| 81 |
PROVIDENCE TRANSITIONAL CARE CENTER |
25018 |
910 COMPASSION CIRCLE |
ANCHORAGE |
AK |
99504 |
2018-03-15 |
677 |
D |
1 |
0 |
M2PE11 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on record review, observation, and interview the facility failed to ensure activities of daily living (ADL care such as hygiene and skin care) were offered and/or provided to 1 resident (#2) out of 4 residents observed receiving care. This failed practice placed the resident at risk for poor outcomes from lack of hygiene and a risk for infection and/or poor skin conditions and a decreased feeling of self-worth. Findings: Record review on 3/14-15/18 revealed Resident #2 was admitted to the facility with a [DIAGNOSES REDACTED]. Review of Resident #2's Care Plan, dated 2/19/18, revealed Can't move around well on my own. lose control of by bladder and/or bowels. Sometimes get confused or can't remember things. don't receive the proper nutrition. have an existing skin injury. The approach included I need my aides to-help me with hygiene and general skin care . Grooming During an observation on 3/14/18 of incontinence care being provided to Resident #2 at 6:20 am and 10:30 am, and repositioning of the Resident at 8:00 am and 9:10 am, the Resident was not offered the opportunity to wash his/her face and hands nor was oral care offered or provided. In addition, the Resident had significant facial hair growth. During an interview on 3/14/18 at 10:40 am, Resident #2's family member stated the Resident had not had his/her teeth brushed. The Family member showed the surveyor two travel sized tubes of toothpaste, kept in the bathroom, one of which was slightly used, and stated Resident #2 had the same tubes of tooth paste since admission nearly 3 weeks ago. Closer examination of the tooth brush revealed it was dry. During an observation on 3/14/18 at 10:50 am, when Certified Nursing Assistant (CNA) #2 entered Resident #2's room, the Family Member stated to the CNA he/she had told evening shift staff the Resident needed to be shaved, the CNA replied I didn't get that message. The CNA then offered to shave the Resident. Observation on 3/15/18 at 8:40 am, observation of the tooth brush and toothpaste, revealed the 2 tubes of toothpaste had not been moved from their position the previous day, and the Resident's tooth brush was dry. During an observation on 3/15/18 at 8:42 am, CNA #3 changed Resident #2's soiled brief. The CNA did not offer the Resident the opportunity to wash his/her face and hands and did not offer oral care to the Resident. During an interview on 3/15/18 at 8:52 am, when asked about Resident #2's oral care, CNA #3 stated Resident #2's oral care was usually done after breakfast. Review of Resident #2's Baseline Care Plan /RDCP (Resident Daily Care Plan), dated 3/13/18, revealed Grooming I do hygiene/grooming tasks: with the help of one person. Review of the CNA documentation dated 3/14/18 at 4:15 pm revealed Additional Care: Oral care performed. Shaving performed. On 3/14/18 at 4:53 pm, AM Hygiene Care was documented Underarms/Peri area cleaned. lotion applied. Skin Care Observation on 3/14/18 at 6:30 am, LN #2 assisted CNA #5 with changing Resident #2's brief. the Resident's brief was saturated with urine. the Resident had a large pink foam dressing covered his/her coccyx (tailbone area). The perineal area, directly below the dressing, was red and appeared macerated (broken down from exposure to mosisture). After washing the Resident's perinea and buttocks and changing the Resident's brief, CNA # 5 and 6 attempted to assist the Resident with putting on some pajama bottoms. Neither of the staff applied a protective barrier cream to the reddened area located on the Resident #2's perineum. During an observation on 3/14/18 at 10:30 am, CNA #s 2 and 7 changed the Resident's incontinence brief after the Resident had voided. The Resident's perineum was red and maserated looking, after cleaning the Resident's buttocks, the CNAs assisted the Resident with donning a dry brief, neither staff applied any protective barrier cream to the reddened area on the Resident's perineum. Observation on 3/15/18 at 8:42 am, Resident #2's incontinent brief and bottom sheet was saturated with urine. CNA #3 washed the Resident's perinea and buttocks, and changed the Resident's brief and bedding. The Resident's perineum, below the dressing was red and raw. During an interview on 3/15/18 at 8:52 am, when asked if any protective ointment was used on the Resident, CNA #3 showed the surveyor a tube of silicone based barrier cream and stated he/she didn't think the Resident needed it right now. During an interview on 3/15/18 at 1:00 pm, when asked about treatment for [REDACTED].#2's perineum, the Wound Nurse stated the Resident should have had a protective barrier cream applied. The Wound Nurse stated there was no order for the barrier cream as it was considered a standard of care. Review of the Resident's Baseline Care Plan/ RDCP revealed Skin Care .check my skin during care Apply lotion/ cream to my barrier cream. Review of the CNA documentation dated 3/14/18 at 7:08 am revealed barrier cream applied. Review of the Providence Anchorage Long Term Care Standard of Care, rev. 2/2017, revealed [NAME]M. care every morning: Hands and face washed . Oral Care completed . Shaved: diabetics shaved with electric razor . Offer a drink of water. Ongoing Care .Use designated continence management products. During an interview on 3/15/18, at 1:32 pm, the Director of Nursing stated the continence management products referred to the disposable incontinence briefs. |
2020-09-01 |