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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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 3371 | 3371 | SPRINGFIELD CENTER | 515188 | 10797 SENECA TRAIL SOUTH | LINDSIDE | WV | 24951 | 2017-11-08 | 156 | D | 0 | 1 | XW9J11 | Based on staff interview, Center for Medicaid and Medicare Services (CMS) Survey and Certification (S&C) letter review, and a review of liablity notices, the facility failed to provide the correct notice when the resident exhausted their Medicare covered skilled nursing facility benefit days. This failed practice affected one (1) of three (3) residents reviewed. Resident identifier: #6. Facility census: 58. Findings include: a) Resident #6 On 11/07/17 at 1:55 p.m., a review of the liability notices revealed Resident #6 received the Notice of Medicare Non-Coverage (NOMNC) Centers for Medicaid and Medicare Services (CMS) form on 07/07/17. The NOMNC form indicated the resident would exhaust Medicare Part A benefits on 07/12/17. On 11/07/17 at 2:02 p.m., Social Worker (SW) #60 said the resident recieved the NOMNC because he had exhausted his skilled service days. The NOMNC form explained the resident had the right to appeal this decision. SW #60 also said she had previously been issuing the Skilled Nursing Facility Advanced Beneficiary Notice (SNFABN) along with the NOMNC but now realized this did not need issued each time the NOMNC was issued. According to CMS Survey and Certification (S&C ) letter 09-20, dated 01/09/09, the skilled nursing facility (SNF) must issue the NOMNC when there is a termination of all Medicare Part A services for coverage reasons. The SNF should not issue this notice if the beneficiary exhausts the Medicare covered days as the number of SNF benefit days set in law and the QIO cannot extend the benefit period. Thus, a service termination due to the exhaustion of benefits is not considered a termination for coverage reasons. | 2020-09-01 |
| 3854 | 3854 | PRINCETON CENTER | 515028 | 1924 GLEN WOOD PARK ROAD | PRINCETON | WV | 24740 | 2017-01-19 | 156 | D | 0 | 1 | DBHB11 | Based on staff interview and record review, the facility failed to ensure Resident #43 received notice of the decision to terminate Medicare covered services two (2) days prior to the proposed end of Medicare services. This was true for one (1) of three (3) residents reviewed for the mandatory care area of liability notices and beneficiary appeal. Resident identifier: #43. Facility census: 62. Findings include: a) Resident #43 At 1:25 p.m. on 01/18/17, Business Office Manager (BOM) #4, provided a copy of the notice of Medicare non-coverage form, Centers for Medicare and Medicaid Services (CMS) form # , issued to Resident #43. The form noted the resident's Medicare services would end on 11/29/16. The first day of non-skilled services would begin on 11/30/16. The resident's responsible party signed the form on 11/29/16. BOM #43 said she was only the keeper of the form, she did not provide the form to the resident's responsible party. She identified the social worker as the employee responsible for issuing the form. At 1:43 p.m. on 01/18/17, Social Worker #84 was unable to provide documentation the responsible party was notified of the determination to end services two (2) days before the proposed cut of services. The responsible party could have been contacted by telephone if unavailable to sign the form; however, no documentation was available to substantiate contact was made with the responsible party within the required time frame. Providing the notice two (2) days prior the end of services allows the resident/responsible party time to contact the Quality Improvement Organization (QIO) if they wish to appeal the decision. Resident #43 remained in the facility with benefit days remaining when the notice of Medicare non-covered services form was given. | 2020-04-01 |
| 4193 | 4193 | TRINITY HEALTH CARE OF LOGAN | 515140 | 1000 WEST PARK AVENUE | LOGAN | WV | 25601 | 2017-04-11 | 156 | D | 0 | 1 | XDKG11 | Based on staff interview and review of the facility's notices of Medicare provider non-coverage forms, the facility failed to notify the beneficiary or responsible party of the decision to terminate covered Medicare services no later than 2 days before the proposed end of the services. This was true for three (3) of three (3) residents reviewed for the care area of liability notices and beneficiary appeal during Stage 2 of the Quality Indicator Survey (QIS). Resident identifiers: #3, #35, and #44. Facility census: 113. Findings include: a) Resident #3 A form entitled Medicare Determination of Non coverage on Continued Stay, noted the resident's last day of Medicare services was 01/14/17. The form contained no information to verify when the responsible party was notified of the decision to terminate Medicare services. b) Resident #35 On 03/10/17, the resident's responsible party signed a form entitled Medicare Determination of Non coverage on Continued Stay. The resident's last day of Medicare coverage was 03/04/17. c) Resident #44 On 01/10/17, the resident's responsible party signed a form entitled Medicare Determination of Non coverage on Continued Stay. The resident's last day of Medicare coverage was 01/10/17. d) At 3:27 p.m. on 04/05/17, Business Office Manager (BOM) #13 confirmed she did not have verification the responsible parties of Residents #3, #35, and #44 had at least a 2 day notice before the proposed end of Medicare services. BOM #13 said she did mail the notices to the responsible parties in advance, but she had no verification as to when the responsible parties actually received the notice. BOM #13 said she was unaware if the resident or responsible party was unable to receive the notice, the facility representative could contact the legal representative and inform him/her by telephone. The date of telephone contact was considered the date the notice was given as long as it was not disputed by the beneficiary. The facility must also follow up the telephone contact with written notice. | 2020-02-01 |
| 4348 | 4348 | CLARY GROVE | 515039 | 209 CLOVER STREET | MARTINSBURG | WV | 25404 | 2016-01-20 | 156 | E | 0 | 1 | 96LU11 | Based on record review and staff interview, the facility failed to provide written information to residents whose Medicare covered services were discontinued. No evidence was presented to determine if liability notices were provided to three (3) of three (3) residents chosen for review by the Quality Indicator Survey (QIS) program during Stage 2 of the QIS survey. Resident identifiers: #72, #168, and #175. Facility census: 115. Findings include: a) Resident #72, #168, and #175 At 2:30 p.m. on 01/19/16, a request was made to the Administrator for the liability notices supplied to Residents #72, #168, and #175. All three (3) residents no longer resided in the facility. At 4:00 p.m., a corporate representative informed the survey team the requested records were not available for review. He said the previous facility owners had taken all paper and electronic records of residents when the facility ownership changed. At 9:30 a.m. on 01/20/16, the Administrator verified the absence of the records for the three (3) residents in question. Due to the absence of any documentation, the facility could not provide any evidence that the required notices were given to the three (3) residents when Medicare services were discontinued. | 2019-11-01 |
| 4822 | 4822 | EASTBROOK CENTER | 515089 | 3819 CHESTERFIELD AVENUE | CHARLESTON | WV | 25304 | 2015-11-05 | 156 | E | 0 | 1 | ZW2211 | Based on observation and staff interview, the facility failed to ensure each resident had access to information regarding how to apply for and use Medicare benefits. The facility had not prominently displayed the written information regarding these benefits as required by this regulation. This had the potential to affect any resident wishing to apply for and use these benefits. Facility census: 129. Findings include: a) On 11/02/15 at 11:25 a.m., an observation of the facility revealed there was no written information posted to inform a resident about how to apply for and use Medicare benefits. This posting is required to fulfill the facility's obligation to adequately inform residents of their benefits. In an interview on 11/03/15 at 3:15 p.m., the Assistant Nursing Home Administrator agreed the facility had not prominently posted the information regarding how residents could apply for and use Medicare benefits. | 2019-07-01 |
| 5071 | 5071 | MORGANTOWN HEALTH AND REHABILITATION CENTER | 515049 | 1379 VAN VOORHIS RD | MORGANTOWN | WV | 26505 | 2015-09-14 | 156 | C | 0 | 1 | HR8011 | Based on observation, resident council president interview, and staff interview, the facility did not post the required information within the facility regarding names, addresses and telephone numbers of all pertinent State client advocacy groups. The facility failed to post the name, address, and telephone number of the Office of Health Facility Licensure and Certification (OHFLAC), and/or a statement that the resident may file a complaint with the State survey and certification agency concerning resident abuse, neglect, and misappropriation of resident property. This practice had the potential to affect all residents at the facility. Facility census: 88. Findings include: a) Observation on 09/08/15 at 12:45 p.m. found no evidence of contact information for the State survey and certification agency posted within the corridors of the facility. At 1:00 p.m. on 09/08/15, Registered Nurse (RN) #20 and the licensed social worker looked for the required posted information. They could not locate a posting with the name, address, and telephone number of the State survey agency, including a statement that the resident may file a complaint with this agency concerning resident abuse, neglect, and misappropriate of resident property, and non-compliance with the advance directives requirements. They said there was none posted within the facility. The social worker devised and posted a temporary form, which included contact information and purpose, until she could obtain a laminated form. During an interview with Resident Council President (RCP) #4 on 09/14/15 at 11:50 a.m., RCP #4 said they did not know how to notify the State if they or other residents had complaints. RCP #4 knew the name of the Ombudsman and his contact information, but had no knowledge of the telephone number or address of the State survey and certification agency. RCP #4 stated she might find that information in the survey book, but did not recall seeing that information posted in the building. | 2019-03-01 |
| 5098 | 5098 | HARPER MILLS | 515086 | 100 HEARTLAND DRIVE | BECKLEY | WV | 25801 | 2016-03-31 | 156 | E | 1 | 0 | LC2M11 | > Based on medical record reviews and staff interviews, the facility failed to ensure each resident had access to updated written information regarding how to contact the certification agency. The Transfer or Discharge Notice had the incorrect address for the certification agency for Residents #20, #26, #59, #109 and #165. This had the potential to affect more than an isolated number of residents. Resident identifiers: Resident #20, #26, #59, #109 and #165. Facility census: 162. Findings include: a) On 03/31/16 at 8:35 a.m., during a review of the Transfer or Discharge Notices for Residents #20, #26, #59, #109 and #165, it was discovered the address for the certification agency was incorrect. The written information provided on the notice regarding the appeal information had not been updated to reflect the correct address for the certification agency. This written information is required to fulfill the facility's obligation to adequately inform residents of their appeal process regarding discharge and transfer. An interview with the Medical Records Clerk, on 03/31/16 at 8:58 a.m., verified the Notice of Transfer or Discharge had the incorrect address for the certification agency for Residents #20, #26, #59, #109 and #169. | 2019-03-01 |
| 5143 | 5143 | SISTERSVILLE CENTER | 515131 | 201 WOOD STREET OPERATIONS, LLC | SISTERSVILLE | WV | 26175 | 2015-06-23 | 156 | F | 0 | 1 | PDA311 | Based on observation and staff interview, the facility failed to prominently display written information about how to apply for and use Medicare and Medicaid benefits, and how to receive refunds for previous payments covered by such benefits. This practice had the potential to affect all residents. Facility census: 55 Findings include: a) Observations throughout the facility, from 06/15/15 through 06/18/15, revealed no evidence the facility displayed information related to Medicare and Medicaid application and benefits. An interview with the nursing home administrator (NHA), on 06/18/15 at 3:10 p.m., confirmed the facility had not posted information about how to apply for and use Medicare or Medicaid benefits, or receive refunds. She related, It would be right here, and gestured at the bulletin board. The NHA asked the maintenance director if he knew where the information was posted in the facility. He related the information was not posted. | 2019-03-01 |
| 5219 | 5219 | NEW MARTINSVILLE CENTER | 515074 | 225 RUSSELL AVENUE | NEW MARTINSVILLE | WV | 26155 | 2015-09-16 | 156 | B | 0 | 1 | 5JCO11 | Based on observation and staff interview, the facility failed to ensure each resident had access to information regarding how to apply for and use Medicare and Medicaid benefits. The facility had not prominently displayed the written information regarding these benefits, as required by this regulation. This had the potential to affect any resident wishing to apply for and use these benefits. Facility census: 81 Findings include: a) Observation of the facility, on 09/14/15 at 11:45 a.m., revealed there was no written information posted in the facility to inform a resident on how to apply for and use Medicare and Medicaid benefits. This posting is required to fulfill the facility's obligation to adequately inform residents of their benefits. An interview with the Nursing Home Administrator, on 09/16/15 at 10:20 a.m., verified the information was not posted prominently to inform residents on how to apply for and use Medicare and Medicaid benefits. | 2019-02-01 |
| 5229 | 5229 | HARPER MILLS | 515086 | 100 HEARTLAND DRIVE | BECKLEY | WV | 25801 | 2015-07-23 | 156 | B | 0 | 1 | 76WG11 | Based on observation, staff interview, and resident interview, the facility failed to ensure each resident had access to information regarding how to apply for and use Medicare and Medicaid benefits, or how to contact the State Ombudsman. The facility did not prominently display the written information regarding these benefits or the Ombudsman contact information. This had the potential to affect more than an isolated number of residents. Facility census: 160 Findings include: a) On 07/22/15 at 1:35 p.m., during an observation of the facility, it was discovered there was no written information posted in the facility to inform residents or responsible parties about how to apply for and use Medicare and Medicaid benefits. This posting is required to fulfill the facility's obligation to adequately inform residents of their benefits. An interview with the Nursing Home Administrator on 07/22/15 at 3:07 p.m., revealed she was unable to locate any information posted to inform residents on how to apply for and use Medicare and Medicaid benefits. b) Ombudsman Information On 07/20/15 at 1:00 p.m., during an interview with the resident council president, the president did not know if the facility had the Ombudsman contact information posted. At 1:20 p.m. on 07/20/15, Director of Nursing #205 and Assistant Administrator #235 toured the facility and confirmed the facility did not have the Ombudsman contact information posted. | 2019-02-01 |
| 5327 | 5327 | WILLOWS CENTER | 515085 | 723 SUMMERS STREET | PARKERSBURG | WV | 26101 | 2015-06-18 | 156 | D | 0 | 1 | 6BSN11 | Based on review of the liability notices and staff interview, the facility failed to provide the correct notice of termination of Medicare services, required by the Centers for Medicare and Medicaid Services (CMS), for one (1) of three (3) residents reviewed for the care area of liability notices and beneficiary appeal. Resident #127 received a notice informing her she could appeal her discharge from a skilled service after she had exhausted her allotted amount of skilled care days. Resident identifier: #127. Facility census: 94. Findings include: a) Resident #94 At 06/18/15 at 9:07 a.m., Clinical Reimbursement Coordinator #78 provided a copy of the notice given to Resident #127 on 01/08/15 regarding the exhaustion of her 100 days benefit period for medically necessary skilled care. The facility had attached to the notice a request for a Medicare Intermediary Review. The resident had indicated on the form that she did not want her bill for the services she continued to need to be submitted to the intermediary for a Medicare decision. According to CMS, the number of skilled care days is set in law and the Medicare Intermediary cannot extend the benefit period. Clinical Reimbursement Coordinator #78 said she did not know the facility could not give residents the right to appeal the exhaustion of the 100-day skilled care period. | 2019-01-01 |
| 5343 | 5343 | PARKERSBURG CENTER | 515102 | 1716 GIHON ROAD | PARKERSBURG | WV | 26101 | 2015-01-28 | 156 | B | 0 | 1 | 11X211 | Based on observation and staff interview, the facility failed to ensure each resident had access to information regarding how to apply for and use Medicare and Medicaid benefits. The facility had not prominently displayed the written information regarding these benefits, as required by this regulation. This had the potential to affect any resident wishing to apply for and use these benefits. Facility census: 64 Findings include: a) On 01/20/15 at 11:45 a.m., during an observation of the facility, observation revealed there was no written information posted in the facility to inform a resident about how to apply for and use Medicare and Medicaid benefits. This posting is required to fulfill the facility's obligation to adequately inform residents of their benefits. During an interview on 01/27/15 at 9:30 a.m. the Nursing Home Administer was unable to locate any information posted to inform residents on how to apply for and use Medicare and Medicaid benefits. | 2019-01-01 |
| 5368 | 5368 | MEADOW GARDEN | 515121 | 606 PENNSYLVANIA AVENUE | RAINELLE | WV | 25962 | 2015-06-25 | 156 | E | 0 | 1 | 1EZS11 | Based on observation and staff interview, the facility failed to ensure each resident had access to information regarding how to apply for and use Medicare and Medicaid benefits. The facility had not prominently displayed the written information regarding these benefits, as required by this regulation. This had the potential to affect any resident wishing to apply for and use these benefits. Facility census: 57 Findings include: a) On 06/22/15 at 11:15 a.m., during an observation of the facility, no written information to inform a resident about how to apply for and use Medicare and Medicaid benefits was observed in the facility. This posting is required to fulfill the facility's obligation to adequately inform residents of their benefits. An interview was conducted on 06/23/15 at 10:15 a.m., with the Nursing Home Administrator. He was unable to locate any information posted to inform residents on how to apply for and use Medicare and Medicaid benefits. | 2019-01-01 |
