cms_WV: 9575
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 9575 | TEAYS VALLEY CENTER | 515106 | 590 NORTH POPLAR FORK ROAD | HURRICANE | WV | 25526 | 2011-07-14 | 279 | D | 0 | 1 | L3JB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, staff interview, resident interview, and observations, the facility failed to develop a comprehensive care plan to address the specific care needs of three (3) of forty-six (46) Stage II sampled residents. No care plan was developed for a resident's who exhibited behaviors for which an antipsychotic and a benzodiazepine (drugs that are used to treat a variety of conditions, including anxiety) had been ordered. A resident who had contractures, and according to her assessments, had had contractures of varying locations, did not have a care plan to address prevention of new - or worsening of currently identified - contractures. No care plan was established for another resident who developed a Stage 2 pressure ulcer. Resident identifiers: #135, #22, and #17. Facility census: 114. Findings include: a) Resident #135 During the Stage I portion of the quality indicator survey (QIS), Resident #135 was identified as receiving the drug [MEDICATION NAME] (an antipsychotic) and the drug [MEDICATION NAME] (a benzodiazepine). Both of these medications must be used judiciously, especially in the elderly. The [AGE] year old resident was selected for Stage II by the QIS software for further review of the appropriateness of these medications. This included a review of the reasons the medications had been ordered, their effect on the resident, whether gradual dosage reductions had been attempted, and whether a care plan had been developed and implemented. Review of the physician's current orders found both medications had been ordered for pacing until exhausted and wringing her hands. Current nursing progress notes indicated she was an elopement risk and wandered the halls. She was noted to wander about talking to residents and staff. She was observed ambulating alone or with other residents on 07/12/11, 07/13/11, and 07/14/11. A copy of the resident's current care plan was requested and provided on 07/07/11. The care plan included a printed notation at the bottom of the page indicating it had last been reviewed on 06/29/11. Review of the resident's care plan found the following: 1. The resident's care plan included a goal of: Ms. (name) will have the smallest most effective dose without side effects x 90 days AEB (as evidenced by) no c/o (complaints of) dry mouth, constipation, increased falls, lethargy. The interventions were: Complete behavior monitoring flow sheet. Gradual dose reduction, as ordered. Monitor for changes in mental status and functional level and report to MD as indicated. Monitor for continued need of medication as related to behavior and mood. Monitor for side effects and consult physician and/or pharmacist as needed. Nothing was found in the resident's care plan for the behaviors of pacing until exhausted and wringing her hands. No interventions were established to provide guidance to the direct care staff in how to intervene when these behaviors occurred. Such interventions were needed to ensure consistent approaches were employed by staff. Consistency in approached would be needed in order to determine whether or not an approach was or was not effective. This was discussed on 07/13/11 at 12:31 p.m. with Employee #62, the registered nurse (RN) unit manager of the Cherry Blossom unit. -- b) Resident #22 During the Stage I portion of the survey, Resident #22 was identified as having contractures through staff interview, observations, and medical record review. As the resident was not noted to have braces or splints, and she stated she did not receive range of motion exercises, she was selected for review in Stage II of the survey. - The resident's annual minimum data set (MDS) assessment (the most recent comprehensive assessment), with an assessment reference date (ARD) of 09/28/10, noted the resident had no limitations or loss of voluntary movement in neck, arms, legs, foot, or other area. This had triggered the need for additional assessment for her activities of daily living function and rehabilitation potential. Her admission MDS, with an ARD of 11/15/05, had noted limitation in range of motion for both feet and legs and that she had full loss of voluntary movement of these extremities. She had subsequently improved in her functional abilities. Her annual MDS, with an ARD of 10/07/09, indicated she had limitation of range of motion and partial loss of voluntary movement of one arm. She had of range of motion and partial loss of voluntary movement for both legs and feet. Her quarterly MDS assessment, with an ARD of 06/01/11, indicated she had impairment on both sides of the upper and lower extremities in Section G, items G0400A and G0400B, respectively. Items O0500A (passive range of motion), O0500B (active range of motion), and O0500C (Splint or brace assistance) were coded as no services being provided. No physical or occupation therapy minutes were noted. Section S of this assessment, noted the following had been coded for contractures: - Hand - none - Wrist - none - Elbow - none - Shoulders - both sides - Neck - none - Ankle - both sides - Knee - none - Hip - none - Other - none She was also noted in Section S to have a dominant right side with full use of her hand / arm. - In an interview with the resident at 8:45 a.m. on 07/13/11, she stated she had been in the hospital when problems with her feet developed. (Observation found she had foot drop bilaterally.) (This was confirmed through staff interviews and record review. Employee #62 reported, on the mid-morning of 07/13/11, the resident had been in the hospital on a ventilator when the problem with her feet had developed.) According to the resident, they had tried braces and other things without success. She said the last time she had gone to a doctor in [MEDICAL CONDITION] - he said he could fix her feet, but he would not do it if it was his mother. She said the doctor said there could be complications that could result in amputation. She said she had told him Thank you, but I will keep my feet. The resident was observed during this interview and at meal time to have functional use of her arms and hands. Her shoulders did appear to be somewhat contracted. On 07/13/11 at 8:45 a.m., the resident demonstrated she could move her hands and fingers, except for her left ring finger. She said it would not straighten like the others. - Review of the resident's care plan found no plan had been established for prevention of further contractures. This was discussed with Employee #114 (an RN) on the afternoon of 07/13/11. She said the resident had had a decline - that is why she could no longer use her sliding board. They had physical therapy evaluate her for safety in using the board. The therapist felt the resident no longer had the upper body strength to use the board safely. -- c) Resident #17 A copy of the resident's current care plan was requested and received on 07/13/11. The care plan indicated it had last been reviewed on 07/01/11. Review of the nurses' notes in the resident's medical record found documentation that a Stage 2 pressure ulcer had been found on the resident's coccyx on 06/05/11. This was also reflected on the Wound Management Tracking Tool. Review of the resident's care plan found no plan had been developed regarding the Stage 2 pressure ulcer. | 2015-10-01 |