cms_GA: 5867
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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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 5867 | GOODWILL HEALTH AND REHAB | 115486 | 4373 HOUSTON AVE. | MACON | GA | 31206 | 2015-10-15 | 323 | K | 1 | 0 | 7J0Y12 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on resident observation, interview, record review, facility policy review and review of the facility's State reported investigations, the facility failed to assure that one (1) resident (#23), who wandered into other resident's rooms, was free from physical abuse and three (3) resident (#3, #44, #45), into whose rooms resident #23 wandered, was free from mental abuse of the ten (10) sampled. The facility failed to ensure disposable razors were properly stored for one (1) resident #40; failed to ensure two (2) sharp objects were removed from the residents smoking area and the cabinet containing resident smoking paraphernalia was locked; failed to ensure a power strip was mounted properly to provide a safe environment for one (1) resident #29, from a sample of forty (40) residents reviewed and twenty (20) smoking residents. The facility's failure to assure that resident #23 did not wander into other residents rooms, caused resident #23 actual harm increasing the likelihood of/or was likely to cause serious harm, impairment or death to resident(s). Resident #23, has suffered actual harm with skin tears, abrasions, and bruises/discolorations, because the facility failed to protect the resident from wandering behaviors. As a result of the wandering behavior of R#23, R #3, R#44 and R#45 have suffered mental abuse including the daily fear of lack of a secure environment and R#23 has suffered mental abuse by the physical, threatening behavior of the other residents. It was determined that the facilities non-compliance with one or more requirements of participation had caused or was likely to cause serious injury or harm to resident therefore on 12/10/15 at 3:20 p.m. the Corporate Director of Operations, Corporate Clinical Director of Clinical Services, and Administrator were notified that an Ongoing Immediate Jeopardy (IJ) caused, or had the likelihood to cause, serious injury, harm, impairment or death to residents of the one-hundred twenty-three (123) residents that reside in the facility. The Ongoing IJ was determined to exist beginning on 9/05/2015 at 1:30 p.m. Findings include: 1. Record review of the Minimum Data Set (MDS) annual assessment dated [DATE] for R#23, revealed the following: Section B : Hearing, Speech and vision - resident usually understood when expressing ideas and wants, difficulty communicating some words or finishing thoughts but able if prompted or given time; resident sometimes understood verbal content, responded adequately to simple, direct communication only; Section C : Cognitive Patterns: Staff Assessment for Mental Status (Brief Interview for Mental Status not completed) - short term and long term memory problems, able to recall staff names and faces only with severely impaired decision making: never/rarely made decisions regarding tasks of daily life Section E: Wandering - behavior occurred daily but did not significantly intrude on the privacy or activities of others; Section I - Active [DIAGNOSES REDACTED]. Cognitive Communication deficit and delusional disorder. Record review of the Behavior/Intervention Monthly Flow Records, for resident #23 for September through November revealed documentation for behaviors regarding: Danger to others, Afraid/Panic. December Behavior/Intervention Monthly Flow Records revealed documentation for behaviors regarding: Danger to others, Afraid/Panic and striking out. Further of the Behavior/Intervention Monthly Flow Records revealed documentation of Danger to others for biting on 10/12/2015, compulsive and danger to self on 10/14/2015. Review of the Nurse's Notes revealed a Situation Background Assessment Report (SBAR) Communication Form and Progress note dated 07/18/2015 regarding a resident to resident incident between R#23 and R#45. R#45 pushed R#23 to the floor R#23's sustained a skin tear to the left forearm. No further information was provided. Review of the SBAR Communication Form and Progress note dated 08/08/2015, revealed a CNA observed R#23 to enter the room of R#45 (no time given) R#45 pushed R#23 to the floor. R#23 sustained skin tears to the right hand index finger and thumb. Review of the SBAR Communication Form and Progress note dated 09/05/2015, (no time given) revealed the R#23 had