cms_GU
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107 rows
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Suggested facets: inspection_date, scope_severity, complaint, standard, eventid, filedate, inspection_date (date), filedate (date)
| Link | rowid ▼ | facility_name | facility_id | address | city | state | zip | inspection_date | deficiency_tag | scope_severity | complaint | standard | eventid | inspection_text | filedate |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | 1 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2019-01-30 | 565 | E | 0 | 1 | IS8311 | Based on record review and interview, the facility did not ensure that guests and/or other individuals attended the resident group meetings only at the respective group's invitation; and did not always act promptly upon the grievances and recommendations raised by the residents regarding issues of resident care and life in the facility. Findings include: 1. During an interview on 1/28/19, Resident 9, a member of the resident council, stated that meetings were held at least monthly by the residents. Resident 9 added that while a facility staff member was present during the meetings to provide assistance such as documenting minutes of discussion, the ombudsman however, was also always present. In the same interview, Resident 9 stated that she did not know that attendance by the ombudsman was by invitation of the resident council only. The resident added that in some cases , the meeting was postponed when the ombudsman was not available. Review of council meeting notes provided by an activity staff member (AD1) on 1/29/19 revealed that the ombudsman was in attendance during meetings including those held in May, (YEAR); June, (YEAR); July, (YEAR); September, (YEAR); and (MONTH) (YEAR). In a separate interview on 1/29/19, AD1 verified that the ombudsman was a regular participant during the resident group meetings. 2. Review of the resident council meeting minutes revealed that efforts made by the facility to address complaints or grievances by the residents were not always sustained. Review of the (MONTH) (YEAR) meeting minutes, for example, noted a complaint by residents waiting to be attended to and not being attended at all. While the complaint was acknowledged by nursing staff as an ongoing problem and corrective actions were undertaken, including reminding staff about addressing resident needs attentively and immediately, the same (or similar issues) were raised again during the September, (YEAR) meeting with the residents reporting being told by staff to wait for your nurse, or I'll come back but does not return… | 2020-09-01 |
| 2 | 2 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2019-01-30 | 583 | C | 0 | 1 | IS8311 | Based on observation and interview the facility failed to provide privacy and confidentiality for 18 out of 18 residents in the nursing unit. This failure exposed the resident's diagnosis, treatments, medications and personal concerns when the census flow sheet was left out on the cart in the hallway. Findings include: During a unit tour on 1/29/2019 at 9:00 a.m., noticed on top of the medication cart the census entire unit flow sheet record. The census flow sheet contained the resident names, diagnosis, medications, treatments and personal concerns. The census flow sheet was not secured and all the resident's information was displayed and anyone walking in the hallway would have access to the residents' confidential medical record information. During an interview on 1/29/2019 at 9:05 a.m., with Staff #5 she acknowledged that the census flow sheet was left out on top of the medication cart which exposed all the residents' personal and confidential information. Staff # 5 quickly apologized and stated that she knows better and should have placed the form into her binder or inside the medication cart. During an interview concurrent with a policy review on 1/29/2019 at 9:50 a.m., with administrative Staff #2 she acknowledged that the census flow sheet definitely disclosed confidential information about the 18 residents on the unit and it should not be left exposed to everyone. She also specified that she had multiple in-services with the nursing staff in regards to safe guarding the patient's confidential information. During the review of the facility policy titled Medical Record Processing for Skilled Nursing Unit disclosed that the medical record will be systematically organized, stored in a safe, secured manner to ensure patient confidentiality. The facility will maintain all patient information in a secure location to ensure protection from loss, destruction or unauthorized use. | 2020-09-01 |
| 3 | 3 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2019-01-30 | 585 | D | 0 | 1 | IS8311 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview the facility failed to implement grievances as per policy and regulation for 1 out of 8 sampled residents (R # 301). Resident's grievances are not being investigated, tracked, no corrective action plans are implemented, no documentation of resolutions and no evidence of the grievance log available for review. This failure prevents proper resolutions to resident and family concerns. Findings include: During a record review on 1/29/2019 reveals that resident #301 was admitted to facility on 3/24/18 with the [DIAGNOSES REDACTED]. Minimum Data Set (MDS) 14 day assessment completed on 4/7/18 disclosed a Brief Interview for Mental Status (BIMS) score of 14. Resident #301 was also admitted to facility for intravenous (IV) antibiotic treatment for [REDACTED]. Additional record review revealed that resident #301 had several nursing notes with documentations of the IV infiltration occurrence during the [MEDICATION NAME] administration and resident IV site was red, swollen, warm to touch and tender. During an interview on 1/29/2019 at 10:00 a.m., with Administrative Staff #9 she indicated that resident #301 spouse was very out spoken with all her concerns and she frequently voiced her concerns. She further explained that the residents and spouse concerns were addressed to their satisfaction but was never documented. When asked if she was aware of the police coming into the facility to question Staff #12 she indicated No during that time she was out on leave and that the person that was providing coverage at the facility did not forward the information to the administration staff. She further explained that her expectation from all staff is to report all concerns to administration. Administrative Staff #9 was not able to provide any evidence that the patient and spouse concerns were ever investigated or resolved. During an interview on 1/29/2019 at 12:00 p.m., with the Staff #12 she indicated that the residents spouse… | 2020-09-01 |
