cms_GA: 55
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 55 | BELL MINOR HOME, THE | 115020 | 2200 OLD HAMILTON PLACE NE | GAINESVILLE | GA | 30507 | 2018-12-06 | 684 | 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 assess for positioning for Resident (R) #55 during meals. The sample included 34 residents. Findings included: R#55 admitted to the facility on [DATE] with current [DIAGNOSES REDACTED]. R#55's Quarterly Minimum Data Set ((MDS) dated [DATE] recorded staff evaluated R#55 as 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 x (times) 2 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. Observations of R#55 on 12/3/18 at 1:18 p.m., revealed the resident's Broda chair back was not 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 three-sided strapped-on foam support behind the resident with wings laterally, which was placed under her shoulder blades. This support acted as another layer of width behind the resident's 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. Interview on 12/4/18 at 4:16 p.m. with Certified Nursing Assistant (CNA) FF in the resident's room, who stated R#55 travels in a Broda chair or is in bed, and staff used a positioning support for her in the Broda chair. CNA FF stated, I never noticed her having position problems when she eats, and never reported it to the charge nurse. CNA FF further stated the CNAs use the Kardex as the CNA care plan. Interview 12/4/18 at 4:18 p.m. with Registered Nurse (RN) DD, who printed off R#55's Kardex and stated there were no positioning devices or instructions on positioning the resident during meals listed on the CNA care plan. Observation on 12/5/18 at 8:58 a.m. in the dining room revealed R#55 was fed breakfast by staff. R#55 was positioned in the same way as observed on 12/3/18, with no head and neck support to sit upright with her neck slightly hyperextended. At 9:23 a.m. the resident had a short episode of coughing. Staff did not reposition the resident during or after her coughing episode. Interview on 12/5/18 at 9:30 a.m. with the CNA in the dining room, who fed the resident breakfast, CNA NN stated she never noticed the resident sitting upright with no support and did not notice the resident sitting back in the chair periodically. CNA NN further stated she did not report positioning concerns to the nurse. Observation on 12/5/18 at 1:00 p.m. in the dining room revealed R#55 fed the lunch meal by staff. R#55 had the same positioning as previous observations, and ate lunch utilizing the same process of sitting forward to eat and drink and periodically resting the top of her head against the chair back causing her neck to be slightly hyperextended. Interview on 12/5/18 at 1:19 p.m. in the dining room with CNA EE who stated the blue lateral support was used to help keep the resident straight in the chair because the resident likes to lean left. CNA EE further stated that she has never seen anyone put a pillow behind the resident when she eats, but, I think a pillow would help her during eating her meals. I never reported the resident's positioning problems to the nurse. Interview on 12/5/18 at 1:40 p.m. at the nurse's station with RN AA who stated she has worked here six months, and That's the way she's always been, referring to the resident's positioning during meals and support devices. RN AA stated she never noticed any positioning problems but frequently monitors R#55's dining room during meals. Interview on 12/5/18 at 1:42 p.m. at the nurse's station with RN DD who stated therapy was working with the resident's positioning, and she has never made a referral to therapy for the resident's positioning. Interview on 12/5/18 at 1:53 p.m.in the Therapy Room with the Physical Therapy Assistant (PTA) and served as the department manager, who stated R#55 ended on Physical Therapy caseload on 12/29/16, almost two years ago. The PTA stated she placed the light blue covering on the resident's chair, a Cozy to offer support at that time, and later nursing added the blue support with lateral side stays for the trunk. The PTA stated, Nobody has made me aware of any concerns for positioning during meals. No referrals have come through nursing for her (R#72's) positioning. Interview on 12/5/18 at 2:01 p.m. with CNA GG who fed the resident lunch, stated she did not notice the resided having trouble with positioning during her meal. CNA GG further stated she never reported any positioning concerns to the nurse. During a follow up interview on 12/5/18 at 2:23 p.m. outside R#55's door, the PTA stated she just finished assessing the resident's chair and placed a pillow under the Cozy because the Broda chair would not come up to 90 degrees. The PTA stated she instructed the CNAs to add one more pillow if it appears the resident needed it during meals. The PTA then spoke to RN DD about this change, to which RN DD answered, OK, but as of 12/6/18 at 2:19 p.m., no Nurse's Note was documented, and no changes to the care plan or Kardex were made. Interview on 12/6/18 at 9:56 a.m., the PTA stated she planned to watch the resident at the lunch meal with the pillow placed. When asked if she would have expected nursing staff to refer the resident to therapy since 12/2016 for positioning during meals, the PTA expressed agreement by saying, I see what you mean. Interview on 12/6/18 at 11:20 with the Interim Director of Nursing (DON) who stated from a dietary standpoint it was certainly a concern for R#55's head to go back and rest on the chair, with the hyperextended neck, especially during eating to prevent choking. The DON stated, I would expect the staff to notice this, CNAs to report to the nurse and the nurses should have noticed over time and referred (her) to therapy for positioning evaluation. Interview on 12/6/18 at 2:44 p.m. with the Speech Language Pathologist (SLP) who stated she did not know R#55, however, generally the proper position for eating would be as upright as possible. The SLP further stated, A resident with dementia and some hyperextension would depend on staff to position her as upright as possible for eating. The facility provided the policy titled, Assistance with meals policy, dated 11/28/17 and updated 8/7/18, which directed staff, 1.c. Residents who cannot feed themselves will be fed with attention to safety, comfort and dignity . An additional policy was provided by the facility titled, Rehabilitative nursing care, dated 11/2016 which directed, 2. Nursing personnel are trained in rehabilitative nursing care. Our facility has an active program of rehabilitative nursing which is developed and coordinated through the resident's care plan .4. Rehabilitative nursing care is performed daily for those residents who require such service. Such program includes, but is not limited to: a. Maintaining good body alignment and proper positioning . The facility failed to observe, assess and refer the resident for proper positioning during meals. | 2020-09-01 |