entered room of 4-A (R#3). R#23 laid down on the bed then R#3 pushed R#23 off the bed. R#23 sustained a skin tear to the right posterior forearm, an abrasion to the right posterior hand and a skin tear underneath the left side of the nose. (Review of resident incident report noted time of 1:30 p.m.) Review of Resident to Resident altercation between R #3 and R #23, State Reported Incident #GA 789, with Resident Incident Reports dated on 09/05/2015 at 1:30 p.m. revealed that Certified nursing assistant (CNA) VV called for help after observing R#23 positioned on his hands and knees beside the doorway of room four (4). The investigation revealed the incident occurred when R#23 went into the room of R#3 (4A) and laid down on the bed of R#3. R#3 revealed he pushed R #23 off the bed and onto the floor. According to the report, R #23 landed on his knees in the entrance to room 4A sustaining a skin tear to his right posterior forearm with bleeding noted, a skin tear to his left nostril and abrasions to his right posterior hand (no bleeding noted). R #23's statement revealed he was sorry. R #3 was advised by Licensed Practical Nurse (LPN), FF (who completed the report) to call for assistance when another resident was in his bed. Resident #3 indicated he would. Review of the SBAR Communication Form and Progress note dated 10/04/2015, (no time given) revealed R#23 was observed by a CNA to be in the bed of room 2- A ( R#45 resided in room 2-B). Resident #45 asked R#23 to get out of the bed/room then began striking R#23 with closed fist. R#23 sustained a light purplish discoloration above the left eyebrow. Review of resident incident report noted time of 10:00 a.m. Review of Resident to Resident altercation between R #23 and R #45, State Reported Incident #GA 729, with Resident Incident Reports dated at 10/04/2015 at 10:00 a.m. revealed CNA YY was walking down the hallway and heard R#45 yelling at R#23 to get out of his room. R#23 was observed lying in bed A with R#45 (from bed B) striking R#23 above the left eyebrow with a closed fist. CNA YY intervened and called for a nurse. R #23 was noted with red and light purple discolorations above the left eyebrow. R #23 was assisted back to his bedroom. Review of the SBAR Communication Form and Progress note dated 10/12/2015, revealed R#23 ambulated into the room of R#3, who resides in room 4-A. Resident #3 began yelling, slapping and hitting R#23. Resident #23 sustained multiple skin tears to the left arm, hand and neck. Review of resident incident report noted time of 6:00 p.m. Review of Resident to Resident altercation between R #3 and R #23, State Reported Incident #GA 000, with resident incident reports dated 10/12/2015 at 6:00 p.m. revealed R#23 ambulated into the room of R#3 (room 4) and the residents began yelling and arguing. Then R#3 began slapping and hitting R#23. R#23 sustained multiple skin tears to his left arm, left hand and to his neck. R#23 was confused and unable to give a description of the event. R#3 revealed he was upset because R#23 kept coming into his room and he did not want him coming into his room. The residents were separated. Review of the SBAR Communication Form and Progress note dated 11/30/2015, 2:15 p.m. revealed R#23 noted as constantly wandering into other resident's rooms was witnessed by a Certified Nursing Assistant (CNA) to walk into the room of the resident in room 2-B bed (R#44). R#44 became agitated and began punching R#23 in the chest, no injuries were noted. Review of Resident to Resident altercation between R # 23 and R # 44, State Reported on December 04, 2015 (with no Incident Number assigned at this time) with resident incident reports dated 11/30/2015 at 2:00 p.m. revealed resident #23 ambulated into the room of R#44 (room 2 B) who became agitated and punched R#23 in the chest. Then at 5:00 p.m. resident #23 went into the room of R#44 (room B) and the residents began fighting. Resident #23 sustained multiple skin tears and bruises to his bilateral, face neck and head. R#23 was confused and unable to give a description of the events. R#45 revealed he hit R#23 because he came into his room. The residents were separated and resident #23 was sent to the emergency room for evaluation. Review of the SBAR Communication Form and Progress note dated 11/30/2015 at 5:00 p.m. revealed that R#23 ambulated into the room 4-A, R#3 and got into the bed. R#3 became agitated and struck R#23. Resident #23 sustained multiple skin tears and bruises to the face and neck and an abrasion to the head. Resident #23 was sent to the emergency room