and Nurse #4. The DON shared that the incident report was completed before she arrived to work on the morning of 08/20/18. She conveyed that someone slid the incident report and the medication variance report under the door to her office over the weekend. The DON also stated that it was her expectation that the nursing staff use two resident identifiers to correctly identify their residents during medication pass. A review of the facility's policy regarding safe medication practices was reviewed and was dated (MONTH) 17, (YEAR). The policy indicated the following: To promote a culture of safety and prevent medication errors, nurses must adhere to the rights of medication administration: --Identify the right resident by using at least two resident identifiers. --Select the right medication --Give the right dose --Give the right medication at the right time --Give the medication by the right route --Provide the right documentation Under the section entitled Implementation the policy also indicated in part, confirm the resident's identity using as least two resident identifiers.", "filedate": "2020-09-01"}
{"rowid": 105, "facility_name": "HUNTINGTON HEALTH AND REHABILITATION CENTER", "facility_id": 515007, "address": "1720 17TH STREET", "city": "HUNTINGTON", "state": "WV", "zip": 25701, "inspection_date": "2018-08-23", "deficiency_tag": 773, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "TKSO11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility failed to ensure two of seven residents reviewed for unnecessary medications obtained laboratory services as ordered by the physician. Resident identifiers: #84 and #93. Facility census: 176. Findings included: a) Resident #93 Resident #93 was admitted to the facility on [DATE] with a [DIAGNOSES REDACTED]. Review of the admission physician's orders dated 01/23/18, was conducted on 08/22/18 at 2:30 PM and revealed an order for [REDACTED].#93 to have his vitamin D level monitored every 6 months. The physician's orders documented the vitamin D level was to be performed in (MONTH) (YEAR). Further review of the clinical record revealed there was no evidence Resident 93's laboratory test for a vitamin D level was obtained in (MONTH) (YEAR). Interview with Licensed Practical Nurse (LPN) #170 on 08/22/18 at 2:18 PM revealed they were not able to find the physician ordered Vitamin D laboratory test results from (MONTH) (YEAR). A call was made to the laboratory responsible for conducting the test and the facility was informed the Vitamin D laboratory test for Resident #93's had never been completed. Staff #170 stated they were unsure of why Resident #93 failed to have the ordered laboratory testing to monitor his vitamin D level. During an interview with LPN Staff #170 again on 08/23/18 at 8:48 AM at the 400 nurses station revealed they had done more research but were still not able to determine why the vitamin D level was not obtained for Resident #93. Staff #170 stated the process for obtaining laboratory tests is the order for the test is obtained and the information is relayed to the laboratory for them to collect the blood sample. He verified Resident #93 was admitted to the facility with an order for [REDACTED]. During an interview with the Director of Nursing and the Administrator on 08/23/18 at 10:35 AM, they both verified Resident #93 failed to have his vitamin D laboratory test completed according to his current physician orders. Review of the facility policy for Diagnostic Testing on 08/23/18 at 10:30 AM revealed the policy was dated 11/17. The policy documented laboratory services provided must be both accurate and timely. Timely means that the tests are completed, and results are provided to the facility within timeframe's normal for appropriate intervention. The facility is responsible for quality and timely services whether services are provided by the facility or an outside agency. b) Resident #84 A review of the admission record for resident #84 was conducted on 08/22/18 at approximately 4:52 PM. The admission record revealed that Resident #84 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. A review of the physician's orders for Resident #84 was conducted on 08/22/18 at approximately 4:52 PM. The order summary noted that Resident #84 was scheduled to have a HgbA1C (a measure of average blood sugar over the past 3 months) every three months d/t (due to) DM (Diabetes Mellitus)-Due (MONTH) (YEAR). Upon further review, it was determined that the HgbA1C laboratory (lab) results were not located in the clinical record. An interview was conducted with nurse #28 on 08/22/18 at approximately 4:52 PM regarding the missing HgbA1C level for the month of (MONTH) (YEAR). Nurse #28 stated, It's not in the lab book and the lab doesn't have it in their records either. Nurse #28 shared that she had looked in the both the clinical record and well as the South unit's lab book. She explained that the lab book maintains labs that need to be drawn daily. Nurse #28 stated that she had also called the lab to see if they had the lab in their database, but there was no record of the HgbA1C. A review of the MDS (Minimum Data Set) assessment was conducted on 08/22/18 at 4:59 PM. The MDS assessment, dated 04/27/18, had the resident coded as having a [DIAGNOSES REDACTED]. The MDS assessment also indicated that the resident had received insulin injections on six occasions within the last seven days. An interview was conducted with the Director of Nursing (DON) regarding the missing HgbA1C level on 08/22/18 at 5:07 PM. The DON said she would follow-up on the missing HgbA1C level. A review of the facility's policy entitled Diagnostic Services Management, dated (MONTH) (YEAR), was reviewed on 08/24/18 at approximately 10:30 AM. The policy read in in part, Residents requiring laboratory, radiology or other diagnostic services will receive accurate and timely testing services from certified diagnostic facilities in accordance with Federal regulations to support [DIAGNOSES REDACTED]. The facility is responsible for quality and timely services whether services are provided by the facility or an outside agency.", "filedate": "2020-09-01"}
{"rowid": 106, "facility_name": "HUNTINGTON HEALTH AND REHABILITATION CENTER", "facility_id": 515007, "address": "1720 17TH STREET", "city": "HUNTINGTON", "state": "WV", "zip": 25701, "inspection_date": "2018-08-23", "deficiency_tag": 880, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "TKSO11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed ensure that staff properly changed gloves and performed hand hygiene during personal care to maintain good infection control practices and failed to ensure the urine drainage bag was positioned properly so that it did not touch the floor. This affected one of two residents reviewed for urinary catheter in the sample of 28 residents. Resident identifier: #92. Facility census: 176. Findings included: a) Resident #92 Resident #92's medical record was reviewed on 08/22/18 at 02:17 PM. Resident #92 is severely cognitively impaired according to the Minimum Data Assessment, dated 05/24/18. Resident #92 has multiple [DIAGNOSES REDACTED]. Resident #92 had a physician's orders [REDACTED]. On 8/22/18 at 10:10 AM Certified Nursing Assistant (CNA) #44 was observed providing peri care to Resident #92. After gathering the care supplies, CNA #44 washed her hands and applied gloves prior to starting peri care. As CNA #44 was cleansing the peri area, she removed a small amount of feces using the washcloth. Each time she cleansed the peri area, which was four times, she touched the feces soiled washcloth with gloved hands. After completing peri care CNA #44 did not change her gloves. CNA #44 then touched the resident's gown, arms, legs, hands, pillows, back of the resident's head, and bed control mechanism while still wearing the same feces contaminated gloves. CNA #44 was interviewed afterwards and said that she should have changed her gloves after the peri care was complete. On 08/20/18 at 11:34 AM, 03:57 PM, on 08/21/18 at 01:38 PM and on 08/22/18 at 08:44 AM, the Resident #92's urine catheter bag was in contact with the floor. Resident #92's bed was in the low position and the catheter bag was hooked to the bed frame. The bottom of the urine catheter bag was in direct contact with the floor. On 08/22/18 at 08:44 AM Unit Manager/Licensed Practical Nurse (LPN) #55 confirmed that the urine catheter bag was in contact with the floor. LPN #55 said the bag should not be touching the floor. The facility policy titled Indwelling urinary catheter (Foley) care and management, revised 11/17/17, stated in part, Keep the drainage bag below the level of the patient's bladder to prevent backflow of urine into the bladder .However, don't place the drainage bag on the floor to reduce the risk of contamination and subsequent CAUTI (Catheter Acquired Urinary Tract Infection). The facility policy titled Hand Hygiene, revised 05/18/18, stated in part, The hands are the conduits for almost every transfer of potential pathogens form on patient to another, form a contaminated object to a patient, and from a staff member to a patient. Hand hygiene, therefore, is the single most important procedure in preventing infection.", "filedate": "2020-09-01"}
{"rowid": 107, "facility_name": "HUNTINGTON HEALTH AND REHABILITATION CENTER", "facility_id": 515007, "address": "1720 17TH STREET", "city": "HUNTINGTON", "state": "WV", "zip": 25701, "inspection_date": "2017-09-07", "deficiency_tag": 152, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "QLZ111", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview, the facility staff failed to identify the appointed Health Care Surrogate (HCS) for Resident #84, as designated by the attending physician on 06/05/17. Thus, the designated HCS was unable to exercise the resident rights to the extent provided by state law. Resident identifier: #84. Facility census: 180. Findings include: a) Resident #84 Review of Resident #84's medical records, on 08/30/17 at 11:15 a.m., found the resident was admitted to the facility on [DATE] following a hospitalization . Admission paperwork was completed by the resident's daughter. Further review found a HCS selection form completed 06/05/17, by the attending physician, designating the son as the HCS. No further HCS designation forms could be located in the medical records. Interview with Employee #122, social worker (SW), on 09/06/17 at 9:15 a.m., revealed she thought the daughter was the HCS on admission and had asked to appoint her brother the HCS due to personal issues. When asked, Is there another HCS designation form. She replied, I don't see any in the medical records. On 09/06/17 at 11:00 a.m., Employee #122, SW, provided a HCS designation form dated 05/30/17. She further confirmed this form had been faxed to her on 09/06/17 at 10:35 a.m. This HCS form indicated the Daughter was in fact appointed as the HCS while the resident was in the hospital. However, this HCS became void when the attending physician at the facility appointed Resident #84's son as the HCS on 06/05/17. The facility continued to notify Resident #84's daughter of changes in her condition and had the daughter listed as the health care decision maker on the resident face sheet even after Resident #84's son was appointed HCS on 06/05/17. On 09/07/17 at 10:25 a.m., the Director of Nursing (DON) and the Nursing Home Administrator (NHA) was both notified. No further information was provided.", "filedate": "2020-09-01"}
{"rowid": 108, "facility_name": "HUNTINGTON HEALTH AND REHABILITATION CENTER", "facility_id": 515007, "address": "1720 17TH STREET", "city": "HUNTINGTON", "state": "WV", "zip": 25701, "inspection_date": "2017-09-07", "deficiency_tag": 157, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "QLZ111", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview, the facility failed to notify the resident, physician, and/or resident responsible party when a significant change occurred in the residents condition. This deficient practice affected two (2) of twenty-nine (29) residents reviewed during Stage 2 of the Quality Indicator Survey (QIS). For Resident #84, the facility staff failed to notify the appropriate Health Care Surrogate(HCS) after 06/05/17, when a new HCS was appointed. Resident #19's responsible party was not notified when there was a change in her medication regimen. Resident identifiers: #84 and #19. Facility census: 180 Findings include: a) Resident #84 Review of Resident #84's medical records, on 08/30/17 at 11:15 a.m., found the resident was admitted to the facility on [DATE] following a hospitalization . Admission paperwork was completed by the resident's daughter. Further review found a HCS selection form completed 06/05/17, by the attending physician, designating the son as the HCS. No further HCS designation forms could be located in the medical records. Interview with Employee #122, social worker (SW), on 09/06/17 at 9:15 a.m., revealed she thought the daughter was the HCS on admission and had asked to appoint her brother the HCS due to personal issues. When asked, Is there another HCS designation form. She replied, I don't see any in the medical records. On 09/06/17 at 11:00 a.m., Employee #122, SW, provided a HCS designation form dated 05/30/17. She further confirmed this form had been faxed to her on 09/06/17 at 10:35 a.m. This HCS form indicated the Daughter was in fact appointed as the HCS while the resident was in the hospital. However, this HCS became void when the attending physician at the facility appointed Resident #84's son as the HCS on 06/05/17. The facility continued to notify Resident #84's daughter of changes in her condition and had the daughter listed as the health care decision maker on the resident face sheet even after Resident #84's son was appointed HCS on 06/05/17. On 09/07/17 at 10:25 a.m., the Director of Nursing (DON) and the Nursing Home Administrator (NHA) was both notified. No further information was provided. b) Resident #19 Record review found the physician reduced the resident's [MEDICATION NAME] on 07/14/17 from 2 milligrams (mg's), give 0.5 tablet by mouth, every 6 hours to [MEDICATION NAME] 1.5 mg's, give 0.5 mg. tablet three times a day for increased agitation, yelling, cursing, secondary to anxiety. At 4:07 p.m. on 09/06/17, the Director of Nursing (DON) said the facility had a blanket consent to increase and decrease the resident's [MEDICATION NAME]. The DON provided a copy of a psychoactive medication consent for [MEDICATION NAME]. The consent was signed by facility staff indicating verbal consent was obtained from the responsible party on 11/25/16 to use the antianxiety medication, [MEDICATION NAME]. On the consent form was a hand written notation, MD (physician) may (symbol for increase) or (symbol for decrease) PRN (as needed). The regulations require notification of the responsible party with each need to alter treatment. The DON confirmed she had no verification the responsible party was made aware of the decrease in the resident's [MEDICATION NAME] on 07/14/17.", "filedate": "2020-09-01"}
{"rowid": 109, "facility_name": "HUNTINGTON HEALTH AND REHABILITATION CENTER", "facility_id": 515007, "address": "1720 17TH STREET", "city": "HUNTINGTON", "state": "WV", "zip": 25701, "inspection_date": "2017-09-07", "deficiency_tag": 159, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "QLZ111", "inspection_text": "Based on review of the resident's personal funds accounts and staff interview, the facility failed to notify each resident that receives Medicaid benefits when the amount in the resident ' s account reaches $200 less than the SSI resource limit for one person ($2,000). This deficient practice affected five (5) of ninety (90) residents that have personal funds managed by the facility. Resident identifiers: #307, #286, #256, #229, #224. Facility census: 180. Findings include: a) Residents Personal Funds Account: Review of residents' personal funds account, on 09/06/17 at 2:25 p.m., found five (5) residents had personal funds within $200.00 dollars of the $2,000.00 dollar limit allowed for residents receiving Medicaid benefits. Review of resident individual account balances for 08/06/17 found the following residents within $200.00 dollars of the $2,000.00 dollar limits: --Resident #307- $1,802.10 --Resident #286- $1980.45 --Resident #256- $2,204.38 --Resident #229- $1,907.79 Further review of resident individual account balances for 09/05/17 found the following residents within $200.00 dollars of the $2,000.00 dollar limits: --Resident #224- $2,103.15 --Resident #229- $2,209.79 Upon interview on 09/07/17, at 9:20 a.m., with the Business Office Manager (BOM), she found the computer generated notice when the resident's personal funds reaches $1,800.00 dollar limit. She further confirmed she was unaware she was to provide the notice to the residents and/or responsible party until the corporate offices informed her of the responsibility of printing and providing the resident and/or the responsible party today (09/07/17). On 09/07/17 at 10:25 a.m., the Director of Nursing (DON) and the Nursing Home Administrator (NHA) was both notified. No further information was provided.", "filedate": "2020-09-01"}
{"rowid": 110, "facility_name": "HUNTINGTON HEALTH AND REHABILITATION CENTER", "facility_id": 515007, "address": "1720 17TH STREET", "city": "HUNTINGTON", "state": "WV", "zip": 25701, "inspection_date": "2017-09-07", "deficiency_tag": 160, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "QLZ111", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility failed to ensure one (1) of three (3) residents reviewed for the care area of personal funds during Stage 2 of the Quality Indicator Survey (QIS), had her/his personal funds conveyed within 30 days of death to the individual or probate jurisdiction administering the resident's estate. Resident identifier: # 382. Facility census: 180. Findings include: a) Resident #382. Medical records found Resident # 382 expired on [DATE]. On [DATE], a check for the amount of $1,144.03 dollars was made out to Resident #382 and mailed to the family. At 9:20 a.m., on [DATE]. Business Office Manager (BOM) confirmed the personal funds of Resident #382 was not conveyed to the proper individual or probate jurisdiction administering the residents' estate after her death. On [DATE] at 10:25 a.m., the Director of Nursing (DON) and the Nursing Home Administrator (NHA) was both notified. No further information was provided.", "filedate": "2020-09-01"}
{"rowid": 111, "facility_name": "HUNTINGTON HEALTH AND REHABILITATION CENTER", "facility_id": 515007, "address": "1720 17TH STREET", "city": "HUNTINGTON", "state": "WV", "zip": 25701, "inspection_date": "2017-09-07", "deficiency_tag": 161, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "QLZ111", "inspection_text": "Based on record review and staff interviews, the facility failed to ensure a surety bond was in place in the amount to assure the security of all personal funds of residents deposited with the facility. Specifically, the surety bond that was purchased by the facility was not sufficient to cover the amount of deposits made by the residents in the facility. This practice had the potential to affect all 90 residents who have their money managed by the facility. Facility census: 180. The findings included: a) Record Review On 09/06/17 at 1:47 p.m., a review of the facility accounting records revealed that the personal needs funds on deposit with the facility totaled on the following dates: --04/03/17 - $77,144.71 --06/02/17 - $80,504.19 --07/03/17 - $73,506.75 --07/06/17 - $64,187.41 --07/10/17 - $62,240.07 The current resident fund surety bond in effect, issued 7/1/17, for the amount of $61,000. b) Staff Interview The Business Office Manager (BOM) was interviewed on 09/07/17 at 9:20 a.m. She confirmed that the current surety bond of $61,000 dollars is less than the amount deposited in the personal needs account. On 09/07/17 at 10:25 a.m., the Director of Nursing (DON) and the Nursing Home Administrator (NHA) was both notified. No further information was provided.", "filedate": "2020-09-01"}
{"rowid": 112, "facility_name": "HUNTINGTON HEALTH AND REHABILITATION CENTER", "facility_id": 515007, "address": "1720 17TH STREET", "city": "HUNTINGTON", "state": "WV", "zip": 25701, "inspection_date": "2017-09-07", "deficiency_tag": 225, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "QLZ111", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, policy review, and staff interview the facility failed to thoroughly investigate the background of potential employees prior to or upon their employment at the facility. This was true for Employee # 150 who was hired by the facility on 04/10/17. As of 08/30/17 the facility had not screened Employee #150 through the West Virginia Cares Registry and Employment Screening (WV CARES) program as required by West Virginia State Code 16-49-9. This employee had access to all residents residing at the facility. Also, the facility failed to report three (3) of thirty-five (35) reportable incidents to the appropriate state agency. The facility reported these allegations to the Nursing Home Program even though a nurse aide was identified during the investigation as the alleged perpetrator therefore the allegations should have been reported to the Nurse Aide Program. These reportable incidents involved Resident #322, #372, and #280. Additionally, the facility failed to report all allegations of abuse and/or neglect to the appropriate state agencies for four (4) of fifty-five (55) complaints/concerns completed by the facility for the month of (MONTH) (YEAR). The allegations not reported involved Resident # 84, #110, #233, and #290. Finally, the facility failed to report a verbal allegation of neglect to the appropriate state agency for resident #367. Resident Identifiers: #84, #110, #233, #290, #322. #372, #280 and #367. Employee Identifier: #150. Facility Census: 180. Findings Include: a) WV CARES West Virginia Code 16-49-9 established new criminal background check requirements for applicants for employment as direct access personnel in long-term care facilities. Effective 08/01/15, all nursing home facilities were required to .prescreen all direct access personnel applicants considered for hire for negative findings by way of an Internet search of registries and licensure databases through the WV Cares website. WV CARES is administered by the Department of Health and Human Resources and the WV State Police Criminal Investigation Bureau (CIB) in consultation with the Centers for Medicare and Medicaid Services (CMS), the Department of Justice (DOJ) and the Federal Bureau of Investigation (FBI). The program uses web-based technologies to provide employers a single portal for checking state and national abuse registries and the state and national sex offender registries. The web-based system also provides employers access to Nurse Aide Registries for all 50 states and professional licensure registries where available. The web based system provides an efficient and effective means for an employer to check an applicant's status prior to paying the cost of a criminal history background check. Through fingerprinting, this program provides a comprehensive criminal history records search of national and state criminal history records that was not available under the previous reliance on name-based record searches. The program relies on new technology to monitor criminal histories and alert officials when a subsequent change in criminal history occurs (i.e., rapback) A monitored criminal history record means the cost of re-fingerprinting is not required for employees who change employers in this industry (or apply for work at more than one employer) within the timeframe of a valid background check. All fitness determinations will be performed by WV CARES who have cleared state and federal background check requirements. Employers will receive a notice of the applicants employment eligibility once the fingerprint based background check results are received. At 8:48 a.m. on 08/30/17 a Notification of Eligible Fitness Determination letter from WV Cares was requested for Employee #150 who was hired in the dietary department on 04/10/17. At 11:47 a.m. on 08/30/17 Employee #183, the area human resource manager, stated that they did not have a WV Cares Notification of Eligible Fitness Determination letter for Employee #150. She stated that she was finger printed on 04/05/17 by MorphoTrust but that the results were never sent to WV Cares. She indicated she did not realize that they had not been sent to WV CARES until she went to pull it from the WV CARES system when it was requested by the surveyor on 08/30/17. b) Resident #322 A review of the reportable incidents beginning at 10:40 a.m. on 08/30/17 found an Immediate Fax Reporting of Allegations - Nursing Home Program completed on 07/27/17 listing Resident #322 as the alleged victim. On the form under the section titled, Brief Description of the Incident the following was hand written: (typed at written) Resident alleges (unidentified) CNA (Certified Nursing Assistant) is rude, yells, and cusses at him and he alleges this CNA told him that they were not going to change him every 2 (two) hours. Review of the five - day follow up pertaining to this allegation completed by Licensed Practical Nurse (LPN) Social Service Manager (SSM) #15 found the following: (typed as written) I spoke with the resident and he told me that the CNA was (first name of Nurse Aide (NA) #13) . I spoke with the CNA (first and last name of NA #13) who told me she recall the evening and stated in fact the resident was the one who was cussing and screaming and she stated she immediately went out and told the co worker what had happened. During an interview with LPN - SSM #15 beginning at 3:35 p.m. on 08/30/17 in regards to this allegation she stated this was not reported to the Nurse Aide Program after a Nurse Aide was identified because she spoke with Resident #322 and he had stated the NA just needed to be fine tuned and therefore she did not feel it was substantiated so she did not report it to the Nurse Aide Program. c) Resident #372 A review of the reportable incidents beginning at 10:40 a.m. on 08/30/17 found an Immediate Fax Reporting of Allegations - Nursing Home Program completed on 08/01/17 listing Resident #372 as the alleged victim. On the form under the section titled, Brief Description of the Incident the following was typed: (typed as written) The residents son alleges the following: Resident has had a decline in status and wont do anything, call light not answered timely, alleges waited 3 1/2 hours to be changed after a bowel movement and pain medication it not effective enough. Review of the five - day follow up pertaining to this allegation completed by LPN - SSM #15 found the following: (typed as written) . In regards to allegation of having a bowel movement and waiting 3 hours to be changed. he states this was Saturday into Sunday from 4:30 a.m. to 8:00 a.m During an interview with LPN-SSM #15 beginning at 3:35 p.m. on 08/30/17, when asked if once the resident gave her a specific time frame if she reported the Nurse Aide who was assigned to him during this time frame to the Nurse Aide Program as an alleged perpetrator she stated, No because the allegation was not substantiated therefore I did not report it to the Nurse Aide Program. She further stated, Maybe I should have done that. d) Resident #280 A review of the reportable incidents beginning at 10:40 a.m. on 08/30/17 found an Immediate Fax Reporting of Allegations - Nursing Home Program completed on 07/26/17 listing Resident #280 as the alleged victim. On the form under the section titled, Brief Description of the Incident the following was hand written: (typed as written) Resident alleged CNA took her to the shower room and during the time in the shower alleges CNA left shower and told her she had to get another resident off the bedpan - states CNA was gone less than five minutes and no issues occurred . Review of the five - day follow up pertaining to this allegation completed by LPN - SSM #15 found the following: (typed as written) After interviewing the resident, it was found the date she is alleging was 07/17/17. It was also found out that the CNA was (First and Last Name of NA #145). I spoke with (First Name of NA #145) regarding this allegation and she reports she does remember this day and she took the resident to the shower and it was very hot in the shower room. She stated that (First name of Resident #280) was safely in her chair and she told the resident she was going to open the first door to the shower room to catch her breath and she would be able to hear her (stating it was just a few feet away) During an interview with LPN-SSM #15 beginning at 3:35 p.m. on 08/30/17, when asked if once the Nurse Aide was identified if this allegation was then reported to the Nurse Aide Program she stated, No it was not, because it was unsubstantiated so I did not think to report it. e) Resident #84 A review of the complaints and concerns beginning at 12:00 p.m. on 08/30/17 found a concern form dated 06/19/17 which identified Resident #84 as the Resident involved. Under the section titled, Description of Concern the following was hand written: (typed as written) Daughter states he did not get shower, toothbrush or water pitcher from Saturday until Wednesday. Feels like they left him up too long in his wheelchair on Wednesday. Review of the reportable incidents for the month (MONTH) (YEAR) found no reportable incident related to concern voiced by Resident #84's daughter. During an interview with LPN-SSM #15 beginning at 3:35 p.m. on 08/30/17, when asked if this allegation was reported as an allegation of neglect she stated, No because I pulled the ADL (Activities of Daily Living) flow sheet report immediately and the daughter was fine with that. f) Resident #110 A review of the complaints and concerns beginning at 12:00 p.m. on 08/30/17 found a concern form dated 07/15/17 which identified Resident #110 as the resident involved. Under the section titled, Description of Concern the following was hand written: (typed as written) Resident stated she had been asking since lunch time to be cleaned up. Went into room at 3:45 p.m. to change dressing and resident voiced concern about not being cleaned. CNA went into room to clean up resident at this time. Resident states this is not the first time. Resident room partner stated yellow ring around the residents sheet. Review of the reportable incidents for the month of (MONTH) (YEAR) found no reportable incident related to concern voiced by Resident #110. An interview with the Nursing Home Administrator (NHA) at 4:21 p.m. on 08/30/17, confirmed he was the person who handled this concern for Resident #110. When asked if this concern had been reported as an allegation of neglect he stated, No because after doing further interviews he did not feel like it was a reportable incident. g) Resident #233 A review of the complaints and concerns beginning at 12:00 p.m. on 08/30/17 found a concern form dated 07/17/17 which identified Resident #233 as the resident involved. Under the section titled, Description of Concern the following was hand written: (typed as written) Resident reports that the weekend was terrible and her got into an argument with RCS - (First name of RCS) on 4 occasions. Reports a very bad attitude - that she put him down on Saturday as refusing a bath and he did not refuse. She would not make his bed how he asked her too. She fuss with me every time she to come into my room. My roommate laid in a dirt brief from breakfast to noon yesterday. They would come in and turn light off and would not change him. Finally around noon he got changed. Last night (Sunday after Midnight) I put my call light on and it took 40 minutes to get someone in here. Review of the reportable incidents for the month of (MONTH) (YEAR) found no reportable incident related to this concern voiced by Resident #233. An interview with the NHA at 4:11 p.m. on 08/30/17 confirmed this concern was not reported as an allegation of abuse and/or neglect. He indicated after he finished up his investigation he did not feel it was substantiated therefore he did not report it. h) Resident #290 A review of the complaints and concerns beginning at 12:00 p.m. on 08/30/17 found a concern form dated 07/16/17 which identified Resident #290 as the resident involved. Under the section titled, Description of Concern the following was hand written: (typed as written) Husband states nurse forced her to take medicine, among other issues. Wants to talk to administrator . Review of the reportable incidents for the month of (MONTH) (YEAR) found no reportable incident related to this concern voiced by Resident #290. An interview with the NHA at 4:19 p.m. on 08/30/17, confirmed this allegation of abuse was not reported. He stated that after he talked to Resident #290's husband it was clear the nurse was just adamant that the resident take her medicine and she did not force her to take it. He indicated that is why he did not report this allegation of abuse. i) Resident #367 On 08/29/17 at 11:14 a.m., during a Stage 1 interview of the QIS survey, Resident #96 said a female resident across the hall from him had yelled for 30 minutes needing a bed pan. Resident #96 did not know if the other resident's call light was on. Resident #96 also did not know if this resident ever received assistance. During an interview with Administrator #107, on 09/07/17 at 10:38 am., he said he did have knowledge of this issue and had spoken with Resident #96 and had identified Resident #367 as the resident who needed assistance. During the interview, on 09/07/17 at 10:38 a.m., Administrator #107 provided hand written notes dated 08/21/17. The notes reflect Administrator #107's conversation with Resident #96 and Resident #367. Resident #367 was identified as having a [DIAGNOSES REDACTED].#107's conversation with Resident #367 the resident denied having any issues with needing a bedpan the night before. The administrator noted the resident had a catheter, was on a toileting plan and was care planned for yelling out and turning call light on continuously. Administrator #107 said he had not interviewed any staff regarding this issue nor had he identified this as an allegation of neglect. He also confirmed he had not reported this issue to the appropriate outside State agencies. He said he did not report this issue because after speaking with the resident and obtaining information from other sources he concluded the resident had not been neglected. j) Policy Review A review of the facility's Abuse and Neglect Prohibition Policy with revision date of (MONTH) (YEAR), on 08/30/17 at 9:00 a.m., found the following under the section titled Reporting and Response: 1. The facility will report all allegations and substantiated occurrences of abuse, neglect, exploitation, mistreatment, injuries of unknown origin, and misappropriation of property to the administrator, State Survey Agency, and law enforcement officials and Adult Protective Services (where state law provides for jurisdiction in long term care facilities) in accordance with state law through established procedures. Timeline for reporting is as follows: a. If the events that caused the allegation involve abuse or result in serious bodily injury, a report is made no later than 2 hours after the management staff becomes aware of allegation. b. If the events that cause the allegation do not involve abuse and do not result in serious bodily injury a report is made not later than 24 hours after the management team become aware of the allegation 3. The facility will report any occurrences of abuse by licensed or certified staff and any knowledge it has of actions by a court of law against an employee , which would indicate unfitness for employment to the applicable state board in accordance with the state law.", "filedate": "2020-09-01"}
{"rowid": 113, "facility_name": "HUNTINGTON HEALTH AND REHABILITATION CENTER", "facility_id": 515007, "address": "1720 17TH STREET", "city": "HUNTINGTON", "state": "WV", "zip": 25701, "inspection_date": "2017-09-07", "deficiency_tag": 226, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "QLZ111", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, policy review, and staff interview, the facility failed to develop an abuse policy that included all required components. The policy did not address training related to dementia management and resident abuse prevention. The policy also included time frames for reporting abuse that were established from the time the management staff became aware of the allegation and not the actual time the allegation was made. In addition, the facility did not implement its policy as it pertained to the reporting of all allegations of abuse and neglect. The facility failed to report all allegations of abuse and/or neglect to the appropriate state agencies for four (4) of fifty-five (55) complaints/concerns completed by the facility for the month of (MONTH) (YEAR). The allegations not reported involved Resident # 84, #110, #233, and #290. Also there was one allegation of neglect made in regards to Resident #367 which was not written on a concern form and it was also not reported to the appropriate state agencies. Also, the facility failed to report three (3) of 35 reportable's to the appropriate state agency. The facility reported these allegations to the nursing home program even though a nurse aide was identified during the investigation as the alleged perpetrator therefore the allegations should have been reported to the Nurse Aide Program. These reportable instances involved Resident #322, #372, and #280. The failure of the facility to develop a policy that contains all required components and the failure of the facility to implement their current policy has the potential to effect all residents currently residing in the facility. Resident Identifiers: #84, #110, #233, #290, #322, #372, #367, and #280. Facility Census: 180. Findings Include: a) Policy Development 1. Dementia Management and Resident Abuse Prevention. A review of the facility's Abuse and Neglect Prohibition policy with a revision date of (MONTH) (YEAR), at 9:00 a.m. on 08/30/17 found the following pertaining to the training of employees: 1. The facility will train each employee on this policy during orientation, annually, and more often as determined by the facility. 2. The facility will provide training regarding related policies and procedures. 3. The facility will provide education for those individuals involved with the resident (i.e. family responsible party or legal representative, visitors.) Review of the State Operations Manual Appendix PP - Guidance to Surveyors for Long Term Care Facilities revision 168, with a revision date of 03/08/17 found the following, F226 ** (Rev. 168, Issued: 03-08-17, Effective: 03-08-17, Implementation: 03-08-17) 483.12(b) The facility must develop and implement written policies and procedures that . (3) Include training as required at paragraph 483.95 . 483.95(c) Abuse, neglect, and exploitation. In addition to the freedom from abuse, neglect, and exploitation requirements in 483.12, facilities must also provide training to their staff that at a minimum educates staff on- 483.95(c)(1) Activities that constitute abuse, neglect, exploitation, and misappropriation of resident property as set forth at 483.12. 483.95(c)(2) Procedures for reporting incidents of abuse, neglect, exploitation, or the misappropriation of resident property 483.95(c)(3) Dementia management and resident abuse prevention. 483.95(c)(1) and 483.95(c)(2) are covered in the facility's policy which the facility indicates they will train the staff, however 483.95(c)(3) dementia management and resident abuse prevention is not contained in the policy. These findings were discussed with the Nursing Home Administrator (NHA) at 9:22 a.m. on 08/31/17. He stated that he would have to make sure this was the most recent policy they had in place. At 9:32 a.m. on 08/31/17 the NHA stated that this was the most recent policy they had. He confirmed dementia management and resident abuse prevention was not contained in this policy as required. 2. Reporting and Response A review of the facility's Abuse and Neglect Prohibition Policy with revision date of (MONTH) (YEAR), on 08/30/17 at 9:00 a.m., found the following under the section titled Reporting and Response: 1. The facility will report all allegations and substantiated occurrences of abuse, neglect, exploitation, mistreatment, injuries of unknown origin, and misappropriation of property to the administrator, State Survey Agency, and law enforcement officials and Adult Protective Services (where state law provides for jurisdiction in long term care facilities) in accordance with state law through established procedures. Timeline for reporting is as follows: a. If the events that caused the allegation involve abuse or result in serious bodily injury, a report is made no later than 2 hours after the management staff becomes aware of allegation. b. If the events that cause the allegation do not involve abuse and do not result in serious bodily injury a report is made not later than 24 hours after the management team becomes aware of the allegation 3. The facility will report any occurrences of abuse by licensed or certified staff and any knowledge it has of actions by a court of law against an employee , which would indicate unfitness for employment to the applicable state board in accordance with the state law. Review of the State Operations Manual (SOM) Appendix PP - Guidance to Surveyors for Long Term Care Facilities revision 168, with a revision date of 03/08/17 found the following in regards to F225 and reporting of allegations: 483.12(c)(1) Ensure that all alleged violations involving abuse, neglect, exploitation or mistreatment, including injuries of unknown source and misappropriation of resident property, are reported immediately, but not later than 2 hours after the allegation is made, if the events that cause the allegation involve abuse or result in serious bodily injury, or not later than 24 hours if the events that cause the allegation do not involve abuse and do not result in serious bodily injury, to the administrator of the facility and to other officials (including to the State Survey Agency and adult protective services where state law provides for jurisdiction in long-term care facilities) in accordance with State law through established procedures. The SOM specifies that reporting is to be done within 2 hours or 24 hours depending on the circumstances after the allegation is made not after the management team has been made aware of the allegation. These findings were discussed with the Nursing Home Administrator (NHA) at 9:22 a.m. on 08/31/17. He stated that he would have to make sure this was the most recent policy they had in place. At 9:32 a.m. on 08/31/17 the NHA stated that this was the most recent policy they had. He confirmed their policy indicating the reporting times began after the management team was made aware of the allegation. He stated we always have a manger here and staff are to immediately report to the manager any allegations or abuse or neglect to get the process started. b) Policy Implementation in regards to reporting of alleged abuse and or neglect, A review of the facility's Abuse and Neglect Prohibition Policy with revision date of (MONTH) (YEAR), on 08/30/17 at 9:00 a.m., found the following under the section titled Reporting and Response: 1. The facility will report all allegations and substantiated occurrences of abuse, neglect, exploitation, mistreatment, injuries of unknown origin, and misappropriation of property to the administrator, State Survey Agency, and law enforcement officials and Adult Protective Services (where state law provides for jurisdiction in long term care facilities) in accordance with state law through established procedures . Timeline for reporting is as follows: a. If the events that caused the allegation involve abuse or result in serious bodily injury, a report is made no later than 2 hours after the management staff becomes aware of allegation. b. If the events that cause the allegation do not involve abuse and do not result in serious bodily injury a report is made not later than 24 hours after the management team become aware of the allegation. 3. The facility will report any occurrences of abuse by licensed or certified staff and any knowledge it has of actions by a court of law against an employee, which would indicate unfitness for employment to the applicable state board in accordance with the state law. The following instances were found where the facility failed to implement their policy related to reporting and response: 1) Resident #322 A review of the reportable incidents beginning at 10:40 a.m. on 08/30/17 found an Immediate Fax Reporting of Allegations - Nursing Home Program completed on 07/27/17 listing Resident #322 as the alleged victim. On the form under the section titled, Brief Description of the Incident the following was hand written: (typed at written) Resident alleges (unidentified) CNA (Certified Nursing Assistant) is rude, yells, and cusses at him and he alleges this CNA told him that they were not going to change him every 2 (two) hours. Review of the five - day follow up pertaining to this allegation completed by Licensed Practical Nurse (LPN) Social Service Manager (SSM) #15 found the following: (typed as written) I spoke with the resident and he told me that the CNA was (first name of Nurse Aide (NA) #13) . I spoke with the CNA (first and last name of NA #13) who told me she recall the evening and stated in fact the resident was the one who was cussing and screaming and she stated she immediately went out and told the co worker what had happened. During an interview with LPN - SSM #15 beginning at 3:35 p.m. on 08/30/17 in regards to this allegation she stated this was not reported to the Nurse Aide Program after a Nurse Aide was identified because she spoke with Resident #322 and he had stated the NA just needed to be fine tuned and therefore she did not feel it was substantiated so she did not report it to the Nurse Aide Program. 2) Resident #372 A review of the reportable incidents beginning at 10:40 a.m. on 08/30/17 found an Immediate Fax Reporting of Allegations - Nursing Home Program completed on 08/01/17 listing Resident #372 as the alleged victim. On the form under the section titled, Brief Description of the Incident the following was typed: (typed as written) The residents son alleges the following: Resident has had a decline in status and wont do anything, call light not answered timely, alleges waited 3 1/2 hours to be changed after a bowel movement and pain medication it not effective enough. Review of the five - day follow up pertaining to this allegation completed by LPN - SSM #15 found the following: (typed as written) . In regards to allegation of having a bowel movement and waiting 3 hours to be changed. he states this was Saturday into Sunday from 4:30 a.m. to 8:00 a.m During an interview with LPN-SSM #15 beginning at 3:35 p.m. on 08/30/17, when asked if once the resident gave her a specific time frame if she reported the Nurse Aide who was assigned to him during this time frame to the Nurse Aide Program as an alleged perpetrator she stated, No because the allegation was not substantiated therefore I did not report it to the Nurse Aide Program. She further stated, Maybe I should have done that. 3) Resident #280 A review of the reportable incidents beginning at 10:40 a.m. on 08/30/17 found an Immediate Fax Reporting of Allegations - Nursing Home Program completed on 07/26/17 listing Resident #280 as the alleged victim. On the form under the section titled, Brief Description of the Incident the following was hand written: (typed as written) Resident alleged CNA took her to the shower room and during the time in the shower alleges CNA left shower and told her she had to get another resident off the bedpan - states CNA was gone less than five minutes and no issues occurred . Review of the five - day follow up pertaining to this allegation completed by LPN - SSM #15 found the following: (typed as written) After interviewing the resident, it was found the date she is alleging was 07/17/17. It was also found out that the CNA was (First and Last Name of NA #145). I spoke with (First Name of NA #145) regarding this allegation and she reports she does remember this day and she took the resident to the shower and it was very hot in the shower room. She stated that (First name of Resident #280) was safely in her chair and she told the resident she was going to open the first door to the shower room to catch her breath and she would be able to hear her (stating it was just a few feet away) During an interview with LPN-SSM #15 beginning at 3:35 p.m. on 08/30/17, when asked if once the Nurse Aide was identified if this allegation was then reported to the Nurse Aide Program she stated, No it was not, because it was unsubstantiated so I did not think to report it. 4) Resident #84 A review of the complaints and concerns beginning at 12:00 p.m. on 08/30/17 found a concern form dated 06/19/17 which identified Resident #84 as the Resident involved. Under the section titled, Description of Concern the following was hand written: (typed as written) Daughter states he did not get shower, toothbrush or water pitcher from Saturday until Wednesday. Feels like they left him up too long in his wheelchair on Wednesday. Review of the reportable incidents for the month (MONTH) (YEAR) found no reportable incident related to concern voiced by Resident #84's daughter. During an interview with LPN-SSM #15 beginning at 3:35 p.m. on 08/30/17, when asked if this allegation was reported as an allegation of neglect she stated, No because I pulled the ADL (Activities of Daily Living) flow sheet report immediately and the daughter was fine with that. 5) Resident #110 A review of the complaints and concerns beginning at 12:00 p.m. on 08/30/17 found a concern form dated 07/15/17 which identified Resident #110 as the resident involved. Under the section titled, Description of Concern the following was hand written: (typed as written) Resident stated she had been asking since lunch time to be cleaned up. Went into room at 3:45 p.m. to change dressing and resident voiced concern about not being cleaned. CNA went into room to clean up resident at this time. Resident states this is not the first time. Resident room partner stated yellow ring around the residents sheet. Review of the reportable incidents for the month of (MONTH) (YEAR) found no reportable incident related to concern voiced by Resident #110. An interview with the Nursing Home Administrator (NHA) at 4:21 p.m. on 08/30/17, confirmed he was the person who handled this concern for Resident #110. When asked if this concern had been reported as an allegation of neglect he stated, No because after doing further interviews he did not feel like it was a reportable incident. 6) Resident #233 A review of the complaints and concerns beginning at 12:00 p.m. on 08/30/17 found a concern form dated 07/17/17 which identified Resident #233 as the resident involved. Under the section titled, Description of Concern the following was hand written: (typed as written) Resident reports that the weekend was terrible and her got into an argument with RCS - (First name of RCS) on 4 occasions. Reports a very bad attitude - that she put him down on Saturday as refusing a bath and he did not refuse. She would not make his bed how he asked her too. She fuss with me every time she to come into my room. My roommate laid in a dirt brief from breakfast to noon yesterday. They would come in and turn light off and would not change him. Finally around noon her got changed. Last night (Sunday after Midnight) I put my call light on and it took 40 minutes to get someone in here. Review of the reportable incidents for the month of (MONTH) (YEAR) found no reportable incident related to this concern voiced by Resident #233. An interview with the NHA at 4:11 p.m. on 08/30/17 confirmed this concern was not reported as an allegation of abuse and/or neglect. He indicated after he finished up his investigation he did not feel it was substantiated therefore he did not report it. 7) Resident #290 A review of the complaints and concerns beginning at 12:00 p.m. on 08/30/17 found a concern form dated 07/16/17 which identified Resident #290 as the resident involved. Under the section titled, Description of Concern the following was hand written: (typed as written) Husband states nurse forced her to take medicine, among other issues. Wants to talk to administrator . Review of the reportable incidents for the month of (MONTH) (YEAR) found no reportable incident related to this concern voiced by Resident #290. An interview with the NHA at 4:19 p.m. on 08/30/17, confirmed this allegation of abuse was not reported. He stated that after he talked to Resident #290's husband it was clear the nurse was just adamant that the resident take her medicine and she did not force her to take it. He indicated that is why he did not report this allegation of abuse. j) Resident #367 On 08/29/17 at 11:14 a.m., during a Stage 1 interview of the QIS survey, Resident #96 said a female resident across the hall from him had yelled for 30 minutes needing a bed pan. The resident did not know if the other resident's call light was on. Resident #96 also did not know if this resident ever received assistance. During an interview with Administrator #107, on 09/07/17 at 10:38 am., he said he did have knowledge of this issue and had spoken with Resident #96 and had identified Resident #367 as the resident who needed assistance. During the interview, on 09/07/17 at 10:38 a.m., Administrator #107 provided hand written notes dated 08/21/17. The notes reflect Administrator #107's conversation with Resident #96 and Resident #367. Resident #367 was identified as having a [DIAGNOSES REDACTED].#107's conversation with Resident #367 the resident denied having any issues with needing a bedpan the night before. The administrator noted the resident had a catheter, was on a toileting plan and was care planned for yelling out and turning call light on continuously. Administrator #107 said he had not interviewed any staff regarding this issue nor had he identified this as an allegation of neglect. He also confirmed he had not reported this issue to the appropriate outside State agencies. He said he did not report this issue because after speaking with the resident and obtaining information from other sources he concluded the resident had not been neglected", "filedate": "2020-09-01"}
{"rowid": 114, "facility_name": "HUNTINGTON HEALTH AND REHABILITATION CENTER", "facility_id": 515007, "address": "1720 17TH STREET", "city": "HUNTINGTON", "state": "WV", "zip": 25701, "inspection_date": "2017-09-07", "deficiency_tag": 241, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "QLZ111", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on family interview, record review, observation and staff interview, the facility failed to ensure residents were treated with dignity and respect. Three (3) residents, residing in separate rooms, did not receive their meals at the same time as their roommates. These random observations were made during the meal service. In addition one (1) of three (3) residents reviewed for the care area of dignity was sent to a physicians' appointment dressed only in a brief and was not wearing his dentures. Resident identifiers: #121, #69, #19, and #73. Facility census: 180. Findings include: a) Resident #121 Observation of the noon meal at 12:34 a.m. on 08/28/17 found the resident's roommate had finished eating her noon meal. Resident #121 did not have her tray. Employee #87, a Registered Nurse (RN) unit manager said Resident #121 requires assistance with eating so she does not have her tray. The tray comes out on another cart. The staff have to pass all trays to residents who can feed themselves, then they return to provide assistance to the residents who can't feed themselves. Resident #121's tray is on the second cart. At 4:00 p.m. on 08/28/17, the Registered Nurse (RN), District Director of Clinical Services, stated, We have always served the residents who can feed themselves first. We are fixing the trays right now so roommates will have their trays at the same time. b) Resident #69 Observation of the morning meal on 08/29/17, at 8:29 a.m. found the resident's roommate had finished eating his meal. Resident #69 did not have a tray. The roommate, Resident #286 stated his roommate does not have a tray yet because someone has to feed him. He gets his tray later. c) Resident #19 Observation of the noon meal on the 400 hallway found Resident #19's roommate had finished eating her breakfast at 8:49 a.m. on 08/29/17. Resident #19 did not have her meal. Nursing assistant (NA) #58 said Resident #19's tray comes out on the second cart. She stated residents who can feed themselves get their trays first. The roommate can feed herself, Resident #19 requires assistance. We pass trays to all the residents who feed themselves on the first cart then the second cart contains the trays of all the residents who require assistance with eating. At 11:17 a.m. on 09/05/17, the Director of Nursing (DON) said all staff have been educated to make sure roommates receive their trays at the same time. This was an issue but now it has been corrected. d) Resident 73 Resident #73 was admitted to the facility with a pressure ulcer on his heel. On Tuesday mornings he was transported by ambulance to a wound care facility for treatment of [REDACTED]. Telephone interview with Resident's family member during Stage I of the survey on 08/29/17 at 11:27 a.m. revealed Resident #73 had been transported to his weekly appointment at the wound care facility dressed only in an incontinence brief. The family member was unsure of the exact date this happened, but stated it occurred approximately three (3) weeks ago. The family member also stated Resident #73 had been transported to the wound care facility without his dentures the day of the interview, 08/29/17. Unit Manager (UM) #87 was interviewed on 09/05/17 at 8:30 a.m. UM #87 stated several weeks ago there was a miscommunication with Emergency Medical Services (EMS) and Resident #73 was transferred to his appointment at the wound care facility wrapped in a sheet and dressed only in an incontinence brief. UM stated EMS did not want to wait for the resident to be dressed, and that is why they did not inform the staff Resident #87 was not dressed appropriately for an appointment. UM #87 was unable to explain why Resident #73 was in bed dressed only in an incontinence brief when EMS arrived. However, he stated it was breakfast time and hectic. He also stated Resident #73 had recently been admitted and the facility was not aware he had an appointment at the wound care facility the morning he was transferred only in an incontinence brief. UM stated he would have made sure Resident #87 had been dressed if he had been aware the resident was not dressed. During the interview on 09/05/17 at 8:30 a.m., UM #87 also stated he was aware that Resident #73 had been transferred to the wound care facility without his dentures. UM stated he didn't feel the resident needed his dentures for a wound care clinic. However, because the resident's family member stated she preferred the resident to wear his dentures to appointments, staff now made sure this was done. On 09/05/17 at 9:35 a.m., Resident #73 was observed being transported by EMS to his appointment at the wound care facility. Morning hygiene had been performed, and resident was dressed in a shirt and pants. He was wearing dentures. During an interview on 09/05/17 at 9:35 a.m., EMS stated they had never transported Resident #73 before, and, therefore, were unable to provide information regarding the incident during which he was dressed only in an incontinence brief. However, EMS stated the facility usually had residents ready for transportation to appointments. EMS stated they would alert the nurse if a resident was not dressed, but sometimes they have to transport the resident anyway due to time constraints. The Director of Nursing was interviewed on 09/05/17 at 11:16. She provided no further information regarding the situation.", "filedate": "2020-09-01"}
