cms_GA: 8078
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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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 8078 | WYNFIELD PARK HEALTH AND REHABILITATION | 115625 | 223 W.THIRD AVENUE | ALBANY | GA | 31701 | 2012-03-29 | 318 | E | 0 | 1 | LF6S11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews with residents and staff, and record review, it was determined that the facility failed to provide range of motion exercises, adaptive devices and/or ambulation assistance to maintain function, range of motion abilities and prevent contractures for five residents (W, #19, R, H and S) in a total sample of 36 residents. Findings include: 1. Resident W had [DIAGNOSES REDACTED]. He/She was coded on the 2/02/12 Minimum Data Set (MDS) assessment as needing total assistance for all activities of daily living (ADLs). There was a care plan since 2/16/12 to address his/her need for extensive assistance with activities of daily living (ADLs). There was an intervention for restorative nursing services as indicated. On the 3/10/12 Functional Program form, the occupational therapist documented that nursing staff was to properly place a left shoulder brace on the resident daily and a left resting hand splint daily to prevent further contractures. However, it was observed on 3/27/12 at 4:00 p.m., on 3/28/12 at 8:50 a.m., 1:00 p.m., 2:15 p.m. and 4:50 p.m. and on 3/29/12 on 8:55 a.m., 10:30 a.m. and 11:30 a.m., that staff had failed to apply the left resting hand splint. During the observations on 3/28/12 and 3/29/12, the staff also had failed to apply the left shoulder brace on the resident. During an interview on 3/28/12 at 2:15 p.m., resident W stated that he/she had not worn the hand splint for about two weeks. He/She stated that the shoulder brace had not been put on that morning because the girl said that she did not know how to do it. In an interview on 3/29/12 at 12 p.m., the occupational therapy aide confirmed that the staff should have applied a splint to the resident's left hand and a brace to his/her left shoulder every day. She/He said that this (the application of the splint and brace) had been a concern since the CNAs caring for the resident were made responsible for applying those splints and braces. During an interview on 3/29/12 at 12:30 p.m., licensed nurse XX confirmed that the CNAs caring for the resident should have applied the splint and brace as planned by the occupational therapy staff to address his/her positioning needs and maintain his/her level of function. 2. Resident #19 had [DIAGNOSES REDACTED]. On the 2/22/12 quarterly MDS assessment, licensed staff coded him/her with limitations in range of motion on both sides of his/her upper and lower extremities. He/She was coded as having received passive range of motion exercises six days a week , active range of motion exercises five days a week, and a splint or brace applied six days a week. There was an 11/30/11 Seating Positioning Addendum form with documentation by the physical therapist that the resident had contractures of his/her upper and lower extremities. The therapist noted that bilateral elbow splints were used because of flexion contractures, and the bilateral AFOs were used to maintain joint alignment. There was a care plan since 11/30/11 to address his/her need for total care by nursing staff with all of his/her ADLs. There was an intervention for nursing staff to apply bilateral hand, elbow and ankle splints daily as tolerated. There was an ADL Care Pan with documentation that right and left elbow splints and bilateral ankle foot orthosis (AFO) were to be applied daily as tolerated. There were March 2012 physician's orders [REDACTED]. However despite the physician's orders [REDACTED]. 12:20 p.m., that nursing staff had not applied any splints or AFOs on the resident as ordered and planned. The resident was not wearing splints or AFOs during those observations. 3. Resident R had a care plan since 5/25/11 to address his/her impaired mobility related to his/her cognitive impairment and dementia. There was an intervention for nursing staff to perform passive range of motion exercises to affected joints as indicated and document, and to assist with positioning and transfers as necessary. There were current restorative nursing service orders for the resident to be out of bed in a geri-chair for positioning purposes and safety, and to position him/her in the geri-chair daily with a bilateral step down cushion and foot box. However, during observations of the resident seated in a geri-chair on 3/27/12 at 2:35 p.m. and 4:20 p.m., staff had not provided a foot box for positioning. Resident R received skilled occupational therapy from 10/14/11 until 12/8/11 when he/she was discharged to a functional program to receive active range of motion (ROM) exercises daily to his/her upper extremities for all joints and all planes for 4 sets of 25 repetitions. The resident received skilled physical therapy from 10/14/11 until 12/7/11 when he/she was discharged to a functional program to walk in the hallway with contact guard - stand by assistance with a rolling walker as tolerated and to receive ROM to bilateral lower extremities that included leg kicks while seated, marches and ankle pumps all in a seated position for three (3) sets of 15 repetitions. Review of the Aide Assignment Record revealed documentation by the CNAs that the resident had been provided ROM exercises to his/her upper extremities from 12/8/11 through 12/31/11. However, there was no evidence that nursing staff had provided ROM exercises for the resident's lower extremities in December 2011 or for either the resident's upper or lower extremities in January, February, and March 2012. There was a 1/5/12 request for