for further evaluation. When the family member was notified she stated the resident would not be returning to the facility, however, the resident did return to the facility after the emergency room visit. Review of Resident to Resident altercation between R #3 and R #23, State Reported Incident #GA 304, had a Facility Incident Report Form dated 11/30/2015 at 5:15 p.m.that revealed R#23 went into the room of R#3's (room 4A) and got into the bed of R#3. R#3 became agitated and began hitting R#23. R#23 sustained multiple skin tears as well as a hematoma to the right forehead. R#23 was sent to the emergency room for evaluation. Observation on 12/07/2015 at 12:15 p.m. revealed Resident #23 up ambulating in the hallway, several scabbed areas observed on bilateral arms. Observation on 12/08/2015 at 7:50 a.m. on Faith Two (the secured unit). Yelling heard from room four (4). Observed resident #23 in the bed of resident in room 2 B, R#60. R#60 yelling loudly at resident R #23 for resident to get out of his room (resident in bed 2 A, R #3, not present). Resident #23 got up off the bed but continued wandering around the bed with resident R#60 yelling at him the entire time. After five (5) minutes (7:55 a.m.), resident #23 left the room and began walking up the hallway. The stop sign was not up on the doorway of room 4. Administrator appeared and put the stop sign up on the doorway and apologized to the R#60. Staff assisted resident #23 up the hallway. Interview on 12/08/2015 at 8:00 a.m. with resident #60 revealed there were two (2) wanderers on the unit including Resident #23 (he did not name the other resident) who went in and out of resident's rooms. It only bothered the R#60 if he was trying to watch TV (this TV was presently on). R#60 added that the facility had put a stop sign up which was working to keep residents from wandering into his room. Interview on 12/09/2015 at 8:45 a.m. with the Director of Nursing and the Assistant Director of Nursing regarding resident #23. Resident #23 required redirecting. A new psychiatrist started and reviewed the resident's medications and made changes, a stop sign was put up on the door to one room to deter him and staff attempted to keep an eye on him and to keep him entertained. Interview on 12/09/2015 at 9:20 a.m. with the Social Service Director (SSD) regarding resident #23, he required constant redirection. A room change on the unit was discussed, however the resident was in and out of every room on the unit regardless. Interview on 12/10/2015 at 8:45 a.m. with the Medical Director (MD) regarding altercations with physical injury involving resident #23, the MD would expect the resident to be watched to make sure that did not happen. He thought the SSD had been trying to place the resident in another facility but was having difficulty due to his behaviors. Resident #23 had medications available but the MD was opposed to chemical restraints. There was also a new psychiatrist available and Salus Behavior Management was available. Interview on 12/10/2015 at 10:30 a.m. with the DON, ADON and LPN AA in the nursing office revealed that, LPN AA was responsible for staffing on Faith Two. When asked if they had ever considered increasing the staff on Faith Two due to occurrences with resident #23 the staff replied that they had to go with what they had due to people resigning/quitting and the paycheck problems they had. Also, not everyone desires to work with the special populations such as the residents on Faith Two. The physician had suggested medication changes but the family did not want resident #45 on certain medications. He had altercations with a prior roommate (#45) so that resident was moved to another room on Faith II, but resident #23 continued to identify with the old roommate and go into the new room with ongoing altercations with resident #45 resulting in resident #45 being transferred to a different facility with a behavior unit 2. Review of the MDS Annual assessment dated [DATE] for R#3 revealed the following: Section B : Hearing, Speech and vision - resident sometimes understood when expressing ideas and wants, ability is limited to making concrete requests; resident sometimes understands verbal content, responds adequately to simple, direct communication only; Section C: Cognitive Patterns - Brief Interview for Mental Status (BIMS) Summary score 06 - severely impaired cognition; Section E: No behavior symptoms; Section F: Interview for daily preferences -it was very important for the resident to take care of his personal belongings or things, and; Section