cms_WV: 8235
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 8235 | ELDERCARE HEALTH AND REHABILITATION | 515065 | 107 MILLER DRIVE | RIPLEY | WV | 25271 | 2012-05-03 | 282 | D | 0 | 1 | 9YCU11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observations, and interview, the facility failed to implement the care plan for 1 of 3 residents reviewed with pressure ulcers; and 1 of 3 residents reviewed, out of 4 residents identified for investigation in the Care Area of Activities of Daily Living, as being inappropriately dressed for the time of day.(Resident #58 and Resident #13) Findings include: a) Resident #58 This resident was admitted to the facility on [DATE], with a [DIAGNOSES REDACTED]. Review of the most recent Minimum Data Set, dated dated [DATE], found the resident was at risk for the development of a pressure ulcer and required the extensive assistance of 2 staff members for bed mobility. This MDS also documented Resident #58 had a deep tissue injury wound and necrotic skin tissue and was to have pressure reduction to her bed. The care plan, dated 12/13/11, documented impaired skin integrity and impaired mobility. Staff were to conduct weekly skin assessments, encourage fluids, provide a pressure reducing mattress, assist with repositioning, minimize pressure on bony prominences and use pillows for support. Staff were to observe skin during care and report changes to the nurse. On 01/17/12, the care plan indicated a new entry of a pressure ulcer to the right heel. On 02/03/12, the care plan was updated to reflect heel riser when in bed, as tolerated. Review of the current physician orders [REDACTED]. Review of the nursing weekly skin assessments, on 12/17/11, found the resident continued to have a Stage 2 open ulcer to right heel. On 03/10/12, this area was documented as a dry scabbed area. The skin care plan remained in place indicating the staff should minimize pressure on the resident's bony prominences Observation of Resident #58, on 05/1/12 at 10:05 a.m., revealed she was in bed on her back with her feet elevated off the bed with the heel elevator in place. Also on this date, at 12:26 p.m., the resident was observed in her wheelchair in the hall with no pressure relief device noted in her chair. She was noted to have non-skid socks on her feet and her heels were resting on the cement tile floor. There was no observation of any pressure reduction to relieve pressure on the bony prominence of her heels during this observation. Interview with the treatment nurse at that time revealed she thought the resident should have shoes on, but was not sure. In an interview with the Nurse Assistant #102, at 12:35 p.m., she stated the resident had not worn shoes in a long time and she wears only non-skid socks when she is up in her wheelchair. On 05/01/12 at 12:57 p.m., Resident #58 was observed in her wheelchair with no pressure relief in the chair, but the staff had placed house slippers on her feet. The current skin care plan documented the resident was at high risk for the development of pressure ulcers and staff should minimize pressure to all bony prominences. Observation of the wound, on 05/02/12 at 11:00 a.m., revealed the area on her right outer heel was a dark scabbed area with a white flaky surface. The wound nurse stated the area had been closed for awhile, but they were just doing a preventive treatment to the area since she was susceptible to skin breakdown in that area again. This observation was shared with the DON during an interview interview at 3:20 p.m. on 05/02/12. She indicated the resident's heels should not be resting on the hard surface of the floor. She said she would make a referral to the podiatrist to obtain something to ensure pressure relief to the resident's heels while she was up in her wheelchair. b) Resident #13 Review of the medical record for Resident #13 revealed a most recent admission date of [DATE] and pertinent [DIAGNOSES REDACTED]. The most recent Minimum Data Set (MDS), a comprehensive assessment dated [DATE], revealed Resident #13 had both short and long term memory problems. The MDS also revealed the resident had moderately impaired decision-making skills and required cues and supervision. Resident #13 was also assessed to be dependent on staff for bed mobility, transfers, dressing, eating and personal hygiene. Review of the care plans for Resident #13 revealed a care plan dated 03/14/12 related to the resident's self care deficit due to her chronic illness, [MEDICAL CONDITION], weakness and decreased ability for understanding. The interventions for the care plan included: to provide the resident with a wet wash cloth and give simple instructions and cues to wash her own face and hands, to provide assistance with oral hygiene and grooming daily, to provide extensive to total assistance during shower and daily bathing, and to provide simple choices of clothing daily. The same interventions were noted to be listed on a document titled, CNA Care Card, found in a binder at the nurses' station. Resident #13 was observed in bed wearing a pink night gown on 04/30/12 at 2:40 p.m., on 05/01/12 at 10:02 a.m., 11:11 a.m., 12:45 p.m., 1:59 p.m., and 3:14 p.m. Resident #13 was also observed in bed wearing the same pink night gown on 05/02/12 at 7:06 a.m. and 11:15 a.m. During an interview, on 05/02/12 at 11:15 a.m., with nurse aide (NA) #83, identified as one of the NAs caring for Resident #13, it was stated the resident gets up to the chair once a day around 4:30 in the afternoon, receives a bed bath daily and a shower twice a week in the afternoon around 2:30 p.m. NA #83 stated there is a shower book that tells them when the residents are to receive a shower and another book that tells them what care each resident required. During an interview, on 05/02/12 at 12:34 p.m., with NA #109, identified as the NA caring for Resident #13, it was stated the resident gets a shower every Tuesday and Saturday or whenever she gets time. It was verified during the interview that Resident #13 did not have a shower on 05/01/12, as she should have and NA #109 did not change her night gown because she did not have time to do it. NA #109 verified she was scheduled to work 05/01/12, 05/02/12, and 05/03/12. During an interview with the Director of Nursing on 05/03/12 at 10:27 a.m., it was verified the expectation was Resident #13 would have her clothes changed daily as stated in the Activities of Daily Living care plan. It was also verified the NAs were to provide care as directed by the NA care cards located in binders at the nurses' station. | 2016-07-01 |