{"rowid": 115, "facility_name": "HUNTINGTON HEALTH AND REHABILITATION CENTER", "facility_id": 515007, "address": "1720 17TH STREET", "city": "HUNTINGTON", "state": "WV", "zip": 25701, "inspection_date": "2017-09-07", "deficiency_tag": 246, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "QLZ111", "inspection_text": "Based on observation, resident interview and staff interview the facility failed to ensure once (1) resident received grooming tools to ensure she could perform activities of daily living. During this random opportunity for discovery the resident was observed having long hair on her chin. Resident identifier: #35. Facility census: 180. Findings include: a) Resident #35 On 08/29/17 at 9:12 a.m. an observation of Resident #35 revealed Resident #35 had long chin hairs. Resident #35 said, I'm growing a beard, I use to get them waxed when I went to the beauty shop. They will give you a razor but you have to ask. On 08/30/17 at 9:00 a.m. Resident Care Specialist (RCS) #145 indicated she had been assigned to work with Resident #35. RCS #145 was asked to go to Resident #35's room. Once in the room Resident #35 asked RCS #145 for a razor and RCS #145 said she would get one for her. Upon leaving the room RCS #145 agreed the resident had long hair on her chin and said the resident had never asked her for a razor. On 08/31/17 at 12:55 p.m. Resident #35 said the facility had given her a razor a few months ago but she had broken it and did not want to ask for another one. She said, they should have noticed because I was starting to look like a goat.", "filedate": "2020-09-01"}
{"rowid": 116, "facility_name": "HUNTINGTON HEALTH AND REHABILITATION CENTER", "facility_id": 515007, "address": "1720 17TH STREET", "city": "HUNTINGTON", "state": "WV", "zip": 25701, "inspection_date": "2017-09-07", "deficiency_tag": 247, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "QLZ111", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on family interview, record review and staff interview, the facility failed to ensure notice was provided to one (1) of four (4) residents reviewed during Stage 2 of the Quality Indicator survey (QIS) who voiced concerns regarding room moves without notification. Resident identifier: #30. Facility census: 180. Findings include: a) Resident #30 At 4:17 p.m. on 08/28/17, the resident's responsible party said the resident had been moved on several occasions and notification prior to room moves was not always provided. Review of resident census found the following dates the resident was moved to other rooms in the facility: --On 12/21/16, the resident was admitted to the facility and was placed in room [ROOM NUMBER] B on the first floor. --On 03/01/17, the resident moved from first room floor 35 B to room [ROOM NUMBER] B also on the first floor. --On 04/05/17, the resident was moved from room [ROOM NUMBER]B on the first floor to third floor, room [ROOM NUMBER] B. --On 05/09/17, the resident was moved from room [ROOM NUMBER] B to fourth floor, room [ROOM NUMBER]. --On 06/02/17, the resident was moved from fourth floor, room [ROOM NUMBER] to third floor, room [ROOM NUMBER]. --On 06/16/17, the resident was moved from room [ROOM NUMBER] to first floor, room [ROOM NUMBER]. --On 06/27/17, the resident was moved to third floor, room [ROOM NUMBER]. --On 07/10/17 the resident was moved from room [ROOM NUMBER] to room [ROOM NUMBER] on the third floor. Record review found the facility provided written forms, entitled, Notification Of Room Change, for the room moves occurring on 04/05/17, 06/02/17, 06/27/17, 07/10/17. The notification was provided to the responsible party. Review of the medical record with the director of nursing (DON) at 10:08 a.m. on 09/06/17, found the facility had no documentation the responsible party/resident was notified of the room moves occurring on 03/01/17, 05/09/17, and 06/16/17. The DON confirmed the responsible party should have been notified of the room changes as the resident does not have capacity to make health care decisions.", "filedate": "2020-09-01"}
{"rowid": 117, "facility_name": "HUNTINGTON HEALTH AND REHABILITATION CENTER", "facility_id": 515007, "address": "1720 17TH STREET", "city": "HUNTINGTON", "state": "WV", "zip": 25701, "inspection_date": "2017-09-07", "deficiency_tag": 272, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "QLZ111", "inspection_text": "**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 one (1) of twenty-nine (29) residents whose MDS's were reviewed during Stage 2 of the Quality Indicator survey (QIS). Resident #19's MDS was incorrect in the area of diagnosis. Resident identifier: #19. Facility census: 180. Findings include: a) Resident #19 Review of the current residents Medication Administration Record [REDACTED]. On 04/20/17, the pharmacist advised the physician to please consider either documenting more appropriate justification for use of the [MEDICATION NAME] or titrate off this agent until justification is apparent or it is possible to discontinue the agent. At 2:55 p.m. on 08/30/17, the Director of Nursing (DON) provided a physician's progress visit note, completed by Employee #178, the Advanced Practice Registered Nurse. The visit was signed by E #178 on 05/02/17. Documentation noted the resident had a [DIAGNOSES REDACTED]. At 12:12 p.m. on 09/05/17, two (2) Advanced Nurse Practioners, #177 and #178 who visit the resident at the facility, said the resident has always had mental illness. Employees #117 and #178 provided a copy of a visit by a third Advanced Practice Registered Nurse indicating the resident had mental illness on 11/04/16. This visit noted the resident had a [DIAGNOSES REDACTED].#178 said she had spoken to the family members of the resident and she believed the son also told her about the mental illness. E#178 said the third Advanced Nurse Practioner specialized in psychiatric illness. [NAME] #178 did not explain why the [DIAGNOSES REDACTED]. One annual minimum data set (MDS) with an assessment reference date (ARD) of 03/12/17 was completed after the [DIAGNOSES REDACTED]. Section I, of the MDS provides boxes to check for a [DIAGNOSES REDACTED]. and [MEDICAL CONDITION]. The MDS did not reflect the resident had a [DIAGNOSES REDACTED]. The Registered Nurse (RN), Resident Care Manager, RN #3, said she coded the MDS's but did not know the medication was being given for a mental illness during her interview at 1:18 p.m. on 09/05/17. If that's what they are giving it for, then they should say so.", "filedate": "2020-09-01"}
{"rowid": 118, "facility_name": "HUNTINGTON HEALTH AND REHABILITATION CENTER", "facility_id": 515007, "address": "1720 17TH STREET", "city": "HUNTINGTON", "state": "WV", "zip": 25701, "inspection_date": "2017-09-07", "deficiency_tag": 278, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "QLZ111", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility failed to ensure four (4) quarterly minimum data sets (MDS's) were accurately completed for one (1) of twenty-nine (29) residents whose MDS's were reviewed during Stage 2 of the Quality Indicator survey (QIS). Resident #19's quarterly MDS's were incorrect in the area of diagnosis. Resident identifier: #19. Facility census: 180. Findings include: a) Resident #19 Review of the current residents Medication Administration Record [REDACTED]. On 04/20/17, the pharmacist advised the physician to please consider either documenting more appropriate justification for use of the [MEDICATION NAME] or titrate off this agent until justification is apparent or it is possible to discontinue the agent. At 2:55 p.m. on 08/30/17, the Director of Nursing (DON) provided a physician's progress visit note, completed by Employee #178, the Advanced Practice Registered Nurse. The visit was signed by E #178 on 05/02/17. Documentation noted the resident had a [DIAGNOSES REDACTED]. At 12:12 p.m. on 09/05/17, two (2) Advanced Nurse Practioners, #177 and #178 who visit the resident at the facility, said the resident has always had mental illness. Employees #117 and #178 provided a copy of a visit by a third Advanced Practice Registered Nurse indicating the resident had mental illness on 11/04/16. This visit noted the resident had a [DIAGNOSES REDACTED].#178 said she had spoken to the family members of the resident and she believed the son also told her about the mental illness. E#178 said the third Advanced Nurse Practioner specialized in psychiatric illness. [NAME] #178 did not explain why the [DIAGNOSES REDACTED]. Four quarterly MDS's have been completed since the [DIAGNOSES REDACTED]. 02/16/16, 06/05/17, 07/28/17, and 08/18/17. Section I, of the MDS provides boxes to check for a [DIAGNOSES REDACTED]. and [MEDICAL CONDITION]. None of the four (4) quarterly MDS's coded the resident as having a [DIAGNOSES REDACTED]. The Registered Nurse (RN), Resident Care Manager, RN #3, said she coded the MDS's but did not know the medication was being given for a mental illness during her interview at 1:18 p.m. on 09/05/17. If that's what they are giving it for, then they should say so.", "filedate": "2020-09-01"}
{"rowid": 119, "facility_name": "HUNTINGTON HEALTH AND REHABILITATION CENTER", "facility_id": 515007, "address": "1720 17TH STREET", "city": "HUNTINGTON", "state": "WV", "zip": 25701, "inspection_date": "2017-09-07", "deficiency_tag": 279, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "QLZ111", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, resident interview and staff interview, the facility failed to identify and develop a comprehensive care plan for significant weight loss for one (1) of twenty-nine (29) residents reviewed during Stage 2 of the Quality Indicatior Survey. Resident Identifier: #320. Facility Census: 180 Findings include: a) Resident #320 Resident #320 lost 10.8% (percent) of his body weight, from 04/22/17 to 05/05/17, which represented a severe weight loss. Additionally, Resident #320 lost 13.1% of his body weight from 04/22/17 to 06/04/17, which again represented a severe weight loss. There was no evidence the facility identified these weight losses nor assessed causes and/or provided interventions to prevent additional weight loss. A record review on 09/05/17 at 12:08 p.m., revealed the Nursing Initial Plan of Care completed on 04/22/17, Section E. Nutrition, 1. Focus, 2. Goal, 3. Interventions, and 4. Responsible Disciplines had no responses. It was signed by Employee #87. The Nursing Care Plan completed on 06/06/17, which was the current care plan at the time of this review, stated, Focus: (First name of resident #320) has nutritional problem or potential nutritional problem (skin breakdown) r/t Obesity (weight 277, BMI/IBW 34.6/196-206). Date Initiated: 04/28/2017. Revision on: 04/28/2017. Goal: (First name of resident #320) will have gradual weight loss (1-2 lbs per month) through review date. Date Initiated: 04/28/2017. Revision on: 05/03/2017. Target Date: 08/02/2017. (Resident #320's last name) will maintain adequate nutritional status as evidenced by maintaining weight within (10)% of (196), no s/sx of malnutrition, and consuming at least (50)% of at least (2) meals daily through review date. Date Initiated: 04/28/2017. Revision on: 05/03/2017. Target Date: 08/02/2017. (First name of resident #320) will not develop complications related to obesity, includng skin breakdown, ineffective breathing pattern, altered cardiac output, diabetes, impaired moblity through review date. Date Initiated: 04/28/2017. Revision on: 05/03/2017. Target Date: 08/02/2017. Interventions: (included) Develop an activity program that includes exercise, mobility. Offer activities of choice to help divert attention from food. Date Initiated: 04/28/2017. Observe/record/ report to MD PRN s/sx of malnutrition: Emaciation (Cachexia), muscle wasting, significant weight loss. Date Initiated: 04/28/2017. RD to evaluate and make diet change recommendations PRN. Date Initiated: 04/28/2017. Weigh at same time of day and record each month. Date Initiated: 04/28/2017 Revision on 04/28/2017. A record review on 08/30/17 at 8:28 a.m., revealed the folllowing weights for Resident #320: -- 04/22/17: 277.0 pounds -- 05/05/17: 247.0 pounds (-10.8%, -30.0 pounds) -- 06/04/17: 240.8 pounds (-13.1%, -36.2 pounds) The resident's percentage of weight loss from 04/22/17 to 05/05/17 and from 04/22/17 to 06/06/17 were calculated using the following formula % of weight loss = (usual weight - actual weight) / (usual weight) x 100. -- From 04/22/17 to 05/05/17, the resident lost 10.8% of his body weight. -- From 04/22/17 to 06/04/17, the resident lost 13.1% of his body weight. Review of resident #320 physician's orders [REDACTED]. Dietary supervisor clarified this order as Controlled Carbohydrate Diet, No Added Salt Diet, Regular Texture, Regular Consistency. From 4/22/17 to 5/19/17, two (2) Nutrition Data Collection had been completed. The first note, description admitted d 4/22/17 at 12:00 p.m., signed and locked 4/28/17 at 2:17 p.m The most recent weight was noted in Section A: 277.0 Lbs on 4/22/17 at 1:54 p.m. The Diet/Supplement/Snack/Fortified Foods was noted in Section I, 2 Regular Diet and the Average meal intake percentage/day was noted in Section A: 1,3 50-75%. The Summary/Plan/Progress Note was noted in Section K,2, which included, Resident evaluated for initial admission nutritional status. Current diet is NAS with average intake of 75-100%, which is adequate to meet needs. Weight is 277/34.6, and indicates overweight/obesity status. Current diet order is adequate and appropriate. Will follow prn. The second Nutrition Data Collection dated 5/19/17 at 10:45 a.m., signed and locked 5/30/17 at 09:24 a.m. by Employee #182. The most recent weight was noted in Section A: 249.6 on 5/10/17 at 09:39. Section B, Weight Status, 1. Is there a change in weight? Response: a. No Change. In 3. Weight Loss =/> 5% in 30 days, 7.5% in 90 days, or 10% in 180 days?; however, there was No Response noted in this section. In 4. Please select concerning =/> 5% weight loss; however there was No Response noted in this section. In Section I, 2,Diet/Supplement/Snack/Fortified Foods: CCD/NAS/REG texture. Section I. 3 Average meal intake percentage/day: 100%. In Section K Summary/Plan/Progress Note: Pt with history of GERD/T2DM/Unsteady Gait/Pt is post home-invasion with facial trauma. No problems with eating. Glucose is running elevated. He has a history low H&H and depressed [MEDICATION NAME]. Per pt he has no problems. The Nutrition RD assessment dated [DATE] at 09:03 a.m., signed and locked 5/3/17 at 09:06. Section A: Nutrient Estimated Needs, 1. Calories: 20-25/kg ABW of 98kg=1965-2450. 2. Protein: 1-1.1g/kg ABW=98-108. 3. Fluid: 1mL/kcal= 1965-2450. Section B : Nutrition Diagnosis, 1d. Predicted excessive energy intake NI-1.5. Section C: Problem/Etiology/Signs/Symptoms Statement, 3. Nutrition Goals: Maintain/improve nutritional status. Slow, gradual wt. loss of 3-5 # per month. Avg intake >50%. The Nutrition Status Review dated 7/22/15 at 12:00 p.m, signed and locked 7/29/17 at 5:40 p.m Section B: Weight Status, 3 Weight Loss =/> 5% in 30 days, 7.55 in 90 days, or 10% in 180 days?: No Response. In 4. Please select concerning =/>5% weight loss: No Response. The Nursing Monthly Summary for Resident #320, dated 6/23/17 at 2:00 p.m., signed and locked 6/23/17 at 3:09 p.m., noted Eating 4h: Usual Appetite: b. Fair. Interview was conducted with Resident #320 on 9/5/17 from 1:45 PM-2:30 p.m. The resident explained the events that led up to his admission in April, as well as the therapy received initially. He stated that his appetite when first admitted to the facility was I don't remember much when I first came here. I guess I ate pretty good. I don't really know. I don't have any problem eating now, though. When asked if he was aware he had lost weight after his admission, he replied, No, I really don't. They keep record of it I guess, so I guess they took care of it. Resident #320 said, I don't have any problems eating now. When asked if the staff ever offer him something else to eat, if he doesn't eat and/or like what has been served, he replied, No, I guess they would if I'd ask. Interview was conducted with Employee #40 on 9/7/17 at 9:17 a.m. regarding Resident #320's noted weight loss for April, (MONTH) and (MONTH) (YEAR). She reviewed the Weight Summary report and noted the weight loss for this time period and stated I'll have to talk with (First name of Employee #180) and check if there were interventions for his weight loss. No other information was provided during the survey.", "filedate": "2020-09-01"}
{"rowid": 120, "facility_name": "HUNTINGTON HEALTH AND REHABILITATION CENTER", "facility_id": 515007, "address": "1720 17TH STREET", "city": "HUNTINGTON", "state": "WV", "zip": 25701, "inspection_date": "2017-09-07", "deficiency_tag": 280, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "QLZ111", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, staff interview, family interview and resident interview the facility failed to ensure four (4) of twenty-nine (29) residents whose care plans were reviewed had care plans that were revised as the resident's needs changed. The facility failed to revise Resident #59's care plan in the area of incontinence, Resident #84's care plan was not revised in the area of nutritional status, Resident #284's care plan was not revised in the area of accidents after a resident experienced three (3) falls, and Resident #286's care plan in the area of discharge planning. Additionally, Resident 19's responsible party was not given enough notice to attend care plan meetings. Resident identifiers: #59, #84, #284, #286 and #19 Facility census: 180. Findings include: a) Resident #59 The Minimum Data Set (MDS) review for Resident #59 indicated this resident was assessed as occasionally incontinent on the admission MDS. On the quarterly MDS, completed on 06/02/17, this resident was assessed as frequently incontinent. The care plan review revealed a focus area of occasional incontinence. This focus area was initiated on 03/27/17. The goal for the resident to be continent at all times was revised on 04/18/17 with a target date of 07/17/17. During an interview on 09/07/17 at 10:21 a.m. with Registered Nurse/MDS #46 she confirmed the resident's care plan was not revised to show the resident's decline from occasional to frequent incontinence. b) Resident #84 The medical record review for Resident #84 revealed a weight loss between the dates of 07/11/17 and 08/15/17. The resident weighed 207 pounds (lbs) on 07/11/17 and 180 lbs on 08/15/17. While in the hospital on [DATE] a weight was recorded as 187 lbs. The care plan dated 08/05/17 stated Resident #84 was at nutritional risk related to history of therapeutic diet, [MEDICAL CONDITIONS], hypertension, wound, [MEDICAL CONDITION] and abnormal labs. On 07/11/17 the physician ordered [MEDICATION NAME] 20 milligram (mg) every day for 3 days due to [MEDICAL CONDITION]. On 07/20/17 the physician ordered [MEDICATION NAME] 20 mg once a day for three days due to [MEDICAL CONDITION]. On 08/02/17 the physician ordered [MEDICATION NAME] 40 mg for five (5) days once a day for [MEDICAL CONDITION]. The nurse practitioner had indicated the resident had [MEDICAL CONDITION] on 06/29/17, 07/07/27, 07/24/17, 08/01/17 and on 08/04/17 the [MEDICAL CONDITION] was noted as stable. On 09/05/2017 at 2:56 p.m. during an interview with Registered Dietician (RD) #181 regarding the resident's nutritional care plan, RD #181 agreed the plan for nutrition did not take into account that the residents' weight fluctuations could be related to [MEDICAL CONDITION]. In a progress note from the dietician dated 09/06/17, the dietician indicated the resident's weight loss could be multi-factorial due to increased [MEDICATION NAME] due to [MEDICAL CONDITION] and [MEDICAL CONDITION]. c) Resident #284 Resident #284 was originally admitted to the facility on [DATE], and was discharged on [DATE]. Care planning related to a risk for falls was initiated on 03/29/17. Resident #284 was readmitted to the facility on [DATE]. The care plan goal revised on 06/20/17 was (Resident #284) will be free of falls through the review date. The care plan focus revised on 06/22/17 was (Resident #284) is at risk for falls related to impaired cognition, muscle weakness, impaired balance, wounds. On 07/30/17 at 7:45 p.m., Resident #284 was found lying face first on the floor beside his bed. He suffered an abrasion to his left forearm and a skin tear to his right hand. On 07/31/17, bilateral floor mats at all times were ordered. An updated care plan intervention for bilateral floor mats was also initiated on 07/31/17. On 08/01/17 at 5:00 a.m., Resident #284 was again found lying on the floor next his bed. A small circular skin tear was noted to his left great toe. On 09/0517 at 5:34 a.m., Resident #284 was again found lying on the floor next to his bed. No injury was noted. Resident #284's care plan focus and goal were not updated after he experienced three (3) falls. During an interview on 09/06/2017 at 4:06 p.m., the Director of Nursing (DON) had no additional information about the care plan not being updated to reflect that Resident #284 had experienced falls. On 09/06/17, after the DoN had been interviewed, the care plan focus related to falls was updated to (Resident #284) has experienced a fall and is expected to experience further falls related to impaired mobility, impaired cognition, poor safety awareness and history of falls. The goal was updated to (Resident #284) will be free of injury as a result of fall through next review period. d) Resident #286 Review of the resident's admission minimum data set (MDS) with an assessment reference date (ARD) of 4/26/17 noted the resident participated in his care plan and expected to be discharged to the community. According to the MDS active discharge planning was occurring for the resident to return to the community. Review of the current care plan found the following problem: (Name of Resident) wishes to return home to his trailer at discharge however his HCS (Health Care Surrogate) would like possible long term placement. The goal associated with the problem: (Name of Resident) will be able to verbalize required assistance post-discharge and the services required to meet needs before discharge. Interventions included: Establish a pre-discharge plan with the resident/family/caregiver and evaluate progress and revisit plan as needed. Evaluate the resident's motivation to return to the community. At 2:26 p.m. on 09/05/17, Employee #77 (social worker) said the resident had to re-gain capacity before going home. She verified the care plan did not entail the steps the resident needed to take to complete his discharge to home. She could provide no evidence the care plan was updated with a specific pre-discharge plan. e) Resident #19 A family interview with the resident's responsible party, by telephone, at 9:43 a.m. on 08/29/17, found the facility provided, short notice, for care plan attendance. The responsible party said she needed at least a 2 week notice or more to be able to schedule time away from work to attend the care plans. Review of the paper medical record at 9:05 a.m. on 08/30/17, found the following invitations to care plan meetings for Resident #19: March 28, (YEAR) at 11:15 a.m. April 18, (YEAR) at 10:00 a.m. June 15, (YEAR) at 11:15 a.m. August 15, (YEAR) at 1:00 p.m. Each invitation letter was a form letter, containing the following information, A care plan conference will be held for (Name of Resident) (date and time). This time has been set aside to review the plan of care being provided by our facility. Please inform the Resident Care Management Department at least one day prior to the above scheduled time if you plan to attend. If you are unable to attend and would like a phone conference, please call and schedule. Thank you, The resident care management department Each letter contained the same information and did not indicate to whom the letter was mailed, or the date the invitation was generated. Upon interview, on 8/30/17 at 9:05 a.m., Employee #133, the minimum data set (MDS) coordinator, said she was in charge of mailing the care plan invitations . She could not provide documentation to verify when the care plan letter was actually mailed. She stated, If she would have called I could re-schedule. The letter says if you are unable to attend and would like a phone conference to please call. The Responsible party said she wanted to attend the care plan in person but did not have time to schedule time away from work. At 9:55 a.m. on 08/30/17, [NAME] #133 confirmed she had no way to verify when the care plan letter was actually mailed to the responsible party. c) Resident #284 Resident #284 was originally admitted to the facility on [DATE], and was discharged on [DATE]. Care planning related to a risk for falls was initiated on 03/29/17. Resident #284 was readmitted to the facility on [DATE]. The care plan goal revised on 06/20/17 was (Resident #284) will be free of falls through the review date. The care plan focus revised on 06/22/17 was (Resident #284) is at risk for falls related to impaired cognition, muscle weakness, impaired balance, wounds. On 07/30/17 at 7:45 p.m., Resident #284 was found lying face first on the floor beside his bed. He suffered an abrasion to his left forearm and a skin tear to his right hand. On 07/31/17, bilateral floor mats at all times were ordered. An updated care plan intervention for bilateral floor mats was also initiated on 07/31/17. On 08/01/17 at 5:00 a.m., Resident #284 was again found lying on the floor next his bed. A small circular skin tear was noted to his left great toe. On 09/0517 at 5:34 a.m., Resident #284 was again found lying on the floor next to his bed. No injury was noted. Resident #284's care plan focus and goal were not updated after he experienced three (3) falls. During an interview on 09/06/2017 at 4:06 p.m., the Director of Nursing (DoN) had no additional information about the care plan not being updated to reflect that Resident #284 had experienced falls. On 09/06/17, after the DoN had been interviewed, the care plan focus related to falls was updated to (Resident #284) has experienced a fall and is expected to experience further falls related to impaired mobility, impaired cognition, poor safety awareness and history of falls. The goal was updated to (Resident #284) will be free of injury as a result of fall through next review period.", "filedate": "2020-09-01"}
{"rowid": 121, "facility_name": "HUNTINGTON HEALTH AND REHABILITATION CENTER", "facility_id": 515007, "address": "1720 17TH STREET", "city": "HUNTINGTON", "state": "WV", "zip": 25701, "inspection_date": "2017-09-07", "deficiency_tag": 282, "scope_severity": "D", "complaint": 1, "standard": 1, "eventid": "QLZ111", "inspection_text": "**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 two (2) of twenty-nine (29) residents whose care plans were reviewed during Stage 2 of the Quality Indicator Survey (QIS). Resident #19 did not receive restorative services according to the care plan. Resident #320's care plan was not implemented for bladder incontinence. Resident identifiers: #19 and #320. Facility census: 180. Findings include: a) Resident #19 Review of the resident's current care plan found the following problem: Resident has limited physical mobility related to disease process dementia, [MEDICAL CONDITION], weakness, revised on 08/24/17. The goal associated with the problem: Resident will remain free of complications related to immobility, including contractures, thrombus formation, skin breakdown, fall related injury through the next review date, revised on 08/24/17. Interventions included; Nursing Rehabilitation/Restorative: Active range of motion, revised on 08/24/17. On 08/22/17, the physical therapist referred the resident to the facility's restorative program. On 08/24/17, the resident began the following restorative program: The goal for restorative therapy was: Maintain strength and functional mobility level Activities to be performed for restorative: 1. Stretching to Bilateral hamstrings and bilateral gastrocnemius muscles 30-45 second hold. (MONTH) do in seated or supine position. 2. Therapeutic exercises for bilateral lower extremities ankle pumps, heel slides straight leg raises, hip abduction/adduction and hip flexions long arc quads, 2 sets of 10 reps; may do in seated or supine. 3. Wheel chair mobility 50-100 feet Bilateral upper extremities and bilateral lower extremities for propulsion, min Assistance to SBA (stand by assistance); instruct patient on safe turning of wheel chair, safe negotiation of obstacles and correct upper extremity and lower extremity placement. At 2:19 p.m. on 08/30/17, the unit manager, Registered Nurse (RN) #116 said the restorative aides keep paper documentation of restorative services provided to residents. RN #116 said the resident had not received any therapy and she did not know why. RN #116 called Restorative Aide (RA) #33 to review the restorative therapy services. RA #33 said the resident had not had any therapy because a second aide who normally works this floor had not been working due to an injury. RA #33 said she had not been on this floor since last Thursday because she had been pulled to the floor to work as a nursing assistant. At 12:50 p.m. on 09/05/17, RN #116 was asked if the second restorative aide had returned to work. She said the RA was in the dining room today. An interview with the second RA #42 at 1:05 p.m. on 09/05/17, found he was in the dining room assisting with lunch. RA #42 said he was on light duty so he would not be able to work with Resident #19. At 1:10 p.m. RA #33 said she worked the floor yesterday so she did not get to see the resident. She stated, I last saw her on 08/31/17 and she refused her therapy. The resident was seen only one (1) time between 08/24/17 and 08/31/17. The resident had not received restorative therapy during the month of September, according to RA #33. The DON confirmed Resident #19 was not receiving her restorative therapy as ordered upon interview on 09/05/17 at 4:17 p.m., after review of the Rehabilitation/Restorative Service Delivery Record. At 4:17 p.m. on 09/05/17, the administrator confirmed RA #42 was injured on the job, sometime last week. At 9:49 a.m. on 09/07/17, the Registered Nurse, Resident Care Management Director, (RN) #3 reviewed the restorative services delivery record and confirmed the Resident's care plan addressing the resident's limited physical mobility was not implemented. b) Resident #320 A record review on 09/05/17 at 12:08 p.m., revealed the Nursing Care Plan completed on 06/06/17, read as follows, Focus: (Resident #320's first name) has bowel incontinence r/t Decreased Activity, Weakness. Date Initiated: 05/03/2017 Revision on: 05/03/2017 Goal: (Resident #320's first name) will have less than two episodes of incontinence per day through the review date. Date Initiated: 05/03/2017. Revision on: 05/03/2017. Target Date: 08/02/2017. Interventions: (included) Check resident every two hours and assist with toileting as needed. Date Initiated: 05/03/2017 Provide bedpan/bedside commode. Date Initiated: 05/03/2017 Provide loose fitting, easy to remove clothing. Date Initiated: 05/03/2017 Provide peri care after each incontinent episode. Date Initiated: 05/03/2017 Resident #320 also had a Nursing Care Plan completed on 07/06/2017, which read as follows: Focus: (Resident #320's first name) has bladder incontinence r/t Weakness, Decreased Activity, DM. Date Initiated: 05/03/2017 Revision on: 05/03/2017. Goal: (Resident #320's first name) will remain free from skin breakdown due to incontinence and brief use through the review date. Date Initiated: 05/03/2017. Revision on: 05/03/2017. Target Date: 08/02/2017. Interventions: (included) Clean peri-area with each incontinence episode. Date Initiated: 05/03/2017 Have call light within easy reach. Date Initiated: 05/03/2017 Incontinent: Check EVERY TWO HOURS AND PRN for incontinence. Wash, rinse and dry perineum. Change clothing PRN after incontinence episodes. Date Initiated: 05/03/2017 Revision on 05/03/2017 Interview was conducted with Resident #320 on 9/5/17 at 1:45 PM. The resident explained the events that led up to admission in April, as well as the therapy received initially. He explained that he isn't able to walk, and transfers in his wheelchair. The resident stated he is not on a scheduled toileting program. He stated, No, they come and change me twice a day, every morning and every evening. They used to change me only one time a day, and they recently increased changing me two times a day. At this time, a male Nurse Aide entered the room, carrying supplies, and stated he was there to check the resident. Surveyor stepped out into the hall until he was finished. Approximately five (5) minutes passed, and the male Nurse Aide came out of the resident's room, pulled the door closed, and stated, I have to get some help Approximately five (5) minutes later, the male staff came back to Resident #320s room, along with a female assistant, who was pushing a Hoyer Lift. I asked the female staff what type of lift it was, and she replied, It's a special one that enables us to stand a resident up. Both assistants left the room in approximately 10 minutes. Interview with the male Nurse Aide and asked him how often do they check and/or assist the resident, and he replied, We do it with every round. I asked the male assistant how frequently to they make rounds, and he replied, It always depends on what all we've got going on. This surveyor re-entered Resident #320 room to resume my interview, I asked resident if anyone had instructed him how to use his call-light, and he replied, Yes, ma'am. Upon further interview he was asked if anyone at the facilty had instructed him to turn on his call-light every time he needs to go to the restroom, and he replied, No, I just wait until they come in to change me. When asked if the staff get a wash basin with water and soap to wash him after they remove the soiled brief. Resident smiled, and replied, No, they use those wet-ones, you know, that come in a pack. Resident added, I'm unable to stand up, so they bring a lift-thing that they use to stand me up. When asked if he had any sore or raw areas on his bottom, or between his legs and private area, and he replied, No. I asked him if the Nurse Aides or anyone applies any type of ointment, cream &/or powder on him during his care, and he replied, No.", "filedate": "2020-09-01"}
{"rowid": 122, "facility_name": "HUNTINGTON HEALTH AND REHABILITATION CENTER", "facility_id": 515007, "address": "1720 17TH STREET", "city": "HUNTINGTON", "state": "WV", "zip": 25701, "inspection_date": "2017-09-07", "deficiency_tag": 309, "scope_severity": "E", "complaint": 1, "standard": 1, "eventid": "QLZ111", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on staff interview, record review, resident interview, and policy review the facility failed to ensure that each resident received the necessary care and services to enable them to maintain and or attain their highest practicable physical, mental and psychosocial well-being. For Resident #235 the facility failed to follow a physician order [REDACTED]. The facility failed to ensure Resident #141 received a physician ordered medication to treat a headache. For Resident #284 and #336 the facility failed to assess a pressure ulcer upon admission to the facility. The facility failed to coordinate care between the [MEDICAL TREATMENT] center and the facility for Resident #382. For Resident #19 the facility failed to follow the physician guidance to contact the responsible party in regards to completing further laboratory testing. These failures affected six (6) of twenty-nine (29) sampled Stage 2 residents. Resident Identifiers: #235, #141, #284, #336, #382, and #19. Facility Census: 180. Findings include: a) Resident #235 1. Aspirin A review of Resident #235's medical record at 9:44 a.m. on 09/06/17 found the following physician order [REDACTED]. Increase ASA (Aspirin) dose to 325 mg (milligrams) 1 po (by mouth) qd (every day) for PE (pulmonary embolism). CBC (completed blood count) 1 wk (week). Review of Resident #235's Medication Administration Record [REDACTED]. In fact Resident #235 has received Aspirin 81 mg daily since 01/05/17 with no change in dosage. An interview with the interim Director of Nursing (DON) at 2:41 p.m. on 09/06/17 confirmed Resident #235's aspirin dose was never increased as the physician order [REDACTED]. 2. Pain Management A review of Resident #235's medical record at 9:44 a.m. on 09/06/17 found the following physician note dated 02/21/17 which read under the section titled, Plan: For Chronic pai[DIAGNOSES REDACTED] continue biofreeze . Further review of the record found a physician order [REDACTED]. This order has remained in effect since 01/09/17 it was revised on 03/29/17 to read as follows: Biofreeze Liquid (Menthol(Topical [MEDICATION NAME]) Apply to bilateral legs topically every four (4) hours for pain. An interview with Resident #235 and her husband at 12:30 p.m. on 09/06/17 revealed Resident #235 often experiences pain in her legs and her feet. When asked what helps with the pain she stated, Biofreeze helps the most. She continued, But I don't always get it like I am supposed to and my legs and feet will hurt. She stated, When I have the biofreeze I do not have to ask for pain medication because the biofreeze takes care of my pain. Review of the Treatment Administration Record (TAR) from 02/01/17 through 09/05/17 found the following days and times when Resident #235 did not receive her biofreeze. Unless otherwise noted the MAR indicated [REDACTED] --02/02/17 at 12:00 a.m. and 4:00 a.m. --02/04/17 at 12:00 a.m. and 4:00 a.m. --02/05/17 at 4:00 a.m. --02/08/17 and 02/09/17 at 12:00 a.m. and 4:00 a.m. --02/12/17 at 12:00 a.m., 4:00 a.m., 8:00 a.m. and 12:00 p.m. --02/13/17 at 4:00 p.m. and 8:00 p.m. --02/14/17 at 12:00 a.m. and 4:00 a.m. --02/15/17 at 12:00 a.m., 4:00 a.m., 4:00 p.m. and 8:00 p.m. --02/17/17 at 12:00 a.m., 4:00 a.m., and 8:00 p.m. --02/18/17 at 12:00 a.m. and 4:00 a.m. --02/19/17 at 4:00 p.m. and 8:00 p.m. --02/21/17 at 12:00 a.m. and 4:00 a.m. --02/24/17, 02/25/17, and 02/26/17 at 4:00 p.m. and 8:00 p.m. Unless otherwise noted the MAR indicated [REDACTED] --03/03/17 at 12:00 a.m. and 4:00 a.m. --03/08/17 and 03/10/17 at 8:00 p.m. --03/11/17 at 12:00 a.m. and 4:00 a.m. --03/13/17 at 4:00 a.m. --03/14/17 at 8:00 p.m. --03/16/17 at 8:00 a.m. and 12:00 p.m. --03/18/17 at 4:00 a.m. --03/19/17 at 12:00 p.m. --03/20/17 at 8:00 a.m. and 12:00 p.m. --03/21/17 at 12:00 a.m. and 4:00 a.m. --03/25/17 at 8:00 p.m. --03/27/17 at 4:00 p.m. and 8:00 p.m. --03/29/17 at 4:00 a.m., 4:00 p.m., and 8:00 p.m. --03/30/17 at 12:00 a.m. and 4:00 a.m. --03/31/17 at 8:00 a.m. and 12:00 p.m. Unless otherwise noted the MAR indicated [REDACTED] --04/01/17 at 8:00 p.m. --04/03/17 at 4:00 p.m. and 8:00 p.m. --04/04/17 at 4:00 a.m., 8:00 a.m., 12:00 p.m., 4:00 p.m. and 8:00 p.m. --04/14/17 at 8:00 a.m. and 12:00 p.m. --04/15/17 at 4:00 a.m. --04/16/17 at 12:00 a.m., 4:00 a.m., 4:00 p.m. and 8:00 p.m. --04/17/17 at 8:00 p.m. --04/18/17 at 12:00 a.m., 4:00 a.m., 8:00 a.m., and 12:00 p.m. --04/22/17 at 12:00 a.m. and 4:00 a.m. --04/23/17 at 12:00 p.m., 4:00 p.m. and 8:00 p.m. --04/24/17 at 12:00 a.m. and 4:00 a.m. Unless otherwise noted the MAR indicated [REDACTED] --05/04/17 at 12:00 p.m. --05/08/17 at 8:00 p.m. --05/13/17 at 8:00 p.m. --05/19/17 at 8:00 a.m. and 12:00 p.m. --05/20/17 at 12:00 p.m. --05/21/17 at 4:00 a.m. --On 05/22/17 at 12:00 a.m., 4:00 a.m., 8:00 a.m., and 12:00 p.m. Progress notes indicated the Biofreeze was not available and they were awaiting its arrival. --05/27/17 at 4:00 a.m., and 8:00 p.m. --Resident was in the hospital from 05/29/17 through 06/05/17. Unless otherwise noted the MAR indicated [REDACTED] --06/10/17 at 4:00 a.m. and 8:00 p.m. --06/11/17 at 8:00 p.m. --06/14/17 at 4:00 a.m., 8:00 a.m and 12:00 p.m. --06/15/17 at 4:00 a.m. Unless otherwise noted the MAR indicated [REDACTED] --07/05/17 ay 8:00 p.m. --07/10/17 at 4:00 p.m. and 8:00 p.m. --07/14/17 at 4:00 p.m. and 8:00 p.m. --07/26/17 at 4:00 p.m. and 8:00 p.m. --07/30/17 at 4:00 a.m. Unless otherwise noted the MAR indicated [REDACTED] --08/02/17 at 4:00 a.m. --08/08/17 at 4:00 p.m. --08/26/17 at 4:00 a.m. During an interview with the Interim DON at 2:41 p.m. on 09/06/17, the above findings were reviewed with her. She indicated that they appear to have a documentation problem and that the TAR should not be left blank. She stated it should have a check mark or a code number indicating why the treatment was not administered. b) Resident # 141 A review of Resident #141's medical record at 8:41 a.m. on 08/31/17 found the following physician order [REDACTED]. Review of the Medication Administration Record [REDACTED]. For the [MEDICATION NAME] the MAR indicated [REDACTED]. Review of the progress note dated 05/27/17 at 4:58 p.m. indicated the medication was not administered because they were awaiting its arrival from the pharmacy. An interview with the Interim DON at 11:27 a.m. on 08/31/17 confirmed Resident #141 did not receive the ordered dose of [MEDICATION NAME]. She indicated that she called the pharmacy and it was delivered to the facility on [DATE] at 7:08 p.m. but the nurse had already entered the note and there was no indication in the medical record that the medication was ever administered to Resident #141. c) Resident #284 Resident #284 was discharged from the facility to an outside hospital on [DATE] due to lethargy and a general decline in his condition. At the time of his discharge, Resident #284 had a stage IV pressure ulcer on his right heel. He also had a surgical wound on his coccyx where a skin flap procedure had been performed. Resident #284 returned to the facility on [DATE]. The Nursing Admission Data Collection, performed on 08/26/17 at 8:26 p.m., documented the presence of a wound on the back of his right lower leg, in addition to the coccyx wound and the right heel pressure ulcer that were present upon discharge. No description of the right lower leg wound, including measurement and staging, was documented. On 08/28/17 at 5:11 p.m., a Skin - Weekly Pressure Ulcer Record evaluation was performed. A new right lateral calf pressure ulcer was documented. The date of onset was given as 08/26/17, and the pressure ulcer was noted to have been present since admission. The pressure ulcer was described as a Stage III with measurements of 3 cm x 3.2 cm x 1 cm. The wound base was noted to be 100% yellow tissue. Because the right lower leg pressure ulcer had not been assessed upon admission, it cannot be determined whether the wound worsened from the time of admission on 08/26/17 to the time of assessment on 08/28/17. According to the facility's Skin Management policy and procedure with a revision date of (MONTH) (YEAR), Residents admitted with skin impairments will have wound location and characteristics documented in the Nursing admitted Collection Set (UDA). During an interview on 09/05/17 at 4:42 p.m., the Director of Nursing (DoN) stated wound assessment was not performed by the nurse completing the admission assessment. The wound care nurse performed assessment of wounds and pressure ulcers, including measurement and staging, in order to ensure consistency. Resident #284 was readmitted to the facility on [DATE], which was a Saturday. The wound care nurse was not in the facility on the weekend. The wound care nurse assessed Resident 284's wounds when she returned to the facility on Monday, 08/28/17. The DoN stated the Skin Management policy and procedure with a revision date of (MONTH) (YEAR) was the current policy and procedure. d) Resident #336 Medical record review, on 09/06/17 at 11:10 a.m., for Resident #336 revealed she was admitted on [DATE] after a hospitalization . Review of the Nursing Admission Data Collection Form, indicated the resident had open areas on her coccyx, left, and right buttock. No measurements or description of the open areas could be found. On 05/20/17 at 1:54 a.m., a Nursing Initial care Plan was completed. This care plan found a focus Potential breakdown. Goal: Resident's skin will remain intact without signs of breakdown by next review. Interventions included, Provide wound care/preventative skin care per order and Skin checks weekly per facility protocol, document findings. Review of daily skilled note on 05/20/17 at 3:55 p.m., revealed no skin issues documented. Additional medical record review found initial pressure ulcer record dated 05/22/17 at 1:47 p.m., which revealed Resident # 336 had a total of three (3) pressure ulcers as follows: --Left buttocks- unstageable and measured 4 centimeter (cm) in length and 4 cm in width, depth unknown due to 50% of yellow tissue and 50% purple tissue in wound base. --Coccyx-unstageable and measured 2 cm in length and 1.5 cm in width, depth unknown due to 75% red tissue and 25% purple tissue in wound base. --Right buttocks- unstageable and measured 1.5 cm in length and 1.5 cm in width , depth unknown due to 30% red tissue, 30% yellow tissue and 40% purple tissue in wound base. Physician orders [REDACTED]. During an interview with the Director of Nursing (DON) on 09/07/17 at 12:15 p.m., she verified there was not any documentation by the nursing staff concerning the size, staging and treatments for the resident's pressure ulcers until 05/22/17,three (3) days after admission to the facility. She reviewed the chart and confirmed even though no measurements, staging and treatments were written, the facility claimed the three (3) pressure ulcers were present on admission. She also confirmed there was no documentation to show if the pressure ulcers had changed since admission on 05/19/17. e) Resident #382 A review of the information submitted by the facility regarding how many residents in the facility received [MEDICAL TREATMENT] treatment revealed Resident #382 received [MEDICAL TREATMENT] on Tuesday, Thursday and Saturday. The physician's orders [REDACTED]. The physician's orders [REDACTED]. On 08/31/17 at 10:05 a.m. Licensed Practical Nurse (LPN) #111 said she was not sure what days the resident attended [MEDICAL TREATMENT] but thought she went in the evening. A second conversation with LPN #111 on 08/31/17 at 10:37 a.m., revealed LPN #11 felt the resident's [MEDICAL TREATMENT] time slots varied and sometimes she went in the morning and sometimes in the evening. LPN #111 said it depended on whether or not the [MEDICAL TREATMENT] center had a seat for the resident in the mornings. She said they would call in the mornings and let the facility know if the resident could attend in the morning instead of the evening. LPN #111 said they mostly called before 9:00 a.m. A progress note, dated 09/05/17, stated the residents regularly scheduled time for [MEDICAL TREATMENT] would be Monday, Wednesday, Friday but was subject to change based on the [MEDICAL TREATMENT] center availability. On 08/31/17 at 11:07 a.m. Resident #382 said she had called the dietary department to make sure she got a meal tray at 5:00 p.m. everyday just to make sure she would get it early on the days she attends [MEDICAL TREATMENT]. On 08/31/17 at 11:07 a.m., during an interview with Resident #382, the resident explained that the facility was not doing a very good job regarding the coordination of her care. She said a nurse aide came on the morning of 08/31/17 and asked her if she was ready to get dressed for [MEDICAL TREATMENT]. She said she reminded the nurse aide that she did not attend [MEDICAL TREATMENT] on Thursdays. Resident #382 also said she had concerns over showering because she did not think she could get her Permacath (special catheter inserted in the jugular vein on the neck or upper chest area to aid in [MEDICAL TREATMENT]) wet. She said staff members felt they could cover up the Permacath and give her a shower. On 08/30/17 at 10:00 a.m., during a confidential interview with a registered nurse (RN), the RN said she was not sure if the Permacath could be covered for showering. She also said she was not positive if there were any medications she could not give prior to [MEDICAL TREATMENT]. The RN said she thought she might not be able to give the blood pressure medications prior to [MEDICAL TREATMENT]. Nurse Aide #145, on 08/30/17 at 10:10 a.m., said she thought you could cover the Permacath with a plastic type covering and give the resident a shower. A progress note dated 09/05/17 stated, Due to Permacath, resident should not receive showers and only bed baths should be given The note also indicated that all medications could be given prior to [MEDICAL TREATMENT] with no concerns. 09/05/17 Note Text: Spoke with[NAME]t [MEDICAL TREATMENT] center to clarify [MEDICAL TREATMENT] order for resident. The Pre/Post Treatment information sheet from a [MEDICAL TREATMENT] treatment on 08/25/17 was not received by the facility until 08/30/17 at 12:06 p.m. Licensed Practical Nurse (LPN) #103 was asked about the Pre/Post [MEDICAL TREATMENT] treatment sheet for 08/25/17 on 08/30/17 at 11:44 a.m. LPN #103 said the [MEDICAL TREATMENT] treatment center did not send this sheet back on 08/25/17 and he had requested they fax it to the facility. He said he was not sure who may have requested it before he did. On 09/05/17 at 12:12 p.m. during an interview with Assistant Director of Nursing (ADON) #40 it was explained that the nursing staff did not have good coordination with the [MEDICAL TREATMENT] center regarding the care for Resident #382. The issues with the confusion over which days and what time the resident went to [MEDICAL TREATMENT] was discussed as well as the issues with the Permacath, medications and dietary. Following the interview with the ADON, RN #87 telephoned the [MEDICAL TREATMENT] center. The following note was recorded in the resident's medical record, Spoke with (staff name) at [MEDICAL TREATMENT] center to clarify [MEDICAL TREATMENT] order for resident. (Staff name) confirmed that her scheduled time is to be MWF at 1800 but is subject to change based on center's availability. (Name of ambulance company) to transport to all appointment times. (Staff name) also said that all medications could be given prior to the resident arriving at [MEDICAL TREATMENT] with no concerns. Also, due to Permacath, resident should not receive showers and only bed baths should be given. Resident is aware of the above and agrees with all f) Resident #19 On 07/17/17 a laboratory specimen for a renal panel was collected per the physician's orders [REDACTED]. The results of the specimen were reviewed by the physician on 07/17/17. The results indicated the following abnormalities: Sodium was high, Chloride was high, BUN (blood Urea Nitrogen) was high, Glucose was high and Calcium was low. The physician ordered a no added salt diet and directed staff to encourage oral fluids, after reviewing the laboratory results. The physician advised the nurse to contact the resident's responsible party to determine if the responsible party wants repeated laboratory reports. Further review of the resident's Physician order [REDACTED]. Under the heading, Medically Administered Fluids and Nutrition, No Labs, had been hand written under the category of other orders. A straight line had been drawn through, No Labs, and above was hand written D/C 05/20/15. The POST form was unclear as to if the responsible party wanted or did not want any laboratory values drawn. The Director Of Nursing reviewed the laboratory report and the POST form at 10:10 a.m. on 08/30/17. She said she would follow up with the unit manager, Registered Nurse (RN) #116 to see if she contacted the responsible party. At 12:06 p.m. on 08/30/17, the DON said she was unable to find any evidence the responsible party was contacted in regards to obtaining future laboratory values.", "filedate": "2020-09-01"}
{"rowid": 123, "facility_name": "HUNTINGTON HEALTH AND REHABILITATION CENTER", "facility_id": 515007, "address": "1720 17TH STREET", "city": "HUNTINGTON", "state": "WV", "zip": 25701, "inspection_date": "2017-09-07", "deficiency_tag": 311, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "QLZ111", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility failed to provide restorative therapy as ordered by the physician for one (1) of three (3) resident's reviewed for the care area of activities of daily living (ADL's) during Stage 2 of the Quality Indicator Survey. Resident identifier: #19. Facility census: 180. Findings include: a) Resident #19 On 08/22/17, the physical therapist referred the resident to the facility's restorative program. On 08/24/17, the resident began the following restorative program: The goal for restorative therapy was: Maintain strength and functional mobility level Activities to be performed for restorative: 1. Stretching to Bilateral hamstrings and bilateral gastrocnemius muscles 30-45 second hold. (MONTH) do in seated or supine position 2. Therapeutic exercises for bilateral lower extremities ankle pumps, heel slides straight leg raises, hip abduction/adduction and hip flexions long arc quads, 2 sets of 10 reps; may do in seated or supine. 3. Wheel chair mobility 50-100 feet Bilateral upper extremities and bilateral lower extremities for propulsion, min Assistance to SBA (stand by assistance); instruct patient on safe turning of wheel chair, safe negotiation of obstacles and correct upper extremity and lower extremity placement. At 2:19 p.m. on 08/30/17, the unit manager, Registered Nurse (RN) #116 said the restorative aides keep paper documentation of restorative services provided to residents. RN #116 said the resident had not received any therapy and she did not know why. RN #116 called Restorative Aide (RA) #33 to review the restorative therapy services. RA #33 said the resident had not had any therapy because a second aide who normally works this floor had not been working due to an injury. RA #33 said she had not been on this floor since last Thursday because she had been pulled to the floor to work as a nursing assistant. At 12:50 p.m. on 09/05/17, RN #116 was asked if the second restorative aide had returned to work. She said the RA was in the dining room today. An interview with the second RA #42 at 1:05 p.m. on 09/05/17, found he was in the dining room assisting with lunch. RA #42 said he was on light duty so he would not be able to work with Resident #19. At 1:10 p.m. RA #33 said she worked the floor yesterday so she did not get to see the resident. She stated, I last saw her on 08/31/17 and she refused her therapy. The resident was seen only one (1) time between 08/24/17 and 08/31/17. The resident had not received restorative therapy during the month of September, according to RA #33. The DON confirmed, Resident #19 was not receiving her restorative therapy as ordered on [DATE] at 4:17 p.m. after review of the Rehabilitation/Restorative Service Delivery Record. At 4:17 p.m. on 09/05/17, the administrator confirmed RA #42 was injured on the job, sometime last week.", "filedate": "2020-09-01"}
{"rowid": 124, "facility_name": "HUNTINGTON HEALTH AND REHABILITATION CENTER", "facility_id": 515007, "address": "1720 17TH STREET", "city": "HUNTINGTON", "state": "WV", "zip": 25701, "inspection_date": "2017-09-07", "deficiency_tag": 312, "scope_severity": "D", "complaint": 1, "standard": 1, "eventid": "QLZ111", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on observation, resident interview, record review, and staff interview, the facility failed to ensure one (1) of three (3) residents reviewed for the care area of activities of daily living (ADL's) was provided care for oral hygiene. The facility was unaware Resident #90, who had resided at the facility since 02/12/15, had a upper partial. Resident identifier: #90. Facility census: 180. Findings include: a) Resident #90 Observation of the resident's oral cavity at 10:41 a.m. on 08/29/17, found the resident had what appeared to be her own teeth. Some were missing, discolored and were covered with a white, chalky substance that appeared to be plaque. Observation of the resident's oral cavity with the Registered Nurse (RN) unit manager, at 12:57 p.m. on 09/05/17, found RN #116 discovered the resident had an upper partial and, What looks like a cavity on the lower back tooth. The resident said she had a partial. She stated, I am not going to show it to you because you might steal it. Three (3) nursing assistants (NA's) #47, #5 and #58, (all working on the resident's unit) and RN #116 denied knowing the resident had a partial at 1:21 p.m. on 09/05/17. All denied removing the partial for cleaning. RN #116 was asked if she could find any evidence the facility was ever aware the resident had a partial or any documentation the partial had been removed for cleaning. Record review found the resident was admitted to the facility on [DATE]. The most recent minimum data set (MDS), a quarterly, with an assessment reference date (ARD) of 06/29/17 notes the resident requires extensive assistance of 1 staff member for personal hygiene, which includes brushing teeth. Review of the last 3 nursing monthly assessments, dated 06/12/17, 07/12/17, and 08/12/17 noted the resident has her own teeth under the section entitled, Dentition. The form also allowed the nurse completing the assessment to note the resident had a Partial(s) Bridge(s). This section was not completed, indicating the resident did not have a partial. At approximately 3:00 p.m. on 09/05/17, the Registered Nurse (RN), Resident Care Manager, #3, provided a progress note from a local dentist. She said the family had requested a dental appointment during the resident's care plan meeting. She said the resident did not cooperate and a follow up appointment was going to be scheduled when the family could attend. She said this was the only dental consult she could find for the resident. The dental consult, dated 08/02/17 noted: Patient barely opened mouth for exam. Patient states she does wear a partial on the MX (maxillary) however was unable to have her remove it. There was gross amount of plaque present. Patient will require [MEDICATION NAME] and a more comprehensive exam. Review of the resident's MDS Kardex Report for the nursing assistants found documentation an upper partial had been added to the Kardex on 09/05/17. At 4:16 p.m. on 09/05/17, the Director of Nursing confirmed she had no further information to present regarding the resident's oral status.", "filedate": "2020-09-01"}
