| 125 |
HUNTINGTON HEALTH AND REHABILITATION CENTER |
515007 |
1720 17TH STREET |
HUNTINGTON |
WV |
25701 |
2017-09-07 |
315 |
D |
0 |
1 |
QLZ111 |
**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. |
2020-09-01 |