I - Active [DIAGNOSES REDACTED]. Review of the Behavior/Intervention Monthly Flow Records, for resident #3 dated November 2015 revealed evidence of behaviors including yelling out, refusal of care and danger to others with one episode of yelling out on 7 a.m. to 7 p.m. shift on 11/14/2015. Review of the Care Now Comprehensive Psychiatric Diagnostic Evaluation dated 07/06/2015 revealed a [DIAGNOSES REDACTED]. Review of the Behavioral Health Evaluation dated 08/04/2015 revealed the R#3 had a history of [REDACTED]. No current psychosis noted. Review of the Care Now Services Behavioral Health Services Progress Note dated 09/21/2015, revealed R#3 had an altercation on 09/05/2015 with another resident (SBAR revealed this to have been with R#23). R#3 could be agitated at times but denied problems with another resident. (resident not specified in the progress note). R#3 is estranged from family and has no visitors. R#3 appeared displeased and hopeless with a flat affect. 09/05/2015 Resident #23 entered the room of resident #3 and laid down on the bed. Resident #3 pushed R#23 off the bed. (according to the SBAR communication for res R#23, R#23 sustained a skin tear to his right posterior forearm and underneath the left side of his nose and an abrasion to his right posterior hand) 10/12/2015 R#3 became upset due to R#23 continuing to enter his room. R#3 was yelling at and slapping R#23. (according to SBAR for resident R#23, R#23 sustained multiple skin tears to his left arm, left hand and to the neck). Review of the SBAR Communication Form and Progress Note dated 11/30/2015, R#23 got in to the bed of R#3. R#3 became agitated and started to fight the R#23. R#23 and R#3 were separated, and a police report filed. Interview on 12/08/2015 at 1:35 p.m. with the Licensed Clinical Social Worker (LCSW) for Care Now Services revealed R#3 had depression regarding his placement in a facility and regarding his lack of family support, therefore his room was his whole word and he became agitated if other residents got in his personal space. 3. Review of the Minimum Data Set (MDS) annual assessment dated [DATE] for R#45 revealed the following: Section B: Hearing, Speech and vision - resident understood when expressing ideas and wants, resident usually understands - misses some part/intent of message but comprehends most conversation; Section C: Cognitive Patterns: Staff Assessment for Mental Status (Brief Interview for Mental Status not conducted) - short term and long term memory problems, able to recall current season, location of room, staff names and faces, and that he/she is in a nursing home. Moderately impaired Cognitive skills for making decisions regarding tasks of daily life: decisions poor, and cues/supervision required; Section E: no behavior symptoms or wandering. Section F: Interview for daily preferences not completed - resident rarely/never understood and, Section I - Active [DIAGNOSES REDACTED]. Review of the Nurse's Notes and SBAR Communication Form and Progress note revealed, the following: On 07/06/2015 (time not given, MD notified at 6:57 p.m.), R#45 pushed another resident (not identified) into the dining room table. The other resident sustained [REDACTED]. On 07/16/2015 (time not given, family notified at 11 a.m.) R#23 and R#45 (room 1 A&B) were upset with each other and resident #23 rushed out of the room, tripped, fell and stated resident #45 was crazy. Resident #45 responded that resident #23 had stood over his bed and scared him. No physical altercation. Resident #45 was transferred to another room. On 07/18/2015 (time not given but family notified at 2:15 p.m.) Residents #45 and R#23 were observed arguing and yelling at each other (location not given) when resident R#45 pushed R#23 to the floor. R#23 sustained at skin tear to the left forearm. On 08/08/2015 (time not given, but family notified at 8:45 p.m.) R#23 wandered into the room of R#45 (2B)where R#45 grabbed R#23 by the hand causing injury to R#23 ' s hand (not specified) and causing R#23 to fall. On 09/07/2015 (time not given but family notified 5:40 p.m.), R#23 went into room 2B of R#45 who pushed R#23 to the floor. Resident #23 sustained a laceration to the right eye. On 09/07/2015 (times not noted) R#45 struck R#5 in the abdomen, because R#5 sat beside R#45 (location not given). On 09/21/2015 (time not noted but family notified at 4 p.m.) R#45 became agitated in the dining room and threw a chair at the staff. On 10/04/2015 (time not noted but family notified at 4:40 p.m.)Resident #45 entered his room - 2 bed B and found R#23 was lying