cms_WV
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44 rows where "inspection_date" is on date 2020-02-26
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| Link | rowid ▼ | facility_name | facility_id | address | city | state | zip | inspection_date | deficiency_tag | scope_severity | complaint | standard | eventid | inspection_text | filedate |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1152 | 1152 | HOLBROOK HEALTHCARE CENTER | 515076 | 183 HOLBROOK ROAD | BUCKHANNON | WV | 26201 | 2020-02-26 | 584 | D | 0 | 1 | Y7AK11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations and staff interview, the facility failed to provide maintenance services for two (2) of fifty-nine rooms observed during the long-term care survey process. This issues identified included missing paint and a scraped wall. Room Identifiers: #106 and 108. Facility census 104. Findings included: a) room [ROOM NUMBER] & 108 Observations on 02/26/20 at 8:27 AM, revealed: --room [ROOM NUMBER]-The wall next to the sink was scraped in several places and missing paint. --room [ROOM NUMBER]-The wall in front of bed- A was scraped in several places and missing paint. In an interview and observation of room [ROOM NUMBER] and 108 on 02/26/20 at 11:15 Am, with Maintenance Technician (MT) #1, he agreed the walls were scrapped in several places and had missing paint. MT #1 acknowledged the walls needed repair. | 2020-09-01 |
| 1153 | 1153 | HOLBROOK HEALTHCARE CENTER | 515076 | 183 HOLBROOK ROAD | BUCKHANNON | WV | 26201 | 2020-02-26 | 657 | D | 0 | 1 | Y7AK11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview, the facility failed to revise a comprehensive care plan for a resident's wander guard bracelet, and staff's participation in dressing and bathing. This was true for two (2) of 25 sampled residents. Resident Identifiers: #40 and #67. Facility census 104. Findings Included: a) Resident # 40 A review of the resident #40's significant change Minimum Data Set (MDS) with an Assessment Reference Date (ARD) of 12/30/19 on 02/25/20 at 8:55 AM, revealed the resident required two (2) plus person physical assist for her dressing and bathing needs during the seven (7) day look back period. A review of Resident #40's care plan found a focus related to an activity of living (ADL) self-care performance deficit. This focus statement was initiated on 12/31/19. Interventions for this focus statement included: Resident #40 requires one (1) staff support to help her dress and bathe. Both care plan interventions were initiated on 12/31/19, with a revision date of 01/07/20. An interview on 02/26/20 at 4:25 PM with the Reimbursement Assessment Coordinator (RAS) #14, confirmed Resident #40's care plan needed to be revised to reflect her true ADL statues. RAS #14 confirmed Resident #40 requires two (2) person assistance with her dressing and bathing and this needed to be reflected on the care plan. b) Resident #67 On 02/25/20 at 3:20 PM a review of Resident #67's medical records revealed, a physician's orders [REDACTED]. A review of Resident #67's current care plan with the date of 12/31/19 found a care plan addressing elopement risk, wandering and impaired safety awareness, with the focus and interventions for a Project Life Saver bracelet. Interventions to check placement and the battery daily with transmitter # 2 every shift, every day, evening and night shift. Resident #67's care plan was not updated to reflect the resident's current wander alert bracelet. An interview with the Employee #200, on 02/26/20 at 11:00… | 2020-09-01 |
| 1154 | 1154 | HOLBROOK HEALTHCARE CENTER | 515076 | 183 HOLBROOK ROAD | BUCKHANNON | WV | 26201 | 2020-02-26 | 684 | D | 0 | 1 | Y7AK11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, record review, resident interview, and staff interview, the facility failed to ensure a resident received treatment and care in accordance with professional standards of practice concerning heel protectors. Physicians orders for bilateral heel protectors were not followed. This was a random opportunity for discovery. Resident identifier: #245. Facility census: 104. Findings included: a) Resident #245 Observation of Resident (R#245), on 02/25/20 at 08:54 AM, revealed R#245 lying in bed resting without any heel protectors on her heels. Review of records revealed R#245 was admitted to the facility on [DATE] and had a physician's orders [REDACTED]. Observations on 02/26/20 at 10:30 AM, revealed the treatment nurse LPN#17 provided wound care to R#245's surgical wound on top of the resident's head and a venous stasis ulcer on her right lower leg. This surveyor asked LPN#17, when she finished providing wound care, if R#245 had heel protectors on her heels. LPN#17 confirmed the resident did not have any heel protectors on. LPN#17 verified the physician's orders [REDACTED]. Resident interview revealed the resident had not worn any heel protectors since being at the facility. LPN#17 returned and applied heel protectors to the resident's heels after surveyor intervention. | 2020-09-01 |
| 1155 | 1155 | HOLBROOK HEALTHCARE CENTER | 515076 | 183 HOLBROOK ROAD | BUCKHANNON | WV | 26201 | 2020-02-26 | 689 | D | 0 | 1 | Y7AK11 | Based on observation and interview the facility did not ensure the resident's environment was free from accident hazards. The over bed table was placed on the residents fall mat causing an accident hazard. This was a random opportunity for discovery. Resident identifier: #38. Facility census: 104. Findings included: a) Resident #38 During the initial tour on 2/24/20 at 12:10 PM, Resident #38's over bed table was placed on the fall mat causing a fall hazard. An interview on 02/24/20 at 12:19 PM, with Licensed Practical Nurse (LPN) #115 verified the over bed table should not be placed on any fall mats. LPN #115 removed the over bed table from the fall mat at this time. | 2020-09-01 |
| 1156 | 1156 | HOLBROOK HEALTHCARE CENTER | 515076 | 183 HOLBROOK ROAD | BUCKHANNON | WV | 26201 | 2020-02-26 | 697 | D | 0 | 1 | Y7AK11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, resident interview, and staff interview, the facility failed to monitor and assess accurately the 'Pain Management Score' for effectiveness of pain medication for one (1) of one (1) residents reviewed for pain management. Resident identifier: #9. Facility census: 104. Findings included: a) Resident #9 On 02/25/20 at 9:17 AM, an interview with Resident (R#9) revealed the resident takes Tylenol for pain and another pain pill at night. R#9 said the Tylenol did not always work to control her pain during the day. R#9 stated she told different nurses at different times that it was not always working. R#9 said the nurses ask her if she has pain and what number she rated her pain at. Review of records show the resident's Brief Interview for Mental Status (BIMS) score of fifteen (15) indicating the resident is cognitively intact. R#9 has chronic pain and one of her [DIAGNOSES REDACTED]. Review of Resident #9's physician orders, on 02/25/20 at 01:31 PM, revealed the resident was to receive [MEDICATION NAME] (Tylenol) 325 milligrams (mg) times two (x2) (650 mg) two times a day by mouth (BID PO) for pain, not to exceed 3 grams (3000 mg) in 24 hours. The resident was also to get [MEDICATION NAME] ([MEDICATION NAME]-[MEDICATION NAME]) 5-325 mg PO once a day at 9:00 PM for pain with the instructions Do not exceed 3g [MEDICATION NAME] in 24 hours. Also scheduled at 09:00 AM, 01:00 PM, and 05:00 PM was [MEDICATION NAME] 400 mg for neuropathic pain, and a topical creme Ben-Gay Greaseless ([MEDICATION NAME]-menthol) one application twice a day. Review of record also revealed Duplicate Therapy Alert stating; Use of [MEDICATION NAME] ([MEDICATION NAME]-[MEDICATION NAME]) - Schedule II tablet; 5-325 mg; amt: 5-325mg; oral and [MEDICATION NAME] oral tablet 325 mg represents duplication in ingredient based on their common ingredient [MEDICATION NAME]. Prescriber is aware of this potential risk the resident's condition will be monitore… | 2020-09-01 |
| 1157 | 1157 | HOLBROOK HEALTHCARE CENTER | 515076 | 183 HOLBROOK ROAD | BUCKHANNON | WV | 26201 | 2020-02-26 | 698 | E | 0 | 1 | Y7AK11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, family interview, and staff interview the facility failed to ensure safe transportation to a [MEDICAL TREATMENT] center for a resident requiring this life-sustaining medical treatment. This deficient practice was found for one (1) of one (1) resident reviewed for the care area of [MEDICAL TREATMENT]. Resident identifier: #17. Facility census: 104. Findings included: a) Family Interview During an interview on 02/24/20 at 11:05 AM Resident #17's cousin stated that she transported Resident #17 to [MEDICAL TREATMENT] three (3) times per week because the facility did not have transportation available for Resident #17. At the end of the interview at 11:08 AM, Resident #17 was observed leaving the facility for [MEDICAL TREATMENT] with his cousin and no other individuals. b) Record Review A review of Resident #17's medical record during the survey found a signed care conference note dated 12/18/19. The note stated, It was agreed between Executive Director, Ombudsman and family that as long as the facility can schedule his appointments, we will start to take him to appointments (with exception of [MEDICAL TREATMENT]) after 6 months since schedule is already booked 6 months out and family in agreement that in urgent situations such as if resident would need fistula repair with several appointments following, that we may not be able to accommodate in such situations. A review of the facility's [MEDICAL TREATMENT] policy, titled [MEDICAL TREATMENT] Care and Monitoring, last revised on 03/23/18, found a list of signs and symptoms for staff to monitor in residents receiving [MEDICAL TREATMENT]. The signs and symptoms included aneurysms and bleeding, which would require proper identification and transport to an acute care provider (e.g. a hospital). A review of the facility's transportation agreement, effective 01/23/20, found that, (Name of Emergency Squad) will provide all non emergency transports for (Name of Nursing … | 2020-09-01 |
