cms_WV: 9832
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 9832 | ELKINS REGIONAL CONVALESCENT CENTER | 515025 | 1175 BEVERLY PIKE | ELKINS | WV | 26241 | 2012-05-24 | 327 | G | 1 | 0 | 4S5211 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** . Based on facility record review, hospital record review, staff interview, and anonymous information received during a complaint investigation, the facility failed to provide adequate amounts of fluid to maintain proper hydration for one (1) of ten (10) sampled residents. The resident experience a change in health status and was subsequently hospitalized . An admitting [DIAGNOSES REDACTED]. Resident identifier: #105. Facility census 103. Findings include: a) Resident #105 A review of the medical record revealed this [AGE] year old male was admitted to the facility on [DATE], with [DIAGNOSES REDACTED]. He had a Foley catheter placed to facilitate healing of the pressure ulcers. At 4:00 p.m. on 03/03/12, after transferring himself from the wheelchair into bed, Resident #103 complained to nursing that his Foley catheter was hurting him. He had 200 cc of amber urine in his drainage bag. At 9:00 p.m. the nurse's note, written by Nurse #4, stated, "...resident was c/o (complaining of) pain upon exam. It was noted cath (catheter) was clamped - and there was some blood in the cath bag." The physician was notified and the catheter was discontinued at the resident's request. The nurse also noted, "Resident voided X 3 lg amts of cl (large amounts of clear) amber urine since." The nurse's note by Employee #115 (Registered Nurse) stated at 2:00 p.m. on 03/04/12, "Resident c/o burning with urination. Will obtain clean catch UA (urinalysis) with resident's next void." There was no evidence a urine specimen was obtained or sent for testing. The medical record contained no entries for 03/05/12 or 03/06/12. The last nurse's note which contained any reference to intake or output was 03/03/12. There were no further entries in the nurse's notes indicating either intake or output until four (4) days later, on 03/07/12 at 11:00 p.m. Nursing notes, dated 03/07/12 at 11:25 a.m., described the resident had an unwitnessed fall in the bathroom. He sustained a two (2) inch scratch to the top of his head. The physician was notified and the resident was sent to the emergency room for examination. A CAT scan failed to identify any acute injury and the resident was returned to the facility at 4:30 p.m. While in the emergency room , a urinalysis was done. The resident was diagnosed with [REDACTED]. At 11:00 p.m. on 03/07/12, the nurse's notes stated, "Resident rested most of evening taking clothes off - throwing empty cups and other items on floor - ". This was the first entry of these behaviors in either the nurses' notes or the social service notes since admission. The nurse included, "Nutritional intake fair." There was no other intake and output information in the nurse's note. At 12:45 a.m. on 03/08/12, the notes indicted the resident "...had emesis X 1." At 7:35 p.m. on 03/08/12, the resident was described as, "...very quiet this evening..." At 11:00 p.m. on 03/09/12, the resident, "...refused to eat supper.. had 360 cc of H2O....Very hard to wake resident up tonight. Temp (temperature) was taken at 11p 100.5 ax (axillary) - cool wash cloths applied at this time..." The medical record contained no evidence of any follow up nursing assessment until an entry at 4:00 p.m. on 03/11/12 (forty-one (41) hours later), which noted the resident had "difficulty swallowing pills..." At 2:30 p.m. on 03/12/12, Nurse #109 notified the physician the resident had a temperature, was lethargic, and "was still not doing well." Orders were received to stop the antibiotic and obtain urine for testing "in the morning." At 10:30 p.m. on 03/12/12, the notes indicated, "Resident refuse meals....lethargic." At 7:30 p.m. on 03/13/12, the notes indicated, "Resident lethargic - combative..." He was visited by the attending physician and sent to the emergency room at 7:00 p.m. The attending physician's progress notes of 03/13/12 stated, "Unresponsive, Shook him several times. Doesn't wake up. Nurses report pt (patient) has been sleeping for 2 days now. Refuses to take meds. Does not want to eat. Plan to send to ER for evaluation." Review of the