cms_GA: 51
Data source: Big Local News · About: big-local-datasette
| rowid | facility_name | facility_id | address | city | state | zip | inspection_date | deficiency_tag | scope_severity | complaint | standard | eventid | inspection_text | filedate |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 51 | BELL MINOR HOME, THE | 115020 | 2200 OLD HAMILTON PLACE NE | GAINESVILLE | GA | 30507 | 2018-12-06 | 580 | D | 0 | 1 | Q9R911 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to notify the physician of a change in condition for one sampled Resident (R) #72 out of a total of 34 residents. Findings include: Resident #72 was admitted to the facility on [DATE] and re-admitted on [DATE] with current [DIAGNOSES REDACTED]. Review of the Quarterly Minimum Data Set ((MDS) dated [DATE] for R#72 revealed the resident's cognition was intact, with the Brief Interview for Mental Status (BIMS) score of 15/15. The care plan dated 10/22/18 revealed the problem statement, I have an actual impairment to skin integrity r/t (related to) fistula which created an abdominal abscess to my LLQ (left lower quadrant). I have an ostomy bag in place for drainage. Interventions included: Staff will follow facility protocols for treatment of [REDACTED]. Treatment nurse and WC (wound care) will observe on rounds/document location, size and treatment of [REDACTED]. to MD. During resident observation and interview on 12/3/18 at 2:38 p.m., R#72 stated that a few weeks ago, she had a [MEDICAL CONDITION] done. I had a bump on my belly (pointed to her lower left abdomen), and had nurses look at it, but they never did anything about it until it turned into a bump, and I complained of that knot there, and they looked at it, but just said it will go away, or that I need to get 'cleaned out' (have a bowel movement). Then it formed a head, and then they had the doctor look at it, and he said it was a cyst, and opened it. It went down about 1-1/2 inches into my colon. So, they did this [MEDICAL CONDITION] . Review of the Nurses' Notes revealed: 8/21/2018 18:58 Nurses Note: C/O (complained of) stomach hurting all day. Said it hurt more than usual. Will continue to monitor. (No follow up documentation was noted by nursing for this change of condition until 8/25/18) 8/25/2018 16:55 Nurses Note: C/O stomach hurting. Resident stated she felt something on her left side of her abdomen. I felt her stomach and noted slight swelling on the left side of her abdomen. Resident stated it was tender to the touch. Will continue to monitor. 8/31/2018 13:50 Nurses Note: C/o stomach pain more than usual. Resident says the severity of the pain has increased. Says pain medication only helps a little. Will continue to monitor. Seven attempts were made to contact the nurse who wrote the above notes, but she was unavailable for interview. 10/13/2018 11:54 Nurses Note: Resident has a large abscess to L (left) hip. Area is red and inflamed. Resident states that area was tender yesterday, but (sic) did not notice the nodule until today. Tx (treatment) nurse aware. Warm compresses applied to area. 10/13/2018 14:15 Nurses Note. BP (blood pressure) 10/65 (sic) Temp (temperature) 98.1 axillary, Pulse 66, RR (respiratory rate) 17. Resident c/o of tenderness on L hip abscess. 10/14/2018 10:46 Nurses Note: Stool and pus drainage from abscess on L hip. 2 Tylenol 500mg given with minimal relief. ABD (abdominal) pad applied. 10/16/2018 20:35 Skin/Wound Note Text: Resident seen by NP (Nurse Practitioner) for abscess to left hip. Resident had very dark brown and white puss with very foul smell noted draining out of abscess opening. Resident abscess was sharp debrided and flushes with NSS (normal saline solution). resident had dankins (sic) (Dakin's solution) soaked gauze packing applied to wound and covered with ABD pad. 10/17/2018 13:27 Nurses Note: Transport picked resident up @ 1325. Resident left facility via stretcher on route to ER (emergency room ) for CT (computed tomography) scan of abscess in left quadrant. On 12/05/18 at 3:39 p.m., in the 100 hall during an interview with Registered Nurse (RN) DD, nursing notes for R #72 were reviewed and RN DD was queried as to what does Will continue to monitor mean as it relates to the residents' complaints. RN DD stated if she saw the note, Will continue to monitor, she would follow up with it, whatever the problem was. RN DD stated, I don't use that wording, because it doesn't specify the nurse's action. It's vague. On 12/5/18 at 3:43 p.m., in the 200 hall, Licensed Practical Nurse (LPN) CC was queried as to what does Will continue to monitor mean as it relates to the residents' complaints. Licensed Practical Nurse (LPN) CC stated if she saw the note Will continue to monitor, she would wonder how often it should be monitored, hourly, weekly? LPN CC stated, It's very vague, probably I would call the doctor, or go to my charge nurse for clarity. On 12/6/18 at 10:28 a.m., in the 100 hall, RN BB was queried as to what does Will continue to monitor mean as it relates to the residents' complaints. RN BB stated, Will continue to monitor? If I saw that note, I would expect another entry and the follow up where the nurse reassessed and documented the follow up that the nurse did with a reassessment. Interview on 12/6/18 at 10:21 a.m., in the Interim Director of Nurse's (DON) office, the DON agreed the note written by the nurse dated 8/25/18 indicated a change of condition for R#72. Maybe a hernia, doctor certainly needs to be aware of it. LLQ pain I would be thinking bowel impaction, diverticulitis, [MEDICAL CONDITION]. 'Will continue to monitor' to me would mean going back to the resident every 15-30 minutes to reassess. It's very vague to document 'continue to monitor.' I would prefer she said to return in 15-30 minutes to reassess, especially with complaints of pain, some tenderness upon palpation. (She should have) call(ed) the doctor with the change of condition, because it is pain related. R#72 is a very articulate lady, communicates well. She has frequently complained, not necessarily physical. In reference to the 8/31/18 note, the DON stated, But even with a history (of complaints), the nurse should have assessed and monitored, six days later, concerned about this because it has increased, pain should have been assessed more specifically for location, intensity, frequency, (and the nurse) should have notified the doctor. If she had called the doctor right away, maybe he would have ordered an abdominal xray then to see what was going on. Better to call the doctor and be told it's not a problem, then to not call and have something like this happen. Interview on 12/6/18 at 11:42 a.m., in her office, the RN Administrator stated regarding the 8/25/18 Nurse's Note she would expect some kind of follow up to resolve it or give a reason why it stopped being monitored. I would have expected her to notify the physician, and it was a change of condition. Interview on 12/6/18 at 11:53 a.m. with the Medical Director (MD) who stated R#72's condition was, One of those things that you could be brewing, and you don't know about it until you get imaging studies. The MD further stated he was made aware of the resident's tender abdomen and complaints on 9/19/18, and, If it came to my attention earlier, I would have come in to see her (R#72). I assume I would have examined her and asked her if she had any signs and symptoms .if I had been called sooner, I would have addressed her problems. The facility provided the policy titled, Notification of resident's change in condition dated (MONTH) 2014, and updated (MONTH) (YEAR). The policy directed, 2.3. except in medical emergencies, notifications will be made within twenty-four (24) hours of a change occurring in the resident's medical/mental condition or status. | 2020-09-01 |