cms_DC: 1978
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| rowid | facility_name | facility_id | address | city | state | zip | inspection_date | deficiency_tag | scope_severity | complaint | standard | eventid | inspection_text | filedate |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1978 | THE WASHINGTON HOME | 95005 | 3720 UPTON STREET NW | WASHINGTON | DC | 20016 | 2012-03-06 | 279 | E | 0 | 1 | KI3J11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, record review and interviews for six (6) of 50 sampled residents, it was determined that facility staff failed to initiate care plans with goals and objectives to address: one (1) resident with a positive Level Two Screen; approaches required to ensure safe oral intake of pleasure meals for one (1) resident with dysphagia; for refusal of medications and activities for one (1) resident; for one (1) resident with contractures; one (1) resident with urinary incontinence; and for one (1) resident with allergies [REDACTED].#107, #175, #178, #287 and #337. The findings include: 1. Facility staff failed to develop a care plan with measureable goals and objectives for Resident #2 who has a positive screen for Mental [MEDICAL CONDITION]. A review of the medical record for Resident #2 identifies that the resident was admitted to the facility in March 25, 1968. Review of the PASSAR (Pre-Admissions Screen/Resident Review for Mental Illness and/or Mental [MEDICAL CONDITION]) Screen dated January 20, 2008, identified the resident as positive for Mental [MEDICAL CONDITION]. Review of the quarterly Minimum Data Set with an ARD (Assessment Reference Date) of November 16, 2011 identifies: Section I : [DIAGNOSES REDACTED]. Review of the Social Service's Notes reviewed that the resident's care conference was conducted on December 1, 2011. Relative attended via telephone. Review of the care plans last updated December 1, 2011 lacked evidence of a care plan with appropriate goals and approach to address and resident with a positive screen for Mental [MEDICAL CONDITION]. A face-to-face interview was conducted with the Employee #4 on February 24, 2012 at 5:10 PM. After a review of the care plans, he/she acknowledged the findings. The record was reviewed on February 24, 2012. 2. A review of the clinical record for Resident #107 lacked evidence of problem identification, goals and approaches required to ensure safe oral intake of pleasure meals for the resident whose [DIAGNOSES REDACTED]. According to physician ' s progress notes dated January 20, 2012, Resident #107 ' s [DIAGNOSES REDACTED]. physician's order [REDACTED]. A review of the speech therapy progress notes dated February 22, 2012 read: the patient is safely tolerating pleasure feeds of nectar-thick liquids and puree consistency solids. SLP (speech/language pathologist) wrote an order and arranged for patient to receive pleasure feedings with the patient to improve quality of life. Patient consumes less than 25% at each pleasure feed meal .provided ongoing diet texture evaluation and established effective swallowing compensatory strategies for the patient. Educated the family on safe swallowing compensatory strategies .(training) ongoing with family/POA (power of attorney) who is the one requesting pleasure feeds and will be the one to give pleasure feeds . The record lacked documented evidence of the development interventions and approaches in the comprehensive care plan to address the swallowing requirements for Resident #107. There was no evidence that training was provided to the caregiver staff as it relates to safe swallow strategies. A face-to-face interview was conducted on March 5, 2012 at approximately 3:30 PM with Employee #40 regarding the lack of a care plan and training of staff regarding the resident ' s oral intake requirements. S/he reviewed the record and acknowledged the findings. The record was reviewed March 1, 2012. 3. Facility staff failed to initiate a care plan for Resident #175 ' s refusal of medication and activities. The resident was observed in room in bed watching television per his/her choice on February 21, 22, 28, and 29, 2012. The psychiatric follow-up note dated February 9, 2012 revealed, Resident #175 has been refusing to go along with the recommended IV (Intravenous) antibiotic treatment for [REDACTED]. He/she has also been losing weight slowly and reluctant to eat regularly. Recommendations: 1. A slight increase in his/her [MEDICATION NAME] (150 mg to 250 mg) may be marginal benefit, although the majority of his/her denial and resistance to therapy appears related to his/her sense of loneliness and loss of control. 2. Given the difficulty with weight control, would recommend that we loosen the dietary restrictions as much as possible to allow him/her to eat what he/she might enjoy more. Ideas discussed included meals brought on visits by (name) team as well as take out lunches ordered through his/her petty cash account by TWH staff . 