in bed 2 bed A. R#45 began striking R#23 with his fist above the left eyebrow causing injury. (Injury not specified). R#45 discharged to another facility on 10/07/2015. Observation on 12/07/2015 at 9:55 a.m. revealed eleven (11) residents sitting up in the day room/dining room with the television (TV) on, no staff members observed in the room. Interview on 12/07/2015 at 10:00 a.m. with LPN AA on the Faith Two (the locked unit) revealed there was usually one (1) nurse and three (3) CNA's on the unit. Observation on 12/07/2015 at 10:15 a.m. revealed rooms 1 and 2 to be across the hall from each other and rooms 2 and 4 to be diagonally across the hall from each other. Soft Velcro stop sign across doorway of room 4. Interview on 12/08/2015 at 10:40 a.m. with CNA EE revealed that to help control behaviors the staff attempted to keep the residents occupied with activities such as movies, singing, playing games and throwing balls. Regarding wanderers the staff monitored the residents walking in the halls to keep them from going into other resident's rooms and getting into other resident's belongings. Residents were re-directed from other resident's rooms as needed and attempted to keep occupied. Attempts were made to have a staff member in the dining room at all times and to have someone monitoring the other residents at all times. A stop was sign was put up to keep R#23 from going into one of the rooms. Interview on 12/09/2015 at 8:30 AM with LPN FF revealed if a resident becomes agitated she does 1:1 by having the resident stay with her while she is passing medications. The residents responded to the attention and would settle down. Interview on 12/09/2015 at 9:20 a.m. with the Social Service Director (SSD) revealed she completed the MDS for sections C (Cognition), D (mood), E (behaviors) and Q (participation and goal setting). She also completed the care plan for these sections with appropriate interventions including those for redirection. Examples of caring for dementia residents would include understanding their face and body language since they cannot communicate like non- dementia residents, look at past work history for topics of conversation or related activities and talking with them, getting into their word is very important. Interview on 12/09/2015 at 2:15 p.m. with the Administrator, Regional Plant and Facility Supervisor, Corporate Clinical Director of Clinical Services and Corporate Director of Operations revealed that the intervention to assure the safety of residents on the unit was to separate them. The interview further revealed that there were nursing staff that rotated being on call and could come in to the facility if needed to help cover staff shortages, however, they were unaware of any current staff shortages. Interview on 12/10/2015 at 8:45 a.m. with the Medical Director (MD) regarding residents with behaviors. He stated the facility should have enough staff and manage the residents. Stated the facility needed more staff for resident safety and he had addressed this in the Quality Assurance Committee (QUA) meetings, the meeting prior to the last one. The MD revealed that in some cases the need for additional staffing could place residents at risk for harm due to aggressive behaviors putting residents and staff at risk, however, there were so many residents with psychiatric issues, staffing might not effect that regardless. Regarding management of behaviors, the MD revealed that he completed medication reviews but was against oversedating residents to manage behaviors. The MD went on to reveal he thought the facility was not equipped to take residents with behavior issues. Interview on 12/10/2015 at 10:30 a.m. with the DON, ADON and LPN AA in the nursing office revealed that, LPN AA was responsible for staffing on Faith Two. LPN AA revealed that she attempted to have three (3) CNA's for the 7-3 and 3-11 shifts and two (2) for the 11-7 shift. If there was a call out she, or designated staff, attempted to find a replacement. During the day, up until 5 p.m. to 6 p.m., there were staff available in the building to help as needed including a Unit Manager that worked between Faith Two and Haven Two, an activity person, a central supply person who was also a CNA and restorative nursing were on the unit at times. After 5 p.m. there would be a shift supervisor present over the entire building until 7 p.m. (hours 1 p.m. - 7 p.m.) and then on the 11 p.m. -7 a.m. shift. For weekends, there was a weekend supervisor and a department manager available. Any extra resident care staff in the building