| 1158 | 1158 | HOLBROOK HEALTHCARE CENTER | 515076 | 183 HOLBROOK ROAD | BUCKHANNON | WV | 26201 | 2020-02-26 | 730 | E | 0 | 1 | Y7AK11 | Based on record review and staff interview, the facility failed to perform a yearly job performance review every 12 months as required. This was true for five (5) of five (5) nurse aides reviewed. Employee Identifiers: #15, #92, #54, #56, and #64. Facility census 104. Findings Included: A review of the personnel files for Nurse Aides #15, #92, #54, #56, and #64 was completed on 02/26/20 at 4:04 p.m. with the Executive Director and the Director of Human resources. This review found the following dates of hire for each Nurse Aide: Nurse Aide #15 was hired on 05/27/15. Nurse Aide #92 was hired on 06/14/18. Nurse Aide #54 was hired on 04/18/05. Nurse Aide #56 was hired on 10/04/18. Nurse Aide #64 was hired on 07/26/06. Further review of the personnel files found the five (5) nurse aides had not had an employee performance evaluation completed in 2019. The Executive Director agreed that each of the five nurse aides had not had an evaluation completed in the previous 12 months as required. | 2020-09-01 |
| 1159 | 1159 | HOLBROOK HEALTHCARE CENTER | 515076 | 183 HOLBROOK ROAD | BUCKHANNON | WV | 26201 | 2020-02-26 | 810 | D | 0 | 1 | Y7AK11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, record review and staff interviews, the facility failed to provide assistive devices for one (1) of two (2) resident reviewed for assistive devices. Resident Identifier #85. Facility census 104. Findings included: a) Resident #85. Resident #85 was observed in her room with a bedside table near her on 02/24/20 at 11:22 AM. On the table was two (2) plastic cups, one (1) with red Kool-Aid, and one (1) with water and no lid. An interview on 02/24/20 at 11:26 AM, with Nurse Aide (NA) #108, confirmed Resident #85 should have a lid for all her drinks. Resident #85 had physician order [REDACTED]. A review of Resident #85 care plan found an intervention dated 08/23/19 to receive spout cup lids to aid in fluid intake. During an interview with the Director of Nursing (DON) on 02/24/20 at 12:07 PM, the DON said she would have to check her chart to see if Resident #85 should have lids on her drinks. The DON on 02/24/20 at 12:27 PM, stated that, Resident #85 is to have spout lids for all her fluids. | 2020-09-01 |
| 1160 | 1160 | HOLBROOK HEALTHCARE CENTER | 515076 | 183 HOLBROOK ROAD | BUCKHANNON | WV | 26201 | 2020-02-26 | 812 | E | 0 | 1 | Y7AK11 | Based on observation, record review, and staff interview the facility failed to maintain their kitchen and resident nourishment rooms in a safe and sanitary manner when they failed to discard outdated thickener, prevent contact of the ice machine scoop with clean ice inside the ice machine, and completely fill out nourishment room refrigerator temperature logs. This deficient practice had the potential to affect more than an isolated number of residents. Facility census: 104. Findings included: a) Main Kitchen A tour of the facility's main kitchen began on 02/24/20 at 10:27 AM. At 10:36 AM a six (6) liter plastic container of beverage thickener was labeled 2-9 2-12, indicating that it was placed in the container on 02/09/20 and should have been discarded on 02/12/20. A scoop inside the container was partially buried in the thickener, contaminating it. On 02/24/20 at 10:38 AM the facility's Certified Dietary Manager (CDM) agreed that the thickener should have been discarded on 02/12/20 and that the scoop should not have been stored inside the container with the thickener. b) Back Nourishment Room Ice Machine On 02/24/20 at 10:46 AM an ice scoop in the back nourishment room was observed to be stored in the ice machine with the clean ice. The facility's CDM was present at the time of the finding and agreed that the scoop should not have been stored with the clean ice inside the machine. c) Front and Back Nourishment Room Refrigerator Temperature Logs Upon viewing both the front and back nourishment rooms on 02/24/20, it was noted that no temperature logs were present on the refrigerators. The facility's CDM stated that the logs were in the kitchen. The logs were provided on 02/24/20 at 10:51 AM and reviewed with the CDM at that time. The front nourishment room refrigerator log was blank on the following dates: 02/01/20, 02/04/20, 02/05/20, 02/08/20, 02/09/20, 02/10/20, 02/20/20, 02/21/20, 02/22/20, and 02/23/20. The back nourishment room refrigerator log was blank on the following dates: 02/01/20, 02/04/20, 02/05/20… | 2020-09-01 |
| 1161 | 1161 | HOLBROOK HEALTHCARE CENTER | 515076 | 183 HOLBROOK ROAD | BUCKHANNON | WV | 26201 | 2020-02-26 | 880 | D | 0 | 1 | Y7AK11 | Based on observation and staff interview, the facility failed to implement an infection prevention and control program designed to help prevent the development and transmission of communicable diseases and infection for one (1) of three (3) residents reviewed for incontinence care. Resident identifier: #245. Facility census: 104. Findings included: a) Resident #245 Observations of Nurse Aid (NA#65) and NA#74 providing incontinence care to Resident (R#245), on 02/26/20 at 10:14 AM, revealed a breach in infection control principals. Incontinence care refers to washing the genitals and anal area. Licensed Practical Nurse, LPN#106 was also in the room observing the NAs. The NAs placed a plastic wash basin with clean water on the overbed table on a paper towel barrier. NA#74 washed R#245's genitals and anal area using multiple different washcloths, after each use NA#74 would pass the soiled washcloth to NA#65. NA#65 draped and balanced the soiled wash clothes precariously around the top edge of the wash basin. A few wet soiled wash clothes fell off the edge of the wash basin onto the paper towel barrier. The paper towel barrier absorbed the moisture from the soiled wet wash clothes. After incontinence care was finished, NA#65 removed the wash basin and took the paper towel barrier now wet from the soiled wash clothes and wiped the top of the overbed table with the paper towel barrier, contaminating its surface. After the NAs confirmed they were finished and were starting to leave the room, this surveyor stopped them to discuss the surveyor's observations. The treatment nurse, Licensed Practical Nurse (LPN#17), entered the room to provide wound care to Resident (R#245). LPN#17 was present during the discussion with the nurse aids concerning contaminating the overbed table surface by wiping it with the wet soiled paper towel barrier. NA#65, NA#74, LPN#106, and LPN#17 confirmed it was a breach in infection control. On 02/26/20 at 10:30 AM, the treatment nurse LPN#17 proceeded to provide wound care to R#245's surgical wou… | 2020-09-01 |
| 2585 | 2585 | WILLOW TREE HEALTHCARE CENTER | 515156 | 1263 SOUTH GEORGE STREET | CHARLES TOWN | WV | 25414 | 2020-02-26 | 550 | D | 0 | 1 | UH0711 | Based on observation and staff interview, the facility failed to provide a dignified dining experience for Resident #67. This occurrence was a random opportunity for discovery and had the potential to affect a limited number of residents. Resident identifier: #67. Facility census: 102. Findings included: a) Resident #67 During dining observation on 02/24/20 at 12:25 PM, several Residents were seated at various tables in the dining room. At 12:44 PM, a staff member passed out clothing protectors. At 12:50 PM staff handed out wipes for Residents to clean their hands. At 12:52 PM, the meal trays arrived the dining room and Nursing Aide (NA) #107 and Clinical Support Services (CSS) #18 passed out the meal trays. Trays served to two residents at the table with Resident #67. Resident #67 was not served at the same time as the table mates. Staff continued to pass out trays by next going to the table beside Resident #67. At 1:00 PM Resident #67's two (2) dining partners had finished eating and left the table. At 1:02 PM staff handed Resident #67 a yogurt and said Here eat this until your food gets here and Resident #67 appeared confused as to what the yogurt was for and set it on the table. At 1:05 PM a meal tray arrived for Resident #67, the Resident was served, and she began to eat her lunch alone at the table. During an interview at 1:30 PM on 2/24/20 Clinical support specialist #18 stated, Well the resident usually eats in room, so we had a hard time getting tray sent to dining room for her. CSS #18 agreed staff should have waited and served all Residents at the table at the same time when Resident #67's meal tray arrived. | 2020-09-01 |
