cms_GA: 53
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 53 | BELL MINOR HOME, THE | 115020 | 2200 OLD HAMILTON PLACE NE | GAINESVILLE | GA | 30507 | 2018-12-06 | 657 | 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 revise care plans to address the current care needs of two sampled Residents (R#'s 72 and 55) out of 34 residents. Findings included: The facility provided the policy titled, Resident Assessments, dated 11/28/17 which directed, Resident assessments will be completed upon admission, quarterly, annually, and with a significant change in status. The resident's comprehensive assessment is not only for the purpose of understanding a resident's needs, but to understand their strengths, goals, like history and preferences . 1. R#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) assessment dated [DATE] 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 interview on 12/3/18 at 2:38 p.m., in the resident's room R#72 stated that a few weeks ago, she had a [MEDICAL CONDITION] done. R#72 further stated, Staff never comes in to check my [MEDICAL CONDITION] bag, I have not told them not to check it, they just don't. When I think it's full, I call them, and they empty it. Last Saturday, I misjudged, and the bag broke; it was such a mess. During an interview with R#72 on 12/4/18 at 9:35 a.m., in the resident's room, the resident stated, Nobody on last evening or night shifts checked my [MEDICAL CONDITION] bag. On 12/4/18 at 4:18 p.m. in the 100 hall nurse's station, the Certified Nursing Assistant (CNA) Kardex for R #72 was reviewed with Registered Nurse (RN) DD. RN DD, who stated there were no directions for the CNAs to check or care for the resident's [MEDICAL CONDITION] listed on the CNA care plan. On 12/5/18 at 2:09 p.m., in the resident's room, R #72 was asked how staff cares for her [MEDICAL CONDITION]. R #72 responded, Nobody had checked her bag the last day, and nobody checks it ever, unless I ask. On 12/6/18 at 4:44 p.m, the care plan for R #72 was reviewed with the Interim Director of Nursing (DON). The DON agreed there were no specific interventions in the care plan or the CNA Kardex care plan to direct the nursing staff to care for R#72's fistula/ostomy bag. The Interim DON acknowledged that nursing staff did not check the resident's ostomy bag. An interview on 12/6/18 at 3:28 p.m. concerning who is responsible for updating care plans was conducted with Minimum Data Set (MDS) Nurse JJ in her office. MDS Nurse JJ stated that floor nurses do not add to the care plan. Weekend and night shift nurses communicate with the MDS nurses via email with updates, information is also obtained from the communication board or morning report to update care plans. MDS Nurse JJ further stated we update the Kardex for the CNAs also. When asked if she knew why R#72's care plan was not updated to include ostomy care, MDS Nurse JJ responded R#72's care plan should include interventions like checking the amount and consistency of stool, monitoring of skin integrity. MDS Nurse JJ agreed specific interventions were not in place for R#72, because the Kardex, pulls the information from the care plan, and it wasn't there. 2. R#55 was admitted to the facility on [DATE] with current [DIAGNOSES REDACTED]. R#55's Quarterly Minimum Data Set ((MDS) dated [DATE] recorded the resident was severely cognitively impaired. The MDS noted R#55 required extensive assistance of staff for bed mobility, transfers, dressing, eating and toilet use, and was totally dependent on staff for personal hygiene, locomotion and bathing. Review of the Activities of Daily Living (ADLs) care plan dated 11/6/18 directed staff: Anticipate my needs. BATHING: I require total staff participation with bathing. BED MOBILITY: I require total x2 staff participation to reposition and turn in bed. CODE STATUS: DNR (do not resuscitate). DRESSING: I require total x1 staff participation to dress. EATING: I require total assist x1 staff participation to eat. Heel boots as tolerated. PERSONAL HYGIENE/ORAL CARE: I require total staff participation with personal hygiene and oral care. Promote dignity by ensuring my privacy. SIDE RAILS: 3/4 Side rails up for safety during care provision, to assist with bed mobility. Observe for injury or entrapment related to side rail use. Reposition PRN (as needed) to avoid injury. Staff to keep in mind that my level of assistance may fluctuate r/t (related to) my significant impairments in cognition and mobility. Document amount of assistance required. TOILET USE: I require total assist x2 staff participation to use toilet. TRANSFER: I require total assist x2 staff participation with transfers. SKIN INSPECTION: I require for staff to observe my skin for changes/alterations during ADL (Activities of Daily Living) care. Observe for redness, open areas, scratches, cuts, bruises and report changes to the Nurse. Review of the total care plan directed the intervention repositioning the resident, but R#55's care plan did not contain any information directing staff to position the resident during meals. Observation of R#55 on 12/3/18 at 1:18 p.m. in the dining room revealed the resident finished her lunch meal with one episode of coughing and was fed her meal by staff. The resident's broda chair was not reclined at 90 degrees and her head and neck were not supported during the meal. Observation further revealed the resident sat forward to take a bite from the offered spoon or straw, and periodically relaxed her head against the chair back. R#55's neck was mildly hyperextended. R#55's broda chair had a blue 3-sided strapped-on foam support behind the resident with wings laterally, which was placed behind her shoulder blades. This support acted as another layer of width behind her back, and with the chair back not upright, the resident rested the top of her head against the chair with more hyperextension of the neck than before, when she rested. On 12/4/18 at 4:18 p.m. R#55's Kardex was reviewed at the 100 nurse's station, with Registered Nurse (RN) DD, there were no positioning devices or instructions on positioning during meals listed on the CNA care plan (listed on Kardex). An interview on 12/6/18 at 3:28 p.m. in the Minimum Data Set (MDS) office concerning who is responsible for updating care plans was conducted with Minimum Data Set (MDS) Nurse J[NAME] MDS Nurse JJ stated that floor nurses do not add to the care plan. Weekend and night shift nurses communicate with the MDS nurses via email with updates, information is also obtained from the communication board or morning report to update care plans. MDS Nurse JJ further stated we update the Kardex for the CNAs also. MDS Nurse JJ further stated R#55's care plan should include the devices used for positioning and positioning during meals. MDS Nurse JJ agreed specific interventions were not in place for R#55, because the Kardex, pulls the information from the care plan, and no device interventions are listed. Interview on 12/6/18 at 4:44 p.m. with the Interim Director of Nurses (DON) in the Conference Room. The DON reviewed the resident's care plan and Kardex and agreed there were no specific interventions in the care plan or the CNA Kardex care plan to direct the nursing staff to place devices for R#55's positioning during meals. Cross reference F684 for R#55 | 2020-09-01 |