{"rowid": 125, "facility_name": "HUNTINGTON HEALTH AND REHABILITATION CENTER", "facility_id": 515007, "address": "1720 17TH STREET", "city": "HUNTINGTON", "state": "WV", "zip": 25701, "inspection_date": "2017-09-07", "deficiency_tag": 315, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "QLZ111", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview the facility failed to ensure Resident #141 and Resident #320 received the services and assistance necessary to maintain their bladder continence status. Resident #141 and Resident #320 both suffered a decline in bladder continence status since their admission to the facility. The facility failed to consistently provide services to these residents to help them to maintain their bladder continence status. This practice affected two (2) of four (4) residents reviewed for the care area of urinary incontinence during Stage Two (2) of the Quality Indicator Survey (QIS). Resident Identifiers: #141 and #320. Facility Census: 180. Findings Include: a) Resident #141 During a Stage 1 interview with Resident #141 at 11:12 a.m. on 08/29/17, when asked if she received enough fluids between meals Resident #141 replied, they bring me plenty to drink but I watch what I drink because I wet on myself now and I never used to do that and I don't like it so I try not to drink to much. A review of Resident #141's medical record beginning at 8:02 a.m. on 09/07/17, found Resident #141 was admitted to the facility on [DATE] at which time she had an indwelling urinary catheter. Resident #141 continued to have a catheter until 01/27/17 at which time it was removed. A review of the nurse aides documentation pertaining to urinary continence was completed beginning with (MONTH) (YEAR) through 09/07/17. This review found the following ( the review was not started until (MONTH) due to the use of the catheter until 01/27/17): In (MONTH) (YEAR) Resident #141 was incontinent of her bladder 16.25 percent (%) of the time. In (MONTH) (YEAR) Resident #141 was incontinent of her bladder 16.48 % of the time. In (MONTH) (YEAR) Resident #141 was incontinent of her bladder 5.19 % of the time. In (MONTH) (YEAR) Resident #141 was incontinent of her bladder 79.57 % of the time. In (MONTH) (YEAR) Resident #141 was incontinent of her bladder 83.70 % of the time. In (MONTH) (YEAR) Resident #141 was incontinent of her bladder 73.91 % of the time. In (MONTH) (YEAR) Resident #141 was incontinent of her bladder 78.49 % of the time. In (MONTH) (YEAR) Resident #141 was incontinent of her bladder 78.95 % of the time. Further review of the record found a physician order [REDACTED]. This order was added after the resident had a fall as an intervention to prevent further falls. This toileting plan was not initiated due to Resident #141's decline in continence status. Review of Resident #141's Minimum Data Sets (MDS) found the following: An admission MDS with an Assessment Reference Date (ARD) of 12/13/17 found the resident had an Indwelling Catheter and was occasionally incontinent of urine and was not in a toileting program. A quarterly MDS with an ARD of 03/13/17 found the resident was occasionally incontinent or urine and was not currently in a toileting program. A quarterly MDS with an ARD of 06/02/17 found the resident was frequently incontinent of urine and was not currently in a toileting program. (Please note this MDS was completed after the toileting plan was ordered on [DATE].) Further review of the record found Resident #141 had the following bowel and bladder evaluations completed. Each bowel and bladder evaluation contained these directions for completion If resident is continent of both bowel and bladder evaluation complete. If resident is Incontinent of either bowel and/or bladder continue with the evaluation: -- Evaluation Dated 12/06/17 indicated Resident #141 was incontinent of urine. (Please note at the time this evaluation was completed Resident #141 had an indwelling catheter and her continent status could not be determined as incontinent due to the catheter.) -- Evaluation Dated 03/06/17 indicated Resident #141 was continent of urine. The remainder of the evaluation was not completed because she was marked as continent of bowel and bladder therefore the evaluation was complete. -- Evaluation Dated 06/06/17 indicated Resident #141 was incontinent of bladder. The remainder of this evaluation was not complete even though it should have been completed because Resident #141 was marked as incontinent of bowel and bladder. The Director of Nursing was interviewed at 8:45 a.m. on 09/07/17 she was asked to show evidence the toileting plan initiated on 05/15/17 was being implemented by the Nurse Aides. She referred to the treatment administration record (TAR). Review of the TAR for 05/2017 through 09/07/17 found the nurses initialed the toileting plan as being completed three times daily at 7:00 a.m., 3:00 p.m., and 11:00 p.m. Further review of the TARs found on the following dates and times the nurses failed to initial the toileting plan was completed: -- 05/16/17 at 3:00 p.m. -- 05/17/17 at 7:00 a.m. -- 05/19/17 at 7:00 a.m. -- 06/08/17 at 7:00 a.m. -- 06/09/17 at 7:00 a.m. -- 07/14/17 at 3:00 p.m. -- 07/19/17 at 3:00 p.m. and 11:00 p.m. -- 07/20/17 at 3:00 p.m. -- 07/25/17 at 7:00 a.m. -- 07/26/17 at 3:00 p.m. -- 07/29/17 at 7:00 a.m. -- 09/05/17 at 3:00 p.m. The DON was then asked if the nurse aides document anywhere to indicate the resident is on a toileting program. She pulled up a follow up question report, in the electronic medical record, for Resident #141. The question which the nurse aides were asked to answer on every shift was, Is the resident on a toileting or bladder retraining program? A review of the nurse aides answers were reviewed for the time period of 05/15/17 through 09/07/17 and found the nurse aides only answered yes to this question on 05/31/17 at 8:30 a.m., 06/30/17 at 2:58 p.m., 07/21/17 at 8:39 a.m., 08/08/17 at 6:38 p.m., 08/12/17 at 9:33 a.m., 08/13/17 at 9:36 a.m., 08/17/17 at 7:35 a.m., 08/21/17 at 7:58 a.m., and 08/27/17 at 4:31 p.m. On all other days three times daily the Nurse Aides answered no to this question. The DON agreed the Nurse Aides are responsible for toileting the resident on the majority of occasions. She stated, The nurses are supposed to make sure it is done. The DON was also asked why the remainder of the bowel and bladder evaluation dated 06/06/17 was not completed. She agreed the remainder of the evaluation should have been completed because the resident was marked as incontinent of her bowel and bladder. She indicated she did not know why the evaluation was not complete and stated, It should not have let them sign it as complete with it remaining blank. A final interview was completed with the DON, the District Director of Clinical Services and the Nursing Home Administrator, at 12:20 p.m. on 09/07/17. At which time they asserted the resident's fluid intake with her meals had not decreased, but they had no way of measuring the amount of fluids which the resident took in between meals which was the subject of the Stage 1 question posed to Resident #141. They also asserted that nursing will at times toilet the resident which is likely true, but they agreed the majority of the toileting program implementation was the responsibility of the Nurse Aides who were documenting that Resident #141 was not on a toileting program. No other information was provided. b.) Resident #320 Review of Resident #320's medical record at 8/30/17 at 12:25 p.m., found: MDS Findings: Section H' Bladder and Bowel 4/29/17: H0300. Urinary Continence: *2. Frequently Incontinent (7 or more episodes of urinary incontinence, but at least one episode of continent-voiding) 5/8/17: H0300. Urinary Continence: *2. Frequently Incontinent (7 or more episodes of urinary incontinence, but at least one episode of continent-voiding) 5/22/17: H0300. Urinary Continence: 3. Always Incontinent (no episodes of continent voiding) 6/17/17: H0300. Urinary Continence: *2. Frequently Incontinent (7 or more episodes of urinary incontinence, but at least one episode of continent-voiding) 7/22/17: H0300. Urinary Continence: 3. Always Incontinent (no episodes of continent voiding) Review of Braden Scale for Predicting Pressure Sore Risk: 04/22/2017 at 2:18 p.m. 2. Moisture: Degree to which skin is exposed to moisture: 3. Occasionally Moist: Skin is occasionally moist, requiring an extra linen change approximately once a day. (3 pts.) 04/25/2017 at 4:24 p.m. 2. Moisture: Degree to which skin is exposed to moisture: 1. Constantly Moist: Skin is kept moist almost constantly by perspiration, urine, etc. Dampness is detected every time patient is moved or turned. (1 pt.) 05/02/2017 at 4:24 p.m. 2. Moisture: Degree to which skin is exposed to moisture: 2. Very Moist: Skin is often, but not always moist. Linen must be changed at least once a shift. (2 pts.) 05/09/2017 at 4:24 p.m. 2. Moisture: Degree to which skin is exposed to moisture: 3. Occasionally Moist: Skin is occasionally moist, reqiring an extra linen change approximately once a day. (3 pts.) 06/16/2017 at 9:43 a.m. 2. Moisture: Degree to which skin is exposed to moisture: 3. Occasionally Moist: Skin is occasionally moist, reqiring an extra linen change approximately once a day. (3 pts.) A Verbal physician's orders [REDACTED]. Confirmed by Employee #1. The above order was discontinued by telephone on 05/05/2017 at 3:08 p.m. Confirmed by Employee #81. A Telephone physician's orders [REDACTED].#81. Review of Treatment Administration Record 05/01/2017-05/31/2017 included the following: Cleanse bilateral buttocks, coccyx, and sacrum with warm soapy water, rinse, pat dry, apply [MEDICATION NAME] cream topically and prn every shift for increased risk for skin break down. -Order Date 04/25/2017 at 4:33 p.m. -D/C Date 05/05/2017 at 2:55 p.m. Cleanse bilateral buttocks, coccyx and sacrum with warm soapy water. Rinse and pat dry-apply [MEDICATION NAME] cream topically every shift. -Order Date 05/05/2017 at 2:55 p.m. -D/C Date 07/10/2017 at 8:18 a.m. Wash coccyx with warm, soapy water, rinse, pat dry, apply [MEDICATION NAME] q shift and prn every shift for prevention. -Order Date 04/22/2017 at 6:59 p.m. -D/C Date 05/05/2017 at 3:08 p.m. Cleanse bilateral buttocks, coccyx and sacrum with warm soapy water. Rinse and pat dry-apply [MEDICATION NAME] cream topically as needed for increased risk for skin breakdown. -Order Date 05/05/2017 at 2:55 p.m. -D/C Date 07/10/2017 at 8:18 a.m. Review of Treatment Administration Record 06/01/2017-06/30/2017 included the following: Cleanse bilateral buttocks, coccyx and sacrum with warm soapy water. Rinse and pat dry-apply [MEDICATION NAME] cream topically every shift. -Order Date 05/05/2017 at 2:55 p.m. -D/C Date 07/10/2017 at 8:18 a.m. Cleanse bilateral buttocks, coccyx and sacrum with warm soapy water. Rinse and pat dry-apply [MEDICATION NAME] cream topically as needed for increased risk for skin breakdown. -Order Date 05/05/2017 at 2:55 p.m. -D/C Date 07/10/2017 at 8:18 a.m. Review of Treatment Administration Record 07/01/2017-07/31/2017 included the following: Cleanse bilateral buttocks, coccyx and sacrum with warm soapy water. Rinse and pat dry-apply [MEDICATION NAME] cream topically every shift. -Order Date 05/05/2017 at 2:55 p.m. -D/C Date 07/10/2017 at 8:18 a.m. Cleanse bilateral buttocks, coccyx, scrotum, and sacrum with warm soapy water. Rinse and pat dry- apply [MEDICATION NAME] cream topically every shift. -Order Date 07/10/2017 at 8:18 p.m. Cleanse scrotum with warm soapy water, rinse, pat dry, and apply [MEDICATION NAME] every shift. -Order Date 07/01/2017 at 5:03 a.m. -D/C Date 07/10/2017 at 8:17 a.m. Cleanse bilateral buttocks, coccyx and sacrum with warm soapy water. Rinse and pat dry -apply [MEDICATION NAME] cream topically as needed for increased risk for skin breakdown. -Order Date 05/05/2017 at 2:55 p.m. -D/C Date 07/10/2017 at 8:18 a.m. Cleanse bilateral buttocks, coccyx, scrotum, and sacrum with warm soapy water. Rinse and pat dry- apply [MEDICATION NAME] cream topically as needed for increased risk for skin breakdown. -Order Date 07/10/2017 at 8:18 p.m. Review of Treatment Administration Record 08/01/2017-08/31/2017 included the following: Cleanse bilateral buttocks, coccyx, scrotum, and sacrum with warm soapy water. Rinse and pat dry- apply [MEDICATION NAME] cream topically every shift. -Order Date 07/10/2017 at 8:18 p.m. Cleanse bilateral buttocks, coccyx, scrotum, and sacrum with warm soapy water. Rinse and pat dry- apply [MEDICATION NAME] cream topically as needed for increased risk for skin breakdown. -Order Date 07/10/2017 at 8:18 p.m. Review of the Nursing Daily Skilled Charting-V 1: (4/22/17, 4/24/17, 4/25/17, 4/26/17, 4/27/17, 4/28/17, 4/29/17, 4/30/17, 5/1/17, 5/2/17, 5/3/17, 5/4/17, 5/5/17, 5/6/17, 5/7/17, 5/8/17, 5/9/17, 5/10/17, 5/11/17, 5/12/17 and 5/27/17) F. GU/BLADDER: 1 b. Bladder Continence: b. INCONTINENT (Total 21 Days) Review of the Nursing Daily Skilled Charting-V 1: (5/13/17, 5/14/17, 5/15/17, 5/16/17, 5/17/17, 5/18/17, 5/19/17, 5/21/17, 5/22/17, 5/23/17, 5/24/17, 5/25/17, 5/26/17, 5/29/17, 5/30/17 and 5/31/17) F. GU/BLADDER: 1 b. Bladder Continence: a. CONTINENT (Total 16 Days) Review of the Nursing Daily Skilled Charting-V 1: (6/9/17,6/12/17, 6/13/17, 6/26/17 and 6/27/17) F. GU/BLADDER: 1 b. Bladder Continence: b. INCONTINENT (Total 5 Days) Review of the Nursing Daily Skilled Charting-V 1: (6/1/17, 6/2/17, 6/4/17, 6/5/17, 6/6/17, 6/7/17, 6/8/17, 6/10/17, 6/11/17, 6/14/17, 6/15/17, 6/17/17, 6/18/17, 6/19/17, 6/20/17, 6/21/17, 6/22/17, 6/23/17, 6/24/17, 6/25/17, 6/28/18, 6/29/17 and 6/30/17) F. GU/BLADDER: 1 b. Bladder Continence: a. CONTINENT (Total 23 Days) Review of the Nursing Daily Skilled Charting-V 1: (7/2/17, 7/3/17, 7/4/17, 7/10/17, 7/17/17, 7/18/17, 7/19/17, 7/20/17, 7/21/17, 7/22/17, 7/23/17, 7/24/17, 7/25/17, 7/26/17, 7/27/17, 7/28/17, 7/29/17, 7/30/17, 7/31/17, 8/1/17, 8/2/17 and 8/15/17 ) F. GU/BLADDER: 1 b. Bladder Continence: b. INCONTINENT (Total 22 Days) Review of the Nursing Daily Skilled Charting-V 1: (7/1/17, 7/5/17, 7/6/17, 7/7/17, 7/8/17, 7/9/17, 7/11/17, 7/12/17, 7/13/17, 7/14/17, 7/15/17 and 7/16/17) F. GU/BLADDER: 1 b. Bladder Continence: a. CONTINENT (Total 12 Days) Review of the Nursing Monthly Summary dated 6/23/2017, Section [NAME] GU/Bladder, 1. What is resident's bladder status? a. Continent 2. Scheduled Toileting Plan 2a. Is resident on a Scheduled Toileting Plan? b. No Review of the Nursing Monthly Summary dated 7/23/2017, Section [NAME] GU/Bladder, 1. What is resident's bladder status? a. Continent 2. Scheduled Toileting Plan 2a. Is resident on a Scheduled Toileting Plan? b. No Review of the Nursing Monthly Summary dated 8/23/2017, Section [NAME] GU/Bladder, 1. What is resident's bladder status? b. Incontinent 2. Scheduled Toileting Plan 2a. Is resident on a Scheduled Toileting Plan? a. Yes Interview conducted with Resident #320 on 9/5/17 at 1:45 PM. He explained the events that led up to his admission in April, as well as the therapy he received initially. He explained that he isn't able to walk, and transfers in his wheelchair. When asked if the facility had him on a scheduled toileting program, and he replied, No. Observation found his call-light was within his reach. When asked if he turns on the call-light when he needs to go to the restroom. Resident stated, No, they come and change me twice a day, every morning and every evening. They used to change me only one time a day, and they recently increased changing me two times a day. At this time, a male Nurse Aide entered the room, carrying supplies, and stated he was there to check the resident. Approximately five (5) minutes passed, and the male Nurse Aide came out of the resident's room, pulled the door closed, and stated, I have to get some help. Approximately five (5) minutes later, the male Nurse Aide came back to Resident #320s room, along with a female Nurse Aide, who was pushing a Hoyer Lift. I asked the female staff what type of lift it was, and she replied, It's a special one that enables us to stand a resident up. Both Nurse Aides left the room in approximately 10 minutes. During an nterview with the male Nurse Aide he was asked him how often do they check and/or assist the resident, and he replied, We do it with every round. When asked how frequently do they make rounds, and he replied, It always depends on what all we've got going on. Upon re-entering Resident #320 room to resume the resident interview, he was asked if anyone had instructed him how to use his call-light, and he replied, Yes, ma'am.When asked if they had instructed him to turn on his call-light every time he needs to go to the restroom, he replied, No, I just wait until they come in to change me. When asked if the staff get a wash basin with water and soap to wash him after they remove the soiled brief. Resident smiled, and replied, No, they use those wet-ones, you know, that come in a pack. Resident added, I'm unable to stand up, so they bring a lift-thing that they use to stand me up. When asked if he had any sore or raw areas on his bottom, or between his legs and private area, and he replied, No. When asked him if the Nurse Aide or anyone applies any type of ointment, cream &/or powder on him during his care, and he replied, No. Interview conducted with Employee #40 on 9/7/17 at 9:17 a.m. regarding Resident #320's noted incontinence for April, (MONTH) and (MONTH) (YEAR), and asked if Resident #320 was on a toileting plan. She replied, I'll have to talk with (First name of Employee #180) and check if there is a toileting plan in place for this resident. No one provided this Surveyor with any additional and/or follow-up information.", "filedate": "2020-09-01"}
{"rowid": 126, "facility_name": "HUNTINGTON HEALTH AND REHABILITATION CENTER", "facility_id": 515007, "address": "1720 17TH STREET", "city": "HUNTINGTON", "state": "WV", "zip": 25701, "inspection_date": "2017-09-07", "deficiency_tag": 323, "scope_severity": "D", "complaint": 1, "standard": 1, "eventid": "QLZ111", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on observation and staff interview, the facility failed to ensure the resident's environment, over which the facility had control, was free from accidents. Resident #350's over the bed table was sitting on a fall mat. Resident #214's grab bars in the bathroom were loose. This was true for one of three residents reviewed for the care area of accidents during Stage 2 of The Quality Indicator survey (QIS) and one random observation. Resident identifiers: #350 and #214. Facility census: 180. Findings include: a) Resident #350 Record review found the resident was admitted to the facility on [DATE]. The resident's current care plan, included a problem for: Being at risk of falls related to CVA (cerebral vascular accident) with aphasia, incontinence, muscle weakness, impaired balance, impaired cognition, history of falls. The goal associated with the problem is: Resident will not sustain serious injury through the review date Interventions included: Low bed with bilateral floor mats per MD (physician) order The resident needs a safe environment with (even floor free from spills and or clutter, etc.) Record review found the resident had seven (7) falls since his admission: --06/09/17 - Resident up in wheelchair in room attempted to stand and fell in floor no injuries noted. --06/13/17 - Resident seen by nurse sliding off edge of bed onto the floor on his knees. --06/20/17 - Resident found lying on his left side on the floor mat beside his bed. --06/22/17 - at 5:30 a.m., Resident noted sitting in floor on mat beside his bed --06/22/17 - at 1:15 a.m., Resident observed sitting in the floor next to his bed --08/21/17 - Resident found lying in front of his wheelchair in the day room. --08/27/17 - Resident found sitting on the left side of his bed on floor mat, obtained a skin tear to the upper part of the back of his right and left arm. Five (5) of the falls occurred when the resident fell from bed. On 06/28/17, the physical ordered a low bed with bilateral floor mats at all times while in bed-verify position and placement. At 4:28 p.m. on 08/30/17, the resident was in bed sleeping. The over the bed table was observed sitting on the fall mat on the right side of the resident's bed. The Registered Nurse (RN) unit manager, Employee #116, was asked if the over the bed table should be on top of the fall mat and could the table pose a risk if the resident fell from bed. RN #116 said she would move the over the bed table. Observation of the resident at 2:56 p.m. on 09/05/17, found he was again in bed with the over the bed table on top of the right fall mat. The Registered Nurse (RN), Resident Care Manager, RN #3, was asked if the over the bed table should be parked on top of the fall mat. She said she would move the table. The Director of Nursing (DON) was advised of the above observations on 09/05/17 at 4:13 p.m. She confirmed the over the bed table should not be sitting on the resident's floor mats. b) Resident #214 Observation of the resident's bathroom at 10:36 a.m. on 08/29/17, found two grab bars in the bathroom, located beside the commode, were loose. A second observation of the resident's bathroom with the maintenance supervisor at 12:55 p.m. on 09/06/17, found the grab bar to the right side of the toilet was easily moved with the touch of a hand. A second grab bar, on the wall behind the commode, was protruding outward from the wall. The screw that held the bar to the wall could be seen between the space between the bar and the wall. The maintenance supervisor confirmed the bars were loose and said he would fix them immediately.", "filedate": "2020-09-01"}
{"rowid": 127, "facility_name": "HUNTINGTON HEALTH AND REHABILITATION CENTER", "facility_id": 515007, "address": "1720 17TH STREET", "city": "HUNTINGTON", "state": "WV", "zip": 25701, "inspection_date": "2017-09-07", "deficiency_tag": 325, "scope_severity": "D", "complaint": 1, "standard": 1, "eventid": "QLZ111", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on medical record review, resident interview and staff interview, the facility failed to identify and address a severe weight loss for one (1) of three (3) residents reviewed for the care area of nutrition during Stage 2 Quality Indicator Survey. Resident #320 lost 10.8% (percent) of his body weight, from 04/22/17 to 05/05/17, which represented a severe weight loss. Additionally, Resident #320 lost 13.1% of his body weight from 04/22/17 to 06/ , which again represented a severe weight loss. There was no evidence the facility identified these weight losses nor assessed causes and/or provided interventions to prevent additional weight losses. As no interventions had been implemented, the weight loss could not be determined to be unavoidable. This represents actual harm to resident #320. Resident Identifier: #320. Facility Census: 180 Findings Include: a) Resident #320 A record review on 08/30/17 at 8:28 a.m., revealed the following weights for Resident #320: -- 04/22/17: 277.0 pounds -- 05/05/17: 247.0 pounds (-10.8%, -30.0 pounds) -- 06/04/17: 240.8 pounds (-13.1%, -36.2 pounds) The resident's percentage of weight loss from 04/22/17 to 05/05/17 and from 04/22/17 to 06/06/17 were calculated using the following formula % of weight loss = (usual weight - actual weight) / (usual weight) x 100. -- From 04/22/17 to 05/05/17, the resident lost 10.8% of his body weight. -- From 04/22/17 to 06/04/17, the resident lost 13.1% of his body weight. Review of resident #320 physician's orders [REDACTED]. Dietary supervisor clarified this order as Controlled Carbohydrate Diet, No Added Salt Diet, Regular Texture, Regular Consistency. Review of resident #320 medical record found a Minimum data set (MDS) with an assessment reference date of 06/17/17. Section K of this MDS Swallowing/Nutritional Status K0300: Weight Loss of the MDS, indicated Resident #320 had not had a Loss of 5% or more in the last month or loss of 10% or more in last 6 months. Further review of the medical record found a 7/22/17: MDS Modified & Accepted; however, it was noted there were not any changes in Section K: Weight Loss: (Loss of 5% or more in the last month or loss of 10%in last 6 months): 0 NO or UNKNOWN From 4/22/17 to 5/19/17, two (2) Nutrition Data Collection had been completed. The first note, description admitted d 4/22/17 at 12:00 p.m., signed and locked 4/28/17 at 2:17 p.m The most recent weight was noted in Section A: 277.0 Lbs on 4/22/17 at 1:54 p.m. The Diet/Supplement/Snack/Fortified Foods was noted in Section I, 2 Regular Diet and the Average meal intake percentage/day was noted in Section A: 1,3 50-75%. The Summary/Plan/Progress Note was noted in Section K,2, which included, Resident evaluated for initial admission nutritional status. Current diet is NAS with average intake of 75-100%, which is adequate to meet needs. Weight is 277/34.6, and indicates overweight/obesity status. Current diet order is adequate and appropriate. Will follow prn. The second Nutrition Data Collection dated 5/19/17 at 10:45 a.m., signed and locked 5/30/17 at 09:24 a.m. by Employee #182. The most recent weight was noted in Section A: 249.6 on 5/10/17 at 09:39. Section B, Weight Status, 1. Is there a change in weight? Response: a. No Change. In 3. Weight Loss =/> 5% in 30 days, 7.5% in 90 days, or 10% in 180 days?; however, there was No Response noted in this section. In 4. Please select concerning =/> 5% weight loss; however there was No Response noted in this section. In Section I, 2,Diet/Supplement/Snack/Fortified Foods: CCD/NAS/REG texture. Section I. 3 Average meal intake percentage/day: 100%. In Section K Summary/Plan/Progress Note: Pt with history of GERD/DM/Unsteady Gait/Pt is post home-invasion with facial trauma. No problems with eating. Glucose is running elevated. He has a history low H&H and depressed [MEDICATION NAME]. Per pt he has no problems. The Nutrition RD assessment dated [DATE] at 09:03 a.m., signed and locked 5/3/17 at 09:06. Section A: Nutrient Estimated Needs, 1. Calories: 20-25/kg ABW of 98kg=1965-2450. 2. Protein: 1-1.1g/kg ABW=98-108. 3. Fluid: 1mL/kcal= 1965-2450. Section B : Nutrition Diagnosis, 1d.Predicticted excessive energy intake NI-1.5. Section C: Problem/Etiology/Signs/Symptoms Statement, 3. Nutrition Goals: Maintain/improve nutritional status. Slow, gradual wt. loss of 3-5 # per month. Avg intake >50%. The Nutrition Status Review dated 7/22/15 at 12:00 p.m, signed and locked 7/29/17 at 5:40 p.m Section B: Weight Status, 3 Weight Loss =/> 5% in 30 days, 7.55 in 90 days, or 10% in 180 days?: No Response. In 4. Please select concerning =/>5% weight loss: No Response. The Nursing Monthly Summary for Resident #320, dated 6/23/17 at 2:00 p.m., signed and locked 6/23/17 at 3:09 p.m., noted Eating 4h: Usual Appetite: b. Fair. The Quarterly MDS Review dated 6/17/17, 2. GO110-H Eating: Independent. 3. KO300. Weight: 258 lbs Weight Loss: (Loss of 5% or more in the last month or loss of 10%in last 6 months): 0 NO or UNKNOWN. The Modified & Accepted MDS dated [DATE] was reviewed, and there were not any noted changes in Section K. Weight Loss: (Loss of 5% or more in the last month or loss of 10%in last 6 months): 0 NO or UNKNOWN. Record review of the Resident #320's Monthly Meal Consumption documentation for April, (MONTH) and (MONTH) (YEAR), revealed the following findings: APRIL (YEAR): Total Meals Documented: 26 Percentage Guide 0 0-25% 0 1 26%-50% 5 2 51%-75% 14 3 76%-100% 7 MAY (YEAR): Total Meals Documented: 91 Percentage Guide Missed Documentation 2 0 0-25% 0 1 26%-50% 4 2 51%-75% 53 3 76%-100% 34 JUNE (YEAR): Total Meals Documented: 90 Percentage Guide Missed Documentation 0 0 0-25% 0 1 26%-50% 1 2 51%-75% 33 3 76%-100% 56 Review of Facility's Food Consumption Chart reference tool for staff reference, which gives the specific examples of 0%, 25%, 50%, 75% and 100%; however, the Facility failed to have a Food Consumption Chart reference tool for staff reference for examples of the percentage guide they currently use, which is 0 0-25%, 1 26%-50%, 2 51%-75%, and 3 76%-100%. During an interview conducted with Resident #320 on 9/5/17 beginning at 1:45 p.m., he explained to me the events that led up to his admission in April, as well as the therapy he received initially. I asked him how his appetite was when he was first admitted to the Facility, and he replied, I don't remember much when I first came here. I guess I ate pretty good. I don't really know. I don't have any problem eating now, though. I asked him if he was aware he had lost weight after his admission, and he replied, No, I really don't. They keep record of it I guess, so I guess they took care of it. Resident #320 smiled and said, I don't have any problems eating now. I asked if the staff ever offer him something else to eat, if he doesn't eat and/or like what has been served. He replied, No, I guess they would if I'd ask. During an interview conducted with Employee #40 on 9/7/17 at 9:17 a.m. regarding Resident #320's noted weight loss for April, (MONTH) and (MONTH) (YEAR). Employee #40 reviewed the Weight Summary report, and noted the weight loss for this time period, and stated, I'll have to talk with (First name of Employee #180) and check if there were interventions for his weight loss. No one provided this Surveyor with any additional and/or follow-up information. Resident #320 lost 10.8% (percent) of his body weight, from 04/22/17 to 05/05/17, which represented a severe weight loss. Additionally, Resident #320 lost 13.1% of his body weight from 04/22/17 to 06/ , which again represented a severe weight loss. There was no evidence the facility identified these weight losses nor assessed causes and/or provided interventions to prevent additional weight losses. As no interventions had been implemented, the weight loss could not be determined to be unavoidable. This represents actual harm to resident #320.", "filedate": "2020-09-01"}
{"rowid": 128, "facility_name": "HUNTINGTON HEALTH AND REHABILITATION CENTER", "facility_id": 515007, "address": "1720 17TH STREET", "city": "HUNTINGTON", "state": "WV", "zip": 25701, "inspection_date": "2017-09-07", "deficiency_tag": 329, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "QLZ111", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview, the facility failed to ensure two (2) of six (6) residents reviewed for the care area of unnecessary medication use were free from unnecessary medications. Resident #19 was receiving an excessive dosage of an anti-anxiety medication, identified by the pharmacist, without justification. In addition, the resident was receiving two (2) antidepressant medications without physician justification. Resident #350's insulin was not administered according to physician's orders [REDACTED]. In addition, Resident #350 received a mood stabilizer and an antidepressant without evidence of non-pharmacological interventions attempted before stating the medications. Resident identifiers: #19 and #350. Facility census: 180. Findings include: a) Resident #19 1. [MEDICATION NAME], an anti-anxiety medication On 11/25/16 the physician prescribed, [MEDICATION NAME] 1 milligram (mg.), every six (6) hours for agitation. A total of four (4) mg's in a twenty-four hour period. On 01/09/17, the prior order was discontinued and the physician ordered: [MEDICATION NAME] 1 mg., every six (6) hours for increased agitation, yelling, cursing, secondary to anxiety. The pharmacist reviewed the resident's medications on 01/13/17 and provided the following information in a written report to the physician: (Name of Resident) receives [MEDICATION NAME] 1 mg. at a total daily dose which is greater than the usual recommended maximum. Recommendations: Please consider re-evaluating continued use of [MEDICATION NAME] at this dose. If this therapy is to continue, its is recommended that a) the prescriber document an assessment of risk versus benefit, indicating that it continues to be a valid therapeutic intervention for this individual; and b) the facility interdisciplinary team ensure ongoing monitoring for effectiveness and potential adverse consequences. The physician responded with the following comments: I have re-evaluated this therapy and do not wish to implement any changes due to the reasons below: The physician provided no reasons. The physician signed the report on 01/19/17. At 12:16 p.m. on 08/30/17, the Director of Nursing (DON) confirmed the physician did not provide rational for the use of [MEDICATION NAME] according to pharmacy instruction. The DON provided a copy of the Physician's Desk Reference (PDR) (the drug handbook used by the facility) for the use of [MEDICATION NAME].The federal Omnibus Budget Reconciliation Act (OBRA) regulates the use of anxiolytics in long-term care facility (LTCF) residents Max: 2 mg/day Po (by mouth) in residents meeting the criteria for treatment, except when documentation is provided showing that higher does are necessary to maintain or improve the resident's functional status. In addition, the facility should attempt periodic tapering or the medication or provide documentation of medical necessity in accordance with OBRA guidelines 2. Antidepressants: Mitazapine ([MEDICATION NAME]) and [MEDICATION NAME] Review of the Medication Administration Record [REDACTED] [MEDICATION NAME] 7.5 mg's at bedtime for decreased PO (by mouth) intake secondary to depression. Order date 02/24/17. [MEDICATION NAME] HCI, 50 mg's, three times a day for refusals of care related to [MEDICAL CONDITION]. ordered on [DATE]. On 07/20/17, the pharmacist reviewed the resident's medications and provided the following written report to the physician: (Name of Resident) receives two antidepressants: [MEDICATION NAME] 15 mg's and [MEDICATION NAME] HCL 50 mg TID (three times a day). Recommendation: Please re-evaluate the need for both agents. Rational for Recommendation: Use of two or more antidepressants simultaneously may increase risk of side effects; in such cases, there should be documentation of expected benefits that outweigh the associated risks and monitoring for any increase in side effects. Agents usually classified as anti-depressants may be prescribed for conditions other than depression including anxiety disorders, post-traumatic stress disorder, [MEDICAL CONDITIONS], neuropathic pain (e.g. diabetic [MEDICAL CONDITION]), migraine headaches, urinary incontinence, and others. If dual therapy is to continue, it is recommended that a) the prescriber document an assessment of risk versus benefit, indicating that it continues to be a valid therapeutic intervention for this individual; and b) The facility interdisciplinary team ensure ongoing monitoring for effectiveness and potential adverse consequences such as dizziness, nausea, diarrhea, anxiety, nervousness, [MEDICAL CONDITION], somnolence, weight gain, anorexia or increased appetite or falls. The physician responded with the following comments: I accept the recommendations above with the following modification: Decrease [MEDICATION NAME] to 7.5 mg QHS (at bedtime). The physician did not provide documentation/rational for the use of two antidepressants. At 12:16 p.m. on 08/30/17, the Director of Nursing (DON) confirmed the physician did not provide rational for the use [MEDICATION NAME] 1 mg. every 6 hours, which was greater than usual recommendation maximum. In addition, the DON confirmed the physician did not provide rational to justify the use of two (2) antidepressants. b) Resident #350 1. [MEDICATION NAME] administration Review of the resident's (MONTH) Medication Administration Record [REDACTED] [MEDICATION NAME] Flex Pen Solution Pen-injector 100 units (ML (insulin [MEDICATION NAME]). Inject 10 unit subcutaneously before meals related to Type 2 Diabetes Mellitus with [MEDICAL CONDITION], hold for Blood sugar less than 150. Order date 08/03/17. On 08/22/17 the order was changed to [MEDICATION NAME] Flex pen Solution Pen-Injector 100 unit/ML (insulin [MEDICATION NAME]). Inject 5 units subcutaneously before meals related to Type 2 Diabetes Mellitus with [MEDICAL CONDITION], hold for blood sugar less than 150. [MEDICATION NAME] was administered on the following ten (10) dates and times when the resident's blood sugar (BS) was less than 150: --08/05/17, at 5:00 p.m., BS was 148. --08/07/17, at 7:00 a.m. BS was 122 --08/09/17, at 7:00 a.m. BS was 130 --08/13/17, at 7:00 p.m. B/S 147 --08/14/17, at 7:00 a.m. B/S was 127 --08/17/17, at 7:00 a.m. B/S was 112 --08/19/17, at 11:00 a.m. B/S was 146 --08/20/17, at 11:00 a.m. B/S was 144 --08/23/17, at 7:00 a.m. B/S was 124 --08/29/17, at 7:00 a.m. B/S was 127 At 9:47 a.m. on 08/31/17, the DON, compared the recorded blood sugars to the MAR. The DON verified the insulin was administered on the above dates and times, when the insulin should have been held. The DON said a performance improvement plan was started on 07/07/17 to correct the above issue. She said, I thought the problem had been corrected but I guess not. 2. [MEDICATION NAME] and [MEDICATION NAME] The resident was admitted to the facility on [DATE]. On 06/28/17, the physician prescribed [MEDICATION NAME] tablet delayed release 500 mg., give 1 tablet by mouth 2 times a day for yelling/increased agitation related to unspecified [MEDICAL CONDITION] not due to a substance or known physiological condition. On 06/29/17, the physician prescribed [MEDICATION NAME] HCI 50 mg's give 0.5 tablet by mouth three (3) times a day related to restlessness and agitation. The behavior monitoring sheet, attached to the MAR, was ordered on [DATE], to observed the resident for yelling and agitation. At 11:38 a.m. on 08/31/17, the DON was asked why the resident was started on [MEDICATION NAME] and [MEDICATION NAME]. The DON said a nurses note, dated 06/21/17, noted the resident was screaming out on all shifts and pushing the call light for no reason. A nurses note, dated 06/22/17, found the following, RN (Registered Nurse) assessment/LPN (Licensed Practical Nurse) appearance of resident-What I think is going on with the resident is: To be wanting to get up and is tired of lying in bed. He states that he understands that he is not supposed to get up. A nurses note, dated 06/22/17, While this nurse and the CNA (certified nursing assistant) were picking up resident off the floor he started to yell and hit CNA demanding that we get him up right now and put him in his chair. This nurse calmed resident down and explained to him that we do not yell and hit staff. At 12:57 p.m. on 08/31/17, the DON provided a psychoactive medication evaluation, dated 06/28/17, related to the use of [MEDICATION NAME] for yelling/agitation. Ineffective interventions were listed as distraction, relaxation, reassurance, offer activities. The DON was unable to provide how and when these interventions were applied. For example, what activities were offered and when, how was the resident distracted, etc. The DON confirmed the nurses notes only discussed the residents behaviors on 2 dates: 06/21/17 and 06/22/17. The nurses note, dated 06/22/17 noted the nurse was able to calm the resident down. The DON was asked if the facility considered the nursing documentation, The resident is wanting to get up and is tired of lying in bed. He understands that he is not supposed to get up. What did the staff do to allow the resident to get out of bed? The DON was unable to answer this question. At 4:14 p.m. on 09/05/17, the DON was asked if she had any further information to present regarding the use of [MEDICATION NAME] and [MEDICATION NAME] without documentation of non-pharmacological interventions attempted before starting the medications. The DON provide no further information.", "filedate": "2020-09-01"}
{"rowid": 129, "facility_name": "HUNTINGTON HEALTH AND REHABILITATION CENTER", "facility_id": 515007, "address": "1720 17TH STREET", "city": "HUNTINGTON", "state": "WV", "zip": 25701, "inspection_date": "2017-09-07", "deficiency_tag": 334, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "QLZ111", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, policy review, and staff interview, the staff failed to obtain a consent prior to administering the [MEDICAL CONDITION] vaccine in (YEAR) for three (3) of five (5) residents reviewed. Resident identifiers: #19, #95, and #190. Facility census: 180. Findings include: a) Resident #19 According to the Medication Administration Record, [REDACTED]. However, no informed consent was obtained before the [MEDICAL CONDITION] vaccine injection on 10/27/16. b) Resident #95 According to the Medication Administration Record, [REDACTED]. On 09/07/17 at 1:35 p.m., Unit Manager (UM) #87 was unable to locate any documentation that consent for the [MEDICAL CONDITION] vaccine had been obtained from Resident #95 or his representative at any time. c) Resident #190 According to the Medication Administration Record, [REDACTED]. On 09/07/17 at 1:35 p.m., Unit Manager (UM) #87 was unable to locate any documentation that consent for the [MEDICAL CONDITION] vaccine had been obtained from Resident #190 or her representative at any time. According to the facility's policy and procedure entitled Immunizations: Influenza (Flu) Vaccination of Residents, Staff, and Volunteers, Informed consent in the form of a discussion regarding risks and benefits of vaccination will occur prior to vaccination. According to the facility's policy and procedure entitled Standing Orders for Administering Influenza Vaccine to Adults, Provide all patients with a copy of the most current federal Vaccine Information Statement (VIS). You must document in the patient's medical record or office log, the publication date of the VIS and the date it was given to the patient. UM #22 and UM #87 were interviewed on 09/07/17 at 1:35 p.m. UM #22 stated verbal consent was obtained from the resident or the resident's representative prior to administration of the [MEDICAL CONDITION] vaccine. UM #87 stated that written consent is obtained. The Director of Nursing (DoN) was also interviewed on 09/07/17 at 1:35 p.m. The DoN stated consents for the [MEDICAL CONDITION] vaccine are not obtained annually. She stated once consent had been obtained, the vaccine was administered yearly based on this consent.", "filedate": "2020-09-01"}
{"rowid": 130, "facility_name": "HUNTINGTON HEALTH AND REHABILITATION CENTER", "facility_id": 515007, "address": "1720 17TH STREET", "city": "HUNTINGTON", "state": "WV", "zip": 25701, "inspection_date": "2017-09-07", "deficiency_tag": 353, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "QLZ111", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, staff interview, resident interview, policy review, and observation, the facility failed to ensure qualified nursing staff provided day to day care to meet the resident's needs in an environment which promoted each resident's physical, mental, and psychosocial well-being, to enhance their quality of life. The facility failed to ensure all employees were thoroughly screened prior to employment (Employee #150 was not screened through West Virginia (WV) Cares as required by law.) For Residents #322, #372, #280, #84, #110, #233, #290 and #367's allegations of abuse/neglect was not thoroughly investigated and reported to the appropriate state agencies. For Resident #235, the facility failed to follow physician orders [REDACTED]. For Resident #141, the facility failed to follow physician orders [REDACTED]. For Residents #284 and #336 the facility failed to assess pressure ulcers present on admission. For Resident #382, the facility failed to correlate care and services for a resident receiving [MEDICAL TREATMENT] treatments. For Resident #19, the facility failed to follow physician's guidance to contact the responsible party in regard to completing lab tests. For Resident #19, the facility failed to provide restorative services as ordered by the physician. For Resident #90, the facility failed to have the knowledge needed to provide oral care for a dependent care resident. For Residents #141 and #320, the facility failed to provide the necessary services for each resident to restore and/or maintain the resident's bladder functioning. For Residents #350 and #214, the facility failed to ensure the residents environment was as free of accident hazards as possible. For Resident #320, the facility failed to ensure acceptable parameters of nutrition was maintained. For Resident # 350, the facility failed to administer insulin as ordered. These deficient practices had the potential to affect more than an isolated number of residents. Employee identifier: #150. Resident identifiers: #322, #372, #280, #84, #110, #233, #290, #367, #235, #141, #284, #336, #382, #19, #90, #320, #214, #350 and #320. Facility census: 180. Findings include: a) Resident #382 A review of the information submitted by the facility regarding how many residents in the facility received [MEDICAL TREATMENT] treatment revealed Resident #382 received [MEDICAL TREATMENT] on Tuesday, Thursday and Saturday. The physician's orders [REDACTED]. The physician's orders [REDACTED]. On 08/31/17 at 10:05 a.m. Licensed Practical Nurse (LPN) #111 said she was not sure what days the resident attended [MEDICAL TREATMENT] but thought she went in the evening. A second conversation, with LPN #111 on 08/31/17 at 10:37 a.m., revealed LPN #11 felt the resident's [MEDICAL TREATMENT] time slots varied and sometimes she went in the morning and sometimes in the evening. LPN #111 said it depended on whether or not the [MEDICAL TREATMENT] center had a seat for the resident in the mornings. She said they would call in the mornings and let the facility know if the resident could attend in the morning instead of the evening. LPN #111 said they mostly called before 9:00 a.m. A progress note, dated 09/05/17, stated the resident's regularly scheduled time for [MEDICAL TREATMENT] would be Monday, Wednesday, Friday but was subject to change based on the [MEDICAL TREATMENT] center availability. On 08/31/17 at 11:07 a.m. Resident #382 said she had called the dietary department to make sure she got a meal tray at 5:00 p.m. everyday just to make sure she would get it early on the days she attends [MEDICAL TREATMENT]. On 08/31/17 at 11:07 a.m., during an interview with Resident #382, the resident explained that the facility was not doing a very good job regarding the coordination of her care. She said a nurse aide came on the morning of 08/31/17 and asked her if she was ready to get dressed for [MEDICAL TREATMENT]. She said she reminded the nurse aide that she did not attend [MEDICAL TREATMENT] on Thursdays. Resident #382 also said she had concerns over showering because she did not think she could get her Permacath (special catheter inserted in the jugular vein on the neck or upper chest area to aid in [MEDICAL TREATMENT]) wet. She said staff members felt they could cover up the Permacath and give her a shower. On 08/30/17 at 10:00 a.m., during a confidential interview with a registered nurse (RN), the RN said she was not sure if the Permacath could be covered for showering. She also said she was not positive if there were any medications she could not give prior to [MEDICAL TREATMENT]. The RN said she thought she might not be able to give the blood pressure medications prior to [MEDICAL TREATMENT]. Nurse Aide #145, on 08/30/17 at 10:10 a.m., said she thought you could cover the Permacath with a plastic type covering and give the resident a shower. A progress note dated 09/05/17 stated, Due to Permacath, resident should not receive showers and only bed baths should be given The note also indicated that all medications could be given prior to [MEDICAL TREATMENT] with no concerns. 09/05/17 Note Text: Spoke with Debra at [MEDICAL TREATMENT] center to clarify [MEDICAL TREATMENT] order for resident. The Pre/Post Treatment information sheet from a [MEDICAL TREATMENT] treatment on 08/25/17 was not received by the facility until 08/30/17 at 12:06 p.m. Licensed Practical Nurse (LPN) #103 was asked about the Pre/Post [MEDICAL TREATMENT] treatment sheet for 08/25/17 on 08/30/17 at 11:44 a.m. LPN #103 said the [MEDICAL TREATMENT] treatment center did not send this sheet back on 08/25/17 and he had requested they fax it to the facility. He said he was not sure who may have requested it before he did. On 09/05/17 at 12:12 p.m. during an interview with Assistant Director of Nursing (ADON) #40 it was explained that the nursing staff did not have good coordination with the [MEDICAL TREATMENT] center regarding the care for Resident #382. The issues with the confusion over which days and and what time the resident went to [MEDICAL TREATMENT] was discussed as well as the issues with the Permacath, medications and dietary. Following the interview with the ADON, RN #87 telephoned the [MEDICAL TREATMENT] center. The following note was recorded in the resident's medical record, Spoke with (staff name) at [MEDICAL TREATMENT] center to clarify [MEDICAL TREATMENT] order for resident. (Staff name) confirmed that her scheduled time is to be MWF at 1800 but is subject to change based on center's availability. (Name of ambulance company) to transport to all appointment times. (Staff name) also said that all medications could be given prior to the resident arriving at [MEDICAL TREATMENT] with no concerns. Also, due to Permacath, resident should not receive showers and only bed baths should be given. Resident is aware of the above and agrees with all b) Resident #19 On 07/17/17 a laboratory specimen for a renal panel was collected per the physician's orders [REDACTED]. The results of the specimen were reviewed by the physician on 07/17/17. The results indicated the following abnormalities: Sodium was high, Chloride was high, BUN (blood Urea Nitrogen) was high, Glucose was high and Calcium was low. The physician ordered a no added salt diet and directed staff to encourage oral fluids, after reviewing the laboratory results. The physician advised the nurse to contact the resident's responsible party to determine if the responsible party wants repeated laboratory reports. Further review of the resident's Physician order [REDACTED]. Under the heading, Medically Administered Fluids and Nutrition, No Labs, had been hand written under the category of other orders. A straight line had been drawn through, No Labs, and above was hand written D/C 05/20/15. The POST form was unclear as to if the responsible party wanted or did not want any laboratory values drawn. The Director Of Nursing reviewed the laboratory report and the POST form at 10:10 a.m. on 08/30/17. She said she would follow up with the unit manager, Registered Nurse (RN) #116 to see if she contacted the responsible party. At 12:06 p.m. on 08/30/17, the DON said she was unable to find any evidence the responsible party was contacted in regards to obtaining future laboratory values. c) Resident #284 Resident #284 was discharged from the facility to an outside hospital on [DATE] due to lethargy and a general decline in his condition. At the time of his discharge, Resident #284 had a stage IV pressure ulcer on his right heel. He also had a surgical wound on his coccyx where a skin flap procedure had been performed. Resident #284 returned to the facility on [DATE]. The Nursing Admission Data Collection, performed on 08/26/17 at 8:26 p.m., documented the presence of a wound on the back of his right lower leg, in addition to the coccyx wound and the right heel pressure ulcer that were present upon discharge. No description of the right lower leg wound, including measurement and staging, was documented. On 08/28/17 at 5:11 p.m., a Skin - Weekly Pressure Ulcer Record evaluation was performed. A new right lateral calf pressure ulcer was documented. The date of onset was given as 08/26/17, and the pressure ulcer was noted to have been present since admission. The pressure ulcer was described as a Stage III with measurements of 3 cm x 3.2 cm x 1 cm. The wound base was noted to be 100% yellow tissue. Because the right lower leg pressure ulcer had not been assessed upon admission, it cannot be determined whether the wound worsened from the time of admission on 08/26/17 to the time of assessment on 08/28/17. According to the facility's Skin Management policy and procedure with a revision date of (MONTH) (YEAR), Residents admitted with skin impairments will have wound location and characteristics documented in the Nursing admitted Collection Set (UDA). During an interview on 09/05/17 at 4:42 p.m., the Director of Nursing (DoN) stated wound assessment was not performed by the nurse completing the admission assessment. The wound care nurse performed assessment of wounds and pressure ulcers, including measurement and staging, in order to ensure consistency. Resident #284 was readmitted to the facility on [DATE], which was a Saturday. The wound care nurse was not in the facility on the weekend. The wound care nurse assessed Resident 284's wounds when she returned to the facility on Monday, 08/28/17. The DoN stated the Skin Management policy and procedure with a revision date of (MONTH) (YEAR) was the current policy and procedure. d) Resident #336 Medical record review, on 09/06/17 at 11:10 a.m., for Resident #336 revealed she was admitted on [DATE] after a hospitalization . Review of the Nursing Admission Data Collection Form, indicated the resident had open areas on her coccyx, left, and right buttock. No measurements or description of the open areas could be found. On 05/20/17 at 1:54 a.m., a Nursing Initial care Plan was completed. This care plan found a focus Potential breakdown. Goal: Resident's skin will remain intact without signs of breakdown by next review. Interventions included, Provide wound care/preventative skin care per order and Skin checks weekly per facility protocol, document findings. Review of daily skilled note on 05/20/17 at 3:55 p.m., revealed no skin issues documented. Additional medical record review found initial pressure ulcer record dated 05/22/17 at 1:47 p.m., which revealed Resident # 336 had a total of three (3) pressure ulcers as follows: --Left buttocks- unstageable and measured 4 centimeter (cm) in length and 4 cm in width, depth unknown due to 50% of yellow tissue and 50% purple tissue in wound base. --Coccyx-unstageable and measured 2 cm in length and 1.5 cm in width, depth unknown due to 75% red tissue and 25% purple tissue in wound base. --Right buttocks- unstageable and measured 1.5 cm in length and 1.5 cm in width , depth unknown due to 30% red tissue, 30% yellow tissue and 40% purple tissue in wound base. Physician orders [REDACTED]. During an interview with the Director of Nursing (DON) on 09/07/17 at 12:15 p.m., she verified there was not any documentation by the nursing staff concerning the size, staging and treatments for the resident's pressure ulcers until 05/22/17, three (3) days after admission to the facility. She reviewed the chart and confirmed even though no measurements, staging and treatments were written, the facility claimed the three (3) pressure ulcers were present on admission. She also confirmed there was no documentation to show if the pressure ulcers had changed since admission on 05/19/17. e) Resident #235 1. Aspirin A review of Resident #235's medical record at 9:44 a.m. on 09/06/17 found the following physician order [REDACTED]. Increase ASA (Aspirin) dose to 325 mg (milligrams) 1 po (by mouth) qd (every day) for PE (pulmonary embolism). CBC (completed blood count) 1 wk (week). Review of Resident #235's Medication Administration Record [REDACTED]. In fact Resident #235 has received Aspirin 81 mg daily since 01/05/17 with no change in dosage. An interview with the interim Director of Nursing (DON) at 2:41 p.m. on 09/06/17 confirmed Resident #235's aspirin dose was never increased as the physician order [REDACTED]. 