| 2586 | 2586 | WILLOW TREE HEALTHCARE CENTER | 515156 | 1263 SOUTH GEORGE STREET | CHARLES TOWN | WV | 25414 | 2020-02-26 | 565 | E | 0 | 1 | UH0711 | Based on resident interview, record review and staff interview, the facility failed to consider and act promptly on the recommendations and grievances of the resident council. This practice has the potential to effect more than a limited number. Facility census: 102. Findings included: On 02/24/20 at 2:15 PM thirteen (13) residents participated in a resident council meeting. The brief interview for mental status (BI[CONDITION]) of these residents are; five (5) have severe cognitive impact, three (3) have moderate impairment, and five (5) have intact cognitive responses. Residents voiced the following concerns: --Lunch was cold today and meals are often cold. Hot plates are not always used. --Condiments are either not provided or there is not enough for all residents. --Disliked foods are often on their tray. --Food is often late and sometimes very late. On this date lunch on the 200 halls was due at 12:25 PM and service began at 1:15 PM. --Snacks are not available, even for diabetic residents. --The kitchen runs out of food to serve. Review of the previous five (5) months of Resident Council minutes found: September 2019: --Resident concerns include: There is not enough washcloths to care for the residents, food is cooked to long and is mushy, grilled cheese toast is not buttered, not receiving items that are on the menu and receiving dislikes on their tray. --Facility response include: Cooking and tray line procedures will be reviewed. October 2019: --Resident concerns include: Not receiving a complete silverware set, food isn't hot enough, menus are too repetitious, do not always receive condiments with meals, receives dislikes on their tray, would like veggies added to eggs and pizza, and there is not enough chocolate milk. --Facility response include: Tray line procedure reviewed with staff, food temperatures are confirmed acceptable prior to service, individual preferences will be reviewed and items substituted if possible, tray audits will be conducted to ensure accuracy, addition of vegetables and the use … | 2020-09-01 |
| 2587 | 2587 | WILLOW TREE HEALTHCARE CENTER | 515156 | 1263 SOUTH GEORGE STREET | CHARLES TOWN | WV | 25414 | 2020-02-26 | 584 | E | 0 | 1 | UH0711 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and staff interview, the facility failed to provide a clean comfortable and homelike environment. The arm rest on resident wheel chairs were worn and areas of the building were in need of cleaning and/or repair. This practice has the potential to effect more than a limited number. Resident identifiers: #46, #23 and #57. Facility census: 102. Findings include: a) Resident: #46, #23 and #57 During the survey process observation found the left arm rest on wheelchairs of Resident #46, #23, and #57 to be worn down, exposing the padding under the arm cover. This prevents the arm from being thoroughly cleaned. On 02/26/20 at 2:00 PM the maintenance supervisor #[AGE], agreed the arms were worn. The worn arms on the wheelchairs were replaced. b) On 02/24/20 at 1:50 PM accompanied by the Administrator the environment revealed the following: --Shower room on the 300 unit has brown grime/dirt on the far shower wall tile near the floor and extending to the left wall floor. --room [ROOM NUMBER] has brown grime/dirt around the base of the toilet near the floor. --room [ROOM NUMBER] cracked, split and discolored floor tile by the entrance door threshold. The Administrator stated the observed areas need to be cleaned and/or repaired. | 2020-09-01 |
| 2588 | 2588 | WILLOW TREE HEALTHCARE CENTER | 515156 | 1263 SOUTH GEORGE STREET | CHARLES TOWN | WV | 25414 | 2020-02-26 | 600 | G | 0 | 1 | UH0711 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, resident interview and staff interview, the facility failed to ensure residents are free from abuse and neglect. The facility's failure to provide effective interventions to ensure the safety of residents while utilizing mechanical lifts (Hoyer lift) resulted in serious injury with actual physical harm to residents #[AGE] and #57. This failed practice had the potential to affect a limited number of residents. Resident identifiers: #[AGE] and #57. Facility census: 102. Findings included: a) Facility policy Review of the facility policy titled: West Virginia Abuse, Neglect &Misappropriation, Policy #NS 1018-02 with an effective date of 10/07/17 and revised date: 02/12/18 and 04/01/19. revealed the following (typed as written): --Adverse Event: untoward, undesirable and usually unanticipated event that causes death or serious injury or the risk thereof. --Neglect: is the failure of the facility, its employees or service providers to provide goods and services to a resident that are necessary to avoid physical harm, pain, mental anguish, or emotional distress. --Serious bodily injury: an injury involving extreme physical pain; involving substantial risk of death; involving protracted loss or impairment of the function of a bodily member. b) Resident #[AGE] On 02/25/20 at 1:50 PM Resident #[AGE] reported, In mid September 2019, can't remember the exact date, I was being transferred with a Hoyer lift from my chair to the bed when I was dropped to the floor by the Nurse Aides (NA's). I was sitting on the floor with my right leg under my body. The NA's said we did not drop you and I told them, well I am sitting on the floor with my leg under my body. I was sent to (name of hospital) and the x-ray's showed a bad fracture, but they could not do any surgery so I have to wear this boot. Resident continued to state, I am afraid every day when I have to be transferred because they might drop me again and I can only be transfered wit… | 2020-09-01 |
| 2589 | 2589 | WILLOW TREE HEALTHCARE CENTER | 515156 | 1263 SOUTH GEORGE STREET | CHARLES TOWN | WV | 25414 | 2020-02-26 | 609 | D | 0 | 1 | UH0711 | Based on record review, resident interview, and staff interview, the facility failed to report an event of alleged physical abuse and/or neglect to the state survey agency. The event involved the use of a mechanical lift (Hoyer Lift) for transfers resulting in serious injury causing actual physical harm to resident #[AGE]. In addition, the facility failed to identify and investigate an allegation by Resident #[AGE]'s family related to resident's fractured right ankle when she was dropped during a mechanical lift transfer. This practice has the potential to affect a limited number of residents residing in the facility. Resident identifiers: #[AGE]. Facility census: 102. Findings included: a) Facility policy Review of the facility policy titled: West Virginia Abuse, Neglect & Misappropriation, Policy #NS 1018-02 with an effective date of 10/07/17 and revised date: 02/12/18 and 04/01/19. revealed the following (typed as written): --Adverse Event: untoward, undesirable and usually unanticipated event that causes death or serious injury or the risk thereof. --Neglect: Neglect is the failure of the facility, its employees or service providers to provide goods and services to a resident that are necessary to avoid physical harm, pain, mental anguish, or emotional distress. --Serious bodily injury: an injury involving extreme physical pain; involving substantial risk of death; involving protracted loss or impairment of the function of a bodily member. b) Resident #57 According to a nursing note dated 10/16/19 at 1:15 PM, Resident #57 was lifted via hoyer lift on 10/16/19 by one staff person and a non-facility staff member. The hoyer lift grab bar shifted causing the entire hoyer lift to shift. As a result, the resident ended up on the floor with noted right leg rotated and shorter than the left leg. The resident was yelling in pain. This was witnessed incident resulting in actual harm due to physical harm and pain from fractures. Record review under found: --Nurses Note of what happened written by NA #99 entered by Assis… | 2020-09-01 |
| 2590 | 2590 | WILLOW TREE HEALTHCARE CENTER | 515156 | 1263 SOUTH GEORGE STREET | CHARLES TOWN | WV | 25414 | 2020-02-26 | 610 | D | 0 | 1 | UH0711 | Based on record review, resident interview, and staff interview, the facility failed to thoroughly investigate an event of alleged physical abuse and/or neglect. The event involved the use of a mechanical lift (Hoyer Lift) for transfers resulting in serious injury causing actual physical harm to resident #[AGE]. In addition, the facility failed to identify and investigate an allegation by Resident #[AGE]'s family related to resident's fractured right ankle when she was dropped during a mechanical lift transfer. This practice has the potential to affect a limited number of residents residing in the facility. Resident identifiers: #[AGE]. Facility census: 102. Findings included: a) Facility policy Review of the facility policy titled: West Virginia Abuse, Neglect &Misappropriation, Policy #NS 1018-02 with an effective date of 10/07/17 and revised date: 02/12/18 and 04/01/19. revealed the following (typed as written): --Adverse Event: untoward, undesirable and usually unanticipated event that causes death or serious injury or the risk thereof. --Neglect: Neglect is the failure of the facility, its employees or service providers to provide goods and services to a resident that are necessary to avoid physical harm, pain, mental anguish, or emotional distress. --Serious bodily injury: an injury involving extreme physical pain; involving substantial risk of death; involving protracted loss or impairment of the function of a bodily member. b) Resident #[AGE] On 02/25/20 at 2:50 PM, review of the medical record discovered a progress note written by the DON stating (typed as written): --9/26/2019 14:30 Nurses Note: Had a meeting with resident's daughter ________(name) and sister _____-(name). There concerns were about the resident's fractured right ankle that she obtained during a mechanical lift transfer. I had explained that the lift pad was not properly placed on the resident and when staff lifted she began sliding out and the CNA's lowered her to the floor. The daughter was quite upset and stated that she was dropped n… | 2020-09-01 |