| 4 | 4 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2019-01-30 | 655 | E | 0 | 1 | IS8311 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to develop and implement baseline nursing care plans for 1 of 8 sampled residents (Resident 18). Failure to assess, develop, and implement baseline nursing care plans for Resident 18's history of smoking could subject the resident and other residents at risk for potential injury associated with smoking. Additionally, failure to assess, develop and implement a base line nursing care plan associated with the use of [MEDICATION NAME] could potentially lead to the failure to identify signs and symptoms of adverse effects associated with use of the anticoagulant. Findings include: 1. Resident 18 is a [AGE] year-old male who was admitted on [DATE] with a [DIAGNOSES REDACTED]. His social history shows he had a history of [REDACTED]. The records also reflect he had no desire to quit tobacco use. During the resident interview on 1/28/2019, the resident stated that while at the skilled nursing unit he had been smoking unsupervised in the designated smoking area, and that he maintained his own cigarettes and lighter. On 1/30/2019 during a concurrent record review and interview with a licensed nurse (LN2) she validated that the facility did not complete an assessment to determine if Resident 18 was safe with the use of his cigarettes. LN2 also validated the facility did not develop and implement a nursing care plan associated with Resident 18's cigarette use. On that same day the facility policy titled Skilled Nursing Unit (SNU) Smoking Policy was reviewed. The procedure within the policy had several items listed 1 through 24 and the relevant items state: #7 .Residents with authorization from their physician or licensed independent practitioner may be allowed to smoke in designated areas. #12 .Staff is responsible for ensuring that smoking by residents is done in a safe manner. #13 .Residents will be allowed to smoke and use smoking material only as specified in their care plan. 2. During further i… | 2020-09-01 |
| 5 | 5 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2019-01-30 | 656 | D | 0 | 1 | IS8311 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to develop and implement a comprehensive person centered nursing care plan with measurable objectives to meet the resident smoking needs for 1 of 8 sampled residents (R#4). Failure to develop and implement the nursing care plans for R #4, a current smoker could place the resident and other residents at risk for potential injury associated with smoking. Findings include: During an interview on 1/28/2019 at 12:45 p.m., resident #4 admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Resident is alert and oriented x 3, his Minimum Data Set (MDS) Annual Assessment disclosed a Brief Interview for Mental Status (BIMS) score of 15. Resident #4 indicated that he was waiting for proper home placement because he needs ADL care. In addition Resident #4 validated that he is a current smoker since admitted at the facility. He verbalized that he maintained all of his smoking supplies at bedside which includes the cigarette and the lighter and only smoke at the designated smoking areas assigned by the facility. During an interview on 1/29/2019 at 1:30 p.m., with the administrative staff #2 she indicated that the R #4 according to the smoking policy should have had a smoking care plan identifying his safety needs and expectations. During an interview on 1/29/2019 at 1:40 p.m., with the Administrative Staff #11, she validated that a smoking care plan was not developed or implemented for resident #4 as per policy. During an a record review of the smoking policy on 1/29/2019 titled SNU Smoking Policy disclosed that resident would be allowed to smoke and use smoking materials only as specified in their care plan. | 2020-09-01 |
| 6 | 6 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2019-01-30 | 690 | D | 0 | 1 | IS8311 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, and interview, the facility did not ensure that a resident who had an indwelling catheter was assessed for removal of the catheter as soon as possible and received treatment and services to prevent urinary tract infections. Findings include: 1. Resident 9 was admitted to the facility on [DATE] with several [DIAGNOSES REDACTED]. Review of the quarterly minimum data set ((MDS) dated [DATE] revealed that the resident had a BIMS (brief interview of mental status) score of 15 indicating that she had no cognitive impairments and that she was dependent on staff for most activities of daily living. The medical record also noted that the resident also had a [MEDICAL CONDITION] as well as an indwelling catheter. During the survey on 1/28/19, Resident 9 was observed with a urinary drainage bag at the bedside draining yellow urine. Review of the care area assessment dated [DATE] revealed that urinary incontinence was triggered because of the resident's use of an indwelling catheter due to restricted mobility and presence of healing stage 4 sacral pressure sore. The assessment noted that a care plan will be developed to ensure that the resident will maintain continuous drainage of her bladder while minimizing the risk of negative outcomes. Review of the medical record revealed that Resident 9 has had several urinary tract infections which were treated with antibiotics: On 6/27/18, a urine culture and sensitivity (C&S) test result revealed infection with Citrobacter koseri (100,000 org/ml). On 7/13/18, another urine C&S test result revealed the presence of Eschirichia coli (100,000 org/ml). On 7/27/18, a urine C&S result indicated continuing infection with Eschirichia coli (100,000 org/ml) and yeast (100,000 org/ml). On 10/04/18, a C&S obtained revealed the presence of infection with Eschirichia coli (100,000 org/ml) and proteus mirabilis (100,000) org/ml). On 11/19/18, another urine C&S revealed infection with [DIAGNOS… | 2020-09-01 |
| 7 | 7 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2019-01-30 | 693 | D | 0 | 1 | IS8311 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to ensure that one of eight sample residents (Resident 5) who was fed by enteral means received appropriate care and services to prevent potential complications associated with the tube feeding. Failure to administer tube feedings as ordered and in accordance with standards of practice has the potential to contribute to facility acquired conditions. Finding includes: Resident 5 is a [AGE] year old female that was admitted into the skilled nursing unit on 1/13/2019. Her admission [DIAGNOSES REDACTED]. The records also identified that she was totally dependent on staff for all care. Her other [DIAGNOSES REDACTED]. The resident also had a gastric tube which was being used for nutritional feeding and was placed sometime in the past. On 1/29/2019, a licensed nurse (LN5) was observed preparing seven medications that were to be administered to Resident 5 at 9:00 a.m. At that same time the resident was to receive her ordered intermittent bolus tube feeding of [MEDICATION NAME] (1 carton) which equaled to approximately 250 milliliters (ml) of liquid. Prior to administering the medications or tube feeding LN5 checked placement of the tube and checked for gastric residual. Resident 5 had a gastric residual of approximately 50 - 60 ml. LN5 consulted with the physician and held the medications and feeding till 10:00 a.m. At 10:00 a.m., LN5 again checked placement of the gastric tube and assessed for gastric residual. Resident 5 had After administering the medications and the tube feeding LN5 acknowledged she did not flush the gastric tube with water between each medication. She also validated that she gave 1 and 1/2 cartons of the [MEDICATION NAME] tube feeding. LN5 validated that the only times Resident 5 was to receive one and a half carton of tube feeding was at 1:00 a.m. and at 1:00 p.m. Later that same day, LN2 provided the Enternal (SIC) Tube Medication Administration policy. With… | 2020-09-01 |