2. Pain Management A review of Resident #235's medical record at 9:44 a.m. on 09/06/17 found the following physician note dated 02/21/17 which read under the section titled, Plan: For Chronic pai[DIAGNOSES REDACTED] continue biofreeze . Further review of the record found a physician order [REDACTED]. This order has remained in effect since 01/09/17 it was revised on 03/29/17 to read as follows: Biofreeze Liquid (Menthol(Topical [MEDICATION NAME]) Apply to bilateral legs topically every four (4) hours for pain. An interview with Resident #235 and her husband at 12:30 p.m. on 09/06/17 revealed Resident #235 often experiences pain in her legs and her feet. When asked what helps with the pain she stated, Biofreeze helps the most. She continued, But I don't always get it like I am supposed to and my legs and feet will hurt. She stated, When I have the biofreeze I do not have to ask for pain medication because the biofreeze takes care of my pain. Review of the Treatment Administration Record (TAR) from 02/01/17 through 09/05/17 found the following days and times when Resident #235 did not receive her biofreeze. Unless otherwise noted the MAR indicated [REDACTED] --02/02/17 at 12:00 a.m. and 4:00 a.m. --02/04/17 at 12:00 a.m. and 4:00 a.m. --02/05/17 at 4:00 a.m. --02/08/17 and 02/09/17 at 12:00 a.m. and 4:00 a.m. --02/12/17 at 12:00 a.m., 4:00 a.m., 8:00 a.m. and 12:00 p.m. --02/13/17 at 4:00 p.m. and 8:00 p.m. --02/14/17 at 12:00 a.m. and 4:00 a.m. --02/15/17 at 12:00 a.m., 4:00 a.m., 4:00 p.m. and 8:00 p.m. --02/17/17 at 12:00 a.m., 4:00 a.m., and 8:00 p.m. --02/18/17 at 12:00 a.m. and 4:00 a.m. --02/19/17 at 4:00 p.m. and 8:00 p.m. --02/21/17 at 12:00 a.m. and 4:00 a.m. --02/24/17, 02/25/17, and 02/26/17 at 4:00 p.m. and 8:00 p.m. Unless otherwise noted the MAR indicated [REDACTED] --03/03/17 at 12:00 a.m. and 4:00 a.m. --03/08/17 and 03/10/17 at 8:00 p.m. --03/11/17 at 12:00 a.m. and 4:00 a.m. --03/13/17 at 4:00 a.m. --03/14/17 at 8:00 p.m. --03/16/17 at 8:00 a.m. and 12:00 p.m. --03/18/17 at 4:00 a.m. --03/19/17 at 12:00 p.m. --03/20/17 at 8:00 a.m. and 12:00 p.m. --03/21/17 at 12:00 a.m. and 4:00 a.m. --03/25/17 at 8:00 p.m. --03/27/17 at 4:00 p.m. and 8:00 p.m. --03/29/17 at 4:00 a.m., 4:00 p.m., and 8:00 p.m. --03/30/17 at 12:00 a.m. and 4:00 a.m. --03/31/17 at 8:00 a.m. and 12:00 p.m. Unless otherwise noted the MAR indicated [REDACTED] --04/01/17 at 8:00 p.m. --04/03/17 at 4:00 p.m. and 8:00 p.m. --04/04/17 at 4:00 a.m., 8:00 a.m., 12:00 p.m., 4:00 p.m. and 8:00 p.m. --04/14/17 at 8:00 a.m. and 12:00 p.m. --04/15/17 at 4:00 a.m. --04/16/17 at 12:00 a.m., 4:00 a.m., 4:00 p.m. and 8:00 p.m. --04/17/17 at 8:00 p.m. --04/18/17 at 12:00 a.m., 4:00 a.m., 8:00 a.m., and 12:00 p.m. --04/22/17 at 12:00 a.m. and 4:00 a.m. --04/23/17 at 12:00 p.m., 4:00 p.m. and 8:00 p.m. --04/24/17 at 12:00 a.m. and 4:00 a.m. Unless otherwise noted the MAR indicated [REDACTED] --05/04/17 at 12:00 p.m. --05/08/17 at 8:00 p.m. --05/13/17 at 8:00 p.m. --05/19/17 at 8:00 a.m. and 12:00 p.m. --05/20/17 at 12:00 p.m. --05/21/17 at 4:00 a.m. --On 05/22/17 at 12:00 a.m., 4:00 a.m., 8:00 a.m., and 12:00 p.m. Progress notes indicated the Biofreeze was not available and they were awaiting its arrival. --05/27/17 at 4:00 a.m., and 8:00 p.m. --Resident was in the hospital from 05/29/17 through 06/05/17. Unless otherwise noted the MAR indicated [REDACTED] --06/10/17 at 4:00 a.m. and 8:00 p.m. --06/11/17 at 8:00 p.m. --06/14/17 at 4:00 a.m., 8:00 a.m. and 12:00 p.m. --06/15/17 at 4:00 a.m. Unless otherwise noted the MAR indicated [REDACTED] --07/05/17 ay 8:00 p.m. --07/10/17 at 4:00 p.m. and 8:00 p.m. --07/14/17 at 4:00 p.m. and 8:00 p.m. --07/26/17 at 4:00 p.m. and 8:00 p.m. --07/30/17 at 4:00 a.m. Unless otherwise noted the MAR indicated [REDACTED] --08/02/17 at 4:00 a.m. --08/08/17 at 4:00 p.m. --08/26/17 at 4:00 a.m. During an interview with the Interim DON at 2:41 p.m. on 09/06/17, the above findings were reviewed with her. She indicated that they appear to have a documentation problem and that the TAR should not be left blank. She stated it should have a check mark or a code number indicating why the treatment was not administered. f) Resident # 141 A review of Resident #141's medical record at 8:41 a.m. on 08/31/17 found the following physician order [REDACTED]. Review of the Medication Administration Record [REDACTED]. For the [MEDICATION NAME] the MAR indicated [REDACTED]. Review of the progress note dated 05/27/17 at 4:58 p.m. indicated the medication was not administered because they were awaiting its arrival from the pharmacy. An interview with the Interim DON at 11:27 a.m. on 08/31/17 confirmed Resident #141 did not receive the ordered dose of [MEDICATION NAME]. She indicated that she called the pharmacy and it was delivered to the facility on [DATE] at 7:08 p.m. but the nurse had already entered the note and there was no indication in the medical record that the medication was ever administered to Resident #141. g) Resident #19 On 08/22/17, the physical therapist referred the resident to the facility's restorative program. On 08/24/17, the resident began the following restorative program: The goal for restorative therapy was: Maintain strength and functional mobility level Activities to be performed for restorative: 1. Stretching to Bilateral hamstrings and bilateral gastrocnemius muscles 30-45 second hold. (MONTH) do in seated or supine position 2. Therapeutic exercises for bilateral lower extremities ankle pumps, heel slides straight leg raises, hip abduction/adduction and hip flexions long arc quads, 2 sets of 10 reps; may do in seated or supine. 3. Wheel chair mobility 50-100 feet Bilateral upper extremities and bilateral lower extremities for propulsion, min Assistance to SBA (stand by assistance); instruct patient on safe turning of wheel chair, safe negotiation of obstacles and correct upper extremity and lower extremity placement. At 2:19 p.m. on 08/30/17, the unit manager, Registered Nurse (RN) #116 said the restorative aides keep paper documentation of restorative services provided to residents. RN #116 said the resident had not received any therapy and she did not know why. RN #116 called Restorative Aide (RA) #33 to review the restorative therapy services. RA #33 said the resident had not had any therapy because a second aide who normally works this floor had not been working due to an injury. RA #33 said she had not been on this floor since last Thursday because she had been pulled to the floor to work as a nursing assistant. At 12:50 p.m. on 09/05/17, RN #116 was asked if the second restorative aide had returned to work. She said the RA was in the dining room today. An interview with the second RA #42 at 1:05 p.m. on 09/05/17, found he was in the dining room assisting with lunch. RA #42 said he was on light duty so he would not be able to work with Resident #19. At 1:10 p.m. RA #33 said she worked the floor yesterday so she did not get to see the resident. She stated, I last saw her on 08/31/17 and she refused her therapy. The resident was seen only one (1) time between 08/24/17 and 08/31/17. The resident had not received restorative therapy during the month of September, according to RA #33. The DON confirmed, Resident #19 was not receiving her restorative therapy as ordered on [DATE] at 4:17 p.m. after review of the Rehabilitation/Restorative Service Delivery Record. At 4:17 p.m. on 09/05/17, the administrator confirmed RA #42 was injured on the job, sometime last week. h) Resident #90 Observation of the resident's oral cavity at 10:41 a.m. on 08/29/17, found the resident had what appeared to be her own teeth. Some were missing, discolored and were covered with a white, chalky substance that appeared to be plaque. Observation of the resident's oral cavity with the Registered Nurse (RN) unit manager, at 12:57 p.m. on 09/05/17, found RN #116 discovered the resident had an upper partial and, What looks like a cavity on the lower back tooth. The resident said she had a partial. She stated, I am not going to show it to you because you might steal it. Three (3) nursing assistants (NA's) #47, #5 and #58, (all working on the resident's unit) and RN #116 denied knowing the resident had a partial at 1:21 p.m. on 09/05/17. All denied removing the partial for cleaning. RN #116 was asked if she could find any evidence the facility was ever aware the resident had a partial or any documentation the partial had been removed for cleaning. Record review found the resident was admitted to the facility on [DATE]. The most recent minimum data set (MDS), a quarterly, with an assessment reference date (ARD) of 06/29/17 notes the resident requires extensive assistance of 1 staff member for personal hygiene, which includes brushing teeth. Review of the last 3 nursing monthly assessments, dated 06/12/17, 07/12/17, and 08/12/17 noted the resident has her own teeth under the section entitled, Dentition. The form also allowed the nurse completing the assessment to note the resident had a Partial(s) Bridge(s). This section was not completed, indicating the resident did not have a partial. At approximately 3:00 p.m. on 09/05/17, the Registered Nurse (RN), Resident Care Manager, #3, provided a progress note from a local dentist. She said the family had requested a dental appointment during the resident's care plan meeting. She said the resident did not cooperate and a follow up appointment was going to be scheduled when the family could attend. She said this was the only dental consult she could find for the resident. The dental consult, dated 08/02/17 noted: Patient barely opened mouth for exam. Patient states she does wear a partial on the MX (maxillary) however was unable to have her remove it. There was gross amount of plaque present. Patient will require [MEDICATION NAME] and a more comprehensive exam. Review of the resident's MDS Kardex Report for the nursing assistants found documentation an upper partial had been added to the Kardex on 09/05/17. At 4:16 p.m. on 09/05/17, the Director of Nursing confirmed she had no further information to present regarding the resident's oral status. i) Resident #320 Review of Resident #320's medical record at 8/30/17 at 12:25 p.m., found: MDS Findings: Section H' Bladder and Bowel 4/29/17: H0300. Urinary Continence: *2. Frequently Incontinent (7 or more episodes of urinary incontinence, but at least one episode of continent-voiding) 5/8/17: H0300. Urinary Continence: *2. Frequently Incontinent (7 or more episodes of urinary incontinence, but at least one episode of continent-voiding) 5/22/17: H0300. Urinary Continence: 3. Always Incontinent (no episodes of continent voiding) 6/17/17: H0300. Urinary Continence: *2. Frequently Incontinent (7 or more episodes of urinary incontinence, but at least one episode of continent-voiding) 7/22/17: H0300. Urinary Continence: 3. Always Incontinent (no episodes of continent voiding) Review of Braden Scale for Predicting Pressure Sore Risk: 04/22/2017 at 2:18 p.m. 2. Moisture: Degree to which skin is exposed to moisture: 3. Occasionally Moist: Skin is occasionally moist, requiring an extra linen change approximately once a day. (3 pts.) 04/25/2017 at 4:24 p.m. 2. Moisture: Degree to which skin is exposed to moisture: 1. Constantly Moist: Skin is kept moist almost constantly by perspiration, urine, etc. Dampness is detected every time patient is moved or turned. (1 pt.) 05/02/2017 at 4:24 p.m. 2. Moisture: Degree to which skin is exposed to moisture: 2. Very Moist: Skin is often, but not always moist. Linen must be changed at least once a shift. (2 pts.) 05/09/2017 at 4:24 p.m. 2. Moisture: Degree to which skin is exposed to moisture: 3. Occasionally Moist: Skin is occasionally moist, reqiring an extra linen change approximately once a day. (3 pts.) 06/16/2017 at 9:43 a.m. 2. Moisture: Degree to which skin is exposed to moisture: 3. Occasionally Moist: Skin is occasionally moist, reqiring an extra linen change approximately once a day. (3 pts.) A Verbal physician's orders [REDACTED]. Confirmed by Employee #1. The above order was discontinued by telephone on 05/05/2017 at 3:08 p.m. Confirmed by Employee #81. A Telephone physician's orders [REDACTED].#81. Review of Treatment Administration Record 05/01/2017-05/31/2017 included the following: Cleanse bilateral buttocks, coccyx, and sacrum with warm soapy water, rinse, pat dry, apply [MEDICATION NAME] cream topically and prn every shift for increased risk for skin break down. -Order Date 04/25/2017 at 4:33 p.m. -D/C Date 05/05/2017 at 2:55 p.m. Cleanse bilateral buttocks, coccyx and sacrum with warm soapy water. Rinse and pat dry-apply [MEDICATION NAME] cream topically every shift. -Order Date 05/05/2017 at 2:55 p.m. -D/C Date 07/10/2017 at 8:18 a.m. Wash coccyx with warm, soapy water, rinse, pat dry, apply [MEDICATION NAME] q shift and prn every shift for prevention. -Order Date 04/22/2017 at 6:59 p.m. -D/C Date 05/05/2017 at 3:08 p.m. Cleanse bilateral buttocks, coccyx and sacrum with warm soapy water. Rinse and pat dry-apply [MEDICATION NAME] cream topically as needed for increased risk for skin breakdown. -Order Date 05/05/2017 at 2:55 p.m. -D/C Date 07/10/2017 at 8:18 a.m. Review of Treatment Administration Record 06/01/2017-06/30/2017 included the following: Cleanse bilateral buttocks, coccyx and sacrum with warm soapy water. Rinse and pat dry-apply [MEDICATION NAME] cream topically every shift. -Order Date 05/05/2017 at 2:55 p.m. -D/C Date 07/10/2017 at 8:18 a.m. Cleanse bilateral buttocks, coccyx and sacrum with warm soapy water. Rinse and pat dry-apply [MEDICATION NAME] cream topically as needed for increased risk for skin breakdown. -Order Date 05/05/2017 at 2:55 p.m. -D/C Date 07/10/2017 at 8:18 a.m. Review of Treatment Administration Record 07/01/2017-07/31/2017 included the following: Cleanse bilateral buttocks, coccyx and sacrum with warm soapy water. Rinse and pat dry-apply [MEDICATION NAME] cream topically every shift. -Order Date 05/05/2017 at 2:55 p.m. -D/C Date 07/10/2017 at 8:18 a.m. Cleanse bilateral buttocks, coccyx, scrotum, and sacrum with warm soapy water. Rinse and pat dry- apply [MEDICATION NAME] cream topically every shift. -Order Date 07/10/2017 at 8:18 p.m. Cleanse scrotum with warm soapy water, rinse, pat dry, and apply [MEDICATION NAME] every shift. -Order Date 07/01/2017 at 5:03 a.m. -D/C Date 07/10/2017 at 8:17 a.m. Cleanse bilateral buttocks, coccyx and sacrum with warm soapy water. Rinse and pat dry -apply [MEDICATION NAME] cream topically as needed for increased risk for skin breakdown. -Order Date 05/05/2017 at 2:55 p.m. -D/C Date 07/10/2017 at 8:18 a.m. Cleanse bilateral buttocks, coccyx, scrotum, and sacrum with warm soapy water. Rinse and pat dry- apply [MEDICATION NAME] cream topically as needed for increased risk for skin breakdown. -Order Date 07/10/2017 at 8:18 p.m. Review of Treatment Administration Record 08/01/2017-08/31/2017 included the following: Cleanse bilateral buttocks, coccyx, scrotum, and sacrum with warm soapy water. Rinse and pat dry- apply [MEDICATION NAME] cream topically every shift. -Order Date 07/10/2017 at 8:18 p.m. Cleanse bilateral buttocks, coccyx, scrotum, and sacrum with warm soapy water. Rinse and pat dry- apply [MEDICATION NAME] cream topically as needed for increased risk for skin breakdown. -Order Date 07/10/2017 at 8:18 p.m. Review of the Nursing Daily Skilled Charting-V 1: (4/22/17, 4/24/17, 4/25/17, 4/26/17, 4/27/17, 4/28/17, 4/29/17, 4/30/17, 5/1/17, 5/2/17, 5/3/17, 5/4/17, 5/5/17, 5/6/17, 5/7/17, 5/8/17, 5/9/17, 5/10/17, 5/11/17, 5/12/17 and 5/27/17) F. GU/BLADDER: 1 b. Bladder Continence: b. INCONTINENT (Total 21 Days) Review of the Nursing Daily Skilled Charting-V 1: (5/13/17, 5/14/17, 5/15/17, 5/16/17, 5/17/17, 5/18/17, 5/19/17, 5/21/17, 5/22/17, 5/23/17, 5/24/17, 5/25/17, 5/26/17, 5/29/17, 5/30/17 and 5/31/17) F. GU/BLADDER: 1 b. Bladder Continence: a. CONTINENT (Total 16 Days) Review of the Nursing Daily Skilled Charting-V 1: (6/9/17,6/12/17, 6/13/17, 6/26/17 and 6/27/17) F. GU/BLADDER: 1 b. Bladder Continence: b. INCONTINENT (Total 5 Days) Review of the Nursing Daily Skilled Charting-V 1: (6/1/17, 6/2/17, 6/4/17, 6/5/17, 6/6/17, 6/7/17, 6/8/17, 6/10/17, 6/11/17, 6/14/17, 6/15/17, 6/17/17, 6/18/17, 6/19/17, 6/20/17, 6/21/17, 6/22/17, 6/23/17, 6/24/17, 6/25/17, 6/28/18, 6/29/17 and 6/30/17) F. GU/BLADDER: 1 b. Bladder Continence: a. CONTINENT (Total 23 Days) Review of the Nursing Daily Skilled Charting-V 1: (7/2/17, 7/3/17, 7/4/17, 7/10/17, 7/17/17, 7/18/17, 7/19/17, 7/20/17, 7/21/17, 7/22/17, 7/23/17, 7/24/17, 7/25/17, 7/26/17, 7/27/17, 7/28/17, 7/29/17 (TRUNCATED)", "filedate": "2020-09-01"}
{"rowid": 131, "facility_name": "HUNTINGTON HEALTH AND REHABILITATION CENTER", "facility_id": 515007, "address": "1720 17TH STREET", "city": "HUNTINGTON", "state": "WV", "zip": 25701, "inspection_date": "2017-09-07", "deficiency_tag": 356, "scope_severity": "B", "complaint": 0, "standard": 1, "eventid": "QLZ111", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and staff interview, the facility failed to ensure the nurse staff posting contained the correct date. This practice had the potential to effect more than a limited number of residents and or family members wishing to view the posting. Facility census: 180. Findings include: a) Staff posting Upon entrance to the facility for the initial tour, at 11:14 a.m. on 08/28/18, observation found the staff nursing posting was dated 08/27/17. Employee #104, the [MEDICAL CONDITION] program manager, confirmed the date on the posting was incorrect. Employee #111, a Licensed Practice Nurse (LPN) said she put the incorrect date in error because she had been working all night. The staff posting was corrected immediately. At 1:26 p.m. on 09/06/17, the administrator was advised of the above findings. The administrator provided no comment.", "filedate": "2020-09-01"}
{"rowid": 132, "facility_name": "HUNTINGTON HEALTH AND REHABILITATION CENTER", "facility_id": 515007, "address": "1720 17TH STREET", "city": "HUNTINGTON", "state": "WV", "zip": 25701, "inspection_date": "2017-09-07", "deficiency_tag": 362, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "QLZ111", "inspection_text": "Based on observation and staff interview the facility failed to ensure one (1) resident observed through random opportunity received the lunch meal on 08/28/17 in a timely manner. Resident #85 received her tray 50 minutes after trays were delivered on her floor. Resident identifier: #85. Facility census: 180. Findings include: a) Resident #85 On 08/28/17 at 1:00 p.m. an observation revealed Resident #85 in her room in bed. She appeared to be sleeping. Her eyes were closed. Lunch trays were delivered to fourth floor and were passed to residents at 1:00 p.m. on 08/28/17. Continued observations of Resident #85 continued until 1:30 p.m. on 08/28/17. The observations revealed the resident did not have a lunch tray and remained in bed with her eyes closed. At 1:30 p.m. Licensed Practical Nurse (LPN) #55 was asked if Resident #55 would be getting a lunch tray. LPN #55 said Resident #85 typically ate in the dining room and they had asked for her tray to be brought to fourth floor. At 1:50 p.m. on 08/28/17, LPN #131 delivered Resident #85's tray. On 09/06/17 at 4:26 p.m. the district director of clinical services stated the facility staff could have been trying to get the resident to attend dining in the dining room and that could have caused the delay in delivering her tray.", "filedate": "2020-09-01"}
{"rowid": 133, "facility_name": "HUNTINGTON HEALTH AND REHABILITATION CENTER", "facility_id": 515007, "address": "1720 17TH STREET", "city": "HUNTINGTON", "state": "WV", "zip": 25701, "inspection_date": "2017-09-07", "deficiency_tag": 412, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "QLZ111", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, family interview, staff interview, and record review, the facility failed to provide a medicaid resident routine dental services when the resident lost her dentures. This was true for one (1) of three (3) residents reviewed for dental care during Stage 2 of the Quality Indicator Survey (QIS). Resident identifier: #19. Facility census: 180. Findings include: a) Resident #19 During a telephone interview with the resident's responsible party at 9:56 a.m. on 08/29/17, the responsible party expressed concern because the resident's bottom dentures were missing. The responsible party said she was unsure how long the dentures had been missing. The responsible party stated she could not afford to replace the dentures and the facility did not offer to assist with replacing the dentures. At 10:27 a.m. on 08/29/17 the resident was observed in her room without any upper or lower dentures and no natural teeth. At 12:10 p.m. on 08/30/17, Employee #15, the social services manager, said she was unaware the resident's bottom denture was missing. She stated the admission agreement specifies the facility does not replace lost or missing items. At 12:20 p.m. on 08/30/17, the resident was observed to be up in her wheelchair sitting at the nurses station. She had no lower or upper dentures. At 2:23 p.m. on 08/30/17, the unit charge nurse, Registered Nurse (RN) #116 was asked if the resident had dentures. She stated, I knew she had uppers and apparently they are missing now. I just found out, we are looking for them. An interview with the resident's nursing assistant, (NA) # ///, at 2:29 p.m. on 08/30/17 found she knew the resident had upper dentures. I don't know how long they have been missing, I don't remember the last time I saw them. At 2:35 p.m. on 08/30/17 an interview with [NAME] #15 found she was unaware the residents upper dentures were now missing. When asked if the facility arranges for financial assistance to replace the dentures, she stated, We haven't in the past. She verified she was unaware of any appointments made in the past to explore replacing the lower dentures. Review of the resident's personal inventory sheet, completed upon her admission to the facility on [DATE], noted the resident was admitted with both upper and lower dentures. A second personal inventory sheet, completed on 05/21/15, noted the resident only had upper dentures. At 11:28 a.m. on 09/05/17, the Director of nursing was asked if the facility had located the resident's upper dentures. The DON stated the upper dentures had not been located at 4:22 p.m. on 09/05/17. At the same time, the administrator stated if the dentures were affecting her ability to eat she could be sent to see a dentist.", "filedate": "2020-09-01"}
{"rowid": 134, "facility_name": "HUNTINGTON HEALTH AND REHABILITATION CENTER", "facility_id": 515007, "address": "1720 17TH STREET", "city": "HUNTINGTON", "state": "WV", "zip": 25701, "inspection_date": "2017-09-07", "deficiency_tag": 425, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "QLZ111", "inspection_text": "Based on observation and staff interview, the facility failed to ensure that expired medication was not administered to residents. One (1) of three (3) residents observed during medication administration was found to have an expired medication. Resident identifier: #103. Facility census: 180. Findings include: a) Resident #103 Medication administration was observed for Resident #103 on 08/30/17 at 8:55 a.m. Sertraline Hydrochloride, an antidepressant, 100 mg every day was ordered for Resident #103. The medication was supplied in a pack containing thirty (30) individual blisters. Each individual blister contained one (1) tablet. The medication expiration date was printed on the front of the pack. The medication expiration date was also printed on the back of each blister. The medication expiration date was 07/31/17, indicating that the medication was expired. The pharmacy label affixed on the front of the pack indicated that the medication had been supplied to the facility by the pharmacy on 08/17/17. Nine (9) of the tablets from the individual blisters were missing, having been dispensed to Resident #103 on previous days. The medication administration to Resident #103 was performed by Licensed Practical Nurse (LPN) #176. On 08/30/17 at 8:55 a.m., LPN #176 agreed the Sertraline Hydrochloride for Resident #103 had expired on 07/31/17. On 08/30/17 at 9:00 a.m., Unit Manager (UM) #22 also agreed the Sertraline Hydrochloride for Resident #103 had expired on 07/31/17. UM #22 also stated that all medications in the medication cart would be audited to ensure that no other medications were expired. UM #22 obtained Sertraline Hydrochloride 100 mg with a current expiration date from the facility's medication dispensing system, and this tablet was administered to Resident #103. During an interview on 08/30/17 at 2:00 p.m., the Director of Nursing stated she had already been notified by nursing staff about the expired Sertraline Hydrochloride for Resident #103.", "filedate": "2020-09-01"}
{"rowid": 135, "facility_name": "HUNTINGTON HEALTH AND REHABILITATION CENTER", "facility_id": 515007, "address": "1720 17TH STREET", "city": "HUNTINGTON", "state": "WV", "zip": 25701, "inspection_date": "2017-09-07", "deficiency_tag": 428, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "QLZ111", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility failed to ensure the pharmacist identified and reported irregularities during the monthly medication regimen review for one (1) of six (6) residents reviewed for unnecessary medications. The pharmacist did not identify Resident #350's insulin was not administered according to physician's orders [REDACTED].#350. Facility census: 180. Findings include: a) Resident #350 The resident was admitted to the facility on [DATE]. Review of the resident's (MONTH) Medication Administration Record [REDACTED] Novolog Flex Pen Solution Pen-injector 100 units (ML (insulin Aspart). Inject 10 units subcutaneously before meals related to Type 2 Diabetes Mellitus with Hyperglycemia, hold for Blood sugar (BS) less than 150. Order date 08/03/17. On 08/22/17 the order was changed to Novolog Flex pen Solution Pen-Injector 100 unit/ML (insulin Aspart). Inject 5 units subcutaneously before meals related to Type 2 Diabetes Mellitus with Hyperglycemia, hold for blood sugar less than 150. Novolog was administered on the following ten (10) dates and times when the resident's blood sugar (BS) was less than 150: --08/05/17, at 5:00 p.m., BS was 148. --08/07/17, at 7:00 a.m. BS was 122 --08/09/17, at 7:00 a.m. BS was 130 --08/13/17, at 7:00 p.m. BS 147 --08/14/17, at 7:00 a.m. BS was 127 --08/17/17, at 7:00 a.m. BS was 112 --08/19/17, at 11:00 a.m. BS was 146 --08/20/17, at 11:00 a.m. BS was 144 --08/23/17, at 7:00 a.m. BS was 124 --08/29/17, at 7:00 a.m. BS was 127 At 9:47 a.m. on 08/31/17, the DON, compared the recorded blood sugars to the MAR. The DON verified the insulin was administered on the above dates and times, when the insulin should have been held. The DON said a performance improvement plan was started on 07/07/17 to correct the above issue. She said, I thought the problem had been corrected but I guess not. On 08/16/17, the pharmacist completed a monthly medication regimen review and reported no irregularities. The resident's insulin was administered incorrectly on five (5) occasions before the monthly medication review. At 4:14 p.m. on 09/05/17, the DON verified the pharmacist failed to identify this irregularity during his 08/16/17 review of the resident's medications.", "filedate": "2020-09-01"}
{"rowid": 136, "facility_name": "HUNTINGTON HEALTH AND REHABILITATION CENTER", "facility_id": 515007, "address": "1720 17TH STREET", "city": "HUNTINGTON", "state": "WV", "zip": 25701, "inspection_date": "2017-09-07", "deficiency_tag": 441, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "QLZ111", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and staff interview, the facility failed to follow infection control practices to prevent the spread of disease. Staff failed to provide a barrier between a box and bottle of medication and the bedside table for Resident #103, who was one (1) of three (3) residents observed during medication administration. Additionally, beverages were left uncovered on a cart in the hallway before distribution to residents. This practice had the potential to affect more than a limited number of residents. Resident identifier: #103. Facility census: 180. Findings include: a) Resident #103 Licensed Practical Nurse (LPN) #176 was observed during morning medication administration on 08/30/17. Resident #103 was ordered [MEDICATION NAME], a nasal spray supplied in a bottle intended for multiple uses by the resident. The [MEDICATION NAME] nasal spray bottle is contained in a box. On 08/13/17 at 8:55 a.m., LPN #176 removed the [MEDICATION NAME] box from the medication cart. She carried the box into Resident #103's room. LPN #176 removed the [MEDICATION NAME] bottle from the box, and placed both the box and the bottle directly on Resident 103's bedside table. She did not place a barrier between the [MEDICATION NAME] box and bottle and the bedside table. Resident #103 declined [MEDICATION NAME] administration. LPN #176 placed the [MEDICATION NAME] bottle back into the box, and then placed the box back into the medication cart. During an interview with LPN #176 at 9:00 a.m., she stated she should have used a barrier, such as a paper towel, between the [MEDICATION NAME] box and bottle and Resident #103's bedside table. On 08/30/17 at 2:00 p.m., the Director of Nursing was notified of the above findings. b) Noontime meal observation On 08/28/17 at 12:30 p.m., two surveyors performed meal observation of residents on the fourth floor. At 12:30 p.m., beverages in uncovered glasses were noted on a cart in the hallway. The beverages remained uncovered on the cart in the hallway until 1:00 p.m. At 1:00 p.m., the lunch trays for fourth floor residents arrived. The trays were distributed to the residents, along with the beverages that had been uncovered in the hallway for at least thirty minutes. During an observation on 09/05/17 at 12:00 p.m., beverages on a cart on the fourth floor were noted to be in pitchers covered with plastic wrap. The beverages were poured into glasses immediately before being served to residents along with their meal trays. On 09/06/17 at 4:24 p.m., the District Director of Clinical Services was notified of the observations made on 08/28/17 and 09/05/17. She stated beverages to be served with meals arrive from the kitchen in pitchers covered with plastic wrap. She also stated the beverages were probably pre-poured into the glasses on the unit on 08/28/17, and then the meal trays arrived later than expected.", "filedate": "2020-09-01"}
{"rowid": 137, "facility_name": "HUNTINGTON HEALTH AND REHABILITATION CENTER", "facility_id": 515007, "address": "1720 17TH STREET", "city": "HUNTINGTON", "state": "WV", "zip": 25701, "inspection_date": "2017-09-07", "deficiency_tag": 463, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "QLZ111", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and staff interview the facility failed to ensure one (1) of 40 residents had a functioning call light system. Resident identifier: #84. Facility census: 180. Findings include: a) Resident #84 08/29/17 at 11:51 a.m. Resident #84's call light was observed not functioning. It did not light up above the resident's door when the button was pushed. Resident #84 did have the ability to use the call light. Nurse Aide #134 verified this light was not working. Resident #84's brief interview for mental status (BIMS) completed on the admission minimum data set ((MDS) dated [DATE] revealed the resident's BIMS score as 15. A score of 15 indicated the resident was cognitively intact.", "filedate": "2020-09-01"}
{"rowid": 138, "facility_name": "HUNTINGTON HEALTH AND REHABILITATION CENTER", "facility_id": 515007, "address": "1720 17TH STREET", "city": "HUNTINGTON", "state": "WV", "zip": 25701, "inspection_date": "2017-09-07", "deficiency_tag": 465, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "QLZ111", "inspection_text": "Based on observation and staff interview the facility failed to ensure the heating and air conditioning unit in one (1) of 38 rooms observed during Stage 1 of the quality indicator survey (QIS) was in good repair. The heating/air condition unit in Room #409 had broken vents in the top of the unit. Room number: #409. Facility census: 180. Findings include: a) Room #409 On 08/29/17 at 2:39 p.m. an observation of the heat/air unit in Room #409 revealed the unit had broken vents in the top. The entire section of the top of the unit where the heat/air unit was missing. During an observation with Maintenance Supervisor #34, on 08/30/17 at 10:24 a.m., he agreed the unit needed replaced.", "filedate": "2020-09-01"}
{"rowid": 139, "facility_name": "HUNTINGTON HEALTH AND REHABILITATION CENTER", "facility_id": 515007, "address": "1720 17TH STREET", "city": "HUNTINGTON", "state": "WV", "zip": 25701, "inspection_date": "2017-09-07", "deficiency_tag": 497, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "QLZ111", "inspection_text": "Based on staff interview, observation, and review of employee personnel records, the facility failed to ensure a performance review was completed every twelve (12) months for two (2) of five (5) nurse aides reviewed during the extended survey. Employee identifiers: #74 and #126. Facility census: 180. Findings include: a) Review of personnel files At 10:58 a.m. on 09/07/17, the Director of Nursing (DON) and the Human Resources Director, #183, confirmed Nurse Aides (NA's) #74 and #126 did not have a performance review completed within the past twelve (12) months.", "filedate": "2020-09-01"}
{"rowid": 140, "facility_name": "HUNTINGTON HEALTH AND REHABILITATION CENTER", "facility_id": 515007, "address": "1720 17TH STREET", "city": "HUNTINGTON", "state": "WV", "zip": 25701, "inspection_date": "2017-09-07", "deficiency_tag": 498, "scope_severity": "F", "complaint": 0, "standard": 1, "eventid": "QLZ111", "inspection_text": "Based on staff interview and employee personnel files review, the facility failed to ensure five (5) of five (5) nurse aides (NA) were able to demonstrate competency in skills and techniques necessary to care for residents' needs. Employees: #56, #74, #126, #131, and #99. Facility census: 180. Findings include: a) Personnel Records Review At 2:00 p.m. on 09/06/17, review of the active employee list provided by the facility, found the following employees and their dates of hire: --NA #56, hire date, 04/24/15; --NA #74, hire date, 08/27/15; --NA #126, hire date, 09/15/14; --NA #131, hire date, 09/15/14; --NA #99, hire date, 10/02/12. At 2:56 p.m. on 09/06/2017, the director of nursing (DON) confirmed the facility did not have any documentation to substantiate nurse aides had demonstrated competency in skills necessary to provide daily resident care. The DON said she had realized this was an issue last week and she had started a performance improvement plan.", "filedate": "2020-09-01"}
{"rowid": 141, "facility_name": "HUNTINGTON HEALTH AND REHABILITATION CENTER", "facility_id": 515007, "address": "1720 17TH STREET", "city": "HUNTINGTON", "state": "WV", "zip": 25701, "inspection_date": "2017-09-07", "deficiency_tag": 502, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "QLZ111", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview the facility failed to obtain a physician ordered laboratory test for Resident #235. This was true for one (1) of six (6) residents reviewed for the care area of unnecessary medications during Stage 2 of the Quality Indicator Survey. Resident Identifiers: #235. Facility Census: 180. Findings Include: a) Resident #235 A review of Resident #235's medical record at 9:24 a.m. on 09/06/17 found the following physician progress notes [REDACTED]. Plan: For Pneumonia- completed [MEDICATION NAME] 2 days ago. Cough and Congestion have improved. Will Continue [MEDICATION NAME] for 5 more days and monitor. EXG - NSR, [MEDICAL CONDITION] resolved at this time but will continue to monitor heart rate. Will Check CBC (complete blood count) and CMP in the AM. The Interim Director of Nursing (DON) shortly after this review was asked to provide the results of the CBC and CMP which should have been obtained on 06/23/17. At 11:46 a.m. on 09/06/17 the interim DON reported she did not have the requested lab results. She stated, there was never an order put in for it and they never obtained it.", "filedate": "2020-09-01"}
{"rowid": 142, "facility_name": "HUNTINGTON HEALTH AND REHABILITATION CENTER", "facility_id": 515007, "address": "1720 17TH STREET", "city": "HUNTINGTON", "state": "WV", "zip": 25701, "inspection_date": "2017-09-07", "deficiency_tag": 514, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "QLZ111", "inspection_text": "Based on record review and staff interview, the facility failed to ensure the resident's medical record was correct in the area of Health Care Surrogate (HCS) and whom to notify when Resident #84 experienced a change which would require notification of the appropriate responsible party. The facility had conflicting contact information on Resident #84's face sheet concerning responsible party. Resident identifier: #84. Facility census: 180. Findings include: a) Resident #84 Review of Resident #84's face sheet, on 09/06/17 at 9:00 a.m, found under section titled, Contacts , the residents daughter was listed as the first contact and it was indicated she was the Power of Attorney (POA) and his son was listed as secondary contact. Further review found a HCS selection form completed 06/05/17, by the attending physician, designating the son as the HCS. No further HCS designation forms could be located in the medical records. Additionally, the daughter is not his PO[NAME] Interview with Employee #122, social worker (SW), on 09/06/17 at 9:15 a.m., revealed she thought the daughter was the HCS on admission and had asked to appoint her brother the HCS due to personal issues. When asked, Is there another HCS designation form. She replied, I don't see any in the medical records. On 09/06/17 at 11:00 a.m., Employee #122, SW, provided this surveyor with a HCS designation form dated 05/30/17. She further confirmed this form had been faxed to her on 09/06/17 at 10:35 a.m. This HCS form indicated the Daughter was in fact appointed as the HCS while the resident was in the hospital. However, this HCS became void when the attending physician at the facility appointed Resident #84's son as the HCS on 06/05/17. The facility continued to notify Resident #84's daughter of changes in her condition and had the daughter listed as the health care decision make on the resident face sheet even after Resident #84's son was appointed HCS on 06/05/17 and Resident #84 does not have a power of attorney.", "filedate": "2020-09-01"}
{"rowid": 143, "facility_name": "HUNTINGTON HEALTH AND REHABILITATION CENTER", "facility_id": 515007, "address": "1720 17TH STREET", "city": "HUNTINGTON", "state": "WV", "zip": 25701, "inspection_date": "2017-09-07", "deficiency_tag": 520, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "QLZ111", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, staff interview, policy review, observation, and employee personnel record review the facility failed to ensure that there Quality Assessment and Assurance (QA & A) committee identified and corrected quality deficiencies in which it did have knowledge of or should have had knowledge of. This failure has the potential to effect more than an isolated number of residents. Resident Identifiers: Resident #87, #307, #286, #256, #229, #224, #322, #372, #280, #84, #110, #233, #290, #367, #19, #121, #284, #336, and #382. Employee Identifiers: #150, #74, #126, #56, #131, and #99. Facility Census: 180. Findings Include: a) Facility Management of Personal Funds Review of residents' personal funds account, on 09/06/17 at 2:25 p.m., found five (5) residents had personal funds within $200.00 dollars of the $2,000.00 dollar limit allowed for residents receiving Medicaid benefits. Review of resident individual account balances for 08/06/17 found the following residents within $200.00 dollars of the $2,000.00 dollar limits: --Resident #307- $1,802.10 --Resident #286- $1980.45 --Resident #256- $2,204.38 --Resident #229- $1,907.79 Further review of resident individual account balances for 09/05/17 found the following residents within $200.00 dollars of the $2,000.00 dollar limits: --Resident #224- $2,103.15 --Resident #229- $2,209.79 Upon interview on 09/07/17, at 9:20 a.m., with the Business Office Manager (BOM), she found the computer generated notice when the resident's personal funds reaches $1,800.00 dollar limit. She further confirmed she was unaware she was to provide the notice to the residents and/or responsible party until the corporate offices informed her of the responsibility of printing and providing the resident and/or the responsible party today (09/07/17). On 09/07/17 at 10:25 a.m., the Director of Nursing (DON) and the Nursing Home Administrator (NHA) was both notified. No further information was provided. b) Investigate Individuals and Report Allegations 1. WV CARES West Virginia Code 16-49-9 established new criminal background check requirements for applicants for employment as direct access personnel in long-term care facilities. Effective 08/01/15, all nursing home facilities were required to .prescreen all direct access personnel applicants considered for hire for negative findings by way of an Internet search of registries and licensure databases through the WV Cares website. WV CARES is administered by the Department of Health and Human Resources and the WV State Police Criminal Investigation Bureau (CIB) in consultation with the Centers for Medicare and Medicaid Services (CMS), the Department of Justice (DOJ) and the Federal Bureau of Investigation (FBI). The program uses web-based technologies to provide employers a single portal for checking state and national abuse registries and the state and national sex offender registries. The web-based system also provides employers access to Nurse Aide Registries for all 50 states and professional licensure registries where available. The web based system provides an efficient and effective means for an employer to check an applicant's status prior to paying the cost of a criminal history background check. Through fingerprinting, this program provides a comprehensive criminal history records search of national and state criminal history records that was not available under the previous reliance on name-based record searches. The program relies on new technology to monitor criminal histories and alert officials when a subsequent change in criminal history occurs (i.e., rapback) A monitored criminal history record means the cost of re-fingerprinting is not required for employees who change employers in this industry (or apply for work at more than one employer) within the timeframe of a valid background check. All fitness determinations will be performed by WV CARES who have cleared state and federal background check requirements. Employers will receive a notice of the applicants employment eligibility once the fingerprint based background check results are received. At 8:48 a.m. on 08/30/17 a Notification of Eligible Fitness Determination letter from WV Cares was requested for Employee #150 who was hired in the dietary department on 04/10/17. At 11:47 a.m. on 08/30/17 Employee #183, the area human resource manager, stated that they did not have a WV Cares Notification of Eligible Fitness Determination letter for Employee #150. She stated that she was finger printed on 04/05/17 by MorphoTrust but that the results were never sent to WV Cares. She indicated she did not realize that they had not been sent to WV CARES until she went to pull it from the WV CARES system when it was requested by the surveyor on 08/30/17. 2. Resident #322 A review of the reportable incidents beginning at 10:40 a.m. on 08/30/17 found an Immediate Fax Reporting of Allegations - Nursing Home Program completed on 07/27/17 listing Resident #322 as the alleged victim. On the form under the section titled, Brief Description of the Incident the following was hand written: (typed at written) Resident alleges (unidentified) CNA (Certified Nursing Assistant) is rude, yells, and cusses at him and he alleges this CNA told him that they were not going to change him every 2 (two) hours. Review of the five - day follow up pertaining to this allegation completed by Licensed Practical Nurse (LPN) Social Service Manager (SSM) #15 found the following: (typed as written) I spoke with the resident and he told me that the CNA was (first name of Nurse Aide (NA) #13) . I spoke with the CNA (first and last name of NA #13) who told me she recall the evening and stated in fact the resident was the one who was cussing and screaming and she stated she immediately went out and told the co worker what had happened. During an interview with LPN - SSM #15 beginning at 3:35 p.m. on 08/30/17 in regards to this allegation she stated this was not reported to the Nurse Aide Program after a Nurse Aide was identified because she spoke with Resident #322 and he had stated the NA just needed to be fine tuned and therefore she did not feel it was substantiated so she did not report it to the Nurse Aide Program. 3. Resident #372 A review of the reportable incidents beginning at 10:40 a.m. on 08/30/17 found an Immediate Fax Reporting of Allegations - Nursing Home Program completed on 08/01/17 listing Resident #372 as the alleged victim. On the form under the section titled, Brief Description of the Incident the following was typed: (typed as written) The residents son alleges the following: Resident has had a decline in status and wont do anything, call light not answered timely, alleges waited 3 1/2 hours to be changed after a bowel movement and pain medication it not effective enough. Review of the five - day follow up pertaining to this allegation completed by LPN - SSM #15 found the following: (typed as written) . In regards to allegation of having a bowel movement and waiting 3 hours to be changed. he states this was Saturday into Sunday from 4:30 a.m. to 8:00 a.m During an interview with LPN-SSM #15 beginning at 3:35 p.m. on 08/30/17, when asked if once the resident gave her a specific time frame if she reported the Nurse Aide who was assigned to him during this time frame to the Nurse Aide Program as an alleged perpetrator she stated, No because the allegation was not substantiated therefore I did not report it to the Nurse Aide Program. She further stated, Maybe I should have done that. 4. Resident #280 A review of the reportable incidents beginning at 10:40 a.m. on 08/30/17 found an Immediate Fax Reporting of Allegations - Nursing Home Program completed on 07/26/17 listing Resident #280 as the alleged victim. On the form under the section titled, Brief Description of the Incident the following was hand written: (typed as written) Resident alleged CNA took her to the shower room and during the time in the shower alleges CNA left shower and told her she had to get another resident off the bedpan - states CNA was gone less than five minutes and no issues occurred . Review of the five - day follow up pertaining to this allegation completed by LPN - SSM #15 found the following: (typed as written) After interviewing the resident, it was found the date she is alleging was 07/17/17. It was also found out that the CNA was (First and Last Name of NA #145). I spoke with (First Name of NA #145) regarding this allegation and she reports she does remember this day and she took the resident to the shower and it was very hot in the shower room. She stated that (First name of Resident #280) was safely in her chair and she told the resident she was going to open the first door to the shower room to catch her breath and she would be able to hear her (stating it was just a few feet away) During an interview with LPN-SSM #15 beginning at 3:35 p.m. on 08/30/17, when asked if once the Nurse Aide was identified if this allegation was then reported to the Nurse Aide Program she stated, No it was not, because it was unsubstantiated so I did not think to report it. 5. Resident #84 A review of the complaints and concerns beginning at 12:00 p.m. on 08/30/17 found a concern form dated 06/19/17 which identified Resident #84 as the Resident involved. Under the section titled, Description of Concern the following was hand written: (typed as written) Daughter states he did not get shower, toothbrush or water pitcher from Saturday until Wednesday. Feels like they left him up too long in his wheelchair on Wednesday. Review of the reportable incidents for the month (MONTH) (YEAR) found no reportable incident related to concern voiced by Resident #84's daughter. During an interview with LPN-SSM #15 beginning at 3:35 p.m. on 08/30/17, when asked if this allegation was reported as an allegation of neglect she stated, No because I pulled the ADL (Activities of Daily Living) flow sheet report immediately and the daughter was fine with that. 6. Resident #110 A review of the complaints and concerns beginning at 12:00 p.m. on 08/30/17 found a concern form dated 07/15/17 which identified Resident #110 as the resident involved. Under the section titled, Description of Concern the following was hand written: (typed as written) Resident stated she had been asking since lunch time to be cleaned up. Went into room at 3:45 p.m. to change dressing and resident voiced concern about not being cleaned. CNA went into room to clean up resident at this time. Resident states this is not the first time. Resident room partner stated yellow ring around the residents sheet. Review of the reportable incidents for the month of (MONTH) (YEAR) found no reportable incident related to concern voiced by Resident #110. An interview with the Nursing Home Administrator (NHA) at 4:21 p.m. on 08/30/17, confirmed he was the person who handled this concern for Resident #110. When asked if this concern had been reported as an allegation of neglect he stated, No because after doing further interviews he did not feel like it was a reportable incident. 7. Resident #233 A review of the complaints and concerns beginning at 12:00 p.m. on 08/30/17 found a concern form dated 07/17/17 which identified Resident #233 as the resident involved. Under the section titled, Description of Concern the following was hand written: (typed as written) Resident reports that the weekend was terrible and her got into an argument with RCS - (First name of RCS) on 4 occasions. Reports a very bad attitude - that she put him down on Saturday as refusing a bath and he did not refuse. She would not make his bed how he asked her too. She fuss with me every time she to come into my room. My roommate laid in a dirt brief from breakfast to noon yesterday. They would come in and turn light off and would not change him. Finally around noon he got changed. Last night (Sunday after Midnight) I put my call light on and it took 40 minutes to get someone in here. Review of the reportable incidents for the month of (MONTH) (YEAR) found no reportable incident related to this concern voiced by Resident #233. An interview with the NHA at 4:11 p.m. on 08/30/17 confirmed this concern was not reported as an allegation of abuse and/or neglect. He indicated after he finished up his investigation he did not feel it was substantiated therefore he did not report it. 8. Resident #290 A review of the complaints and concerns beginning at 12:00 p.m. on 08/30/17 found a concern form dated 07/16/17 which identified Resident #290 as the resident involved. Under the section titled, Description of Concern the following was hand written: (typed as written) Husband states nurse forced her to take medicine, among other issues. Wants to talk to administrator . Review of the reportable incidents for the month of (MONTH) (YEAR) found no reportable incident related to this concern voiced by Resident #290. An interview with the NHA at 4:19 p.m. on 08/30/17, confirmed this allegation of abuse was not reported. He stated that after he talked to Resident #290's husband it was clear the nurse was just adamant that the resident take her medicine and she did not force her to take it. He indicated that is why he did not report this allegation of abuse. 9. Resident #367 On 08/29/17 at 11:14 a.m., during a Stage 1 interview of the QIS survey, Resident #96 said a female resident across the hall from him had yelled for 30 minutes needing a bed pan. Resident #96 did not know if the other resident's call light was on. Resident #96 also did not know if this resident ever received assistance. During an interview with Administrator #107, on 09/07/17 at 10:38 am., he said he did have knowledge of this issue and had spoken with Resident #96 and had identified Resident #367 as the resident who needed assistance. During the interview, on 09/07/17 at 10:38 a.m., Administrator #107 provided hand written notes dated 08/21/17. The notes reflect Administrator #107's conversation with Resident #96 and Resident #367. Resident #367 was identified as having a [DIAGNOSES REDACTED].#107's conversation with Resident #367 the resident denied having any issues with needing a bedpan the night before. The administrator noted the resident had a catheter, was on a toileting plan and was care planned for yelling out and turning call light on continuously. Administrator #107 said he had not interviewed any staff regarding this issue nor had he identified this as an allegation of neglect. He also confirmed he had not reported this issue to the appropriate outside State agencies. He said he did not report this issue because after speaking with the resident and obtaining information from other sources he concluded the resident had not been neglected. 10. Policy Review A review of the facility's Abuse and Neglect Prohibition Policy with revision date of (MONTH) (YEAR), on 08/30/17 at 9:00 a.m., found the following under the section titled Reporting and Response: 1. The facility will report all allegations and substantiated occurrences of abuse, neglect, exploitation, mistreatment, injuries of unknown origin, and misappropriation of property to the administrator, State Survey Agency, and law enforcement officials and Adult Protective Services (where state law provides for jurisdiction in long term care facilities) in accordance with state law through established procedures. Timeline for reporting is as follows: a. If the events that caused the allegation involve abuse or result in serious bodily injury, a report is made no later than 2 hours after the management staff becomes aware of allegation. b. If the events that cause the allegation do not involve abuse and do not result in serious bodily injury a report is made not later than 24 hours after the management team become aware of the allegation 3. The facility will report any occurrences of abuse by licensed or certified staff and any knowledge it has of actions by a court of law against an employee , which would indicate unfitness for employment to the applicable state board in accordance with the state law. c) Develop and Implement Abuse/Neglect Policies Policy Development: a. Dementia Management and Resident Abuse Prevention. A review of the facility's Abuse and Neglect Prohibition policy with a revision date of (MONTH) (YEAR), at 9:00 a.m. on 08/30/17 found the following pertaining to the training of employees: 1. The facility will train each employee on this policy during orientation, annually, and more often as determined by the facility. 2. The facility will provide training regarding related policies and procedures. 3. The facility will provide education for those individuals involved with the resident (i.e. family responsible party or legal representative, visitors.) Review of the State Operations Manual Appendix PP - Guidance to Surveyors for Long Term Care Facilities revision 168, with a revision date of 03/08/17 found the following, F226 ** (Rev. 168, Issued: 03-08-17, Effective: 03-08-17, Implementation: 03-08-17) 483.12(b) The facility must develop and implement written policies and procedures that . (3) Include training as required at paragraph 483.95 . 483.95(c) Abuse, neglect, and exploitation. In addition to the freedom from abuse, neglect, and exploitation requirements in 483.12, facilities must also provide training to their staff that at a minimum educates staff on- 483.95(c)(1) Activities that constitute abuse, neglect, exploitation, and misappropriation of resident property as set forth at 483.12. 483.95(c)(2) Procedures for reporting incidents of abuse, neglect, exploitation, or the misappropriation of resident property 483.95(c)(3) Dementia management and resident abuse prevention. 483.95(c)(1) and 483.95(c)(2) are covered in the facility's policy which the facility indicates they will train the staff, however 483.95(c)(3) dementia management and resident abuse prevention is not contained in the policy. These findings were discussed with the Nursing Home Administrator (NHA) at 9:22 a.m. on 08/31/17. He stated that he would have to make sure this was the most recent policy they had in place. At 9:32 a.m. on 08/31/17 the NHA stated that this was the most recent policy they had. He confirmed dementia management and resident abuse prevention was not contained in this policy as required. Reporting and Response: A review of the facility's Abuse and Neglect Prohibition Policy with revision date of (MONTH) (YEAR), on 08/30/17 at 9:00 a.m., found the following under the section titled Reporting and Response: 1. The facility will report all allegations and substantiated occurrences of abuse, neglect, exploitation, mistreatment, injuries of unknown origin, and misappropriation of property to the administrator, State Survey Agency, and law enforcement officials and Adult Protective Services (where state law provides for jurisdiction in long term care facilities) in accordance with state law through established procedures. Timeline for reporting is as follows: a. If the events that caused the allegation involve abuse or result in serious bodily injury, a report is made no later than 2 hours after the management staff becomes aware of allegation. b. If the events that cause the allegation do not involve abuse and do not result in serious bodily injury a report is made not later than 24 hours after the management team becomes aware of the allegation 3. The facility will report any occurrences of abuse by licensed or certified staff and any knowledge it has of actions by a court of law against an employee , which would indicate unfitness for employment to the applicable state board in accordance with the state law. Review of the State Operations Manual (SOM) Appendix PP - Guidance to Surveyors for Long Term Care Facilities revision 168, with a revision date of 03/08/17 found the following in regards to F225 and reporting of allegations: 483.12(c)(1) Ensure that all alleged violations involving abuse, neglect, exploitation or mistreatment, including injuries of unknown source and misappropriation of resident property, are reported immediately, but not later than 2 hours after the allegation is made, if the events that cause the allegation involve abuse or result in serious bodily injury, or not later than 24 hours if the events that cause the allegation do not involve abuse and do not result in serious bodily injury, to the administrator of the facility and to other officials (including to the State Survey Agency and adult protective services where state law provides for jurisdiction in long-term care facilities) in accordance with State law through established procedures. The SOM specifies that reporting is to be done within 2 hours or 24 hours depending on the circumstances after the allegation is made not after the management team has been made aware of the allegation. These findings were discussed with the Nursing Home Administrator (NHA) at 9:22 a.m. on 08/31/17. He stated that he would have to make sure this was the most recent policy they had in place. At 9:32 a.m. on 08/31/17 the NHA stated that this was the most recent policy they had. He confirmed their policy indicating the reporting times began after the management team was made aware of the allegation. He stated we always have a manger here and staff are to immediately report to the manager any allegations or abuse or neglect to get the process started. 