| 5397 | 5397 | LEWISBURG CENTER | 515144 | 979 ROCKY HILL ROAD | RONCEVERTE | WV | 24970 | 2015-06-11 | 156 | D | 0 | 1 | 3Y2511 | Based on review of liability notices and staff interview, the facility failed to provide the correct notice of termination of Medicare services, required by the Centers for Medicare and Medicaid Services (CMS), for one (1) of three (3) residents reviewed for the care area of liability notices and beneficiary appeal. Resident #32 did not receive the appropriate notice when skilled care services were terminated with skilled days remaining, and the resident remained in the facility. Resident identifier: #32. Facility census: 81. Findings include: a) Resident #32 At 2:18 p.m. on 06/10/15, Bookkeeper #44 provided a copy of the Medicare non-coverage form given to Resident #32 when Medicare services were terminated. The facility issued CMS form # to Resident #32, on 01/16/15, to notify him Medicare services were being terminated on 01/18/15. Bookkeeper #44 verified Resident #32 began receiving skilled care services on 01/02/14, and was discharged from skilled care services on 01/18/15. She further verified the resident had skilled days remaining and the resident continued to remain at the facility after the termination of skilled care services. According to a memorandum issued by CMS on 01/09/09, The Notice of Medicare Provider Non-coverage (form CMS- is issued when all covered services end for coverage reasons. If after issuing the Notice of Medicare Provider Non-coverage, the SNF (skilled nursing facility) expects the beneficiary to remain in the facility in a non-covered stay, either the SNFABN (skilled nursing facility advanced beneficiary notice) (form CMS- ) or a denial Letter must be issued to inform the beneficiary of potential liability for the non-covered stay. During this evaluation of liability notices and beneficiary appeal rights, Bookkeeper #44 confirmed the facility did not issue the correct notice of Medicare non-coverage form to Resident #32. | 2019-01-01 |
| 5448 | 5448 | OAK RIDGE CENTER | 515174 | 1000 ASSOCIATION DRIVE | CHARLESTON | WV | 25311 | 2015-06-26 | 156 | D | 0 | 1 | 7OP711 | Based on staff interview and review of the liability notices, the facility failed to ensure one (1) of three (3) residents, reviewed for the care area of liability notices and beneficiary appeal rights, received the notice of termination of Medicare services forty-eight (48) hours before the proposed end of services as required by the Centers for Medicare and Medicaid Services (CMS). Resident identifier: #13. Facility census: 71. Findings include: a) Resident #13 At 8:18 a.m. on 06/24/15, the care area of liability notices and beneficiary appeal rights were reviewed with Employee #29, the business office manager. Resident #13 was receiving Part A Medicare skilled services at the time of termination of benefits. The facility provided the resident's responsible party a copy of CMS form # . The form notified the responsible party the resident's skilled nursing services would end on 02/13/15. CMS form was signed by the responsible party on 02/12/15. This signature indicated the responsible party was notified that coverage of services would end on 02/13/15, and the responsible party had the right to appeal the decision of termination by the facility. Employee #29 was unable to locate any evidence the responsible party was contacted by any means, including telephone notification of termination of services, forty-eight (48) hours prior to termination of the services as required by CMS. Employee #29 stated, We do so many of them, I guess someone could have missed notifying her daughter. According to CMS reference letter S&C-09-20, issued on 01/09/2009, . The SNF (skilled nursing facility) is required to notify the beneficiary of the decision to terminate covered services (Generic Notice, CMS ) no later than 2 days before the proposed end of services . At 3:54 p.m. on 06/24/15, when the administrator was advised of the findings, he stated his business office manager had already told him about the issue. | 2019-01-01 |
| 5477 | 5477 | OHIO VALLEY HEALTH CARE | 515181 | 222 NICOLETTE ROAD | PARKERSBURG | WV | 26104 | 2015-09-24 | 156 | B | 0 | 1 | HNWB11 | Based on observation and staff interview, the facility failed to ensure each resident had access to information regarding how to apply for and use Medicare and Medicaid benefits. The facility had not prominently displayed the written information regarding these benefits, as required by this regulation. This had the potential to affect any resident wishing to apply for and use these benefits. Facility Census: 65. Findings include: a) On 09/21/15 at 11:45 a.m., during an observation of the facility, it was discovered there was no written information posted in the facility to inform a resident on how to apply for and use Medicare and Medicaid benefits. This posting is required to fulfill the facility's obligation to adequately inform residents of their benefits. In an interview on 09/24/15 at 10:20 a.m., the Nursing Home Administrator, agreed the information was not posted prominently to inform residents on how to apply for and use Medicare and Medicaid benefits. | 2019-01-01 |
| 5507 | 5507 | MINNIE HAMILTON HEALTH CARE | 51A013 | 186 HOSPITAL DRIVE | GRANTSVILLE | WV | 26147 | 2015-10-07 | 156 | B | 0 | 1 | WP4G11 | Based on observation and staff interview, the facility failed to ensure each resident had access to information regarding how to apply for and use Medicare benefits. The facility had not prominently displayed the written information regarding these benefits, as required by this regulation. This had the potential to affect any resident wishing to apply for and use these benefits. Facility Census: 22 Findings include: a) On 10/05/15 at 11:45 a.m., an observation of the facility revealed there was no written information posted in the facility to inform a resident how to apply for and use Medicare benefits. This posting is required to fulfill the facility's obligation to adequately inform residents of their benefits. In an interview, on 10/06/15 at 9:45 a.m., the Director of Social Services agreed the information was not posted prominently to inform residents on how to apply for and use Medicare benefits. | 2019-01-01 |
| 5573 | 5573 | HERITAGE CENTER | 515060 | 101-13TH STREET | HUNTINGTON | WV | 25701 | 2014-12-12 | 156 | D | 0 | 1 | VNJW11 | Based on review of the facility's reported allegations to proper state authorities, staff interview, record review, resident interview, and review of the care area of liability notices and beneficiary appeal right review, the facility failed to ensure Residents #9 and #47 were informed of the facility's rules regarding safeguarding of personal property prior to alleged allegations of misappropriation of resident property made by both residents. This was true for two (2) of eight (8) reported allegations to proper state authorities reviewed. The facility also failed to ensure Resident #181 received notice of the decision to terminate Medicare covered services two (2) days before the proposed end of services. This was true for one (1) of three (3) residents reviewed for the care area of liability notices and beneficiary appeal right review. Resident identifiers: #9, #47 and #181. Facility census: 154. Findings include: a) Resident #9 Review of the facility's immediate fax reporting of allegations to the nursing home program, on 12/02/14, found the resident reported $70.00 was missing from her purse. The incident was reported to the Office of Health Facilities Licensure and Certification (OHFLAC) on 11/04/14. The five (5) day follow up report, completed on 11/10/14, found the corrective action by the facility was, Has resident trust available and access to that money at all times. Has a locked drawer she can keep her valuables in. In an interview with the administrator and the social services director, at 8:48 a.m. on 12/04/14, the administrator stated residents could get a lock on their night stand drawer and a key if they wished to lock up valuables. The administrator verified the facility's admission agreement did not contain this information, but residents were informed of a locking drawer by the activity director during competition of a recreational assessment. At 10:45 a.m. on 12/04/14, the administrator provided a copy of the recreation assessment and stated the activity staff ask resident's the question, How… | 2018-09-01 |
| 5988 | 5988 | PLEASANT VALLEY NURSING AND REHABILITATION CENTER | 515064 | 640 SAND HILL ROAD | POINT PLEASANT | WV | 25550 | 2014-09-18 | 156 | D | 0 | 1 | 7HHJ11 | Based on staff interview, review of the facility's liability and appeal notices, and review of the memorandum from the Centers for Medicare and Medicaid Services (CMS) regarding liability notices and beneficiary appeal rights in nursing homes (issued on 01/09/09), the facility failed to issue the correct notice of Medicare non-coverage form for two (2) of three (3) residents when Medicare services were discontinued by the facility. Both residents were receiving therapy and were discharged from Medicare services with Medicare benefit days remaining. Resident identifiers: #60 and #62. Facility census: 98. Findings include: a) Resident #60 Review of the resident's notice of Medicare non-coverage form with Employee #94, the registered nurse (RN) admissions coordinator, at 1:53 p.m. on 09/17/14, found Resident #60 was discharged from Medicare skilled services on 04/23/14. The reason for the discontinuation was, Resident has met goals established with PT. OT (physical and occupational therapy) and has plateaued. RN #94 verified the resident had benefit days remaining. RN #94 issued form CMS to the resident's responsible party on 04/21/14. b) Resident #62 Review of the resident's Notice of Medicare Non-Coverage form, with RN #94 at 1:53 p.m. on 09/17/14 found the resident's last covered day of Medicare skilled services was 04/02/14. The reason for the denial was, Patient has met all goals with therapy and no longer meets criteria for skilled services. RN #94 verified the resident had benefit days remaining when discontinued from Medicare services. RN #94 issued form CMS to the resident's responsible party on 03/31/14. c) According to the CMS, S&C-09-20 memorandum guidance, dated 01/09/09, Use the Notice of Provider Noncoverage (Form CMS ) also known as the Generic Notice to notify resident of the right to an expedited review by a QIO (Quality Improvement Organization): All covered services are ending for coverage reasons and resident has benefit days remaining. The example provided was, SNF (skilled nursing facility) de… | 2018-05-01 |
| 6157 | 6157 | MONTGOMERY GENERAL ELDERLY CARE | 515152 | 501 ADAMS STREET | MONTGOMERY | WV | 25136 | 2014-08-26 | 156 | D | 0 | 1 | 6MJ711 | Based on staff interview, review of the Centers for Medicare and Medicaid Services (CMS) instructions for notices of Medicare noncoverage, and review of the facility's liability and appeal notices, the facility failed to issue the correct notice of Medicare noncoverage form for one (1) of three (3) residents reviewed when a resident was terminated from Part A Medicare services with benefit days remaining. Resident identifier: #16. Facility census: 55. Findings include: a) Resident #16 An interview with Employee #65, the social worker, at 10:40 a.m. on 08/21/14, found Resident #16 was cut from Medicare part A services on 04/08/14. The facility issued a Center for Medicare and Medicaid Services (CMS) Form # , skilled nursing facility advance beneficiary notice (SNFABN), to the resident on 04/04/14 stating the resident was being cut from Medicare part A services because the resident had reached her maximum rehabilitation potential. The resident had remaining days remaining. The facility also provided a second notice of Medicare non-coverage, CMS form # to the resident on 04/04/14. The resident had remaining benefit days and according to the directions on the CMS, SNF (skilled nursing facility) Notice Structure, the resident should have received CMS form # . The instructions stated: . Use the Notice of Provider Noncoverage (Form CMS # ) also know as the 'Generic Notice' to notify resident of the right to an expedited review by a QIO (Quality Improvement Organization): All covered services are ending for coverage reasons and resident has benefit days remaining. The example provided by CMS for use of form # was, SNF decides to discharge the resident because s/he has reached all therapy goals and no other qualifying medical conditions exist, which was the exact condition for ending Medicare coverage for Resident #16. On 08/21/14 at 10:40 a.m., Employee #65 verified Resident #16 should have received CMS form # , instead of CMS form # issued by the facility. | 2018-05-01 |
| 6185 | 6185 | MAPLES NURSING HOME | 515186 | 1600 BLAND STREET | BLUEFIELD | WV | 24701 | 2014-09-18 | 156 | B | 0 | 1 | O60P11 | Based on observation and staff interview, the facility failed to ensure each resident had access to information regarding how to apply for and use Medicare and Medicaid benefits. The facility had not prominently displayed the written information regarding these benefits, as required by this regulation. This had the potential to affect any resident wishing to apply for and use these benefits. Facility Census: 55 Findings include: a) On 09/17/14 at 10:10 a.m., during an observation of the facility, it was discovered there was no written information posted in the facility to inform a resident about how to apply for and use Medicare and Medicaid benefits. This posting is required to fulfill the facility's obligation to adequately inform residents of their benefits. An interview was conducted on 09/17/14 at 1:20 p.m., with the Nursing Home Administrator. She was unable to locate any information posted to inform residents on how to apply for and use Medicare and Medicaid benefits. | 2018-05-01 |
| 6732 | 6732 | ELDERCARE HEALTH AND REHABILITATION | 515065 | 107 MILLER DRIVE | RIPLEY | WV | 25271 | 2013-11-13 | 156 | B | 0 | 1 | IQK011 | Based on observation and staff interview, the facility failed to ensure each resident had access to information regarding how to apply for and use Medicare and Medicaid benefits. The facility had not prominently displayed the written information regarding these benefits, as required by this regulation. This had the potential to affect any resident wishing to apply for and use these benefits. Facility census: 107. Findings include: a) On 11/12/13 at 2:15 p.m., during an observation of the facility, it was discovered there was no written information posted in the facility to inform a resident about how to apply for and use Medicare and Medicaid benefits. This posting is required to fulfill the facility's obligation to adequately inform residents of these benefits. An interview was conducted, on 11/12/13 at 2:45 p.m., with the Nursing Home Administrator. He was unable to locate any information posted to inform residents on how to apply for and use Medicare and Medicaid benefits. | 2017-11-01 |
| 6795 | 6795 | CABELL HUNTINGTON HOSPITAL TCU | 515126 | 1340 HAL GREER BOULEVARD | HUNTINGTON | WV | 25701 | 2014-08-08 | 156 | D | 0 | 1 | 6TWN11 | Based on review of liability notices and through staff interview, it was determined the facility had not given liability notices in the timeframe established by Centers for Medicare and Medicaid (CMS) and was providing the notices using an outdated form. Resident identifiers: #54 and #53. Facility census: 11. Findings include: a) Resident #54 This resident was given a liability notice stating the services for the Transitional Care Unit were going to end effective 02/19/14, and signed as received the same day. Instructions from the Centers for Medicare and Medicaid indicate these notices are to be given two (2) days prior to the services being cut. b) Resident #53 This resident was presented with a liability notice dated 03/27/14 and signed as received the same day, 03/27/14, indicating coverage for Transitional Care Unit services would end that date. c) Discussion with Registered Nurse (RN) Coordinator #2 on 08/05/14 at 2:25 p.m., revealed the residents were verbally given notification at a meeting on Tuesdays that services will be stopped on Thursday or Friday which were usually discharge days and the residents went home. The written notices were given and signed on the date of discharge and not two (2) days prior as required by instructions on using the form by CMS. Additionally the facility was using the form to give the notices dated 06/30/08. The most current form is dated 12/31/11. | 2017-11-01 |
| 7027 | 7027 | CARE HAVEN CENTER | 515178 | 2720 CHARLES TOWN ROAD | MARTINSBURG | WV | 25401 | 2013-08-14 | 156 | B | 0 | 1 | 66WU11 | Based on record review, policy review, and staff interview the facility failed to ensure the information communicated to the residents when there was a change in their skilled status was complete. The liability notices did not identify the services being discontinued and/or the reason for the action for three (3) of six (6) sampled residents who had medicare covered services discontinued. Resident identifiers: #87, #78, and #112. Facility census 68. Findings include: a) Residents # 87, 78, and 112 A review of the Notice of Medicare Provider Non-Coverage document which was provided to the residents and/or their responsible parties revealed the following verbiage: The Effective Date Coverage of Your Current: SKILLED NURSING Services Will End (date). The document did not, in a language the resident can understand, identify all skilled services that were being received by the residents which were being discontinued. The document also did not explain why the service was being discontinued. A review of the medical records of Residents #87, #56, and #86 revealed that they were also receiving Skilled Therapy services. The residents were being asked to make an appeal decision without this information. During an interview with Employee #97 (Physical Therapy Aid) at 8:30 a.m. on 08/07/13, she confirmed Residents #87, #56, and #86 were receiving Physical Therapy services which were discontinued on the date stated in the Medicare Non-Coverage notice. After reviewing the liability notices with the Administrator at 8:45 a.m. on 08/13/13, he acknowledged the notices did not contain what services were being discontinued or why they were being discontinued. During an interview with the Social Worker (Employee #68) at 1:45 p.m. on 08/13/13, she stated she knew the resident or his responsible party should be informed of all services and the reason for discontinuing them. She stated she was not the person who filled out the notices, although she did sign them indicating she issued the notice to Resident #112. | 2017-09-01 |