| 8 | 8 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2019-01-30 | 732 | C | 0 | 1 | IS8311 | Based on observation and interview, the facility did not post the actual hours worked by nursing staff directly responsible for resident care per shift. Finding includes: The facility's staffing information was noted on a white, dry erase board in the hallway across from the nursing station. While the posting included the current date, census, as well as the number of registered nurses, licensed vocational nurses, and certified nurse aides directly responsible for resident care per shift, it did not, however, include their actual number of hours worked, as required. | 2020-09-01 |
| 9 | 9 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2019-01-30 | 757 | D | 0 | 1 | IS8311 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility did not ensure that the resident's was free of unnecessary drugs including drugs used without adequate monitoring. Findings include: 1. Resident 9 was admitted to the facility on [DATE] with several [DIAGNOSES REDACTED]. The medical record revealed that the resident had a [MEDICAL CONDITION] and an indwelling catheter and was described as being a paraplegic. The most recent minimum data set assessment ((MDS) dated [DATE] described the resident has having a BIMS (brief interview of mental status) score of 15 indicating that she had no cognitive impairments. The MDS also noted that she had no [MEDICAL CONDITION], no mood disorders except for poor appetite (or overeating), and was totally dependent on staff for all activities of daily living. A physician's note dated 11/14/18 revealed that the resident had [MEDICAL CONDITION] disorder that was Likely contributing to issues medically; and that she was being followed by a psychiatrist. Review of the medical record revealed that Resident 9 was receiving [MEDICATION NAME] 20 mgs for depression daily. The depression, according to behavior monitoring sheets, was manifested by withdrawal. On 12/20/18, a physician's orders [REDACTED]. Review of monitoring sheets including those completed in (MONTH) (2018), and (MONTH) (2019) revealed that monitoring for withdrawal was not always being conducted on all three shifts, and at times, for several days to a week (12/12/18 - 12/19/18). For days when entries were available, monitoring noted 0 indicating no withdrawal behaviors were observed. In addition, monitoring for side effects was not always being conducted. During the survey, Resident 9 was observed being wheeled to the day room by staff in her bed where she could watch television or interact with other residents who were in the room. In an interview on 1/29/19, the resident stated that she was usually brought to the day room around mid-day because it was … | 2020-09-01 |
| 10 | 10 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2019-01-30 | 761 | E | 0 | 1 | IS8311 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and interview, the facility failed to ensure that all single use medical solutions without preservatives were used only once. Failure to use single use irrigation solutions per the manufacture recommendations could result in health care acquired infections. In addition the facility failed to store all drugs in a locked medication cart. This failure has the potential to have an unauthorized person with access to the residents medications. Findings include: 1. On 1/29/2019 a licensed nurse (LN6) was observed doing a dressing change for Resident 5 on the right buttock and sacral area pressure ulcers. Resident 5 is a [AGE] year old female who was admitted to the skilled nursing unit on 1/13/2019. Her admission [DIAGNOSES REDACTED]. The records also identified that she was totally dependent on the facility for all care. Her other [DIAGNOSES REDACTED]. Resident 5 also had a gastric tube and left heel wound. The left heel wound, the gastric tube site, the sacral pressure ulcer and the right buttock pressure ulcer were all to be cleaned initially with normal saline solution. During the sacral and right buttock pressure ulcers wound care observation, LN6 cleaned the wounds with normal saline solution then applied a wet dressing of 0.125% Dakin's solution. The wounds were then covered with a clean dry gauze and secured with paper tape. The Dakin's solution was labeled with an open date and a discard date. The 500-milliliter (ml) normal saline solution was marked with an open date of 1/28/2019. The normal saline solution was used and returned to its storage area. On 1/30/2019 another observation of Resident 5's normal saline solution occurred. The bottle of solution that had been opened on 1/28/2019 and was still being used for her all her wound or gastric tube site care. The manufactures label indicated the solution was a single use item, there was no reference stating the solution had any form of preservative or bacterial static o… | 2020-09-01 |
| 11 | 11 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2019-01-30 | 812 | C | 0 | 1 | IS8311 | Based on observation, interview, and record review, the facility's kitchen failed to always monitor the refrigerated food temperatures. Failure to monitor refrigerated food temperatures can lead to a potential for food loss and or food-borne illness. Finding includes: On 1/28/2019, the initial tour of the kitchen was completed. On 1/30/2019, the meal service observation was completed and further investigation occurred regarding periodic failures to record the refrigerator and freezer food temperatures. The facility policy titled Storing Food and Supplies stated, Freezer and refrigerator walk-ins and reach-ins are provided with a built in outside thermometer and an inside thermometer. Temperatures are checked and recorded twice daily by cooks on duty . During an interview with the food service manager (FS1) she indicated her expectation was for temperatures to be recorded twice a day. During a concurrent record review of the walk-in chiller and walk-in freezer temperatures, FS1 manager acknowledged that on 12/21/2018 and 12/20/2018 there were failures to document the refrigerator temperature readings twice a day. Additionally, on 12/24/2018, FS1 also validated there was a failure to document the freezer temperatures twice a day. | 2020-09-01 |
| 12 | 12 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2019-01-30 | 814 | C | 0 | 1 | IS8311 | Based on observation, interview, and record review, the facility failed to ensure that the facility garbage and food waste container on the exterior of the building was covered. Failure to cover the facility garbage container had the potential to attract insects and vermin to the facility. Finding includes: On 1/28/2019 the initial tour of the kitchen was completed in the presence of the food service manager (FS1). On 1/30/2019, the meal service observation and investigation was completed near 11:45 a.m. with the all the dietary staff. During the observation FS1 was requested to show the location where the kitchen trash was located. The manager stated the exterior dumpster was the receptacle for all of the facility trash. The manager acknowledged the lid of the dumpster was off and she proceeded to replace the lid on the dumpster. | 2020-09-01 |