a skilled therapy screening due to the resident having weakness in his/her lower extremities. According to the comprehensive rehabilitation screen completed on 1/6/12, the physical therapist did not recommend that a skilled evaluation be done because, the resident had recently been discharged from skilled physical therapy services on 12/7/11 and was on a restorative nursing program. However, there was not any evidence that restorative nursing staff was providing a functional program for the resident as planned. During an interview on 3/28/12 at 2:50 p.m., resident R stated that he/she had gone to therapy when he/she was first admitted and could walk with a rolling walker with some help. He/She said that he/she was afraid to do that now because, no one had helped him/her exercise or walk. Resident R said that his/her legs were getting stiff. He/She stated that he/she went to the group exercise program as many mornings as he/she could but, sometimes he/she did not get up early enough to attend. 4. Resident S was admitted on [DATE] with [DIAGNOSES REDACTED]. There was a physician's orders [REDACTED].The resident had a new [DIAGNOSES REDACTED]. Licensed staff coded him/her on the 8/24/11 Minimum Data Set (MDS) for comprehensive assessment on admission and the 11/22/11 and 2/16/12 quarterly MDS assessments as not having limitations with upper and lower extremities range of motion. There was a care plan since 10/29/11 to address the resident having frequent pain in multiple sites because of arthralgia. The interventions included that he/she should receive active range of motion by the restorative program six days a week to prevent joint contracture. During an interview on 3/27/12 at 9:40 a.m., resident S stated that his/her left arm hurt. The resident was in bed being bathed by a Certified Nursing Assistant ( CNA), an agency CNA, who stated that was the first time she had worked with resident and was not aware of his/her shoulder pain. The resident stated that his/her left arm and shoulder had hurt ever since he/she had heart problems while in the hospital. He/She stated that the doctor, who had looked at his/her arm and shoulder the other day, said it was something like arthritis and ordered some pain medicine. The resident stated that staff did not assist him/her to exercise his/her arms and legs or provide therapy. He/She stated that the therapist had looked at him/her for therapy but, he/she guessed because of his/her heart condition that he/she did not qualify. The resident demonstrated that he/she had difficulty raising his/her left arm. When the CNA attempted to take off the resident's gown during care, the resident complained about the pain in his/her shoulder and was unable to raise his/her left arm. The resident assisted with taking off the gown with his/her right arm which he/she said caused him/her no problems. The resident stated that he/she had not received any staff assistance and was to exercise his/her own shoulder. During an interview on 3/27/12 at 4:30 p.m., CNA WW, who was assigned to give care to the resident , stated that the resident complained of pain in his/her left shoulder. She said that the nurse was aware of the pain but, she did not exercise or assist the resident to exercise his/her arms or legs. She said that the resident moved them when he/she turned in bed. A review of the Aide Assignment Record revealed documentation by the CNAs that they were providing care to the resident. However, there was no documented information about the resident having been unable to raise his/her left arm. There was no evidence that the facility had addressed the resident's left arm limitations and need to continue exercises to maintain his/her range of motion abilities. On 3/29/12 at 9:30 a.m., observation with licensed nurse TT revealed that the resident complained of pain when TT attempted to do range of motion with the resident's left shoulder. Nurse TT stated that she had known that the resident had complained of pain but, was not aware that the resident could not move that shoulder. 5. Resident H had [DIAGNOSES REDACTED]. The documented goal was that the resident's mobility would not decrease. There were interventions for nursing staff to provide support with transfers as needed and for physical therapy and occupational therapy as needed. The resident had received occupational therapy from 1/31/2 through 2/27/12. On the 2/27/12 Functional Program form, the occupational therapist documented that active/assisted range of motion exercises for both of the resident's shoulders, elbows and wrists were to be done daily as tolerated to maintain level of function. The resident had received physical therapy from 1/31/12 through 2/27/12 . On the 2/27/12 Physical Therapy Discharge Note, the therapist documented a plan for the resident to walk in the hallway with a rolling walker and contact guard to stand-by assistance for more than 300 feet or as tolerated, and for strengthening exercises while sitting in the wheelchair to maintain his/her strength and functional abilities. However, during an interview on 3/28/10 at 10 a.m., resident H said that no one was assisting him/her to walk in the hall. He/She said that no one had been assisting him/her with any exercises for awhile now. Review of the CNA Care Plan Worksheet revealed no documentation of restorative interventions to be provided for the resident. During an interview on 3/29/12 at 1 p.m., CNA FF said that she did not recall having been instructed on restorative services to provide for resident H. She said that she had not assisted him/her to ambulate and to perform range of motion exercises. During an interview on 3/29/12 at 1:15 p.m., licensed nurse GG said that therapy was supposed to be providing services for resident H. | 2016-07-01 |