cms_WV
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43 rows where "inspection_date" is on date 2011-06-08
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Suggested facets: facility_name, facility_id, address, city, zip, scope_severity, complaint, standard, eventid, filedate, filedate (date)
| Link | rowid ▼ | facility_name | facility_id | address | city | state | zip | inspection_date | deficiency_tag | scope_severity | complaint | standard | eventid | inspection_text | filedate |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 9196 | 9196 | EASTBROOK CENTER LLC | 515089 | 3819 CHESTERFIELD AVENUE | CHARLESTON | WV | 25304 | 2011-06-08 | 156 | C | 0 | 1 | MZQB11 | Based on observation and staff interview, the facility failed to prominently display required information and post the names, addresses and phone numbers of all pertinent State client advocacy groups and information concerning how to file a complaint with the appropriate State agency(ies) concerning abuse, neglect or misappropriation of resident property in the facility. This practice has the potential to affect all residents and families desiring to view this information. Facility census: 149 at the onset of the complaint investigation on 05/18/11 and 144 at the onset of the annual survey on 05/24/11. Finding include: a) During the initial tour of the facility at the onset of the complaint investigation on 05/18/11, this surveyor attempted to view the posting of the required information. The entire first floor was toured, and there was no evidence of any posting containing contact information for the required State agencies. The director of nursing (DON), when questioned about the posting at 3:20 p.m. on 05/18/11, stated the facility had been remodeling and the posting must have been temporarily taken down while this was being done. During the initial tour of the facility at the onset of the annual Medicare / Medicaid certification resurvey at 11:00 a.m. on 05/24/11, observation found the State agency contact information had been posted on the front office door. Access to the front lobby through double doors from the nursing unit was also restricted for any resident wearing a Wanderguard bracelet, so this information would not have been readily available to all residents even if it were posted. | 2016-01-01 |
| 9197 | 9197 | EASTBROOK CENTER LLC | 515089 | 3819 CHESTERFIELD AVENUE | CHARLESTON | WV | 25304 | 2011-06-08 | 224 | G | 0 | 1 | MZQB12 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, review of hospital records, review of facility policies and clinical services notices, and staff interview, the facility failed to provide care and services necessary to avoid physical harm for two (2) of fourteen (14) sampled residents. - Resident #141, who was receiving an anticoagulant on a routine basis, had a witnessed fall at 10:45 a.m. on [DATE], during which he struck the left side of his head and left shoulder with force sufficient to cause a fracture to his upper arm. The licensed practical nurse (LPN) recorded the fall on the incident report and in the nursing notes, initially noting as the only injury a skin tear to the left elbow. Shortly after, the resident complained of left shoulder pain; a nurse notified the physician of the shoulder pain, and the physician ordered an in-house x-ray of the left arm. There was no evidence to reflect nursing staff, at the time of the fall or at any time thereafter, notified the physician that the resident had hit his head. After the fall occurred, staff did not follow facility policy, by not moving the resident until he was examined by emergency personnel or a head injury was ruled out. Although a neurological evaluation form was initiated for this fall, the assessments recorded were not complete / accurate (e.g., several entries identified limitations in motor movement to the wrong limb), and times were not always recorded; as a result, it could not be verified that these neuro checks were being completed at progressive intervals as specified in the directions on the form. After the fall on [DATE], the resident was noted to have a significant decline in the self-performance of activities of daily living, which was attributed to possible pneumonia with no consideration that a head injury may have caused or contributed to these declines. On [DATE], prior to the resident leaving the facility for an outpatient appointment with an orthopedist, the nurse was notified … | 2016-01-01 |
| 9198 | 9198 | EASTBROOK CENTER LLC | 515089 | 3819 CHESTERFIELD AVENUE | CHARLESTON | WV | 25304 | 2011-06-08 | 241 | D | 0 | 1 | MZQB11 | Based on observation, resident interview, and staff interview, the facility failed to provide care in an environment at meal time that provided and maintained each resident's dignity. Three (3) of thirty-eight (38) Stage II sampled residents were not treated in a dignified manner at meal time. Resident #228 was not provided with a bedside table for use during meals and was, instead, provided a small plastic isolation cart with wheels; the height of the isolation cart was not adjustable, and the resident spilled food on her gown and bed linens as she attempted to feed herself. Resident #70 was served her meal well after her roommate, was asked if she wanted a bib, and was not given adaptive utensils as per her tray slip. Resident #85 was also not served his meal in a timely manner. Facility census: 149 at the onset of the complaint investigation on 05/18/11 and 144 at the onset of the annual survey on 05/24/11. Findings include: a) Resident #228 During the initial tour of the facility on 05/18/11 at 12:00 p.m., this resident was observed eating her lunch in her bed. Her tray was sitting on a plastic cart with wheels, which was located on the left side of her bed. This was noted to be her isolation cart with supplies in it required for maintaining contact isolation precautions. Resident #228 was feeding herself with her right hand, and her left arm was just lying on the bed. She was reaching over and getting chili on her spoon and was having difficulty getting it to her mouth without spilling it on her gown and bed linens. She said she could do it, but she just had to do a little bit at a time. When questioned about the cart her tray was sitting on, she stated she guessed that was all they had. She stated she ate on it earlier that morning. She stated someone fixed that up for her or she probably wouldn't have had anything to sit her tray on. She said, It doesn't look like much, but at least it works. She verified she could not use her left arm because she had a stroke and she was having a difficult time reaching o… | 2016-01-01 |
| 9199 | 9199 | EASTBROOK CENTER LLC | 515089 | 3819 CHESTERFIELD AVENUE | CHARLESTON | WV | 25304 | 2011-06-08 | 246 | D | 0 | 1 | MZQB11 | Based on observation, record review, resident interview, and staff interview, the facility failed to make reasonable accommodations to meet the individual needs of residents. The facility failed to ensure staff answered call lights within a reasonable period of time for two (2) of thirty-eight (38) residents on the Stage II sample and one (1) randomly observed resident. During a period of approximately one (1) hour, three (3) call lights were observed to be on for thirteen (13) to twenty-two (22) minutes without staff responding for more than ten (10) minutes. Additionally, Resident #228 was not provided with a bedside table for use during meals and was, instead, provided a small plastic isolation cart with wheels; the height of the isolation cart was not adjustable, and the resident spilled food on her gown and bed linens as she attempted to feed herself. Resident identifiers #60, #85, #155, and #228. Facility census: 149 at the onset of the complaint investigation on 05/18/11 and 144 at the onset of the annual survey on 05/24/11. Findings include: a) Residents #60, #85, and #155 1. On 06/08/11, while reviewing some information at the second floor nurses' station, it was noted at approximately 8:00 a.m., call lights were remaining on for extended periods of time. The display panel, the telephone display, staff in the halls, and the rooms were observed for staff's responses to the call lights. During this time, the following were noted on C hall: - Resident #60's call light rang for seventeen (17) minutes, - Resident #85's call light rang for twenty-two (22) minutes, and - Resident #155's call light rang for thirteen (13) minutes. Employee #58 (licensed practical nurse - LPN) was passing medication on the unit. Several nursing assistants (including, but not limited to, Employees #122 and #127) were also observed on C hall. No one answered the call lights in a timely manner. 2. Resident Council Meeting minutes Review of the Resident Council meeting minutes, dated 05/16/11, found under Nursing for Any requests (com… | 2016-01-01 |
| 9200 | 9200 | EASTBROOK CENTER LLC | 515089 | 3819 CHESTERFIELD AVENUE | CHARLESTON | WV | 25304 | 2011-06-08 | 250 | D | 0 | 1 | MZQB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview, the facility failed to provide medically-related social services to one (1) of thirty-eight (38) Stage II sample residents who was approved for short-term placement at the facility, by failing to assess the resident's goals with respect to discharge and develop an appropriate discharge plan to accomplish those goals. Resident identifier: #148. Facility census: 144. Findings include: a) Resident #148 Medical record review revealed this [AGE] year old female was originally admitted to the facility on [DATE], and was discharged to home on 08/31/10. The resident was readmitted to the facility on [DATE] after she suffered a fracture of the right femur. Her current active [DIAGNOSES REDACTED]. Further record review revealed a social work assessment and history, dated 03/29/11. The sections addressing the resident's expected length of stay, anticipated discharge potential, anticipated discharge destination, and community resources potentially needed after discharge were not completed. Review of the resident's pre-admission screening (form PAS-2000) revealed the physician expected her to be able to return home in less than three (3) months. The PAS-2000 was signed by the physician on 03/21/11. Review of her minimum data set assessment (MDS 3.0), with an assessment reference date (ARD) of 04/01/11, found in Section Q0400 (Discharge Plan) that a determination for discharge had not been made. Employee #25 (physical therapy assistant), when interviewed on 06/02/11 at 11:05 a.m., stated he had treated the resident around this time last year and she was able to return home. He stated her son and husband had been very active in her treatment on her last admission, but he had not seen them this time around. He stated he was not sure what had happened. Employee #34 (licensed social worker), when interviewed on 06/02/11 at 10:35 a.m., stated she thought the resident was going to be a long term placement, but … | 2016-01-01 |