would get pulled to Faith II. Also, there were residents that went off the hall for activities, which meant fewer residents to care for during those times. Staffing was based on the acuity of care and the census. Acuity of care could mean such things as: more or an increase in the prevalence of behaviors, new residents getting acclimated, transfers from other halls and prevalence of roommate compatibility issues. LPN AA revealed she considered input from the staff who worked with the residents when completing the schedule. When asked if there had ever been consideration of increasing the staff on Faith Two due to occurrences with resident #23, the staff replied that they had to go with what they had due to people resigning/quitting and the paycheck problems they recently had. Also, not everyone desires to work with the special populations such as the residents on Faith Two. Staffing concerns had been brought up to corporate who had determined that two CNA's were adequate as long as the charge nurse could be available to assist, so changes to how medications were scheduled and administrated were implemented to allow the charge nurse more time off the cart to assist with resident care ( This was earlier in the year sometime). Nothing else they could recall had been brought up to corporate, however it was mentioned that they could not recall ever having such a high census on Faith Two. Regarding R#23, the interview revealed the physician had reviewed the medications and suggested some changes to the family who refused certain medications including Depakote in particular citing they felt the resident had been overly sedated at the last facility he was at. Interview on 12/10/2015 at 12:20 p. m. with the administrator revealed there were ten (10) wanderers on Faith Two. Interview on 12/11/2015 at 7:45 a. m. (works the night shift) with LPN GG revealed there were five (5) wanderers on the unit (resident #23 discharged to another facility). If a resident becomes agitated they might have a prn order available and staff can redirect as much as they can, supervise, and attempt to take to their own room. Were she to need additional staff on her hall she could check with another hall for staff to pull and call her supervisor. She had been on staff her for four years and could not recall a problem with needing help at night. Regarding the safety of resident #23, he was redirected back to his room and discouraged form contact with other residents and has prn available. It can be challenging when more than one resident at time requires redirection. Interview on 12/11/2015 at 10:40 a.m. with LPN HH revealed resident #23 had dementia and was in and out of resident's rooms. He required constant redirection and checking on where he was. He would get out of his bed and go to other rooms without staff seeing. He would swing out at other residents. It was especially difficult with two CNAs on 7 a.m. - 7 p.m. She stated the residents were possessive and wanted their privacy. Every time resident #23 got into an altercation with another resident it was because he went into their room. He would take their clothing and have their shoes on. The staff cannot provide 1:1 and the hall is L shaped so one staff member has to be able to see down the other hallway which was extremely difficult, especially if working with short staff; was manageable with three but when there were two CNAs, the incidents would increase. But, it was not like that every day. There were days on which nothing would occur. Also there were a lot of residents with behaviors. The physician tried to adjust resident #23s medications but the family refused certain medications due to feeling the resident was over sedated at his last facility. A review of staffing on days of incident occurrence revealed two CNA's on Faith II when the following occurred: 11/30/2015 5:15 p.m. Resident #23 and resident #3 - 2 CNA's 3-11 Census 30 10/12/2015 6:00 p.m. Resident #23 and resident #3 - 2 CNA's 3-11 Census 28 Review of the Facility Policy regarding Resident Rights revealed the residents had the right to be free from mental and physical abuse, had the right to self-determination and to security of possessions. Abuse prohibition review completed and revealed no concerns. Observations made on 12/07/15 at 11:15 a. m. revealed that the facility had two (2) resident smoking areas, main smoking area, located out the alcove off the main dining room, and the secured smoking area, located off of Faith 2 (secured unit). Continued observations of the main smoking area revealed a broken