| 13 | 13 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2019-01-30 | 880 | F | 0 | 1 | IS8311 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record, review the facility failed to operationalize its infection control program to control to prevent the spread of infections. Failure to always monitor, track, trend, and plot infections within the facility had the potential to contribute to healthcare acquired infections. Additionally, failure to follow the facility policy related to handwashing can also contribute to healthcare acquired infections. Findings include: 1. On 1/29/19, an observation of a pressure ulcer dressing change occurred on Resident 5. The staff completing the procedure were a licensed nurse (LN6) and a certified nursing assistant (CNA4). During the dressing change, the resident defecated 4 times. CNA4 was observed cleaning the bowel movement 3 of the 4 times. After she cleaned the bowel movement she removed her gloves and used a hand sanitizer but did not wash her hands. The facility policy titled hand hygiene was reviewed on that same day. The policy stated in the procedure at item H to, Perform Hand Hygiene after contact with body fluids or excretions mucous membranes non-intact skin and wound dressings. Later that day during an interview with a nursing administrative staff (LN2), she stated that CNA4 should have washed her hands rather than just using the hand sanitizer. On 1/29/2019, during an interview with the infection control prevention (IP1), it was acknowledged that an on-site visit of the contracted laundry service had not been completed within the last year or recertification period. IP1 was also unable to validate if the contracted service was washing facility laundry at the appropriate temperatures and with the appropriate cleaning agents to help prevent the transmission of infectious. 2. During a record review on 1/28/2019 at 1:00 p.m., resident #301 was admitted to facility on 3/24/18 with the [DIAGNOSES REDACTED]. Minimum Data Set (MDS) 14 day assessment completed on 4/7/18 disclosed a Brief Interview for Mental … | 2020-09-01 |
| 14 | 14 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2017-08-24 | 157 | D | 0 | 1 | 10C511 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review and staff interview, the facility failed to notify 1 resident's (R) R5, out of a survey sample of 8 residents, physician of an abnormal blood sugar before administering 2 packets of sugar. Findings include: Per clinical record review, R5 was admitted to the facility on [DATE], with a [DIAGNOSES REDACTED]. A physician's order dated 8/17/17 noted, for the clinical staff, to do accuchecks twice a day and to administer regular insulin according to the results of the sliding scale (SS) via subcutaneous (SQ) as follows: if the resident's blood sugar was greater than 400 units to administer 20 units of Regular Insulin; if the resident's blood sugar was between 301 and 400 to administer 16 units of Regular Insulin; if the resident's blood sugar was between 201 and 300 to administer 8 units of Regular Insulin; finally, if the resident's blood sugar was greater than 150 to administer 4 units of Regular Insulin. There was no physician ordered parameters for blood sugar levels less than 149. The Medication Administration Record [REDACTED]. The Nurse's Notes dated 8/19/17 documented the following .Head of bed elevated for aspiration. Blood sugar 74 mg/dl (Milligrams per Deciliter) GT (gastrostomy tube) feeding with 2 packets of sugar added. At around 1800 (6:00 p.m.) blood sugar rechecked 102 mg/dl . There was no nursing documentation to show the physician was notified of the resident's low blood sugar nor were there any notes, from the physician, that would have directed the clinical staff to administer the resident 2 packets of sugar. An interview was conducted with Staff Member 11 on 8/22/17 at 9:05 a.m. The staff member stated she would expect that a physician's order would be in place before giving 2 packets of sugar. Staff Member 11 stated that there were also no parameters, in the electronic medical records, for notifying the physician when the blood sugar was low. An interview was conducted with Staff Member 3 on 8/… | 2020-09-01 |
| 15 | 15 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2017-08-24 | 205 | B | 0 | 1 | 10C511 | Based on record review and interview the facility failed to ensure 1 of 8 sample residents (closed record 8) received proper notification of the facility bed hold policy on admission or during any time during the resident's stay at the facility. Failure to issue notification of information regarding the bed hold policy has the potential to infringe on the resident's rights. Findings include: On 08/23/2017 the facility policy titled Skilled Nursing Unit (SNU) Notice of Bed-Hold and Readmission Policy was reviewed. The policy indicates Upon admission and before a resident is transferred to a hospital or goes to on therapeutic leave, GMHA's (Guam Memorial Hospital Authority) Skilled Nursing Unit will provide written information to the resident and a family member or legal representative that specifies the facility Bed-Hold Policy. The policy also specifies Obtain resident, family member or legal representative sign (sic) form indicating receipt of bed-hold information. On that same date during a concurrent close record review and interview with Staff 18, she validated Resident 8's close record did not contain a signed bed-hold form and acknowledged it would be difficult to ascertain if the facility policy was followed. | 2020-09-01 |
| 16 | 16 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2017-08-24 | 226 | E | 0 | 1 | 10C511 | Based on interview and record review the facility failed to implement written policies and procedures that prohibit and prevent all forms of abuse, neglect, and exploitation of residents. Failure to operationalize policies and procedures that prohibit and prevent all forms of abuse, neglect and exploitation prior to initial access to residents allows of the potential opportunities for abuse. Findings include: On 08/23/2017 the facility policy titled Patient/SNU Resident Abuse, Neglect and Injuries of Known or Unknown Source (with an effective dated (MONTH) 06, (YEAR)) was reviewed and it indicates GMHA (Guam Memorial Hospital Authority)/SNU staff shall be educated regarding recognition of abuse, neglect, mistreatment and misappropriation of property, identification of victims of abuse, and the mandatory reporting duties. Staff education will take place during employee orientation, as well as in unit-specific in-service train programs and other hospital-wide training sessions. On that same date during a concurrent interview and record review of the staff training records with Staff 18 it was validated that 4 of 59 total Skilled Nursing Unit (SNU) staff failed to complete abuse training during orientation or prior to access to potentially vulnerable residents. | 2020-09-01 |