| 9201 | 9201 | EASTBROOK CENTER LLC | 515089 | 3819 CHESTERFIELD AVENUE | CHARLESTON | WV | 25304 | 2011-06-08 | 272 | E | 0 | 1 | MZQB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, resident interview, and staff interview, the facility's interdisciplinary team failed to complete assessments to accurately reflect each resident's health status / condition for six (6) of thirty-eight (38) Stage II sample residents. Complete and accurate assessments were not conducted for Resident #223's pressure ulcer, Resident #129's indwelling catheter, Residents #116 and #199's bladder continence, Resident #155's dental status, and Resident #125's complaints of a sore toe. Facility census: 149 at the onset of the complaint investigation on 05/18/11 and 144 at the onset of the annual survey on 05/24/11. Findings include: a) Resident #223 During a review of Resident #223's initial Medicare 5-Day minimum data set assessment (MDS), with an assessment reference date of 04/14/11, found this resident had a pressure ulcer measuring 2.5 cm x 3.4 cm. This pressure ulcer, which was noted to have been present on admission to the facility, was identified on the MDS as being unstageable due to the presence of slough or eschar. Further review of the MDS found in Section V that the care area of Pressure Ulcer was then triggered and addressed in the care plan. The assessor noted that the further information for this care area could be found in a worksheet dated 04/18/11. The Care Area Assessment (CAA) worksheet dated 04/18/11, when reviewed, found in the analysis of this ulcer that this represented a potential problem. The nature of the problem was stated: At risk for pressure ulcers. The end note stated: (Resident #223) could be at risk for a pressure ulcer related to impaired mobility and incontinent. See the plan of care documentation for 4/11/2011. The staff will continue to assist her as needed for frequent position changes as well as prompt incontinence care. Any concerns with her skin will be reported to the MD promptly. Will proceed to care plan. This CAA did not reflect the resident's actual condition or evaluate the caus… | 2016-01-01 |
| 9202 | 9202 | EASTBROOK CENTER LLC | 515089 | 3819 CHESTERFIELD AVENUE | CHARLESTON | WV | 25304 | 2011-06-08 | 278 | D | 0 | 1 | MZQB12 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview, the facility failed to ensure minimum data set assessments (MDSs) accurately reflected the health and functional status of two (2) of fourteen (14) sampled records. Resident identifiers: #141 and #21. Facility census: 140. Findings include: a) Resident #141 Record review revealed Resident #141 was admitted to the facility on [DATE]. Review of Resident #141's discharge MDS, with assessment reference date (ARD) of 08/04/11, found the assessor noted the number of falls since the prior assessment (which was a quarterly MDS with an ARD of 07/13/11) as follows: - Fall with no injury - none - Fall with injury (except major) - none - Fall with major injury - 1 - A review of the incident reports, nursing notes, and the significant event reporting in the computer revealed that Resident #141 had sustained falls as follows: - On 07/20/11 at 5:00 p.m., he was found on the floor and had sustained a scratch to his right hand measuring approximately 5 cm long. - On 07/22/11 at 7:30 p.m., he slid down the side of a chair after missing the seat, and an assessment found no apparent injuries. - On 07/24/11 at 10:45 a.m., he fell , hitting his left arm and the left side of his head against a door frame; he subsequently was found to have sustained a fractured humerus and a subdural hematoma. - The above assessment was inaccurate with respect to the numbers and types of falls that had occurred since his prior MDS with an ARD of 07/13/11. -- b) Resident #21 A review of a significant change in status MDS with an ARD of 05/02/11 found the assessor indicated, in Item M0300F, that Resident #21 had one (1) unstageable pressure ulcer. In a quarterly MDS with ARD of 07/27/11, the assessor again indicated the presence of one (1) unstageable pressure ulcer (measuring 0.4 cm x 0.5 cm) in Item M0300F. - Review of the resident's nursing notes revealed an entry, at 9:50 a.m. on 06/21/11, stating: Note necrotic tissue to L (left… | 2016-01-01 |
| 9203 | 9203 | EASTBROOK CENTER LLC | 515089 | 3819 CHESTERFIELD AVENUE | CHARLESTON | WV | 25304 | 2011-06-08 | 279 | E | 0 | 1 | MZQB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observation, resident interview, staff interview, and family interview, the facility's interdisciplinary team failed to develop comprehensive care plans to address the care needs and to describe the services needed for residents to maintain a safe environment, prevent further condition decline, and prevent complications in their condition. The care plans were not complete and/or did not provide instructions to provide care in the areas of accidents / falls, activities of daily living, dental needs, hospitalization , nutrition, behaviors, the use of psychoactive medications, pressure ulcers, range of motion, contractures, indwelling urinary catheters, and management of urinary incontinence. The care plans did not address specific care needs for thirteen (13) of thirty-eight (38) stage II sampled residents. Resident identifiers: #228, #223, #129, #116, #199, #169, #138, #5, #148, #55, #3, #155, and #215. Facility census: 149 at the onset of the complaint investigation on 05/18/11 and 144 at the onset of the annual survey on 05/24/11. Findings include: a) Resident #228 A complaint investigation was initiated at this facility at 12:00 p.m. on 05/18/11. Review of Resident #228's medical record revealed this [AGE] year old female was admitted to the facility at 8:30 p.m. on 05/17/11. According to hospital records provided on admission, this resident had dementia and a history of falls. That she had frequent falls was also noted on her physician's admission orders [REDACTED] According to the nursing notes dated 05/18/11 at 2:30 a.m., Resident #228 was found face down in the floor in her room with blood on her right hand and on the left side of her forehead; she was subsequently transferred to the hospital for evaluation due to complaints of pain in her left leg. The resident was in this facility for a total of six (6) hours prior to falling and being transferred to the hospital. She subsequently returned to the facility at 6:… | 2016-01-01 |
| 9204 | 9204 | EASTBROOK CENTER LLC | 515089 | 3819 CHESTERFIELD AVENUE | CHARLESTON | WV | 25304 | 2011-06-08 | 280 | D | 0 | 1 | MZQB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, staff interviews, family interviews, and review of medical records, the facility's interdisciplinary team failed to periodically review and revise residents' care plans to address changes in their conditions and needs. One (1) resident's care plan was not updated to reflect her discharge from hospice or the change in her functional abilities. Another resident had an indwelling urinary catheter that was noted to be in place for excoriation; the care plan had not been updated to plan for removal of the catheter after resolution of the excoriation. Two (2) of thirty-eight (38) residents on the Stage II sample were affected. Resident identifiers: #116 and #129. Facility census: 144 at the onset of the annual survey on 05/24/11. Findings include: a) Resident #116 A copy of the resident's current care plan was requested. The copy was noted to have a print date of 06/01/11. A second copy was provided in response to a request for information regarding another issue. The second copy had a print date of 06/07/11. The resident had been discharged from hospice early in May 2011. The actual physician's orders [REDACTED]. A significant change in status assessment (SCSA), with an assessment reference date (ARD) of 05/02/11, was signed as complete on 05/12/11. The care plan should have been updated to address the results of the comprehensive assessment within seven (7) days of the assessment completion date. 1. The care plan printed on 06/01/11 still referenced receipt of hospice care in the interventions for two (2) goals. - 2. According to the assessment, the resident was totally dependent for bed mobility, locomotion on the unit, locomotion off unit, dressing, eating, toilet use, and personal hygiene. She required extensive assistance for transfers. The walk in room and walk in corridor items were coded as the activity having not occurred. Both of the care plans included interventions that included: Resident wonders (sic) around the… | 2016-01-01 |
| 9205 | 9205 | EASTBROOK CENTER LLC | 515089 | 3819 CHESTERFIELD AVENUE | CHARLESTON | WV | 25304 | 2011-06-08 | 281 | D | 0 | 1 | MZQB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, staff interview, and record review, the facility failed to assure staff adequately assessed the patency of a gastrostomy tube prior to administering the medications and tube feeding. The nurse did not verify the placement of the tube by aspirating for residual per physician order. The physician's orders [REDACTED]. This did not occur for one (1) of one (1) resident observed during medication administration by gastrostomy tube. Resident identifier: #76. Facility census: 144. Findings include: a) Resident #76 During medication administration on 05/31/11 at 1:30 p.m., a licensed practical nurse (LPN - Employee #100) prepared to administer a medication to Resident #76 via gastrostomy tube. Employee #100 stated it was also time to turn on the resident's tube feeding, so she would do that too as soon as she gave his medication. Employee #100 administered the resident's medication in his enteral gastrostomy tube and then turned on his feeding of [MEDICATION NAME] 1.5 at a rate of 66 ml/hour as ordered. She stated this was ordered to run until 1320 cc of the tube feeding had infused. After administering this medication and turning on the feeding, the nurse then checked the Medication Administration Record [REDACTED]. If 400 ml of residual, hold the feeding and call the MD. The nurse, when questioned about verifying placement of the tube, stated, I know I forgot to aspirate to verify placement and check the residual. She verified that this should have been checked prior to administering the medication and starting the feeding. . | 2016-01-01 |