wooden broom handle with a Sharpe and jagged end. Further observations of the main smoking area revealed that there was an unlocked metal cabinet that contained unlocked block boxes. The black boxes were tabled with with resident names. It was revealed that the containers contained cigarette lighters and cigarettes. Further observations revealed metal rod with a hinge in the middle. Each portion of the rods measured approximately 3 (three) feet in length when folded, and approximately 6 (six) feet in length when unfolded. Each end of the medal rod had a Sharpe and pointed end. The metal rod was located on the window ledge on the right side of the metal cabinet. Further observations revealed that a door that was leading to the laundry department, from the resident smoking area, was propped open with a wooden handle and floor dryer. Observations on 12/07/15 at 11:30 a. m. revealed that fifteen (15) resident went on the scheduled smoke break. One (1) staff member was observed passing out cigarettes, Observations revealed that some residents received 2 (two) cigarettes at a time, when others were given just one. Residents were observed placing cigarette butts on the ground, on window ledges, and on the lids of the disposal trash cans. Interview on 12/08/15 at 8:30 a. pm. with Certified Nursing Assistant (CNA) RR revealed that the resident smoking supplies were stored and locked in the metal cabinet. RR revealed that each resident had a separate black box with cigarettes and lighters. The storage cabinet is to be kept locked and secured. It was further revealed that different floor staff are assigned to different smoke breaks. Interview further revealed that the residents get two cigarettes during the break, and that some get one at a time with others getting both. When asked about the cigarette butts that were not placed in the proper disposal containers, the interview revealed that the residents should place the discarded butts in the provided containers. CNA RR that should not be any cigarette butts on the ground or window ledges. Interview revealed that they were there when the day shift came to work. CNA RR revealed that each unit and environmental services monitor different smoke braes, and that all staff do not monitor the residents like they should. Interview revealed that the environmental services was to keep area clean and that the area should be clean. Observation on 12/07/15 at 1:30 p.m., 12/08/15 at 10:15 a.m., and 10/09/15 at 12:05 p.m. of resident #29 room revealed a power strip on the floor towards the right side of the bed side night stand. Continued observation revealed that the power strip was 2 feet from the resident's reclining chair and the resident's oxygen concentrator was plugged into the strip. Interview on 12/09/15 at 12:25 p.m. with the Regional Plant and Facility Engineer Supervisor they acknowledged that the power strip was located on the floor with resident medical care equipment plugged in. Continued interview revealed that he expects staff to notify him if a resident requires additional outlets for equipment. He revealed that he was told from someone who's name he cannot recall that the facility is not to use any power strips in the resident's sleeping areas. Surveyor: Olson, Elizabeth Review of R#40's Quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed a Brief Interview for Mental Status (BIMS) cognitive status of eleven (11) which indicated cognitive impairment . Further review of the 7/31/15 MDS section G revealed R#40 required extensive assistance with personal hygiene and section I revealed [DIAGNOSES REDACTED].Altered Mental Status and Genarized Muscle Weakness. Observation on 12/7/15 at 4:17 p.m. of room # 60 revealed R #40 was in bed, alert and revealed he/she was not able to get out of bed because he/she would fall.Observation revealed the presence of three blue(3) disposable razors in the window sill next to the resident's bed. Licensed Practical Nurse (LPN) LL was informed of the presence of the razors at 4:17 p.m. on 12/7/15 and he/she confirmed the presence of the razors in the window sill next to the resident's bed and removed them. The resident stated he threw the razors on the window sill because he shaves himself. Resident #40 stated he shaves every other day and uses one razor each time he shaves. During interview the resident was observed to not have a roommate and revealed no residents come into his room . R#40 further revealed that if anyone came into his room he/she would call the nurse. During an interview on 12/7/15 at 4:20 | 2018-05-01 |