| 7083 | 7083 | MONTGOMERY GENERAL HOSPITAL | 515081 | 401 6TH AVENUE | MONTGOMERY | WV | 25136 | 2013-11-21 | 156 | B | 0 | 1 | DACE11 | Based on observation and staff interview, the facility failed to ensure it had prominently displayed written information about how to apply for and use Medicare and Medicaid benefits. This practice had the potential to affect any residents and/or residents' responsible parties who might need access to this information. Facility census: 36. Findings include: a) During the initial tour of the facility on 11/18/13, at approximately 11:45 a.m., observations found the posting of how to apply for and use Medicare and Medicaid benefits was not present. On 11/21/13 at 11:30 a.m. the director of nursing and the social worker, Employee #35, confirmed the information was not posted in the facility. Employee #35 stated the building had recently been painted and she thought the painters must have removed the information. | 2017-08-01 |
| 7094 | 7094 | CEDAR RIDGE CENTER | 515087 | 302 CEDAR RIDGE ROAD | SISSONVILLE | WV | 25320 | 2013-09-26 | 156 | C | 0 | 1 | 1ZMG11 | Based on observation, staff interview, and resident interview, the facility failed to ensure residents were informed both orally and in writing, and in a language the resident understands, of his or her rights during the stay in the facility. The facility did not post the address for the State survey agency. This agency serves as the entity to which residents can make formal complaints about the care they are receiving. This practice had the potential to affect all residents and/or their responsible parties. Facility census: 118. Findings include: a) On 09/16/13 at 4:00 p.m., the resident council president (Resident #61) said she did not know where the posting was that had the name, address, and telephone number of the State survey agency. This agency is responsible for receiving complaints from residents regarding their care in nursing homes. At 4:30 p.m. on 09/16/13, an observation of the posting revealed the name and telephone number of the State survey and certification agency was posted; however, the posting did not contain the address for this agency. On 09/17/13 at 10:55 a.m., during an interview, the administrator (Employee #66) said he said he would update the postings so they contained this information. | 2017-08-01 |
| 7275 | 7275 | COLUMBIA ST. FRANCIS HOSPITAL | 515110 | 333 LAIDLEY STREET | CHARLESTON | WV | 25322 | 2014-05-15 | 156 | B | 0 | 1 | SERN11 | Based on observation and staff interview, the facility failed to ensure it had prominently displayed written information about how to apply for and use Medicaid benefits. This practice had the potential to affect any residents and/or residents' responsible parties who might need access to this information. Facility census: 15. Findings include: a) During the initial tour of the facility on 05/12/14 at 10:50 a.m., observations found the posting of how to apply for and use Medicaid benefits was not present. On 11/14/14 at 11:15 a.m., Employee #1, the registered nurse clinical coordinator supervisor (RN, CCS) and Employee #20, the social worker, confirmed the facility had not posted the information in the facility. | 2017-06-01 |
| 7317 | 7317 | MAPLES NURSING HOME | 515186 | 1600 BLAND STREET | BLUEFIELD | WV | 24701 | 2013-04-18 | 156 | D | 0 | 1 | KPNE11 | Based on record review and staff interview, the facility failed to ensure one (1) of three (3) residents selected for the liability notice and beneficiary appeal rights review were given information in writing when they were discharged from a skilled service covered by Medicare. Resident identifier: #20. Facility census: 51. Findings include: a) Resident #20 On 04/16/13 at 1:00 p.m., the billing clerk (Employee #74) assisted in a review of the liability notices and beneficiary appeal rights for three (3) residents. Two (2) of the three (3) residents selected for review were discharged to another skilled nursing facility. Resident #20 had refused to participate in the skilled therapy service. Employee #74 said the resident said she was too sick to participate. Employee #74 indicated she did not send the resident a written notice informing her of her discharge from a skilled service covered by Medicare. She said she did not think she had to send a written notice when the resident refused to participate. According to the Centers for Medicare and Medicaid Services (CMS) survey and certification letter 09-20: If a SNF provider believes on admission or during a resident's stay that Medicare will not pay for skilled nursing or specialized rehabilitative services and the provider believes that an otherwise covered item or service may be denied as not reasonable and necessary, the facility must inform the resident or his/her legal representative in writing why these specific services may not be covered and the beneficiary's potential liability for payment for the non-covered services. | 2017-06-01 |
| 7358 | 7358 | TYGART CENTER AT FAIRMONT CAMPUS | 515053 | 1539 COUNTRY CLUB ROAD | FAIRMONT | WV | 26554 | 2013-07-22 | 156 | B | 0 | 1 | MT7G11 | Based on observation and staff interview, the facility failed to post contact information of pertinent State client advocacy groups in a manner which was accessible to wheelchair bound residents. This had the potential to affect more than a limited number of residents. Facility census: 104. Findings include: a) During a random observation on 07/22/13, a copy of residents' rights with a listing of telephone numbers was observed posted in the lobby of the facility. The bottom of the form was about eye level, if standing. Upon inquiry, on 07/22/13 at 8:15 a.m., Employee #131 (social services), confirmed the information was not posted in another area accessible to residents. She also acknowledged the posted information, containing residents rights and contact information for pertinent State client advocacy groups, would be difficult to read from a seated position, such as a wheelchair, and was therefore not accessible to all residents. | 2017-05-01 |
| 7532 | 7532 | GLENVILLE CENTER | 515103 | 111 FAIRGROUND ROAD | GLENVILLE | WV | 26351 | 2013-07-18 | 156 | D | 0 | 1 | 5IAE11 | Based on review of Medicare beneficiary liability notices and staff interview, the facility failed to provide notice of termination of Medicare services at least two (2) days in advance of the service termination. This was true for one (1) of three (3) residents selected for review during the quality indicator survey. Resident identifier: #84. Facility census: 61. Findings include: a) Resident #84 Review of liability notices (Centers for Medicare Services - form number ) found the notice was provided to Resident #84's responsible party on 05/21/13. An interview was conducted with Employee #25, the register nurse responsible for issuing the liability notice, at 4:22 p.m. on 07/17/13. It was revealed the last day of covered services for Resident #84, was 05/22/13. Employee #25 verified the responsible party should have received the notice at least two (2) days in advance of the service termination. | 2017-04-01 |
| 7557 | 7557 | MARMET CENTER | 515146 | ONE SUTPHIN DRIVE | MARMET | WV | 25315 | 2013-06-13 | 156 | D | 0 | 1 | UM2S11 | Based on record review and staff interview, the facility did not inform Resident #68 when her level of care no longer met the qualifications for Medicare payment. Beginning on 04/11/13 Resident #68 had a change in payer source. The resident's Medicare benefit no longer paid for her care and services. There was no evidence the facility had issued the appropriate notices to the resident when her Medicare coverage ended. The facility was unable to provide evidence the resident had been notified of Medicare non-coverage. This was true for one (1) of three (3) sampled residents. Resident Identifier: #68. Facility Census: 88. Findings Include: a) Resident #68 Employee #45, the business office manager (BOM), was interviewed at 12:30 p.m. on 06/11/13. This interview revealed Resident #68's payer source changed on 04/11/13. The BOM confirmed the resident's last covered day for Medicare services was 04/10/13. The BOM also confirmed Resident #68 was not notified when her care no longer met the requirements for Medicare coverage. | 2017-04-01 |
| 7691 | 7691 | SUMMERSVILLE REGIONAL MEDICAL CENTER | 515029 | 400 FAIRVIEW HEIGHTS ROAD | SUMMERSVILLE | WV | 26651 | 2013-04-18 | 156 | D | 0 | 1 | JBS911 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview, the facility failed to ensure a resident, who the facility determined was no longer eligible for Medicare services, received the proper notice before discontinuing Medicare services. This was true for one (1) of three (3) residents reviewed for liability notices during the Quality Indicator Survey. Resident identifier: #58. Facility census: 51. Findings include: a) Resident #58 Medical record review found Resident #58 was admitted to the facility on [DATE]. Further review found the resident was notified in writing, by a facility generated form, on 12/06/13, that Medicare services would end on 12/12/12. The reason for the discontinuation of services was listed as, discontinuation of skilled therapy. According to the Centers for Medicare and Medicaid Services (CMS), termination (end of covered care) requires the provider to, Use the notice of provider non coverage (form CMS ) also known as the 'Generic Notice' to notify the resident of the right to an expedited review by a QIO (Quality Improvement Organization): All covered services are ending for coverage reasons and resident has benefit days remaining. The director of nursing (DON) was interviewed at 2:00 p.m. on 04/17/13. She verified the facility had not used the CMS form to notify the resident of the discontinuation of Medicare services. She further agreed the facility notice provided to the resident did not include the telephone number of the QIO for appeal. The DON also verified the resident had remaining benefit days when Medicare was discontinued. . | 2017-02-01 |
| 7736 | 7736 | CAMERON NURSING AND REHABILITATION CENTER | 515125 | ROUTE 4, BOX 20 | CAMERON | WV | 26033 | 2013-05-01 | 156 | B | 0 | 1 | H1U811 | Based on review of liability notices and staff interview, the facility failed to provide specific written information to three (3) of three (3) residents whose Medicare covered skilled services were discontinued. The liability notices provided these residents did not indicate the reason the services would no longer be covered. Resident identifiers: #9, #53, and #51. Facility census: 44. Findings include: a) Residents #9, #53, and #51 A review of the Notice of Medicare Provider Non-Coverage document which was provided to residents and/or their responsible parties included the following statement: THE EFFECTIVE DATE COVERAGE OF YOUR CURRENT SKILLED SERVICES WILL END (followed by the date). The document did not identify which service was being discontinued and did not explain why the service was being discontinued. The resident was being asked to make an appeal decision without this information. During an interview with the administrator, at 9:45 a.m. on 04/24/13, he acknowledged the form did not indicate which skilled service was being discontinued or the reason for the discontinuation. | 2017-02-01 |
| 7803 | 7803 | ROANE GENERAL HOSPITAL | 515099 | 200 HOSPITAL DRIVE | SPENCER | WV | 25276 | 2013-03-07 | 156 | D | 0 | 1 | 22CL11 | Based on record review and staff interview, the facility failed, for one (1) of four (4) residents reviewed for liability notices, to give notice to the resident when therapy services were ending and how to appeal the decision if desired. Resident identifier: #15. Facility census: 33. Findings include: a) Resident #15 Medical record review revealed that Speech Therapy, Occupational Therapy, and Physical Therapy were discontinued in December 2012 for Resident #15. Medical record review found no evidence that a liability notice, or the right to appeal the cessation of coverage, was given to this resident, or to her power of attorney. During an interview with the Director of Nursing (DON), on 03/02/13 at 10:00 a.m., she said she thought this resident should have received a notification letter, but other staff had been adamant that she did not require a notification letter. Findings include: c) Resident #1 Resident #1 was interviewed on 03/05/13 at 11:40 a.m., regarding resident council issues. She said she was unaware of who to notify or how to formally notify a state agency if she had a concern. Upon further inquiry, the resident was adamant she would not know what to do, or to whom to report concerns outside of the facility. The Resident council minutes provided by the facility, reviewed on 03/05/13 at 1:30 p.m., provided no evidence of a discussion related to how to report concerns to a state agency. | 2017-01-01 |
| 7823 | 7823 | MEADOW GARDEN | 515121 | 606 PENNSYLVANIA AVENUE | RAINELLE | WV | 25962 | 2012-08-23 | 156 | C | 0 | 1 | 1T2X11 | Based on review of information posted in the facility, review of medical records, and staff interview, it was determined the facility had not posted the names, addresses and telephone numbers for the agencies that are required to be posted to provide information to the residents and others. This practice had the potential to affect all residents who resided in the facility and should have access to this information. Additionally, the facility had not provided residents with a timely notice of their right to appeal when Medicare coverage of services was to be discontinued. The appeal notice timeliness affected two (2) of three (3) residents who were reviewed for appeal notices. Resident identifiers: #69 and #24. Census: 56. Findings include: a) Observation of informational materials posted in the facility found the name, address, and telephone number for the Medicaid Fraud Unit were not posted on the boards that contained information for the residents, their families, and the public. Additionally, there was no notice of how to file a complaint with the State survey and certification agency, nor how to apply for Medicare and Medicaid services. This was discussed with the administrator, Employee #78 and the social worker, Employee #35, on the afternoon of 08/20/12. b) Resident #69 Review of Resident #69's medical records found no evidence she was provided a forty-eight (48) hour notification of discontinuation of skilled services. Medical record review revealed, on 03/27/12, the facility had determined this resident no longer qualified for skilled services beginning 03/08/12. On 03/27/12, the resident signed section C of the form, the acknowledgement of receipt of the notice of non-coverage of services under Medicare. This was nineteen (19) days after the date services would no longer be covered. Staff interview, on 08/22/12 at 09:00 a.m., with Employee #35 (social worker) confirmed Employee #35 did not give Resident #69 a 48 hour notification as required. c) Resident # 24 Review, on 08/22/12 at 9:15 a.m., of Reside… | 2017-01-01 |
| 7888 | 7888 | HARPER MILLS | 515086 | 100 HEARTLAND DRIVE | BECKLEY | WV | 25801 | 2012-08-17 | 156 | D | 0 | 1 | INBY11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to provide appropriate liability notices to two residents (Resident #6 and #41) out of five sampled residents reviewed for liability notices and beneficiary appeal rights. Findings Include: Resident #6 was admitted on [DATE], with [DIAGNOSES REDACTED]. Resident #6 was notified by the facility that skilled nursing services would end on July 18, 2012. Notice of Medicare Non-Coverage (CMS Form ) was signed by the resident's Medical Power of Attorney on July 17, 2012. Resident #41 was admitted on [DATE], with [DIAGNOSES REDACTED]. Resident #41 was notified by the facility that skilled nursing services would end on July 27, 2012. Notice of Medicare Non-Coverage (CMS Form ) was signed by the resident's Power of Attorney on August 1, 2012, 5 days after the cessation of the services on July 27, 2012. Both resident #6 and #41 remained in the facility and were not discharged following the end of covered services. However, the residents were not issued the Skilled Nursing Facility Advance Beneficiary Notice (CMS Form ) or an appropriate generic denial letter. An interview with employee #176 was conducted on August 17, 2012. Employee #176 stated that she issued the CMS Form and not the CMS Form or another appropriate Denial Letter. A subsequent interview was conducted with licensed social worker on August 17, 2012. Staff stated that she was aware of the requirements for issuing liability notices but could not locate the form in the facility's computer drive and believed that it was not the facility policy to issue any liability notices other than the CMS . A verbal policy that the facility complies with Federal requirements regarding liability notices was provided by the facility. | 2016-12-01 |
| 7919 | 7919 | PINEY VALLEY | 515122 | 135 SOUTHERN DRIVE | KEYSER | WV | 26726 | 2012-08-24 | 156 | D | 0 | 1 | PYCQ11 | Based on staff interview and review of 3 liability notices, the facility failed to provide timely notice for one (resident #29) of the three prior to discharging the resident from Medicare skilled services. This involved Resident #29. Findings include: A review of three randomly selected closed records for residents recently discharged from Medicare skilled services was conducted. Resident #29 was a Medicare beneficiary who was discharged from skilled services on 3/10/2012. A review of the Notice of Medicare Provider Non-Coverage letter (denial letter) was conducted. The denial letter issued by the facility indicated the following statement: The effective date of coverage of your skilled services will end 3/10/2012 The Additional Information section of the denial letter also indicated, Resident will be cut from skilled services on 3/10/2012. Under the section entitled, please sign below to indicate that you have received this notice was the following statement: I have been notified that coverage of my services will end on the effective date indicated on this notice and that I may appeal this decision by contacting my QIO. The resident's power of attorney (POA) signed the letter on 3/12/2012, two days after Medicare skilled services had ended. As a result, the facility did not provide the resident or POA sufficient time to appeal the decision to the QIO, (Quality Improvement Organization) should they have desired to utilize the appeal process. An interview was conducted with both the facility administrator and the director of care delivery on 8/23/2012 at 5:05 PM. The facility personnel were unable to provide any other documentation to indicate that the resident's POA had been notified prior to discharging the resident from skilled services. The administrator commented that the resident began receiving Hospice services on 3/10/2012, but still was unable to validate that the responsible party had been notified of the discharge from skilled services prior to the effective date that all skilled services were terminat… | 2016-12-01 |