| 9206 | 9206 | EASTBROOK CENTER LLC | 515089 | 3819 CHESTERFIELD AVENUE | CHARLESTON | WV | 25304 | 2011-06-08 | 282 | D | 0 | 1 | MZQB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation, staff interview, and resident interview, the facility failed to ensure implementation of established care plans for three (3) of thirty-eight (38) residents on the Stage II sample. The residents' care plans identified specific approaches direct care staff was to employ to address each identified problem, but these approaches were not consistently implemented. For example, a resident, who had a physician's orders [REDACTED]. This individual also had interventions identifying she enjoyed watching westerns on television, enjoyed listening to county music in her room, and for her glasses to be worn due to impaired vision. These interventions were not noted to be implemented until near the end of the third week of the survey. Other residents had care plans identifying hygienic needs, but these needs were not being met prior to identification of deficits by a survey team member. Resident identifiers: #5, #40, and #125. Facility census: 144. Findings include: a) Resident #5 1. Review of the resident's care plan found a problem of At risk for respiratory impairment related to risk for aspiration d/t (due to) dysphagia. Three (3) goals had been established for this problem: - Maintain patent airway - Will have no acute respiratory distress - Will exhibit no S&S (signs and symptoms) of aspiration such as coughing, fever, etc. One (1) of the interventions was: Position as upright as possible for meals and 30 minutes afterwards. The speech therapist had noted, in an evaluation dated 02/15/11, the resident needed to be in upright position. On 05/26/11, the resident was observed drinking her afternoon supplement while in bed in her room. The head of the resident's bed was elevated at only approximately 30 degrees. On 05/31/11 at approximately 2:00 p.m., observation found the resident lying in bed holding a carton of supplement. The head of her bed was elevated at only approximately 30 degrees. On 06/01/11 at 11:… | 2016-01-01 |
| 9207 | 9207 | EASTBROOK CENTER LLC | 515089 | 3819 CHESTERFIELD AVENUE | CHARLESTON | WV | 25304 | 2011-06-08 | 309 | G | 0 | 1 | MZQB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, medical record review, resident interview, and staff interview, the facility failed to ensure residents received the services and care necessary to promote their highest level of well being. The facility failed to provide services to promote comfort and relieve pain and failed to communicate the recommendations of a consulting physician to a resident's attending physician related to lab studies for three (3) of thirty-eight (38) Stage II sample residents. The failure to provide these services caused actual harm to Resident #228, with the potential for more than minimal harm for Residents #227 and #125. Resident #228 suffered a fall with injuries and was sent to the emergency room six (6) hours after her admission to this facility. Her wound was treated, and she was sent back to the nursing home with instructions from the emergency room physician for follow up care of her injuries and measures for pain relief. This resident verbalized that she was experiencing pain at 3:15 p.m. on 05/18/11. She said she would like to have ice on her eye but they told to they did not have any. Observation found she had a hematoma, a laceration, and facial swelling around her left eye, as well as a large area of bruising. There was no evidence that any pain assessments or any pain relief interventions had been initiated for this resident since her return from the emergency room at 6:30 a.m. on 05/18/11. Resident #227 was admitted to the facility with wounds on his coccyx and was going to the wound healing center every week for treatment. On his visit to the wound center on 05/26/11, the following recommendation was communicated in writing to the facility by the wound center's physician: If he has not had a PT ([MEDICATION NAME] Time) / INR (International Normalized Ratio) recently, please check. Patient bled during assessment and cleaning. (These are blood test to assess the clotting tendency of the blood and are also used to detect bleedi… | 2016-01-01 |
| 9208 | 9208 | EASTBROOK CENTER LLC | 515089 | 3819 CHESTERFIELD AVENUE | CHARLESTON | WV | 25304 | 2011-06-08 | 312 | D | 0 | 1 | MZQB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on resident interview, observations, medical record review, and staff interview, the facility failed to provide necessary services to maintain good grooming and personal and oral hygiene for two (2) of thirty-eight Stage II sample residents. Each of these residents, who required assistance with activities of daily living (ADLs), were not provided this assistance. There were care plans to provide and/or assist the residents; however, the staff failed to implement the care plans. One (1) resident needed personal hygiene and oral care; the other resident needed assistance with grooming. Resident identifiers: #40 and #125. Facility census: 144. Findings include: a) Resident #40 During Stage I of the survey on 05/25/11 at 1:19 p.m., Resident #40 was asked, Does staff help you as necessary to clean your teeth? The resident said staff did not. The resident further stated he had not asked them to brush his teeth. The next question asked was: How often are your teeth / mouth cleaned? The resident answered his teeth had not been brushed for a month or more, because he was no longer able to brush them due to his [MEDICAL CONDITION] (MS). He stated no one had brushed them for him. The resident said he would really like to have his teeth brushed. When asked if he had a toothbrush, the resident said, Look in that drawer and see. There was an unopened toothbrush and an unopened box of toothpaste in the drawer. At 9:00 a.m. on 06/01/11, Employee #58 (licensed practical nurse - LPN), when asked if this resident was compliant with the provision of care, responded, Oh yes, he allows care needs to be met. He is very compliant with care. On 06/01/11, review of the resident's medical record revealed [REDACTED]. An intervention to assist the resident in achieving this goal was: Assist with daily hygiene, grooming, dressing, and oral care as needed. At 2:45 p.m. on 06/01/11, the resident was visited with the director of nursing (DON - Employee #12). Upon inqui… | 2016-01-01 |
| 9209 | 9209 | EASTBROOK CENTER LLC | 515089 | 3819 CHESTERFIELD AVENUE | CHARLESTON | WV | 25304 | 2011-06-08 | 314 | D | 0 | 1 | MZQB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility failed to provide the necessary services to promote wound healing. This was found to be true for one (1) of thirty-eight (38) Stage II sample residents. A resident was assessed by the facility's registered dietitian (RD) on 04/11/11, at which time the RD recommended a multivitamin and Pro-Mod (a protein powder) to promote wound healing. These interventions were not initiated until 04/27/11 - sixteen (16) days after the recommendation was made. Resident identifier: #223. Facility census: 149 at the onset of the complaint investigation on 05/18/11 and 144 at the onset of the annual survey on 05/24/11. Findings include: a) Resident #223 Review of Resident #223's closed record revealed she was admitted to the facility on [DATE] with a pressure area on her left buttock. This area was identified as an unstageable area and described as having dark necrotic tissue present. Review of the RD's assessment and progress note, dated 04/11/11, found the RD assessed the resident's nutritional needs and recommended a multivitamin (MVI) and ProMod twice daily (BID) to promote healing of the wound on the left buttock. There was no evidence to reflect these recommendations were communicated to nursing or that these supplements were ordered by the physician. On 04/19/11, the RD wrote: Previously documented resident with pressure area on left buttock. - Incorrect. Resident without pressure area. No new dietary interventions. On 04/20/11, the RD wrote: Note 4/19/11 documented resident with no pressure area - incorrect - wrong resident. Resident admitted with pressure area on coccyx which has increased in size this week. Will recommend ProMod 30 ml BID (100 kcal, 10 g pro) and MVI to promote wound healing. This was the same recommendation the RD had made on 04/11/11 but was never initiated. On 04/21/11, an interdisciplinary care plan meeting was held. The RD was present as well as all other disciplines and the… | 2016-01-01 |
| 9210 | 9210 | EASTBROOK CENTER LLC | 515089 | 3819 CHESTERFIELD AVENUE | CHARLESTON | WV | 25304 | 2011-06-08 | 315 | D | 0 | 1 | MZQB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on resident interview, observation, medical record review, and staff interview, the facility failed to assess each resident's bladder function and develop / implement measures to restore as much normal bladder function as possible. Resident #129 had an indwelling Foley urinary catheter present without a [DIAGNOSES REDACTED]. She had a catheter change followed by a urinary tract infection, and the continued need for the catheter was not re-evaluated. There was no current [DIAGNOSES REDACTED]. Residents #116 and #199 did not receive services to improve their bladder function. There was no evidence to reflect efforts by the facility to ascertain the type of urinary incontinence each was experiencing, nor did the facility implement measures in an effort to improve their urinary incontinence. This deficient practice affected three (3) of thirty-eight (38) Stage II sample residents. Resident identifiers: #129, #116, and #199. Facility census: 144. Findings include: a) Resident #129 During an interview with Resident #129 on 05/25/11 at 1:00 p.m., observation revealed she had an indwelling Foley urinary catheter. When questioned about the presence of the catheter, Resident #129 stated the catheter had been inserted at the facility where she was prior to coming here. Record review revealed Resident #129 was admitted from a hospital to the facility on [DATE] with an order for [REDACTED]. Resident #129's admission minimum data set assessment (MDS), with an assessment reference date (ARD) of 03/11/11, revealed, in Section H, this resident had an indwelling urinary catheter. This triggered the care area Urinary Incontinence and Indwelling Catheter in Section V of the MDS, where the assessor recorded that the location and date of the CAA could be found in the worksheet dated 03/16/11. In Section M of the MDS, the assessor did not identify the presence of any pressure ulcers or open areas. The resident's CAA worksheet for Urinary Incontinence and Indw… | 2016-01-01 |