| 2591 | 2591 | WILLOW TREE HEALTHCARE CENTER | 515156 | 1263 SOUTH GEORGE STREET | CHARLES TOWN | WV | 25414 | 2020-02-26 | 641 | D | 0 | 1 | UH0711 | Based on record review and staff interview, the facility failed to ensure the accuracy of a MDS for a resident receiving Hospice services. This practice was found for one (1) of 22 residents reviewed during the LTCSP survey. Resident identifier: #28. Facility census: 102. Findings included: a) Resident #28 On 02/25/20 at 8:20 AM, review of the medical record revealed Resident #28 was admitted to Hospice services on [DATE]. Review of the quarterly MDS with assessment reference date (ARD) of 01/07/20 discovered the following: Section J, titled Health Conditions, J 1400 Prognosis, coded as: NO. MDS RAI version 3.0 manual coding instructions for J 1400 Prognosis (typed as written): . --Code 1, yes: if the medical record includes physician documentation: 1) that the resident is terminally ill; or 2) the resident is receiving hospice services. After review of the quarterly MDS with ARD of 01/07/20 on 02/26/20 at 8:30 AM, Employee #111 stated, Yes, it is coded wrong. | 2020-09-01 |
| 2592 | 2592 | WILLOW TREE HEALTHCARE CENTER | 515156 | 1263 SOUTH GEORGE STREET | CHARLES TOWN | WV | 25414 | 2020-02-26 | 656 | E | 0 | 1 | UH0711 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility failed to develop and/or implement a comprehensive person-centered care plan for each resident, consistent with the resident rights with measurable objectives and time frames to meet a resident's medical, nursing, and mental and psychosocial needs. This practice was found for four (4) of twenty-two (22) residents reviewed during the LTCSP survey. Resident Identifiers: #[AGE], #28, #44 and #34. Facility census: 102. Findings included: a) Resident # [AGE] Record review on 02/25/20 at 3:35 PM revealed a care plan initiated on 03/29/19 and revision date of 01/29/20: --Focus (typed as written); at risk for falls r/t Gait/balance problems, [MEDICAL CONDITION], lt amputation., --Interventions include (typed as written): .Hoyer lift for transfers. The significant change Minimum Data Set (MDS) with Assessment Reference Date (ARD) of 03/21/2019 was coded for two (2) + person transfers. After review of the care plan on 02/25/20 at 3:45 PM, the Administrator stated, We do have a policy for Hoyer lift transfers always requiring two person assist, but the care plan does not say that. b) Resident #28 (Activities) On 02/24/20 at 11:00 PM observed Resident #28 sitting in the common area at a table on the 300 unit looking at the wall on the other side of the table. A television on the wall at the end of table was not turned on. Upon initial interview inquiry Resident #28 stated, Just sit here. Further interview inquiry was unable to be completed due to the resident's cognition. Continued random observations on 02/24, 02/25 and 02/26/2020 at various times throughout the day consistently found Resident #28 sitting in the common area at a table on the 300 unit looking at the wall on the other side of the table with no activity. One observation on the morning of 02/25/20, a magazine was in front of the resident on the table. On 02/25/20 at 8:20 AM, review of the medical record revealed Resident #28 was admit… | 2020-09-01 |
| 2593 | 2593 | WILLOW TREE HEALTHCARE CENTER | 515156 | 1263 SOUTH GEORGE STREET | CHARLES TOWN | WV | 25414 | 2020-02-26 | 679 | D | 0 | 1 | UH0711 | Based on observation, record review, and staff interview, the facility failed to implement an ongoing resident centered activities program designed to meet the interests of and support the physical, mental, and psychosocial well-being of each resident. An individualized resident centered activity program was not created to provide opportunities for Resident #28 to have a meaningful life by meeting the special needs of a resident on Hospice services. Recently admitted Resident #47 was not provided activities to assist with the adjustment of being in a long term care facility. This practice was found for two (2) of twenty-two (22) residents reviewed during the LTCSP. Resident identifiers: #28 and #47. Facility census: 102. Findings included: a) Resident #28 On 02/24/20 at 11:00 PM observed Resident #28 sitting in the common area at a table on the 300 unit looking at the wall on the other side of the table. A television on the wall at the end of table was not turned on. Upon initial interview inquiry Resident #28 stated, Just sit here. Further interview inquiry was unable to be completed due to the resident's cognition. Continued random observations on 02/24, 02/25 and 02/26/2020 at various times throughout the day consistently found Resident #28 sitting in the common area at a table on the 300 unit looking at the wall on the other side of the table with no activity. One observation on the morning of 02/25/20, a magazine was in front of the resident on the table. On 02/25/20 at 8:20 AM, review of the medical record revealed Resident #28 was admitted to Hospice services on [DATE]. An Activities Progress Note dated 1/16/2020 states (typed as written): .continues to be an active participant in group activities on her unit. Her interests include spa day, hand massages, nail painting, table games, food/movie/music socials, special events, trivia, group discussions, skimming through the Spirit newspaper and magazines, spending time outdoors, cooking club, reminiscing, watching TV, family visits, and socializing with other… | 2020-09-01 |
| 2594 | 2594 | WILLOW TREE HEALTHCARE CENTER | 515156 | 1263 SOUTH GEORGE STREET | CHARLES TOWN | WV | 25414 | 2020-02-26 | 689 | G | 0 | 1 | UH0711 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on resident interview, record review and staff interview, the facility failed to provide adequate supervision, and environment free from accident hazards over which the facility had control concerning falls and the use of the hoyer lift. This failed practice caused actual harm to two (2) of (2) residents reviewed. Resident #57 experience actual physical harm as a result of fractures post fall from a hoyer lift. Resident #[AGE] experienced actual physical and emotional harm as a result of fractures post fall from a hoyer lift. Resident identifiers: #57 and #[AGE]. Facility census: 102. Findings included: a) Resident #57 Review of medical records reveals the following nursing note with a date of 10/16/19 at 1:15 PM (typed as written): --This nurse was walking down the hall to take another resident some medication and noticed the CNA along with the PCT (person doing medical transport) using the hoyer lift to transfer the resident from the stretcher back to the wheelchair, at this time while the hoyer was up in the air the grab bar shifted, causing the whole hoyer to shift and the resident fell to the floor on his right side, at the time, while being assessed for injury on the floor, he grimaced and yell out in pain and holding his right leg, the right leg was noted to be externally rotated and shorter than the left, while being lifted the hoyer lift did the same as before, he was place on the stretcher, and this nurse received order to send to ED for evaluation and treatment, ADON notified, unable to start vital signs at this time but the fall was witness and he did not hit his head, sent to Jefferson Memorial. This resulted in a [MEDICAL CONDITION] femur. Hospital admission records on 10/16/19 reveal the resident's weight as 333 pounds. During an interview on 02/25/20 Resident #57 explained his arm and leg were hurt while on a hoyer lift, about three (3) or four (4) months ago. Review of medical records found no order to use a hoyer lift … | 2020-09-01 |
| 2595 | 2595 | WILLOW TREE HEALTHCARE CENTER | 515156 | 1263 SOUTH GEORGE STREET | CHARLES TOWN | WV | 25414 | 2020-02-26 | 695 | D | 0 | 1 | UH0711 | Based on resident interview and staff interview the facility failed to provide care and services consistent with professional standards of practice, the comprehensive person-centered care plan and the resident's preferences, related to respiratory care. This is true for one (1) of one (1) residents reviewed. Resident identifier: #[AGE]. Facility census: 102. Findings included: a) Resident #[AGE] On 02/25/20 at 9:10 AM Resident #[AGE] explained the use of oxygen during the evening and at night while sleeping. The oxygen concentrator sometimes alarms (quits working) and staff resets the machine. The concentrator also sometimes spews water through the tubing and into the resident's nose. Resident #[AGE] then uses the call bell for staff assistance. At 3:35 PM on 02/25/20 nursing assistant (NA) #71 confirmed the concentrator alarms about one time each evening shift and water sometimes spews through the tubing and into the resident's nose. When this happens, the licensed nurse is informed and replaces the tubing. Licensed nurse (LPN) #105 explained the concentrator was replaced in the last few weeks. The concentrator filter is cleaned, and the tubing replaced every Sunday. An individual resident council concern form with a date of 0[DATE] reveals resident states her concentrator shuts off by itself and needs replaced. LPN #105 replaced the concentrator on 01/28/20. Resident #[AGE] expressed the concentrator alarm going off, and water spewing into her nose happened as recently as a few days ago. | 2020-09-01 |
| 2596 | 2596 | WILLOW TREE HEALTHCARE CENTER | 515156 | 1263 SOUTH GEORGE STREET | CHARLES TOWN | WV | 25414 | 2020-02-26 | 698 | D | 0 | 1 | UH0711 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview, the facility failed to complete post [MEDICAL TREATMENT] assessments as ordered. This was true for one (1) of one (1) residents reviewed for [MEDICAL TREATMENT]. Resident identifier: 44. Facility census: 102. Findings included: a) Review of the medical record on 02/25/20 at 1:00 PM, revealed Resident (R) #44 receives [MEDICAL TREATMENT] treatments three (3) days a week. The physician order [REDACTED]. In the afternoon every Mon (Monday), Wed (Wednesday), Fri ( Friday). The [MEDICAL TREATMENT] book confirms R#44 received [MEDICAL TREATMENT] treatments three days a week including the following days: 01/01/20, [DATE], 01/13/20, 01/24/20, 0[DATE], 02/03/20, 02/10/20, [DATE] and 0[DATE]. The computerized nursing assessments lack post [MEDICAL TREATMENT] assessments for these dates. During an interview on 02/25/20 at 2:00 PM, the Corporate Consultant (CC) #100 and the Director of Nursing (DON) confirmed R #44's post [MEDICAL TREATMENT] assessments were not completed as ordered after each [MEDICAL TREATMENT] treatment. | 2020-09-01 |