| 7947 | 7947 | PIERPONT CENTER AT FAIRMONT CAMPUS | 515155 | 1543 COUNTRY CLUB ROAD | FAIRMONT | WV | 26554 | 2012-08-20 | 156 | D | 0 | 1 | HTLJ11 | Based on staff interview and record review the facility failed to provide 3 of 3 sampled residents ( #17, #74 and #113), or their responsible party, a specific reason for their discharge from skilled medical services. Findings include: A review of three randomly selected closed records was conducted for Medicare beneficiaries who were discharged from skilled services within the past six months. Resident # 17 was a Medicare beneficiary who was discharged from skilled services on 3/30/2012. The denial letter was issued by the facility and signed by the business office representative on 3/23/2012. The business office representative' s signature represented that the notice was delivered telephonically. The letter was also signed by the resident's responsible party on 3/26/2012. There was no reason for discharge listed on the denial letter. Resident # 74 was also a Medicare beneficiary who was discharged from skilled services on 6/22/2012. The denial letter was issued by the facility and signed by a business office representative on 6/15/2012. The business office representative's signature represented that the notice was delivered telephonically. The letter was also signed by the resident's responsible party on 6/26/2012. No reason for discharge was listed on the denial letter. Resident # 113 was a Medicare beneficiary who was discharged from skilled services on 3/20/2012. The denial letter was issued by the facility and signed by the business office representative. The business office representative's signature represented that the notice had been issued telephonically. There was no date indicating the date that the form was signed by the business office representative. The letter was also signed by the resident's responsible party on 3/17/2012. There was no reason for discharge listed on the denial letter. An interview was conducted with the business office representative (facility employee # 4) on 8/15/2012, at 10:00 AM. The business office manager voiced that she is unsure why the Notice of Medicare Non-Coverage (… | 2016-12-01 |
| 8037 | 8037 | BISHOP JOSEPH HODGES CONTINUOUS CARE CENTER | 515055 | 600 MEDICAL PARK | WHEELING | WV | 26003 | 2012-08-22 | 156 | B | 0 | 1 | 8KXK11 | Based on record review and staff interview, the facility failed to identify the services being discontinued and/or the reason for the action on the liability notices. This affected three (3) of three (3) sampled residents who had Medicare covered services discontinued. Resident identifiers: #228, #21, and #215. Facility census: 127. Findings include: Residents #228, #21, and #215 A review of the Notice of Medicare Provider Non-Coverage document, which was provided to the residents and/or their responsible parties, found the following verbiage: THE EFFECTIVE DATE COVERAGE OF YOUR CURRENT SKILLED SERVICES WILL END: (followed by the date) The document did not, in a language the resident could understand, identify the service that was being discontinued, nor did it explain why the service was being discontinued. The resident was being asked to decide whether to make an appeal of the decision without this information. During an interview with the Social Worker on the skilled unit, at 11:00 a.m. on 08/22/12, it was revealed that Residents #228 and #21 had met their goals and were either discharged to home or another health care facility. During an interview with the Administrator and the Director of Nurses, at 11:30 a.m. on 08/22/12, the Administrator acknowledged that the name of the service and reason for discontinuing it were not being added to the form, although it was a CMS approved form. | 2016-10-01 |
| 8049 | 8049 | MAPLESHIRE NURSING AND REHABILITATION CENTER | 515058 | 30 MON GENERAL DRIVE | MORGANTOWN | WV | 26505 | 2012-06-06 | 156 | C | 0 | 1 | RKJW11 | Based on observation and staff interview, the facility failed to prominently display the required written information on how to apply for Medicare and Medicaid. This had the potential to affect all facility residents. Facility census: 87. Findings include: a) On 05/29/12 at 2:20 p.m., a tour of the facility revealed no prominently displayed written information on how to apply for Medicare and Medicaid. In an interview with the administrator and social worker (Employee #24) at that time, they agreed there was no posting of the information on how to apply for Medicare and Medicaid in the building. Employee #24 stated she was not aware this was a requirement. | 2016-10-01 |
| 8094 | 8094 | LEWISBURG CENTER | 515144 | 979 ROCKY HL | RONCEVERTE | WV | 24970 | 2012-06-21 | 156 | E | 0 | 1 | URTG11 | Based on a review of liability notices and beneficiary appeal rights, and staff interview, the facility failed to ensure four (4) of four (4) residents who were cut from Medicare Part A skilled services, received the appropriate information regarding their discharge. Resident identifiers: #119, #117, #36, and #126. Facility census: 87. Findings include: a) Residents #119, #126, and #36 On 06/21/12, at approximately 8:30 a.m., the admission director (Employee #40) provided a list of resident's who were discharged from a Medicare Part A skilled service within the past seven (7) months. Resident #119 discharged from a skilled nursing service on 05/17/12. Resident #126 was discharged from a skilled nursing service on 01/11/12. Resident #36 was discharged from a skilled service on 05/04/12. The facility provided the residents with the Notice of Medicare Non-Coverage (CMS - ). The form did not explain to the residents the reason for the discontinuation of the skilled service. Employee #40 indicated the skilled services ended because all three (3) residents were discharged from the facility to a private residence. According to the Center for Medicare Services (CMS), the facility has no obligation to provide the resident with a notice if they discharge home. The resident, and not the facility made the decision to terminate services. The facility should not issue the Notice of Medicare Non-Coverage when the resident discharges to home. b) Resident #117 Resident #117 was discharged from Medicare Part A services on 11/25/11. Employee #40 indicated the resident had exhausted her Medicare Part A benefit days. The facility provided the resident with the Notice of Medicare Non-Coverage (CMS ). According to CMS, the facility should not issue the Notice of Medicare Non-Coverage also known as the generic notice if the resident exhausted the Medicare covered days. The Medicare covered days are set in law and the Quality Improvement Organization (QIO) cannot extend the benefit period. c) On 06/21/12 at approximately 9:00 a.m., Emplo… | 2016-10-01 |
| 8102 | 8102 | MCDOWELL NURSING AND REHABILITATION CENTER, LLC | 515162 | ROUTE 103 VENUS ROAD | GARY | WV | 24836 | 2012-10-30 | 156 | C | 0 | 1 | QR3O11 | Based on observation and staff interview, it was determined the facility had not posted the correct addresses for the State survey agency and the Medicaid Fraud Unit. These addresses are to be posted for all residents and the public should an individual wish to contact one of the agencies. Census: 97. Findings include: a) Review of information posted in the hallways on first floor for residents and the public noted the wrong address was listed for the Office of Health Facility Licensure and Certification. This was verified with the administrator, Employee #107, and the social worker, Employee #61, on 10/24/12 at 9:30 a.m. b) Posting of advocacy groups - Medicaid Fraud Control Unit At 10:15 a.m. on 10/25/12, a poster containing the address and telephone number of the State Medicaid Fraud Control Unit was observed on the first floor beside the elevator. An interview with the administrator, on 10/25/12 at 10:30 a.m., confirmed the address of the State Medicaid Fraud Control Unit was incorrect. | 2016-10-01 |
| 8107 | 8107 | SUMMERS NURSING AND REHABILITATION CENTER LLC | 515170 | 198 JOHN COOK NURSING HOME ROAD | HINTON | WV | 25951 | 2012-10-11 | 156 | D | 0 | 1 | YXKJ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to provide appropriate liability and appeal notices to two residents (#'s 1 and 66) out of three residents discharged from skilled services. Findings include: -Resident #1 was admitted to the facility on [DATE], with [DIAGNOSES REDACTED]. Resident #1 was discharged from skilled services on [DATE], and remained in the facility with benefit days remaining until the resident expired on [DATE]. The facility was unable to provide evidence that the resident or responsible party had been provided the appropriate liability and appeal notices. Resident #66 was admitted to the facility on [DATE], with [DIAGNOSES REDACTED]. Resident #66 was discharged from skilled services on [DATE] and remained in the facility with benefit days remaining. The facility was unable to provide evidence that the resident or the responsible party had been provided the appropriate liability and appeal notices. An interview was conducted with licensed nursing staff #118 on [DATE]. Staff stated that she had not kept copies of the notice of medicare non-coverage letters that were provided to both residents and/or responsible parties prior to the cessation of their skilled services. Furthermore, staff was unaware that an additional denial letter or CMS- should have been provided once the residents remained in the facility with benefit days remaining after their last covered day. | 2016-10-01 |
| 8186 | 8186 | HUNTINGTON HEALTH AND REHABILITATION CENTER | 515007 | 1720 17TH STREET | HUNTINGTON | WV | 25701 | 2012-05-18 | 156 | B | 0 | 1 | 6XWO11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to provide appropriate liability notices to one (resident #277) out of four sampled residents reviewed for liability notices and beneficiary appeal rights. Findings Include: Resident #277 was admitted on [DATE], with [DIAGNOSES REDACTED]. Resident was notified by the facility that skilled nursing services would end on May 12, 2012. Notice of Medicare Non-Coverage (CMS Form ) was signed by the resident on May 10, 2012. Resident remained in the facility and was not discharged following the end of covered services. However, the resident was not issued the Skilled Nursing Facility Advance Beneficiary Notice (CMS Form ). An interview with employee #76 was conducted on May 16, 2012. Employee #76 stated that she issued the CMS Form and not the CMS Form . A subsequent interview was conducted with employee #76 on May 17, 2012. Employee #76 stated that she misunderstood the training she received regarding the requirements for issuing liability notices. | 2016-07-01 |
| 8198 | 8198 | HILLTOP CENTER | 515061 | PO BOX 125 | HILLTOP | WV | 25855 | 2012-05-22 | 156 | E | 0 | 1 | JXHC11 | Based on medical record review, staff interview, resident interview, and observation, the facility did not ensure written information was prominently displayed about how to apply for and use Medicaid benefits. The facility also failed to ensure one (1) of forty- six (46) residents had received information regarding how to contact the physician responsible for her care. In addition, the facility failed to ensure two (2) of five (5) residents received the appropriate liability notice after they were discharged from a Medicare Part A service. Resident identifiers: #45, #58, and #114. Facility census: 115. Findings include: a) On 05/15/12, at approximately 9:00 a.m., an observation of the facility revealed they had not posted the necessary information regarding how to apply for and use Medicaid benefits. On 05/16/12, at approximately 9:00 a.m., the administrator (Employee #43) agreed the facility had not posted this information. She indicated the facility had previously posted the information, but people kept taking it down. b) Resident #114 On 05/15/12, at approximately 4:00 p.m., the director of admissions (Employee #68) indicated she gave the residents the consent for treatment and release of information form at the time of admission. Review of Resident #114's medical record, conducted on 05/15/12, at approximately 4:30 p.m., found the consent for treatment and release of information form. The form did list the resident's physician; however, the form did not have contact information listed for the physician. The form had a place to list the physician's telephone number and physician's address, but this information had not been provided on the form. In an interview on 05/22/12, at approximately 8:45 a.m., Resident #114 indicated she did not know how to contact her physician. On 05/22/12, at approximately 5:00 p.m., the director of nursing (Employee #2) asked what type of contact information the facility needed to give the residents regarding how to contact their physician. The director of nursing agreed that the re… | 2016-07-01 |
| 8286 | 8286 | COLUMBIA ST. FRANCIS HOSPITAL | 515110 | 333 LAIDLEY STREET | CHARLESTON | WV | 25322 | 2013-02-01 | 156 | E | 0 | 1 | BSMW11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record reviews and staff interviews, the facility failed to post information for residents on how to apply for Medicaid and Medicare, and failed to post the correct address for the Office of Health Facility Licensure and Certification (OHFLAC). Findings a) On 01/29/13 at 2:30 p.m., an interview was completed with Employee #7, the Activities Coordinator, who stated that she was responsible for the required postings on the bulletin board. Employee #7 was shown there were no postings providing written information about how to apply for and use Medicaid or Medicare benefits. It was also brought to her attention that the address for OHFLAC was incorrect and the correct address was under state health department.' OHFLAC is not the state health department. b) A review was completed on 01/30/13 at 8:30 a.m. of the facility's Skilled Nursing Unit Determination of Continued Stay/Notice of Discharge. There was a sample of three (3) residents who had received these notices. Review of their discharge plans were completed on 01/30/13 at 9:00 a.m 1) Resident #127 The notice for Resident #127 was signed and dated on 11/19/12. Resident #127 was also discharged and the services ended on 11/19/12. The resident was not given the required two (2) days notice of discharge. 2) Resident #86 The resident signed her notice on 09/17/12. Which was on the same day her services ended and she was discharged . This resident was not given the required two (2) days notice of discharge. 3) Resident #84 Resident #84, signed his notice on 08/30/12. His services were also ended and he was discharged on [DATE]. This resident was not given the required two (2) days notice of discharge. c) Employee #14 (the admissions nurse) was interviewed on 01/30/13 at 1:30 p.m. The liability notices for the three (3) residents were shown to her. She stated to her knowledge, these notices were given to the residents on the day of their discharge. She was asked how the facili… | 2016-07-01 |
| 8370 | 8370 | WELCH COMMUNITY HOSPITAL | 51A009 | 454 MCDOWELL STREET | WELCH | WV | 24801 | 2012-11-29 | 156 | C | 0 | 1 | X70T11 | Based on observation of posted information and staff interview, it was discovered the facility did not have the current address for the (state agency) Office of Health Facility Licensure and Certification (OHFLAC) posted as required. This practice had the potential to affect all residents and the public, who are to have access to this information. Facility census: 48. Findings include: a) While observing posted information on 11/28/12, at mid morning, it was discovered the address posted for OHFLAC was incorrect. The address listed was not the address for this agency, and had not been for more than a year. This was discussed and confirmed with the director of nursing, Employee #127, and the social worker, Employee #292, at the time of the review. | 2016-07-01 |
| 8522 | 8522 | HARPER MILLS | 515086 | 100 HEARTLAND DRIVE | BECKLEY | WV | 25801 | 2013-05-30 | 156 | D | 1 | 0 | 6GZU11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility failed to provide information upon admission to a resident to ensure the resident had knowledge of his/her rights, and information related to the responsibilities of the facility. During a random review of the medical record for Resident #67, it was discovered the resident was admitted to the facility on [DATE], but did not receive or sign information in the admission packet until ten (10) days after her admission to the facility. Resident identifiers: #67. Facility census: 137. Findings include: a) Resident #67 During a review of the medical record for Resident #67, on 05/29/13 at 12:45 p.m., it was discovered the resident was admitted to the facility on [DATE]. Further review identified the resident did not receive information provided in the facility's admission packet until 05/24/13 - two (2) weeks after admission. The facility's admission packet included the following information provided to each resident upon admission to the facility. I. Rights and Responsibilities of the patient. 1.01 Room and Board Rate 1.02 Ancillary Charges 1.02 a. Transportation 1.03 Collection/Late payments 1.04 Independent Providers 1.05 Governmental Programs 1.06 Third party payors and managed care organizations 1.07 Private pay patient 1.08 Admission information 1.09 Application for Benefits 1.10 Primary Reasonability for Payment 1.11 Personal Physician 1.12 Pharmacy II. Rights and Responsibility of the Responsible party. 2.01 Legal Authority 2.02 Agreement to make payments on behalf of patient 2.03 Exhaustion of Patient's Funds 2.04 Cooperation for Financial Assistance 2.05 Actions Upon Discharge 2.06 Additional Responsibilities III. Rights and Responsibility of the Center 3.01 Room and Standard Services 3.02 Other services 3.30 Deposit 3.04 Refunds IV. General Provisions 4.01 Consent to Release Information 4.02 Consent to Treat (signed on 05/10/13) 4.03 Consent to Photographs 4.04 Notice of Services, P… | 2016-05-01 |
| 8527 | 8527 | CEDAR RIDGE CENTER | 515087 | 302 CEDAR RIDGE ROAD | SISSONVILLE | WV | 25320 | 2012-04-26 | 156 | E | 0 | 1 | JZJM11 | Based on observation and interview, the facility failed to post the names, addresses and telephone numbers of all pertinent client advocacy groups in a manner in which Residents can view them. The facility also failed to post contact numbers for the State Survey and Certification agency with a statement that a Resident may file a complaint in a manner that Residents can read them. This had the potential to affect any resident dependent on a wheel chair for ambulation. Findings include: a) Observations of the facility on 04/26/12, revealed a bulletin board located across from the social service office on the south side of the building. There was small poster board located on the top left hand side of the bulletin board. The poster board contained information concerning the State Survey and Certification agency and Medicaid and Medicare. The contact information for the agencies was small and difficult to read from a seated wheelchair position. Observations of the facility on 04/26/12, revealed a bulletin board located across from the south nurses' station. At the top right hand corner of the bulletin board was a small poster board which contained information about the Ombudsman including a contact number. The information was not easily accessible for residents. A nurse's treatment cart was located in front of the bulletin board preventing residents, staff and visitors from easily viewing the information. Observations of the facility on 04/26/12, revealed a bulletin board located across from the north nurses' station. There were no posted names, addresses and telephone numbers for pertinent client advocacy groups or contact numbers for the State Survey and Certification agency. During an interview with the facility Administrator, on 04/26/12 at 12:35 p.m., it was verified the required information of all State client advocacy groups was not easily accessible to all residents, staff, and visitors. | 2016-05-01 |