| 9211 | 9211 | EASTBROOK CENTER LLC | 515089 | 3819 CHESTERFIELD AVENUE | CHARLESTON | WV | 25304 | 2011-06-08 | 318 | D | 0 | 1 | MZQB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, medical record review, and staff interview, the facility failed to assure two (2) of thirty-eight (38) Stage II sample residents received treatment and services, including preventive care, to increase range of motion (ROM) and/or to prevent further decrease in ROM. The facility had no individualized plans in place for these two (2) residents, each with a limited range of motion, which assured each resident was provided services to reach and maintain his or her highest level of range of motion, or to prevent decline of range of motion. Resident identifiers: #3 and #55. Facility census: 144. Findings include: a) Resident #3 During Stage I of this survey, this resident was identified with a contracture of the right hand. The resident did not have a splint / device or receive ROM activities. Medical record review, on 06/01/11, revealed no order for splints or other devices; however, the facility's current Patient Information Worksheet indicated the resident was to have hand palm protector on at all times. Observation of the resident, at 10:45 a.m. 06/01/11, revealed the resident was in bed and had no hand rolls in place. The resident was observed again at 1:30 p.m. on 06/01/11, and no hand rolls were in place. Medical record review, on 05/31/11, revealed a care plan, last revised on 02/02/11 with the following goal: Will exhibit no decline in ROM within confines of disease. There were no interventions regarding the contracture of the resident's right hand. Interview with the rehabilitation manager (Employee #110), on 06/01/11 at 1:30 p.m., revealed the resident's last rehabilitation evaluation occurred in November 2010. According to Employee #110, at that time, a palm protector for the right hand was recommended. On 06/02/11 at 11:00 a.m., the director of nursing (DON - Employee #12) stated the resident now had an order for [REDACTED]. The DON confirmed occupational therapy had evaluated the resident's need for a device in N… | 2016-01-01 |
| 9212 | 9212 | EASTBROOK CENTER LLC | 515089 | 3819 CHESTERFIELD AVENUE | CHARLESTON | WV | 25304 | 2011-06-08 | 323 | G | 0 | 1 | MZQB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, medical record, and staff interview, the facility failed to provide adequate supervision and/or assistive devices to prevent avoidable accidents and to promote resident safety. The facility failed to assess the immediate safety needs for Resident #228, a newly admitted resident who was identified in her admission information as having dementia and a history of falls. Failure of the facility to assess the resident upon admission for safety needs and to implement measures to prevent falls resulted in the resident falling only six (6) hours after she arrived at the facility and sustaining a head injury. She was transferred to the emergency room and treated for [REDACTED]. After safety measures were ordered upon her return to the facility (to include a low bed without side rails and mats on both sides of her bed), she was observed in her bed with a mat on only one (1) side of bed and tile floor on the other side. Resident #76, who had a [DIAGNOSES REDACTED]. He was in a low bed, and according to his treatment record, he was to have mats on both sides of the bed. Two (2) mats were stacked on top of each other on one (1) side of the bed with the tile floor on the other side. Resident #48 was observed to have Theraband used in a manner that was presented an accident hazard to this cognitively impaired resident. This band, which had been tied to the wheelchair to secure her leg secured to the chair, presented a hazard when the resident attempted to stand up from the chair without assistance. Resident #5 was observed at meal time to have straws in beverages, which were contrary to his physician's orders [REDACTED]. This was an accident hazard for this resident. Failure of the facility to assess the residents for safety needs and implement measures to prevent accidents and injuries affected three (4) of thirty-eight (38) Stage II sample residents. Resident identifiers: #228, #76, #48, and #5. Facility census: 149 at the onset of t… | 2016-01-01 |
| 9213 | 9213 | EASTBROOK CENTER LLC | 515089 | 3819 CHESTERFIELD AVENUE | CHARLESTON | WV | 25304 | 2011-06-08 | 325 | D | 0 | 1 | MZQB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation and staff interview, the facility failed to assure the resident received nutritional supplements as ordered by the physician after the resident experienced a 7 pound weight loss in three (3) days. The facility failed to specify how often the resident would be weighed to monitor the effectiveness of the diet ordered. This was true for one (1) of thirty-eight (38) Stage II sample residents. Resident identifier: #215. Facility census: 144. Findings include: a) Resident #215 Medical record review revealed an [AGE] year old male admitted to the facility on [DATE]. The resident's admission weight was 129.8 pounds (#). On 03/21/11, the resident's weight was 122.8#. On 03/21/11, the physician added nutritional supplements to the resident's diet in an effort to address the resident's unplanned weight loss. Review of the nutrition risk assessment completed by the registered dietitian (RD) on 03/31/11 stated, . note 3/18/11 wt. (weight) 129.8# and 3/21/11 wt. of 122.8 #. ? (symbol for 'question') accuracy of these wts. - will monitor wt. status. Review of the June 2011 recapitulation of the monthly physician's orders [REDACTED]. On 04/07/11, the physician added one (1) house supplement with lunch. In total, the resident was now to receive three (3) house supplements and three (3) cans of Ensure daily, according to the physician's orders [REDACTED]. Observation of the resident's noon meal, on 06/06/11, found the resident was served lunch without the Ensure; however, the house supplement was present on the noon tray. Employee #24 (assistant dietary manager), when interviewed at 2:15 p.m. on 06/06/11, was unaware of the orders for Ensure to be served with each meal. She produced a copy of the resident's tray ticket, which verified the dietary department would send only a house supplement with the noon meal. Employee #81 (RD), when interviewed on 06/06/11 at 2:30 p.m., stated she thought the physician's orders [RE… | 2016-01-01 |
| 9214 | 9214 | EASTBROOK CENTER LLC | 515089 | 3819 CHESTERFIELD AVENUE | CHARLESTON | WV | 25304 | 2011-06-08 | 329 | D | 0 | 1 | MZQB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview the facility failed to: (1)identify the problem or need for a medication; (2) identify the targeted behaviors for use of a psychoactive medication; (3) implement non-pharmacological interventions before administering a psychoactive medication to control a resident's behavior; (4) monitor for potential adverse side effects of a psychoactive medication; (5) monitor the resident's response to medications; and (6) act upon recommendations made by the consultant pharmacist. This was true for two (2) of thirty-eight (38) Stage II sample residents. Resident identifiers: #215 and #73. Facility census: 144. Findings include: a) Resident #215 Review of Resident #215's medical record revealed this [AGE] year old male resident was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Further review of the medical record revealed an order, handwritten by the physician on 04/07/11, for: [MEDICATION NAME] 0.125 mg PO (by mouth) PRN (as needed) every evening for anxiety and agitation (family request). Review of the April 2011 Medication Administration Record [REDACTED]. On 04/24/11, the physician gave an order for [REDACTED]. Review of the nurses' notes from 04/24/11 through 04/30/11 revealed the following entries: - On 04/24/11: Resident has been to the desk several times c/o (complaining of) different things . - On 04/28/11: Resident has been at N.S. (nurses station) several times. c/o of different things. Wanting wife returned to bed then (symbol for 'up'). (Resident #215 shared a room at the facility with his wife.) Review of the May 2011 MAR found the PRN [MEDICATION NAME] was administered on eighteen (18) occasions. Review of the nurses notes from 05/01/11 through 05/31/11 revealed resident behaviors were documented on only two (2) occasions - 05/26/11 and 05/28/11. - On 05/26/11: Out in hallway demanding in loud voice that he pays for paper towels and he does not have any. Staff offered to get… | 2016-01-01 |