2. Policy Implementation in regards to reporting of alleged abuse and or neglect, A review of the facility's Abuse and Neglect Prohibition Policy with revision date of (MONTH) (YEAR), on 08/30/17 at 9:00 a.m., found the following under the section titled Reporting and Response: 1. The facility will report all allegations and substantiated occurrences of abuse, neglect, exploitation, mistreatment, injuries of unknown origin, and misappropriation of property to the administrator, State Survey Agency, and law enforcement officials and Adult Protective Services (where state law provides for jurisdiction in long term care facilities) in accordance with state law through established procedures . Timeline for reporting is as follows: a. If the events that caused the allegation involve abuse or result in serious bodily injury, a report is made no later than 2 hours after the management staff becomes aware of allegation. b. If the events that cause the allegation do not involve abuse and do not result in serious bodily injury a report is made not later than 24 hours after the management team become aware of the allegation. 3. The facility will report any occurrences of abuse by licensed or certified staff and any knowledge it has of actions by a court of law against an employee, which would indicate unfitness for employment to the applicable state board in accordance with the state law. The following instances were found where the facility failed to implement their policy related to reporting and response: 3. Resident #322 A review of the reportable incidents beginning at 10:40 a.m. on 08/30/17 found an Immediate Fax Reporting of Allegations - Nursing Home Program completed on 07/27/17 listing Resident #322 as the alleged victim. On the form under the section titled, Brief Description of the Incident the following was hand written: (typed at written) Resident alleges (unidentified) CNA (Certified Nursing Assistant) is rude, yells, and cusses at him and he alleges this CNA told him that they were not going to change him every 2 (two) hours. Review of the five - day follow up pertaining to this allegation completed by Licensed Practical Nurse (LPN) Social Service Manager (SSM) #15 found the following: (typed as written) I spoke with the resident and he told me that the CNA was (first name of Nurse Aide (NA) #13) . I spoke with the CNA (first and last name of NA #13) who told me she recall the evening and stated in fact the resident was the one who was cussing and screaming and she stated she immediately went out and told the co worker what had happened. During an interview with LPN - SSM #15 beginning at 3:35 p.m. on 08/30/17 in regards to this allegation she stated this was not reported to the Nurse Aide Program after a Nurse Aide was identified because she spoke with Resident #322 and he had stated the NA just needed to be fine tuned and therefore she did not feel it was substantiated so she did not report it to the Nurse Aide Program. 4. Resident #372 A review of the reportable incidents beginning at 10:40 a.m. on 08/30/17 found an Immediate Fax Reporting of Allegations - Nursing Home Program completed on 08/01/17 listing Resident #372 as the alleged victim. On the form under the section titled, Brief Description of the Incident the following was typed: (typed as written) The residents son alleges the following: Resident has had a decline in status and wont do anything, call light not answered timely, alleges waited 3 1/2 hours to be changed after a bowel movement and pain medication it not effective enough. Review of the five - day follow up pertaining to this allegation completed by LPN - SSM #15 found the following: (typed as written) . In regards to allegation of having a bowel movement and waiting 3 hours to be changed. he states this was Saturday into Sunday from 4:30 a.m. to 8:00 a.m During an interview with LPN-SSM #15 beginning at 3:35 p.m. on 08/30/17, when asked if once the resident gave her a specific time frame if she reported the Nurse Aide who was assigned to him during this time frame to the Nurse Aide Program as an alleged perpetrator she stated, No because the allegation was not substantiated therefore I did not report it to the Nurse Aide Program. She further stated, Maybe I should have done that. 5. Resident #280 A review of the reportable incidents beginning at 10:40 a.m. on 08/30/17 found an Immediate Fax Reporting of Allegations - Nursing Home Program completed on 07/26/17 listing Resident #280 as the alleged victim. On the form under the section titled, Brief Description of the Incident the following was hand written: (typed as written) Resident alleged CNA took her to the shower room and during the time in the shower alleges CNA left shower and told her she had to get another resident off the bedpan - states CNA was gone less than five minutes and no issues occurred . Review of the five - day follow up pertaining to this allegation completed by LPN - SSM #15 found the following: (typed as written) After interviewing the resident, it was found the date she is alleging was 07/17/17. It was also found out that the CNA was (First and Last Name of NA #145). I spoke with (First Name of NA #145) regarding this allegation and she reports she does remember this day and she took the resident to the shower and it was very hot in the shower room. She stated that (First name of Resident #280) was safely in her chair and she told the resident she was going to open the first door to the shower room to catch her breath and she would be able to hear her (stating it was just a few feet away) During an interview with LPN-SSM #15 beginning at 3:35 p.m. on 08/30/17, when asked if once the Nurse Aide was identified if this allegation was then reported to the Nurse Aide Program she stated, No it was not, because it was unsubstantiated so I did not think to report it. 6. Resident #84 A review of the complaints and concerns beginning at 12:00 p.m. on 08/30/17 found a concern form dated 06/19/17 which identified Resident #84 as the Resident involved. Under the section titled, Description of Concern the following was hand written: (typed as written) Daughter states he did not get shower, toothbrush or water pitcher from Saturday until Wednesday. Feels like they left him up too long in his wheelchair on Wednesday. Review of the reportable incidents for the month (MONTH) (YEAR) found no reportable incident related to concern voiced by Resident #84's daughter. During an interview with LPN-SSM #15 beginning at 3:35 p.m. on 08/30/17, when asked if this allegation was reported as an allegation of neglect she stated, No because I pulled the ADL (Activities of Daily Living) flow sheet report immediately and the daughter was fine with that. 7. Resident #110 A review of the complaints and concerns beginning at 12:00 p.m. on 08/30/17 found a concern form dated 07/15/17 which identified Resident #110 as the resident involved. Under the section titled, Description of Concern the following was hand written: (typed as written) Resident stated she had been asking since lunch time to be cleaned up. Went into room at 3:45 p.m. to change dressing and resident voiced concern about not being cleaned. CNA went into room to clean up resident at this time. Resident states this is not the first time. Resident room partner stated yellow ring around the residents sheet. Review of the reportable incidents for the month of (MONTH) (YEAR) found no reportable incident related to concern voiced by Resident #110. An interview with the Nursing Home Administrator (NHA) at 4:21 p.m. on 08/30/17, confirmed he was the person who handled this concern for Resident #110. When asked if this concern had been reported as an allegation of neglect he stated, No because after doing further interviews he did not feel like it was a reportable incident. 8. Resident #233 A review of the complaints and concerns beginning at 12:00 p.m. on 08/30/17 found a concern form dated 07/17/17 which identified Resident #233 as the resident involved. Under the section titled, Description of Concern the following was hand written: (typed as written) Resident reports that the weekend was terrible and her got into an argument with RCS - (First name of RCS) on 4 occasions. Reports a very bad attitude - that she put him down on Saturday as refusing a bath and he did not refuse. She would not make his bed how he asked her too. She fuss with me every time she to come into my room. My roommate laid in a dirt brief from breakfast to noon yesterday. They would come in and turn light off and would not change him. Finally around noon her got changed. Last night (Sunday after Midnight) I put my call light on and it took 40 minutes to get someone in here. Review of the reportable incidents for the month of (MONTH) (YEAR) found no reportable incident related to this concern voiced by Resident #233. An interview with the NHA at 4:11 p.m. on 08/30/17 confirmed this concern was not reported as an allegation of abuse and/or neglect. He indicated after he finished up his investigation he did not feel it was substantiated therefore he did not report it. 9. Resident #290 A review of the complaints and concerns beginning at 12:00 p.m. on 08/30/17 found a concern form dated 07/16/17 which identified Resident #290 as the resident involved. Under the section titled, Description of Concern the following was hand written: (typed as written) Husband states nurse forced her to take medicine, among other issues. Wants to talk to administrator . Review of the reportable incidents for the month of (MONTH) (YEAR) found no reportable incident related to this concern voiced by Resident #290. An interview with the NHA at 4:19 p.m. on 08/30/17, confirmed this allegation of abuse was not reported. He stated that after he talked to Resident #290's husband it was clear the nurse was just adamant that the resident take her medicine and she did not force her to take it. He indicated that is why he did not report this allegation of abuse. 10. Resident #367 On 08/29/17 at 11:14 a.m., durin (TRUNCATED)", "filedate": "2020-09-01"}
{"rowid": 144, "facility_name": "HUNTINGTON HEALTH AND REHABILITATION CENTER", "facility_id": 515007, "address": "1720 17TH STREET", "city": "HUNTINGTON", "state": "WV", "zip": 25701, "inspection_date": "2019-10-10", "deficiency_tag": 550, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "RPKM11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and staff interview, the facility failed to treat each resident with respect and dignity for 4 out of 35 residents. For Residents #104, #94, and #9, the facility failed to provide a dignified dining experience. For Resident #177, the facility failed to provide privacy when administering an injection. This failed practice had the potential to affect more than a limited number of residents. Resident identifiers: #104, #94, #9, and #177. Facility census 182. Findings included: a) Resident #104 On 10/07/19 at 12:30 PM, resident meal delivery / tray pass began on the OB Park unit. On 10/07/19 at 12:40 PM, Resident #104 had not received a tray. On 10/07/19 at 12:54 PM, Resident #104's tray was delivered. During an interview on 10/07/19 at 12:55 PM, Employee #199 was asked why Resident #104 did not receive a tray during the initial meal delivery on the unit. Employee #199 stated I can't tell you why he didn't get his tray with everyone else. The tray must have been shoved up too high and the staff didn't see it. On 10/09/19 at 8:22 AM, an interview with the Administrator and the Director of Nursing (DON) did not reveal any further information. b) Resident #94 On 10/07/19 at 12:30 PM, resident meal delivery / tray pass began on the OB Park unit. On 10/07/19 at 12:37 PM, Resident #94 had not received a tray. During an interview on 10/07/19 at 12:55 PM, Employee #199 was asked why another resident (Resident #104) had not received a tray. Employee #199 stated that the other resident (Resident #104) had been given a tray. During this interview, Employee #199 was asked if all residents now had their meals and trays delivered. Employee #199 stated that they had. The surveyor noted to Employee #199 that Resident #94 still had not received his tray. Employee #199 stated that she did not know that Resident #94 had not received a tray. Resident #94's tray was delivered on 10/07/19 at 1:02 PM. On 10/09/19 at 8:22 AM, an interview with the Administrator and the Director of Nursing (DON) did not reveal any further information. c) Resident #9 On 10/07/19 at 12:30 PM, resident meal delivery / tray pass began on the OB Park unit. On 10/07/19 at 12:38 PM, Resident #9 had not received a tray. During an interview on 10/07/19 at 12:55 PM, Employee #199 was asked why another resident (Resident #104) had not received a tray. Employee #199 stated that the other resident (Resident #104) had been given a tray. During this interview, Employee #199 was asked if all residents now had their meals and trays delivered. Employee #199 stated that they had. The surveyor noted to Employee #199 that Resident #9 still had not received his tray. Employee #199 stated that she did not know that Resident #9 had not received a tray. Resident #9's tray was delivered on 10/07/19 at 12:59 PM. On 10/09/19 at 8:22 AM, an interview with the Administrator and the Director of Nursing (DON) did not reveal any further information. d) Resident #177 During an observation of medication administration on 10/09/19 at 7:46 AM, Licensed Practical Nurse (LPN) # 185 was administration an injection of [MEDICATION NAME] 20 mg (used for the treatment for [REDACTED]. LPN #185 entered the room of Resident #185, she did not knock on the door, before entering. She asked Resident #185 where he wanted his injection. He said, in his normal spot. She opened the privacy curtain. Without closing the door or the privacy curtain, she pulled his shirt up exposing his abdomen, and administrated the medication. During an interview on 10/09/19 at 7:57 AM, LPN #185 was asked if she normally would have knocked on the door, closed the door and curtain before providing treatment? She stated, that she should have. On 10/10/19 at 9:30 AM, during an interview with Administrator and Director of Nursing, they were informed of the observations for Resident #177. They had no comments.", "filedate": "2020-09-01"}
{"rowid": 145, "facility_name": "HUNTINGTON HEALTH AND REHABILITATION CENTER", "facility_id": 515007, "address": "1720 17TH STREET", "city": "HUNTINGTON", "state": "WV", "zip": 25701, "inspection_date": "2019-10-10", "deficiency_tag": 578, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "RPKM11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview, the facility failed to ensure that each resident's Physician order [REDACTED]. This failed practice had the potential to affect all residents residing at the facility. Resident identifiers: #125, #139, #9, #95, #108, and #137. Facility census: 182. Findings included: a) Resident #125 Review of Resident #125's medical records found a POST form completed and signed by the attending physician on [DATE]. No signature and/or verbal consent documented on the POST form. Interview with the Director of Nursing (DON) on [DATE] at 2:00 pm, confirmed there was no resident/family signature on the POST form dated [DATE]. b) Resident #139 Review of Resident #139's medical records found a POST form completed and signed by the attending physician and verbal consent given on [DATE]. The POST form was inaccurately marked to attempt resuscitation/CPR and comfort measures. Interview with the Director of Nursing (DON) on [DATE] at 2:00 pm, confirmed the POST form dated [DATE] was inaccurately noted the resident should have been marked Do Not Resuscitate/DNR. c) Resident #137 Review of Resident #137's physician's orders [REDACTED].N. (Registered Nurse) may pronounce death - (MONTH) have IV fluids for trial period no longer than 3 days - No feeding tube. Review of Resident #137's medical records revealed a Physician order [REDACTED]. During an interview on [DATE] at 2:57 PM, the Director of Nursing and the District DIrector of Clinical Services were informed Resident #137's most recent POST form did not correspond with the current physician's orders [REDACTED]. On [DATE] at 4:03 PM, the administrator was notified of the situation. During an interview on [DATE] at 3:00 PM, the Director of Nursing stated the order had been corrected. d) Resident #108 During a review of Resident #108's medical record on [DATE] at 9:34 AM Resident #108's physician orders [REDACTED].#108's preferences for intravenous (IV) fluids or a feeding tube. However, Resident #108's physician's orders [REDACTED]. The above findings were discussed with the facility's Director of Nursing (DoN) as well as District Director of Clinical Services on [DATE] at 2:50 PM. The DoN acknowledged that Resident #108's POST form and orders did not match. No further information was provided prior to exit. e) Resident #9 On [DATE] at 8:36 AM, a record review of the resident's chart on the unit revealed that there was a Physician order [REDACTED]. The POST form is an advanced directive, indicating resident / resident representative's wishes. The POST form was signed by Resident #9's medical power of attorney (MPOA) / healthcare surrogate / resident representative on [DATE]. As of [DATE], Resident #9's POST form had not been signed by a physician. According to the POST form, Resident #9 was supposed to be a Do No Attempt Resuscitation (DNR), comfort measures, intravenous (IV) fluids for a trial period to be determined, and a feeding tube long term. Employee #199 verified that the POST form had not been signed by a physician. On [DATE] at 8:22 AM, the findings were discussed with the Administrator and the Director of Nursing (DON) and no further information was provided f) Resident #95 On [DATE] at 8:36 AM, a record review of the resident's chart on the unit revealed that there was a Physician order [REDACTED]. The POST form is an advanced directive, indicating resident / resident representative's wishes. The POST form was signed by Resident #95's medical power of attorney (MPOA) / healthcare surrogate / resident representative on [DATE]. As of [DATE], Resident #9's POST form had not been signed by a physician. According to the POST form, Resident #95 was supposed to be attempt Cardiopulmonary Resuscitation (CPR), full interventions, intravenous (IV) fluids for a trial period to be determined, and a feeding tube to be determined at time of need. Employee #199 verified that the POST form had not been signed by a physician. On [DATE] at 8:22 AM, the findings were discussed with the Administrator and the Director of Nursing (DON) and no further information was provided.", "filedate": "2020-09-01"}
{"rowid": 146, "facility_name": "HUNTINGTON HEALTH AND REHABILITATION CENTER", "facility_id": 515007, "address": "1720 17TH STREET", "city": "HUNTINGTON", "state": "WV", "zip": 25701, "inspection_date": "2019-10-10", "deficiency_tag": 584, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "RPKM11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and staff interview, the facility failed to provide a safe, sanitary, and homelike environment. Resident #9 had an order for [REDACTED]. Resident identifier: #9. Facility census: 182. Findings included: a) Resident #9 On 10/07/19 at 4:13 PM, during an observation of Resident #9's room, the fall mat located near the bathroom, was noted to have fluid underneath the entire length of the fall mat. Moreover, the fall mat located on the right side of Resident #9's bed had debris underneath the fall mat. The fall mat on the left side of Resident #9's bed had fluid underneath the fall mat, spanning the length of the mat. The floor underneath the fall mat was white, and discolored. On 10/07/19 at 4:15 PM, Employee #81, Unit Manger, entered Resident #9's room and observed the fluid underneath two fall mats and the debris underneath the third fall mat. Employee #81 stated that she would notify housekeeping. On 10/07/19 at 4:24 PM, the Director of Nursing (DON) and the District Director of Clinical Services were informed of the findings. On 10/09/19 at 2:06 PM, the findings were discussed with the Administrator and the DON and no further information was provided", "filedate": "2020-09-01"}
{"rowid": 147, "facility_name": "HUNTINGTON HEALTH AND REHABILITATION CENTER", "facility_id": 515007, "address": "1720 17TH STREET", "city": "HUNTINGTON", "state": "WV", "zip": 25701, "inspection_date": "2019-10-10", "deficiency_tag": 605, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "RPKM11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility failed to ensure all residents were free from chemical restraint for purposes of discipline or staff convenience for 2 out of 35 sampled residents. This failed practice had the potential to affect a limited number of residents. Identified Resident identifiers: #161, and #9. Facility census 182. Findings included: a) Resident #161 During a review of medical records for Resident #161 on 10/08/19 at 12:30 PM, revealed his care plan had the following intervention: --Resident #161 receives antipsychotic medication-- [MEDICATION NAME]-- for refusal of care/mood changes. This was initiated on 03/20/18. During an interview on 10/10/19 at 9:45 AM, Director of Nursing agreed, he should not be given a medication for refusal of care, and that it was his right to refuse showering/bathing. b) Resident #9 Review of the medical record revealed a current order, dated 08/05/19 for [MEDICATION NAME] 200 mg given at bedtime for refusal of care related to [MEDICAL CONDITION] disorder, recurrent, and unspecified. Review of the care plan found the resident refuses to wear his identification bracelet. The care plan also noted that the resident would refuse incontinent care. The care plan referenced the use of an anti-anxiety medication and said the resident refused care related to anxiety but the specific care refused was not documented. On 10/10/19 at 11:26 AM, the findings were discussed with the Administrator and the Director of Nursing (DON). No further information was provided to indicated what type of care the resident refused, prior to the survey conclusion. There was no evidence provided to verify the resident refused any type of care.", "filedate": "2020-09-01"}
{"rowid": 148, "facility_name": "HUNTINGTON HEALTH AND REHABILITATION CENTER", "facility_id": 515007, "address": "1720 17TH STREET", "city": "HUNTINGTON", "state": "WV", "zip": 25701, "inspection_date": "2019-10-10", "deficiency_tag": 623, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "RPKM11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical review and staff interview, the facility failed to notify the Ombudsman when Residents #94, #119, and #95 were transferred to a local hospital. This was true for two (2) of three (3) residents reviewed for hospital transfers and one (1) random opportunity for discovery. Resident identifiers: #94, #119, and #95. Facility census 182. Findings included: a) Resident #94 Record review on 10/07/19 at 8:19 PM, revealed the resident was discharged to the hospital on [DATE] at 11:13 AM, due to abnormal labs. b) Resident #119 Record review on 10/07/19 at 8:19 PM, revealed the resident was discharged to the hospital on [DATE] at 6:45 PM, due to abnormal and critical lab work. c) Resident #95 Record review on 10/08/19 at 9:04 AM, revealed the resident was discharged to the hospital on [DATE] at 7:25 PM, per resident and family request. d) Interviews On 10/08/19 at 1:20 PM, the Administrator stated the Social Worker completes the notifications to the Ombudsman regarding facility-initiated discharges. During an interview on 10/08/19 at 1:21 PM, Employee #126, Social Services Manager, stated the facility sends the discharge notifications to the Ombudsman every time a resident leaves the facility. Employee #126 was asked to provide the Ombudsman notification for Resident #94, #119, and #95 when each resident was transferred to a local hospital. Employee #126 stated that the facility does not notify the Ombudsman when a resident is discharged to the hospital. The facility only notifies the Ombudsman when the resident discharges to home or is transferred to another facility. On 10/09/19 at 8:22 AM, the findings were discussed with the Administrator and the Director of Nursing (DON).", "filedate": "2020-09-01"}
{"rowid": 149, "facility_name": "HUNTINGTON HEALTH AND REHABILITATION CENTER", "facility_id": 515007, "address": "1720 17TH STREET", "city": "HUNTINGTON", "state": "WV", "zip": 25701, "inspection_date": "2019-10-10", "deficiency_tag": 625, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "RPKM11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical review and staff interview, the facility failed to provide the resident/resident representative notice of the bed hold policy when Resident #95 was transferred to a local hospital. This was true for one (1) of three (3) residents reviewed for hospital transfers. Resident identifier: #95. Facility census 182. Findings include: a) Resident #95 During a medical record review, on 10/08/19, it was discovered that Resident #95 was transferred to a local hospital on [DATE] at 7:25 PM. There was no evidence the resident or the residents representative received a copy of the bed hold policy at the time of transfer. In addition there was no documentation in the medical record of contacting the resident / resident representative regarding the bed hold policy. During a record review on 10/08/19 at 1:47 PM, a copy of the bed hold notice could not be located on Resident #95's chart on the unit or in the thinned medical record. On 10/08/19 at 3:57 PM, the chart was given to the Director of Nursing (DON) for review to see if the bed hold notice could be located. The DON was unable to locate the bed hold notice. During an interview with the DON on 10/08/19 at 4:11 PM, the DON stated that she could not find the transfer form with the stamp that indicated that the notice of bed hold policy was provided upon discharge. The findings were discussed with the DON and Administrator on 10/09/19 at 8:22 AM and no further information was provided.", "filedate": "2020-09-01"}
{"rowid": 150, "facility_name": "HUNTINGTON HEALTH AND REHABILITATION CENTER", "facility_id": 515007, "address": "1720 17TH STREET", "city": "HUNTINGTON", "state": "WV", "zip": 25701, "inspection_date": "2019-10-10", "deficiency_tag": 641, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "RPKM11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview, the facility failed to ensure accurately completed assessment for Resident #151 reflecting urinary catheterization for 1 of 35 sampled residents. This practice had the potential to affect a limited number of residents. Resident identifiers: R#151 Facility census: 181. Findings included: a) Resident #151 Review of records, on 10/08/19 at 12:28 PM, revealed Resident (R#151) was admitted on [DATE]. Review of the 5-day minimum data set (MDS) with an assessment reference date (ARD) 09/17/19 revealed the MDS was marked indicating an indwelling catheter and intermittent catheterization. Review of orders revealed an order Straight Cath resident if greater than 300 ml (milliliter) residual leave catheter in and follow up with provider . Physician was notified R#151 had 500 ml of output when catheter was initially inserted, an order was given to leave as an indwelling catheter. According to the National Library of Medicine, 'intermittent catheterization' is the insertion and removal of a catheter several times a day to empty the bladder. This type of catheterization is used to drain urine from a bladder that is not emptying adequately. Intermittent catheters are only used at certain times and they are removed right after the urine is drained. On 10/09/19 at 09:54 AM, an interview and review of records with Resident Care Management Director (RCMD#165) responsible for developing MDSs, revealed R#151's 5-day MDS was in error. RCMD#165 verified R#151's 5-day MDS should only have been marked indwelling catheter. Indwelling catheter due to when intermittent catheterization was first attempted the resident had 500 cc of urine drained and the catheter was not removed but remained indwelling and was attached to a closed drainage system as ordered.", "filedate": "2020-09-01"}
{"rowid": 151, "facility_name": "HUNTINGTON HEALTH AND REHABILITATION CENTER", "facility_id": 515007, "address": "1720 17TH STREET", "city": "HUNTINGTON", "state": "WV", "zip": 25701, "inspection_date": "2019-10-10", "deficiency_tag": 657, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "RPKM11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview the facility failed to revise care plans regarding falls, behaviors, and Total [MEDICATION NAME] Nutrition (TPN). This was true for two (2) out of thirty-five (35) resident's care plans reviewed. This failed practice had the potential to affect a limited number of residents. Resident identifiers: R#116 and R#94. Facility census: 181. Findings included: a) Resident (R#116) 1. Falls Review of resident (R#116)'s recent annual minimum data set (MDS) with an assessment reference date (ARD) 09/06/19, on 10/08/19 at 03:53 PM, revealed the following. The resident's Brief Interview for Mental Status (BIMS) score is 3 indicating the resident has a severe cognitive impairment. The resident did not have any behaviors during the 7 day look back period. R#116 needs extensive assistance with all activities of daily living and has range of motion impairments on both sides of his upper and lower extremities. The resident has an indwelling catheter and is continent of bowels. Some pertinent [DIAGNOSES REDACTED]. The resident takes Antipsychotic medication daily. The resident has history of falls and currently participates in occupational therapy services. Review of records, on 10/08/19 at 04:23 PM, revealed the resident had an unwitnessed fall in the courtyard on 08/19/19. The resident fell out of his wheelchair bending forward to retrieve an item off the ground. The resident suffered an abrasion above the right eye on 08/19/19. Approximately a month later, on 09/12/19, the resident again fell out of wheelchair in courtyard reaching forward to pick something up off the ground, causing an abrasion to the back of his left hand's knuckle area. Both times the injured areas were appropriately cleaned and treated; vital signs and neuro checks were completed; and proper notifications were made. On 10/09/19 at 10:29 AM, an interview with Registered Nurse (RN#96) revealed at every morning meeting a post fall review from the day before is completed. If a fall is unwitnessed or if the resident hits their head, then a physical therapy referral is made for an evaluation and neuro checks are done for 3 days after the fall. Records showed an interdisciplinary team (IDT) meeting note dated 8/20/19, was held to discuss the fall occurring on 8/19/19. The note included the following Intervention: hey therapy (physical therapy referral), neuro-checks, skin treatment/first aid, provider eval with an order for [REDACTED]. Review of R#116's care plan, on 10/09/19 at 10:56 AM, revealed only one revision concerning the fall was made to the care plan after the 1st fall out of the wheelchair. The revision was made on 08/22/19. The revision stated, to have reacher at bedside. A reacher is a reaching extension tool used for grasping items in hard-to-reach places without having to bend over. An interview with RN#96, on 10/09/19 at 11:08 AM, revealed RN#96 confirmed the care plan was not revised appropriately. RN#96 said, The resident did not fall out of the bed, but both times out of his wheelchair, reaching for things on the ground. The care plan should not have limited the reacher to be only at bedside, so it would be available when or where he needed it. On 10/09/19 at 01:12 PM, an interview and review of records with Resident Care Management Director (RCMD#165) responsible for developing resident's MDS and care plans, revealed R#116 care plan was not revised as it should have been, to address the issue of the resident falling out of his wheel chair due to reaching for items on the ground. Also, the care plan was not revised with any new or different interventions when the resident fell out of the wheelchair the second time while reaching for items on the ground. 2. Resident (R#116) Behavioral needs Review of resident (R#116)'s recent annual minimum data set (MDS) with an assessment reference date (ARD) 09/06/19, on 10/08/19 at 03:53 PM, revealed the following. The resident's Brief Interview for Mental Status (BIMS) score is 3 indicating the resident has a severe cognitive impairment. The resident did not have any behaviors during the 7 day look back period. R#116 needs extensive assistance with all activities of daily living and has range of motion impairments on both sides of his upper and lower extremities. The resident has an indwelling catheter and is continent of bowels. Some pertinent [DIAGNOSES REDACTED]. The resident takes Antipsychotic medication daily and was admitted to the facility on [DATE]. Review of records showed an order for [REDACTED].#116 refused care. Review of the care plan revealed a care area receives antipsychotic medication [MEDICATION NAME] d/t refusal of care r/t [MEDICAL CONDITION]. The care plan did not reveal a care focus area concerning refusing care or any other interventions to address refusing care, such as encouraging, prompting, cueing, or redirecting. Review of the (MONTH) and (MONTH) 2019 medication administration records (MARs) revealed Observation: Antipsychotic Med: Observe for behavior: refusal of care & doc. #of episodes (and document number of episodes). Observe for side effects: (listed side effects) Document 'Y' if resident is free of side effects. 'N' if the resident is not free of side effects. If 'N' document SE (side effects)in the progress notes every shift. Neither month documented the resident refused care. The MAR indicated [REDACTED]. Observations made by Surveyor # and Surveyor # during the initial dining tour revealed R#116 eating his lunch with his face down in his plate using his mouth to eat out of his plate without the use of any eating utensils or his fingers. On 10/09/19 at 10: 44 AM, an interview with Registered Nurse (RN#96) revealed R#116 has behaviors and has a [DIAGNOSES REDACTED].#96 described the resident has verbal outburst; is easily agitated; and has unusual mannerisms like the way he eats with his mouth in his plate. When asked where staff monitors and documents these behaviors, RN#96 said on the MAR (medication administration record) with the [MEDICAL CONDITION] medication. RN#96 denied there was any other behavior monitoring sheet to track identified behaviors other than the MAR. On 10/09/19 at 12:53 PM resident was observed in dining room without participating in lunch. The resident stated he was going to wait until dinner and did not want lunch now. Nursing Assistant Mentor (NA#54) was monitoring the dining room. An interview with Nursing Assistant Mentor (NA#54), who helps train newly hired NAs, revealed she often observes R#116 using unusual eating habits at meals. NA#54 stated she has worked at the facility a few years prior to R#116 being admitted to the facility. NA#54 said since R#116 has been at the facility, she has often seen R#116 placing his face in his plate when eating, she said, He usually does. NA#54 stated, It's like, he likes to sleep in it. If anyone tries to correct him, he will go off. This surveyor asked if R#116 had ever fallen asleep in his food, NA#54 denied ever seeing him sleeping in his plate, but said, It just looks like it sometimes. When asked, How would a newly employeed NA know about his specific behaviors and how they should handle them? NA#54 said grinning, If they try to correct him, they will get an ear full. They should follow the Kardex, it comes from the care plan. This surveyor asked, Is his eating behavior and other behaviors addressed in the care plan? NA#54 replied, I would like to think so. It should be addressed in it. When asked what NAs are trained to do if the resident has an outburst or is agitated, NA#54 replied, They should redirect him and use a calming voice. They should just follow the care plan. On 10/09/19 at 01:12 PM, an interview and review of records with Resident Care Management Director (RCMD#165) responsible for developing MDSs and care plans, revealed R#116 care plan was not revised to monitor or address his unusual eating habit or different behaviors unique to R#116. Review of care plan revealed a focus area, (Resident's name) is verbally aggressive at times and will curse and yell. The 3 interventions noted in the care plan were Administer medications as ordered. Observe/document for side effects and effectiveness.; Give the resident as many choices as possible about care and activities.; and Psychiatric/Psychogeriatric consult as indicated. There was no guidance to staff on individualized specific strategies that R#116 responds to or works well for the resident. RCMD#165 agreed the care plan needed to be revised to include more individualized and person-centered strategies to address the resident's specific behaviors. b) Resident #94 During a record review, Resident #94's care plan noted the resident received total paranteral nutrition (TPN). TPN is an intravenous (IV) fluid that attempts to provide all the body's need for nutrition without using the gastrointestinal (GI) tract. Review of Residents #94's care plan found a focus/problem: [NAME] will self disconnect TPN from catheter. The goal associated with this problem: [NAME] will have fewer episodes of listed behaviors by review date. Interventions included: -- Allow choices within individual's decision making abilities. -- Anticipate and meet the resident's needs. Focus/problem: [NAME] has a potential fluid deficit r/t (related to) need for TPN. The goal associated with this problem: [NAME] will be free of symptoms of dehydration and maintain moist mucous membranes, good skin turgor. Interventions included: -- Ensure the resident has access to fluids of choice whenever possible. During an interview on 10/09/19 at 10:48 AM, Employee #165, Care Management Minimum Data Set (MDS) Director, confirmed the resident no longers receives TPN. Employee #165 stated that the care plan had not been updated since the TPN had been discontinued. On 10/09/19 at 11:06 AM, the findings were discussed with the Administrator, the Director of Nursing (DON), and the District Director of Clinical Services.", "filedate": "2020-09-01"}
{"rowid": 152, "facility_name": "HUNTINGTON HEALTH AND REHABILITATION CENTER", "facility_id": 515007, "address": "1720 17TH STREET", "city": "HUNTINGTON", "state": "WV", "zip": 25701, "inspection_date": "2019-10-10", "deficiency_tag": 684, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "RPKM11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on resident interview, staff interview, policy review, and medical record review, the facility failed to ensure each resident received medication as physicians orders; which includes the administration of medication timely for five (5) out of thirty-five (35) sampled residents. This failed practice had the potential to affect more than a limited number of residents residing at the facility. Resident identifiers: #139, #182, #130, #37 and #432. Facility census: 182. Findings included: a) Resident #139 Medical record review for Resident #139, revealed he was admitted to the facility on [DATE]. [DIAGNOSES REDACTED]. Resident is unresponsive and requires a gastrostomy feeding tube for all nutritional needs and [MEDICAL CONDITION] in place secondary to [MEDICAL CONDITION]. Resident #139 is to receive nothing by mouth (po) secondary to dysphagia and aspiration. Further review of Resident #139's medical records found an order for [REDACTED]. Review of the Controlled Medication Utilization Record for 09/29/19 at 1:00 am through 10/01/19 at 5:00 pm, found Resident #139 received [MEDICATION NAME] 20 mg per 1ml; which equals 20 mgs by mouth (po) every hour. Resident #139 received fifty-one (51) doses of 20 mgs of [MEDICATION NAME] instead of the 4mgs and the resident received the [MEDICATION NAME] po instead of SL as ordered. Interview with attending physician on 10/09/19 at 5:00 pm revealed the [MEDICATION NAME] should be given SL not po and the dosage should be 20mg per 1 ml - give 0.25 ml which equals 4 mg every hour as needed for pain. Clarification orders noted by the attending physician to give SL not po due to aspiration. Interview on 10/10/19 at 10:00 am with the Director of Nursing (DON), found the resident received the wrong dosage of [MEDICATION NAME] on the above dates. Additionally, she confirmed the [MEDICATION NAME] was to be given SL but was documented it was administered po. Review of Resident #139's medical record found an order for [REDACTED]. Order effective 08/15/19. Review of the August, (MONTH) and (MONTH) 2019, Medication Administration Record [REDACTED]. Interview with the DON on 10/10/19 at 10:00 am, confirmed the resident's blood pressure and heart rate was not taken and documented prior to the administration of the [MEDICATION NAME]. b) Resident #182 Review of Resident #182's medical record found an order for [REDACTED]. Order effective 06/17/19. Review of the June, July, and (MONTH) 2019, Medication Administration Record [REDACTED]. Interview with the DON on 10/10/19 at 10:00 am, confirmed the resident's heart rate was not taken and documented prior to the administration of the [MEDICATION NAME]. c) Resident #130 During a review of the Medical Administration Record (MAR), it revealed, was ordered: [MEDICATION NAME] Powder 0 Units/Grams, to be applied every shift to the groin. (This is an antibiotic which is used for both fungal and/or yeast infection). It is recommended to be given two (2) three (3) times a day and given at the same time daily. The facility nurses are scheduled from 7:00 AM, to 7:00 PM, and 7:00 PM, to 7:00 AM. Therefore, making the medication due every 12 hours. Below are the times it was administrated: On 10/01/19 due at 7:00 AM- time given-1:58 PM. The next dose due 7:00 PM-time given- 7:25 PM. Making the time between the first dose and the second dose, five (5) hours and 25 minutes. On 10/05/19 due at 7:00 AM- time given-5:10 PM, the second dose due at 7:00 PM-time given- 8:19 PM. Making the time between the first and second dose, three (3) hours and 9 minutes. On 10/06/19 due at 7:00 AM-time given-5:58 PM, the second dose due at 7:00 PM-time given-8:20 PM. Making the time between the first dose and second dose, one (1) hour and 22 minutes. During an interview on 10/09/19 at 12:30 PM, Director of Nursing about late medication administration and being given too close together to the next dose. She said, it can be given anytime during their shift. She was asked if she thought that one (1) hour to five (5) hour was to close together between doses was beneficial? She said, that she would look into it. d) Resident #37 During review of the facility Medication Administration Record [REDACTED] On 10/01/19 the following medications were scheduled to be administrated at 9:00 AM and was documented as given at 11:07 AM. One (1) hour and seven (7) minutes beyond the allotted time: -[MEDICATION NAME] 40 milligrams (mg) once a day (is a diuretic to treat [MEDICAL CONDITION] for congested heart failure) -[MEDICATION NAME] Bisulfate 75 mg once daily (for congested heart failure). -Protein Liquid 30cc twice daily (for wound healing) -[MEDICATION NAME] 25 mg once daily (for hypertension). -Magnesium Oxide 400 mg once daily (supplement) -[MEDICATION NAME] XR 75 mg once daily (for mood disorder). -Bactrim DS 800-160 mg, twice a day (for acute hematogenous osteo[DIAGNOSES REDACTED]-bone infection-) -Acidophilus one (1) capsule twice a day (antibiotic) -[MEDICATION NAME] 325 (65 FE) once a day (for [MEDICAL CONDITION]) On 10/01/19 the following medications were scheduled to be administrated at 9:00 PM, and was documented as given at 11:12 PM, resulting in the medications being given one (1) hour and 17 minutes too late: -Bactrim DS 800/160 mg twice a day (Antibiotic) -Acidophilus twice a day (antibiotic) -[MEDICATION NAME] Solution Pen-injector 15 units at bedtime (used to control diabetes) On 10/02/19 Humalog five (5) units (for treatment of [REDACTED]. The next dose was scheduled for at 12:00 PM, and was documented as being administrated at 1:22 PM, this resulted in instead of of the administration time having four (4) hours between the two (2) scheduled doses, it was only -one (1) hour and 17 minutes- between them. Resident #37's glucose levels on this day were as follows: -6:30 AM, 148 -11:30 AM, 270 -4:30 PM, 94 On 10/02/19 the following medications were scheduled to be administrated at 9:00 AM and was documented as given at 12:05 AM. Two (2) hour and five (5) minutes late. -[MEDICATION NAME] 40 milligrams (mg) once a day (is a diuretic to treat [MEDICAL CONDITION] for congested heart failure) -[MEDICATION NAME] Bisulfate 75 mg once daily (for congested heart failure). -Protein Liquid 30cc twice daily (for wound healing) -[MEDICATION NAME] 25 mg once daily (for hypertension). -Magnesium Oxide 400 mg once daily (supplement) -[MEDICATION NAME] XR 75 mg once daily (for mood disorder). -Bactrim DS 800-160 mg, twice a day (for acute hematogenous osteo[DIAGNOSES REDACTED]-bone infection-) -Acidophilus one (1) capsule twice a day (antibiotic) -[MEDICATION NAME] 325 (65 FE) once a day (for [MEDICAL CONDITION]) On 10/02/19 the following medications were scheduled ti be administrated at 5:00 PM, and was documented as given at 8:36 PM, meaning it was received three (3) hour and 36 minutes late. -Tigecycline 50 mg intravenously two times a day, (for an acute hematogenous osteo[DIAGNOSES REDACTED]). On 10/02/19 the following medications were scheduled ti be administrated at 9:00 PM, and was documented as given at 11:43 PM, meaning it was received one (1) hour and 46 minutes late. -Bactrim DS 800/160 mg twice a day (Antibiotic) -Acidophilus twice a day (antibiotic) -[MEDICATION NAME] Solution Pen-injector 15 units at bedtime (used to control diabetes). On 10/05/19, Humalog five (5) units (for treatment of [REDACTED]. On 10/06/19 the following medications were scheduled to be administrated at 9:00 AM and was documented as given at 11:56 AM. one (1) hour and 56 minutes late. -[MEDICATION NAME] 40 milligrams (mg) once a day (is a diuretic to treat [MEDICAL CONDITION] for congested heart failure) -[MEDICATION NAME] Bisulfate 75 mg once daily (for congested heart failure). -Protein Liquid 30cc twice daily (for wound healing) -[MEDICATION NAME] 25 mg once daily (for hypertension). -Magnesium Oxide 400 mg once daily (supplement) -[MEDICATION NAME] XR 75 mg once daily (for mood disorder). -Bactrim DS 800-160 mg, twice a day (for acute hematogenous osteo[DIAGNOSES REDACTED]-bone infection-) -Acidophilus one (1) capsule twice a day (antibiotic) -[MEDICATION NAME] 325 (65 FE) once a day (for [MEDICAL CONDITION]) During an interview on 10/09/19 at 12:30 PM, Director of Nursing (DoN), was informed about late medication administration and the insulin being given too close. She said, I know it's not right, but I believe the nurses did given the medication on time, but did not document the time until later. She agreed that the nurses can manually enter a time given, however the electronic system records the actual time it was documented, and that time cannot be altered. e) Resident #432 During an interview on 10/07/19 at 11:21 AM, Resident #432 stated, she had to wait eight (8) hours on her first night here for pain medications. She went on to say, waits more than an hour every time she asks for her pain medication. Resident # 432 had knee surgery on 10/01/19 and was admitted to the facility on [DATE]. She was tearful during the interview, and she said, she had to stop her physical therapy just now, because she was in so much pain. The Physical Therapist Assistant #202 was in Resident #432's room at the beginning of the interview. He told her to let the physical therapy department know when she gets her pain under control, and they will try again. She stated, that she was supposed to get the pain medications before she goes to physical therapy. On this day that Resident #432 was in pain she received [MEDICATION NAME] 10-325 mg at 11:12AM. Her last dose was on 10/06/19 at 2:10 PM, which shows she did not receive any pain medication for 21 hours. During review of the facility Medication Administration Record [REDACTED]. On 10/04/19 Resident #432 was ordered [MEDICATION NAME] 10-325 mg every four (4) hours as needed for pain. Licensed Practical Nurse (LPN) #43 recorded the administration time this at 8:25 PM, however the electronic audit record shows this medication was administrated on 10/05/19 at 12:06 AM. Which is a four-hour (4) difference in time. On 10/04/19 the following medications were scheduled for 9:00 PM, and the recorded time documented was 11:46 PM. This was one (1) hour and 46 minutes late: -[MEDICATION NAME] 150 mg (for [MEDICAL CONDITION]) -[MEDICATION NAME] Sodium 100 mg (for constipation) -Requip 3 mg (for restless leg syndrome) The following medications were scheduled for 9:00 PM, and the recorded time documented was 12:13 AM. This was two (2) hours and 13 minutes late. -[MEDICATION NAME] 5 mg (for diabetes) - [MEDICATION NAME] 40 mg ([MEDICAL CONDITION]) On 10/06/19 [MEDICATION NAME] 10-325 mg LPN #167 put 2:00 AM, as the time administration, the electronic audit record shows this medication was administrated at 8:24 AM. This was a seven (7) hour and 24-minute difference in time. This same medication was recorded as being administrated at 8:27 AM. Which was three (3) minutes after the last time this medication was given. [MEDICATION NAME] 10-325 mg (is an opioid pain medication) and is commended to not to be given in a higher dose than 10-325 mg. On 10/06/19 [MEDICATION NAME] 10-325 mg, LPN #37 documented she administrated this medication at 10:09 AM, the electronic audit records show this medication was documented as given at 2:09 PM and again at 2:10 PM. On 10/07/19 the following medication were scheduled administration time was 9:00 AM and was documented on the electronic audit record shows the medication were administrated at 12:42 PM. This resulted in the medications being two (2) hours and 42 minutes late. -[MEDICATION NAME] Solution Pen-injector 1.8 milliliters daily (for diabetic control of blood glucose) -[MEDICATION NAME] Sodium injection 40 mg (use following a surgical joint replacement to prevent blood clots) -[MEDICATION NAME] 50 mg daily (treatment for [REDACTED].>-[MEDICATION NAME] 5 mg twice daily (treatment for [REDACTED].>-[MEDICATION NAME] 150 mg twice daily (treatment for [REDACTED].>-Duloxetine 30 mg daily (treatment for [REDACTED].>-[MEDICATION NAME] 300 mg daily (treatment for [REDACTED].>-[MEDICATION NAME] 40 mg twice daily (for [MEDICAL CONDITION]) -[MEDICATION NAME] XL 25 mg daily (for hypertension) -Aspirin 325 mg daily (used after joint replacement) On 10/07/19 the following medication were scheduled administration time was 1:00 PM and was documented on the electronic audit record shows the medication were administrated at 3:19 PM. This resulted in the the medications being two (2) hours and 19 minutes late, by LPN #50: -[MEDICATION NAME] 40 mg (for hypertension) During an interview on 10/09/19 at 12:30 PM, Director of Nursing (DoN), was informed about late medication administration and the insulin being given too close. She said, I know it's not right, but I believe the nurses did given the medication on time but did not document the time until later. She agreed that the nurses can manually enter a time given, however the electronic system records the actual time it was documented, and that time cannot be altered.", "filedate": "2020-09-01"}
{"rowid": 153, "facility_name": "HUNTINGTON HEALTH AND REHABILITATION CENTER", "facility_id": 515007, "address": "1720 17TH STREET", "city": "HUNTINGTON", "state": "WV", "zip": 25701, "inspection_date": "2019-10-10", "deficiency_tag": 689, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "RPKM11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility failed to provide an environment free from accident hazards over which the facility had control. This was true for 1 of 5 residents reviewed for care area of accidents. This practice had the potential to affect a limited number of residents. Resident identifiers: R#116. Facility census: 181 Findings included: a) Resident #116 Review of resident (R#116)'s recent annual minimum data set (MDS) with an assessment reference date (ARD) 09/06/19, on 10/08/19 at 03:53 PM, revealed the following. The resident's Brief Interview for Mental Status (BIMS) score is 3 indicating the resident has a severe cognitive impairment. R#116 needs extensive assistance with all activities of daily living and has range of motion impairments on both sides of his upper and lower extremities. The resident has an indwelling catheter and is continent of bowels. Some pertinent [DIAGNOSES REDACTED]. The resident takes Antipsychotic medication daily. The resident has history of falls and currently participates in occupational therapy services. Review of records, on 10/08/19 at 04:23 PM, revealed the resident had an unwitnessed fall in the courtyard on 08/19/19. The resident fell out of his wheelchair bending forward to retrieve an item off the ground. The resident suffered an abrasion above the right eye on 08/19/19. Approximately a month later, on 09/12/19, the resident again fell out of wheelchair in courtyard reaching forward to pick something up off the ground, causing an abrasion to the back of his left hand's knuckle area. On 10/09/19 at 10:29 AM, an interview with Registered Nurse (RN#96) revealed at every morning meeting a post fall review from the day before is completed. If a fall is unwitnessed or if the resident hits their head, then a physical therapy referral is made for an evaluation and neuro checks are done for 3 days after the fall. Records showed an interdisciplinary team (IDT) meeting note dated 8/20/19, was held to discuss the fall occurring on 8/19/19. The note included the following Intervention: hey therapy (physical therapy referral), neuro-checks, skin treatment/first aid, provider eval with an order for [REDACTED]. Review of records showed a revision was made to R#116's care plan after the first fall but no revisions were made the second time the resident had a similar fall. R#116's care plan, on 10/09/19 at 10:56 AM, revealed the facility's intervention was to provide the resident with a reacher at bedside. A reacher is a reaching extension tool used for grasping items in hard-to-reach places without having to bend over. This intervention would be helpful to the resident with picking up items without the resident stretching out and toppling forward, however the resident was not toppling forward out of his bed, but out of his wheelchair. There was no evidence the facility assessed or reevaluated the effectiveness of the intervention of a reacher bedside after the resident had the second similar fall. There was no evidence the facility monitored or encouraged the resident to use the reacher. An interview with RN#96, on 10/09/19 at 11:08 AM, revealed RN#96 confirmed there was no evidence the facility assessed or reevaluated the effectiveness of the intervention of a reacher bedside. RN#96 said, The resident did not fall out of the bed, but both times out of his wheelchair, reaching for things on the ground. RN#96 reviewed records and confirmed there was no evidence the facility monitored or encouraged the resident to use the reacher, nor were there any other different interventions put into place after the second fall.", "filedate": "2020-09-01"}
{"rowid": 154, "facility_name": "HUNTINGTON HEALTH AND REHABILITATION CENTER", "facility_id": 515007, "address": "1720 17TH STREET", "city": "HUNTINGTON", "state": "WV", "zip": 25701, "inspection_date": "2019-10-10", "deficiency_tag": 698, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "RPKM11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Bsed on record review and staff interview, the facility failed to ensure the [MEDICAL TREATMENT] Communication Record post [MEDICAL TREATMENT] section was completed for Resident #151 each time he went to [MEDICAL TREATMENT]. The facility failed to follow up with the [MEDICAL TREATMENT] center regarding pre and post weights, and failed to follow the medication recommendations from the [MEDICAL TREATMENT] center. This practice had the potential to affect a limited number of residents. Resident identifiers: R#151. Facility census: 181 Findings included: a) Resident #151 Resident (R#151) was transferred and admitted to the facility on [DATE], after the resident had a failed kidney transplant. Some pertinent [DIAGNOSES REDACTED]. The resident was admitted to current [MEDICAL TREATMENT] services on 09/04/19. Interview with Licensed Practical Nurse (LPN#84), on 10/09/19 at 01:55 PM, revealed the facility maintains a communication record with the [MEDICAL TREATMENT] center in a [MEDICAL TREATMENT] communication book. The facility keeps forms in the book that requires pertinent information to be recorded by [MEDICAL TREATMENT] staff and facility nursing staff. Review of the resident's [MEDICAL TREATMENT] communications book with LPN#84 revealed the post [MEDICAL TREATMENT] section for R#151 was not completed by [MEDICAL TREATMENT] staff each time R#151 went to [MEDICAL TREATMENT]. The facility staff failed to follow up and obtain the pre and post weights from the [MEDICAL TREATMENT] center on 09/06/19, and post weights on 09/11/19. The facility staff failed to follow up or discontinue medications the [MEDICAL TREATMENT] center identified on 09/06/19 and requested the resident stop taking. ` The [MEDICAL TREATMENT] communication sheet dated 09/06/19 revealed no pre or post [MEDICAL TREATMENT] weights were recorded. In the 'Recommendation/Follow-up' section of the communication sheet dated 09/06/19 where orders from the [MEDICAL TREATMENT] center are written, the [MEDICAL TREATMENT] center specified Stop Calcium Acetate, Stop [MEDICATION NAME], and Please continue [MEDICATION NAME]. Review of records showed, since R#151's admission to the facility, the resident was not taking [MEDICATION NAME] or [MEDICATION NAME]. The resident was taking [MEDICATION NAME] suspension related to kidney transplant status, which is a [MEDICATION NAME] for organ rejection. The resident was taking Calcium Acetate 1334 mg daily and continued to take it until surveyor intervention. LPN#84 confirmed staff should have contacted the [MEDICAL TREATMENT] center and obtained weights, followed the [MEDICAL TREATMENT] center recommendations, and clarified the resident's medications. Review of orders revealed Calcium Acetate Capsule 667 mg (milligrams). Give 2 capsule by mouth with meals every Mon, Wed, Fri related to End Stage [MEDICAL CONDITION] (Time on [MEDICAL TREATMENT] days) 2 capsules to equal 1334 mg; and Calcium Acetate Capsule 667 mg. Give 2 capsule by mouth with meals every Tue, Thu, Sat, Sun related to End Stage [MEDICAL CONDITION] (Timed for non-[MEDICAL TREATMENT] days) 2 capsules to equal 1334 mg. Review of R#151's Medication Administration Record [REDACTED]. The resident received Calcium Acetate (a base binder) for thirty-three (33) more days after it should have been discontinued. On 10/10/19 at 11:53 AM, a phone interview with the [MEDICAL TREATMENT] Center Clinic Manager revealed R#151 was admitted to [MEDICAL TREATMENT] service on 09/04/19 and labs were taken at that time showing the resident's calcium was high and phosphorus level was low. Calcium and phosphorus are essential minerals found in the bone, blood and soft tissue of the body and have a role in numerous body functions. The [MEDICAL TREATMENT] Center Clinic Manager stated their doctor does not like to use a calcium base binder (binds to phosphorus to remove phosphorus from the body) and since the resident's phosphorus was already low. The [MEDICAL TREATMENT] Center Clinic Manager voiced concern that by R#151 continuing to take the binder it could make R#151's phosphorus levels even lower. The [MEDICAL TREATMENT] Center Clinic Manager said the facility had contacted them yesterday and notified them the resident had continued to receive the Calcium Acetate, so labs were drawn, and they were awaiting the results. (Surveyor was notified by the [MEDICAL TREATMENT] Center Clinic Manager the last lab results were within normal limits.)", "filedate": "2020-09-01"}