| 8641 | 8641 | GOLDEN LIVINGCENTER - RIVERSIDE | 515035 | 6500 MACCORKLE AVENUE SW | SAINT ALBANS | WV | 25177 | 2011-08-17 | 156 | C | 0 | 1 | 5VE911 | Based on observation and staff interview, the facility failed to post the current address of the State survey agency. This practice has the potential to affect all residents and members of the general, public since all are to have access to this information. Facility census: 89. Findings include: a) On 08/09/11 at mid morning, observation of postings containing the contact information (addresses and telephone numbers) for various State client advocacy groups found the address for the State survey agency was not current. The agency had moved its office to a new location in July 2010, and the address in the posting had not been updated to reflect this change. This was brought to the attention of the facility's administrator (Employee #15) at the time. She verified the information was incorrect and had staff change the information to reflect the new address. | 2016-04-01 |
| 8660 | 8660 | TRINITY HEALTH CARE OF MINGO | 515069 | 100 HILLCREST DRIVE | WILLIAMSON | WV | 25661 | 2012-01-11 | 156 | C | 0 | 1 | 46GB11 | Based on interview and review of documentation, the facility was not using the correct Centers for Medicare and Medicaid Services (CMS) form when notifying residents of changes in the services being provided them under the plan. Residents are to be notified when they no longer are going to receive Medicare skilled services using form CMS . The facility was using a a form entitled C-4. This was evident for three (3) of three (3) residents whose records for denial of payment for services were reviewed. This practice had the potential to affect any resident who was discharged from Medicare services. Resident identifiers: #40, #26 and #70. Facility census: 76. Findings include: a) Residents #40, #26, and #70 Review of documentation given these residents, when they no longer qualified for Medicare services, revealed the facility was using a form entitled C-4. This was not the required form as specified by CMS. The form specified by CMS is form CMS . This is the form to be given at the time residents are no longer eligible for skilled services. Such reasons include: when a resident has used all their days, has reached his/her potential, and/or for any reasons, as set forth by CMS, in which Medicare services are discontinued. This was discussed, on 01/09/12 at mid-morning, with the business office manager(Employee #63) who was responsible for providing these notices. Employee #63 stated he was not aware of form CMS , and would begin using it immediately. | 2016-04-01 |
| 8691 | 8691 | ST. MARY'S HOSPITAL | 515113 | 2900 FIRST STREET | HUNTINGTON | WV | 25702 | 2012-03-22 | 156 | E | 0 | 1 | GA6A11 | Based on the liability notice and beneficiary appeal review and staff interview, the facility failed to ensure three (3) of three (3) residents who were discharged from a Medicare Part A skilled service received the appropriate notice. In addition, the facility did not ensure the residents were informed of the reason they were discharged from a skilled service. Resident identifiers: #5, #15, and #9. Facility census: 13. Findings include: a) Residents #5, #15, and #9 On 03/21/12, at approximately 3:00 p.m., the social worker (Employee #30) provided a copy of the notices that were given to three (3) residents who were discharged from a skilled service. Resident #5 received the notice of Medicare Provider Non-Coverage (CMS ) on 10/18/11. The form did not state why the facility had discharged the resident from the skilled service. According to the social worker the resident had reached her maximum potential in therapy. She was discharged from the facility on 10/19/11. Resident #15 received the notice of Medicare Provider Non-Coverage (CMS ) on 11/29/11. He was discharged from the facility on 12/02/11. The notice did not contain the reason the resident was discharged from the skilled service. According to the social worker this resident had reached his maximum potential in therapy. Resident #9 received the notice of Medicare Provider Non-Coverage (CMS ) on 10/28/11. She was discharged from the facility on 10/29/11. The notice did not contain the reason why the resident was discharged from the skilled service. According to the social worker this resident had reached her maximum potential in therapy. According to the Center for Medicare and Medicaid Services Survey and Certification letter (S&C-09-20) the facility has the obligation to not only issue the CMS- , but also the SNFABN (skilled nursing facility advanced beneficiary notice) or a denial letter to address liability for payment. The SNFABN is given because benefit days remain to inform the patient of potential financial liability. The generic notice (CMS ) is gi… | 2016-04-01 |
| 8698 | 8698 | MEADOWBROOK ACRES | 515134 | 2149 GREENBRIER STREET | CHARLESTON | WV | 25311 | 2011-11-03 | 156 | C | 0 | 1 | S3DJ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and staff interview, the facility failed to prominently display in the facility, written information about how to apply for and use Medicare and Medicaid benefits, and how to receive refunds for previous payments covered by such benefits. The information could not be located in the area of the facility to which residents and visitors members were directed on the facility's information board. This practice had the potential to affect all residents and visitors wishing to review this information. Facility census: 57. Findings include: a) Upon initial entrance to the facility on [DATE] at approximately 10:45 a.m., a notice was observed in the entrance hallway on a board with other mandatory posting, stating survey results and information related to applying for Medicaid and Medicare could be found in the white binder in the front lobby. Employee #59 (front office personnel), when questioned, confirmed the front lobby was considered to be an area by the front door where two (2) chairs and a table were located. This area was searched, and no white binder was located. Employee #59, when subsequently approached about the inability of the surveyor to locate the binder of information, confirmed it was not in the designated location. This employee further stated residents sometimes carried the notebook off. In approximately fifteen (15) minutes, Employee #59 returned and had located the white binder. The necessary information was included, as stated in the posting on the information board. | 2016-04-01 |
| 8755 | 8755 | GUARDIAN ELDER CARE AT WHEELING, LLC | 515002 | 20 HOMESTEAD AVENUE | WHEELING | WV | 26003 | 2012-01-11 | 156 | D | 0 | 1 | K0ZK11 | Based on record review and staff interview, the facility failed to identify the services being discontinued, and / or the reason for the action, on the liability notices provided to three (3) of three (3) sampled residents who had Medicare covered services discontinued. Resident identifiers: # 22, #26, and #42. Facility census 141. Findings include: a) Residents #22, #26, and #42 A review of the Notice of Medicare Provider Non-Coverage document which was provided to the residents and / or their responsible parties included the following verbiage: THE EFFECTIVE DATE COVERAGE OF YOUR CURRENT SKILLED SERVICES WILL END: SEPTEMBER 27, 2011 The document did not, in a language the resident could understand, identify which service was being discontinued and explain why the service was being discontinued. The resident was being asked to make an appeal decision without this information. During an interview with the administrator and the corporate clinical consultant, at 9:00 a.m. on 01/10/12, the administrator stated that she was sure this was a CMS approved form. When the form being used was reviewed, they nodded in agreement that the name of the service and reason for discontinuing it could be written in under Additional information. | 2016-03-01 |
| 8767 | 8767 | ELKINS REGIONAL CONVALESCENT CENTER | 515025 | 1175 BEVERLY PIKE | ELKINS | WV | 26241 | 2012-05-03 | 156 | C | 0 | 1 | 2ZMR11 | Based on observation and staff interview, the facility failed to ensure written information regarding how residents could apply for and use Medicare and Medicaid benefits, and how to receive refunds for previous payments covered by such benefits, was prominently displayed. This had the potential to affect more than an isolated number of residents. Facility census: 101. Findings include: a) On 05/03/12, at approximately 9:00 a.m., a tour of the facility revealed no information was displayed regarding how residents could apply for and use Medicare and Medicaid benefits, and how to receive refunds for previous payments covered by such benefits. The administrator (Employee #23), who accompanied the tour of the facility, agreed there were no postings regarding how to apply for and use these benefits, or to receive refunds. | 2016-03-01 |
| 8827 | 8827 | SALEM CENTER | 515071 | 255 SUNBRIDGE DRIVE | SALEM | WV | 26426 | 2011-08-31 | 156 | C | 0 | 1 | 5Y7411 | Based on observation and staff interview, the facility failed to prominently display, for residents and applicants, written information about how to apply for and use Medicare and Medicaid benefits and how to receive refunds for previous payments covered by such benefits. This deficient practice had the potential to affect all residents and families desiring to view this information. Facility census: 100. Findings include: a) Observations of the facility, on 08/30/11, failed to find any prominent postings of information about how to apply for and use Medicare and Medicaid benefits and how to receive refunds for previous payments covered by such benefits. The activity director (Employee #23) and the interim administrator (Employee #119) were unable to locate the posting when asked at 11:35 a.m. on 08/30/11. Employee #23 stated the information had been posted at one time but someone must have taken it down. | 2016-03-01 |
| 8896 | 8896 | WAYNE NURSING AND REHABILITATION CENTER, LLC | 515168 | 6999 ROUTE 152 | WAYNE | WV | 25570 | 2012-03-29 | 156 | D | 0 | 1 | EEP611 | Based on the liability notice and beneficiary appeal rights review and staff interview, the facility failed to issue the correct notice to one (1) of five (5) residents discharged from a skilled service due to exhausting all Medicare Part A benefits. Resident identifier: #65. Facility census: 60. Findings include: a) Resident #65 On 03/28/12, at approximately 11:00 a.m., Employee #69, the registered nurse assessment coordinator (RNAC), provided copies of the liability notice letters given to five (5) residents who were discharged from a skilled service within the last six (6) months. Resident #65 was discharged from a skilled service (therapy) on 12/25/11. The facility failed to send the appropriate liability notice to the resident's representative. The facility issued the CMS - (Notice of Medicare Provider Non-Coverage). The facility did not issue the NEMB (Notice of Exclusion from Medicare Benefits) (CMS ). In cases where a resident terminates Medicare Part A due to exhausting the 100 day benefits and remains in the facility under another payer source, the NEMB-SNF is issued for technical details. Resident #65 remained in the facility with Medicaid as primary payer source. On 03/28/12 at 2:20 p.m., Employee #69 indicated she had not sent the NEMB-SNF notice to Resident #65's representative. | 2016-03-01 |
| 8914 | 8914 | JACKIE WITHROW HOSPITAL | 5.1e+110 | 105 SOUTH EISENHOWER DRIVE | BECKLEY | WV | 25801 | 2011-12-08 | 156 | C | 0 | 1 | NP7N11 | Based on observation and staff interview, the facility failed to ensure they had prominently displayed written information about how to apply for and use Medicare and Medicaid benefits. The facility did not display information regarding how to apply for and use Medicare and Medicaid benefits on one (1) of three (3) units. This practice had the potential to affect all residents of that unit. Facility census: 90. Findings include: a) During a tour of the facility, on 12/07/11, at approximately 4:30 p.m., the postings of written information regarding how to apply for and use Medicare and Medicaid benefits were located on the second and third floor units. However, the first floor unit did not have this information posted. On 12/07/11, at approximately 4:45 p.m., the administrator (Employee #10) and the director of social services (Employee #100) both verified the first floor unit did not contain this information. | 2016-03-01 |
| 8938 | 8938 | BRIDGEPORT HEALTH CARE CENTER | 5.1e+153 | 1081 MAPLEWOOD DRIVE | BRIDGEPORT | WV | 26330 | 2012-09-27 | 156 | C | 0 | 1 | R8A111 | Based on observation and staff interview, the facility failed to prominently display how to apply for Medicare and Medicaid. Furthermore, the facility failed to post current contact information for the regional Ombudsman and State survey and certification agency. This practice had the potential to affect all residents residing in the facility. Facility census: 50. Findings include: a) On 09/19/12 at 4:47 p.m., a tour of the facility was conducted with the administrator. During the tour, no information was found posted regarding how residents could apply for Medicare and Medicaid. The administrator agreed this information was not posted. Also, the poster containing resident rights did not have the current address and phone number for the survey and certification agency or the name, address and phone number for the regional ombudsman. The administrator stated she would contact the social worker about this posting to see why this was an old posting. At 5:15 p.m., the social worker stated the correct posting had fallen off the wall and broke the glass. The social worker further stated the old posting had been put in its place until the frame was repaired. | 2016-03-01 |
| 9034 | 9034 | DUNBAR CENTER | 515066 | 501 CALDWELL LANE | DUNBAR | WV | 25064 | 2013-03-14 | 156 | C | 0 | 1 | RKHC11 | Based on observation and staff interview, the facility failed to display instructions about how to apply for Medicare and Medicaid. Additionally, the address for reporting Medicaid fraud was incorrect. This had the potential to affect all residents residing in the facility. Facility census: 113. Findings include: a) On 03/11/13 at 2:00 p.m., a random tour of the building, with the nursing home administrator (NHA), revealed no evidence of prominently displayed information about how to apply for and use Medicare and Medicaid benefits. The NHA agreed this information was not displayed, and stated she was unaware of this. b) On 03/07/13 at 10:23 a.m., another observation of posted information revealed the address for reporting Medicaid fraud was incorrect. The posting contained an outdated address. On 03/11/13 at 2:00 p.m., this was brought to the attention of the NHA. She agreed the address was not correct, and stated she would immediately correct the address. | 2016-02-01 |
| 9116 | 9116 | MAPLES NURSING HOME | 515186 | 1600 BLAND STREET | BLUEFIELD | WV | 24701 | 2011-09-22 | 156 | E | 0 | 1 | REFP12 | Deficiency Text Not Available | 2016-02-01 |
| 9187 | 9187 | PLEASANT VALLEY NSG. & REHAB C | 515064 | 1200 SAND HILL ROAD | POINT PLEASANT | WV | 25550 | 2011-09-21 | 156 | B | 0 | 1 | 2WLP11 | Based on review of beneficiary liability notices and staff interview, the facility failed to complete the liability notices in accordance with CMS instructions. The facility was not documenting the reasons why Medicare-covered services were being discontinued and/or specific information regarding the delivery of the notices themselves. This was evident for three (3) of three (3) discharged residents whose beneficiary liability notices were reviewed. Resident identifiers: #147, #48, and #104. Facility census: 94. Findings include: a) Resident #147 Review of Resident #147's Notice of Medicare Provider Non-Coverage form found it did not contain any information regarding the reason the Medicare-covered services were being discontinued. The notice recorded the date the service was ending (05/08/11), and there was a note stating: Wife was notified by phone on 5-8-11. -- b) Resident #48 Review of Resident #48's Notice of Medicare Provider Non-Coverage form indicated the Medicare-covered services would end on 07/17/11. The notice also stated staff notified son (POA) (power of attorney) by phone on 7-17-11. -- c) Resident #104 Review of Resident #104's Notice of Medicare Provider Non-Coverage form found the Medicare-covered services were to be discontinued on 05/10/11. The only other notation was: Wife notified by phone 5-10-11. -- d) According to instructions from the Centers for Medicare & Medicaid Services (CMS), when completing the Generic Notice CMS- form, the facility is to insert the kind of services being terminated, such as skilled nursing, home health, hospice or comprehensive outpatient rehab. This information was not recorded on any of the forms reviewed. The instructions further stated that, if the provider is unable to personally deliver a notice of non-coverage to a person legally acting on behalf of a beneficiary, then the provider should telephone the representative to advise him or her when the beneficiary's services are no longer covered as follows: - The beneficiary's appeal rights must be explained to… | 2016-01-01 |
| 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 |
| 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 |
| 9274 | 9274 | MONTGOMERY GEN. ELDERLY CARE | 515152 | 501 ADAMS STREET | MONTGOMERY | WV | 25136 | 2011-11-04 | 156 | C | 0 | 1 | PGFX11 | Based on observation and staff interview, the facility failed to publicly post the contact information for the State survey and certification agency. This has the potential to affect all residents and visitors who may wish to have access to this information. Facility census: 55. Findings include: a) During the initial tour of the facility beginning at 8:30 a.m. on 11/01/11 and subsequent observations over the course of this survey event until 11/04/11, no posting of the telephone number and address of the State survey and certification agency could be found. On 11/04/11 at 12:30 p.m., this issue was brought to the attention of the administrator. At that time, this surveyor and administrator reviewed all publicly posted addressed and telephone numbers for pertinent State client advocacy groups, and the administrator verified that no contact information was posted for the survey agency. | 2016-01-01 |
