cms_WV: 3490
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 3490 | CABELL HEALTH CARE CENTER | 515192 | 30 HIDDEN BROOK WAY | CULLODEN | WV | 25510 | 2018-09-27 | 677 | D | 0 | 1 | DXEI11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, resident interview and staff interview, the facility failed to ensure two (2) of three (3) dependent residents received assistance with activities of daily living (ADL's) Resident #78 did not receive assistance with meals when needed. Resident #20 did not receive assistance with personal grooming as desired. Resident identifiers; #78 and #20. Facility census: 89. Findings include: a) Resident #78 Observation of the first meal served, after entrance to the facility, was the noon meal on 09/24/18 at 12:30 PM. The resident was in bed when the noon meal was served. Staff delivered the resident's tray, set up the tray, on the over the bed table, and left the room. The resident was sleeping, laying on her right side in a fetal position. The resident did not get out of bed for the meal. Approximately ten minutes after serving the tray, staff returned to pick up the tray. Documentation on the meal intake noted the resident refused the tray. Review of the medical record found the resident's diet orders: NDD level 1, pureed texture, regular consistency, Kennedy cup with straws for all meals. A level 1 national dysphagia diet (NDD) includes only pureed foods. Pureed foods should have the same texture as pudding. They should be smooth and free of lumps. At approximately 12:30 PM on 09/25/18, the resident received the noon meal tray. She was seated in a personal recliner beside her bed. The nursing assistant (NA) set up her tray by opening the silverware and removing the lids from bowls. The resident's milk was poured in her Kennedy cup and she had a straw. The NA left the resident's room. At 1:06 p.m. on 09/25/18, the resident was observed with a bite of a pureed sandwich pocketed in her mouth. It appeared the resident had only taken 1 bite of the pureed sandwich. Her spoon was still sticking straight up in the bowl of pureed broccoli cheese soup, which she had not attempted to feed herself. She was slumped to the right side of the recliner, sleeping. At 1:08 p.m. on 09/25/18, the physical therapy assistant (PTA) observed the resident in her room. She verified the resident had pocketed her food, which was still in her lower lip, between the lip and the gum. The PTA verified the positioning of the resident in her recliner was, Poor. The PTA stated, Normally she is up in the wheelchair, it has lateral supports so she doesn't lean to the side. She does better in the wheelchair. The over the bed table was too high making it difficult for the resident to reach her food. The Kennedy cup with her milk had been placed at the back of the over the bed table. The PTA said most likely the resident could not reach her drink. The PTA said she would get the resident's NA to help the resident with her meal. At 1:10 PM on 09/25/18, the resident's NA #72 entered the resident's room. NA #72 said she is suppose to set up the resident's meal tray. NA #72 tried to talk the resident into eating her meal. The resident did not respond, only stared at the N[NAME] The NA did give her a drink of her milk and the resident finally swallowed the pocketed food in her mouth. The NA said she did not know how long the resident was unable to feed herself. The NA said, therapy was in here yesterday trying to get her to eat. NA #72 did not attempt to reposition the resident in her chair while feeding the resident. The resident did not eat by herself. At 1:23 PM PM 09/25/18, the resident was observed eating the broccoli cheese soup being fed by NA #72. Staff later recorded the resident ate 30% of her meal in the documentation of meal intake in the electronic medical record. Review of the resident's current care plan found the problem: Resident has a nutritional problem related to Alzheimer, [MEDICAL CONDITION] a GERD. She has decreased meal intake at times. The goal associated with the problem: Patient will maintain adequate nutritional status as evidenced by maintaining weight within 75 to 85 pounds, no signs or symptoms of malnutrition and consuming at least 50% of at least 2 meals daily through review date. Interventions included: Provide adaptive equipment for dining as ordered Kennedy cup with straw. A second care plan problem: Resident has a ADL (activities of daily living) self care Performance deficit related to impaired mobility, weakness, impaired memory. The goal associated with the problem: Patient is expected to have variations in her ADL's due to Alzheimer's. She will have no