cms_GA: 99
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 99 | CENTER FOR ADVANCED REHAB AT PARKSIDE, THE | 115040 | 110 PARK CITY ROAD | ROSSVILLE | GA | 30741 | 2018-08-23 | 690 | D | 1 | 1 | 07R411 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on observation, record review, and staff interview, the facility failed to perform perineal care in a manner to prevent potential urinary tract infections [MEDICAL CONDITION] to the extent possible for one resident (R) (R#25). The sample size was 34 residents. Findings include: Review of R#25's clinical record revealed that she had [MEDICAL CONDITION] (paralysis on one side of the body) following a stroke, urine retention, and a history of UTIs. Review of R#25's Modification of Annual Minimum Data Set ((MDS) dated [DATE] revealed that she was always incontinent of urine, and needed extensive assistance for toilet use. Review of R#25's urine cultures revealed infections with the following organisms: 11/14/17: Proteus mirabilis 3/20/18: Proteus mirabilis 5/10/18: [MEDICATION NAME] raffinosus During an observation of incontinence care with R#25's permission by Certified Nursing Assistant (CNA) BB on 8/20/18 at 4:13 p.m., the CNA was observed to obtain and place several wet washcloths on top of the resident's bed rail before removing her incontinent brief, which had a moderate amount of urine in it. Further observation revealed that the CNA asked R#25 if she wanted to wipe herself and she responded yes, and was given one of the wet washcloths. The resident was observed to wipe her right eye with the washcloth, and the CNA instructed her to wipe between her legs at which time she reached between her legs and wiped herself several times from the rectal area towards the urethra (back to front). Continued observation revealed that the CNA did not stop and instruct her the proper way to wipe. CNA BB was then observed to get another one of the wet washcloths on the bed rail, and cleaned the resident's perineal area properly from the front towards the back, and then turned her to her side and washed her buttocks with another wet washcloth from the bed rail. Further observation revealed that CNA BB did not dry the resident's skin before putting a clean incontinent brief on her. During interview with CNA BB on 8/20/18 at 4:35 p.m., he stated that he usually got a bath basin with water and peri-wash to perform incontinence care, but that R#25 liked to wipe herself, so he just used the wet washcloths. During an observation of a shower with R#25's permission on 8/22/18 at 7:25 a.m., she was observed in the common shower room in a shower chair with a large circular opening in the seat of the chair, and was placed in the shower stall by CNA CC. After washing the rest of her body, CNA CC obtained a clean soapy washcloth and first wiped R#25's inguinal areas, and then used the same washcloth to wipe the perineal and rectal area from underneath the opening in the chair in a circular and back and forth motion, and then rinsed her off. During interview with the Licensed Practical Nurse (LPN) Infection Control Nurse on 8/22/18 at 10:34 a.m., she stated that her expectations were that the staff wipe from the front to the back when doing perineal care, and that a separate section of the washcloth be used for each stroke. She stated during further interview that if a resident was allowed to wipe themselves and was doing it incorrectly, that the staff should educate them on why it was important to go from the front to the back due to the possible increase in urinary tract infection, and if they needed assistance to do so. The LPN Infection Control nurse further stated that a bath basin should be used for perineal care with warm water and soap and plenty of washcloths, and that it was not acceptable to place the washcloths on the bed rail, as there may be microbes on the rail. She further stated that the resident should be dried before a clean brief was applied. During continued interview, she stated that perineal care should be done in the same manner when a resident was in a shower chair and the staff reaching up from the opening in the chair, with a clean washcloth used and the resident cleaned from the front to the back with a different area of the washcloth for each stroke. Review of the facility's Perineal Care policy revised (MONTH) (YEAR) revealed: The following equipment and supplies will be necessary when performing this procedure: 1. Wash basin . Steps in the Procedure: 1. Place the equipment on the bedside stand . 3. Fill the wash basin one-half full of warm water. Place the wash basin on the bedside stand within easy reach. 8. For a female resident: a. Wet washcloth and apply soap or skin cleansing agent. b. Wash perineal area, wiping from front to back. (4) Gently dry perineum. | 2020-09-01 |