| 9215 | 9215 | EASTBROOK CENTER LLC | 515089 | 3819 CHESTERFIELD AVENUE | CHARLESTON | WV | 25304 | 2011-06-08 | 332 | E | 0 | 1 | MZQB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, record review, and staff interview, the facility failed to assure the medications were administered as ordered by the physician and that the medication error rate was not greater than five percent (5%). The medication errors included omissions, the incorrect dosage, administration of the incorrect type of vitamins, and inadequate flushing of the gastrostomy tube when administering medications. There error rate for the facility was sixteen and seven one-hundredth percent (16.07%). There were medication errors observed for six (6) of eleven (11) residents observed during medication pass. Resident identifiers: #68, #142, #76, #169, #6, and #37. Facility census: 144. Findings include: a) Resident #68 During a medication administration on 06/02/11 at 1:13 p.m., a licensed practical nurse (LPN - Employee #100) was observed preparing the medications for Resident #68. During this preparation, she was observed to prepare a tablet of Multivitamin (MVI) with Iron. The medication administration record (MAR) did not indicate this resident was to receive a MVI with Iron. Prior to going in to the resident's room to administer these medications, the nurse was questioned about the medications. She stated this was all of them. She was stopped and asked to review the MAR with the nurse surveyor, who brought to her attention there was no MVI with Iron scheduled for this resident. She stated, That is what our House Supplement is. It was noted on the MAR this resident was to receive a house supplement TID (three-times-a day). This nurse surveyor again asked Employee #100 if she was sure this was what she should give, and the LPN stated, Yes. This surveyor told the LPN at that time that she was told earlier the house supplement written on the MAR was something sent from the kitchen for the residents to drink for extra calories. Employee #100 stated, If that is what it is, no one has ever told me. The LPN then proceeded in to the resident's ro… | 2016-01-01 |
| 9216 | 9216 | EASTBROOK CENTER LLC | 515089 | 3819 CHESTERFIELD AVENUE | CHARLESTON | WV | 25304 | 2011-06-08 | 356 | B | 0 | 1 | MZQB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, the facility failed to post the required nurse staffing information in an area readily accessible to the residents. The posting was observed in the front lobby on the office door, in an area not readily accessible to most of the residents. This practice has the potential to affect more than an isolated number of residents who may desire to view this information. Facility census: 149 at the onset of the complaint investigation on 05/18/11 and 144 at the onset of the annual survey on 05/24/11. Findings include: a) Upon entrance to the facility on [DATE] at 12:00 p.m., the nurse staffing posting was observed in the front lobby on the office door. During a tour of the facility, other areas of the facility were observed, and the front lobby was the only area where the nurse staffing posting was displayed. Access to the front lobby through double doors from the nursing unit was restricted for any resident wearing a Wanderguard bracelet. Observations were continued throughout the survey event from 05/24/11 to 06/08/11, and the front lobby was the only area in which the nurse staffing posting was displayed. According to the requirement, this posting must be in a prominent place readily accessible to residents and visitors. The front lobby area was readily accessible to visitors, but this area was not readily accessible to all residents. | 2016-01-01 |
| 9217 | 9217 | EASTBROOK CENTER LLC | 515089 | 3819 CHESTERFIELD AVENUE | CHARLESTON | WV | 25304 | 2011-06-08 | 369 | D | 0 | 1 | MZQB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, review of medical records, resident interview, and review of a resident's dietary slip, the facility failed to ensure each residents received special utensils at meal times as indicated. A resident did not have the specialized utensils provided for two (2) of four (4) meals observed. One (1) of thirty-eight (38) Stage II sample residents was affected. Resident identifier: #70. Facility census: 144. Findings include: a) Resident #70 Record review revealed this resident's [DIAGNOSES REDACTED]. On 05/24/11, the resident was observed sitting in her wheelchair in her room at lunch time. After she was served her meal and began to eat, observation found she had some difficulty in manipulating the standard flatware. When asked whether she had ever tried using large handled or other adaptive utensils, she reached for her communication board. Using her communication board, the resident spelled out: I got some in Kitchen. She then spelled out: They probably forgot. At the bottom of her tray slip was printed RED NAPKIN, which she got, and SPECIAL, SPOON, FORK, which she did not receive. She was provided the special utensils at lunch time on 06/01/11, but she did not receive them at lunch time on 06/02/11. She had them again at lunch time on 06/06/11, at which time she demonstrated how she used her spoon with the special handle that went around her hand. | 2016-01-01 |
| 9218 | 9218 | EASTBROOK CENTER LLC | 515089 | 3819 CHESTERFIELD AVENUE | CHARLESTON | WV | 25304 | 2011-06-08 | 371 | F | 0 | 1 | MZQB11 | Based on observation, information from the ServSafe Manual (Fifth Edition), and temperature measurement, the facility did not store the emergency food supply in a manner to assure food safety. The temperature of the outdoor emergency food storage area was higher than recommended, and it was not ventilated to help keep the interior temperature and humidity constant throughout the storage area as recommended. This practice had the potential to affect all residents who received nourishment from the dietary department. Facility census: 144. Findings include: a) At 1:15 p.m. on 05/31/11, the outside food storage area, where emergency foods were stored, was found to have an interior temperature of 78 degrees Fahrenheit (F). In addition, the area was not well ventilated to assist in keeping the temperature and humidity constant. According to the ServSafe Manual (Fifth Edition), To keep food at its highest quality and to assure food safety, the temperature of the dry-storage area should be between 50 (degree sign) F and 70 (degree sign) F. Additionally, the ServSafe Manual discussed the need to (m)ake sure dry-storage areas are well ventilated to help keep temperature and humidity constant throughout the storage area. | 2016-01-01 |
| 9219 | 9219 | EASTBROOK CENTER LLC | 515089 | 3819 CHESTERFIELD AVENUE | CHARLESTON | WV | 25304 | 2011-06-08 | 412 | D | 0 | 1 | MZQB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on resident interview, medical record review, and staff interview, the facility failed to assess the resident's dental needs, resulting in a failure to arrange dental services. This was true for one (1) of thirty-eight (38) Stage II residents reviewed. Resident identifier: #155. Facility census: 144. Findings include: a) Resident #155 Medical record review revealed this [AGE] year old male resident was admitted to the facility on [DATE] with the following Diagnoses: [REDACTED]. During two (2) interviews with the resident (on 05/25/11 at 8:46 a.m. and again on 05/31/11 at 11:20 a.m.), the resident stated his teeth hurt, especially when eating. He related he had about seven (7) teeth and they were rotted out. On 05/31/11 at 12:20 p.m., the director of nursing (DON) was interviewed regarding the resident's dental needs and was advised the resident had stated his teeth were hurting when he ate. On 06/01/11 at 2:00 p.m., the DON stated she could find no evidence of a dental assessment and no evidence the resident had been evaluated by a dentist since his admission on 11/18/09. She stated the facility had scheduled a dental consult for the resident. Review of the medical record, on 06/01/11, revealed a telephone order received on 05/31/11 at 6:15 p.m. for: Consult dentist due to toothache. Further review of the medical record revealed a nursing admission evaluation completed on 10/08/10. In Section F, regarding the resident's condition of teeth, the assessor indicated the resident had broken teeth. The resident's annual comprehensive minimum data set (MDS), with an assessment reference date of 11/10/10, did not indicate the resident had any oral problems in Section L (Oral / Dental Status). On 06/02/11 at 3:00 p.m., Employee #95, a registered nurse (RN), was asked to assess the resident's dental needs. Employee #95 assessed the resident's teeth and stated, Looks like he may have a cavity in that back tooth. | 2016-01-01 |
| 9220 | 9220 | EASTBROOK CENTER LLC | 515089 | 3819 CHESTERFIELD AVENUE | CHARLESTON | WV | 25304 | 2011-06-08 | 425 | E | 0 | 1 | MZQB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, resident interview, staff interview, and a review of the facility's inservice records and procedures for ordering medications, the facility failed to assure medications were acquired timely and available for administration as ordered by the physician. Medications for newly admitted residents were not obtained in a timely manner, the emergency box was not checked to see if a medication was available when it was not found on the medication cart, and there was no evidence that staff notified the physician when medications were not administered in accordance with the orders. Review of residents' medication administration records (MARs) revealed medications were frequently not available and were not administered, with no interventions or follow-up actions evident. This practice was true for six (6) of thirty-eight (38) Stage II sample residents and one (1) resident of random opportunity. Resident identifiers: #228, #116, #112, #6, #40, #3, and #215. Facility census: 149 at the onset of the complaint investigation on 05/18/11 and 144 at the onset of the annual survey on 05/24/11. Findings include: a) Resident #228 During a complaint investigation beginning at 12:00 p.m. on 05/18/11, a nurse surveyor found Resident #228 was admitted at 8:30 p.m. the prior evening (on 05/17/11). On admission, the physician ordered multiple medications for this resident. The orders were stamped STAT at that time, and someone had written on the orders: STAT meds (medications) please. The resident had orders to receive sixteen (16) medications on a daily basis, and she did not receive morning doses for any of these medications on 05/18/11. Her orders included six (6) medications to treat high blood pressure (Tenormin, Diovan, Lisinopril, Catapres, Apresoline, Zaroxolyn and Lasix). Her vital signs were recorded by staff at 8:00 a.m., and her blood pressure was not elevated (132/72). The resident's medication nurse - a licensed practic… | 2016-01-01 |