complications related to current level of function in bed mobility, transfers, eating, dressing, toilet use and/or personal hygiene through next review date. Interventions included: Patient requires set up assistance, she is to be in wheelchair or recliner for breakfast, lunch and dinner. A third problem on the care plan: Resident has a swallowing problem related to holding food in mouth/cheeks (pocketing). The goal associated with the problem: Patient will have no choking episodes when eating through the review date. Interventions included: Resident tends to pocket food and push them out, she consumes food with greater ease when pancake syrup is drizzled over it. If you notice pocketing of foods or poor intake please ask kitchen for syrup. Check mouth after meal for pocketing and debris. Report to unit charge nurse. Provide oral care to remove debris. On 09/25/18 at 01:49 PM, the administrator was advised of the above observations related to the resident's meal service. At 7:50 a.m. on 9/26/18, the Speech Therapist (ST) #83 was observed in the resident's room. ST #83 said the resident needs to be fed. ST #83 introduced a student who was feeding the resident under the supervision of ST #83. ST #83 said the resident occasionally drinks her liquids by herself. The resident was in bed during the feeding of the morning meal. When asked if ST #83 knew the care plan said the resident was to be up in the wheelchair or her recliner for all meals, she replied, It isn't a problem, she is up in bed and positioned for her meal. Continued observation found the student fed the resident the entire meal while the resident was in bed. On 09/26/18 at 8:54 AM, the dietary manager (DM) #75 said the resident is to be up for all meals as directed by the care plan. He was unaware the ST had a student feed the resident in bed while she was in bed. He was aware the resident has gradually been loosing weight. Weight on 03/26/18 was 87.1 pounds. The resident's weight on 09/17/18 was 80.6 pounds. The facility addressed the resident's weight loss by changing her diet, adding supplements and protein, getting her up for meals, etc. At 9:41 AM on 09/26/18 the occupational therapist registered/licensed, (OTR) #63, said he was going to evaluate the resident to determine how much assistance the resident requires with eating. On 09/26/18 at 2:00 PM, the Registered Nurse Assessment Coordinator (RNAC) provided at copy of a new intervention for the care plan. Eating self performance: Patient requires set up assistance; she is to be in wheelchair or recliner for breakfast, lunch, and dinner. Please assure dentures are in for all meals. Staff to assist with meal intake as needed if (Name of Resident) has poor intake. (The care plan modification noted staff are to assist with meals as needed if the resident has poor intake.) At 10:23 a.m. on 09/27/18, the OTR said the resident requires supervision during meal time. Supervision is more than just set up the tray. There are some of those days when the resident needs more. Now we have it care planned for a short table when in the wheelchair and if needed the short table when she is in her reclining chair. She can use the regular table when she is in bed. The OTR provided a copy of his note completed on 09/26/18.Patient continues to require supervision with self feeding during all meals. Patient was observed during lunch using a standard bedside table while sitting in wheelchair. Patient presented with mild difficulty due to height of table. Maintenance was notified that patient would benefit with shorter bedside table while sitting in wheelchair. Maintenance was able to supply patient with shorter bedside table in order to improve positioning during self feeding. At approximately 11:00 a.m. on 09/27/18, the above observations, record review, and staff interview was relayed to the director of nursing (DON). No further information was provided. b) Resident #20 An observation of Resident #20 on 09/24/18 at 4:23 p.m. found hair on this female residents chin at least one half inch in length. When asked if she was okay with having the hair on her chin, Resident #20 stated, No I am not okay with it. When asked if she would like someone to help her to remove the hair she stated that she would like that. At this time Registered Nurse (RN) #71 indicated she would get someone to help shave the resident. She confirmed the hair on Resident #20's chin needed to be removed and Resident #20 was not able to remove it herself. A review of Resident #20's care plan at 4:23 p.m. on 09/24/18 found Resident #20 required extensive assistance with her personal hygiene with a staff assistance of one (1). | 2020-09-01 |