cms_WV: 534
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 534 | MERCER NURSING AND REHABILITATION CENTER | 515052 | 1275 SOUTHVIEW DRIVE | BLUEFIELD | WV | 24701 | 2018-11-29 | 656 | E | 0 | 1 | J9FW11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observation, and staff interview, the facility failed to develop/and or implement care plans for 4 of 23 residents whose care plans were reviewed. Resident #44's care plan was not developed to include how the facility would provide care to a Dementia resident. Resident #45's care plan was not was implemented for Dementia care. Residents #6 and #70's care plans were not implemented to anchor catheters. Resident identifiers: #44, #45, #6, and #70. Facility census: 97. Findings include: a) Resident #44 Review of the current care plan, revised on 07/20/17, found the problem: (Name of Resident ) has impaired cognitive function related to Dementia. The goal associated with the problem was: Patient will maintain current level of cognitive function through the review date. Interventions included: Administer Meds ([MEDICATION NAME]) as ordered Document/report to physician any changes in cognitive function, specifically changes in: decision making ability, memory, recall and general awareness, difficulty expressing self, difficulty understanding others, level of consciousness, mental status. Engage patient in simple, structured activities that avoid overly demanding tasks. A second care plan problem addressed the resident was receiving [MEDICATION NAME] for delusions and hallucinations. The goal of this care plan was: The resident will be/remain free of drug related complications including movement disorder. Interventions included: Administer medications as ordered and monitor for side effects. Encourage resident to vent feelings. Monitor/record/report to physician as needed side effects and adverse reactions From the guidance to surveyors: Residents living with dementia require specialized services and supports, (e.g., specialized activities, nutrition, and environmental modifications) that vary, based on the individual's abilities and challenges related to their condition. Dementia causes significant intellectual functioning impairments that interfere with life, including activities and relationships. People living with dementia may lose their ability to communicate, solve problems, and cope with stressors. They may also experience fear, confusion, sadness, and agitation. On 06/01/18, the resident's physician prescribed [MEDICATION NAME], an antipsychotic medication, .25 milligrams (mg's) two times a day (BID) for a [DIAGNOSES REDACTED]. The physician documented the reason for starting [MEDICATION NAME] as, Patient will not leave her room to attend activities stating, If I leave the bugs will come in my room and get in my bed, I have to keep the door shut to keep the bugs out, they sometimes knock on my window and try to get in. At 9:15 on 11/29/18, the care plan was discussed with the director of nursing (DON). The DON was unable to provide evidence the care plan addressed interventions as to how the staff were to provide care when the resident was delusional. The DON confirmed the care plan did not discuss what staff should do when the resident had delusions and hallucinations. The DON could not demonstrate how the care plan individualized this resident's dementia care needs. b) Resident #45 Record review found the resident was admitted to the facility on [DATE]. Current [DIAGNOSES REDACTED].>[MEDICAL CONDITION], Dementia, and Depression. On 09/12/18, the antipsychotic, [MEDICATION NAME] 25 mg., two times (BID) a day was added to the residents medication regime for behaviors. Review of the current care plan, updated on 04/25/18, found the following problems related to the resident's behaviors: (Name of Resident) is verbally abusive and physically aggressive behaviors toward staff while providing care related to ineffective coping skills. The goal was the patient will demonstrate effective coping skills, as evidenced by not being verbally abusive to staff while providing care through next review date. Interventions included: Analyze key times, places, circumstances, triggers and what de-escalates behavior and document. assess patients coping skills and support system. Anticipate patients needs: food, thirst, toileting needs, comfort level, body positioning, pain etc. Assess patients understanding of the situation. Allow time for the patient to express self and feelings towards the situation. When patient becomes agitated: Intervene before agitation escalates; guide away from source of distress; engage calmly in conversation if response is aggressive staff to walk calmly away, and approach later. A second care plan