| 17 | 17 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2017-08-24 | 241 | E | 0 | 1 | 10C511 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, staff and resident interviews, and facility policy review, the facility failed to ensure that 2 stage 2 sample Residents (R)1 and R4 and 5 random residents were served meals in a dignified manner by the kitchen staff. The residents were served part of their meal in Styrofoam cups. The facility failed to ensure that R5 was provided privacy during personal care. The survey sample is 8. Findings include: 1. Per clinical record review R1 was admitted to the facility on [DATE]. Per clinical record review R4 was admitted to the facility on [DATE]. An initial kitchen tour was conducted on 8/21/17 at 9:20 am. During this tour, it was discovered that the dishwasher was broken and kitchen staff were washing dishes manually. Per interview with staff, the dishwasher was in disrepair since 6/29/17. Maintenance staff were in the process of getting dishwasher repaired during this time, and eventually purchased a new dishwasher. As of the date of this observation, the dishwasher still had not been delivered or installed. A tray line observation was conducted on 8/22/17 at 7:15 a.m. It was during this observation that a random dietary staff member placed hot oatmeal into a Styrofoam cup. An interview was conducted at 7:21 a.m. with dietary staff member 6. Staff Member 6 stated that the dietary staff communicated with her that they could only manually wash dishes, silverware, cups and not bowls. She went onto say the residents have been spoken to about the use of the Styrofoam cups and Staff Member 6 stated that residents were fine using the Styrofoam cups. A resident group interview, which included R1 and R4, was conducted on 8/22/17 at 2:00 p.m. The group of sample and random residents were asked if they were served part of their meals in Styrofoam cups. Each resident responded yes and 1 random resident gave a thumb up gesture. When asked what type of food was served in the Styrofoam cups, multiple residents stated that they were serve… | 2020-09-01 |
| 18 | 18 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2017-08-24 | 253 | B | 0 | 1 | 10C511 | Based on observation and interview the facility failed to ensure all resident restroom water faucets were continuously operational to promote a sanitary orderly and comfortable interior. Failure to ensure all resident room water faucets are operational may potentially contribute to the spread of health care acquired infections. Finding include: On 08/21/2017 the Initial Tour of the facility, resident rooms and restrooms occurred with Staff 11. During the tour observations were made and Staff 11 tested several bed call lights, rest room call lights, toilet functionality and sink water temperature/functionality. When checking the restroom sink faucet for room 129, Staff 11 validated after several attempts, the restroom sink was non-operational. Staff 11 immediately requested that Staff 8 be informed of the nonfunctional water faucet. Later that same date Staff 8 acknowledged the nonfunctional water faucet for room 129 had been repaired; he could not validate how long the sink had been nonfunctional. | 2020-09-01 |
| 19 | 19 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2017-08-24 | 279 | E | 0 | 1 | 10C511 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to develop a comprehensive plan of care that was individualized for each resident to meet the resident's medical, nursing, mental and psychosocial needs identified nor did the facility update the care plan when there was a change in the resident's condition for 3 Residents (R)2, R3, R7) of 8 sampled residents. Findings include: 1. Review of the medical record for Resident (R) 3, revealed that the resident was admitted to the facility on [DATE], with [DIAGNOSES REDACTED]. Review of the R3's care plan dated 11/10/17, with Staff Member 18 on 8/22/17 at 2:00 p.m., revealed that the facility uses the Nursing [DIAGNOSES REDACTED]. a. R3 had a care plan for constipation. Comments stated Patient is having [MEDICAL CONDITION]. The Problem statement read; Constipation: related to abdominal muscle weakness; habitual denial; habitual ignoring of urge to defecate; inadequate toileting; irregular defection habits; insufficient physical activity; recent environmental changes; depression, emotional stress, mental confusion, nonsteroidal anti-[MEDICAL CONDITION] drugs (NASAIDs), opioids, phenothiazine's, and sedatives, neurological impairment, electrolyte imbalance, hemorrhoids, Hirschsprungs's disease (a dis condition that affects the large intestine (colon) and causes problems with passing stool). pregnancy, prostate enlargement . The care plan failed to be individualized. The long-term outcome was that the Patient will maintain passage of soft formed stool every 1 to 3 days without straining; state relief from discomfort of constipation and identify measures that prevent or treat constipation. Intervention 1: included to assess usual pattern of defecation, history of bowel habits or laxative use; diet, obstetrical/gynecological history, alterations in perianal sensation. Intervention 6: included to encourage patients to resume walking and activities of daily living as soon as possible … | 2020-09-01 |
| 20 | 20 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2017-08-24 | 309 | D | 0 | 1 | 10C511 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review, staff interview, and facility policy Bowel Management dated as revised 12/15 review, the facility failed to ensure that a bowel protocol was implemented for 1 Resident (R) 4 out of a survey sample of 8. Findings include: Per clinical record review, R4 was admitted to the facility on [DATE], with a [DIAGNOSES REDACTED]. Per clinical record review, the Nurse's Notes dated 4/21/17 noted that the resident had a bowel movement (BM) on 4/18/17. A care plan, dated 4/25/17, identified the resident would be assisted to the bathroom or use a bedpan when the resident feels the urge to have a BM. There was no indication that the resident was on a bowel protocol. The admission Minimum Data Set (MDS) assessment for R4 dated 4/28/17, Section C for cognition, identified the resident's Brief Interview Mental Status (BIMS) score was 13 which indicated that the resident was cognitively intact. Section H, for Bowel and Bladder, identified that the resident was always incontinent of bowel. Review of the clinical record for R4 included physician orders [REDACTED]. A physician's orders [REDACTED]. A physician's orders [REDACTED]. [MEDICATION NAME] 10 mg suppository, to be administered rectally daily, as needed if no BM for 3 days. The Medication Administration Record [REDACTED]. From 5/7/17 through 10/17 and from 5/12/17 through 5/14/17 that the resident did not have a BM during this time period. There was no evidence on the MAR indicated [REDACTED]. There were no Nurse's Notes to indicate that the resident refused bowel care on these dates. On the MAR indicated [REDACTED]. There was no documented evidence, on the MAR, or in the Nurse's Notes that the resident was administered laxatives on these dates, per physician order. There were no Nurse's Notes notes to indicate that the resident refused bowel care on these dates. The MAR indicated [REDACTED]. There was no documented evidence, on the MAR indicated [REDACTED]. There were no Nur… | 2020-09-01 |