| 9287 | 9287 | WEBSTER NURSING AND REHABILITATION CENTER, LLC | 515165 | ERBACON ROAD, PO BOX 989 | COWEN | WV | 26206 | 2012-03-09 | 156 | C | 0 | 1 | LL6H11 | I. Based on the liability notice and beneficiary appeal review and staff interview, the facility failed to ensure three (3) of three (3) residents selected for review had received the appropriate notice when there was a termination of Medicare Part A services. Resident identifiers: #27, #28, and #64. Facility census: 55. Findings include: a) On 03/08/12, at approximately 10:00 a.m., the liability notice and beneficiary appeal review revealed three (3) of three (3) residents discharged from a Medicare Part A skilled service in the past six (6) months did not receive the appropriate notice when there was a termination of Medicare Part A services. Resident #27 received the notice of Medicare provider non-coverage (CMS - - Generic Expedited Determination Notice Fee For Service Beneficiary) on 01/17/12. At that point the facility felt Medicare probably would not continue to pay for her therapy due to her plateau in therapy progress. The facility did not provide the resident / responsible party with the SNFABN (Skilled Nursing Facility Advanced Beneficiary Notice - CMS - ). This resident / responsible party should have received this notice to inform the resident of potential financial liability since the resident still had benefit days. Resident #28 received the notice of Medicare provider non-coverage (CMS - - Generic Expedited Determination Notice) on 01/05/11. At that time the facility determined the resident no longer met the criteria for skilled nursing services. The resident / responsible party should have also received the SNFABN (CMS - ). Resident #64 received the notice of Medicare provide non-coverage (CMS - ) on 01/04/12. At that time the resident had used all of her available Medicare Part A days. The facility did not send the Notice of Exclusions from Medicare Benefits Skilled Nursing Facility (CMS - - NEMB - SNF). This notice should have been provided for technical details. The facility did not need to send the generic notice (CMS - ) because the resident had exhausted Medicare Part A benefits. On 03/08/1… | 2016-01-01 |
| 9302 | 9302 | MILETREE CENTER | 515182 | 825 SUMMIT STREET | SPENCER | WV | 25276 | 2011-10-20 | 156 | C | 0 | 1 | EWP711 | Based on observation and staff interview, the facility failed to prominently display required information related to how to apply for and use Medicare and Medicaid benefits, and how to receive refunds for previous payments covered by such benefits. This practice has the potential to affect all residents and visitors desiring to view this information. Facility census: 59. Findings include: a) During the initial tour of the facility at the onset of the survey on 10/17/11, this surveyor attempted to view the posting of the required information. The entire facility was toured, and there was no evidence of any posting containing information on how to apply for Medicare and Medicaid benefits. This observation was immediately reported to the administrator (Employee #1) on 10/17/11, who confirmed the information was not posted prominently. | 2016-01-01 |
| 9349 | 9349 | SUMMERSVILLE REGIONAL MEDICAL CENTER D/P | 515029 | 400 FAIRVIEW HEIGHTS ROAD | SUMMERSVILLE | WV | 26651 | 2011-10-04 | 156 | C | 0 | 1 | 4F0I11 | Based on observation and staff interview, the facility failed to prominently display in the facility written information about how to apply for and use Medicare benefits and how to receive refunds for previous payments covered by Medicare benefits. This deficient practice had the potential to affect any resident or family member wishing to view the information. Facility census: 51. Findings include: a) On the morning of 09/29/11, observation revealed a bulletin board in the main corridor leading to the kitchen area. The bulletin board contained information on how to apply and use Medicaid benefits and how to receive refunds for previous payments covered by Medicaid, but it failed to contain the same information pertaining to Medicare benefits. On 09/29/11 at 9:20 a.m., the above deficient practice was discussed with the director of nursing, who stated the situation would be corrected. | 2015-11-01 |
| 9363 | 9363 | GOLDEN LIVINGCENTER - MORGANTOWN | 515049 | 1379 VAN VOORHIS RD | MORGANTOWN | WV | 26505 | 2010-02-25 | 156 | D | 0 | 1 | 2RPR11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility failed to inform the responsible parties of two (2) of thirty-two (32) Stage II sampled residents when Medicare-covered skilled treatments were discontinued and/or the reason(s) for the services being discontinued. Resident identifiers: #102 and #63. Facility census: 87. Findings include: a) Resident #102 A review of the medical record revealed that resident #102, who was admitted on [DATE], had received therapy services from 10/19/09 through 11/28/09. Althought the responsible party was notified by letter that the resident's Medicare Part A benefit days had exhausted on 11/28/09, there was no evidence in the medical record to show that the responsible party had been notified which services had been discontinued and no medical reason was given for the stoppage. The physical therapy (PT) notes written on 11/18/09, state: d/c (discontinue) PT - all goals met, and the occupational therapy (OT) notes written on 11/26/09, stated that the goals were partially met; but, neither indicated that this had been discussed with the family. The nurses notes from 11/24/09 - 12/03/09 were reviewed without any evidence of discussion with resident and/or family regarding the changes in the resident's care. During an interview with the director of nursing and the assistant director of nursing at 2:00 p.m. on 02/24/10, they stated that they could find no documentation that an explanation of which services were being discontinued and the reason for this had been given to the family, although they stated that they were sure it had been done. b) Resident #63 A review of the medical record revealed that resident #63, who was admitted on [DATE], received physical therapy (PT) and occupational therapy (OT) services from 09/15/09 - 12/21/09. A review of the nurses notes from 12/15/09 - 01/06/10 and of the PT and OT discharge notes failed to reveal any evidence that the resident and/or family had been notified of w… | 2015-11-01 |
| 9400 | 9400 | RIVER OAKS | 515120 | 100 PARKWAY DRIVE | CLARKSBURG | WV | 26301 | 2010-04-08 | 156 | B | 0 | 1 | 85AT11 | Based on record review and staff interview, the facility failed to assure one (1) of one (1) applicable resident / responsible party was informed of the right to request a demand bill when the resident's Medicare-covered services were discontinued by the facility. This practice had the potential to affect any resident who was discontinued from Medicare-covered skilled services. Resident identifier: #60. Facility census: 97. Findings include: a) Resident #60 On 04/07/10 at 3:30 p.m., a review was conducted, with the facility's business office manager, of residents whose Medicare-covered skilled services had been discontinued by the facility. Three (3) of four (4) residents reviewed had met their rehabilitation potential and were discharged home. One (1) resident (Resident #60) was discontinued from Medicare-covered services but remained in the facility. He had not exhausted his allowable one hundred (100) Medicare days, but facility staff believed he had met his rehabilitation potential. Because of this, he should have been offered the opportunity to request a demand bill. Review of the notice provided to the resident revealed the form did not contain an option for the resident / responsible party to request a demand bill. There was a space to indicate no regarding submission of a demand bill, but no space to indicate yes requesting the facility to submit a demand bill. In an interview conducted with the social worker (Employee #103) at 4:00 p.m. on 04/07/10, Employee #103 stated she had no idea how this situation had happened but confirmed the form did not contain the required information to allow a resident / responsible party to request the facility submit a demand bill in the resident's behalf. | 2015-11-01 |
| 9478 | 9478 | GREENBRIER MANOR | 515185 | ROUTE 2, BOX 159A | LEWISBURG | WV | 24901 | 2011-02-02 | 156 | D | 0 | 1 | SJCY11 | Based on medical record review, review of information provided to residents upon admission, and staff interview, the facility failed to inform one (1) of thirty-two (32) Stage II sample residents, both orally and in writing, of all the rules and regulations governing resident conduct and responsibilities during the stay in the facility. There was no evidence and/or acknowledgement in writing the resident was notified of the facility's smoking policy prior to or upon admission to the facility. Resident identifier: #109. Facility census: 84. Findings include: a) Resident #109 Closed record review, on 01/26/11, revealed this resident was admitted from the hospital to the facility for rehabilitation services on 12/16/10. The resident had been determined to possess the capacity to understand and make informed making health care decisions. Further review revealed the resident left the facility against medical advice (AMA) on 01/24/11. Interview with the director of nursing (DON - Employee #1), at 10:00 a.m. on 02/01/11, revealed the resident left AMA because he wanted to smoke and the facility was a non-smoking facility. Additional medical record review revealed no evidence the resident was informed, prior or at the time admission, that he would not be able to smoke at the facility. There was no discussion in the record that the resident had been informed of this rule, and there was nothing within the record which the resident had signed acknowledging his understanding of this facility rule. Review of the facility's admission contract revealed it did not contain information relative to the facility's smoke-free status. Additionally, the facility had no formal means of assuring residents were made aware of this facility policy prior to or upon admission. On 02/02/11 at 12:00 p.m., an interview was conducted with one (1) of the facility's social workers (Employee #51). Employee #51 confirmed the facility had not provided Resident #109 with written information regarding the facility's smoking policy. At that time, Employe… | 2015-11-01 |
| 9547 | 9547 | HARPER MILLS | 515086 | 100 HEARTLAND DRIVE | BECKLEY | WV | 25801 | 2009-11-20 | 156 | C | 0 | 1 | 5V2011 | Based on observation and staff interview, the facility failed to include the name, address, and telephone number of the State long-term care ombudsman together in its posting of information. This practice had the potential to affect all residents and visitors. Facility census: 157. Findings include: a) On 11/17/09, an observation of the facility's posting in the front lobby, which included names and addresses of individuals who could be contacted for questions related to long term care, revealed the facility had not listed the name of the State long term care (LTC) ombudsman. On 11/20/09 at 4:00 p.m., the administrator agreed the State ombudsman's name needed listed and agreed to change the posting to correct the issue. (NOTE: On 12/02/09, the administrator faxed to the State survey agency a copy of a posting titled Information Services located elsewhere in the facility. While it did contain the State LTC ombudsman's name and telephone number, it did not contain an address. Consequently, an individual who wanted the name, telephone number, and mailing address of the State LTC ombudsman would have had to locate and access both postings to obtain complete contact information.) | 2015-10-01 |
| 9568 | 9568 | TEAYS VALLEY CENTER | 515106 | 590 NORTH POPLAR FORK ROAD | HURRICANE | WV | 25526 | 2011-07-14 | 156 | C | 0 | 1 | L3JB11 | . Based on observation and staff interview, the facility failed to provide a posting of names, addresses and telephone numbers of all pertinent state client advocacy groups; failed to display a written statement informing residents of their right to file a complaint with the State survey and certification agency concerning abuse, neglect and misappropriation of property and non-compliance with advance directives; and failed to prominently display written information about how to apply for and use Medicare and Medicaid benefits. These practices had the potential to all residents and visitors. Facility census: 114. Findings include: a) On 07/14/11 at approximately 11:42 a.m., observations of the facility's hallways and lobby failed to find postings of necessary information, such as the names, addresses, and telephone numbers of all pertinent state client advocacy groups, a written statement informing residents of their right to file a complaint with the State survey and certification agency concerning abuse, neglect and misappropriation of property and non compliance with advance directives, and written information on how to apply for and use Medicare and Medicaid benefits. At approximately 12:00 p.m., the maintenance supervisor (Employee #89) accompanied the tour of the building and could not locate the signs and postings. He reported these signs were taken down due to the facility's remodeling project. At approximately 2:45 p.m., these signs were located, and the maintenance director said he would ensure they were displayed in the facility. | 2015-10-01 |
| 9652 | 9652 | ANSTED CENTER | 515133 | 106 TYREE STREET OPERATIONS, LLC /P.O DRAWER 400 | ANSTED | WV | 25812 | 2011-02-02 | 156 | C | 0 | 1 | 860Y11 | Based on observation and staff interview, the facility failed to ensure the names, addresses and phone numbers of advocacy groups remained posted and accessible at all times to residents and members of the general public. This practice had the potential to affect all residents. Facility census: 59. Findings include: a) Surveyors were unable to find the posted information related to advocacy groups as is required by regulation. Observations, made on 02/01/11, found a bulletin board where other information was located; however, there was no information regarding the names, addresses and phone numbers for all advocacy groups. The surveyor, on 02/01/11 at 10:36 a.m., then questioned the director of nursing (DON - Employee #15) and the administrator (Employee #25) as to where this information might be. After searching for the missing data, the administrator informed the surveyor that it had been found in a notebook that a confused resident (#61) had been given to put paperwork in. This resident had been known to remove posted items from bulletin boards, and staff would be unable to locate them. The facility provided her with a notebook, which would give staff some idea where to begin looking when things were missing. According to the administrator, this happened frequently, and staff would look once a week to see things were posted as necessary. If not, they would search the notebook. | 2015-10-01 |
| 9724 | 9724 | BRAXTON HEALTH CARE CENTER | 515180 | 859 DAYS DRIVE | SUTTON | WV | 26601 | 2010-10-06 | 156 | B | 0 | 1 | U9W011 | Based on observations and staff interviews, the facility failed to ensure the name of the State long-term care ombudsman was posted, and failed to ensure residents had ready access to information regarding Medicare and Medicaid. This had the potential to affect more than a limited number of residents. Facility census: 60. Findings include: a) State long-term care ombudsman On 10/05/10 at approximately 10:00 a.m., the posting of required information was reviewed as a part of the CMS- Environment observations, triggered by findings in Stage 1. The name of the State long term care ombudsman did not appear on any of the postings, just the address and telephone number. The posting requirement is: A posting of names, addresses, and telephone numbers of all pertinent State client advocacy groups such as the State survey and certification agency, the State licensure office, the State ombudsman program, . -- b) Medicare & Medicaid information On 10/05/10 at approximately 10:00 a.m., the Medicare information (a publication entitled Medicare at a Glance - from CMS) and Medicaid information (Your Guide to Medicaid - from WVDHHR) were observed posted in the entrance hall in a locked glass-covered display case. These contents of these multi-page documents would not be readily accessible to residents wishing to review them. This was discussed with the administrator and social worker during the mid-afternoon on 10/06/10. The administrator stated the social worker had copies and would provide / discuss them with residents / responsible parties and that the nurses had keys to the enclosed display case should a copy be needed. However, it was pointed out that the requirement was for the information to be posted. | 2015-10-01 |
| 9782 | 9782 | MADISON, THE | 515104 | 161 BAKERS RIDGE ROAD | MORGANTOWN | WV | 26508 | 2010-06-01 | 156 | C | 0 | 1 | 2XEX11 | . Based upon review of the notices of non-coverage for Medicare skilled services (denial notices) and staff interview, the facility failed to specify the service being denied and/or the reason for the denial in the letter provided by the facility to the resident and/or responsible party, when informing them of services that would no longer be covered under Medicare, for six (6) of (6) sampled notices. Resident identifiers: #97, #34, #16, #66, #161, and #96. Facility census: 57. Findings include: a) Residents #97, #34, #16, #66, #161, and #96 A review of the Notice of Medicare Non-Coverage letters, on 05/31/10, revealed that the only description of services paid for by Medicare that were no longer being covered, for Residents #97, #34, #16, #66, #161, and #96, was skilled nursing services, and none of the six (6) residents' denial notices provided any reason for the denial of Medicare coverage as required. During a discussion with the facility's administrator (Employee #63) on 05/31/10 at 2:00 p.m., she acknowledged the required information was not included. . | 2015-09-01 |
| 9880 | 9880 | TRINITY HEALTH CARE OF MINGO | 515069 | 100 HILLCREST DRIVE | WILLIAMSON | WV | 25661 | 2012-05-09 | 156 | C | 1 | 0 | SZNR11 | . Based on record review and staff interview, the facility failed to ensure three (3) of three (3) resident's received the appropriate discharge notice, as required by the Centers for Medicare and Medicaid Services (CMS), after they were discharged from a Medicare skilled service. Resident #22, Resident #72, and Resident #39 were all discharged from Medicare Part A skilled services in April 2012. The facility did not issue one (1) of two (2) notices at the time Medicare Part A services ended. Facility census: 77. Findings include: a) Resident #22 This resident was discharged from Medicare Part A, on 04/21/12, due to no further skilled services being available for her. b) Resident #72 This resident was discharged from Medicare Part A, on 04/15/12, due to no further skilled services being available for her. c) Resident #39 This resident was discharged from Medicare Part A, on 04/26/12, due to a completion of antibiotic therapy. d) An interview with Employee #10 (business office manager), on 05/09/12 at 1:00 p.m., revealed these three (3) residents had received the Notice of Non Coverage, CMS form ( ). The generic notice (form ) simply informs the resident of their right to an expedited review of the service termination for coverage reasons. The facility must issue the skilled nursing advanced beneficiary notice to address the resident's potential liability for payment if they remain in the facility. The residents had not received the Skilled Nursing Advanced Beneficiary Notice (SNFABN). According to the business office manager, all three (3) residents remained in the facility under another payer source. The facility needed to give the three (3) residents both notices because all Medicare covered services were ending and the center intended to deliver non-covered care. The SNFABN is given because benefit days remain to inform the resident of potential financial liability. . | 2015-08-01 |