| 9221 | 9221 | EASTBROOK CENTER LLC | 515089 | 3819 CHESTERFIELD AVENUE | CHARLESTON | WV | 25304 | 2011-06-08 | 428 | D | 0 | 1 | MZQB11 | Based on medical record review and staff interview, the facility failed to assure the pharmacist's recommendations of irregularities identified in the medication regimen were acted upon by the attending physician and the director of nursing in a timely manner. This was true for three (3) of thirty-eight (38) Stage II sample residents whose records were reviewed. Resident identifiers: #140, #5, and #73. Facility census: 144. Findings include: a) Resident #140 Review of consultation report from the pharmacist dated 02/10/11 revealed, (Name of resident) is on glimepiride / Amaryl 2 mg qd (every day) and sliding scale insulin QID (four times a day); morning fingerstick's range 78 to 103 mg/dl, excellent control; coverage seldom required as blood sugars seldom are over 150 mg/dl at any time of day. Recommendation: Please consider discontinuing use of sliding scale insulin and begin fingersticks with no coverage alternating mornings Mon, Wed, Fri and 4 p.m. Tues, Thurs, Sat. On 03/21/11, the physician responded to the recommendations from the pharmacist by documenting, Agree. On 03/10/11, the consultant pharmacist reviewed the resident's medication regimen and, again, made the same recommendation as made on the 02/10/11 visit. The resident's physician reviewed and signed this recommendation on 04/04/11. The order to discontinue the sliding scale insulin and previous fingersticks was not written until 04/04/11, after being recommended by the pharmacist on 02/10/11 and 03/10/11. The director of nursing (DON, when interviewed on 05/31/11 at 2:15 p.m., was unable to explain the delay in writing the orders in accordance with the pharmacist's recommendations. She verified the orders should have been written on 03/21/11, when the resident's physician agreed to the recommendations. -- b) Resident #5 On 05/11/11, the consultant pharmacist issued a report that included: Comment: (Resident #5's name) is on Remeron 15 mg qhs (every hour of sleep) since January 2011; due for review and documentation of continued need. This regimen … | 2016-01-01 |
| 9222 | 9222 | EASTBROOK CENTER LLC | 515089 | 3819 CHESTERFIELD AVENUE | CHARLESTON | WV | 25304 | 2011-06-08 | 431 | E | 0 | 1 | MZQB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, and staff interview, the facility failed to ensure drugs and biologicals are labeled in accordance with currently accepted professional principles. Eye drops used for Resident #76 were not labeled to ensure the drops were not administered to another resident, especially in view of the fact this resident had recently been treated for [REDACTED]. This practice have the potential to affect more than an isolated number of residents. Resident identifier: #76. Facility census: 144. Findings include: a) Resident #76 During medication administration on 06/02/11 at 1:45 p.m., the licensed practical nurse (LPN - Employee #100) was observed preparing Resident #76's medications, which included eye drops (Natural Balance Tears 0.4%). Employee #100 removed a box of eye drops from the medication cart; however, there was no name written on the box to ensure these eye drops were administered only to Resident #76. Employee #100 applied her gloves and proceeded to administer eye drops as ordered for this resident. The eye drop container was observed to have direct contact with the resident's eyes. This action contaminated the eye dropper, as well as contamination the resident's eyes with any organisms that may have been on the dropper. (See also citation at F441.) Review of Resident #76's medical record found he had been treated for [REDACTED]. There was a potential for these eye drops to be administered to another resident after being contaminated when used for Resident #76. Employee #100 was questioned at 1:50 p.m. 06/2/11 about the eye drop box not having a label and she said, This is our facility's stock. When asked how she knew these were Resident #76's eye drops, she stated again, They are our facility stock. When the surveyor told the nurse there was no way to assure these eye drops were to be only administered to this resident and had not been used on someone else, she asked the surveyor, Do you want me to write his … | 2016-01-01 |
| 9223 | 9223 | EASTBROOK CENTER LLC | 515089 | 3819 CHESTERFIELD AVENUE | CHARLESTON | WV | 25304 | 2011-06-08 | 441 | E | 0 | 1 | MZQB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, staff interview, and record review, the facility failed to establish and maintain an effective program in which practices of the facility prevent the spread of disease and infection. During medication pass for Resident #76, the nurse contaminated a bottle of eye drops by directly touching the tip of the eye dropper to resident's the eyes (which had been treated for [REDACTED]. The nurse, who was wearing gloves, then wiped the resident's eyes with a tissue. She did not change her gloves prior to administering medications via the resident's his gastrostomy tube. The contaminated bottle of eye drops was then placed back in the medication cart, potentially contaminating other items in the cart. Staff used an isolation cart from outside of Resident #228's room in lieu of an overbed table for serving this resident her meal. Resident #228 was in contact isolation for a multi-drug resistant organism. When staff provided an overbed table for the resident to use for the remainder of the meal, the contaminated isolation cart was placed back out in the hallway. Multiple observations were made of soiled linen and contaminated linen in red bags lying on the floors of residents' rooms and bathrooms. Isolation precautions were not implemented for Resident #3 (who resided on the second floor), when staff suspected she had a condition that could be spread to others. These deficient practices had the potential to cause more than minimal harm to more than an isolated number of residents. Resident identifiers: #76, #228, and #3. Facility census: 149 at the onset of the complaint investigation on 05/18/11 and 144 at the onset of the annual survey on 05/24/11. Findings include: a) Resident #76 1. Eye Drop Technique During medication administration on 06/02/11 at 1:45 p.m., the licensed practical nurse (LPN - Employee #100) was observed preparing Resident #76's medications, which included eye drops (Natural Balance Tears 0.4%). Employee #100 re… | 2016-01-01 |
| 9224 | 9224 | EASTBROOK CENTER LLC | 515089 | 3819 CHESTERFIELD AVENUE | CHARLESTON | WV | 25304 | 2011-06-08 | 513 | D | 0 | 1 | MZQB12 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview, the facility failed to obtain in a timely manner and file on the medical record the results of diagnostic services performed on one (1) of fourteen (14) sampled residents. The results of diagnostic procedures performed to evaluate Resident #33's urinary tract were not obtained and filed on the resident's medical record until thirteen (13) days after the procedures were completed. Resident identifier: #33. Facility census: 140. Findings include: a) Resident #33 Medical record review, on 08/22/11, revealed this [AGE] year old male with [MEDICAL CONDITION] and [MEDICAL CONDITION] bladder had an indwelling Foley urinary catheter in place for a long time. He also had experienced a history of urinary tract infections and [MEDICAL CONDITION]. Resident #33 had a history of [REDACTED]. Further medical record review revealed the resident, at a local hospital on [DATE], underwent a rigid cystourethroscopy (endoscopy of the urinary bladder via the urethra, carried out with a cystoscope). The resident also had a bilateral retrograde pyelography with interpretation (a procedure where the physician injects contrast into the ureter in order to visualize the ureter and kidney). These tests revealed no evidence of hydrouretero[DIAGNOSES REDACTED] (distension of the kidney and/or ureter caused by backward pressure on the kidney when the flow of urine is obstructed). (http://www.merckmanuals.com/home/kidney_and_urinary_tract_disorders/obstruction_of_the_urinary_tract/hydro[DIAGNOSES REDACTED].html#v 1) - When asked about the results of the above mentioned diagnostic procedures on 08/22/11 at 12:00 p.m., Employee #200 (a registered nurse) reported the facility had not yet received the report. She said she had this on a list of items she needed to get. On 08/23/11 at approximately 10:00 a.m., the facility obtained a copy of the diagnostic test results. - Review of the operative report for these two (2) procedures… | 2016-01-01 |
| 9225 | 9225 | EASTBROOK CENTER LLC | 515089 | 3819 CHESTERFIELD AVENUE | CHARLESTON | WV | 25304 | 2011-06-08 | 520 | E | 0 | 1 | MZQB11 | Based on the findings of the current survey, staff interviews, review of documentation of inservices, and review of medical records, the facility's quality assessment and assurance (QAA) committee failed to implement fully implement its action plan to correct identified quality deficiencies with respect to the availability of medications for administration to residents in a timely manner, and failed to implement monitoring activities to ensure the quality deficiencies were corrected going forward. All residents had the potential to be affected. Facility census: 149 at the onset of the complaint investigation on 05/18/11 and 144 at the onset of the annual survey on 05/24/11. Findings include: a) Availability of medications During a complaint investigation beginning at 12:00 p.m. on 05/18/11, a nurse surveyor found Resident #228 was admitted at 8:30 p.m. the prior evening (on 05/17/11). On admission, the physician ordered multiple medications for this resident. The orders were stamped STAT at that time, and someone had written on the orders: STAT meds (medications) please. The resident had orders to receive sixteen (16) medications on a daily basis, and she did not receive morning doses for any of these medications on 05/18/11. (See citation at F425 for additional details related to Resident #228 and additional examples of other residents affected by this deficient practice.) This lack of availability of medications for administration was further investigated during the Quality Indicator Survey (QIS) conducted between 05/24/11 and 06/08/11. It was learned the facility had identified a problem with the timely and / or consistent provision of the medications. Review of the corrective actions taken to correct the problem found inservices had been provided to the facility's licensed nurses beginning in the latter part of April 2011 and continuing into May 2011. The inservice documents included copies of the various forms that were to be used to order / reorder medications, a copy of the pharmacy's presentation slides c… | 2016-01-01 |