| 21 | 21 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2017-08-24 | 315 | D | 0 | 1 | 10C511 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review, staff interviews, and facility policy review, Catheterization with a revised date of 2/16, the facility failed to ensure there was a physician's order, upon admission, for the use of an indwelling urinary catheter, and the care and management of an indwelling urinary catheter for 1 resident (R4). The survey sample was 8. Findings include: Per clinical record review R4 was admitted to the facility on [DATE] with a [DIAGNOSES REDACTED]. The resident was admitted to the facility with a urinary indwelling catheter put in place during her hospital stay. Per electronic clinical record review for R4, there was no physician order for [REDACTED]. The initial admission Minimum Data Set (MDS) assessment dated [DATE] for R4, Section H for Bowel and Bladder, identified that the resident had a indwelling urinary catheter. Under the Care Area Assessment (CAA), Section V, identified that the resident triggered for urinary incontinence and indwelling catheter and directed the staff to care plan. The Skilled Nursing Unit (SNU) Interdisciplinary Plan of Care dated 5/1/17 identified R4 was to receive Foley catheter care per shift. The Medication Administration Records (MAR) were reviewed for the months of 5/17, 6/17, 7/17, and 8/17. It was documented R4 received Foley catheter changes on 5/2/17, 6/3/17, 7/2/17, and on 8/3/17. An interview was conducted with Staff Member 9 on 8/22/17 at 1:35 p.m. and she stated R4 was admitted to the facility from a local hospital with a catheter already inserted. Staff Member 9 said that the nurse should have obtained a physician's order for catheter care, French size, and identify how often the catheter should be changed. Staff Member 9 confirmed that there was no physician's order in place, in the electronic clinical record for the resident. A review was conducted of a facility policy entitled Catheterization with a revised date of 2/16. This policy failed to identify that a physician's order w… | 2020-09-01 |
| 22 | 22 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2017-08-24 | 318 | D | 0 | 1 | 10C511 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to ensure 1 of 8 sample residents (Resident 2), a resident with limited range of motion, receives appropriate treatment and services to increase range of motion and/or to prevent further decrease in range of motion (ROM). Failure to provide services to increase and/or prevent a further decrease in ROM may potentially contribute to worsening of contractures. Findings include: Resident 2 is a [AGE] year old female admitted into the facility on [DATE]. The record reflects some of her [DIAGNOSES REDACTED]. Resident 2 was interviewed on 08/21/2017 and she acknowledged that she had been admitted into the facility with contractures. During further investigation on 8/22/2017, Resident 2 denied consistently receiving ROM exercises 2-3 times a week to her lower extremities. The resident assessments dated 05/10/2017 and 07/23/2017 show both Brief Interviews of Mental Status resulted in a score of 15 indicating the resident is cognitively intact. Both assessment also show the resident has a functional limitation in range of motion to both lower extremities. On 08/23/2017 during a concurrent record review and interview with Staff 18 it was validated: Resident 2 was admitted with lower extremity contractures; that the resident's assessments confirmed the contractures; that no nursing care plan existed to maintain or prevent the worsening of the lower extremity contractures; and, that the Recreational Therapy (RT) notes did not reflect that the patient was receiving ROM exercises 2-3 times each week to improve the contractures and mobility as outlined in the RT care plan. On 08/23/2017 during a concurrent interview and record review of the Recreational Therapy notes with Staff 4 it was validated that the RT care notes did not reflect that the patient was receiving ROM exercises 2-3 times each week to improve contractures or prevent the worsening of the contractures as outlined in the RT c… | 2020-09-01 |
| 23 | 23 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2017-08-24 | 431 | E | 0 | 1 | 10C511 | Based on observation, interview and record review the facility failed to ensure all drugs and biologicals were secure. Failure ensure all drugs and biologicals are secure has the potential for a mishap should a resident, visitor or anybody else happen to ingest any unsecured medications. Findings include: On 08/22/2017 the Medication Pass Observation occurred with several facility nurses. During the medication pass observation for Resident 5 Staff 20 poured the mediations at the entrance of the resident's room then, before administering the medication Staff 20 pushed the medication cart to the nurse's station. The staff member left the poured medications for Resident 5 on top of the cart and departed to check on some information. During the period of time for this observation Staff 20 did not request for another staff member to monitor the unsecured medications left on top of the mediation cart. After returning to the nurse's station, Staff 20 proceeded to push the medication cart back to Resident 5's room and administered the medications. Immediately after the Medication Pass Observation during an interview with Staff 20 she acknowledged she no control of what could have happened to the unsecured poured medications that were left on top of the cart. Later that day during a concurrent interview and record review with Staff 3 and Staff 18 regarding the facility policy titled Locking of Medication Cart and Medication Room (Revision date of 02/2016) it was acknowledged that is the facility's expectation for staff to keep medications secured at all times. | 2020-09-01 |
| 24 | 24 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2017-08-24 | 441 | F | 0 | 1 | 10C511 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews, and review of the facility policy MANAGEMENT OF PATIENTS WITH EPIDEMIOLOGICALLY SIGNIFICANT ORGANISMS (E.[NAME]MULTI-DRUG RESISTANT ORGANISMS, METHICILIN RESISTANT STAPH AUREUS, and [MEDICATION NAME] RESISTANT [MEDICATION NAME] (VRE), last revised in (YEAR), the facility failed to establish and maintain an infection control program designed to provide a safe, sanitary, and comfortable environment to prevent the development and transmission of diseases and infection. This had the potential to affect all resident in the facility and observation revealed the facility failed to follow policy and procedure to prevent the spread of infection for 2 of 8 sampled Residents (R)1 and R4. Findings include: 1. Interview with Staff Member 3 who is the assigned infection control nurse for the skilled nursing unit on 8/23/17 at 8:55 a.m., revealed that she did not have an infection control log to show which residents have infections, where the infection is located, symptoms, any tests that were done, or antibiotics given. The facility also was unable to provide any documentation to show tracking and/or trending of infections. Review of the facility policy titled, MANAGEMENT OF PATIENTS WITH EPIDEMIOLOGICALLY SIGNIFICANT ORGANISMS (E.[NAME]MULTI-DRUG RESISTANT ORGANISMS, METHICILIN RESISTANT STAPH AUREUS, and [MEDICATION NAME] RESISTANT [MEDICATION NAME] (VRE), last reviewed in (YEAR), revealed that the purpose of the policy was to provide guidance on preventing the spread of epidemiologically significant organism infection transmission from patients to other patients, personnel and visitors. Section 4 speaks to personal protective equipment with the following guidelines; a. Gloves: wear gloves upon entry for all interactions i. Minimize touch contamination with use of gloves. ii. Remove gloves and wash hands in between procedures or after contact with material that could contain high concentrations of the MDRO (multi drug re… | 2020-09-01 |