facility's investigation of an allegation, made by the resident's son, revealed signed statements from three (3) nursing assistants, NAs, (#9, #97, and #107). The son alleged the facility failed to ensure adequate fluid intake to prevent dehydration, prior to the resident's hospital admission on 03/13/12. The statements from the NAs each described the resident had stopped eating and/or drinking in the days before his transfer, although none of them could recall exact dates. Their statements, all taken on 03/20/12, included the following (typed as written): -- NA #9: "He stop eating and drinking. We reposition him every 2 hrs. He just mumbled when we did it. When in room stop responded. He would let drinks run out of his mouth. " -- NA #97: "The last 2 times I worked with (resident #105) he would not eat or drink that much for me. I tried to feed him but he said he just couldn't do it and the nurse tried to and she couldn't get anything in him . He would not get up or out of bed either." -- NA #107: "(Resident) had refused to eat or drink. Stop talking just mumbled while we were repositioning him. When asking him a question he wouldn't respond." NAs #9 and #97 verified their statements when interviewed at 10:45 a.m. on 05/24/12, but could not explain the amounts entered by them on the 'Fluid Intake Detail Report' and the 'I/O Detail Report'. These reports showed a total, on 03/12/12, of 1140 cc, on a day when there was documentation, by nurses, which stated the resident was not eating or drinking. During an interview with the administrator, at 2:30 p.m. on 05/24/12, she had no comment about the resident's inaccurate intake record. She acknowledged the resident had no follow-up assessment after a health status change which included complaints of urinary pain, finding the resident's Foley catheter clamped off and blood in his urine, removal of the catheter, and further complaints of pain. The nurse's notes reflected this information on 03/04/12. There were no nurse's notes from 03/04/12 at 2:00 p.m. until 03/07/12 at 11:25 a.m. when the resident had a fall and was sent to the emergency room for evaluation. The resident's hospital record was reviewed. The hospital History and Physical, dated 03/14/12, was completed by the same attending physician who cared for the resident at the facility. The following assessment was made at the hospital by this physician: "The patient had been less responsive since about 4 days prior to this admission and over the past 2 days had become even more unresponsive. He had stopped taking all of his medications and had not eaten or drunk much of anything since then ... He was then admitted for further evaluation, hydration and treatment." The Admitting Impression was: 1. Severe dehydration. 2. Electrolyte abnormality. 3. Acute [MEDICAL CONDITION] on chronic. 4. [MEDICAL CONDITION] secondary to urinary tract infection. The final discharge [DIAGNOSES REDACTED]. 1. Dehydration - corrected (BUN now is 24 and creatinine 1.2 from BUN 132 and creatinine 8.1 on admission). 2. Acute [MEDICAL CONDITION], resolved. 3. Electrolyte imbalance (sodium 145 and potassium 3.6 now from sodium of 166 and potassium of 5.7 on admission). 6. Urinary tract infection, resolved. This information collected during the survey was presented to the administrator and Employee #5 during an interview at 2:30 p.m. on 05/24/12. They had no comment about the missing assessments of the resident's intakes and outputs. The administrator denied the resident was dehydrated when he was admitted to the hospital. The hospital record, written by the resident's attending physician at the nursing facility, stated the resident was dehydrated. The resident's nursing facility medical record did not reflect adequate comprehensive nursing assessments to verify the resident was taking in food and fluids in the days prior to the transfer to the hospital. Resident #105 had several risk factors for becoming dehydrated. These included [MEDICAL CONDITION], unresponsiveness, fever, and refusal to eat or drink. Additionally, on 03/03/12 the resident had amber urine, and on 03/07/12 the resident was diagnosed with [REDACTED]. There was no evidence the risk factors for dehydration or the potential indicators of dehydration were identified and assessed by the facility. . | 2015-08-01 |