| 9230 | 9230 | ROANE GENERAL HOSPITAL, D/P | 515099 | 200 HOSPITAL DRIVE | SPENCER | WV | 25276 | 2011-06-08 | 156 | C | 0 | 1 | O68G11 | Based on observation and staff interview, the facility failed to prominently displayed in the facility written information on how to apply for and use Medicare and Medicaid benefits, and how to receive refunds for previous payments covered by such benefits. Additionally, information posted regarding various agencies' names and addresses contained the wrong address for the State survey agency and the wrong name of the State long-term care ombudsman. This had the potential to affect all residents and visitors. Facility census: 31. Findings include: a) Observations of information posted throughout the unit during the survey revealed a typed notice which contained the names, addresses and telephone numbers of various agencies which the residents may need to contact. On this list, the State survey agency's street address and the name of the State long-term care ombudsman were incorrect. b) Observations also found no notices of any kind which provided information regarding how to apply for Medicaid / Medicare benefits, nor was there information about how to receive refunds for previous payments covered by those benefits. c) These issues were discussed with the social worker (Employee #77) at 1:50 p.m. on 06/ 7/11. She accompanied the surveyor to observe the notices, and she verified the above findings. | 2016-01-01 |
| 9231 | 9231 | ROANE GENERAL HOSPITAL, D/P | 515099 | 200 HOSPITAL DRIVE | SPENCER | WV | 25276 | 2011-06-08 | 167 | C | 0 | 1 | O68G11 | Based on observations and staff interview, the facility had failed to post a notice of the availability of the most recent survey results. This has the potential to affect all residents and visitors. Facility census: 31. Findings include: a) Observations by the surveyor, on 06/07/11 at 10:30 a.m., did not find any survey results of the most recent survey available for review by residents and visitors. When staff at the nursing station was asked where the survey results were posted, they were unaware of the location as well. At 10:40 a.m. on 06/07/11, a registered nurse (Employee #26) informed the surveyor that the information was in a notebook on a bookcase in the activity / dining room area. Subsequent observation of this area found all types of books, such as reading novels, etc., on this bookcase for resident access, including the survey results. There was no signage posted to inform residents or visitors where this information could be located for review. | 2016-01-01 |
| 9232 | 9232 | ROANE GENERAL HOSPITAL, D/P | 515099 | 200 HOSPITAL DRIVE | SPENCER | WV | 25276 | 2011-06-08 | 241 | E | 0 | 1 | O68G11 | Based on observation, review of resident diet slips, and staff interview, the facility failed to provide care to eight (8) of thirty-one (31) residents in a manner and an environment that maintained or enhanced dignity and respect for residents who required assistance with eating. Facility staff and the dietary department referred to these residents as feeders both verbally in the dining room during meal service and in writing on the residents' diet slips. Resident identifiers: #26, #35, #27, #24, #16, #23, #12, and #32. Facility census: 31. Findings include: a) Residents #26, #35, #27, #24, #16, #23, #12, and #32 During random observation of the evening meal service in the main dining room on 05/31/11 at approximately 6:00 p.m., facility staff was overheard referring to residents as feeders. Review of the diet slips left on the tables by the residents' plates noted the slips were labeled with the residents' names and identified them as feeders. During an interview with the nurse manager (Employee #8), on 06/01/11 at 2:15 p.m., she provided a list of all residents with dietary slips which identified them as feeders. She stated that steps had been initiated to correct this practice. | 2016-01-01 |
| 9233 | 9233 | ROANE GENERAL HOSPITAL, D/P | 515099 | 200 HOSPITAL DRIVE | SPENCER | WV | 25276 | 2011-06-08 | 279 | D | 0 | 1 | O68G11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview, the facility failed to develop a care plan with goals and approaches addressing anxiety for two (2) of nineteen (19) Stage II sampled residents with orders for anxiolytic medications. Resident identifiers: #33 and #20. Facility census: 31. Findings include: a) Resident #33 Review of the medical record found this female resident was admitted to the facility on [DATE] with orders for [MEDICATION NAME] 0.25 mg twice-a-day (BID) for anxiety. Review of the behavioral monitoring sheets noted staff was not monitoring for signs and symptoms of anxiety. Staff was monitoring for social withdrawal and [MEDICAL CONDITION]. Review of the current care plan found the facility had not developed goals or approaches related to assisting the resident to reach her highest practicable level of functioning related to experiencing anxiety. The care plan merely addressed the dosage, side effects, and dosage reduction attempts for the use of [MEDICATION NAME]. The minimum data set (MDS) coordinator (Employee #8), when interviewed on the afternoon of 06/01/11, was unable to provide any further evidence that the facility had developed an appropriate care plan related to anxiety for this resident. -- b) Resident #20 Review of the medical record found Resident #20 was prescribed and had received [MEDICATION NAME] 10 mg BID and [MEDICATION NAME] 1 mg BID for a [DIAGNOSES REDACTED]. Review of the care plan found no care plan had been developed related to this resident experiencing anxiety. | 2016-01-01 |
| 9234 | 9234 | ROANE GENERAL HOSPITAL, D/P | 515099 | 200 HOSPITAL DRIVE | SPENCER | WV | 25276 | 2011-06-08 | 309 | D | 0 | 1 | O68G11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview, the facility failed to assure one (1) of nineteen (19) Stage II sampled residents did not receive medications beyond the date the physician determined they should be discontinued. Resident identifier: #33. Facility census: 31. Findings include: a) Resident #33 1. Review of the medical record found a physician's progress note, dated 05/25/11, which documented the resident's potassium was mildly elevated and to stop K-Dur. Review of the Medication Administration Record [REDACTED]. An interview with the unit manager (Employee #8), on 06/07/11 at 2:00 p.m., revealed the physician had overlooked writing an order to stop the potassium for this resident. -- 2. Review of the medical record found the resident received [MEDICATION NAME] (antidepressant) 20 mg daily. A physician's orders [REDACTED]. Review of the MAR found nursing staff members gave the resident both the [MEDICATION NAME] 20 mg and the [MEDICATION NAME] 60 mg on 05/06/11. | 2016-01-01 |
| 9235 | 9235 | ROANE GENERAL HOSPITAL, D/P | 515099 | 200 HOSPITAL DRIVE | SPENCER | WV | 25276 | 2011-06-08 | 329 | D | 0 | 1 | O68G11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and and staff interview, the facility failed to assure the drug regimen, for one (1) of nineteen (19) Stage II sampled residents, was free from unnecessary drugs. Resident #33 was prescribed [MEDICATION NAME] 0.25 mg twice-a-day (BID) without adequate indications for its use. Resident identifier: #33. Facility census: 31. Findings include: a) Resident #33 Review of the medical record found Resident #33 was admitted to the facility on [DATE] with orders for [MEDICATION NAME] 0.25 mg BID for anxiety. Review of the behavior monitoring sheets found facility staff was not monitoring for anxiety or signs and symptoms of anxious behaviors. The behavior monitoring sheets indicated staff was monitoring for social withdrawal and [MEDICAL CONDITION]. Review of the current care plan found no goals or interventions related to the resident experiencing anxiety. Review of the 04/22/11 social worker progress note found the following documentation: . She also stated she feels that she is depressed and has been for several years. The progress note did not address nor give evidence to reflect the resident was experiencing anxiety. A subsequent social worker progress note, written on 05/05/11, contained the following language: . She usually refuses to get out of bed and come out of her room. She did indicate she has symptoms of depression and she gave them a frequency of 2 - 6 days over the past two weeks. Her daughters indicate that she has been depressed for a long time and has not been active This note was also devoid of any evidence that the resident was experiencing anxiety. An interview with the social worker (Employee #77), on 06/07/11 at 12:20 p.m., revealed that Employee #77 visited the resident regularly to encourage her to leave her room and participate in facility life and activities. Employee #77 discussed the resident's depression but could offer no indications of the resident experiencing or demonstrating signs and s… | 2016-01-01 |
| 9236 | 9236 | ROANE GENERAL HOSPITAL, D/P | 515099 | 200 HOSPITAL DRIVE | SPENCER | WV | 25276 | 2011-06-08 | 332 | D | 0 | 1 | O68G11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, staff interview, the facility's medication delivery window policy, and medical record review, the facility failed to ensure a medication error rate less than five percent (5%). Resident identifier: #1. Facility census: 31. Findings include: a) Resident #1 During observation of the facility's medication passes on 06/06/11 and 06/07/11, a licensed practical nurse (LPN - Employee #5) failed to administer Resident #1's medication in a timely manner. Resident #1 had an order for [REDACTED]. On 06/07/11 at 1:13 p.m., Employee #5 again administered Resident #1'[MEDICATION NAME] 24 after the prescribed time. When interviewed on 06/07/11 at 1:30 p.m., the unit manager (Employee #8) could offer no explanation for the error, but she provided a copy of the facility's medication delivery window policy. Review of the medication delivery window identified medications will be delivered to the resident within a window of one (1) hour prior to or one (1) hour after the assigned delivery time. | 2016-01-01 |