3. Most importantly, organized and regular visits with volunteers and friends would give him/her more personal contact and help with his/her loneliness. According to the activity notes: dated November 15, 2011 and February 14, 2012 the resident is encouraged to come out of his/her room to activities. One-to-one visits are provided. A telephone interview was conducted with Employee #32 on February 28, 2012 at 1:20 pm. He/she stated, Yes, every day I offer him /her opportunity to participate in activities. He/she refuses to come out of his/her room. Yes, I go in his/her room and speak with him/her. I stress that our volunteers come and talk to him/her as well. A face-to-face interview was conducted with Employee # 26 on February 28, 2012 at 1:15 pm. He/she stated, We put him/her in the chair. He/she comes out of the room on his/her own. He/she is in an electric chair. We offer him/her to come out but he/she doesn ' t. A face-to-face interview was conducted with Employee # 10 on February 28, 2012 at 3:40 PM. He/she stated that the resident has refused his/her medication therapy several times. There was no evidence that the care plan was initiated with goals and approaches to address the residents refusal of medication therapy, reluctance to eat and to come out of his/her room to participate in activities. A face-to-face interview was conducted with Employee # 10 on February 28, 2012 at 3:40 PM. He/she acknowledged that there was not care plan initiated to address the resident ' s refusal of medication therapy, reluctance to eat and to come out of his/her room. The record was reviewed on February 28, 2012. 4. Facility staff failed to initiate a care plan with goals and objectives to address the resident's contracture of his/her right hand/arm. Resident # 178. A review of the admission data base revealed that the resident was admitted to the facility with [DIAGNOSES REDACTED]. A review of the resident ' s last annual Minimum Data Set (MDS) with an Assessment Reference Date (ARD) of October 19, 2011 revealed that the resident ' s active [DIAGNOSES REDACTED]. Upon observation the resident was observed seated in a wheel chair with his/her right arm resting on the arm of the wheel chair and fingers clasped to the palm. Review of the care plans in the resident ' s active clinical record failed to reveal a care plan to address the resident's contracture. Employee #22 confirmed that the resident had a contracture of the right arm during a face-to-face interview at 10:56 AM on February 23, 2012. After a review of the care plans in the resident ' s clinical record there was no evidence that a care plan was initiated with goals and approaches to address the resident ' s contracture. A face-to-face interview was conducted with Employee # 4 at approximately 10:33 AM on February 29, 2012. During the interview the employee was queried whether the resident had a care plan that addressed his contractured arm and leg. The employee looked at the record and responded, No. I don ' t see one. The record was reviewed on February 29, 2012. The facility staff failed to initiate a care plan with goals and objectives to address the resident's contracture of his/her right hand/arm. 5. Facility staff failed to initiate a care plan with goals and objectives to address Resident # 287 ' s incontinence. A face-to-face interview was conducted with Resident # 287 on March 1, 2012 at approximately 12:00 PM. He/she informed this investigator that he/she has problems with dribbling and wears pull-ups. A review of the admission data base revealed that the resident was admitted to the facility on [DATE]. A review of the admission MDS (Minimum Data Set) with an Assessment Reference Date (ARD) of October 14, 2011 revealed that the resident was coded with a one (1) which indicated that the resident was occasionally incontinence under Section H 300 (Urinary Continence). The coding was the same for the 30 day (11/3/11) and the 60 day (12/6/11) assessments. However, the quarterly assessment dated [DATE] revealed that the resident was coded with a three (3) indicating that the resident was always incontinent. The record lacked evidence that a care plan was initiated with goals and approaches to address the resident' s incontinence A face-to-face interview was also conducted with Employee # 10 at approximately 12:15 PM on March 1, 2012. During the interview the employee acknowledged that the resident was incontinent and that the record lacked evidence of a care plan to address the resident ' s incontinence. The record was reviewed on March 1, 2012. 6. Facility staff failed to initiate a care plan with goals and approaches to address Resident #337's allergies [REDACTED]. A review of January 11, 2012 physician's order [REDACTED]. According to the Nursing Admission Assessment form dated January 11. 2012 revealed: Food/Drug allergies [REDACTED]. The resident ' s care plan initiated January 12, 2012, lacked evidence that a care plan with goals and approaches was developed to address the resident ' s allergies [REDACTED].>A face-to-face interview was conducted on February 27, 2012 at approximately 3:00 PM with Employee #6. He/she acknowledged that there was no care plan for allergies [REDACTED]. The record was reviewed February 27, 2012. | 2015-09-01 |