{"rowid": 155, "facility_name": "HUNTINGTON HEALTH AND REHABILITATION CENTER", "facility_id": 515007, "address": "1720 17TH STREET", "city": "HUNTINGTON", "state": "WV", "zip": 25701, "inspection_date": "2019-10-10", "deficiency_tag": 711, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "RPKM11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview, the facility failed to ensure the physician signed and dated all orders. This was random opportunity for discovery. This failed practice had the potential to affect more than a limited number of residents. Resident identifier: #94, #9, and #95. Facility census 182. Findings included: a) Resident #94 On 10/08/19 at 2:59 PM, during a review of the thinned medical record for a bed hold notification, the surveyor discovered several physician orders [REDACTED]. On 10/08/19 at 3:50 PM, Employee #73, Health Information Coordinator, confirmed that the physician orders [REDACTED].#73 was asked to copy all orders that were flagged. The following orders had not been signed by the physician: --03/21/19 16:02 - [MEDICATION NAME] HCI Tablet 20 MG Give 1 tablet by mouth every 8 hours for abdominal pain. discontinue --03/21/19 16:02 - [MEDICATION NAME] HCI Capsule 10 MG Give 1 capsule by mouth every 6 hours as needed for abdominal pain related to postsurgical malabsorption, not elsewhere classified --03/19/19 05:25 - Apply nourishing skin cream to bilateral lower extremities including feet, every shift for dry skin. discontinue --03/19/19 05:27 - Cleanse bilateral buttocks and coccyx with warm soapy water, rinse, pay dry, apply inzo barrier cream topically every shift for increased risk of skin breakdown and as needed. --03/19/19 05:27 - Cleanse bilateral buttocks, coccyx and sacrum with warm soapy water, rinse, pat dry, apply [MEDICATION NAME] cream topically as needed AND every shift for increased risk of skin breakdown. discontinue --03/19/19 05:28 - Cleanse wound to sacrum with warm soapy water, rinse, pat dry, apply inzo barrier cream topically. Monitor skin surrounding area and report abnormalities to provider. Document in nurses notes if indicated, as needed for wound healing and every shift for wound healing. --03/19/19 05:30 - Cleanse wound to sacrum with warm soapy water, rinse, pat dry, apply thin layer [MEDICATION NAME] paste topically. Monitor skin surrounding area and report abnormalities to provider. Document in nurses notes if indicated, as needed for wound healing and every shift for wound healing. --03/19/19 05:41 - Cleanse wound to sacrum with warm soapy water, rinse, pat dry, apply inzo barrier cream topically. Monitor skin surrounding area and report abnormalities to provider. Document in nurses notes if indicated, as needed for wound healing AND every shift for wound healing. discontinue --03/19/19 06:43 - ROHO cushion to wheelchair at all times, verify placement every shift for wound healing. --03/16/19 07:48 - BMP on Monday 3/18/19 one time only for hypertension until 03/18/2019 23:59 --03/17/19 17:33 - Send resident to CHH ER to replace PICC line d/t (due to) TPN use. one time only until 03/17/2019 23:59. --03/08/19 11:51 - Senna-S-Tablet 8.6-50 MG (Sennosides-[MEDICATION NAME] Sodium) Give 2 tablet by mouth every 24 hours as needed for constipation 2 tablets = 17.2 mg/100mg. Hold 03/08/19 11:51 --03/11/19 11:50 loose stool --02/28/19 16:13 - Sodium Chloride Flush Solution Use 50 ml/hr intravenously in the morning for BUN and Creatinine trending up related to postsurgical malabsorption, not elsewhere classified via central line - while TPN is not Scheduled to run (9am-9pm). --02/28/19 16:13 - Sodium Chloride Flush Solution Use 50 ml/hr intravenously in the morning for BUN and Creatinine trending up related to postsurgical malabsorption, not elsewhere classified via central line - while TPN is not Scheduled to run (9am-9pm). discontinue increased weight gain --02/28/19 16:04 - House Supplement three times a day sugar free health shakes - no straws. discontinue weight gain --02/22/19 14:58 - THERAPY: Occupational Therapy Evaluation and Treatment. discontinue Highest practical level met --02/25/19 08:00 - [MEDICATION NAME] Tablet 20 MG ([MEDICATION NAME]) Give 1 tablet by mouth two times a day related to essential (primary) hypertension; chronic combined systolic (congestive) and diastolic (congestive) heart failure. discontinue --02/25/19 13:23 - CBC Due to cough, BMP due to CKD, BNP due to [MEDICAL CONDITION] one time only until --02/26/2019 23:59 --02/25/19 13:36 - [MEDICATION NAME] Tablet 40 MG ([MEDICATION NAME]) Give 1 tablet by mouth one time a day related to localized [MEDICAL CONDITION]. discontinue. Increased dose --02/25/19 13:28 - [MEDICATION NAME] Tablet 40 MF ([MEDICATION NAME]) Give 1 tablet by mouth one time a day for localized [MEDICAL CONDITION]. --02/25/19 13:30 - [MEDICATION NAME] Tablet 20 MG ([MEDICATION NAME]) Give 1 tablet by mouth one time a day for localized [MEDICAL CONDITION]. --02/22/19 13:30 - TPN: Upon competition of infusion, discontinue and discard unused TPN and tubing. Change needleless connectors and flush line. RN to perform in the morning. --02/22/19 13:30 - TPN: Upon competition of infusion, discontinue and discard unused TPN and tubing. Change needleless connectors and flush line. RN to perform in the morning. discontinue. Clarification --02/22/19 13:26 - [MEDICATION NAME] Solution 10 % Use 1 liter intravenously as needed for if TPN not available or interrupted via central line - see detailed order under other --02/22/19 13:26 - [MEDICATION NAME] Solution 10 % Use 1 liter intravenously as needed for if TPN not available or interrupted via central line - see detailed order under other DISCONTINUE. Clarification. --02/22/19 13:2 - Infusion Set Miscellaneous (IV Sets - Tubing) 1 unit miscellaneous as needed for non-sterile, tubing disconnected, malfunction etc CHANGE 1.2 Micron filter tubing to infuse TPN. Ensure appropriate filter. Label with initials, date, and time. RN to perform AND 1 unit miscellaneous at bedtime for routine care / TPN infusion CHANGE 1.2 Micron filter tubing to infuse TON, Ensure appropriate filter. Label with initials, date, and time, RN to perform. --02/22/19 13:23 - Infusion Set Miscellaneous (IV Sets - Tubing) 1 unit miscellaneous as needed for non-sterile, tubing disconnected, malfunction etc CHANGE 1.2 Micron filter tubing to infuse TPN. Ensure appropriate filter. Label with initials, date, and time. RN to perform AND 1 unit miscellaneous at bedtime for routine care / TPN infusion CHANGE 1.2 Micron filter tubing to infuse TON, Ensure appropriate filter. Label with initials, date, and time, RN to perform. discontinue. Order clarification. --02/22/19 13:16 - Misc. Devices Miscellaneous 1 unit miscellaneous as needed for missing, damaged, etc change central line needleless connectors AND 1 unit miscellaneous in the morning for routine care change central line needleless connectors upon completion of TPN lipids daily. (RN to perform) AND 1 unit miscellaneous every day shift every Fri for routine care change central line needleless connectors with CVC dressing changes. --02/22/19 13:17 - Misc. Devices Miscellaneous 1 unit miscellaneous as needed for missing, damaged etc change needleless connectors AND 1 unit miscellaneous one time only for admission for 1 Day change needleless connectors with CVC dressing changes AND 1 unit miscellaneous in the morning for routine care change needleless connectors upon completion of TPN lipids daily. (RN to perform) AND 1 unit miscellaneous one time a day every Fri for routine change needleless connectors with CVC dressing changes. DISCONTINUE. Order clarification. --02/22/19 13:12 - Normal Saline Flush Solution 0.9% (Sodium Chloride Flush) Use 10 ml intravenously as needed for blood draws, etc flush central line AND Use 10 ml intravenously two times a day for routine care flush central line with 10 mls NSS upon starting and completion of TPN and lipid infusion. --02/22/19 13:12 - Normal Saline Flush Solution 0.9% (Sodium Chloride Flush) Use 10 ml intravenously as needed for blood draws, etc AN Use 10 ml intravenously two times a day for routine care flush with 10mls NSS upon starting and completion of TPN and lipid infusion. discontinue Order clarification. --02/22/19 07:00 - Ensure dressing to left chest tunneled IJ central line is clean dry and intact. Monitor site for increased [MEDICAL CONDITION], [DIAGNOSES REDACTED], bleeding, drainage. Document in nurses note and follow up with Provider as needed every shift. --02/22/19 13:09 - Ensure dressing to left tunneled IJ central line is clean dry and intact. Monitor for increased [MEDICAL CONDITION], [DIAGNOSES REDACTED], bleeding, and drainage. Notify provider. every shift (change dressing if C/D/I). discontinue. Order clarification. --02/22/19 13:06 - Sodium Chloride Flush Solution Use 75 ml/hr intravenously every shift for BUN and Creatinine trending up related to POST SURGICAL MALABSORPTION, NOT ELSEWHERE CLASSIFIED (K91.2) via central line-while TPN is not running. --02/22/19 13:07 - Sodium Chloride Flush Solution Use 75 ml/hr intravenously every shift for BUN and Creatinine trending up related to POST SURGICAL MALABSORPTION, NOT ELSEWHERE CLASSIFIED (K91.2) WHILE TPN IS NOT RUNNIN[NAME] DISCONTINUE. Clarification. On 10/09/19 at 8:22 AM, the findings were discussed with the Administrator and the Director of Nursing (DON) and no further information was provided. On 10/09/19 at 5:05 PM, the Medical Director stated that she cannot sign orders electronically, she still has to sign orders with a pen. b) Resident #9 On 10/08/19 at 2:59 PM, during a review of the thinned medical record for a bed hold notification, the surveyor discovered several physician orders [REDACTED]. On 10/08/19 at 3:50 PM, Employee #73, Health Information Coordinator, confirmed that the physician orders [REDACTED].#73 was asked to copy all orders that were flagged. The following orders had not been signed by the physician: --06/28/19 21:02 - Monitor raised area on forehead every shift for injury for fall --06/28/19 16:46 - Apply ice to raised area on forehead X (times) 20 min every 4 hours for injury from fall for 1 Day --06/28/19 16:46 - Neuro Checks in place for 72 hrs per facility protocol every shift for related to fall for 3 Days. --06/27/19 10:26 - Resident to move to room [ROOM NUMBER] B --06/27/19 13:30 - [MEDICATION NAME] Tablet 0.5 MG (LORazepram) Give 1 tablet by mouth one time a day related to generalized anxiety disorder --06/27/19 13:31 - [MEDICATION NAME] Tablet 0.5 MG (LORazepram) Give 1 tablet by mouth two times a day related to generalized anxiety disorder. discontinue. --06/27/19 13:31 - [MEDICATION NAME] Tablet 25 MG (QUEtiapine [MEDICATION NAME]) Give 2 tablet by mouth two times a day for refusal of care related to attention-deficit [MEDICAL CONDITION] disorder, predominately hyperactive type; adjustment disorder with mixed anxiety and depressed mood monitor and document outcome every shift . discontinue --06/27/19 13:33 - [MEDICATION NAME] Tablet 0.5 MG ([MEDICATION NAME]) Give 1 tablet by mouth one time a day related to generalized anxiety disorder 3 Days. --06/27/19 13:34 - [MEDICATION NAME] Tablet 0.5 MG ([MEDICATION NAME]) Give 1 tablet by mouth one time a day related to generalized anxiety disorder. discontinue. --06/27/19 13:32 - [MEDICATION NAME] Tablet 100 MG (QUEtiapine [MEDICATION NAME]) Give 1 tablet by mouth at bedtime for refusal of care related to attention-deficit [MEDICAL CONDITION] disorder, predominately hyperactive type Monitor and document outcomes. --06/27/19 13:50 - HSG CCD diet. HSF Mech Soft texture. Regular consistency, with ground meat and gravy supervision with all meals, double portions. --06/27/19 13:50 - HSG CCD diet, HSG Puree texture, Regular consistency, supervision with all meals, double portions. discontinue. Diet upgrade. --06/14/19 11:28 - Send resident to (local hospital) to be evaluated /treatment for [REDACTED]. --06/12/19 13:53 - [MEDICATION NAME] Solution 5 MG/ML ([MEDICATION NAME]) Inject 1 ml intramuscularly one time only for increased behaviors and combativeness for 1 Day --06/12/19 15:00 - Eternal Feed-Bolus: [MEDICATION NAME] HN - TWO CANS (474 cc) - via [DEVICE] in the morning related to DYSPHASI[NAME] DISCONTINUE. Per provider orders, resident to obtain nutrition through PO (by mouth) nutrition --06/12/19 15:00 - Apply barrier cream topically to bilateral buttocks, coccyx, and sacrum after each incontinent episode every shift for incont (incontinent) episodes, etc. --06/12/19 15:00 - Cleanse bilateral buttocks and coccyx with warm soapy water. Rinse and pat dry-apply Inzo barrier topically every shift for increased risk for skin breakdown AND as needed for increased risk for skin breakdown. discontinue --02/21/19 01:31 - [MEDICATION NAME] (Concentrate) Solution 20 MG/ML Give 0.25 ml sublingually every 4 hours as needed for pain must document at least 3 non-pharmalogical interventions and outcome of those interventions prior to administration --02/21/19 01:31 - [MEDICATION NAME] (Concentrate) Solution 20 MG/ML Give 0.25 ml sublingually every 4 hours as needed for pain must document at least 3 non-pharmalogical interventions and outcome of those interventions prior to administration. discontinue --02/21/19 12:46 - Monitor Vital Signs three times a day for 3 Days --02/11/19 14:35 - PLO [MEDICATION NAME] Gel (Premium Lecith Organogel Base) Apply to forearm topically two times a day related to unspecified dementia with behavioral disturbance 75mg/2ml-apply 2 ml. --02/11/19 14:38 - [MEDICATION NAME] XR Capsule Extended Release 24 Hours 74 MG ([MEDICATION NAME] HCI ER) Give 1 capsule via PE[DEVICE] one time a day for major [MEDICAL CONDITION]. discontinue. Changed route. --02/09/19 07:37 - Apply ice to Back of head for 15 minutes and then remove for 2 hours, repeat process as directed, every shift for unwitnessed fall for 1 Day. --02/09/19 06:21 - Cleanse skin tear to left elbow with NS, pat dry, apply TAO, non-adherent pad, wrap with [MEDICATION NAME], every day shift for 7 Days --02/09/19 06:21 - Neuro checks x 72 hours d/t (due to) fall every shift for 3 Days. --02/08/19 21:19 - Enteral: Mic-Key tube necessary to malnutrition and dysphasia-may not change at facility --02/08/19 21:19 - Enteral: PEG tube necessary to malnutrition and dysphasia - may not change at facility. discontinue. --02/07/19 18:02 - Enteral: Two-Cal HN at 55 ml/hr via PEG tube for 21 hours, 7 hours, on/1 hour off with 200 ml flushes every 3 hours-total K/cal 2310/24 hours every 8 hours. Turn tube feeding on AND every 8 hours Turn tube feeding off. DISCONTINUE. Changed to bolus feedings. --02/07/19 17:41 - Bolus: TWO CAL HN - TWO CANS - in the morning related to dysphasia, unspecified. --02/07/19 17:41 - Bolus: TWO CAL HN 237 cc at bedtime related to dysphasia, unspecified. --02/07/19 17:41 - Bolus: TWO CAL HN 237 cc in the afternoon related to dysphasia, unspecified. --02/07/19 17:41 - Bolus: TWO CAL HN 237 cc in the evening related to dysphasia, unspecified. --02/07/19 17:41 - FLUSHES: 250 cc free water flushes every 4 hours related to dysphasia, unspecified. --02/07/19 17:40 - [MEDICATION NAME] Tablet 5-325 MG ([MEDICATION NAME]-[MEDICATION NAME]) Give 1 tablet enterally every 6 hours for pain --02/07/19 17:40 - [MEDICATION NAME] Tablet 5-325 MG ([MEDICATION NAME]-[MEDICATION NAME]) Give 1 tablet via PE[DEVICE] every 8 hours for pain. discontinue Increased frequency d/t pain --01/27/19 02:33 - Neuro checks per facility policy for 72 hours. every shift for unattended fall for 3 Days. --01/27/19 02:41 - Cleanse abrasion to left elbow with NSS (normal saline solution), pat dry, and apply TAO. (MONTH) discontinue when healed. --01/27/19 02:43 - Cleanse abrasion to right cheek with NSS, pat dry, and apply TAO. (MONTH) discontinue when healed. --01/23/19 12:06 - Paste Base Paste Apply to bil buttocks, coccyx, sac topically every shift for incontinence acquired [MEDICAL CONDITION] for 14 Days Cleanse bilateral buttocks, coccyx, and sacrum with normal saline, apply magic buttpaste ([MEDICATION NAME] 1%, [MEDICATION NAME] 1:1:1 mix equal parts 180 GM AND Apply to bil buttocks, coccyx, and sacrum with normal saline, apply magic buttpaste ([MEDICATION NAME] 1%, [MEDICATION NAME] 1:1:1 mix equal parts 180 GM. --01/23/19 12:11 - Cleanse wound to sacrum with warm soapy water, rinse, pat dry, apply inzo barrier cream topically. Monitor skin surrounding area and report abnormalities to provider. Document in nurses notes if indicated, every shift for wound healing/increased risk for skin breakdown AND as needed for wound healing/increased risk for skin breakdown. DISCONTINUE. Wound rounds completed with Dr. Pinson and IDT. Paste base paste orders for bilateral buttocks, coccyx and sacrum d/t incontinence acquired [MEDICAL CONDITION]. Wound care will follow prn (as needed) and upon nurses request. --01/22/19 06:50 - Cleanse wound to sacrum with warm soapy water, rinse, pat dry, apply inzo barrier cream topically. Monitor skin surrounding area and report abnormalities to provider. Document in nurses notes if indicated, every shift for wound healing/increased risk for skin breakdown AND as needed for wound healing/increased for skin breakdown. --01/22/19 06:49 - Cleanse bilateral buttocks and coccyx with warm soapy water. Rinse and pat dry-apply Inzo barrier cream topically every shift for increased risk for skin breakdown AND as needed for increased risk for skin breakdown. --01/22/19 06:49 - Cleanse bilateral buttocks, coccyx and sacrum with warm soapy water. Rinse and pat dry-apply Inzo barrier cream topically every shift for increased risk for skin breakdown AND as needed for increased risk for skin breakdown. discontinue. --01/22/19 13:13 - [MEDICATION NAME] Tablet 0.5 MG ([MEDICATION NAME]) Give 1 tablet via PE[DEVICE] two times a day for increased agitation related to generalized anxiety disorder monitor and document outcome every shift. DISCONTINUE. Increasing frequency. --01/22/19 13:13 - [MEDICATION NAME] Tablet 0.5 MG ([MEDICATION NAME]) Give 1 tablet by mouth every 8 hours related to generalized anxiety disorder . --01/22/19 13:22 - HSG Puree diet HSG Puree texture, Nectar consistency, for pleasure food. --01/22/19 13:23 - HSG NPO (Nothing by Mouth) diet NPO (Nothing by Mouth) texture, NPO (Nothing by Mouth) consistency. discontinue. Hospice accepted resident has new diet order. --01/17/19 08:33 - Hospice Consult one time only for 1 Day. --01/16/19 11:53 - Flush PEG tube with 200cc water for hydration /to maintain patency every 3 hours. --01/15/19 15:21 - ADC: Do Not Resuscitate - Comfort - no IV fluids. If feeding tube has been removed by resident-leave out. --01/15/19 15:28 - ADC: Do Not Resuscitate - DNR - Limited interventions - R.N. may pronounce death-May have IV fluids for trial period-Feeding tube long-term. discontinue. Updated. --01/13/19 21:57 - [MEDICATION NAME] Cream 1 % Apply to abdomen topically two times a day for skin irritation apply to affected area around peg tube site. --01/12/19 0:39 - Apply sureprep to wound on left lateral malleolus. Monitor skin surrounding area and report abnormalities to provider. Document in nurses notes if indicated, every shift for wound healing AND as needed for wound healing. discontinue. Resolved. --01/12/19 07:23 - Consult: Occupational Therapy may evaluate and treat as indicated. --01/12/19 07:23 - Consult: Physical Therapy may evaluate and treat as indicated. --01/12/19 07:23 - Consult: Speech Therapy may evaluate and treat as indicated. --01/11/19 13:51 - [MEDICATION NAME] HCI Solution Reconstituted 750 MG Use 750 mg intravenously two times a day related to bacteremia. discontinue. VAMC discontinued. --01/11/19 13:51 - IV Catheter Kit 1 unit miscellaneous as needed for dressing not clean dry and intact Change PICC line dressing (Pharmacy please send central line dressing change trays) AND 1 unit miscellaneous every night shift every Mon, Fri for routine PICC care Change PICC line dressing (Pharmacy please send central line dressing change trays). discontinue. discontinued. --01/11/19 13:52 - Misc. Devices Miscellaneous 1 unit miscellaneous as needed for blood draw, malfunction, dressing changes, etc. Change needleless connectors (Pharmacy please send needleless connectors) AND 3 unit miscellaneous every night shift every Mon, Fri for routine PICC care Change needleless connectors (Pharmacy please send needleless connectors). discontinue. discontinue --01/11/19 13:52 - Kendall Luer Disinfectant Cap Miscellaneous (Parental Therapy Supplies) 1 unit miscellaneous as needed for missing, damaged etc change alcohol cap AND 1 unit miscellaneous in the morning for routine PICC care change alcohol cap after IV administration AND 3 unit miscellaneous every night shift every Mon, Fri for routine dressing changes change alcohol caps to all lumens. --01/06/19 17:05 -[MEDICATION NAME] HCI Solution Reconstituted 750 MG Use 750 mg intravenously two times a day related to bacteremia. --01/06/19 17:12 - [MEDICATION NAME] trough 30 minutes prior to 4th dose on 1/18/19 at 5 am. one time only for 1 Day. --01/05/19 18:03 - [MEDICATION NAME] Tablet 0.5 MG ([MEDICATION NAME]) Give 1 tablet by mouth one time only for increased agitation and refusal of care until 01/05/2019. --01/07/19 03:00 - Neuro checks every 30 min. x 4, every 1 hour x 4 hours x 24 hours, every 8 hours for the remaining 72 hours. discontinue. Order was for 72 hours only. --01/07/19 15:25 - left hip X-ray d/t fall/pain. discontinue. obtained. negative. --01/07/19 15:24 -Send to CHH ER/IR for replacement of PICC line d/t resident pulled out 1/4/19 at 8pm. discontinue. completed. --01/03/19 18:26 - XRAY OF BILATERAL HIPS, 2 VIEW STAT for FALLS/PAIN. --01/04/19 01:57 - Hold [MEDICATION NAME] until trough obtained one time only for 1 Day. --01/04/19 01:58 - [MEDICATION NAME] trough 30 minutes prior to 4th dose one time only for 1 Day. --01/04/19 05:58 - Cleanse skin tear to right forearm with normal saline, pat dry, cover with [MEDICATION NAME], wrap with kerflex. Monitor skin surrounding area and report abnormalities to provider. Document in nurses notes if indicated, as needed for skin tear for 10 Days AND every night shift for skin tear for 10 Days. --01/04/19 05:58 - Ensure dressing to right forearm is CDI (clean, dry, intact) every shift for ensure dressing is CDI for 10 Days. --01/02/19 17:30 - Apply sureprep to wound on left heel. Monitor skin surrounding area and report abnormalities to provider. Document in nurses notes if indicated, every shift for wound healing AND as needed for wound healing. discontinue. resolved. --01/02/19 11:03 - Low bed with bilateral floor mats at all times while in bed-verify position and placement every shift for history of falls. --01/02/19 11:04 - Floor mat to left side of bed AAT's (at all times) every shift for falls. --01/02/19 11:04 - Low Bed AAT's while in bed every shift for falls. --01/02/19 07:00 - Safety checks every shift for history of falls complete paper safety checks form. --01/02/19 11:11 - Safety checks every 30 minutes. --12/31/19 20:46 - Count number of steri strips and document. Leave steri strips in place until they fall off. every shift for skin tear. discontinue. new orders noted On 10/09/19 at 8:22 AM, the findings were discussed with the Administrator and the Director of Nursing (DON) with no further information provided. On 10/09/19 at 5:05 PM, the Medical Director stated that she cannot sign orders electronically, she still has to sign orders with a pen. c) Resident #95 On 10/08/19 at 2:59 PM, during a review of the thinned medical record for a bed hold notification, the surveyor discovered several physician orders [REDACTED]. On 10/08/19 at 3:50 PM, Employee #73, Health Information Coordinator, confirmed that the physician orders [REDACTED].#73 was asked to copy all orders that were flagged. The following orders had not been signed by the physician: --07/12/19 - Order Summary Report --09/21/19 08:12 - CBC, CMP q (every) 6 months d/t (due to)[MEDICAL CONDITION](hypertension) due Feb & Aug one time a day every 181 days(s) --09/21/19 08:12 - CBC, BMP q (every) 6 months d/t HTN. discontinue. Order clarification. --09/21/19 08:09 - vit d level one time only until 10/16/2019 23:59 --09/21/19 08:09 - vit d level one time only for 1 Day --09/21/19 08:08 - CMP, TSH, T4, FLP, annually due 07/2020 one time a day every 364 days(s) --09/21/19 08:08 - CMP, TSH, T4, FLP annually due 07/2020. DISCONTINUE. Order clarification. --09/19/19 20:51 - Acidophilus Capsule (Lactobacillus) Give 1 capsule by mouth every 12 hours for GI protection secondary to antibiotic use related to unspecified escherichia coli (E. coli) as the cause of diseases classified elsewhere unitary tract infection, site not specified. --09/19/19 20:51 - [MEDICATION NAME] Capsule 100 MG ([MEDICATION NAME] Monohyd Macro) Give 1 capsule by mouth two times a day related to unspecified escherichia coli (E. coli) as the cause of diseases classified elsewhere urinary tract infection, site not specified. for 7 Days. --09/19/19 20:52 - Nursing Progress Note every shift for antibiotic monitoring related to unspecified escherichia coli (E. coli) as the cause of diseases classified elsewhere urinary tract infection, site not specified. for 7 Days Also monitor closely for loose stools related to recent hx of [DIAGNOSES REDACTED] --09/19/19 20:55 - Vital Signs every 8 hours for antibiotic monitoring related to unspecified escherichia coli (E. coli) as the cause of diseases classified elsewhere urinary tract infection, site not specified for 7 Days. --09/19/19 20:55 - vitals q shift every 8 hours for 3 Days. --08/25/19 17:34 - Acidophilus Tablet (Lactobacillus) Give 1 tablet by mouth two times a day for ATB Therapy for 3 Days --08/25/19 17:34 - [MEDICATION NAME] Solution Reconstituted 1 GM (cefTRIAX Sodium) Inject 1 application intramuscularly at bedtime for UTI for 3 Days until finished. --08/25/19 17:38 - Temp Q shift while receiving ATB every shift for ATB Therapy for 3 Days. --07/16/19 11:52 - CMP in am one time only for 1 Day --07/16/19 11:52 - CMP in am one time only for 1 Day. discontinue --07/16/19 16:22 - Resident to be out of bed via hoyer lift for lunch daily every day shift for improved participation. On 10/09/19 at 8:22 AM, the findings were discussed with the Administrator and the Director of Nursing (DON) and no further information was provided. On 10/09/19 at 5:05 PM, the Medical Director stated that she cannot sign orders electronically, she still has to sign orders with a pen.", "filedate": "2020-09-01"}
{"rowid": 156, "facility_name": "HUNTINGTON HEALTH AND REHABILITATION CENTER", "facility_id": 515007, "address": "1720 17TH STREET", "city": "HUNTINGTON", "state": "WV", "zip": 25701, "inspection_date": "2019-10-10", "deficiency_tag": 726, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "RPKM11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview, the facility failed to have nursing staff with the appropriate competencies and skills sets to provide nursing and related services to assure resident safety and attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident. Facility staff failed to ensure residents' advance directives contained in their Physician's Orders for Scope of Treatment (POST) forms were complete and/or accurately reflected in the physician's orders. Facility staff failed to ensure residents were free from chemical restraints. Facility staff failed to ensure physician's orders for medication parameters and medication dosages were followed. Facility staff failed to administer medications within the time period prescribed by the physician. Facility staff failed to provide [MEDICAL TREATMENT] services consistent with professional standards of practice. Facility staff failed to ensure residents were free from significant medication errors. Resident identifiers: 125, 139, 148, 9, 95, 108, 137, 161, 37, 130, 432, 182, 151. Facility census: 182. Findings included: a) Cross reference findings at F578 b) Cross reference findings at F605 c) Cross reference findings at F684 d) Cross reference findings at F698 e) Cross reference findings at F760", "filedate": "2020-09-01"}
{"rowid": 157, "facility_name": "HUNTINGTON HEALTH AND REHABILITATION CENTER", "facility_id": 515007, "address": "1720 17TH STREET", "city": "HUNTINGTON", "state": "WV", "zip": 25701, "inspection_date": "2019-10-10", "deficiency_tag": 756, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "RPKM11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview, the facility failed to ensure the consultant pharmacist recognized medications were administered without the required blood pressure and/or heart rates prior to the administration of [MEDICATION NAME] for two (2) random opportunities for discovery. This failed practice had the potential to affect a limited number of residents residing at the facility. Resident identifiers: #139 and #182. Facility census: 182. Findings included: a) Resident #139 Review of Resident #139's medical record found an order for [REDACTED]. Order effective 08/15/19. Review of the August, (MONTH) and (MONTH) 2019, Medication Administration Record [REDACTED]. Review of the monthly medication regimen reviews found the consultant pharmacist completed a medication review on 08/24/19, 09/09/19 and 10/03/19 with no recognition the [MEDICATION NAME] was being administered without the required heart rate and blood pressure obtained prior to the administration of the medication. Interview with the DON on 10/10/19 at 10:00 am, confirmed the resident's blood pressure and heart rate was not taken and documented prior to the administration of the [MEDICATION NAME] and the consultant pharmacist had not recognized the medication was being administered without the required blood pressure and heart rate. b) Resident #182 Review of Resident #182's medical record found an order for [REDACTED]. Order effective 06/17/19. Review of the June, July, and (MONTH) 2019, Medication Administration Record [REDACTED]. Review of the monthly medication regimen reviews found the consultant pharmacist completed a medication review on 06/21/19, 07/17/19, and 08/22/19, with no recognition the [MEDICATION NAME] was being administered without the required heart rate obtained prior to the administration of the medication. Interview with the DON on 10/10/19 at 10:00 am, confirmed the resident's heart rate was not taken and documented prior to the administration of the [MEDICATION NAME] and the consultant pharmacist had not recognized the medication was being administered without the required heart rate.", "filedate": "2020-09-01"}
{"rowid": 158, "facility_name": "HUNTINGTON HEALTH AND REHABILITATION CENTER", "facility_id": 515007, "address": "1720 17TH STREET", "city": "HUNTINGTON", "state": "WV", "zip": 25701, "inspection_date": "2019-10-10", "deficiency_tag": 757, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "RPKM11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility failed to ensure each resident's drug regimen was free from unnecessary medications for three (3) random opportunities of discovery. This failed practice had the potential to affect more than a limited number of residents residing at the facility. Resident identifiers: #139, #182, and #151. Facility census: 182. Findings included: a) Resident #139 Review of Resident #139's medical record found an order for [REDACTED]. Order effective 08/15/19. Review of the August, (MONTH) and (MONTH) 2019, Medication Administration Record [REDACTED]. Interview with the DON on 10/10/19 at 10:00 am, confirmed the resident's blood pressure and heart rate was not taken and documented prior to the administration of the [MEDICATION NAME]. b) Resident #182 Review of Resident #182's medical record found an order for [REDACTED]. Order effective 06/17/19. Review of the June, July, and (MONTH) 2019, Medication Administration Record [REDACTED]. Interview with the DON on 10/10/19 at 10:00 am, confirmed the resident's heart rate was not taken and documented prior to the administration of the [MEDICATION NAME]. c) Resident (R#151) received Calcium Acetate after the [MEDICAL TREATMENT] Center wanted it to be discontinued. Resident (R#151) was transferred and admitted to the facility on [DATE], after the resident had a failed kidney transplant. Some pertinent [DIAGNOSES REDACTED]. The resident was admitted to current [MEDICAL TREATMENT] services on 09/04/19. Interview with Licensed Practical Nurse (LPN#84), on 10/09/19 at 01:55 PM, revealed the facility maintains a communication record with the [MEDICAL TREATMENT] center in a [MEDICAL TREATMENT] communication book. Review of the resident's [MEDICAL TREATMENT] communications book with LPN#84 revealed a [MEDICAL TREATMENT] center communication dated 09/06/19 for R#151 to stop taking Calcium Acetate. ` Review of orders revealed Calcium Acetate Capsule 667 mg (milligrams). Give 2 capsule by mouth with meals every Mon, Wed, Fri related to End Stage [MEDICAL CONDITION] (Time on [MEDICAL TREATMENT] days) 2 capsules to equal 1334 mg; and Calcium Acetate Capsule 667 mg. Give 2 capsule by mouth with meals every Tue, Thu, Sat, Sun related to End Stage [MEDICAL CONDITION] (Timed for non-[MEDICAL TREATMENT] days) 2 capsules to equal 1334 mg. Review of R#151's Medication Administration Record [REDACTED]. The resident received Calcium Acetate (a base binder) for thirty-three (33) more days after it should have been discontinued. On 10/10/19 at 11:53 AM, a phone interview with the [MEDICAL TREATMENT] Center Clinic Manager revealed R#151 was admitted to [MEDICAL TREATMENT] service on 09/04/19 and labs were taken at that time showing the resident's calcium was high and phosphorus level was low. Calcium and phosphorus are essential minerals found in the bone, blood and soft tissue of the body and have a role in numerous body functions. The [MEDICAL TREATMENT] Center Clinic Manager stated their doctor does not like to use a calcium base binder (binds to phosphorus to remove phosphorus from the body) and since the resident's phosphorus was already low. The [MEDICAL TREATMENT] Center Clinic Manager voiced concern that by R#151 continuing to take the binder it could make R#151's phosphorus levels even lower. The [MEDICAL TREATMENT] Center Clinic Manager said the facility had contacted them yesterday and notified them the resident had continued to receive the Calcium Acetate, so labs were drawn, and they were awaiting the results. (Surveyor was notified by the [MEDICAL TREATMENT] Center Clinic Manager the last lab results were within normal limits.)", "filedate": "2020-09-01"}
{"rowid": 159, "facility_name": "HUNTINGTON HEALTH AND REHABILITATION CENTER", "facility_id": 515007, "address": "1720 17TH STREET", "city": "HUNTINGTON", "state": "WV", "zip": 25701, "inspection_date": "2019-10-10", "deficiency_tag": 758, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "RPKM11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility failed to ensure residents were free from unnecessary use of [MEDICAL CONDITION] medications. This was true for two (2) of five (5) reviewed for unnecessary medications. Resident identifiers: #161, and #9. Facility census: 182. Findings included: a) Resident #161 During a review of medical records for Resident #161 on 10/08/19 at 12:30 PM, revealed a statement on his Care Plan, it states, Resident #161 receives antipsychotic medication-- [MEDICATION NAME]-- for refusal of care/mood changes. This was initiated on 03/20/18. During an interview on 10/10/19 at 9:45 AM, Director of Nursing was asked about the care plan stating, that he was receiving this antipsychotic for refusal of care. She agreed, he should not be given a medication for refusal of care, and that it was his right to refuse showering/bathing. b) Resident #9 Review of the medical record revealed a current order, dated 08/05/19 for [MEDICATION NAME] tablet 200 mg at bedtime for refusal of care related to [MEDICAL CONDITION] disorder, recurrent, unspecified. A second order for [MEDICATION NAME] 100 mg, give 1 tablet in the morning for dementia related to dementia with Lewy Bodies was prescribed on 10/01/19. Review of the care plan found the resident refuses to wear his identification bracelet. The care plan also noted that the resident would refuse incontinent care. The care plan referenced the use of an anti-anxiety medication and said the resident refused care related to anxiety but the specific care refused was not documented. A review of Resident #9's [DIAGNOSES REDACTED]. On 10/10/19 at 11:26 AM, the findings were discussed with the Administrator and the Director of Nursing (DON). No further information was provided to indicated what type of care the resident refused, prior to the survey conclusion. There was no evidence provided to verify the resident refused any type of care that would have caused him harm. There was no evidence provided by the facility, prior to survey exit, of any behavioral interventions were explored other than medication. There was no evidence provided by the facility of non-pharmacological approaches attempted when the resident refused care that were directed toward understanding, preventing, relieving, and/or accommodating the resident refusals of care.", "filedate": "2020-09-01"}
{"rowid": 160, "facility_name": "HUNTINGTON HEALTH AND REHABILITATION CENTER", "facility_id": 515007, "address": "1720 17TH STREET", "city": "HUNTINGTON", "state": "WV", "zip": 25701, "inspection_date": "2019-10-10", "deficiency_tag": 760, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "RPKM11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility failed to ensure Resident #139 was free from significant medication error. This failed practice had the potential to affect a limited number of residents residing at the facility. Resident identifier: #139. Facility census: 182. Findings included: a) Resident #139 Medical record review for Resident #139, revealed he was admitted to the facility on [DATE]. [DIAGNOSES REDACTED]. Resident is unresponsive and requires a gastrostomy feeding tube for all nutritional needs and [MEDICAL CONDITION] in place secondary to [MEDICAL CONDITION]. Resident #139 is to receive nothing by mouth (po) secondary to dysphagia and aspiration. Further review of Resident #139's medical records found an order for [REDACTED]. Review of the Controlled Medication Utilization Record for 09/29/19 at 1:00 am through 10/01/19 at 5:00 pm, found Resident #139 received [MEDICATION NAME] 20 mg per 1ml; which equals 20 mgs by mouth (po) every hour. Resident #139 received fifty-one (51) doses of 20mgs of [MEDICATION NAME] instead of the 4mgs and the resident received the [MEDICATION NAME] po instead of SL as ordered. Interview with attending physician on 10/09/19 at 5:00 pm revealed the [MEDICATION NAME] should be given SL not po and the dosage should be 20mg per 1 ml - give 0.25 ml which equals 4 mg every hour as needed for pain. Clarification orders was noted by the attending physician to give SL not po due to aspiration. Interview on 10/10/19 at 10:00 am with the Director of Nursing (DON), found the resident received the wrong dosage of [MEDICATION NAME] on the above dates. Additionally, she confirmed the [MEDICATION NAME] was to be given SL but was documented it was administered po.", "filedate": "2020-09-01"}
{"rowid": 161, "facility_name": "HUNTINGTON HEALTH AND REHABILITATION CENTER", "facility_id": 515007, "address": "1720 17TH STREET", "city": "HUNTINGTON", "state": "WV", "zip": 25701, "inspection_date": "2019-10-10", "deficiency_tag": 804, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "RPKM11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on confidential resident and family interviews, observation, record review, and staff interview the facility failed to provide food to residents that was palatable and attractive. This deficient practice was found during a random opportunity for discovery and affected more than an isolated number of residents. Facility census: 182. Findings included: a) Test Tray On 10/09/19 at 9:18 AM a regular diet test tray was requested for that day's lunch time meal from the facility's Dietary Manager (DM). On 10/09/19 at 11:44 AM the test tray was received and examined by surveyors. The food on the test tray was unattractive. The tray included a watery bowl of discolored tomato and onion slices. The tomato slices were dark and dull. The egg salad sandwich on the tray was so soggy that the buns could not be separated from the egg salad between them. A small bowl on the tray contained a mixture of pineapple chunks and marshmallows. The contents of the bowl were watery, and the marshmallows were actively disintegrating in the excess moisture and turning to mush. The facility's Administrator was advised of the above findings on 10/10/19 at 9:14 AM. No further information was provided prior to exit. b) Confidential Resident #A (CR #A) During the survey, in a interview the CR #A described the facility food as so-so and mediocre. c) Confidential Resident #B (CR #B) During the initial interview the CR #B stated, Most of the time the food around here is cold by the time you get it and not fit to eat. When asked if the foods that were supposed to be served hot was not hot but cold, the resident confirmed and said, That's exactly what I mean. How would you like to eat cold mashed potatoes and gravy? It's disgusting. d) Confidential Resident #C (CR #C) CR #C said, the food is always bad. CR #C stated they do not order pizza or fish but, they still serve it to them. CR #C stated one evening they were not served dinner, then they served fish and then they asked for a grilled cheese. CR #C said the grilled cheese was never provided. e) Confidential Resident #D (CR #D) CR #D said the food is delivered cold, over cooked, has a lot of water in it, and with no seasoning. f) Confidential Resident #E (CR #E) CR #E said, the food is cold, and they are just tired of talking to them about it. They call it the food committee, but nothing changes. The food is over cooked to mush and no seasoning, so it tastes awful. g) Confidential Resident #F (CR #F) CR #F said, the food is[***]y, it's cold just taste bad, and looks bad. CR #F said they and the roommate order out three or four time a week. h) Confidential Resident #G (CR #G) CR #G said the food is cold. CR #G said they are allergic to peas, but they still serve it to them, plus it is totally over cooked and tasted bad. i) Confidential Resident #H (CR #H) CR #H said the food is cold and does not taste good. j) Confidential Resident #I (CR #I) CR #I said the food is cold never hot. The food has not been hot when it should have been. k) Confidential Resident #J (CR #J) During a confidential interview, CI #J stated the food is not at a temperature that they like. The food is not hot when it arrives in the resident's room. The food does not taste good. CI #J notes that salt cannot always be used, but there are other ways to season the food. The food does not have an appealing taste or the vegetables are not cooked properly. The vegetables are overcooked, soggy, mushy, and lack flavor. Also, according to CI #J, the trays do not get served on the unit(s) timely. There are many times that CI #J has had to wait 20 or more extra minutes for a tray to be delivered. On 10/10/19 at 9:14 AM, the findings regarding food palatability, appearance, watery side dishes, and desert variety was discussed with the Administrator. l) Confidential Resident #K (CR #K) During a confidential interview, CI #K stated the food does not taste good. Also, CI #K stated that the food is not hot when it is delivered to his / her room. On 10/10/19 at 9:14 AM, the findings regarding food palatability, appearance, watery side dishes, and desert variety was discussed with the Administrator. m) Confidential Resident #L (CR #L) During a confidential interview, CI #L stated the food is not at a temperature that he / she likes. The food is not hot when it arrives in the resident's room. The food does not taste good. The food is not seasoned and a lot of time the vegetables are soggy and mushy. CI #L states that he / she orders out several times a week due to the quality of the food at the facility. On 10/10/19 at 9:14 AM, the findings regarding food palatability, appearance, watery side dishes, and desert variety was discussed with the Administrator. n) Confidential Resident #M (CR #M) During a confidential interview, CI #M stated some days the food is not as hot as it should be. The food tasted ok, but could use more seasoning. On 10/10/19 at 9:14 AM, the findings regarding food palatability, appearance, watery side dishes, and desert variety was discussed with the Administrator. o) Confidential Resident #N (CR #N) During a confidential interview, CI #N stated that the food sometimes is not hot but it is getting better. The food is not seasoned and tastes bland. CI #N stated that he / she orders from Door Dash due to the food quality at the facility. On 10/10/19 at 9:14 AM, the findings regarding food palatability, appearance, watery side dishes, and desert variety was discussed with the Administrator. p) Resident Council A resident council meeting was held on 10/08/19 at 2:30 PM. Residents stated that there was too much water in food. Sometimes there about an inch of water in the bowl that side dishes were served in. Residents state that trays come out late, especially in the evenings. A review of resident council minutes showed the following: -- 8/27/19 - food not good cold and late -- 9/4/10 - facility conducting a food preference audit on every resident. -- 9/11/19 - no concerns listed. -- 9/26/19 - no issues listed for food. On 10/09.19, the Administrator provided copies of the Performance Improvement Project (PIP) regarding dietary concerns. On 10/09/19 at 3:20 PM, the District Director of Clinical Services reviewed the PIP provided by the Administrator. The PIP for the dietary department began on 08/22/19. The facility has added to the focus areas. The facility has added areas to the section What will you implement based on the Root Cause? -- Weekly Food Committee meeting in addition to Monthly meeting -- Customer Meal Satisfaction Survey -- Call back audit forms -- Dietary to meet with new admissions within 72 hours to discuss preferences -- 100% review of food preferences On 10/10/19 at 9:14 AM, the findings regarding food palatability, appearance, watery side dishes, and desert variety were discussed with the Administrator. q) Staff Interview On 10/09/19 at 9:45 AM, Administrator and Director of Nursing was asked what they have done to address the problems with the food. Administrator said, they have been having weekly meeting with the Residents, to talk about the food. They were asked what changes have been made. They had no response. They both agreed, that the Residents were still not happy about the food. They were both informed, the facility would get a citation about the appearance of the food. It was reported to them that the test tray was not appealing at all. Director of Nursing asked, if a detailed description would be in the findings about the test tray. She was informed that there would be a description of the test tray.", "filedate": "2020-09-01"}
{"rowid": 162, "facility_name": "HUNTINGTON HEALTH AND REHABILITATION CENTER", "facility_id": 515007, "address": "1720 17TH STREET", "city": "HUNTINGTON", "state": "WV", "zip": 25701, "inspection_date": "2019-10-10", "deficiency_tag": 812, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "RPKM11", "inspection_text": "Based on observation, record review, and staff interview, the facility failed to maintain the kitchen and beverages distributed from the kitchen in a safe and sanitary manner. This deficient practice was found during a random opportunity for discovery and had the potential to affect more than an isolated number of residents. Facility census: 182. Findings included: a) Kitchen An initial tour of the facility's kitchen began on 10/07/19 at 10:53 AM. At 10:56 AM a square plastic container of lettuce in the reach-in cooler was found to have a use by date of 10/06/19. Also at 10:56 AM the reach-in cooler near the hand washing sink was found to have no temperature log. At 10:57 AM the facility's Dietary Manager (DM) confirmed that the lettuce had a use by date of 10/06/19. The DM then examined the lettuce closely and stated that it was still good. When asked for the facility's policy on what to do with a product that had passed its best by date, the facility's DM became silent and removed the lettuce from the cooler. At 10:58 AM the facility's DM confirmed there was no temperature log for the above-mentioned reach-in cooler. At 11:00 AM the dish machine temperature log was found to be blank on the following dates and times of the day during the month of (MONTH) 2019: breakfast, lunch, and dinner on 10/04/19, lunch and dinner on 10/05/19, and lunch and dinner on 10/06/19. Additionally, there was a large amount of scale running down the front of the machine. At 11:03 AM the facility's DM confirmed that the dish machine temperature log had not been filled out as it should have been. At 11:07 AM the facility's DM said that the large amount of scale running down the front of the dish machine was a constant problem. At 11:13 AM a 50 ounce can of chicken noodle soup with a large creased dent at the top seam was found in the dry storage area with food for resident service. At 11:14 AM the facility's DM confirmed that this severely damaged can should not have been in regular stock and then moved it to the damaged stock area of the dry storage room. The facility's Administrator was informed of the above findings on 10/07/19 at 2:44 PM. No further information was provided prior to exit. b) Third Floor On 10/07/19 at 12:20 PM a cart containing four (4) beverage pitchers to be used for lunch service was observed on the third floor of the facility. The pitchers were not labeled with dates. On 10/07/19 at 12:35 PM Dietary Employee (DE) #125 arrived on the third floor and examined the pitchers. DE #125 stated that there should have been dates on the pitchers. The above findings were discussed with the facility's Administrator on 10/07/19 at 2:44 PM. No further information was provided prior to exit.", "filedate": "2020-09-01"}
{"rowid": 163, "facility_name": "HUNTINGTON HEALTH AND REHABILITATION CENTER", "facility_id": 515007, "address": "1720 17TH STREET", "city": "HUNTINGTON", "state": "WV", "zip": 25701, "inspection_date": "2019-10-10", "deficiency_tag": 842, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "RPKM11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation, and staff interview, the facility failed to ensure medical records were complete and accurate for 1 of 35 residents in the survey sample. The physician's orders [REDACTED].#19 did not specify the specific supplement. Resident identifier: #19. Facility census: 182. a) Resident #19 Resident #19 had an order written [REDACTED]. The specific supplement was not identified in additional directives. Resident #19's Medication Administration Record [REDACTED]. During an interview on 10/10/19 at 8:28 AM, Licensed Practical Nurse (LPN) #185 stated she was pretty sure Resident #19 was receiving Juven as the commercial supplement. During an interview on 10/10/19 at 8:40 AM, the Director of Nursing (DoN) was informed the physician's orders [REDACTED].#19 did not specify the specific supplement. The DoN had no further information regarding the matter. No further information was provided through the completion of the survey.", "filedate": "2020-09-01"}
{"rowid": 164, "facility_name": "HUNTINGTON HEALTH AND REHABILITATION CENTER", "facility_id": 515007, "address": "1720 17TH STREET", "city": "HUNTINGTON", "state": "WV", "zip": 25701, "inspection_date": "2019-10-10", "deficiency_tag": 867, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "RPKM11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, staff interview, and resident interview, the facility failed to develop and implement appropriate plans of action to correct identified quality deficiencies. The facility had identified a deficient practice in the care area of advance directives, using medications as a chemical restaint for residents that refused care, failing to ensure all residents received medications that met the professional standard of practice, failing to ensure all orders were signed and dated by the physician, and failing to provide food that was palatable, attractive, to fit the needs of the residents, and their preferences. Has the potential to affect more than an isolated number of residents. Facility census 182. Findings included: a) Cross reference findings at F578 b) Cross reference findings at F605 c) Cross reference findings at F684 d) Cross reference findings at F711 e) Cross reference findings at F804 f) Interviews 1. During an interview on 10/10/19 at 11:52 AM, Director of Nursing (DoN) said, they did had audit in (MONTH) of 2019, and found no problems at that time. 2. Discussed the issues with the Post Forms with team and it was determined that the Post Forms was that was found to be incorrect the Post did not match the physician's orders [REDACTED]. Two (2) of the Post Forms were dated before the audit. 3. During an interview on 10/10/19 at 12:00 PM, Director of Nursing was asked about the orders not being signed and dated by the attending physician. DoN stated, that the physician was in transition for starting a new program for signing orders. 4. During an interview on 10/10/19 at 12:10 PM, DoN was asked the nurses not following perimeter on medication administration. DoN stated, that they were aware of the perimeters not being followed and did a Performance Improvement Procedure (PIP) in the Quality Assurance and Preformance Improvement (QAPI) meeting. She went on to say, they found the nurses had trouble using the sliding/scale (S/S) insulin, so they revised s/s to simplify the sliding scale, and worked with the pharmacist as to what Blood Pressure (B/P) medications have to have perimeters. So they stopped a lot of perimeters for these medication because they had been on the same medication for a long time and were stable. These problems are still problem madic, and that is on going during this survey. 5. On 10/10/19 at12:46 PM, DoN was asked about the post forms and the on going perimeters not being followed. She said, the pharmacist is monitoring monthly and the facility does audits quarterly. She agrees it needs to be monitored more often.", "filedate": "2020-09-01"}