| 9237 | 9237 | ROANE GENERAL HOSPITAL, D/P | 515099 | 200 HOSPITAL DRIVE | SPENCER | WV | 25276 | 2011-06-08 | 354 | F | 0 | 1 | O68G11 | Based on review of facility information, observation, and staff interview, the facility failed to designate a registered nurse (RN) to serve as of the director of nursing (DON) on a full time basis. This deficient practice had the potential to affect all thirty-one (31) residents currently residing in the facility. Facility census: 31. Findings include: a) Review of the entrance information, provided by the facility on 05/31/11, found that Employee #000 was identified as the DON. Observations made throughout this two-week survey noted this individual was not present on the unit. An interview was conducted with Employee #000 at 10:51 a.m. on 06/07/11. She stated she did not work on the long term care unit, nor did she direct the provision of nursing care for the residents residing there. She stated the unit manager provides her with monthly reports related to budgetary and administrative concerns. | 2016-01-01 |
| 9238 | 9238 | ROANE GENERAL HOSPITAL, D/P | 515099 | 200 HOSPITAL DRIVE | SPENCER | WV | 25276 | 2011-06-08 | 371 | F | 0 | 1 | O68G11 | Based on observation and staff interview, the facility failed to store food items in a manner that maintained sanitary conditions. Containers of food times were not dated when opened, and one (1) freezer unit was not equipped with a thermometer to ensure foods were being stored at the correct temperature. This practice has the potential to affect all residents who consume food by oral means as all residents are served from this location. Facility census: 31. Findings include: a) During a tour of the nourishment kitchen for the skilled unit at 1:05 p.m. on 06/07/11 with the unit manager (Employee #8), the following sanitation issues were noted: a plastic container of honey thickened water and two (2) plastic containers of nectar thickened products (one (1) filled with water and one (1) filled with cranberry juice) were found opened but not labeled with a date when they were opened. A specific label for recording the open date was attached to one (1) container, but it was blank. b) During this same time period, observation found a freezer unit did not have an internal thermometer nor any temperature device on the outside of the equipment. This freezer was located in the nourishment area where food was served from that room directly to the dining room. c) These issues were found with Employee #8, who accompanied the surveyor at the time of observations. | 2016-01-01 |
| 9239 | 9239 | ROANE GENERAL HOSPITAL, D/P | 515099 | 200 HOSPITAL DRIVE | SPENCER | WV | 25276 | 2011-06-08 | 425 | D | 0 | 1 | O68G11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of medication administration records (MARs) and staff interview, the facility failed to assure medications ordered for residents were available for administration in a timely manner. Two (2) of nineteen (19) Stage II sampled residents did not receive their 5:00 a.m. medications. Resident identifiers: #1 and #12. Facility census: 31. Findings include: a) Resident #1 Review of the resident's MAR, on 06/07/11 at 10:30 a.m., found Resident #1 was ordered Sinemet 25/250 for a [DIAGNOSES REDACTED]. Review of the MAR indicated [REDACTED]. The medication had been circled, and on the reverse side of the MAR, the nurse documented: Sinemet not available. During an interview on 06/07/11 at 10:45 a.m., the unit manager (Employee #8) confirmed the Seroquel 25/250 was available via the hospital pharmacy. Employee #8 could offer no explanation why the medication was not obtained and given to Resident #1 as ordered. -- b) Resident #12 Review of the resident's MAR, on 06/07/11 at 10:30 a.m., found Resident #12 was ordered Seroquel 50 mg to be given twice a day. The morning dose was circled, and the nurse documented: Seroquel not given - not available. At 06/07/11 at 10:45 a.m., Employee #8 confirmed Seroquel was available via the hospital pharmacy. She further stated, The nurse would just need to request the medication from the hospital pharmacy, and it could be obtained. | 2016-01-01 |
| 9240 | 9240 | ROANE GENERAL HOSPITAL, D/P | 515099 | 200 HOSPITAL DRIVE | SPENCER | WV | 25276 | 2011-06-08 | 428 | D | 0 | 1 | O68G11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview, the facility failed to assure the consultant pharmacist reported irregularities related to the drug regimen for one (1) of nineteen (19) facility residents. Residents #33 received an anxiolytic drug without adequate indications for its use, which was not identified by the pharmacist and reported to the attending physician and director of nursing (DON) as required. Resident identifier: #33. Facility census: 31. Findings include: a) Resident #33 Review of the medical record found this female resident was admitted to the facility on [DATE] with orders for Xanax 0.25 mg twice-a-day (BID). The record contained [DIAGNOSES REDACTED]. Review of the behavior monitoring sheets for April 2011 and May 2011 found the facility was monitoring the resident for social withdrawal and insomnia. The behavior monitoring sheets contained no evidence that nursing staff was monitoring for signs and symptoms of anxiety. An interview with the social services director (Employee #77), on 06/07/11 at 12:20 p.m., revealed Employee #77 was concerned that the resident did not come out of her room, she expressed no interest in out-of-room activities, and she exhibited no desire for conversation. Employee #77 stated the resident appeared very depressed. Employee #77 gave no examples of the resident displaying signs and/or symptoms of anxiety. The consultant pharmacist conducted a drug regimen review on 05/02/11 with documentation of .medications & labs reviewed. The drug regimen report contained no evidence the consultant pharmacist identified the absence of a clinical rationale for use of the Xanax to be communicated to the attending physician and DON. | 2016-01-01 |
| 9241 | 9241 | ROANE GENERAL HOSPITAL, D/P | 515099 | 200 HOSPITAL DRIVE | SPENCER | WV | 25276 | 2011-06-08 | 431 | F | 0 | 1 | O68G11 | Based on observation and facility staff interview, the facility failed to store drugs in locked compartments which could be accessed only by authorized personnel. This deficient practice had the potential to affect all residents residing in the facility. Facility census: 31. Findings include: a) An inspection of the facility's medication storage, conducted on the morning of 06/09/11, found the facility maintained an unlocked emergency drug box in an unlocked cabinet at the nursing station. The drug box was accessible to all employees, unsupervised residents, and/or visitors. An interview with the unit manager (Employee #8), at 9:30 a.m. on 06/08/11, elicited the facility kept a list of medications stored in the emergency drug box. Review of this list found the following potentially hazardous medications listed: Digoxin, Geodon, Haloperidol, Nitroglycerin, and Warfarin. -- b) Random observations, conducted on the afternoon of 06/07/11, noted a pharmacy employee and nurse stocking medications in the nursing station. The employees were removing medications from three (3) large blue duffel bags. Further observations, during the medication storage inspection conducted the following day on 06/08/11 at 9:30 a.m., noted three (3) large blue duffel bags stacked in the nursing station in clear view from the dining room and resident hallway. With the assistance of a licensed practical nurse (LPN - Employee #27), an inspection of the three (3) large blue duffel bags revealed the zippers of duffel bags were secured by the use of a luggage-type tab which was merely threaded through the rubber loops to hold the bags closed. This tab was easily removed. An inspection of the contents of all three (3) duffel bags found numerous medications intended for return to the pharmacy. Employee #27 confirmed the three (3) duffel bags containing medications had been present at the nursing station as of the afternoon of 06/07/11. The unit manager placed the duffel bags in her office until pick up by the pharmacy. | 2016-01-01 |
| 10780 | 10780 | EASTBROOK CENTER LLC | 515089 | 3819 CHESTERFIELD AVENUE | CHARLESTON | WV | 25304 | 2011-06-08 | 157 | D | 1 | 0 | MZQB12 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** . Based on medical record review, review of hospital records, and staff interview, the facility failed to immediately and fully inform the physician of significant findings associated with the health status of two (2) of fourteen (14) sampled residents. - Resident #141, who was receiving an anticoagulant on a routine basis, had a witnessed fall at 10:45 a.m. on [DATE], during which he struck the left side of his head and left shoulder with force sufficient to cause a fracture to his upper arm. The licensed practical nurse (LPN) recorded the fall on the incident report and in the nursing notes, initially noting as the only injury a skin tear to the left elbow. Shortly after, the resident complained of left shoulder pain; a nurse notified the physician of the shoulder pain, and the physician ordered an in-house x-ray of the left arm. There was no evidence to reflect nursing staff, at the time of the fall or at any time thereafter, notified the physician that the resident had hit his head. After the fall on [DATE], the resident was noted to have a significant decline in the self-performance of activities of daily living, which was attributed to possible pneumonia with no consideration that a head injury may have caused or contributed to these declines. Upon leaving the orthopedist's office on [DATE], the resident became unresponsive and was transported to the hospital at his son's request, where he was diagnosed with [REDACTED]. The resident, who was deemed not to be a candidate for surgery, was made "do not resuscitate" by his son (who was also his designated medical power of attorney representative - MPOA), and the resident expired on [DATE]. - The care plan of Resident #33, who had a history of [REDACTED]. On the evening of [DATE], a nurse recorded in his medical record an entry describing his urine as being dark, cloudy, and foul-smelling; there was no evidence this information was communicated to the resident's attending physician or a regi… | 2014-12-01 |
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CREATE TABLE [cms_WV] ( [facility_name] TEXT, [facility_id] INTEGER, [address] TEXT, [city] TEXT, [state] TEXT, [zip] INTEGER, [inspection_date] TEXT, [deficiency_tag] INTEGER, [scope_severity] TEXT, [complaint] INTEGER, [standard] INTEGER, [eventid] TEXT, [inspection_text] TEXT, [filedate] TEXT );