| 2597 | 2597 | WILLOW TREE HEALTHCARE CENTER | 515156 | 1263 SOUTH GEORGE STREET | CHARLES TOWN | WV | 25414 | 2020-02-26 | 725 | F | 0 | 1 | UH0711 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, resident interview, staff interview and record review the facility failed to ensure sufficient staff with the appropriate competencies and skills to provide nursing and related services to assure resident safety and attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident, as determined by resident assessments and individual plans of care. The facility did not ensure enough staff members giving direct care, considering the acuity and [DIAGNOSES REDACTED]. This has the potential to effect all residents. Facility census: 102. Findings include: a) On 02/24/20 at 2:15 PM thirteen (13) residents participated in a resident council meeting. The brief interview for mental status (BI[CONDITION]) of these residents are five (5) have severe cognitive impact, three (3) have moderate impairment, and five (5) have intact cognitive responses. Residents voiced the following concerns: --Food service is late and sometimes very late. --For the facility fully staffed is one nursing assistant (NA) on primary hall, one (1) NA on middle hall and two (2) on station two. --On weekends activities are often over before the staff can assist resident out of bed. --Showers are not given on weekends due to lack of staff. --Sometimes there are residents on the unit who require extra attention and when there is only one NA on the unit others do not receive care as needed. --A resident explained on 0[DATE] he/she was not assisted to get out of bed until 3:15 PM, and on 02/23/20 soiled her brief because the wait time to receive care was over thirty (30) minutes. --The facility direct care staff often call off and mandating staff to stay who do not want to work. --The staff are upset because they are being rotated around to different stations. The residents have concerns about getting good care when this happens. --While you (surveyors) are here, they will take care of us but after you leave it will go back … | 2020-09-01 |
| 2598 | 2598 | WILLOW TREE HEALTHCARE CENTER | 515156 | 1263 SOUTH GEORGE STREET | CHARLES TOWN | WV | 25414 | 2020-02-26 | 756 | F | 0 | 1 | UH0711 | Based on policy review and staff interview, the facility failed to develop and maintain policies and procedures for the monthly drug regimen review that include, but are not limited to, time frames for the different steps in the monthly medication regimen review process. This practice has the potential to affect all residents. Facility census: 102. Findings included: a) Medication Regimen Review (MRR) a) A review on 02/25/20 at 2:20 PM revealed the facility MRR with an effective date of 02/16/17 and revision date of 09/23/19 states, the Medication Regimen Review (MRR) of each resident must be reviewed at least once a month by a licensed pharmacist. (typed as written) i. Urgent medication irregularities. 2. Urgent irregularities as determined by the consultant pharmacist will be addressed with the attending physician the day the notification is received or communicated from the consultant pharmacist. ii. Non-urgent medication irregularities 1. Non-urgent medication irregularities will be addressed with the attending physician in a manner that meets the needs of the resident, but no later than their next routine visit to assess the resident or [AGE] days whichever is sooner. Except for the identified non-urgent irregularities, the policy lacks time frames for the different steps in the process. At 2:35 PM on 02/25/20 after review of the facility MRR policy, the Administrator verified it does not contain specific time frames for the different steps in the process. | 2020-09-01 |
| 2599 | 2599 | WILLOW TREE HEALTHCARE CENTER | 515156 | 1263 SOUTH GEORGE STREET | CHARLES TOWN | WV | 25414 | 2020-02-26 | 761 | D | 0 | 1 | UH0711 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and staff interview, the facility failed to provide separately locked, permanently affixed compartments for storage of a controlled drug which is subject to abuse. This practice has the potential to affect more than a limited number of residents. Facility census: 102. Findings included: a) Skilled medication room On 02/25/20 at 07:50 AM in the company of the Director of Nursing (DON) discovered in the skilled medication room refrigerator multiple vials of injectable [MEDICATION NAME] in a locked clear container. The locked clear container was attached to a shelf in the refrigerator which was easily removed from the refrigerator. The DON verified it was easily removed from the refrigerator and not permanently affixed. She stated, Maintenance will be notified immediately to fix this. | 2020-09-01 |
| 2600 | 2600 | WILLOW TREE HEALTHCARE CENTER | 515156 | 1263 SOUTH GEORGE STREET | CHARLES TOWN | WV | 25414 | 2020-02-26 | 804 | E | 0 | 1 | UH0711 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, staff interview and resident interview, the facility failed to serve meals that were appetizing and palatable at an appropriate temperature. This failed practice had the potential to affect all residents residing at the facility. Resident identifiers: #49, #72, #97, #8. Facility census: 102. Findings included: a) Resident Interviews During the initial screening process on 02/24/20 at 2:40 PM, Resident #97 stated, For the most part they treat me good here, but the food could be better its always cold by the time I get it. On 02/24/20 at 9:35 AM Resident #49 stated, See if you do something about the food. It's always cold when we get our trays. On 2/24/20 at 9:39 AM Resident #72 stated, My biggest complaint is the food, I eat here in my room a lot, and the food is always cold, every day three times a day. At 08:34 AM on 02/25/20 Resident #8 stated, The mealtimes are never consistent so I don't even know what time I should be getting my tray, but when I finally do get it its always cold. The Resident further stated, I am the last room on this hall, so I guess I am last served. Resident's room was noted to be the last room on primary hall. b) Food Temperatures On 02/25/20 at 12:04 PM Lunch Tray food cart arrived at primary hall. At 12:15 PM the last tray removed from the cart by Certified Nursing Assistant (CNA) #4 was for Resident #97 in room [ROOM NUMBER]. Certified Nursing Assistant #4 immediately escorted the tray straight to the kitchen by way of the stairs, accompanied by surveyor. Food temperatures of Resident #97's lunch tray obtained at 12:16 PM by Dietary Manager (DM) were as follows: -- Pork with gravy: 129 degrees Fahrenheit (F) -- Rice with gravy: 139 degrees F -- Green beans (mashed in serving bowl by DM for accurate testing): 114 degrees F -- Milk: 45 degrees F On 02/25/20 at 1:10 PM during an Interview Resident #97 was asked how his lunch was today. Resident stated, Good, it was hot. Resident was noted to hav… | 2020-09-01 |
| 2601 | 2601 | WILLOW TREE HEALTHCARE CENTER | 515156 | 1263 SOUTH GEORGE STREET | CHARLES TOWN | WV | 25414 | 2020-02-26 | 812 | F | 0 | 1 | UH0711 | Based on observation and staff interview, the facility failed to maintain essential kitchen equipment in a clean, sanitary operating condition. These practices had the potential to affect all residents receiving nourishment from the kitchen. Facility census: 102 Findings included: a) Observation of the kitchen A tour of the kitchen with the facility's Dietary Manager (DM) #29, on 02/24/20 at 11:14 AM revealed the kitchen range to be maintained in an unsanitary manner due to the soiled drip pans under the stove's burners. The drip pan on left contained dried scorched thick blackened tar like food debris, dried green beans, and aluminum foil that was curled up on ends used for lining the drip pan. The drip pan on the right contained dried up uncooked spiral macaroni (noted not to be the same flat noodles that were used for lunch meal today), a copious amount of black/brown thickened liquid and aluminum foil that was blackened and curled up on the ends used for lining of the drip pan. b) Dietary Manager Interview On 2/24/20 at 11:33 AM, Dietary Manager (DM) #29 agreed both drip pans needed to be cleaned and instructed the staff to do so immediately. DM furthered stated, This is only my second week in this building, the drip pans are supposed to be cleaned at least once a week. | 2020-09-01 |