{"rowid": 165, "facility_name": "ST. BARBARA'S MEMORIAL NURSING HOME", "facility_id": 515012, "address": "PO BOX 9066", "city": "FAIRMONT", "state": "WV", "zip": 26555, "inspection_date": "2017-06-20", "deficiency_tag": 223, "scope_severity": "E", "complaint": 1, "standard": 0, "eventid": "HCKF11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on review of reported allegations, resident interview, staff interview, family interview, staffing records, policy review, and personnel record review; the facility failed to protect residents after an allegation of abuse for one (1) of five (5) allegations reviewed. This practice affected one (1) resident but had the potential to affect more than a limited number of residents. Resident identifier: Resident #1. Facility census: 55. Findings include: a) Resident #1 On 06/20/17 at 11:10 a.m., Assistant Administrator (AA) #11 was questioned as to whether the facility had any reportable allegations in the previous three (3) to six (6) months. The AA referred the question to Registered Nurse (RN) #71. Upon inquiry, the RN provided an allegation which she verbalized was being investigated. The immediate reporting form indicated Nurse Aide (NA) #79 had reported the allegation to the DON on 06//19/17, alleging NA #22 had used foul language/cursed at Resident #1 when the resident requested to be put back to bed after being toileted on the three o'clock to eleven o'clock (3:00 - 11:00) afternoon shift. Licensed Practical Nurse (LPN) #66, interviewed on 06/20/17 at about 10:30 a.m., had verbalized the facility completed annual training in-services, and had one scheduled for Wednesday, 06/21/17, related to abuse and neglect. The nurse said the LPN's role was to tell the director of nursing (DON) and the DON would do the rest. With further questioning, the LPN said the Charge Nurse would be notified on evenings and weekends, and that person would notify the appropriate entities. LPN #66 said if the alleged perpetrator was an employee, the person would not be allowed to work with the involved resident. NA#79, interviewed via telephone on 06/20/17 at 12:10 p.m. verbalized she usually worked day shift, but had worked over that day. The nurse aide said the resident was toileted on the bedside commode and when done was put in the wheelchair (w/c). The NA said the resident asked what time dinner was served and was told about 5:30 p.m. NA#79 stated Resident #1 asked to be put back to bed because it was only 4:00 p.m. The nurse aide alleged NA#22 told the resident they were not playing these f-----g games and don't (do not) care what your daughter says. You are not being babied. NA#79 verbalized she notified LPN #63, who was passing medications. The LPN then ensured Resident #1 was placed back in bed. NA #79 verbalized during the interview, that she went back into the room and apologized for what had happened. The nurse aide said Resident #1 did not exhibit behaviors, was very sweet person. The NA said the resident's routine was to toilet and lay down. The resident would get up fifteen (15) minutes before meals. The NA voiced she thought the family member had talked to the facility about it. The Kardex report noted Resident #1 required assistance of two (2) persons for all transfers. The care plan indicated the resident required extensive assistance (weight bearing assistance) from staff for toileting. The care plan also indicated Resident #1 was at risk for chronic pain related to the [DIAGNOSES REDACTED]. The interventions section noted the resident was able to call for assistance when in pain, ask for medication, and tell staff how much pain was experienced. Resident #1, interviewed on 06/20/17 at about 12:30 p.m. ,was in bed, lying on left side, awake and alert. The resident verbalized that staff sometimes puts her down too hard when putting her back in bed. Resident #1 said when she had a concern she told her daughter and the daughter talked to the facility. Family Member (FM) #1, interviewed at 12:48 p.m., verbalized she had not made a formal complaint because her mother was confused as to dates and times, FM #1 said the resident told someone said, Well, that was totally unnecessary to another staff person when performing care. She said she informed RN#73 last week about Resident #1's concerns, but did not file a formal complaint because she did not know if it was true. The minimum data set (MDS) with an assessment reference date (ARD) of 04/28/17 indicated Resident #1 had a brief interview for mental status (BIMS) score of 08 which indicated moderate cognitive impairment. During another interview with the assistant administrator, at 1:10 p.m., she voiced the LPN started the investigative process, filled out forms, notified the charge nurse called the social worker so there was no lag time. The administrator verbalized that she, the director of nursing, and the social worker were out of the building last week. When asked who was in charge, she said Administrator #10, whatever charge nurse, and RN #71. RN #71, interviewed at 1:17 p.m., voiced FM #1 had spoken to her on Monday (06/19/17) about an incident that happened concerning one of the aides, but did not know whether or not it was truthful. The nurse said the FM did not say what happened. The RN voiced everything was brought to the attention of the DON on Monday morning, around 11:00 a.m., but she already knew about it. The DON, entered the office shared with RN #71 at 1:18 p.m. she said NA #79 told her yesterday morning (06/19/17) , and reported the NA thought she had told the med (medication) cart nurse. The DON said it was still being investigated. The abuse, neglect and exploitation policy, with an implementation date of 11/15/16, was reviewed on 06/20/17 at 11:47 a.m. The policy defined verbal abuse as follows: the use of oral, written, or gestured language that willfully includes disparaging and derogatory terms to residents or their families, or within their hearing distance regardless of their age, ability to comprehend, or disability. The definition of abuse was noted as the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain or mental anguish. This also includes the depravation by an individual, including a caretaker, of goods or services that are necessary to attain or maintain physical, mental, and psychosocial well-being. Policy number eight (8) noted the facility would make efforts to protect all residents after alleged abuse, neglect, .Examples of ways to protect the residents included h.) time off for nursing staff and increased supervision of staff and/or residents. -Number nine (9) required the nurse respond to the needs of the resident and protect them from further incident, -notify the DON and administrator, -initiate an investigation immediately and call the social worker and administrator to assist, -notify the attending physician, resident's family/legal representative and medical director -Suspend the accused employee pending completion of the investigation. Remove the employee from the resident care areas immediately . The schedule, reviewed on 06/20/17 at 12:30 p.m., indicated NA #22 worked on 06/14/17, 06/15/17, 06/16/17 and 06/19/17 on the 3:00 - 11:00 shift. The time card indicated the nurse aide worked: 06/14/17 from 2:57 p.m. to 11:23 p.m. 06/15/17 from 2:57 p.m. to 11:23 p.m. 06/16/17 from 2:57 p.m. to 11:23 p.m. and 06/19/17 from 2:59 p.m. to 6:00 p.m. Assignment sheets noted NA #22 provided care to residents as follows: 06/14/17: Resident #1, #4, #5, #15, #27, #30, #32, #37, #52, #53 and #54 06/15/17: Resident #1, #3, #6, #7, #11, #17, #20, #25, #31, #34, #39, #48, #49 and #56 (discharged ) 06/16/17: Resident #8, #9, #14, #17, #20, #24, #29, #35, #38, #40, #44, #45, 06/19/17: The assignment sheet did not reflect NA #22 had worked. The assignment list reflected NA #22 had worked on two (2) of two (2) hallways. During a follow-up interview with AA #2, at 1:45 p.m., she verbalized she had spoken with Administrator #1, and expressed she understood the facility failed to protect the residents by allowing NA #22 to continue working from 06/14/17 to 06/19/17.", "filedate": "2020-09-01"}
{"rowid": 166, "facility_name": "ST. BARBARA'S MEMORIAL NURSING HOME", "facility_id": 515012, "address": "PO BOX 9066", "city": "FAIRMONT", "state": "WV", "zip": 26555, "inspection_date": "2017-06-20", "deficiency_tag": 225, "scope_severity": "D", "complaint": 1, "standard": 0, "eventid": "HCKF11", "inspection_text": "> Based on review of reported allegations, staff interview, family interview, and policy review, the facility failed to report timely and/or investigate an allegation of abuse for one (1) of five (5) allegations reviewed. Resident identifier: Resident #1. Facility census: 55. Findings include: a) Resident #1 On 06/20/17 at 11:10 a.m., Assistant Administrator (AA) #11 was questioned as to whether the facility had any reportable allegations in the previous three (3) to six (6) months. The AA referred the question to Registered Nurse (RN) #71. Upon inquiry, the RN provided an allegation which she verbalized was being investigated. The immediate reporting form indicated Nurse Aide (NA) #79 had reported the allegation to the DON on 06//19/17, alleging NA #22 had used foul language/cursed at Resident #1 when the resident requested to be put back to bed after being toileted on the three o'clock to eleven o'clock (3:00 - 11:00) afternoon shift. Licensed Practical Nurse (LPN) #66, interviewed on 06/20/17 at about 10:30 a.m., said the LPN's role was to tell the director of nursing (DON), and the DON would do the rest. With further questioning, the LPN said the Charge Nurse would be notified on evenings and weekends, and that person would notify the appropriate entities. NA#79, interviewed via telephone on 06/20/17 at 12:10 p.m. verbalized she usually worked dayshift, but had worked over that day. The nurse aide said the resident was toileted on the bedside commode and when done was put in the wheelchair (w/c). The NA said the resident asked what time dinner was served and was told about 5:30 p.m. NA#79 stated Resident #1 asked to be put back to bed because it was only 4:00 p.m. The nurse aide alleged NA#22 told the resident they were not playing these f-----g games and don't (do not) care what your daughter says. You are not being babied. NA#79 verbalized she notified LPN #63, who was passing medications. The LPN then ensured the resident was placed back in bed. NA #79 verbalized during the interview, that she went back into the room and apologized for what had happened. The nurse aide said Resident #1 did not exhibit behaviors, was a very sweet person. The NA said the resident's routine was to toilet and lay down. The resident would get up fifteen (15) minutes before meals. The NA voiced she thought the family member had talked to the facility about it. Resident #1, interviewed on 06/20/17 at about 12:30 p.m. ,was in bed, lying on left side, awake and alert. The resident verbalized that staff sometimes puts her down too hard when putting her back in bed. Resident #1 said when she had a concern she told her daughter and the daughter talked to the facility. Family Member (FM) #1, interviewed at 12:48 p.m., verbalized she had not made a formal complaint because her mother was confused as to dates and times. FM #1 said the resident informed her that someone said, Well, that was totally unnecessary to another staff person when they were providing care. The family member said she informed RN #73 last week about Resident #1's concerns, but did not file a formal complaint with the facility, because she did not know if it was true. The minimum data set (MDS) with an assessment reference date (ARD) of 04/28/17 indicated Resident #1 had a brief interview for mental status (BIMS) score of 08 which indicated moderate cognitive impairment. During an interview with the assistant administrator, at 1:10 p.m., she voiced the LPN should have started the investigative process, filled out forms, notified the charge nurse, and called the social worker so there was no lag time. The administrator verbalized that she, the director of nursing, and the social worker were out of the building last week. When asked who was in charge, she said Administrator #10, whatever charge nurse, and RN #71. RN #71, interviewed at 1:17 p.m., voiced FM #1 had spoken to her on Monday (06/19/17) about an incident that happened concerning one of the aides, but did not know whether or not it was truthful. The nurse said the FM did not say what happened. The RN voiced everything was brought to the attention of the DON on Monday morning, around 11:00 a.m., but she already knew about it. The DON, entered the office shared with RN #71 at 1:18 p.m. she said NA #79 told her yesterday morning (06/19/17) , and reported the NA thought she had told the med (medication) cart nurse. The DON said the LPN did not identify it as an allegation of abuse, and it was still being investigated. The abuse, neglect and exploitation policy, with an implementation date of 11/15/16, was reviewed on 06/20/17 at 11:47 a.m. The policy defined verbal abuse as follows: the use of oral, written, or gestured language that willfully includes disparaging and derogatory terms to residents or their families, or within their hearing distance regardless of their age, ability to comprehend, or disability. The definition of abuse was noted as the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain or mental anguish. This also includes the depravation by an individual, including a caretaker, of goods or services that are necessary to attain or maintain physical, mental, and psychosocial well-being. Number seven (7) of the abuse policy required when suspicion or reports of abuse, neglect or exploitation or reports of abuse occur, an investigation is immediately warranted. Once the resident is cared for and the initial reporting has occurred, an investigation should be conducted. Components of an investigation may include: Interview the involved resident, if possible, and if the resident is cognitively impaired interview several times to compare responses. Other interviews may include family members, roommates, residents in adjoining rooms, staff members in the area, and visitors in the area. During a discussion with the administrator, on 06/20/17 at 1:45 p.m., she verbalized acknowledgement that anyone could have reported the allegation of abuse, including the nurse aide.", "filedate": "2020-09-01"}
{"rowid": 167, "facility_name": "ST. BARBARA'S MEMORIAL NURSING HOME", "facility_id": 515012, "address": "PO BOX 9066", "city": "FAIRMONT", "state": "WV", "zip": 26555, "inspection_date": "2017-06-20", "deficiency_tag": 226, "scope_severity": "E", "complaint": 1, "standard": 0, "eventid": "HCKF11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on review of reported allegations, resident interview, staff interview, family interview, staffing records, policy review, and personnel record review; the facility failed to implement policies and procedures after an allegation of abuse for one (1) of five (5) allegations reviewed. The facility failed to protect residents, and failed to report and/or investigate the allegation in a timely manner. This had the potential to affect more than an isolated number of residents. Resident identifier: Resident #1. Facility census: 55. Findings include: a) Resident #1 On 06/20/17 at 11:10 a.m., Assistant Administrator (AA) #11 was questioned as to whether the facility had any reportable allegations in the previous three (3) to six (6) months. The AA referred the question to Registered Nurse (RN) #71. Upon inquiry, the RN provided an allegation which she verbalized was being investigated. The immediate reporting form indicated Nurse Aide (NA) #79 had reported the allegation to the DON on 06//19/17, alleging NA #22 had used foul language/cursed at Resident #1 when the resident requested to be put back to bed after being toileted on the three o'clock to eleven o'clock (3:00 - 11:00) afternoon shift. Licensed Practical Nurse (LPN) #66, interviewed on 06/20/17 at about 10:30 a.m., had verbalized the facility completed annual training in-services, and had one scheduled for Wednesday, 06/21/17, related to abuse and neglect. The nurse said the LPN's role was to tell the director of nursing (DON) and the DON would do the rest. With further questioning, the LPN said the Charge Nurse would be notified on evenings and weekends, and that person would notify the appropriate entities. The LPN voiced she was unaware of any reportable allegations, other than six (6) to eight (8) months ago. LPN #66 said if the alleged perpetrator was an employee the person would not be allowed to work with the involved resident. NA#79, interviewed via telephone on 06/20/17 at 12:10 p.m. verbalized she usually worked day shift, but had worked over that day. The nurse aide said the resident was toileted on the bedside commode and when done was put in the wheelchair (w/c). The NA said the resident asked what time dinner was served and was told about 5:30 p.m. NA#79 stated Resident #1 asked to be put back to bed because it was only 4:00 p.m. The nurse aide alleged NA#22 told the resident they were not playing these f-----g games and don't (do not) care what your daughter says. You are not being babied. NA#79 verbalized she notified LPN #63, who was passing medications. The LPN then ensured the resident was placed back in bed. DNA #79 verbalized during the interview, that she went back into the room and apologized for what had happened. The nurse aide said Resident #1 did not exhibit behaviors, was a very sweet person. The DNA said the resident's routine was to toilet and lay down. The resident would get up fifteen (15) minutes before meals. The DNA voiced she thought the family member had talked to the facility about it. Resident #1, interviewed on 06/20/17 at about 12:30 p.m. ,was in bed, lying on the left side, awake and alert. The resident verbalized that staff sometimes puts her down too hard when putting her back in bed. Resident #1 said when she had a concern she told her daughter and the daughter talked to the facility. The Kardex report noted Resident #1 required assistance of two (2) persons for all transfers. The care plan indicated the resident required extensive assistance (weight bearing assistance) from staff for toileting. The care plan also indicated Resident #1 was at risk for chronic pain related to the [DIAGNOSES REDACTED]. The intervention's section noted the resident was able to call for assistance when in pain, ask for medication, and tell staff how much pain was experienced. Resident #1, interviewed on 06/20/17 at about 12:30 p.m. ,was in bed, lying on left side, awake and alert. The resident verbalized that staff sometimes puts her down too hard when putting her back in bed. Resident #1 said when she had a concern she told her daughter and the daughter talked to the facility. Family Member (FM) #1, interviewed at 12:48 p.m., verbalized she had not made a formal complaint because her mother was confused as to dates and times, FM #1 said the resident told someone said, Well, that was totally unnecessary to another staff person when performing care. She said she informed RN#73 last week about Resident #1's concerns, but did not file a formal complaint because she did not know if it was true. The minimum data set (MDS) with an assessment reference date (ARD) of 04/28/17 indicated Resident #1 had a brief interview for mental status (BIMS) score of 08 which indicated moderate cognitive impairment. During another interview with the assistant administrator, at 1:10 p.m., she voiced the LPN started the investigative process, filled out forms, notified the charge nurse called the social worker so there was no lag time. The administrator verbalized that she, the director of nursing, and the social worker were out of the building last week. When asked who was in charge, she said Administrator #10, whatever charge nurse, and RN #71. RN #71, interviewed at 1:17 p.m., voiced FM #1 had spoken to her on Monday (06/19/17) about an incident that happened concerning one of the aides, but did not know whether or not it was truthful. The nurse said the FM did not say what happened. The RN voiced everything was brought to the attention of the DON on Monday morning, around 11:00 a.m., but she already knew about it. The DON, entered the office shared with RN #71 at 1:18 p.m. she said DNA #79 told her yesterday morning (06/19/17) , and reported the DNA thought she had told the med (medication) cart nurse. The DON said it was still being investigated. The abuse, neglect and exploitation policy, with an implementation date of 11/15/16, was reviewed on 06/20/17 at 11:47 a.m. The policy defined verbal abuse as follows: the use of oral, written, or gestured language that willfully includes disparaging and derogatory terms to residents or their families, or within their hearing distance regardless of their age, ability to comprehend, or disability. The definition of abuse was noted as the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain or mental anguish. This also includes the depravation by an individual, including a caretaker, of goods or services that are necessary to attain or maintain physical, mental, and psychosocial well-being. Policy number eight (8) noted the facility would make efforts to protect all residents after alleged abuse, neglect, .Examples of ways to protect the residents included h.) time off for nursing staff and increased supervision of staff and/or residents. -Number nine (9) required the nurse respond to the needs of the resident and protect them from further incident, -notify the DON and administrator, -initiate an investigation immediately and call the social worker and administrator to assist, -notify the attending physician, resident's family/legal representative and medical director -Suspend the accused employee pending completion of the investigation. Remove the employee from the resident care areas immediately . The schedule, reviewed on 06/20/17 at 12:30 p.m., indicated DNA #22 worked on 06/14/17, 06/15/17, 06/16/17 and 06/19/17 on the 3:00 - 11:00 shift. The time card indicated the nurse aide worked: 06/14/17 from 2:57 p.m. to 11:23 p.m. 06/15/17 from 2:57 p.m. to 11:23 p.m. 06/16/17 from 2:57 p.m. to 11:23 p.m. and 06/19/17 from 2:59 p.m. to 6:00 p.m. Assignment sheets noted DNA #22 provided care to residents as follows: 06/14/17: Resident #1, #4, #5, #15, #27, #30, #32, #37, #52, #53 and #54 06/15/17: Resident #1, #3, #6, #7, #11, #17, #20, #25, #31, #34, #39, #48, #49 and #56 (discharged ) 06/16/17: Resident #8, #9, #14, #17, #20, #24, #29, #35, #38, #40, #44, #45, 06/19/17: The assignment sheet did not reflect DNA #22 had worked. The assignment list reflected DNA #22 had worked on two (2) of two (2) hallways. Policy number eight (8) noted the facility would make efforts to protect all residents after alleged abuse, neglect, .Examples of ways to protect the residents included h.) time off for nursing staff and increased supervision of staff and/or residents. Number nine (9) required the nurse respond to the needs of the resident and protect them from further incident, notify the DON and administrator, initiate an investigation immediately and call the social worker and administrator to assist, and notify the attending physician, resident's family/legal representative and medical director. During a follow-up interview with AA #2, at 1:45 p.m., she verbalized she had spoken with Administrator #1, and expressed she understood the facility failed to protect the residents by allowing DNA #22 to continue working from 06/14/17 to 06/19/17.", "filedate": "2020-09-01"}
{"rowid": 168, "facility_name": "ST. BARBARA'S MEMORIAL NURSING HOME", "facility_id": 515012, "address": "PO BOX 9066", "city": "FAIRMONT", "state": "WV", "zip": 26555, "inspection_date": "2019-06-26", "deficiency_tag": 584, "scope_severity": "E", "complaint": 1, "standard": 0, "eventid": "UZ4411", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on observation and staff interview the facility failed to ensure a safe, comfortable, orderly, homelike environment. The screens in the windows of ten (10) out of thirty (30) resident rooms were either torn or not adequately secured snugly to the window. This had the potential to allow entrance of insects or flies into resident rooms. Rooms: 27, 29, 24, 21, 20, 18, 15, 13, 10, 9. Facility census: 53. Findings included: a) room [ROOM NUMBER] On 06/25/19 at 9:45 AM an inspection was made of room [ROOM NUMBER]. The first bed was stripped bare. A tag on the foot of the bed noted this bed was deep cleaned by housekeeping staff on 06/22/19. Resident #49 lay in the bed by the window. The large picture window in this room was closed. A screen was observed in the middle section of the picture window. When asked if she ever opened this window, she replied in the affirmative. The interim director of nursing (DON) unlocked the window and slid it toward the right. The screen had a tear in the lower left corner which was opened to about a two (2) inch by two (2) inch hole. This hole could allow entrance of an insect or a fly into the room if the window was to be opened. The interim DON said she did not know this window could be opened or ever was opened. She noted that the screen also did not fit tightly against the window pane and was loose. She said she would have maintenance make the necessary repairs to this window screen. When asked if a visitor or family member of either resident in this room could potentially have opened the window and let a fly into the room, she said she guessed that was possible. The interim DON informed the administrator of the window screen situation. The administrator then gave directives to the maintenance department to check all the windows in resident rooms for tears in screens or for ill-fitting screens. b) A tour of the facility to check the windows and screens of resident room was conducted on 06/25/19 from 12:30 PM to 1:00 PM. The following issues were found as follows: 1. room [ROOM NUMBER] - The screen does not fit the window securely. There was a small hole in the screen on the right lower corner where it was not flush with the window. 2. room [ROOM NUMBER] - The right side of the screen does not fit tightly. There screen had a gap at the bottom of the window about twelve (12) inches wide. The frame of the screen did not fit well. 3. room [ROOM NUMBER] - The screen on the right toward the bottom corner had a small hole. There was a small hole in the middle on the bottom portion. 4. room [ROOM NUMBER] - The screen had two (2) small holes on the bottom left and middle. 5. room [ROOM NUMBER] - The screen on the lower middle and lower right side had had two (2) small holes. 6. room [ROOM NUMBER] - The screen was loose and did not fit tightly against the metal frame about ten (10) to twelve (12) inches on the left lower side. 7. room [ROOM NUMBER] - The screen on the right side of the left window did not fit snugly against the metal frame. 8. room [ROOM NUMBER] - The left side and the top of the left window screen was very loose. 9. room [ROOM NUMBER] - The lower left area of the screen in the right window has an open area. c) A tour of the facility was conducted with the interim DON on 06/26/19 at approximately 3:00 PM. She agreed with the findings. The window screen in room [ROOM NUMBER] had been repaired.", "filedate": "2020-09-01"}
{"rowid": 169, "facility_name": "ST. BARBARA'S MEMORIAL NURSING HOME", "facility_id": 515012, "address": "PO BOX 9066", "city": "FAIRMONT", "state": "WV", "zip": 26555, "inspection_date": "2019-06-26", "deficiency_tag": 656, "scope_severity": "D", "complaint": 1, "standard": 0, "eventid": "UZ4411", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on medical record review and staff interview, the facility failed to develop person-centered, individualized care plan with measurable goals and appropriate interventions for one (1) of four (4) sampled residents. Resident identifier: #4. Facility census: 53. Findings included: a) Resident #4 The medical record was reviewed on 06/25/19 and continued through 06/26/19. Resident #4 was an elderly resident with [DIAGNOSES REDACTED]. On 04/24/19 a nurse's note conveyed that a venous stasis ulcer was beginning to open on the top of the right foot. Nursing notified the physician. The physician gave orders to cleanse the venous stasis ulcer to the top of the right foot with normal saline, pat dry, apply Silversorb gel to the wound bed, and cover with a dry dressing every day shift and as needed. A nurse's note dated 04/30/19 described the wound to the top of the right foot as full thickness tissue loss, 80% black tissue and 20% slough. The next nurse's note related to the stasis ulcer to the top of the right foot occurred on 05/18/19, when the physician gave new orders for [MEDICATION NAME] (antibiotic) 875 milligram (mg)/125 milligrams (mg) orally twice daily for seven (7) days for wound. A physician's hand-written progress note dated 05/18/19 assessed that the right foot has open area, and skin surrounding it has [DIAGNOSES REDACTED] and some purulent drainage. The diagnostic impression was [MEDICAL CONDITION] of the right foot. The plan was to administer [MEDICATION NAME] 875 mg. twice daily for a week. Review of the weekly wound observation tool dated 06/07/19 found the nurse described the stasis ulcer to the top of the right foot as 100% black, scab-like tissue with a small amount of serosanguinous drainage. The wound measured 75 millimeters long by 22 millimeters wide. A weekly wound observation tool dated 06/21/19 assessed that the stasis ulcer was 100% black, scab-like tissue with a small amount of serosanguinous drainage. Measurements were 70 millimeters long by 30 millimeters wide. Per a nurse's note dated 06/22/19 at 3:11 PM, a nursing assistant (NA) called the nurse to the room. The former director of nursing (DON) was present and was assessing the resident's right foot. The right foot was noted to be swollen and red with two (2) open areas between toes with one (1) white maggot visible. The DON notified the resident's physician, who in turn gave orders to transfer her to the hospital for evaluation. The family was at the bedside at the time. On 06/25/19 at 4:45 PM the interim DON provided a copy of the resident's care plan. Review of this care plan found there were no goals for the stasis ulcer, and no specific interventions for the stasis ulcer. - Page twelve (12) of the care plan had a focus that she was on diuretic therapy related to [MEDICAL CONDITION] from venous stasis and recurring stasis ulcer/[MEDICAL CONDITION]. The goal stated she would be free of any discomfort or adverse side effects of diuretic therapy. - Page thirteen (13) of the care plan had a focus that the resident was on antibiotic therapy ([MEDICATION NAME]) related to infection (venous stasis of right lower leg/foot). The goal stated the following: 1. The resident will be free of any discomfort or adverse side effects of antibiotic therapy through the review date. Interventions were the following: 1. Administer antibiotic medications as ordered by the physician, and monitor/document side effects and effectiveness every shift 2. Monitor/document/report as needed adverse reaction to the antibiotic therapy 3. Monitor/document/report as needed signs and symptoms of secondary infection related to antibiotic therapy such as oral thrush, persistent diarrhea, and vaginitis/itchy perineum or discharge 4. Report pertinent lab test results to the physician. An interview was conducted with the administrator and the DON on 06/25/19 at 5:15 PM. It was discussed that there were no measurable goals or specific intervention in the resident's care plan related to the stasis ulcer to the top of the right foot. They listened and expressed understanding. No further information was provided prior to exit on 06/26/19.", "filedate": "2020-09-01"}
{"rowid": 170, "facility_name": "ST. BARBARA'S MEMORIAL NURSING HOME", "facility_id": 515012, "address": "PO BOX 9066", "city": "FAIRMONT", "state": "WV", "zip": 26555, "inspection_date": "2019-07-10", "deficiency_tag": 656, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "5N8D11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, medical record reviews and staff interviews, the facility failed to develop a person-centered comprehensive care plan for two (2) of twenty one (21) care plans reviewed during the Long Term Care Survey Process (LTCSP). The care plan for R2 was not developed to address her end-of-life wishes and the care plan for R1 did not address the use of an arm sling. Resident identifiers: R1 and R2. Facility census: 53. Findings included: a) R2 During a medical record review on 07/10/19 revealed the care plan had not been developed to reflect R2's wishes for her end-of-life care. In an interview on 07/10/`19 at 9:35 AM with the Nursing Home Administrator verified, the care plan did not address the end-of-life wishes for R2. b) R1 During an interview and observation on 07/08/19 at 12:30 PM, R1 reported she was wearing an arm sling because she had broken her arm and dislocated her shoulder during a stay at another facility. Random observations during the survey revealed R #1's continued use of the right arm sling. Review of the medical record on 07/09/19, revealed an orthopedic note dated 07/18/18 with a [DIAGNOSES REDACTED]. The treatment included a right arm sling. The Occupational Therapy Discharge Note dated 07/30/2018 to 09/25/18, states under the section titled Equipment issued .pt (patient) continues to wear sling per her preference. The current care plan with a revision date of 07/09/19, is silent in regards to R1's continued use of the right arm sling. During an interview on 07/09/19 at 11:00 AM, Licensed Practical Nurse (LPN) #39 confirmed R1's care plan does not identify the arm fracture or address the sling she continues to wear for comfort.", "filedate": "2020-09-01"}
{"rowid": 171, "facility_name": "ST. BARBARA'S MEMORIAL NURSING HOME", "facility_id": 515012, "address": "PO BOX 9066", "city": "FAIRMONT", "state": "WV", "zip": 26555, "inspection_date": "2019-07-10", "deficiency_tag": 657, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "5N8D11", "inspection_text": "**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 care plan had been revised to reflect the discontinued use of a diabetic medication for R45. This was found to be true for one (1) of twenty one (21) care plans reviewed during the Long Term Care Survey Process (LTCSP). Resident identifier: R45 Facility census: 53. Findings included: a) R45 During a medical record review on 07/09/19 revealed the care plan for R2 had not been revised to reflect the discontinuation of the diabetic medication [MEDICATION NAME]. In an interview on 07/09/19 at 2:11 PM with the Director of Nursing, verified the care plan for R45 had not been revised to indicate the diabetic medication [MEDICATION NAME] had been discontinued on 03/06/19.", "filedate": "2020-09-01"}
{"rowid": 172, "facility_name": "ST. BARBARA'S MEMORIAL NURSING HOME", "facility_id": 515012, "address": "PO BOX 9066", "city": "FAIRMONT", "state": "WV", "zip": 26555, "inspection_date": "2019-07-10", "deficiency_tag": 684, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "5N8D11", "inspection_text": "Based on observation, medical record review and staff interview, the facility failed to ensure R52 received treatment and care in accordance with professional standards of practice. During a random observation it was discovered the oxygen concentrator was delivering air flow to R52 at a rate of four (4) liters and not the prescribed two (2)-three (3) liters. This was true for one (1) of two (2) residents reviewed for Respiratory Care Services during the Long Term Care Survey Process (LTCSP). Resident identifier: R52. Facility census: 53. Findings included: a) R52 During an observation on 07/09/19 at 3:50 PM for R52, it was discovered the oxygen concentrator was delivering air flow to R52 at a rate of four (4) liters and not the ordered 2-3 liters via nasal cannula for shortness of breath. In an interview on 07/09/19 at 3:55 PM with E60 Licensed Practical Nurse (LPN) verified the oxygen concentrator for R52 was providing an air flow of four (4) liters and not the ordered two (2)-three (3) liters.", "filedate": "2020-09-01"}
{"rowid": 173, "facility_name": "ST. BARBARA'S MEMORIAL NURSING HOME", "facility_id": 515012, "address": "PO BOX 9066", "city": "FAIRMONT", "state": "WV", "zip": 26555, "inspection_date": "2019-07-10", "deficiency_tag": 689, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "5N8D11", "inspection_text": "Based on observation and staff interview, the facility failed to provide an environment free from accident hazards over which the facility had control. A bottle of shampoo/body wash was accessible to residents in the unsecured community bathroom. This practice had the potential to affect more than a limited number of residents. Facility census: 53. Findings include:d a) Observations During initial tour observation of the middle of the facility hallway by activities room on 07/08/19 at 10:35 AM, discovered the community bathroom door open and unlocked. An eye wash station is located inside the bathroom and a 12 ounce bottle of Soothe and Cool Shampoo and Body Wash was found sitting in the basin of the eye wash station. The label stated, External use only. Avoid contact with eyes. b) Interview Immediately following the observation, Employee #69 walked into the open door of the bathroom and removed the bottle of the shampoo/body wash from the basin of the eye wash station. Upon inquiry she stated, No this bottle does not belong in the bath area or the eye wash station. Employee #69 agreed it is an accident hazard due to being accessible to residents.", "filedate": "2020-09-01"}
{"rowid": 174, "facility_name": "ST. BARBARA'S MEMORIAL NURSING HOME", "facility_id": 515012, "address": "PO BOX 9066", "city": "FAIRMONT", "state": "WV", "zip": 26555, "inspection_date": "2019-07-10", "deficiency_tag": 695, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "5N8D11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, medical record review and staff interview, the facility failed to provide respiratory care services, consistent with professional standards of practice. This was true for one (1) of two (2) residents reviewed for respiratory services. During an observation it was discovered R52 was receiving her oxygen air flow at four 4 litters and not the ordered two (2)-three (3) liters. Resident identifier: R52. Facility census: 53. Findings included: a) R52 During a medical record review on 07/09/19, revealed the physician's orders [REDACTED]. An observation on 07/09/19 at 3:50 PM, it was discovered the oxygen concentrator for R52 had an air flow set on four (4) liters. An observation by E60, licensed practical nurse (LPN) verified the oxygen concentrator for R52 was providing an air flow of four (4) liters and not the ordered two (2) to three (3) liters as per orders.", "filedate": "2020-09-01"}
{"rowid": 175, "facility_name": "ST. BARBARA'S MEMORIAL NURSING HOME", "facility_id": 515012, "address": "PO BOX 9066", "city": "FAIRMONT", "state": "WV", "zip": 26555, "inspection_date": "2019-07-10", "deficiency_tag": 755, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "5N8D11", "inspection_text": "Based on record review and staff interview, the facility failed to maintain complete and accurate drug records to ensure an account of all controlled medications (medications which fall under US Drug Enforcement Agency (DEA) Schedules II-V, and have a potential for abuse, ranging from low to high, and may also lead to physical or psychological dependence). This practice has the potential to affect all residents residing in the facility. Facility census: 53. Findings included: a) At 3:07 PM on 07/09/19, a review of the medication carts with Licensed Practical Nurse (LPN) #60 and LPN #76, revealed incomplete controlled substance medication count sheets on one (1) of two (2) med carts. LPN #76 reported the off going and the on coming nurses count the controlled medications together and then sign the Controlled Substances Shift Count form. LPN #60 confirmed the narcotic count sheet was incomplete on 07/04/19, 07/06/19 and 07/07/19. The Controlled Substance Shift Count form states at the top: Federal Drug Standards require accountability for all controlled substances. The count must be verified at the time there is a change of responsibility for the drugs from one nurse to another. Two (2) licensed nurses, oncoming and off going, will count the controlled drugs together and signed to verify the accuracy of the count. Any discrepancy, without exception, must immediately be reported to the Director of Nursing or Designee . The controlled substance shift count form for (MONTH) 2019, lacks numbers identifying the current medication counts on 07/04/19 day shift and 07/07/19 evening shift. In addition, the signature section is blank for Nurse II on 07/06/19 and 07/07/19 and blank for Nurse I on 07/07/19.", "filedate": "2020-09-01"}
{"rowid": 176, "facility_name": "ST. BARBARA'S MEMORIAL NURSING HOME", "facility_id": 515012, "address": "PO BOX 9066", "city": "FAIRMONT", "state": "WV", "zip": 26555, "inspection_date": "2019-07-10", "deficiency_tag": 756, "scope_severity": "F", "complaint": 0, "standard": 1, "eventid": "5N8D11", "inspection_text": "Based on policy review and staff interview, the facility failed to develop and maintain policies and procedures for the monthly drug regimen review that include time frames for physician notification and response of drug irregularities. This practice has the potential to affect all residents. Facility census: 53. Findings included: a) On 07/09/19 at 2:00 PM, review of the facility policy titled Medication Regimen Review with an implemented date of 12/06/18 and reviewed/revised date of 03/19/19, states the following (typed as written): 5. The pharmacist shall communicate any irregularities to the facility in the following ways: a. Verbal communication to the attending physician, Director of Nursing (DON), and/or staff of any urgent needs. b. Written communication to the attending physician, the facility's Medical Director, and the Director of Nursing. 6. Written Communications from the pharmacist shall become a permanent part of the resident's medical record. 7. Timelines and responsibilities for the Medication Regimen Review: a. The consultant pharmacist shall schedule at least one monthly visit to the facility, and shall allow for sufficient time to complete all required activities. b. The pharmacist shall communicate any recommendations and identified irregularities via written communication within 10 working days of the review. c. If the pharmacist should identify an irregularity that requires urgent action to protect a resident, the DON or designee is informed verbally. d. Facility staff shall act upon all recommendations according to procedures for addressing medication regimen review irregularities. After review of the facility policy titled Medication Regimen Review on 07/09/19 at 2:30 PM, the DON and the Administrator agreed the facility policy does not contain time frames for physician notification and response of drug irregularities. The Administrator and DON explained the procedure is for the pharmacist to notify the physician by written communication. Both agree the policy should include time frames for the notification and response for the physician. The Administrator stated, The team and I will be determining an appropriate time frame and including it in the facility policy.", "filedate": "2020-09-01"}
{"rowid": 177, "facility_name": "ST. BARBARA'S MEMORIAL NURSING HOME", "facility_id": 515012, "address": "PO BOX 9066", "city": "FAIRMONT", "state": "WV", "zip": 26555, "inspection_date": "2019-07-10", "deficiency_tag": 761, "scope_severity": "F", "complaint": 0, "standard": 1, "eventid": "5N8D11", "inspection_text": "Based on observation, record review and staff interview, the facility failed to monitor the temperature of the medication refrigerator daily. This was true for one (1) of one (1) medication refrigerators and has the potential to affect all residents residing in the facility. Facility census: 53. Findings included: a) On 07/09/19 at 3:00 PM, a review of the medication room with Licensed Practical Nurse (LPN) #76, revealed the medication refrigerator temperature was not documented daily. The Refrigerator Temperature Log for (MONTH) 2019, was blank on 07/02/19 and 07/04/19. During this observation, LPN #76 confirmed the temperature log for the medication refrigerator was incomplete. LPN #76 reported the facility policy is the 3-11 nurse checks the temperature and documents the findings.", "filedate": "2020-09-01"}
{"rowid": 178, "facility_name": "ST. BARBARA'S MEMORIAL NURSING HOME", "facility_id": 515012, "address": "PO BOX 9066", "city": "FAIRMONT", "state": "WV", "zip": 26555, "inspection_date": "2019-07-10", "deficiency_tag": 812, "scope_severity": "F", "complaint": 0, "standard": 1, "eventid": "5N8D11", "inspection_text": "Based on observation and staff interview, the facility failed to ensure foods were stored under sanitary conditions after opening. During the kitchen tour it was discovered foods were not dated after opening. These food items were not stored in accordance with professional standards for food service safety. This had the potential to affect all residents receiving their nutrition from the kitchen. Facility census: 53. Findings included: a) Kitchen tour During the kitchen tour on 07/08/19 at 11:24 AM, it was discovered whipped cream, swiss cheese slices, bottled chocolate sauce and mustard were not dated after opening. These food items were not stored in accordance with professional standards for food service safety. In an interview on 07/08/19 at 11:35 AM the dietary manager (DM) verified the whipped cream, swiss cheese slices, chocolate sauce, and mustard were not dated after opening and the foods were not stored under proper food service safety.", "filedate": "2020-09-01"}
{"rowid": 179, "facility_name": "ST. BARBARA'S MEMORIAL NURSING HOME", "facility_id": 515012, "address": "PO BOX 9066", "city": "FAIRMONT", "state": "WV", "zip": 26555, "inspection_date": "2019-07-10", "deficiency_tag": 842, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "5N8D11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview the facility failed to ensure care and treatment was being provided in accordance with professional standards. This was true for two (2) of twenty- one (21) residents physician's orders [REDACTED]. R14 was not receiving oxygen therapy and still had an order for [REDACTED]. Facility census: 53. Findings include a) R14 During a medical record review on 07/10/19 revealed physician's orders [REDACTED]. In an interview with the Director of Nursing (DON) on 07/10/19 at 8:28 AM, verified the order for oxygen therapy should have been discontinued for R14 since she was no longer receiving oxygen. b) R52 During a medical record review on 07/09/19, revealed the physician's orders [REDACTED]. This order was not specific as to the correct amount of oxygen air flow R52 was to receive. In an interview with the Director of Nursing (DON) on 07/10/19 at 8:28 AM, verified the order for R52 was non-specific as to the correct amount of oxygen 2-3L she was to receive. For staff having to decide what air flow to provide 2-3L would be a decision outside their scope of practice.", "filedate": "2020-09-01"}
{"rowid": 180, "facility_name": "ST. BARBARA'S MEMORIAL NURSING HOME", "facility_id": 515012, "address": "PO BOX 9066", "city": "FAIRMONT", "state": "WV", "zip": 26555, "inspection_date": "2019-07-10", "deficiency_tag": 880, "scope_severity": "F", "complaint": 0, "standard": 1, "eventid": "5N8D11", "inspection_text": "Based on observation and staff interview, the facility failed to establish and maintain an infection prevention and control program designed to provide a safe, sanitary and comfortable environment and to help prevent the development and transmission of communicable diseases and infections. The laundry room lacked separation between the soiled and clean laundry/linen area and no identified negative air flow. In addition a cracked and worn computer mouse pad in use located on a medication cart. This has the potential to affect all residents in the facility. Facility census: 53. Findings included: a) Laundry Room On 07/09/19 at 8:30 AM during a tour of the laundry room in the presence of Employee #56 and #47, discovered no separation between the soiled and clean linen, also lacking identified negative air flow. The washers and dryers are located in the same room within close proximity. While standing in the middle of the room could feel air flow descending from ceiling. Employee #56 and #47 explained the laundry room has been like that except last year the facility made the room across the hall with the laundry chute the soiled room. Employee #56 explained the procedure for collecting the soiled linen. The soiled linen is retrieved from the cart under the laundry chute, sorted then covered with a sheet and transported across the hall to the laundry room to place in the washers. At 8:45 AM on 07/09/19, the Administrator and the Assistant Administrator #69 stated, We thought we had fixed the laundry issue when our plan of correction was accepted. We moved the soiled laundry to the other room and sort it there before taking it across the hall. I now understand what you are saying that it is still soiled linen coming into a clean room Upon inquiry about separation between soiled and clean linen with washers and dryers being in the same room, the Administrator stated, We will brainstorm how to separate the washers and dryers. Whether by putting up a wall with negative air flow. Maybe move the washers to the room with the laundry chute, but will need to put water and drains in a cement floor. The Assistant Administrator #69 stated, We will have a plan and figure it out how to correct this issue with the laundry. b) medication cart An observation during medication administration on the North West side on 07/09/19, revealed Licensed Practical Nurse (LPN) #76 utilizing a cracked and worn mouse pad with missing corners. During an interview on 07/09/19, LPN #76 acknowledged the mouse pad was a sanitation concern and needed to be replaced. She reported she would ask for a replacement immediately.", "filedate": "2020-09-01"}
{"rowid": 181, "facility_name": "ST. BARBARA'S MEMORIAL NURSING HOME", "facility_id": 515012, "address": "PO BOX 9066", "city": "FAIRMONT", "state": "WV", "zip": 26555, "inspection_date": "2018-09-27", "deficiency_tag": 550, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "DL7D11", "inspection_text": "Based on random observation, staff interviews and policy review, the facility failed to promote care for residents in a manner that maintained or enhanced dignity. The staff entered a resident's room without knocking, identifying themselves, or obtaining permission. This practice had the potential to affect a minimal number of residents. Resident identifiers: #24 and #31. Facility census 52. Findings included: a) Resident #24 and #31 During an observation of a resident room, on 09/24/18 at 11:30 AM, revealed Nurse Aide (NA) #40 walked into the room without knocking, identifying themselves, and asking for permission to enter Resident #24 and #31's room. NA #40 walked over to Resident #24's bed and stated, It is time to go to the bathroom. NA #40, turned around and left the room. A few minutes later NA#40 returned to room with NA #17 without knocking, identifying themselves, and asking for permission to enter Resident #24 and #31's room. The NA's walked over to Resident #24's bed. NA #17 went around to the far side of the bed. NA #40 was on the opposite side of the bed closest to the Resident in the A - bed and the door. NA#40 reached up and pulled down Resident #24's bed covers exposing the resident in an adult brief to her roommate with the door to the resident's room wide open for anyone to view inside. In an interview on 09/24/18 at 11:32 AM, NA #40 and #17, revealed the NA's forgot to knock on the residents door, identifying themselves and ask for permission prior to enter the room. The NA's also agreed they should have closed the entrance door to the room and pulled the curtain between the residents prior to pulling down Resident #24's bed covers. An interview on 09/24/18 at 12:00 PM, with the Assistant Administrator #13, she was informed of the observation above and she stated, I will address this matter. A review of the facility policy, on 09/27/18 at 2:00 PM, titled Promoting/Maintaining Resident Dignity with a revision date of 08/30/18, stated, Maintain Privacy. Staff shall knock on doors and properly announce themselves before entering.", "filedate": "2020-09-01"}
{"rowid": 182, "facility_name": "ST. BARBARA'S MEMORIAL NURSING HOME", "facility_id": 515012, "address": "PO BOX 9066", "city": "FAIRMONT", "state": "WV", "zip": 26555, "inspection_date": "2018-09-27", "deficiency_tag": 583, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "DL7D11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on random observation, staff interview and policy review, the facility failed to provide privacy for a resident during personal care. Staff failed to pull the curtain while performing personal care and close the door to the resident room. This practice had the potential to affect a minimal number of residents. Resident identifier: #24. Facility census 52. Findings included: a) Resident #24 During an observation of room [ROOM NUMBER], on 09/24/18 at 11:30 AM revealed Nurse Aide (NA) #40, walked into the room without knocking, identifying themselves, and asking for permission to enter Resident #24 and #31's room. NA #40 walked over to Resident #24's bed, in which she resides in the b bed, and stated, It is time to go to the bathroom. NA #40, turned around and left the room. A few minutes later NA#40 returned to room with NA #17 without knocking, identifying themselves, and asking for permission to enter Resident #24 and #31's room. The NA's walked over to Resident #24's bed. NA #17 went around to the far side of the bed. NA #40 was on the opposite side of the bed closes to the Resident in the A - bed and the door. NA#40 reached up and pulled down Resident #24's bed covers exposing the resident in an adult brief to her roommate with the door to the resident's room wide open for anyone to view inside. In an interview on 09/24/18 at 11:32 AM, NA #40 and #17, revealed the NA's forgot to knock on the residents door, identifying themselves and ask for permission prior to enter the room. The NA's also agreed they should have closed the entrance door to the room and pulled the curtain between the residents prior to pulling down Resident #24's bed covers. An interview on 09/24/18 at 12:00 PM, with the Assistant Administrator #13, she was informed of the observation above and she stated, I will address this matter. A review of the facility policy, on 09/27/18 at 2:10 PM, titled Resident Right to Privacy During Care with a revision date of 08/30/18, stated, Privacy curtains are to be pulled during direct patient care. The facility's policy stated that additionally the staff will maintain privacy by knocking on doors and properly announcing themselves before entering resident rooms.", "filedate": "2020-09-01"}
{"rowid": 183, "facility_name": "ST. BARBARA'S MEMORIAL NURSING HOME", "facility_id": 515012, "address": "PO BOX 9066", "city": "FAIRMONT", "state": "WV", "zip": 26555, "inspection_date": "2018-09-27", "deficiency_tag": 761, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "DL7D11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, staff interview, and policy review, the facility failed to ensure all multi-dose vials of insulin were dated when initially opened for used and needle-punctured. According to manufacturer's guidelines, [MEDICATION NAME]left in a multi-dose vial beyond twenty-eight (28) days of opening must be discarded. By not dating the multi-dose vial when initially opened, nursing staff had no way of knowing when to discard the vial. This practice had the potential to negatively impact the safety and/or potency of the insulin. This was evident for one (1) of ten (10) opened and used multi-dose vials of insulin observed. Resident identifier: #26. Facility census: 52. Findings include: a) Resident #26 Opened and used (needle punctured) multi-dose vials of insulin were observed on 09/27/18 at 10:53 AM. An opened and needle punctured vial of [MEDICATION NAME]for this resident contained no date to indicate when it had initially been opened for use. The label on the vial indicated pharmacy filled that prescription on 09/13/18. Licensed nurse employee #25 (E#25) was present at this time. She said staff should have dated this vial when initially opened to ensure that staff disposed of the vial twenty-eight (28) days after it was first opened for use. She said the [MEDICATION NAME]is used as sliding scale coverage for this resident's blood glucose checks per the glucometer. On 09/27/18 at 11:10 AM the director of nursing (DON) provided a copy of their policy titled Labeling of Medications and Biologicals with revision date of 08/30/18. Page two (2) and item number eight (8) of this policy stated All opened or accessed vials should be discarded within twenty-eight (28) days unless the manufacturer specified a different (shorter or longer) date for that opened vial. An interview was conducted with the administrator and assistant administrator on 09/27/18 at 1:15 PM. No further information was provided prior to exit.", "filedate": "2020-09-01"}
{"rowid": 184, "facility_name": "ST. BARBARA'S MEMORIAL NURSING HOME", "facility_id": 515012, "address": "PO BOX 9066", "city": "FAIRMONT", "state": "WV", "zip": 26555, "inspection_date": "2018-09-27", "deficiency_tag": 842, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "DL7D11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation , medical record review, and staff interview, the facility failed to ensure accurate medical transcription and documentation of a physician's orders [REDACTED]. A nurse wrote a physician's orders [REDACTED]. This order was transcribed onto the medication administration record at 2% strength. Nurses documented twelve (12) times they administered a 2% strength dose. However, pharmacy provided this prescription at 0.5% strength. Per a nursing drug handbook information, this ophthalmic ointment is only available at 0.5% strength. This was evident for one (1) of four (4) residents observed during medication pass out of thirty-four (34) medication administration observations. Resident identifier: #50. Facility census: 52. Findings included: a) Resident #50 During a medication administration observation on 09/26/18 at 9:10 AM, licensed nurse employee #26 (E#26) administered [MEDICATION NAME] 0.5% ophthalmic ointment to this resident's right eye. Observation of the electronic medical record found directive to administer [MEDICATION NAME] 2% ointment to the right eye. Review of the hard copy medical record revealed a hand-written physician's verbal order which was written by a nurse on 09/18/18 at 3:00 PM. This order directed to instill [MEDICATION NAME] ointment 2% topically to the right eye twice daily for seven (7) days related to irritation, redness, swelling. Review of the facility's Nursing (YEAR) drug handbook which was located at the nurses' station, found that [MEDICATION NAME] ophthalmic ointment is only available at the 0.5% strength. An interview was conducted with the assistant administrator on 09/26/18 at 9:15 AM regarding this scenario. She said this was a transcription error. The medication administration record (MAR) was reviewed on 09/26/18. The MAR contained a typed order to administer [MEDICATION NAME] ointment 2% to the right eye topically twice daily for seven (7) days. Nursing staff initialed on the electronic MAR twelve (12) times that they administered [MEDICATION NAME] 2% ointment to the right eye (including 09/26/18 for the 9:00 AM dose). An interview was conducted with the administrator and the assistant administrator on 09/27/18 at 1:15 PM where it was discussed that nursing on twelve (12) occasions documented on the MAR that they instilled [MEDICATION NAME] ointment 2%, although the pharmacy supplied [MEDICATION NAME] ophthalmic ointment 0.5%. They acknowledged their understanding. No further information was provided prior to exit.", "filedate": "2020-09-01"}