| 10024 | 10024 | BARBOUR COUNTY GOOD SAMARITAN SOCIETY | 515116 | 216 SAMARITAN CIRCLE | BELINGTON | WV | 26250 | 2010-02-11 | 156 | D | 0 | 1 | 4T1611 | . Based on record review and staff interview, the facility failed to provide to written notification to one (1) of five (5) randomly reviewed residents, who had been discharged from Medicare-covered skilled services, when the skilled services were discontinued and the resident's payer status changed. Resident identifier: #7. Facility census: 50. Findings include: a) Resident #7 A review of facility records reveals Resident #7 was discharged from Medicare-covered skilled services on 10/11/09, but there was no evidence she received a liability notice to inform her of the reason for the discontinuation of skilled services. This was verified by the nurse case manager (Employee #9) at 3:10 p.m. on 02/09/10, who stated that, because the resident had exhausted her one hundred (100) skilled days, she did not receive an notice. A request was made to the nurse to supply evidence the resident or her responsible party had been notified of this change in payer status. During an interview with the director of nurses, Employee #9, and the administrator at 11:10 a.m. on 02/11/10, Employee #9 acknowledged, after reviewing the record, that she could not state the responsible party had been clearly notified of the change in Resident #9's payer status. . | 2015-07-01 |
| 10058 | 10058 | EAGLE POINTE | 515159 | 1600 27TH STREET | PARKERSBURG | WV | 26101 | 2012-01-19 | 156 | D | 0 | 1 | ZNLH11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** . I. Based on record review and staff interview the facility failed to show evidence that one (1) of the two (2) persons who had been appointed "dual" medical power of attorney (MPOA) by one (1) of forty-nine (49) Stage II sampled residents had been included in the admission process and / or had been involved in treatment decisions since admission to the facility. Resident identifier: #102. Facility census: 118. Findings include: a) Resident #102 Review of the medical record revealed Resident #102 was an [AGE] year-old female admitted on [DATE], with [DIAGNOSES REDACTED]. She was determined by her attending physician to lack the capacity to make informed healthcare decisions. On 06/14/05, prior to the decision of incapacity, she had appointed her son and daughter to act jointly as her medical power of attorney (MPOA). Review of the admission process revealed the resident's son had signed all admission documents, including the "Advance Directive Acknowledgement Form" which indicated the resident was to be DNR (Do Not Resuscitate) status. On 12/27/11, he was also the sole MPOA signing the permission for admission of the resident into the Alzheimer's unit of the facility. Review of social service notes failed to reveal any evidence the daughter, who was a dual MPOA, had been consulted about placement or care decisions. In addition, a review of the nurse's notes revealed on 01/10/12, when the resident's health status declined, only the son was notified about her transfer to an acute care hospital. In an interview, at 1:00 p.m. on 01/17/12, the Memory Care director / social worker, Employee #114, stated she "was sure that the daughter was agreeable to the resident being here." She acknowledged, after reviewing the record, there was no evidence of her (the MPOA) involvement in the admission process nor of her permission to have the son complete the admission process. At 2:00 p.m. on 01/18/12, Employee #114 presented documentation indicating contact… | 2015-07-01 |
| 10090 | 10090 | ARBORS AT FAIRMONT | 515189 | 130 KAUFMAN DRIVE | FAIRMONT | WV | 26554 | 2010-03-04 | 156 | E | 0 | 1 | FFCS11 | . Based on observation and staff interview, the facility failed to post the correct names, addresses, and telephone numbers of all pertinent State agencies. Incorrect contact information was posted for the State survey and certification agency and the local Medicaid office. This had the potential to affect any resident who might need to contact these agencies. Facility census: 112. Findings include: a) Observation of the posted contact information for pertinent State agencies, in the company of the administrator at 10:30 a.m. on 03/04/10, found the following: 1. The address of the State survey and certification agency was incorrect. 2. The address and telephone number of the local Medicaid office address were incorrect. The administrator confirmed these errors at the time of the observation. . | 2015-07-01 |
| 10137 | 10137 | HILLTOP CENTER | 515061 | PO BOX 125 | HILLTOP | WV | 25855 | 2010-01-14 | 156 | E | 0 | 1 | CSOG11 | Based on observation and staff interview, the facility failed to ensure the required posting regarding how to apply for Medicaid and Medicare benefits was prominently displayed for public viewing. This practice had the potential to affect more than an isolated number of residents. Facility census: 106. Findings include: a) On 01/14/10 at approximately 12:00 p.m., a tour of the facility revealed the postings for how to apply for Medicaid and Medicare benefits were not present anywhere in the facility. On 01/14/10 at approximately 2:00 p.m., the admissions director (Employee #80) agreed the postings were not where she had originally thought they were. She said visitors were removing them. Employee #80 stated she would arrange to have this information put back on the bulletin board for resident and public viewing. . | 2015-06-01 |
| 10192 | 10192 | WILLOW TREE MANOR | 515156 | 1263 SOUTH GEORGE STREET | CHARLES TOWN | WV | 25414 | 2010-01-28 | 156 | D | 0 | 1 | MFK411 | Based on record review, review of the denial notice letters, and staff interview, the facility failed to include the identification of the service being denied and/or the reason for the denial in the letter provided by the facility to the resident and/or responsible party, informing them of services not covered under Medicare for one (1) or eighteen (18) sampled and two (2) of three (3) random residents whose Medicare notification letters were reviewed; and/or failed to inform the responsibility party of rights related to the formulation of advance directives for one (1) of eighteen (18) sampled residents. Resident identifiers: #29, #41, #34, and #53. Facility census: 100. Findings include: a) Resident #29 A review of the medical record revealed that, upon admission to the nursing home on 06/02/08, Resident #29 had been determined by a physician to have the capacity to make healthcare decisions, and Resident #29 expressed a desire for a "Do Not Resuscitate" (DNR) order. Since this admission, he lost the capacity to make his own healthcare decision. As of 12/30/08, his physician appointed a health care surrogate (HCS) to make these decisions on his behalf, in accordance with his known wishes as required by State law. Further review, however, found no evidence to reflect the facility fully informed the HCS of the resident's DNR decision. During an interview with the social worker at 1:45 p.m. on 01/27/10, she acknowledged she had not discussed the resident's code status with the HCS, but she stated she would do this as soon as possible. b) Residents #41, #34, and #53 A review of the Medicare denial letters for the aforementioned residents revealed the facility failed to indicate which skilled service was being discontinued and the reason(s) for this non-coverage. When this was discussed with the administrator at 9:30 a.m. on 01/27/10, he agreed this information was not present. A follow-up interview with a nurse (Employee #27) confirmed this information was not being included in the denial notices at present, as sh… | 2015-06-01 |
| 10409 | 10409 | HIDDEN VALLEY CENTER | 515147 | 422 23RD STREET | OAK HILL | WV | 25901 | 2009-08-27 | 156 | B | 0 | 1 | Y5MX11 | Based on observation and staff interview, the facility failed to prominently display written information on how to apply for and use Medicare and Medicaid benefits. The facility also failed to include information on how residents / families could receive refunds for previous payments covered by Medicare and Medicaid benefits. This practice has the potential to affect more than an isolated number of residents at the facility. Facility census: 76. Findings include: a) On 08/27/09 at approximately 11:00 a.m., a tour of the facility revealed no posting describing how residents and their families could make application for and use Medicaid or Medicare benefits. The facility had information posted regarding how to file complaints and also advocacy information such as the name / address of the ombudsman; however, Medicare / Medicaid information was not on display. At approximately 11:30 a.m., the administrator agreed this information was not posted. He then made arrangements to have it posted for public display in the facility's main hallway. . | 2015-04-01 |
| 10452 | 10452 | HERITAGE CENTER | 515060 | 101-13TH STREET | HUNTINGTON | WV | 25701 | 2009-08-13 | 156 | B | 0 | 1 | 924C11 | Based on observation and staff interview, the facility failed to post contact information for all pertinent State client advocacy groups in a location accessible to all residents. This practice has the potential to affect more than an isolated number of residents who could benefit from this information. Facility census: 153. Findings include: a) Observation, on the morning of 08/13/09, found the names, addresses, and telephone numbers for State advocacy groups were posted on a bulletin board located between two (2) sets of double doors as one enters the facility. Many residents do not go near this location and would not easily access the information on these postings. When brought to the attention of the administrator on the early afternoon of 08/13/09, he verified the information would be more easily accessible at another location and stated he would move them to a new area which was frequented more often by residents. . | 2015-03-01 |
| 10570 | 10570 | HEARTLAND OF MARTINSBURG | 515039 | 209 CLOVER STREET | MARTINSBURG | WV | 25404 | 2009-10-29 | 156 | E | 0 | 1 | 0YSZ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility failed to fully inform residents both orally and in writing when changes will occur in their bills and/or of their appeal right to request that a bill be submitted to Medicare for three (3) random reviewed residents, and failed to clearly denote in the resident's clinical record the advance directive formulated by the resident for one (1) of twenty-three (23) sampled residents. Resident identifiers: #100, #118, #49, and #116. Facility census: 114. Findings include: a) Residents #100, #118, and #49 A review of the "Skilled Nursing Facility Determination" letters on file at the facility for Residents #100 (two (2) letters on file) and #118 failed to provide evidence that the resident or the resident's legal representative was informed of the discontinuance of a skilled service prior to the service being stopped, as the signatures of the resident and/or the legal representative were not dated, and on the letter dated 08/27/09 for Resident #100, there was no date for the non-coverage of services. None of the letters reviewed show evidence of the resident's or legal representative's decision to request a bill to be submitted to the intermediary for a Medicare decision, as that area of the letter was blank. During an interview with the administrator at 10:20 a.m. on 10/22/09, she acknowledged the letters were not completed per facility policy and the intent of the form. b) Resident #116 Review of the closed record for Resident #116 revealed a Physician order [REDACTED]. In an interview with the social worker (Employee #80) at 4:00 p.m. on 10/21/09, she agreed there was a potential for error made by the inconsistencies. . | 2015-01-01 |
| 10621 | 10621 | HILLCREST HEALTH CARE CENTER | 515117 | P.O. BOX 605 | DANVILLE | WV | 25053 | 2010-12-09 | 156 | D | 0 | 1 | GCMN11 | . Based on record review and staff interview, the facility failed, for one (1) of two (2) applicable residents / responsible parties, to provide notice of the right to request a demand bill when the resident's Medicare-covered services were discontinued by the facility. Resident identifier: #3. Facility census: 83. Findings include: a) Resident #3 During the morning of 12/08/10, records were reviewed for three (3) residents whose Medicare-covered services had been discontinued by the facility. At the same time, interviews were conducted with facility corporate office personnel who were assisting with bookkeeping responsibilities in the absence of the facility's bookkeeper. Record review revealed Resident #3's Medicare-covered services were discontinued on 09/16/10, because he had reached his maximum potential in occupational therapy services. The corporate persons were unable to locate evidence Resident #3 received a notice his Medicare services were discontinued, and no evidence the resident / responsibility party had been given the opportunity to request a demand bill. On 12/09/10, the facility's bookkeeper (Employee #18) searched her records for evidence that the appropriate notices had been given to Resident #3. During the morning of 12/09/10, Employee #18 reported the "cut letter" and opportunity to request a demand had not been provided this resident / responsible party. . | 2015-01-01 |
| 10688 | 10688 | JACKIE WITHROW HOSPITAL | 5.1e+110 | 105 SOUTH EISENHOWER DRIVE | BECKLEY | WV | 25801 | 2009-07-02 | 156 | C | 0 | 1 | DBCB11 | Based on observation and staff interview, the facility failed to post all complete contact information for all applicable State advocacy agencies as required by the regulation. Only the regional ombudsman's name and contact information were posted for public view. This has the potential to affect all residents as all residents and families are to have access to this information. Facility census: 81. Findings include: a) On 07/01/09 at 2:30 p.m., review of posted contact information of all pertinent State client advocacy groups, observed on the third floor of the facility, revealed only the name, address and telephone number of the regional ombudsman. Phone numbers were listed for other agencies, but not addresses. Discussions with the administrator, on the afternoon of 07/01/09 and again on the morning of 070/2/09, revealed the addresses and phone numbers of the other advocacy groups were not posted in any other locations of the facility as well. The following information was omitted from the public postings: - The contact information for the State survey and certification agency (which is also the State licensure office); - The contact information for the State long-term care ombudsman; - The contact information for the protection and advocacy network; - The contact information for the Medicaid fraud control unit; and - A statement that the resident may file a complaint with the State survey and certification agency concerning resident abuse, neglect, and misappropriation of resident property in the facility, and non-compliance with the advance directives requirements. . | 2015-01-01 |
| 10726 | 10726 | SUMMERSVILLE REGIONAL MEDICAL CENTER D/P | 515029 | 400 FAIRVIEW HEIGHTS ROAD | SUMMERSVILLE | WV | 26651 | 2010-10-20 | 156 | B | 0 | 1 | H9I611 | . Based on a review of the facility's Medicare demand bill records and staff interview, the facility failed to provide the appropriate beneficiary liability and appeal notices for three (3) of three (3) residents who had recently had their Medicare-covered services terminated. There was no evidence that the facility notified the beneficiary of his/her potential liability for payment and standard appeal rights. This practice affected Resident #40 and had the potential to effect more than an isolated number of residents who received Medicare-covered services. Facility census: 49. Findings include: a) Resident #40 Record review of residents who had received Medicare-covered services in the last three (3) months revealed one (1) demand bill had been requested. This was for Resident #40. The letter used to notify the resident / responsible party that services would no longer be covered by Medicare was a letter designed by the facility which did not contained all required elements found in Form CMS- or one (1) of the five (5) uniform denial letters found in the CMS Skilled Nursing Manual. The letter sent by the facility did not notify the legal representative of the beneficiary's potential liability for payment of the non-covered services. An interview with the staff member responsible for patient accounts (Employee #130) confirmed the facility was not utilizing the CMS forms to notify residents / responsible parties of Medicare non-coverage and of their right to request demand bills, which contained all of the required information for notification to the beneficiary. . | 2014-12-01 |
| 10833 | 10833 | MAPLES NURSING HOME | 515186 | 1600 BLAND STREET | BLUEFIELD | WV | 24701 | 2009-08-14 | 156 | C | 0 | 1 | L59911 | Based on observation and staff interview, the facility failed to post accurate information regarding the State licensure office. This practice had the potential to affect all facility residents. Facility census: 48. Findings include: a) Observation of facility postings, at 4:00 p.m. on 08/13/09, revealed the address for the Office of Health Facility Licensure and Certification (OHFLAC) was incorrect. Additionally the posting did not state that residents could file a complaint with OHFLAC, but stated that this was the agency to whom the residents should address "appeal rights". This was brought to the attention of the social worker (SW) at 4:05 p.m. on 0/13/09. The SW stated the posted information had just been revised and the wrong form must have been posted. . | 2014-12-01 |
