cms_WV: 10727
Data source: Big Local News · About: big-local-datasette
| rowid | facility_name | facility_id | address | city | state | zip | inspection_date | deficiency_tag | scope_severity | complaint | standard | eventid | inspection_text | filedate |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 10727 | SUMMERSVILLE REGIONAL MEDICAL CENTER D/P | 515029 | 400 FAIRVIEW HEIGHTS ROAD | SUMMERSVILLE | WV | 26651 | 2010-10-20 | 279 | D | 0 | 1 | H9I611 | . Based on observation, record review, and staff interview, the facility failed to develop a care plan to address the oral / dental care needs of one (1) of twenty-three (23) Stage II sample residents. The care plan for Resident #33 did not describe how to provide oral care to this resident, who resisted opening her mouth and clenched her jaws tightly together when the caregivers attempted to perform oral hygiene. Her care plan also did not address the need for an evaluation by a dentist to assure the resident, who had blackened / broken teeth, did not experience pain or impairment in her eating ability as a result of her poor dental status. Resident identifier #33. Facility Census: 49. Findings include: a) Resident #33 While in the dining area at 2:00 p.m. on 10/11/10, observation found Resident #33 with her head tilted back and her mouth opened, which allowed this surveyor to see she had several teeth missing. She had one (1) black tooth in poor condition in the right upper side of her mouth; there were no other teeth present in that area. She also had two (2) broken teeth in the front on the bottom that were just barely above the gum line. Review of Resident #33's medical record found no evidence that a complete oral examination had been performed on this resident. She was admitted to the facility 06/12/06. On 10/13/10 at 4:00 p.m., a licensed practical nurse (LPN - Employee #88) was asked to perform an oral exam on this resident, so the inside of her mouth could be further observed. Employee #88 attempted to use a tongue depressor to view the inside of Resident #33's mouth; the resident did not want to open her mouth and resisted attempts to view inside her mouth. The resident finally allowed the nurse to look briefly inside her mouth, and the nurse confirmed the resident's teeth were in poor condition. The nursing assistant providing care for the resident on 10/13/10 (Employee #50), when interviewed at 5:00 p.m., was questioned about providing oral care for this resident. Employee #50 stated this resident often would not allow her to provide oral care and would clench her mouth tightly so that she could not get inside her mouth. She said, "You have to just return later and try again because, later, she might let you do it." She also reported the resident had a growth in the roof of her mouth. Review of the resident's current care plan (which was last reviewed / revised on 09/08/10) found it did not address the oral care. The only approach for her oral status stated, "Monitor for dental / oral problems or problems with her eyes or ears and notify the physician as indicated, podiatry consult as needed." This intervention was not appropriate, because there was no accurate baseline assessment of resident's oral status. She had multiple broken, carious teeth had not been identified on assessment, and there was no evidence that the growth in the roof of her mouth had been assessed. The minimum data set assessment (MDS) nurse (Employee #44) verified, during an interview at 4:30 p.m. on 10/13/10, that no care plan had been developed to accurately describe the care and services needed to address this resident's oral hygiene and/or dental needs. . | 2014-12-01 |