| 2602 | 2602 | WILLOW TREE HEALTHCARE CENTER | 515156 | 1263 SOUTH GEORGE STREET | CHARLES TOWN | WV | 25414 | 2020-02-26 | 842 | D | 0 | 1 | UH0711 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview, the facility failed to maintain a complete and accurate medical record for a [MEDICAL TREATMENT] resident. The record fails to identify the type of implanted [MEDICAL TREATMENT] port. In addition, staff failed to complete post-[MEDICAL TREATMENT] assessments as ordered. This was found for one (1) of one (1) residents reviewed for [MEDICAL TREATMENT]. Resident identifier: #44. Facility census: 102. Findings included: a) Review of the medical record on 02/25/20, revealed R #44 receives [MEDICAL TREATMENT] three times a week from some type of port in his left upper arm. The record does not identify the type of shunt or graft. The current care plan with a revision date on 01/17/20 states: (Name) has AV (arteriovenous) fistula; shunt or graft-position extremity so that fistula is easily palpated. *The care plan, [MEDICAL TREATMENT] records and medical record lack any information as to the type or location of the fistula used for [MEDICAL TREATMENT]. The [MEDICAL TREATMENT] book confirms R#44 received [MEDICAL TREATMENT] treatments three (3) days a week since 01/01/20. The computerized nursing assessments lack post [MEDICAL TREATMENT] assessments for the following days: 01/01/20, [DATE], 01/13/20, 01/24/20, 0[DATE], 02/03/20, 02/10/20, [DATE] and 0[DATE]. On 02/25/20 at 1:32 PM, Licensed Practical Nurse (LPN) #102 acknowledged the medical record does not identify the type of shunt or graph located in R #44's left upper arm for [MEDICAL TREATMENT]. She reviewed the medical record and confirmed staff did not document a post [MEDICAL TREATMENT] assessment after every treatment as ordered. During an interview on 02/25/20 at 2:00 PM, the Director of Nursing (DON) and Corporate Consultant (CC) #100 confirmed the medical record fails to identify the type of device implanted in R #44's arm for [MEDICAL TREATMENT]. The DON reviewed the physician orders [REDACTED]. | 2020-09-01 |
| 2603 | 2603 | WILLOW TREE HEALTHCARE CENTER | 515156 | 1263 SOUTH GEORGE STREET | CHARLES TOWN | WV | 25414 | 2020-02-26 | 867 | F | 0 | 1 | UH0711 | Based on record review, staff interview, resident interview, and policy/procedure review, the facility's Quality Assessment and Assurance (QA&A) committee failed to develop, revise, and/or implement corrective plans of action of which it was aware or should have been aware. The QA&A committee failed to ensure sufficient qualified staffing is available at all times to provide nursing and related services to meet the needs of the residents; ensure residents are free from physical harm and protected from major injury during the utilization of a mechanical lift (Hoyer Lift); failed to identify abuse/neglect, thoroughly investigate and/or report each incident and inform the resident of the findings; address residents concerns and ensure foods were served at proper temperatures for palatability; ensure an ongoing program of individual and group activities is provided; ensure infection control measures are in place to maintain a safe and sanitary environment for all residents to prevent the development and/or transmission of disease and infection; and ensure the monthly drug regimen review policy was updated to include time frames for the different steps in the process. This has the potential to affect all residents residing in the facility. Facility census 102. Findings included: a) During an interview with the Quality Assurance coordinator, Executive Director #49 on 02/26/20, he stated the Quality Assurance committee meets monthly, and is attended by the required members including the Administrator, the Director of Nursing, the Medical Director, the Infection Preventionist, and other staff members. He reported concerns/ performance improvement needs are identified during daily meetings and weekly interdisciplinary meetings. Findings are discussed at the monthly QA&A meeting. Identified concerns are addressed through data collection tools. Performance improvement plans are developed after a root cause analysis of the identified concern is completed. b) Cross reference deficiencies cited at F[AGE]5 c) Cross reference de… | 2020-09-01 |
| 2604 | 2604 | WILLOW TREE HEALTHCARE CENTER | 515156 | 1263 SOUTH GEORGE STREET | CHARLES TOWN | WV | 25414 | 2020-02-26 | 880 | F | 0 | 1 | UH0711 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and staff interview, the facility staff failed to maintain an infection control program to prevent the development and transmission of communicable and infectious diseases within the facility. These failed practices were a random opportunity for discovery and had the potential affect all residents residing in the facility. Facility census: 102. Findings included: a) Hand Hygiene during meal service During observation of lunch meal in dining room on 02/24/20, lunch trays arrived the dining room at 12:52 PM. Certified Nursing Assistant (CNA) #107 and Clinical Support Services (CSS) #18 washed their hands and began passing out trays to Residents already seated at various tables. The two staff members continued to distribute trays and set up meals for Residents with no hand hygiene performed between Residents. The staff members were noted to have contact with various Resident's wheelchairs, dining chairs and Residents for repositioning while distributing trays, with no hand hygiene performed. No hand sanitizer was noted to be available in the dining room for use. At 1:15 PM after all trays were passed, CSS #18 set down and started to assist a Resident with meal consumption without washing her hands. On 02/25/20 at 8:23 AM, Clinical Support Services (CSS) #18 was asked what the facility's expectations were for hand hygiene during tray distribution in the dining room. CSS #18 stated: I was told as long as we didn't touch the patient just wash our hands before we started. CSS #18 also confirmed no hand sanitizer was used or available in the dining room for use during meal tray distribution. During an interview on 02/25/20 at 8:29 AM the Director of Nursing (DON) was asked what her expectation was for staff regarding hand hygiene during distribution of meal trays in the dining room. The DON replied, They need to wash their hands prior to starting tray pass and then its ok to use hand sanitizer between residents. The DON was told … | 2020-09-01 |
| 3586 | 3586 | NELLA'S INC | 51A010 | 499 FERGUSON ROAD | ELKINS | WV | 26241 | 2020-02-26 | 550 | D | 0 | 1 | VTHQ11 | Based on observation and staff interview, the facility failed to ensure dignity during dining for one (1) of eighteen (18) residents reviewed during the long term care survey process. Resident identifier: #38. Facility census: 76. Findings included: a) Resident #38 Observation of the noon meal served on 02/23/20 at 12:17 PM, found Resident #38's roommate received a tray at approximately 12:19 PM. On 02/23/20 at 12:31 PM, Resident #38 received his tray. Licensed Practical Nurse, (LPN) #67, confirmed Resident #38 did not get tray at same time of roommate. LPN #67 said, Resident #38 has to be fed, we pass the trays to the ones who can feed themselves, then we come back and pass the trays to the residents who need help. | 2020-09-01 |
| 3587 | 3587 | NELLA'S INC | 51A010 | 499 FERGUSON ROAD | ELKINS | WV | 26241 | 2020-02-26 | 580 | D | 0 | 1 | VTHQ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview, the facility failed to notify the resident's representative when a new form of treatment commenced. This was true for one (1) of 19 residents reviewed during the long term care survey. Resident identifier: #58. Facility census: 76. Findings included: a) Resident #58 Review of Resident #58's medical records revealed a nursing note written on 01/05/20 which stated, Noted small red area to right buttocks. The note also stated a dressing with [MEDICATION NAME] was started every day for three (3) days. There was no documentation the resident representative was notified. A nursing note written on 01/07/20 stated an open area was noted on the right buttock, measuring 1x1x0.1 cm, with reddish yellow center. An order was received for hydrogel and dressing daily. According to the nursing note, Resident #58's power of attorney was notified at this time. During an interview on 02/25/20 at 10:25 AM, Licensed Practical Nurse (LPN) #13 and the Director of Nursing (DON) were informed Resident #58's representative was not notified when a new form of treatment, a dressing to the resident's buttock, was started on 01/05/20. LPN #13 and the DON had no further information regarding the matter. | 2020-09-01 |
| 3588 | 3588 | NELLA'S INC | 51A010 | 499 FERGUSON ROAD | ELKINS | WV | 26241 | 2020-02-26 | 641 | D | 0 | 1 | VTHQ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility failed to accurately complete each Minimum Data Set (MDS) to reflect the resident's status. This was true for three (3) of nineteen resident's reviewed. Resident identifiers: #76, #18 and #52. Facility Census: 76. Findings included: a) Resident #76 Review of Resident #76's medical records indicated a hospice consult was initiated on 01/30/20. On 01/31/20, Resident #76 was started on hospice with the admitting terminal [DIAGNOSES REDACTED].#76's prognosis for life expectancy was six (6) months or less if the terminal illness runs its normal course. Review of the significant change MDS with an assessment reference date (ARD) of 02/07/20, found Section J 1400 (Prognosis) was answered to indicate the resident had no terminal prognosis and under Section I (active diagnosis) Heart failure was not checked as a current diagnosis. An interview with the Director of Nursing (DON) and the Nursing Home Administrator (NHA) on 02/24/20 at 2:45 pm, confirmed the MDS with the ARD of 02/07/20 was inaccurate in the areas of prognosis and active diagnosis. b) Resident #18 Review of Resident #18's medical records found the resident uses bilateral one-half (1/2) side rails for turning and positioning. Resident #18 is unable to transfer herself, she requires the assistants of two (2) and the use of a Hoyer lift. Review of the admission MDS with an ARD of 12/01/19 found under section P the bilateral one-half siderails were coded as restraints. Interview with the Director of Nursing (DON) and the Nursing Home Administrator (NHA) on 02/24/20 at 2:45 pm, found the MDS with the ARD of 12/01/19 was inaccurate in the area of restraints. c) Resident #52 A review of the medical record for Resident #52 on 02/24/20, revealed the last two (2) quarterly Minimum Data Set (MDS) assessments with ARDs of 10/11/19 and 01/11/20 were not coded accurately for the [DIAGNOSES REDACTED]. Further review of the [DIAGNOSES REDACTED].#5… | 2020-09-01 |