{"rowid": 185, "facility_name": "ST. BARBARA'S MEMORIAL NURSING HOME", "facility_id": 515012, "address": "PO BOX 9066", "city": "FAIRMONT", "state": "WV", "zip": 26555, "inspection_date": "2018-09-27", "deficiency_tag": 865, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "DL7D11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, staff interview, and policy review, the facility's quality assurance and performance improvement program (QAPI) / quality assessment and assurance (QAA) committee failed to identify and implement corrective action for quality deficiencies for which they should have been aware of to improve the lives of the residents. The facility failed to ensure that 10 out of 13 residents either received the appropriate pneumococcal immunization, or did not receive the pneumococcal immunization due to medical contraindication or refusal. These practices had the potential to affect more than a limited number of residents at the facility. Resident Identifiers: #26, #35, #42, #201, #24, #5, #101, #15, #4, #16, #17, #2, #30. Facility census: 52. Findings included: a) Staff interview at 11:13 on 09/26/18 with Licensed Practical Nurse (LPN) #70 revealed the facility did not routinely offer or administer the 13-valent pneumococcal conjugate vaccine (PVC13, Prevnar 13). The PVC13 is not readily available within the facility. LPN #70 also stated they only administer the PVC13 vaccine if it is specifically ordered by the physician, and the vaccine is not a standing order upon admission. b) Review of facility policy for Pneumococcal Vaccine state under Policy Explanation and Compliance Guidelines each resident will be offered a pneumococcal immunization unless it is medially contraindicated, or the resident has already been immunized, and prior to immunization the resident or resident's representative will have the opportunity to refuse. The policy also state the type of pneumococcal vaccine, 13-valent pneumococcal conjugate vaccine (PVC13, Prevnar 13) or 23-valent pneumococcal [MEDICATION NAME] vaccine (PPSV23, [MEDICATION NAME] 23) offered will depend upon the recipient's age and suitability to pneumonia, in accordance with current Centers for Disease Control (CDC) guidelines and recommendations. Explanation of the facility's compliance guidelines indicate the residents medical record must include documentation that indicates the resident received the pneumococcal immunization or did not receive due to medical contraindication or refusal. c) Centers for Disease Control (CDC) guideline for Pneumococcal Vaccine Timing for adults [AGE] years or older state for those who have not received any pneumococcal vaccines, or those with unknown vaccination history, administer 1 dose of 13-valent pneumococcal conjugate vaccine (PVC13, Prevnar 13) then administer 1 dose of 23-valent pneumococcal [MEDICATION NAME] vaccine ([MEDICATION NAME] 23, PPSV23) at least one (1) year later for most immunocompetent adults or at least eight (8) weeks later for adults with immunocompromising conditions. For those who have previously received 1 dose of PPSV23 at age [AGE] years or older and no doses of PCV13, administer 1 dose of PCV13 at least one year after the dose of PPSV23 for all adults, regardless of medical conditions. d) Review of facility's immunization report documentation dated (MONTH) 26th, (YEAR) reveals no documentation of refusal or administration of the 13-valent pneumococcal conjugate vaccine (PVC13, Prevnar 13) for residents #26, #35, #42, #201, #24, #5, #101, #15, #4, #16, #17, #2, #30. e) These findings were shared on 09/27/18 at 1:10 PM with the Administrator #12 and she stated, We were not aware that we need to offer the Prevnar 13 (13-valent pneumococcal conjugate vaccine (PVC13, Prevnar 13), we have ordered it. No further information regarding the immunization process was provided by the facility prior to exit.", "filedate": "2020-09-01"}
{"rowid": 186, "facility_name": "ST. BARBARA'S MEMORIAL NURSING HOME", "facility_id": 515012, "address": "PO BOX 9066", "city": "FAIRMONT", "state": "WV", "zip": 26555, "inspection_date": "2018-09-27", "deficiency_tag": 880, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "DL7D11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, policy review, and staff interview the facility failed to maintain an effective infection control program designed to provide a safe and sanitary environment to help prevent the development of and transmission of communicable disease to the extent possible. A nursing assistant provided care to Resident #101 who was in contact precautions, without donning a gown or gloves. Licensed nurses cleaned the facility's two (2) resident shared glucometers improperly using 70% ethyl alcohol. One facility staff member was observed utilizing an improper hand-washing technique. The facility also failed to handle, store, and/or process linens in a satisfactory manner to prevent infection. These practices had the potential to affect more than a limited number of residents. Resident identifier: #101. Facility census: 52. Findings included: a) Resident #101 Observation on 09/24/18 at lunch time found nursing assistant employee #32 (E#32) entered the room of Resident #101 to deliver his lunch tray. A sign on the door conveyed that he was in contact precautions. An isolation cart sat outside his door in the hallway. E#32 did not don an isolation gown or gloves. She touched his bed linens with her bare hands. She touched his overbed tray with her bare hands. She picked up the bed control with her bare heads and raised the head of his bed. She helped him become positioned comfortably, and removed the brown plastic lid which covered the hot foods on his plate. At 12:19 PM E#32 walked down the hallway to the dining room where she passed this brown plastic plate cover through the kitchen window, where she placed it on top of other plate covers. She then used hand sanitizer and left the dining room. Review of the medical record on 09/25/18 found a physicians order dated 09/21/18 for contact isolation due to [MEDICAL CONDITION] resistant [DIAGNOSES REDACTED] aureus (MRSA) of the right foot wound. An interview was conducted with infection control registered nurse employee #11 (E#11) on 09/27/18 at 9:30 AM. When presented with the afore mentioned scenario, she said that staff should have gowned and gloved if they touched his bed. She said the lab faxed wound culture and gram stain results to them late in the day on 09/24/18. She said those results were negative. She provided a copy of a physician's orders [REDACTED]. This order was written, signed, and dated as 09/24/18 at 4:00 PM. She acknowledged that he was still in contact precautions at noon on 09/24/18 when observed. On 09/27/18 at 1:15 PM an interview was conducted with the administrator and the assistant administrator. They acknowledged this infection control infraction. No further evidence was provided prior to exit. b) Resident shared glucometers An interview was conducted with licensed nurse employee #47 (E#47) on 09/27/18 at 10:45 AM. She was asked when she cleans the glucometer and how she cleans it. She said she cleans the glucometer used for residents on her end of the hall with a 70% alcohol swab after each patient use. An interview was conducted with licensed nurse employee #25 (E#25) on 09/27/18 at 10:50 AM. She was asked when she cleans the glucometer and how she cleans it. She said she cleans the glucometer used for residents on her end of the hall with a 70% alcohol swab after each patient use. At 11:00 AM on 09/27/18 an interview was conducted with the director of nursing (DON). She provided a policy titled Glucometer Disinfection with revision date 08/27/18. Their policy directed that the facility will ensure blood glucometers will be cleaned and disinfected after each use and according to manufacturer's instructions for multi-resident use. It further stated that the glucometers should be disinfected with a wipe pre-saturated with an EPA (Environmental Protection Agency) registered healthcare disinfectant that is effective [MEDICAL CONDITION](human immunodeficiency virus), [MEDICAL CONDITION] and [MEDICAL CONDITION] virus. The DON produced a canister of Sani-Cloth wipes. She said that staff must use these Sani-Cloth wipes to clean and disinfect the glucometers after each use. She said that 70% alcohol was not acceptable. The label on this canister of Sani-Cloth wipes conveyed this product was a germicidal disposable wipe that was bactericidal, tuberculocidal, and virucidal in two (2) minutes. The label contained a statement that the wipes are effective against bacteria, multi-drug resistant bacteria, viruses, bloodborne pathogens, and pathogenic fungi. An interview was conducted with the administrator and the assistant administrator on 09/27/18 at 1:15 PM. They acknowledged their understanding of this issue. At 2:00 PM on 09/27/18, the assistant administrator provided a list of names of nine (9) residents in the facility who receive accu-checks at least daily. c) During observation of laundry pick up on 09/26/18 at 9:16, Laundry Supervisor (LS) #72 wore the same gloves throughout pick-up of all soiled linens on A wing unit, and while gathering soiled linens from various resident's rooms. LS #72 removed gloves after transferring all the soiled linen bags into the laundry shoot from linen cart. LS #72 did not wash her hands after removing gloves before initiating the next task. Compliance guidelines within the facility's hand washing policy state that all facility personnel must wash their hands for twenty seconds using the appropriate technique after handling soiled dressings, linens, contaminated equipment, and after removing gloves. LS #72 failed to utilize proper hand hygiene to prevent the spread of infection during observation on 09/26/18 at 9:40 AM. LS #72 was observed washing hands with soap and water, turning off water facet with clean hands, then drying hands with paper towels, therefore re-contaminating hands. Facility policy for Hand Washing states that proper hand washing technique is: Use water to wet hands. Apply soap. Rub hands and clean between fingers briskly for 20 seconds. Rinse under warm water. Towel dry with clean disposable towels. Turn off faucet with clean paper towels. d) The facility failed to handle, store, process, and transport linens so as to prevent the spread of infection. Observation of the laundry room on 09/26/18 at 9:22 AM, in the presence of the Laundry Supervisor (LS) #42 reveled the following: No separation between the soiled and clean linen areas. No identified negative airflow from the clean to soiled areas. During this observation LS #42 acknowledged the laundry room lacked separation between the clean and soiled areas and noted she was not aware negative air flow was needed, they were told to crack a window while air conditioning unit was on. LS #42 did not wear any protective barrier, such as apron or disposable gown, while handling soiled or clean linens, while allowing linens to touch her uniform and stated, Dirty laundry is always in a linen bag when they are sent down the laundry shoot, so we don't contaminate the area. LS #42 was observed at 9:30 AM on 09/23/18 removing a clean resident privacy curtain from the washer, allowing the linen to touch the floor and her uniform, then hanging the clean linen on a clothes line in the laundry room after the clean linen came into contact with staff's contaminated uniform. Review of facility policy for handling soiled linen state linen should not be allowed to touch the uniform and floor and should be handled as little as possible, with minimum agitation to avoid contamination of air, surfaces, and person. On 09/26/18 at 11:00 AM informed Assistant Administrator(AA) #13 of infection control issues with laundry and asked for policy on soiled linen, AA #13 advised she was unaware of requirements for laundry area environment requirement of separation of clean and soiled area and have never been cited for an issue.", "filedate": "2020-09-01"}
{"rowid": 187, "facility_name": "ST. BARBARA'S MEMORIAL NURSING HOME", "facility_id": 515012, "address": "PO BOX 9066", "city": "FAIRMONT", "state": "WV", "zip": 26555, "inspection_date": "2018-09-27", "deficiency_tag": 883, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "DL7D11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on staff interview, policy review and documentation review, the facility failed to ensure 10 out of 13 sample residents were given opportunity to receive, refuse, or to have contraindication determined for the appropriate pneumococcal vaccination to be administered. Resident identifiers: #26, #35, #42, #201, #24, #5, #101, #15, #4, #16, #17, #2, #30. Facility census: 52. Findings included: a) Staff interview at 11:13 on 09/26/18 with Licensed Practical Nurse (LPN) #70 revealed the facility did not routinely offer or administer the 13-valent pneumococcal conjugate vaccine (PVC13, Prevnar 13). The PVC13 is not readily available within the facility. LPN #70 also stated they only administer the PVC13 vaccine if it is specifically ordered by the physician, and the vaccine is not a standing order upon admission. b) Review of facility policy for Pneumococcal Vaccine state under Policy Explanation and Compliance Guidelines each resident will be offered a pneumococcal immunization unless it is medially contraindicated, or the resident has already been immunized, and prior to immunization the resident or resident's representative will have the opportunity to refuse. The policy also state the type of pneumococcal vaccine, 13-valent pneumococcal conjugate vaccine (PVC13, Prevnar 13) or 23-valent pneumococcal [MEDICATION NAME] vaccine (PPSV23, [MEDICATION NAME] 23) offered will depend upon the recipient's age and suitability to pneumonia, in accordance with current Centers for Disease Control (CDC) guidelines and recommendations. Explanation of the facility's compliance guidelines indicate the residents medical record must include documentation that indicates the resident received the pneumococcal immunization or did not receive due to medical contraindication or refusal. c) Centers for Disease Control (CDC) guideline for Pneumococcal Vaccine Timing for adults [AGE] years or older state for those who have not received any pneumococcal vaccines, or those with unknown vaccination history, administer 1 dose of 13-valent pneumococcal conjugate vaccine (PVC13, Prevnar 13) then administer 1 dose of 23-valent pneumococcal [MEDICATION NAME] vaccine ([MEDICATION NAME] 23, PPSV23) at least one (1) year later for most immunocompetent adults or at least eight (8) weeks later for adults with immunocompromising conditions. For those who have previously received 1 dose of PPSV23 at age [AGE] years or older and no doses of PCV13, administer 1 dose of PCV13 at least one year after the dose of PPSV23 for all adults, regardless of medical conditions. d) Review of facility's immunization report documentation dated (MONTH) 26th, (YEAR) reveals no documentation of refusal or administration of the 13-valent pneumococcal conjugate vaccine (PVC13, Prevnar 13) for residents #26, #35, #42, #201, #24, #5, #101, #15, #4, #16, #17, #2, #30. e) These findings were shared on 09/27/18 at 1:10 PM with the Administrator #12 and she stated, We were not aware that we need to offer the Prevnar 13 (13-valent pneumococcal conjugate vaccine (PVC13, Prevnar 13), we have ordered it. No further information regarding the immunization process was provided by the facility prior to exit.", "filedate": "2020-09-01"}
{"rowid": 188, "facility_name": "ST. BARBARA'S MEMORIAL NURSING HOME", "facility_id": 515012, "address": "PO BOX 9066", "city": "FAIRMONT", "state": "WV", "zip": 26555, "inspection_date": "2017-10-18", "deficiency_tag": 323, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "XKNG11", "inspection_text": "Based on observation and staff interview, the facility failed to ensure the resident environment over which it had control was as free from accident hazards as possible. Observations during Stage 1 of the Quality Indicator Survey (QIS) found a Soiled Utility closet on Wing one (1) was unlocked with chemicals stored on a shelf, and the Clean Room, which contained biologicals. This had the potential to affect more than an isolated number of residents. Facility census: 55 Findings include: a) Observations of Wing one (1) On 10/16/17 at 10:51 a.m., during an observation on Wing one (1), it was discovered the Soiled Utility closet was unlocked. In the Soiled Utility closet there was one (1) gallon container of Pinesol and one (1) gallon of Lysol mixtures on a shelf. The unlocked door allowed any wandering resident access to this closet with the potential to ingest these hazardous chemicals. During an interview with Employee #80, licensed practical nurse (LPN) on 10/16/17 at 10:52 a.m., verified the Soiled Utility closet was always unlocked, she did agree these chemicals should not be stored in an unlocked area accessible to wandering residents. b) Clean Utility Room A random observation on 10/17/17 at 8:00 a.m. discovered an unlocked room with a plaque on the door stating, clean utility with no lock on the door or door knob. The room contained various supplies which included a drawer containing numerous packets of INZO Barrier Cream with 5% dimethicone (uses include: temporarily protects - and helps relieve chapped or cracked skin - minor cuts), written on the packets was Warning which stated (typed as written): Keep this and all drugs out of reach of children for external use only. Avoid contact with eyes. When accompanied by Licensed Practical Nurse (LPN) #22 to the clean utility room on 10/17/17 at 8:05 a.m., she verified and agreed the door is unlocked with no means of locking the room. She stated, The door has never been locked, commenting the room contains clean supplies which include as Foley catheter insertion kits, dressing supplies, isolation gowns, isolation masks and syringes. Upon opening the cabinet drawer LPN #22 explained, This drawer is full of barrier cream for residents. After reading the Warning on the package label, she stated, We do have wandering residents and this could pose an accident hazard if they got a hold of these packages. I will talk to the Director of Nursing (DON) about this. At 8:20 a.m. on 10/17/17 the DON reported, I will have a lock put on the door (clean utility room). Agree it could potentially be a accident hazard to wandering residents. On 10/17/17 at 8:45 a.m. observed a maintenance employee installing a door knob with a lock on the door to the clean utility room.", "filedate": "2020-09-01"}
{"rowid": 189, "facility_name": "ST. BARBARA'S MEMORIAL NURSING HOME", "facility_id": 515012, "address": "PO BOX 9066", "city": "FAIRMONT", "state": "WV", "zip": 26555, "inspection_date": "2017-10-18", "deficiency_tag": 371, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "XKNG11", "inspection_text": "Based on observation and staff interview the facility failed to store food items under sanitary conditions. Bottles of thickened liquids were found not dated when opened. This practice has the potential to affect more than limited number of residents. Census: 55. Findings include: a) During the initial tour of the dietary department at 10:45 a.m. on 10/16/17 with the certified dietary manager, the following issue was revealed: plastic bottles containing thickened liquids such as prune juice, apple juice and water were found opened but not dated. This would not allow the dietary staff to determine how long the product had been opened and the chance for contamination to be greater.", "filedate": "2020-09-01"}
{"rowid": 190, "facility_name": "ST. BARBARA'S MEMORIAL NURSING HOME", "facility_id": 515012, "address": "PO BOX 9066", "city": "FAIRMONT", "state": "WV", "zip": 26555, "inspection_date": "2017-10-18", "deficiency_tag": 431, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "XKNG11", "inspection_text": "Based on observation and staff interview, the facility failed to ensure it provided permanently affixed compartments for storage of controlled medications and other drugs subject to abuse (Fentanyl, Norco, Morphine Sulfate, Oxycontin, Roxicodone, and Percocet). This was found in one (1) of one (1) medication storage room. This practice has the potential to affect more than an isolated number. Resident census: 55. Findings include: a) An observation of the metal cabinet in the medication storage room on 10/17/15 at 2:20 p.m., with Registered Nurse (RN) #79, revealed an unsecured clear white plastic box sealed with a zip tie and labeled: Attention All Nurses DEA (Drug Enforcement Administration) STOP Controlled Substance. The box contained the following: --5 Acetaminophen / Codeine (Tylenol #3) --5 Alprazolam (Xanax) 0.25 milligrams (mg) --3 Clonazepam (Klonopin) 0.5 mg --3 Diphenoxylate Atropine (Lomotil) 2.5 mg --2 Fentanyl (Duragesic) 25 mg patch --2 Fentanyl (Duragesic) 50 mg patch --6 Hydrocodone/Apap (Norco) 5/325 mg --6 Hydrocodone/Apap (Norco) 7.5/325 mg --6 Hydrocodone/Apap (Norco) 10/325 mg --5 Lorazepam (Ativan) 0.5 mg --5 Morphine Sulfate ER (extended release) (MS Contin) 15 mg --2 30 milliliter (ml) bottles Morphine Sulfate (Roxanol) 20 mg/ml --3 Oxycodone SR (sustained release) (Oxycontin) 10 mg --5 Oxycodone IR (immediate release) (Roxicodone) 5 mg --6 Oxycodone/Apap (Percocet) 5/325 mg --3 Phenobarbital (Phenobarb) 32.4 mg --3 Tramadol (Ultram) 50 mg --3 Zolpidem (Ambien) 5 mg This clear white plastic container was not secured to the metal cabinet and was demonstrated to be easily removed. RN #79, confirmed the clear white box containing controlled substances was not secured to the cabinet and could be removed easily. During an interview on 10/17/17 at 2:35 p.m., the Director of Nursing (DON) agreed the drug box was not secured to the cabinet. She reported the pharmacist routinely checks the drug box and never informed the facility that the box needed to be permanently affixed to the cabinet.", "filedate": "2020-09-01"}
{"rowid": 191, "facility_name": "ST. BARBARA'S MEMORIAL NURSING HOME", "facility_id": 515012, "address": "PO BOX 9066", "city": "FAIRMONT", "state": "WV", "zip": 26555, "inspection_date": "2017-10-18", "deficiency_tag": 441, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "XKNG11", "inspection_text": "Based on observation, policy review and staff interview, the facility failed to maintain an effective infection control program to prevent, recognize, and control, to the extent possible, the onset and spread of infection within the facility. Breaches in infection control practices were observed during medication administration for Resident #7 and Resident #18 and during a random observation of the clean utility room involving a soiled laundry chute. This practice has the potential to affect more than an isolated number of residents residing in the facility. Resident identifiers: #7 and #18. Facility census: 55. Findings include: a) Resident #7 After a medication administration pass observation for Resident #7 on 10/17/17 at 8:04 a.m. Licensed Practical Nurse (LPN) #80 performed hand hygiene with soap and water for fourteen (14) seconds then proceeded to turn off the faucet with the same paper towel used to dry her hands. b) Resident #18 After a medication administration pass observation for Resident #18 on 10/17/17 at 8:17 a.m. LPN #80 performed hand hygiene with soap and water for seventeen (17) seconds then proceeded to turn off the faucet with the same paper towel used to dry her hands. Immediately following the observations LPN #80 stated, I thought I washed my hands for 20 seconds but maybe I did it too quickly. She agreed and verified that the same paper towel used to dry her hands was used to turn off the water faucet. Reported I didn't know I was supposed to get a clean dry paper towel but it makes sense that it would be wet and cause contamination from the faucet. Our hand-washing policy is to wash our hands for twenty (20) seconds). Review of the facility hand-washing policy provided by the Director of Nursing (DON) on 10/17/17 at 8:55 a.m. with titles from Centers for Medicare & Medicaid Services (CMS) and World Health Organization (WHO) with a date of 2009 stated the following (typed as written): .Rub hands and forearms briskly for 20 seconds . The (YEAR) hand hygiene recommendations from the Centers for Disease Control (CDC) include: Recommended techniques for washing hands with soap and water include wetting hands first with clean, running warm water, applying the amount of product recommended by the manufacturer to hands, and rubbing hands together vigorously for at least 20 seconds covering all surfaces of the hands and fingers; then rinsing hands with water and drying thoroughly with a disposable towel; and turning off the faucet on the hand sink with a dry disposable paper towel. The DON reported on 10/17/17 at 9:00 a.m., I have never heard of turning off the faucet with a clean paper towel and we follow the CMS rules. I told my nurse to wash her hands for twenty-five (25) seconds just to be safe. Maybe she counted too fast or was nervous because she was being watched. c) Clean Utility Room with laundry chute A random observation on 10/17/17 at 8:00 a.m. discovered an unlocked room with a plaque on the door stating, clean utility with a soiled laundry chute (A vertical shaft in a building down which dirty clothes and linens can be dropped, to land in a laundry area on a lower floor) located inside the room on the right wall. The stainless steel door to the laundry chute was ajar and not latched with the barrel bolt lock located on the lower part of the door and frame. The door and door frame was soiled and a build up of grime on the inside of the door including the chute itself. Accompanied by LPN #22 to the clean utility room on 10/17/17 at 8:05 a.m., she commented, the room contains clean supplies which include as Foley catheter insertion kits, dressing supplies, isolation gowns, isolation masks, syringes etc. She verified the laundry chute door was ajar and not latched as it is always supposed to be. During the interview a random employee opened the door, pulling a cart containing soiled laundry/linen to the door and place the cloth bags of linen down the laundry chute. Upon inquiry regarding soiled linen being transported into a clean utility room with clean supplies which included a box of isolation masks with the top open, LPN #22 explained this is the way we have always done it and guess it could be an infection control issue. During an observation accompanied by the DON on 10/17/17 at 8:25 a.m., she agreed and verified the laundry chute Door and door frame were soiled. She stated, Certainly needs cleaned and I think housekeeping is responsible for cleaning it. The DON agreed and commented, With the laundry chute used for soiled linen certainly poses an infection control issue with dirty items being brought into a clean area. The door to the chute is always supposed to be shut and locked. Employee #17 verified on 10/17/17 at 10:50 a.m. that the laundry chute door in the clean utility room was again ajar and not latched shut. She stated, They just bring in the bags and put them down the laundry chute. I guess with the door open and not locked that air from the chute could certainly circulate in this room causing an infection control issue. On 10/17/17 at 11:16 a.m. discovered the end of laundry chute is housed downstairs in housekeeping supply room. Employee #15 demonstrated that a cart is brought over to the chute, soiled laundry is removed and transported across the hallway to the soiled laundry room. She commented, The laundry stays in the chute for a while until someone from laundry comes and gets it. I am not sure who is supposed to clean it (laundry chute). Employee #8 requested to view the clean utility room on 10/18/17 at 8:15 a.m. Upon entering the clean utility room the door to the laundry chute was again found to be ajar and unlatched. She verified this observation and stated, It should always be completely shut and securely latched. No one was sure who was supposed to clean the laundry chute and the door but now it is on a cleaning schedule to be done by housekeeping. Agree it is an infection control issue and we are looking at ways to correct it.", "filedate": "2020-09-01"}
{"rowid": 192, "facility_name": "MADISON PARK HEALTHCARE", "facility_id": 515021, "address": "700 MADISON AVENUE", "city": "HUNTINGTON", "state": "WV", "zip": 25704, "inspection_date": "2019-04-11", "deficiency_tag": 578, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "M7ZP11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility failed to ensure all elements of the advance directive were completed for three (3) of 14 residents reviewed during the long-term care survey process. Facility identifiers: #1, #6, #27. Facility census: 39. Findings included: a) Resident #1 Review of Resident #1's West Virginia Physician order [REDACTED]. No length of time had been entered into the space provided on the form. During an interview on 04/09/19 at 1:30 PM, Social Worker #4 agreed Resident #1's POST form did not specify the length of time for the IV fluids trial period. On 4/9/2019 at 2:25 PM, a progress note was written which stated, This DSS (Director of Social Services) and administrator spoke with resident's HCS (Health Care Surrogate) (name of health care surrogate) this date regarding resident's POST form. This DSS asked for clarification of a defined trial period of IV fluids and HCS stated that 1 month would be ideal. This DSS and administrator assured HCS that this would be written in and if the HCS would ever like to change it this can be done. No concerns noted at this time. Will continue to monitor and report any new changes. b) Resident #6 Review of Resident #6's West Virginia Physician order [REDACTED]. The defined trial period was not stated. The POST form did not include an area on the form to indicate the defined trial period. The POST form was dated 05/15/2006 and had been reviewed on 09/26/17 according to the form. During an interview on 04/09/19 at 1:30 PM, Social Worker #4 agreed Resident #6's POST form did not specify the defined trial period for IV fluids or feeding tube. Social Worker #4 stated this POST form was an old form. She stated Resident #4's Health Care Surrogate would be contacted to clarify the interventions and complete a new form. On 04/11/19 at 9:46 AM, Social Worker #4 stated an updated POST form had been completed for Resident #6. c) Resident #27 Review of Resident #27's medical records revealed a West Virginia Physician order [REDACTED]. The POST form had not been signed by the resident's medical power of attorney or health care surrogate. Resident #27 did not have medical decision-making capacity. During an interview on 04/09/19 at 1:30 PM, Social Worker #4 agreed Resident #27's POST form had not been signed by the resident's medical power of attorney or health care surrogate. On 04/11/19 at 9:46 AM, Social Worker #4 stated Resident #27's POST form had been signed by the resident's representative.", "filedate": "2020-09-01"}
{"rowid": 193, "facility_name": "MADISON PARK HEALTHCARE", "facility_id": 515021, "address": "700 MADISON AVENUE", "city": "HUNTINGTON", "state": "WV", "zip": 25704, "inspection_date": "2019-04-11", "deficiency_tag": 584, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "M7ZP11", "inspection_text": "Based on observation, resident interview, and staff interview , the facility failed to provide a safe clean home like environment to the extent possible. A random observation of a dependent resident's bedside phone revealed the phone to be grossly dirty and in need of cleaning and sanitizing. This practice had the potential to affect more than limited number of residents. Resident identifier: #17. Facility census: 39. Findings included: a) Resident #17 Observation of Resident#17's bedside telephone, on 04/10/19 at 9:20 AM, revealed a lot of built up crusty dirt and debris inside the phone cradle, where the ear piece of the phone rested when not in use. Inspection of the earpiece revealed some dried debris coating the outer surface of the earpiece that would lay against the resident's ear when she spoke on the phone. This surveyor asked the resident, When was the last time the phone had been cleaned? The resident replied, I don't remember when it was ever cleaned. This surveyor pointing at the phone, asked the resident if she talked on that phone. The resident replied, Oh yes, I talked to my daughter all the time. On 04/10/19 at 9:23 AM, this Surveyor went into the hallway and asked nurse aide (NA#13) to step into resident 17's room. NA#13 was asked to pick up the resident's phone and look at the cradle. The nurse aide picks up the phone and looking at the cradle gasped, Oh! I will get housekeeping to clean this immediately.", "filedate": "2020-09-01"}
{"rowid": 194, "facility_name": "MADISON PARK HEALTHCARE", "facility_id": 515021, "address": "700 MADISON AVENUE", "city": "HUNTINGTON", "state": "WV", "zip": 25704, "inspection_date": "2019-04-11", "deficiency_tag": 641, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "M7ZP11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview, facility failed to accurately complete the Minimum Data Set (MDS) to reflect Resident #19's urinary continence status. This was true for one (1) of fourteen (14) sampled residents. Resident identifiers: #19. Facility census: 39. Findings included: a) Resident #19 Review of Resident #19's medical records, found the resident was admitted on [DATE]. [DIAGNOSES REDACTED]. Neuromuscular dysfunction of bladder is a problem in which a person lacks bladder control due to a brain, spinal cord, or nerve condition. Review of Resident #19's admission MDS assessment with an assessment reference date (ARD) of 03/01/19, which found section H - Bladder and Bowel indicates the resident has an indwelling Foley catheter. Under Section H 0300 urinary incontinence the MDS was coded 3, to indicate the resident is always incontinent (no episodes of incontinence). Review of the Resident Assessment Instrument (RAI) the appropriate answer is Code 9, not rated: if during the 7-day look-back period the resident had an indwelling bladder catheter, condom catheter, ostomy, or no urine output (e.g., is on chronic [MEDICAL TREATMENT] with no urine output) for the entire 7 days. Interview with the Director of Nursing (DON) on 04/10/19 at 12:15 p.m., after review of the admission MDS with ARD of 03/01/19, she confirmed the MDS was coded in error. She confirmed the answer should have been 9 not 3. She confirmed the admission MDS with ARD of 03/01/19 was inaccurate.", "filedate": "2020-09-01"}
{"rowid": 195, "facility_name": "MADISON PARK HEALTHCARE", "facility_id": 515021, "address": "700 MADISON AVENUE", "city": "HUNTINGTON", "state": "WV", "zip": 25704, "inspection_date": "2019-04-11", "deficiency_tag": 656, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "M7ZP11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, medical record review, resident interview, and staff interview, the facility failed to develop a care plan to include the contact information of a resident's Hospice service provider; and implement care plan interventions related to oxygen therapy, positioning, and skin integrity. This was true for three (3) of fourteen (14) resident care plans reviewed during the annual long-term care survey process. This practice had the potential to affect more than a limited number of residents. Resident identifier: #2, #17, and #1. Facility census: 39. Findings included: a) Resident #2 (R#2) Review of records revealed R#2 was admitted to Hospice services on 07/09/18 and was admitted to the facility on [DATE]. Review of R#2's care plan, on 04/10/19 at 2:54 PM, revealed the Hospice 24-hour contact information was not included in the care plan. An interview, on 04/10/19 at 3:50 PM with the MDS nurse responsible for developing resident care plans, confirmed R#2 care plan was developed without including the Hospice 24-hour contact information. The MDS nurse said the resident already had Hospice services when she came to the facility, and the Hospice 24-hour contact information should have been included when the facility first developed the resident's care plan. The MDS nurse stated she would update the care plan now with the Hospice 24-hour contact information. b) Resident #17 (R#17) Review of the resident's quarterly minimum data set (MDS) with an assessment reference date (ARD) 02/18/19, on 04/10/19 at 09:46 AM, revealed the resident has clear speech, makes them self-understood and understands. The resident's Brief Interview for Mental Status (BIMS) score was twelve (12) indicating the resident is moderately impaired. R#17 did not exhibit any behaviors. The resident is totally dependent with bed mobility, meaning full staff performance every time. The resident needs supervision with eating and is totally dependent with all other activities of daily living (ADLs). ADLs include bed mobility, transfers, dressing, toileting, personal hygiene, and bathing. Resident has impairment in both lower extremities. Some [DIAGNOSES REDACTED]. 1. Oxygen Review of R#17's care plan, on 04/10/19 at 10:28 AM, revealed the resident has chest pain related to [MEDICAL CONDITION] with an intervention: Oxygen (02) via nasal prongs as ordered. Observations, on 04/10/19 at 8:44 AM, revealed resident's oxygen flow meter was set close to 4L (liters per minute). Review of the current orders revealed, oxygen at 2L per nasal cannula continuous related to decrease O2 sats (blood oxygen saturation). On 04/10/19 at 9:01 AM, Registered Nurse (RN#91) and RN#3 entered resident #17's room. This surveyor requested RN#91 look at the oxygen meter to see what rate the flow meter was on. RN#91 stated the 02 was on 3 1/2L, confirming the oxygen rate was not 2L as was ordered and indicated in the care plan. RN#91 adjusted the resident's oxygen rate to 2L as ordered and care planned. 2. Positioning Review of R#17's care plan, on 04/10/19 at 10:28 AM, revealed the resident has an activities of daily living (ADL) self-care performance deficit. Two of the interventions include, Bed mobility: The resident requires extensive to total assistance with repositioning at all times. Transfer: The resident requires Hoyer lift and is dependent on 2 staff for transfer. On 04/08/19 at 12:35 PM, during an interview with the resident, restorative nurse aide (NA#61) entered the room with the resident's lunch tray and sat it on the over bed table. opened items for the resident on the tray, placed butter on the resident's potatoes, NA#61 assisted the resident with her napkin, raised the head of the resident's bed to about seventy five (75) degrees from (45) degrees, and pleasantly ask the resident if there was anything else she wanted, then left the room. Before leaving the nurse aide did not check to make sure the resident could reach items on her tray, or if R#17 was positioned comfortably and/or in good body alignment to facilitate eating. R#17 was lying low in the bed before NA#61 raised the head of the bed. However, when the nurse aide raised the head of the bed the resident slid down even more into the bed. The resident's lower back was curved and raised off the bed surface unsupported in the bend of the bed. The resident's upper torso was hunched over and her chin pointed down to her neck. R#17 struggled to reach the items on her lunch tray. The resident's body positioning was poorly aligned and did not facilitate affective swallowing. This surveyor asked the resident, Are you comfortable? The resident replied, No, I'm not comfortable! This surveyor asked the resident if she could straighten her own self up in the bed, and R#17 answered, No, I can't do it, I need help. This surveyor requested the resident use her call light to get assistance to help straighten her up in the bed. NA#61 answered the call light, and agreed the resident needed pulled up in the bed and repositioned. NA#61 left the room and returned with NA#2 to assist in repositioning the resident in her bed after surveyor intervention. c) Resident #1 Review of Resident #1's medical records revealed the resident had a skin tear on her coccyx, a skin tear on her foot, and a deep tissue injury on her left hip. Weekly wound assessments of the skin tear on the foot and the deep tissue injury on the hip had been documented in the progress notes and on a wound weekly observation tool. The skin tear on the coccyx was first observed on 03/26/19 and the wound was measured as 5 cm x 2.5 cm at that time. No further assessments of the coccyx skin tear could be located in the medical records. Resident #1's comprehensive care plan contained the focus, I have a potential for impairment to skin integrity r/t (related to) fragile skin. The interventions included, I will have weekly treatment documentation to include measurement of each area of skin breakdown's width, length, depth, type of tissue and exudate and any other notable changes or observations. Resident #1 had an order for [REDACTED]. Sure Site is a transparent dressing used to protect a wound while it heals. On 04/11/19 at 10:30 AM, Assistant Director of Nursing (ADoN) #23 was observed changing Resident #1's coccyx Sure Site dressing. ADoN #23 stated she was going to have the physician assess Resident #1's coccyx skin tear to determine if a different treatment and dressing would be beneficial. Resident #1's coccyx wound was addressed in the following progress notes: (The notes are typed as written.) - 03/26/19 at 6:50 PM: Skin tear remains suresite C/D/I (Clean, dry, intact) . - 3/27/19 at 3:04 AM: Skin tear suresite C/D/I . - 03/27/19 at 11:30 AM: Resident with skin tear to her coccyx. Sure site is CDI . - 03/28/19 at 6:25 PM: .Skin tear remains to coccyx . - 03/29/19 at 7:50 PM: .Skin tear remains to coccyx . - 03/30/19 at 5:09 AM: Skin tear remains to coccyx . - 03/30/19 at 6:51 PM: .Skin tear remains to coccyx . - 03/31/19 at 2:44 AM: .Skin tear remains to coccyx . - 04/02/19 at 2:53 AM: .Skin tear remains to coccyx . - 04/03/19 at 1:11 AM: .Skin tear remains to coccyx . - 04/06/19 at 12:37 AM: .Skin tear remains to coccyx . During an interview on 04/11/19 at 1:05 PM, the Director of Nursing (DoN) stated she was unable to locate updated assessments of Resident #1's coccyx skin tear. The DoN stated skin tears do not require assessments on the wound weekly observation tool. During an interview on 04/11/19 at 1:56 PM, the Administrator and Director of Nursing were informed the facility failed to implement Resident #1's comprehensive care plan intervention to perform weekly treatment documentation including measurement of each area of skin breakdown. The Administrator and Director of Nursing had no further information regarding the matter. No information was provided through the completion of the survey.", "filedate": "2020-09-01"}
{"rowid": 196, "facility_name": "MADISON PARK HEALTHCARE", "facility_id": 515021, "address": "700 MADISON AVENUE", "city": "HUNTINGTON", "state": "WV", "zip": 25704, "inspection_date": "2019-04-11", "deficiency_tag": 684, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "M7ZP11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview, the facility failed to ensure Resident #4 received treatment and care with professional standards of practice and the comprehensive person-centered care plan. This was true for one (1) of fourteen (14) residents reviewed. Resident identifier: #4. Facility census: 39. Findings included: a) Resident #4 Review of medical records for Resident #4 found a physician's orders [REDACTED]. oxygen saturation level below 92% (percent) and Check oxygen saturation (SPO2) every shift. Review of the Medication Administration Records (MAR) for 01/01/19 through 04/09/19 found the MAR indicated [REDACTED]. Interview with the Director of Nursing (DON) on 04/10/19 at 1:15 p.m., found the staff had failed to document the results of the SPO2 % as the physician order [REDACTED]. She confirmed the nurses were not following the physician's orders [REDACTED].>", "filedate": "2020-09-01"}
{"rowid": 197, "facility_name": "MADISON PARK HEALTHCARE", "facility_id": 515021, "address": "700 MADISON AVENUE", "city": "HUNTINGTON", "state": "WV", "zip": 25704, "inspection_date": "2019-04-11", "deficiency_tag": 842, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "M7ZP11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview, the facility failed to ensure a complete and accurate medical record for three (3) of 14 residents reviewed during the long-term care survey process. The facility failed to document wound care on Resident #1's Treatment Administration Record. The facility failed to ensure Resident #27's tube feeding order contained all required elements. The facility failed to ensure Resident #10's [DIAGNOSES REDACTED]. Resident identifiers: #1, #27, #10. Facility census: 39. Findings included: a) Resident #1 Resident #1 had an order for [REDACTED]. Sure Site is a transparent dressing used to protect a wound while it heals. On 04/11/19 at 10:30 AM, Assistant Director of Nursing (ADoN) #23 was observed changing Resident #1's coccyx Sure Site dressing because the dressing was soiled with stool. The Sure Site dressing removed had a date of 04/10/19 on it. Resident #1's Treatment Administration Record did not include the order to change the resident's coccyx dressing every seven (7) days and as needed. Resident #1's progress notes contained notations that the Sure Site dressing was clean, dry, and intact, but did not contain information regarding when the dressing was changed. During an interview on 04/11/19 at 1:01 PM, the Director of Nursing agreed Resident #1's coccyx dressing change was not included on the resident's Treatment Administration Record. She stated the resident's coccyx dressing was changed frequently because the resident was incontinent of stool, soiling the dressing. During an interview on 04/11/19 at 1:56 PM, the Administrator was informed Resident #1's coccyx dressing change was not included on the resident's Treatment Administration Record. She had no further information regarding the matter. No information was provided through the completion of the survey. b) Resident #27 Resident #27 had the following tube feeding order: [MEDICATION NAME] 1.2 Cal Liquid (Nutritional Supplements). Give 240 cc via [DEVICE] every 4 hours for sole source feeding give with 120cc h2o flush. (Typed as written.) [DEVICE] feedings can be administered by bolus, which involves the feeding being administered with a syringe over a short or period of time, by infusion over a specified, longer period of time, or by continuous infusion. Resident #27's tube feeding order did not specify how the feeding was to be administered. On 04/11/19 at 11:10 AM, Licensed Practical Nurse (LPN) #62 was observed administering Resident #27's tube feeding. She administered the tube feeding by bolus, using a syringe, over approximately ten (10) minutes. During an interview on 04/11/19 at 12:58 PM, the Director of Nursing (DoN) was informed Resident #27's tube feeding order did not specify how the feeding was to be administered. The DoN confirmed the tube feeding was to be administered by bolus. The DoN stated Resident #27 tolerated bolus tube feedings best. During an interview on 04/11/19 at 1:56 PM, the Administrator was informed Resident #27's tube feeding order did not specify how the feeding was to be administered. She had no further information regarding the matter. No information was provided through the completion of the survey. c) Resident #10 Resident #10 had an order for [REDACTED].#10's comprehensive care plan also contained the focus, The resident uses antidepressant medication r/t (related to) depression. Resident #10's [DIAGNOSES REDACTED]. During an interview on 04/10/19 at 10:50 AM, the Director of Nursing (DoN) was informed Resident #10's [DIAGNOSES REDACTED]. During an interview on 04/10/19 at 2:08 PM, the Administrator confirmed a [DIAGNOSES REDACTED].#10's [DIAGNOSES REDACTED].", "filedate": "2020-09-01"}
{"rowid": 198, "facility_name": "MADISON PARK HEALTHCARE", "facility_id": 515021, "address": "700 MADISON AVENUE", "city": "HUNTINGTON", "state": "WV", "zip": 25704, "inspection_date": "2019-04-11", "deficiency_tag": 880, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "M7ZP11", "inspection_text": "Based on observation, resident interview, and staff interview , the facility failed to implement an ongoing infection prevention and control program (IPCP) to help prevent, recognize, and control the onset, cross-contamination, and spread of infection to the extent possible. A random observation of two nurse aides tidying a dependent resident's bed revealed a breach in infection control principles when a nurse aide held the used bed linens against her uniform. This practice had the potential to affect more than limited number of residents. Resident identifier: #17. Facility census: 39. Findings included: a) Resident #17 Observations, on 04/10/19 at 5:22 PM, revealed Nurse Aide (NA#25) and Nurse Aide (NA#40) in Resident (R#17)'s room. The resident was lying in the bed, NA #25 was straightening the bed linens, and NA#40 was standing at the left side foot of the resident's bed with her arms full of a large amount of wadded up blankets against the uniform of her upper body. Interview with the nurse aides confirmed the blankets NA#40 was holding had just came off the resident's bed. NA #25 said she was straightening the bed and piled the blankets in NA#40's arms to get them out of her way as she was fixing the bed. Both NA #25 and NA#40 confirmed and acknowledged holding used bed linens against their uniform was a breach in infection control principles they were taught in their nurse aide training. According to the Centers for Medicare & Medicaid Services (CMS) laundry includes resident's personal clothing, linens (i.e. sheets, blankets, pillows), towels . CMS Guidance for handling laundry includes, The facility staff should handle all used laundry as potentially contaminated and use standard precautions. CMS Guidance states one of the practices facilities should use, is; Staff should handle soiled textiles/linens with minimum agitation to avoid the contamination of air, surfaces, and persons. Guidance from CMS also states, The facility practices must include how staff will handle and transport the laundry with appropriate measures to prevent cross-contamination. This includes but is not limited to the following; Contaminated linen and laundry bags are not held close to the body . ;", "filedate": "2020-09-01"}
{"rowid": 199, "facility_name": "MADISON PARK HEALTHCARE", "facility_id": 515021, "address": "700 MADISON AVENUE", "city": "HUNTINGTON", "state": "WV", "zip": 25704, "inspection_date": "2017-04-19", "deficiency_tag": 157, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "HZCX11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, staff interview, responsible party interview, and resident interview, the facility failed to notify the responsible party/resident of changes in the residents medications and treatments for three (3) of four (4) residents reviewed for the care area of notification of change during Stage 2 of the Quality Indicator Survey (QIS). This was true for Resident #49, #44 and #8. Resident Identifiers: #49, #44 and #8. Facility Census: 39. Findings Include: a) Resident #49 A review of Resident #49's medical record, at 8:58 a.m. on 04/18/17, found Resident #49 was declared incapacitated by her attending physician on 12/29/16. Also contained in the record was the residents appointment of a Power of Attorney (POA) which was completed on 01/28/11. This POA included medical decision making power. Further review of the record found the following physician orders: --Order dated 01/18/17 for Vitamin D level every 12 months --Order dated 03/24/17 got Physical Therapy five (5) times a week for two (2) weeks --Order dated 03/30/17 for [MEDICATION NAME] 20 milligrams one time a day, KCL 10 meq one time a day, and Basic Metabolic Panel in one week due to pedal [MEDICAL CONDITION] The medical record contained no evidence the POA was notified of these medication/treatment changes. An interview with the Director of Nursing, at 9:57 a.m. on 04/19/17, confirmed the medical record contained no evidence Resident #49's POA was notified of the medication/treatment orders. b) Resident #44. Record review found the resident was admitted to the facility on [DATE]. During Stage 1 of the Quality Indicator Survey (QIS), on 04/17/17 at 12:21 p.m., the resident said she is not included in changes about her medication and care at the facility. She said, They tell my daughter, I guess. They must think I am senile. Review of the resident's most recent annual, minimum data set (MDS) with an assessment reference date (ARD) of 03/13/17, found the resident's brief interview for mental status (BIMS). The resident scored a 15 on her BIMS. A score of 15 is the highest score obtainable and indicates the resident is cognitively intact. The MDS noted the resident was able to understand others and make herself understood. The resident had appointed her daughter as her medical power of attorney (MPOA) on 07/06/15. The facility physician determined the resident lacked capacity to make medical decisions on 03/02/17, due to a [DIAGNOSES REDACTED]. On 03/16/17, the physician wrote an order to discontinue her [MEDICATION NAME], current dose, (current dose was 3 mg daily) and change to [MEDICATION NAME] 1 mg daily. A second order, dated 03/16/17, noted to discontinue [MEDICATION NAME] 20 mg and start [MEDICATION NAME] 20 mg every other day in the morning, for 2 weeks, then 20 mg's on Monday and Thursday for 2 weeks, then 20 mg's on Monday for 1 week - then stop the medication. On 04/06/17, the physician started [MEDICATION NAME], 20 mg daily. At 4:09 p.m. on 04/18/17, Employee #43, a Registered Nurse (RN), chief nursing officer, was asked if the changes in medications had been discussed with the resident and/or her daughter, the MPOA? At 8:11 a.m. on 04/19/17, RN #43 provided a consent for use of psychoactive medications, signed by the daughter on 03/15/17. The consent noted the resident is currently receiving [MEDICATION NAME] 1 mg daily. However, the physician's orders [REDACTED]. RN #43 said the facility knew the physician was going to reduce the [MEDICATION NAME] on 03/15/17, so the daughter was advised of the change on 03/16/17. On 04/05/17, the [MEDICATION NAME] was reduced to 0.5 mg daily. On 04/13/17 the Resperdal was again reduced to 0.25 mg daily, with an end date of 04/20/17. At the close of the survey at 11:45 a.m. on 04/19/17, the facility provided no evidence the daughter/resident had been made aware of the gradual dose reductions (GDR) on [MEDICATION NAME] on 04/05/17 and 04/13/17and [MEDICATION NAME] on 03/16/17. There was no evidence of notification the [MEDICATION NAME] was re-started on 04/06/17. c) Resident #8 Resident #8 was admitted to the facility on [DATE]. The resident is her own responsible party. A review of Resident #8's Annual Minimum Data Set (MDS), with an Assessment Reference Date (ARD) of 02/10/17, was conducted on 04/18/17 at 9:00 a.m. Section C-Cognitive Patterns of the assessment revealed the resident scored a 15 out of 15 on the Brief Interview for Mental Status (BIMS) assessment. A score of 15 indicated the resident was cognitively intact at the time of the assessment. An interview with Resident #8, on 04/18/17 at 9:30 a.m., revealed the facility does not notify her when physician's orders [REDACTED]. A review of Resident #8's medical record, on 04/18/17 at 9:45 a.m., revealed the following orders with no resident notification: --physician's orders [REDACTED]. No documentation of resident notification in the medical record. --physician's orders [REDACTED]. Give Tylenol 325 mg at midnight. No documentation of resident notification in the medical record. --physician's orders [REDACTED]. [MEDICATION NAME] 7.5 mg-325 mg 1 tablet po four times a day for pain. No documentation of resident notification in the medical record. An interview with the Administrator on 04/18/17 at 10:05 a.m. revealed she could not provide any documentation the resident was notified of the medication changes.", "filedate": "2020-09-01"}
{"rowid": 200, "facility_name": "MADISON PARK HEALTHCARE", "facility_id": 515021, "address": "700 MADISON AVENUE", "city": "HUNTINGTON", "state": "WV", "zip": 25704, "inspection_date": "2017-04-19", "deficiency_tag": 242, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "HZCX11", "inspection_text": "Based on medical record review, resident interview and staff interview, the facility failed to ensure a resident received his desired two (2) showers per week for two (2) of the most recent six (6) weeks. This was evident for one (1) of four (4) residents reviewed for choices. Resident identifier: #18. Facility census: 39. Findings include: a) Resident #18 During an interview with Resident #18, on 04/17/17 at 11:59 a.m., he said he would prefer to have showers three (3) times per week. He stated his belief that staff is aware of this desire, but too busy to honor his choice for three (3) showers per week. He said he does not always get even two (2) per week. Review of the significant change minimum data set (MDS) with assessment reference date (ARD) of 03/03/17, found his brief interview of mental assessment (BIMS) score was fourteen (14) out of a possible score of fifteen (15). A BIMS score of fourteen (14) indicates intact cognition. According to this assessment, the resident required extensive assistance for personal hygiene, and required physical help in part of the bathing activity. Review of the shower records, on 04/18/17 at 9:56 a.m., found this resident was scheduled for two (2) showers per week, on Tuesdays and Fridays. Further review found that of the past six (6) weeks, were two (2) weeks where he received only one (1) shower per week. There was no evidence found that he had refused showers, or that he was out of the facility those weeks. The week of 03/12/17 through 03/18/17, he received only one (1) shower, on 03/17/17. The week of 03/26/17 through 04/01/17, he received only one (1) shower, on 03/31/17. An interview was conducted with licensed practical nurse (LPN) #40, on 04/18/17 at 10:12 a.m. She said she was unaware this resident wanted three (3) showers per week. She said if a resident requested changes in his shower schedule, she tells the assistant director of nursing (ADON) #76, who would then make changes in the shower schedule. An interview was then conducted with nurse #76 on 04/18/17 at 10:29 a.m. She said when residents first come to the facility, they are asked how often they want to receive showers. She said after they have been here awhile, sometimes they might make changes. Upon inquiry as to whether two (2) showers per week were this resident's preference, she replied in the affirmative. She said she was not aware of this resident having asked anyone for three showers per week. She asked him at this time, and he replied that he would like three (3) showers per week. At this time he selected Tuesdays, Thursdays, and Saturdays for his shower days. Nurse #76 said she would change the shower schedule to honor his request. Next, we discussed the recorded showers for the most recent six (6) weeks that are located in the shower book at the nurse's station. Nurse #76 reviewed the shower book, and reviewed computer entries. She found that the only documentation on 03/14/17 and on 03/28/17 pertaining to showers just said not applicable. She could find no evidence that he refused showers on those dates, or that he was out of the facility on those dates. She then went to her office to see if she might find other shower sheets that had not been filed for some reason. The outcome was that she could find no evidence that he received two (2) showers per week during the weeks of 03/12/17 through 03/18/17, and 03/26/17 through 04/01/17.", "filedate": "2020-09-01"}