problem, updated on 01/29/18 found: (Name of Resident) has a behavioral problem related to yelling for help instead of utilizing the call bell system for needs and assistance. Resident will hit at staff while providing care. The goal associated with the problem was: The resident will have fewer episodes of yelling for help instead of utilizing the call bell system for requesting her needs. Interventions included: Anticipate and meet patients needs to reduce behavioral symptoms. Intervene as necessary to protect the rights and safety of others. Approach/Speak in a calm manner. Divert attention. Remove from situation and take patient to alternate location as needed. Monitor behavior episodes and attempt to determine underlying cause. Consider location time of day persons involved and situations. Document behaviors and potential causes. Report findings to attending physician and or update care plan as appropriate. Privately discuss inappropriate behaviors with patient and explain why his her behavior is unacceptable in the nursing facility. Document discussion. Report outcome to physician and or update care plan as appropriate. At 11/28/18 at 02:41 PM, the director of nursing confirmed she was unable to provide information to substantiate the above approaches were implemented as directed by the care plan. The DON confirmed the interventions were in place before the antipsychotic medication was started. The DON further confirmed the non-pharmacological interventions were not implemented before starting the antipsychotic medication. During an interview with the DON and administrator on 11/29/18 at 10:34 AM, the DON said, I have nothing else to give you. c) Resident #6 On 11/26/18 at 1:35 pm, an observation with Employee #52, Clinical Care Supervisor (CCS) found Resident #6 had an indwelling Foley Catheter. The catheter was not anchored to the resident's leg. Care Plan from electronic chart reviewed: Focus: Resident #6 has an Indwelling Catheter due to a pressure ulcer on coccyx, 20 FR with 10 cc balloon. Goal: Patient will be/remain free from catheter-related trauma through review date. Intervention: 1. Change catheter every 4 weeks and as needed. 2. Document pain/discomfort/intolerance due to catheter and report to physician as necessary. 3. Document/report to physician s/sx UTI: pain, burning, blood tinged urine, cloudiness, no output, deepening of urine color, increased pulse,increased temp, Urinary frequency, foul smelling urine, fever, chills, altered mental status, change in behavior, change in eating patterns. Provide patient-specific catheter care as ordered 4. URINARY CATHETER: Patient has a Foley. Position drainage bag and tubing below the level of the bladder to allow free flow of urine into the bag. Secure tubing. Cover drainage bag with appropriate privacy bag. Report any concerns to the Unit Charge Nurse. Provide catheter care and record volume of urine every shift. An interview on 11/27/18 at 10:00 am with the DON, the DON was informed of findings. No further information provided. e) Resident #70 On 11/28/18 at 9:23 AM, Indwelling Foley Catheter care observation with Nursing Assistant (NA) #40, it was noted the catheter anchor (used to prevent injury and accidental removal) was not on the resident's leg. Both NA #40 and NA #85 agreed that the anchor was not there and should be on the leg. During an interview on 11/28/18 at 10:04 AM, DoN was notified of findings that were observed. She stated that she was disappointed. The Facility Policy, Catheter Care, Urinary Dated; 8/2002. reads: -Ensure that the catheter remains secured with a leg strap to reduce friction and movement at the insertion site. (Note; Catheter tubing should be strapped to the resident's inner thigh.) Care Plan from electronic chart: Resident #70 has an Indwelling Catheter for [MEDICAL CONDITION] bladder, 16 FR with 10cc balloon. - Patient will be/remain free from catheter-related trauma through review date. Change catheter every 4 weeks and as needed. Document pain/discomfort/intolerance due to catheter and report to physician as necessary. Document/report to physician s/sx UTI: pain, burning, blood tinged urine, cloudiness, no output, deepening of urine color, increased pulse, increased temp, Urinary frequency, foul smelling urine, fever, chills, altered mental status, change in behavior, change in eating patterns. Provide patient-specific catheter care as ordered URINARY CATHETER: Patient has a Foley. Position drainage bag and tubing below the level of the bladder to allow free flow of urine into the bag. Secure tubing. Cover drainage bag with appropriate privacy bag. Report any concerns to the Unit Charge Nurse. Provide catheter care and record volume of urine every shift. | 2020-09-01 |