| 1683 |
WESTBURY CONYERS, LLC |
115469 |
1420 MILSTEAD ROAD |
CONYERS |
GA |
30012 |
2017-07-27 |
241 |
D |
0 |
1 |
DRP811 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, clinical record reviews, and review of facility policy titled Quality of Life-Dignity, the facility failed to ensure resident dignity was maintained, and failed to safeguard clinical information for two of 29 residents (Resident (R) #187, and Resident (R) #201). R#187 & R#201 had Swallow Precautions and diet instructions posted on the wall behind their beds. The findings included: Review of the facility's Quality of Life - Dignity policy revised (MONTH) 09 noted Residents shall be treated with dignity and respect at all times. Treated with dignity means the resident will be assisted in maintaining and enhancing his or her self-esteem and self-worth .Staff shall maintain an environment in which confidential clinical information is protected. 1. Review of R#187's Quarterly Minimum Data Set (MDS) assessment dated [DATE], revealed R#187 was admitted into the facility on [DATE] with [DIAGNOSES REDACTED]. According to the Brief Interview for Mental Status (BIMS) score, R#187 was severely cognitively impaired, scoring 5 out of 15 on the assessment. There were no signs of depression, and no maladaptive behaviors noted on the assessment. R#187 required extensive assistance of two staff for bed mobility and transfers; extensive assistance of one staff for dressing and eating; and total assistance of one staff for toileting and bathing. According to Section K of the MDS, R#187 was 62 inches tall and weighed 150 pounds. She received some nutrition via a feeding tube, and had a mechanically altered and therapeutic diet. R#187 had No loss of liquids/solids from mouth when eating or drinking; no holding food in mouth/cheeks or residual food in mouth after meals; no coughing or choking during meals or when swallowing medications; and no complaints of difficulty or pain when swallowing. During the assessment period, R#187 had Speech Therapy, Respiratory Therapy, and passive Range of Motion (ROM) Restorative Therapy. Review of R#187's care plan dated 3/10/17 addressed R#187's self-care deficits. Interventions included: 1) assisting/cueing/reinforcing R#187 to perform bed mobility skills using side rails to roll from side to side in bed with assistance; 2) motivate and encourage by praising effort, not just success; 3) position and reposition R#187 in bed for comfort, joint support and skin integrity/pressure relief. Continued review of the care plan revealed the potential for Activities of Daily Living (ADL) self-care performance deficits. Interventions included: 1) R#187 is totally dependent on staff for repositioning and turning in bed; 2) dress daily in appropriate clothing daily (sic); 3) R#187 requires staff participation to dress-resident totally dependent on staff with dressing. The care plan did not address eating or swallowing precautions. Review of the R#187's clinical record revealed a physician's orders [REDACTED]. Observations on 7/25/17 at 9:30 a.m., inside R#187's bedroom revealed a sign titled Swallow Precautions was posted on the wall above R#187's head of bed. Observations on 7/26/17 at 9:21 a.m. inside R#187's room revealed the posting remained on the wall above R#187's headboard, and noted the following: Swallowing precautions - 5/23/17 - Recommendation - pureed diet and thin liquids - supervision during all oral intake/sit up with hips flexed at 90 degrees for all oral intake/take small bites and sips/ at least 2 swallows per bite of food and sip of liquid/alternate bites of solid with sips of liquid - resident may have pureed texture and thin liquids with CNA (certified nursing assistant) staff or family. 2. Review of R#201's clinical record revealed R#201 was admitted into the facility on [DATE] and re-admitted on [DATE]. R#201's Admission MDS dated [DATE] listed [DIAGNOSES REDACTED]. R#201's BIMS score was 9 out of 15, which indicated moderate cognitive impairment. R#201 required the total assistance of two staff for bed mobility, and transfers; and total assistance of one staff for dressing, eating, toileting, hygiene and bathing. Section K of the assessment noted R#201 had complaints of difficulty or pain when swallowing. R#201 measured 64 inches tall, weighed 122 pounds during the assessment period, and received a mechanically altered diet. Section V (Care Area Assessment Summary) of the MDS noted that Nutritional Status triggered as a care area for care planning. The triggering conditions were as follows: [MEDICATION NAME]/IV feeding while not a resident & mechanically altered diet while a resident. The analysis of R#201's nutritional status noted this care area as an Actual need/problem. Review of R#201's care plan dated 7/1/17 revealed the resident did not have a plan of care to address his nutritional status. Observations on 7/26/17 at 2:20 p.m. in R#201's room revealed R#201 was in bed lying on his right side. On the wall above his headboard was a sign posted which read: Swallow precautions - dated 7/6/17 - pureed diet, honey consistency/sit up with hips flexed at 90 degrees for all oral intake/ take small bites and sips/ no straws/no thin liquid/no ice chips/crush medication/alternate bites of solid with sips of liquid/check for pocketing. Interview on 7/26/17 at 3:36 p.m. with Certified Nursing Aide (CNA) JJ in the hallway of R#201's room revealed R#201 required total assistance from staff for feeding. CNA JJ stated R#201 did pretty well with eating in the evening time. CNA JJ said the swallow precautions posting above R#201's bed was there to provide staff with information regarding feeding R#201. CNA JJ stated R#201's roommate sometimes had visitors in their room, and the sign was visible to anyone who entered the room. During an interview on 7/27/17 at 9:17 a.m. with the facility's Director of Nursing (DON) in the common sitting area of R #187's hallway, the DON confirmed the swallow precaution posting above R#201's beds should not be there as it was a dignity and privacy issue. The DON stated that information should be listed in the CNA care tracking kiosks, and also in the resident's nursing care plan; however, the residents' personal clinical care information should not be posted in the residents' rooms. Interview on 7/27/17 at 11:07 a.m. with CNA KK in the hallway of R#201's room revealed the aide worked with both R#187 and R#201. CNA KK stated she referred to the swallow precautions posting above the residents' beds for guidance in feeding the residents. CNA KK did not recall any swallowing precaution information being listed in the CNA care tracking kiosks; only above the residents' beds. |
2020-09-01 |