| 3589 | 3589 | NELLA'S INC | 51A010 | 499 FERGUSON ROAD | ELKINS | WV | 26241 | 2020-02-26 | 656 | D | 0 | 1 | VTHQ11 | Based on medical record review and staff interview, the facility failed to appropriately develop the comprehensive care plan in the area of Activities of Daily Living (ADLs) for one (1) of one (1) residents reviewed for the care area of Activities of Daily Living. Resident identifier: #53. Facility census: 76. Findings included: a) Resident #53 Resident #53's comprehensive care plan contained a focus related to self-care deficit. An intervention for this focus was May use Hoyer lift for transfers with staff assist x2. Another intervention for this focus was See ADL (activities of daily living) Kardex for assist required. Resident #53's comprehensive care plan also contained a focus related to being high risk for falls. An intervention for this focus was Requires staff assist x 2 using Hoyer lift for transfers bed to chair. Resident #53's ADL Kardex included for transfer help, Staff x 2 using Hoyer. During an interview on 02/25/20 at 10:25 AM, Licensed Practical Nurse (LPN) #13 and the Director of Nursing (DON) confirmed Resident #53 was always transferred with a Hoyer lift. LPN #13 and the DON were informed Resident #53's care plan contained an intervention for a Hoyer lift as needed. LPN #13 and the DON were informed this is not acceptable because a resident who has required a Hoyer lift cannot safely be transferred without the lift. No further information was provided through the completion of the survey. | 2020-09-01 |
| 3590 | 3590 | NELLA'S INC | 51A010 | 499 FERGUSON ROAD | ELKINS | WV | 26241 | 2020-02-26 | 684 | E | 0 | 1 | VTHQ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility failed to ensure that each residents received treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the residents' choices. This was true for two (2) of nineteen (19) residents reviewed. Resident identifiers: #176 and #26. Facility Census: 76. Findings include: a) Resident #176 Review of medical records for Resident #176, found the resident was re-admitted to the facility on [DATE] with an order for [REDACTED]. Meals are at 7 am, 12noon and 5 pm. Accuchecks are obtained four (4) times daily before meals and at night (6:30 am, 11:30 am, 4:30 pm and 9:00 pm). Review of the Medication Administration Record (MAR) for 01/17/20 through 01/24/20 found the [MEDICATION NAME] regular [MED] was given thirty (30) minutes prior to meals at 6:30 am, 11:30 am and 4:30 pm instead of with meals as directed by the physician order. Interview with the Director of Nursing (DON) on 02/24/20 at 3pm, found the [MED] was not administered as directed by the physician. No further information provided. b) Resident #26 A review of the medical record for Resident #26 on 02/25/20, revealed the accucheck for blood sugars had not been completed on 0[DATE]. The Medication Administration Record (MAR) did not record Resident #26 as receiving any testing for her blood sugars on 0[DATE]. Further review revealed a physician's orders [REDACTED]. An interview with Licensed Practical Nurse (LPN) #87 on 02/25/20 at 8:48 AM, verified there was no evidence documented on the MAR or in the Nursing Progress notes that a blood sugar was completed on 0[DATE] as ordered by the physician. | 2020-09-01 |
| 3591 | 3591 | NELLA'S INC | 51A010 | 499 FERGUSON ROAD | ELKINS | WV | 26241 | 2020-02-26 | 695 | E | 0 | 1 | VTHQ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and staff interview, the facility failed to ensure residents who need respiratory care, were provided such care, consistent with professional standards of practice, the comprehensive person-centered care plan, the residents' goals. Cautionary and safety signs, indicating the use of oxygen, were not present for Resident's #23, #3, and #48. For Resident #23 there was no evidence the [MEDICAL CONDITION] (Bi-level Positive Airway Pressure), machine was consistently used or offered daily per physician orders. In addition, Resident #48's oxygen was not set at the prescribed flow rate. This was true for three (3) of three (3) residents reviewed for respiratory care. Resident identifiers: #23, #3, and #48. Facility census: 76. Findings included: a) Resident #23 Review of the current physician's orders [REDACTED]. [MEDICAL CONDITION] is a non-invasive ventilation machine that is capable of generating two adjustable pressure levels - Inspiratory Positive Airway Pressure (IPAP) - high amount of pressure, applied when the patient inhales and a low Expiratory Positive Airway Pressure (EPAP) during exhalation. Review of the treatment administration record (TAR) and Medication Administration Record [REDACTED]. The TAR's included orders for weekly cleaning of the [MEDICAL CONDITION] machine and daily cleaning the [MEDICAL CONDITION] mask but no orders for daily use of the [MEDICAL CONDITION] machine. On 02/24/20 at 8:33 AM, the Director of Nursing (DON) reviewed the January and February TAR and MAR, and confirmed there was no order for daily use of the [MEDICAL CONDITION] machine. The DON reviewed the December 2019 TAR and found daily documentation the [MEDICAL CONDITION] was in use. The DON said the order to use the [MEDICAL CONDITION] machine daily did not get transcribed to the January 2020 and February 2020 TAR. The DON said the nurses' notes say the [MEDICAL CONDITION] machine was used daily. Review of the nursing not… | 2020-09-01 |
| 3592 | 3592 | NELLA'S INC | 51A010 | 499 FERGUSON ROAD | ELKINS | WV | 26241 | 2020-02-26 | 727 | F | 0 | 1 | VTHQ11 | Based on record review and staff interview, the facility failed to ensure the services of a registered nurse for at least 8 consecutive hours a day, 7 days a week. This was true for two (2) days reviewed for the week of 0[DATE] through 02/29/20. Facility Census: 76. Findings included: Review of the schedule, assignment sheets, staff postings and time cards for the period of 0[DATE] through 02/29/20, found on 0[DATE] and 02/23/20, the facility failed to have a registered nurse (RN) for eight (8) consecutive hours for each day. Interview with the Director of Nursing on 02/25/20 at 2:15 pm, confirmed the RN did clock out and was not in the building for eight (8) consecutive hours on 0[DATE] and 02/23/20. | 2020-09-01 |
| 3593 | 3593 | NELLA'S INC | 51A010 | 499 FERGUSON ROAD | ELKINS | WV | 26241 | 2020-02-26 | 755 | E | 0 | 1 | VTHQ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure an adequate system was in place for the tracking and control of controlled substances, which were received, stored at, and administered by the facility. The facility failed to identify the risk of diversion for high abuse medications. This failure had the potential to affect any resident who had controlled substances sent to, stored at, or administered by the facility. Facility Census: 76. Findings included: a) Controlled Medication Count/ Reconciliation During observation of medication administration on 02/25/20 at 8:15 am, Resident #13 was administered [MEDICATION NAME] 0.5 milligrams (mg) from the locked box on the medication cart. Resident #50 was administered [MEDICATION NAME] 5 mg from a locked box in the medication room by Employee #87, a Licensed Practical Nurse (LPN). Employee #87 failed to sign either medication out on the Individual Resident's Controlled Substance Record. Interview of Employee #87, on 02/25/20 at 9:00 am, found the facility has the Individual Resident's Controlled Substance Record in a separate notebook at the nurses' station. A periodical count was performed on these sheets, but no indication the controlled medications were accurately counted on each shift. There is no system to know how many resident's received controlled medications. An interview with the Director of Nursing (DON) on 02/26/20, found the facility was unsure of the exact count of residents receiving controlled medications and no evidence could be located to indicate the nurses did a narcotic count at the beginning and ending of their shifts to determine if a discrepancy/diversion occurred. Immediate action was taken to count the cards of each resident receiving narcotic (controlled) medication and a system to count before and after each shift was put into place. | 2020-09-01 |
| 3594 | 3594 | NELLA'S INC | 51A010 | 499 FERGUSON ROAD | ELKINS | WV | 26241 | 2020-02-26 | 756 | D | 0 | 1 | VTHQ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record and staff interview, the physician failed, after a pharmacy recommendation, to document the rational for continuing an antidepressant medication. This was true for one (1) of five (5) residents reviewed for unnecessary medications. Resident identifier: #38. Facility census: 76. Findings included: a) Resident #38 Medical record review found the resident is receiving [MEDICATION NAME], 10 milligram tablets, by mouth, daily for a [DIAGNOSES REDACTED]. On 08/26/19, the pharmacist reviewed the residents medication and recommended: Resident is currently on [MEDICATION NAME], 10 mg QD (daily) - Depression. This medication is due for review according to C[CONDITION] (Centers for Medicare / Medicaid Services) The physician signed the pharmacy review but did not provide the date of the signature. In addition, the physician failed to document the reason for continuation of the medication. On 02/24/20 at 11:44 AM, the Director of Nursing (DON) confirmed the physician did not provide a date the pharmacy recommendation was reviewed. In addition, the physician failed to provide a rational for the continued use of the antidepressant. Review of the behavior monitoring sheets, with the DON, for the months of August 2019 through February 2020 found no documentation of any behaviors indicating the resident was depressed. | 2020-09-01 |