| 10884 | 10884 | DUNBAR CENTER | 515066 | 501 CALDWELL LANE | DUNBAR | WV | 25064 | 2009-12-10 | 156 | E | 0 | 1 | 4I6911 | Based on record review and staff interview, the facility failed to provide a written notice to residents who were no longer eligible for Medicare skilled services that stated the reason they no longer qualified, as required in the Medicare Skilled Nursing Manual at "Notifying Patient of Noncoverage SNF-356.1". This practice was observed when reviewing a sample of three (3) such letters that had been provided to residents or their responsible parties in the previous three (3) months. The practice had the potential to affect all residents of the facility who had been, or would be in the future, determined to be ineligible for Medicare-covered skilled services. Resident identifiers: #35, #54, and #37. Facility census: 111. Findings include: a) Residents #35, #54, and #37 The Notice of Medicare Provider Non-Coverage, as provided by the facility for Residents #35, #54, and #37, was requested for review on 12/09/09. Review of these notices disclosed, on the third page of the document associated with Item #4, the document stated: "Because: Not requiring a skilled service." Each of the notices had the same statement and made no explanation specific to the individual resident's discontinuation of Medicare-covered services. The facility employee responsible for the distribution of these notices (Employee #53), when interviewed on 12/09/09 at 2:45 p.m., confirmed this was the notice provided to all residents of the facility at the time they were determined by the facility to no longer qualify for Medicare-covered skilled services. This employee further confirmed the information was not individualized for each resident and situation. . | 2014-11-01 |
| 10945 | 10945 | GREENBRIER MANOR | 515185 | ROUTE 2, BOX 159A | LEWISBURG | WV | 24901 | 2009-05-22 | 156 | C | 0 | 1 | T34S11 | Based on observation and staff interview, the facility failed to post accurate information regarding the regional ombudsman. This practice had the potential to affect all residents. Facility census: 86. Findings include: a) During the initial tour of the facility on 05/18/09 at approximately 3:45 p.m., observation revealed the signs posted in the front lobby area of the building contained the incorrect telephone number and no name listed for the regional ombudsman. Other signs containing this same type of information were posted in various locations throughout the building and did have to correct information related to the regional ombudsman. At approximately 5:00 p.m. on 05/18/09, the administrator agreed the sign in the front area of the building needed to be corrected. . | 2014-11-01 |
| 11118 | 11118 | NEW MARTINSVILLE CENTER | 515074 | 225 RUSSELL AVENUE | NEW MARTINSVILLE | WV | 26155 | 2009-04-30 | 156 | E | 0 | 1 | 6TSD11 | Based on record review and staff interview, this Medicare-participating facility failed, for four (4) of four (4) residents reviewed, for whom a determination was made by the facility that Medicare will not pay for skilled nursing or specialized rehabilitative services and that an otherwise covered item or service may be denied as not reasonable and necessary, to notify the resident or his/her legal representative in writing why these specific services may not be covered; the beneficiary ' s potential liability for payment for the non-covered services; the beneficiary right to have a claim submitted to Medicare; and the beneficiary ' s standard claim appeal rights that apply if the claim is denied by Medicare. This practice had the potential to affect all residents for whom a determination of non-coverage by Medicare had been made by the facility. Resident identifiers: #52, #99, #66, and #4. Facility census: 101. Findings include: a) Residents #52, #99, and #66 A review of the forms entitled "SNF Determination on Continued Stay" for these residents revealed only the date that Medicare-covered services would be discontinued; there was no mention in writing of what specific service may no longer be covered or why. The only verbiage included in the form was "no longer requires skilled services" or "exhausted benefits". During an interview with the administrator and the office person responsible for providing this notification at 3:20 p.m. on 04/27/09, they acknowledged that this was form given to the resident and/or the responsible party as the notification of discontinuance of Medicare-covered skilled services and of their right to appeal this decision. They also agreed, after reviewing the forms, that the documentation did not on these residents' forms did not specify the service that was no longer being covered. When asked, neither person was able to state, during the interview, exactly what service had been discontinued for each of these three (3) residents. b) Resident #4 A review of the Notice of Medicare Prov… | 2014-08-01 |
| 11199 | 11199 | MADISON, THE | 515104 | 161 BAKERS RIDGE ROAD | MORGANTOWN | WV | 26505 | 2010-05-19 | 156 | C | 1 | 0 | 7YYR11 | . Based on observation, review of the facility's procedure for filing complaints, and staff interview, the facility failed to post the correct mailing address for contacting the State survey and certification agency and failed to provide clear and concise information to residents and the public on how to file a complaint with that agency. This practice had any residents, legal representative, or member of the general public wishing to file a complaint with the State. Facility census: 61. Findings include: a) The bulletin board posting in the front lobby of the facility gave an incorrect mailing address listed for the Office of Health Facility Licensure and Certification (OHFLAC - the State survey and certification agency). b) The same bulletin board also contained a posting of how to file complaints. This was a facility-originated form informing residents / legal representatives of the steps to follow if they wanted to report complaints. The information was unclear as to how to make a formal complaint to OHFLAC when an individual believed this action was necessary. c) In an interview with the administrator (Employee #59) and the director of nursing (DON - Employee #54) at 12:30 p.m. on 05/19/10, both agreed the posted address for OHFLAC was incorrect. Both employees also agreed the posted form for making in-house complaints did not clearly address who to contact at the State level to file a complaint. . | 2014-07-01 |
| 11443 | 11443 | EAGLE POINTE | 515159 | 1600 27TH STREET | PARKERSBURG | WV | 26101 | 2011-05-12 | 156 | D | 1I0H11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** . Based on observation, record review, and staff interview, the facility failed to inform rights of their rights by: (a) failing to post the names and current contact information for all pertinent State client advocacy groups, (b) failing to provide accurate appeals information for one (1) of thirty-nine (39) Stage II sample residents, and (c) failing to provide a liability notice to one (1) of thirty-nine (39) Stage II sample residents when Medicare-covered skilled services were discontinued. Resident identifiers: #139 and #2. Facility census: 129. Findings include: a) On 05/11/11 at 11:00 a.m., the surveyor went with the administrator (Employee #200) and the social worker (Employee #129) to find where the required agency postings were located in the facility. It was observed that addresses were not posted at the time. A poster with agency addresses had been in the administrator's office in a framed poster. She said they were taken down so she could change the address of the state agency. The current state agency address will be a year old in July 2011. On 12:46 p.m. on 05/11/11, the administrator presented the surveyors with additional pamphlets, signs, forms, etc. with the advocacy groups names, address and phone numbers listed on it. These were not available at the time of survey. b) Resident #139 Record review revealed that, on 03/17/11, Resident #139 received conflicting notification of transfer / discharge related to which State agency to contact for appeals related to his discharge from the facility to home. Page 2 of the "Notification of Transfer / Discharge" listed several State agencies to which a resident may appeal the transfer / discharge decision, although the only correct State agency was the Office of Inspector General's Board of Review. During an interview on the early afternoon of 05/03/11, after request was made for a copy of the information provided to residents upon transfer or discharge, the administrator reported the 2… | 2014-03-01 | ||
| 39 | 39 | GUARDIAN ELDER CARE AT WHEELING | 515002 | 20 HOMESTEAD AVENUE | WHEELING | WV | 26003 | 2017-03-01 | 157 | D | 0 | 1 | TKXD11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based resident, staff and physician interviews and clinical record review, the facility failed to notify the physician timely of a resident incident for one resident reviewed. The failed practice had the potential to affect an isolated number of residents. Resident identifiers: #260. Facility census 145. Findings include: a.) Resident #260 Clinical record review, conducted on 02/23/17 at 2:00 p.m., revealed Resident #260 was admitted to the facility on [DATE] after right Achilles tendon repair. The 02/21/17 physician order [REDACTED]. The admission physician orders [REDACTED].>--[MEDICATION NAME] 5-325 milligrams (mg) every six (6) hours as needed for pain --Tylenol 325 mg, 2 tablets every four (4) hours as needed for mild pain. The 02/20/17 admission nursing assessment revealed the resident was not steady moving on and off the toilet and with surface to surface transfer, only able to stabilize with staff assistance. The clinical record was silent regarding any incident involving the resident on 02/22/17 or any administration of as needed pain medication. The record contained no notification of the physician of the incident. During an interview, on 02/23/17 at 12:45 p.m., Resident #260 stated she had an incident in the bathroom the previous evening. The resident stated the nurse aide was in a hurry and did not have the wheelchair close and when she went to get off the toilet. Resident #260 further said, I hit my right foot on the floor. It hurt me. I had to get pain medication for it. I had to have Tylenol and [MEDICATION NAME]. I didn't need it since my first day here. The resident stated her foot was still hurting now. During an interview, on 02/23/17 at 1:58 p.m., LPN #64 stated he was unaware Resident #260 had hurt her foot yesterday evening. LPN #64 stated he would immediately notify the physician about the incident. During an interview, on 02/23/17 at 2:52 p.m., the Director of Nursing (DON) stated she was unaware of the incident regard… | 2020-09-01 |
| 108 | 108 | HUNTINGTON HEALTH AND REHABILITATION CENTER | 515007 | 1720 17TH STREET | HUNTINGTON | WV | 25701 | 2017-09-07 | 157 | E | 0 | 1 | QLZ111 | **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, physician, and/or resident responsible party when a significant change occurred in the residents condition. This deficient practice affected two (2) of twenty-nine (29) residents reviewed during Stage 2 of the Quality Indicator Survey (QIS). For Resident #84, the facility staff failed to notify the appropriate Health Care Surrogate(HCS) after 06/05/17, when a new HCS was appointed. Resident #19's responsible party was not notified when there was a change in her medication regimen. Resident identifiers: #84 and #19. Facility census: 180 Findings include: a) Resident #84 Review of Resident #84's medical records, on 08/30/17 at 11:15 a.m., found the resident was admitted to the facility on [DATE] following a hospitalization . Admission paperwork was completed by the resident's daughter. Further review found a HCS selection form completed 06/05/17, by the attending physician, designating the son as the HCS. No further HCS designation forms could be located in the medical records. Interview with Employee #122, social worker (SW), on 09/06/17 at 9:15 a.m., revealed she thought the daughter was the HCS on admission and had asked to appoint her brother the HCS due to personal issues. When asked, Is there another HCS designation form. She replied, I don't see any in the medical records. On 09/06/17 at 11:00 a.m., Employee #122, SW, provided a HCS designation form dated 05/30/17. She further confirmed this form had been faxed to her on 09/06/17 at 10:35 a.m. This HCS form indicated the Daughter was in fact appointed as the HCS while the resident was in the hospital. However, this HCS became void when the attending physician at the facility appointed Resident #84's son as the HCS on 06/05/17. The facility continued to notify Resident #84's daughter of changes in her condition and had the daughter listed as the health care decision maker on the resident face s… | 2020-09-01 |
| 199 | 199 | MADISON PARK HEALTHCARE | 515021 | 700 MADISON AVENUE | HUNTINGTON | WV | 25704 | 2017-04-19 | 157 | E | 0 | 1 | HZCX11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, staff interview, responsible party interview, and resident interview, the facility failed to notify the responsible party/resident of changes in the residents medications and treatments for three (3) of four (4) residents reviewed for the care area of notification of change during Stage 2 of the Quality Indicator Survey (QIS). This was true for Resident #49, #44 and #8. Resident Identifiers: #49, #44 and #8. Facility Census: 39. Findings Include: a) Resident #49 A review of Resident #49's medical record, at 8:58 a.m. on 04/18/17, found Resident #49 was declared incapacitated by her attending physician on 12/29/16. Also contained in the record was the residents appointment of a Power of Attorney (POA) which was completed on 01/28/11. This POA included medical decision making power. Further review of the record found the following physician orders: --Order dated 01/18/17 for Vitamin D level every 12 months --Order dated 03/24/17 got Physical Therapy five (5) times a week for two (2) weeks --Order dated 03/30/17 for [MEDICATION NAME] 20 milligrams one time a day, KCL 10 meq one time a day, and Basic Metabolic Panel in one week due to pedal [MEDICAL CONDITION] The medical record contained no evidence the POA was notified of these medication/treatment changes. An interview with the Director of Nursing, at 9:57 a.m. on 04/19/17, confirmed the medical record contained no evidence Resident #49's POA was notified of the medication/treatment orders. b) Resident #44. Record review found the resident was admitted to the facility on [DATE]. During Stage 1 of the Quality Indicator Survey (QIS), on 04/17/17 at 12:21 p.m., the resident said she is not included in changes about her medication and care at the facility. She said, They tell my daughter, I guess. They must think I am senile. Review of the resident's most recent annual, minimum data set (MDS) with an assessment reference date (ARD) of 03/13/17, found the resident's brief in… | 2020-09-01 |
| 401 | 401 | WORTHINGTON HEALTHCARE CENTER | 515047 | 2675 36TH STREET | PARKERSBURG | WV | 26104 | 2017-08-08 | 157 | D | 1 | 1 | FUQO11 | > Based on resident interview, staff interview, and record review, the facility failed to notify a resident of a room change for one (1) resident reviewed. The failed practice had the potential to affect an isolated number of residents. Resident identifier: #47. Facility census: 98. Findings include: a) Resident #47 An interview with Resident #47 on 08/03/17 at 10:00 a.m. revealed she had been moved to a new room without any notice. The resident stated she could not remember the exact date but the move recently took place. The resident stated she had left her room to visit another resident and upon returning the staff was moving her belongings to a room across the hall. The resident stated she became very upset because nobody told her she was switching rooms. An interview with Licensed Social Worker (LSW) #15 on 08/03/17 at 10:45 a.m. revealed a resident is supposed to be contacted before a room change occurs in order to provide options and to ease the transition for the resident. The LSW stated she did not contact Resident #47 before the room change on 07/03/17 because she was unaware the resident was switching rooms until the change was completed. An interview with the Administrator on 08/08/17 at 12:00 p.m. revealed she is the one who ordered the room change to occur on 07/03/17. The Administrator stated she let the resident's daughter know about the change and instructed the nursing staff to inform the resident. The Administrator stated she cannot be certain if the nursing staff informed the resident prior to the room change. A review of Resident #47's medical record on 08/08/17 at 12:30 p.m. revealed no indication the resident was informed of the room change prior to it occurring. A review of the resident's quarterly Minimum Data Set (MDS), with an Assessment Reference Date (ARD) of 07/18/17, was conducted on 08/08/17 at 12:45 p.m. Section C-Cognitive Patterns of the assessment revealed the resident scored a 14 on the Brief Interview for Mental Status (BIMS) assessment. A score of 14 indicated the resident h… | 2020-09-01 |
| 621 | 621 | HERITAGE CENTER | 515060 | 101-13TH STREET | HUNTINGTON | WV | 25701 | 2017-03-17 | 157 | D | 0 | 1 | 4QX611 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview, the facility failed to immediately notify the physician when Resident #79's blood pressure was outside of the established parameters. This failed practice had the potential to affect one (1) of one (1) residents reviewed during Stage 2 of the Quality Indicator Survey (QIS). Resident identifier: #78. Facility census: 158. Findings include: a) Resident #78 Medical record review for Resident #78, on 03/15/17 at 10:00 a.m., found a physician's orders [REDACTED]. Recheck blood pressure in one (1) hour and if systolic blood pressure (SBP) is greater than 160 millimeters of mercury (mmHg - the unit used to measure blood pressures) call physician. Review of the Resident #78's Medication Administration Record [REDACTED]. At 7:00 p.m. on 01/20/17, recheck of blood pressure was 169/61. Further review of Resident #78's medical records found no evidence the physician was notified. On 03/15/17 at 2:00 p.m., a discussion with Director of Nursing (DON) confirmed the blood pressure for Resident #78 was outside of the physician prescribed parameter. She agreed there was no evidence of physician notification. No additional information was provided prior to exit. | 2020-09-01 |
| 695 | 695 | HERITAGE CENTER | 515060 | 101-13TH STREET | HUNTINGTON | WV | 25701 | 2017-06-15 | 157 | D | 1 | 0 | DQI311 | > Based on record review and staff interview, the facility failed to notify the responsible party when one (1) of three (3) residents reviewed experienced a fall on 06/06/17. Resident identifier: #80. Facility census: 157. Findings include: a) Resident #80 A review of the Incident and Accident records, reported Resident #80 was found on the floor next to her bedresulting in a skin tear to the left upper arm and a bruise on the top of her right foot. No other injuries were noted, and the report stated she was assisted back to her bed by three (3) staff. Neurological checks were implemented and she placed non-skid socks on her feet. The physician was notified and the responsible party was notified. An interview with Resident # 80's legal representative on 06/15/17 at 9:00 a.m., reported she received no call from the facility letting her know about the fall her mother had on 06/06/17. During an interview with the director of nursing (DON) on 06/15/17 at 10:05 a.m., Unit Manager #138, had contacted the wrong person regarding the fall sustained by Resident #80 on 06/06/17. She verified she did not contact the legal representative regarding this fall. | 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 );