| 25 | 25 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2016-09-29 | 241 | E | 0 | 1 | H7FJ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility did not ensure that residents were treated with dignity and respect residents' individuality for 3 of 10 sampled residents (Residents 3, 4, and 5). Findings include: 1. On [DATE] at 2:30 p.m., during an interview, Resident 4 complained about the facility's slow response to call light when he calls for assistance. The resident indicated that at one instance he needed to be changed and he had to wait for a long time. Review of a nurses' progress notes dated [DATE] at 20:41 revealed that at 1730, a licensed nurse went to the resident's room to give his medicine and the resident was so mad and cursed the nurse. Resident 4 refused to take his medication because he was wet, pointing his diaper. The licensed nurse documented, I told him I will call (name of assigned CNA) to help you. Review of Resident 4's latest quarterly assessment dated [DATE] revealed the resident has a Brief Interview of Mental Status (BIMS) of 9 indicating moderate impairment of cognitive skills. Also the resident's functional status for toilet use was extensive assistance with one-person physical assist. Although the resident was identified as always continent of urine, he was assessed as frequently incontinent of bowel. This was confirmed by a licensed nurse (LN1) during the initial tour of the facility on [DATE] at 10:40 a.m. LN1 indicated that the resident uses the urinal located at the resident ' s bedside. Review of the resident council meeting minutes dated [DATE] revealed an old business related to resident concern indicating that a resident called for help and it took them more than 20 minutes. The resident ended up having to call anyone else out there. The facility's corrective action revealed that the Unit supervisor has discussed the issues with her staff at the monthly staff meeting and reminded them of the importance of responding to resident call lights and bedside manners. Review of the resident co… | 2020-09-01 |
| 26 | 26 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2016-09-29 | 248 | E | 0 | 1 | H7FJ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility did not provide an ongoing program of activities designed to meet the interests and the physical, mental and psychosocial well-being of each resident for four (4) of 10 sampled residents. (Residents 3, 4, 5 and 9). Findings include: 1. Resident 4 was admitted to the facility on [DATE] with the following Diagnoses: [REDACTED]. Review of the initial assessment dated [DATE] revealed that Resident 4's activity preferences included having books, newspapers and magazines to read; keeping up with the news; listening to music he liked; doing things with groups of people; going outside to get fresh air when the weather was good; being around animals as pets, and participating in religious activities. Resident care plan dated 1/12/16 revealed a problem of activity deficit - little or no involvement in activities. Comments documented include for the patient to have at least one enjoyable activity to participate in throughout stay, and also to participate in socialization with staff or friends/family members when demonstrating appropriate behavior at least once a week. The care plan outcome noted: Will participate in activities ___ times per ___. Interventions documented: Review level of activity prior to change in health status by talking with Family/Representative/Resident; Explain importance of social or relaxation or leisure activities; Advise daily of activities available and invite to participate; Offer a variety of both in and out of room activities; also allow resident to make choices; Ask family or representatives to encourage activities and to accompany resident in activity. From 9/26/16 to 9/29/16 during the days of the survey, Resident 4 was observed staying in the room most of the time and occasionally going to the dining/activity room to have lunch. On 9/26/16 at 10:45 a.m. to 12:00 p.m., the resident was observed to remain in his bed taking naps at intervals. Review of the act… | 2020-09-01 |
| 27 | 27 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2016-09-29 | 250 | D | 0 | 1 | H7FJ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility did not provide medically-related social services to enable the resident to attain or maintain the highest practicable physical, mental, and psychosocial well-being. Finding includes: Resident 9 was admitted to the facility on [DATE] with several [DIAGNOSES REDACTED]. The most current MDS dated [DATE] described the resident as having short or long-term memory problems, with severely impaired cognitive skills for daily decision making, and was dependent on staff for most activities of daily living (ADLs). The MDS also noted that the resident did not have any mood or behavior problems. Review of the medical record also revealed the the lack of any indication that Resident 9 was bedbound. During the survey, Resident 9 was always observed in bed sleeping or looking out to the hallway when repositioned on her right side. In an interview on 9/28/16, a licensed staff (LN7) stated that the resident did not want to get out of bed but received 1:1 visits in her room (at the bedside) with recreational therapy staff. In separate interviews on 9/28/16, two recreational therapy staff members (AS1, AS2) stated that as far as they can remember, Resident 9 had been out of bed only twice since admission. Both AS1 and AS2 added that Resident 9 did not want to get out of bed but received 1:1 visits instead. AS1 and AS2 stated that they did not know why the resident preferred to stay in bed in her room. Further review of the medical record revealed that in spite of the isolation and refusal to get out of bed, there was no evidence of social services participation in determining the cause of the behavior or in identifying potential functional and/or psychosocial factors, and correlating these with her [DIAGNOSES REDACTED]. On 4/12/16, another RT note revealed that Resident 9's spouse who was admitted with a [DIAGNOSES REDACTED]. In the same interview on 9/28/16, LN7 stated that Resident 9's spouse su… | 2020-09-01 |