| 3595 | 3595 | NELLA'S INC | 51A010 | 499 FERGUSON ROAD | ELKINS | WV | 26241 | 2020-02-26 | 757 | D | 0 | 1 | VTHQ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview, the facility failed to ensure residents were free from unnecessary medications for one (1) of five (5) residents reviewed for medication pass. Resident identifier: #326. Facility census: 76. Findings included: a) Resident #326 Resident #327's Medication Administration Record (MAR) was reviewed after his medication pass was observed. Resident #327 was noted to have the following medication orders written on 02/12/20: - [MEDICATION NAME] 10 mg orally twice a day for hypertension, hold for systolic blood pressure less than 100 - [MEDICATION NAME] 50 mg every day, hold for systolic blood pressure less than 110 or pulse less than [AGE] He also had an order for [REDACTED]. Review of Resident #327 s Medication Administration Record (MAR) demonstrated he had received [MEDICATION NAME] every day at 9:00 AM and 9:00 PM. He had also received [MEDICATION NAME] every day at 9:00 AM. The resident's blood pressure and pulse measurements were not documented on the MAR. Additionally, the resident's blood pressure and pulse readings were not documented on the vital signs sheet. On 02/24/20 at 10:30 AM, the Director of Nursing (DON) stated blood pressure and pulse measurements for Resident #327 were recorded in the progress notes. Review of Resident #327's progress notes revealed blood pressure and pulse measurements had been recorded twice daily in the progress notes. On 0[DATE] at 8:00 AM, Resident #327's blood pressure was recorded as 98/[AGE]. Review of Resident #327's MAR documented he had received both [MEDICATION NAME] and [MEDICATION NAME] at 9:00 AM on 0[DATE]. On 02/24/20 at 10:45 AM, the Director of Nursing acknowledged Resident #327's blood pressure on the morning of 0[DATE] was below the parameters for which he should have received [MEDICATION NAME] and [MEDICATION NAME] administration. | 2020-09-01 |
| 3596 | 3596 | NELLA'S INC | 51A010 | 499 FERGUSON ROAD | ELKINS | WV | 26241 | 2020-02-26 | 812 | E | 0 | 1 | VTHQ11 | Based on observation, refrigerator temperature log review and staff interview the facility failed to store food in accordance with professional standards for food service safety. The facility failed to label and date food items in both the refrigerator and freezer areas, store items in a tightly sealed container and properly log refrigerator temperatures. The failed practice had the potential to affect more than a limited number of residents. Facility census: 76. Findings included: A policy review titled, Food Safety Requirements with no revised date noted, on 02/24/20 at 1:00 PM, revealed, Food will be stored, prepared and served in accordance with professional standards for food service safety. Refrigerator storage- Labeling, dating and monitoring food, including, but not limited to leftovers, so it is used by its use-by-date, or frozen (where applicable)/discarded. Keeping food covered or in tight containers. a) Initial Tour An observation during initial tour, on 02/23/20 at 10:35 AM, revealed an incomplete refrigerator temperature log located near door of the walk-in refrigerator. An interview with Assistant Kitchen Supervisor (AKS) #11, on 02/23/20 at 10:40 AM, confirmed on 0[DATE] and 02/23/20 refrigerator temperatures were not completed. AKS #11 stated that she would have expected that the dates of 0[DATE] and 02/23/20 to be completed by now. An observation in the refrigerator, on 02/23/20 at 10:45 AM revealed the following sanitation concerns: - One (1) pack of approximately 50 hotdog's were opened and not labeled or dated - Four (4) individual Dairy Pure low fat milk cartons laying on the floor of the refrigerator - A plastic bag that contained three (3) blocks of white American Cheese was not properly sealed and had no label or date. - A plastic bag that contained two (2) blocks of yellow American Cheese did not have a legible date. An immediate interview with AKS #11, on 02/23/20 at 10:45 AM, confirmed the hotdogs should have been labeled and dated, the white American Cheese should have been sealed tig… | 2020-09-01 |
| 3597 | 3597 | NELLA'S INC | 51A010 | 499 FERGUSON ROAD | ELKINS | WV | 26241 | 2020-02-26 | 842 | E | 0 | 1 | VTHQ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, medical record review and staff interview, the facility failed to ensure and maintain medical records on each resident that were complete and accurate. This had the potential to affect more than a limited number of residents residing in the facility. Resident identifiers: #55, #13, #50 and # 376. Facility Census: 76. Findings include: a) Medication Observation and Record Review Medication observation completed on 02/25/20 with Employee # 87, an Licensed Practical Nurse (LPN), found medication was administered to Residents #55, #13 and #50. Review of Medication Administration Records (MAR) and Physician order [REDACTED]. 1) Resident #55's MAR indicated [REDACTED]. [MEDICATION NAME] dose was marked through and new dosage was inserted with no explanation. Further review found the [MEDICATION NAME] dosage had been changed on 10/28/19. Review of the physician orders [REDACTED]. Some of the writing was illegible. 2) Resident #13's MAR indicated [REDACTED]. Review of the physician orders [REDACTED]. Some of the writing was illegible. 3) Resident #50's MAR indicated [REDACTED]. Review of the physician orders [REDACTED]. Some of the writing was illegible During an Interview with the Director of Nursing (DON) on 02/26/20 at 9:00 am, she agreed the physician orders [REDACTED].#55, #13 and #50's did not match with times and dosages and was unable to determine who or when the changes had been made. She also agreed some were illegible. B) Resident #376 Review of Resident #376's medical records revealed an order written [REDACTED]. The administration parameters, or the blood pressure reading that would require the medication, were not specified. Resident #376's Medication Administration Record [REDACTED]. The medication had not been administered since the medication was ordered. On 02/24/20 at 10:17 AM, the Director of Nursing (DON) was informed Resident #376's as needed [MEDICATION NAME] order did not specify the parameters for admini… | 2020-09-01 |
| 3598 | 3598 | NELLA'S INC | 51A010 | 499 FERGUSON ROAD | ELKINS | WV | 26241 | 2020-02-26 | 880 | D | 0 | 1 | VTHQ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, medical record review, and staff interview, the facility failed to establish and maintain an infection prevention and control program designed to help prevent the development and transmission of communicable diseases and infections. Hand hygiene was not performed between medication administration. Additionally, a resident's medication capsule was touched with bare hands. This was a random opportunity for discovery during the facility of task of medication administration. Also, one (1) of three (3) residents reviewed for the care area of oxygen did not have the [MEDICAL CONDITION] mask and tubing properly stored in a sanitary manner. Resident identifiers: #62, and #23. Facility census: 76. Findings included: a) Medication administration On 02/24/20 at 8:17 AM, medication administration by Licensed Practical Nurse (LPN) #67 was observed. LPN #67 prepared medications for Resident #326 from the medication cart. He then entered the resident's room and administered the medications to the resident. LPN #67 then returned to the medication cart and began preparing the medications for Resident #62. He did not perform hand hygiene between administering medications to Resident #326 and preparing medications for Resident #62. Preparing Resident #62's medications included puncturing the resident's vitamin D capsule so the medication could be squeezed into her mouth. LPN #67 touched the capsule with his bare hands to puncture the tablet. LPN #67 also did not perform hand hygiene before entering Resident #62's room and administering medications to her. On 02/24/20 at 8:45 AM, LPN #67 was informed he did not perform hand hygiene between administering medications to Resident #326 and preparing and administering medications to Resident #62. LPN #67 stated there was hand sanitizer located in the hallway he could use for hand hygiene during medication pass. On 02/24/20 at 8:56 AM, the Director of Nursing was notified of the situation, and sh… | 2020-09-01 |
| 3599 | 3599 | NELLA'S INC | 51A010 | 499 FERGUSON ROAD | ELKINS | WV | 26241 | 2020-02-26 | 883 | D | 0 | 1 | VTHQ11 | Based on medical record review and staff interview, the facility failed to document screening to assess for potential medical contraindications for influenza vaccination administration for one (1) of five (5) residents reviewed for the care area of vaccinations. Resident identifier: #41. Facility census: 76. Findings included: a) Resident #41 Review of Resident #41's medical records revealed on 09/27/19 the resident's representative consented for the resident to receive influenza (flu) vaccination by signing a Vaccine Consent and Administration Record form. The form included screening questions to assess for potential medical contraindications for receiving the vaccination. None of these questions had been answered. During an interview on 02/25/20 at 3:27 PM, Licensed Practical Nurse (LPN) #20 was informed Resident #41's vaccination consent signed by the resident's representative on 09/27/19 was incomplete because the screening questions to assess for potential medical contraindications for receiving the vaccination were not completed. LPN #20 had no additional information regarding the matter. No additional information was provided through the completion of the survey. | 2020-09-01 |
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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 );