| 28 | 28 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2016-09-29 | 279 | D | 0 | 1 | H7FJ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility did not develop a comprehensive plan of care for each resident to meet the resident's medical, nursing, mental and psychosocial needs identified in the initial assessment for one of 10 sampled residents (Resident 6). Finding includes: Resident 6 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Review of the printed skilled nursing unit's (SNU) Admission Assessment form dated 9/22/16 lacked information related to over all condition of the resident upon admission. On 9/28/16 a handwritten Assessment form dated 9/21/16 timed at 10:35 p.m. was presented. The assessment revealed the resident was lethargic and verbally non-responsive, and that the information was obtained from the resident's husband. The resident had a [MEDICATION NAME] lock as an intravenous access on the right hand and an indwelling catheter on admission. She was also identified as totally dependent for all activities of daily living. The resident's code status was Do Not Resuscitate (DNR). A pain assessment revealed the presence of generalized mild pain on movement. There was also the presence of a Stage 2 pressure ulcer on the left buttocks upon admission. The assessment form identified the following problems: acute pain, alteration in tissue perfusion, alteration in nutrition, risk for aspiration, risk for constipation, impaired gas exchange, and impaired skin integrity. The nursing [DIAGNOSES REDACTED]. As a newly admitted resident that had been in the facility for less than 14 days, the facility identified a problem list for the resident's special needs, however, an individualized plan of care was not initiated to address each of the problem area identified. On 9/26/16 at 11 a.m., during the initial tour the SNU's nursing supervisor revealed that Resident 6 has been designated as comfort care due to metastatic [MEDICAL CONDITION]. On 9/27/16 during a concurrent review of the resident's plan of … | 2020-09-01 |
| 29 | 29 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2016-09-29 | 286 | E | 0 | 1 | H7FJ11 | Based on observation, interview, and record review, the facility did not maintain all minimum data set (MDS) assessments completed within the previous 15 months in the resident's active record. Finding includes: Review of medical records revealed that completed MDS assessments were not always available in the resident's active medical records. While a request for the assessments were made following the initial tour on 9/26/16, the documents were then made available only in the afternoon on 9/27/16 at about 3:00 p.m. when a request was made to print them for residents in the sample whose assessments were missing. During an interview on 9/27/16, a licensed staff (LN1) stated that the MDS assessments were not part of the electronic medical records and was maintained in a separate database accessible only by designated staff person who had the administrative rights to print the documents. (Reference Residents 1 through 5, Resident 7 through 11). | 2020-09-01 |
| 30 | 30 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2016-09-29 | 315 | D | 0 | 1 | H7FJ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on the resident's comprehensive assessment, the facility must ensure that a resident who entered the facility without an indwelling catheter was not catheterized unless the resident's clinical condition demonstrated that catheterization was necessary; and a resident who was incontinent of bladder received appropriate treatment and services to prevent urinary tract infections and to restore as much normal bladder function as possible. (Reference Residents 2 and 9) Finding includes: 1. Resident 9 was admitted to the facility on [DATE] with several [DIAGNOSES REDACTED]. The most current MDS dated [DATE] described the resident as having short or long-term memory problems, with severely impaired cognitive skills for daily decision making, and was dependent on staff for most activities of daily living (ADLs). The MDS indicated that the resident did not have an indwelling catheter. During the initial tour on 9/26/16, Resident 9 was observed in bed with a urinary tubing and drainage bag at the bedside. In an interview after the tour (on 9/26/16) a licensed staff (LN6) stated that Resident 9 had an indwelling catheter. Review of the medical record revealed a physician's orders [REDACTED]. Review of progress notes revealed that the resident had an episode of [MEDICAL CONDITION] prompting insertion of the catheter. Further record review however revealed the lack of indication that an evaluation of the use of the indwelling catheter was conducted or that a referral to appropriate health care professionals was considered to determine the cause of the retention and whether continued use of the device was warranted. A physician's progress note dated 5/25/16 revealed the lack of mention of the catheter or any other urinary problems. In addition, the MDS dated [DATE] revealed the lack of an active urinary problem (or diagnoses) that required use of the catheter. Review of the medical record further revealed that a care plan for the use of the indwelling… | 2020-09-01 |
| 31 | 31 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2016-09-29 | 322 | D | 0 | 1 | H7FJ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility did not ensure that a resident who was fed by a gastrostomy tube received the appropriate treatment and services to restore normal eating skills for one of 10 sampled residents (Resident 5). Finding includes: Resident 5 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Review of the latest MDS assessment dated [DATE] revealed the resident had a BIMS of 15 indicating that he was cognitively intact and totally dependent and required one person physical assist with bed mobility, dressing, eating, toilet use, personal hygiene, and bathing. On 9/26/16 at 10:50 a.m., during the initial tour, the resident was observed in bed inside a dark resident room with all window curtains drawn. The resident was awake and communicated by text messages using his personal cell phone. The resident was observed with right upper extremity contracture and able to move his left hand. On 9/27/16 at 8:30 a.m. during breakfast meal observation, Resident 5 was observed in his room eating pureed diet with foamy liquid at the side of his mouth. A nurse at the hallway was notified and assisted the resident in suctioning his mouth. Review of the latest quarterly assessment dated [DATE] revealed the resident had a BIMS of 15 indicating that he was cognitively intact and he was totally dependent with one person physical assist with eating. The active [DIAGNOSES REDACTED]. He was noted as having no signs and symptoms of swallowing disorder and had no weight loss in the last 6 months. He was described as having an abdominal feeding tube (PEG) and was receiving mechanically altered diet (pureed food). The resident received 51% or more proportion of total calories and an average fluid intake of 500 cc/day or more through tube feeding. Review of the dietetic technician's latest documentation dated 9/12/16 revealed the following: Recommended enteral feeding: Glucerna at 4 cans per day and pureed diet wit… | 2020-09-01 |
| 32 | 32 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2016-09-29 | 325 | D | 0 | 1 | H7FJ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility did not ensure that the resident maintained acceptable parameters of nutritional status, such as body weight unless the resident's clinical condition demonstrated that this was not possible. Finding includes: Resident 3 was readmitted to the facility on [DATE] with several [DIAGNOSES REDACTED]. The most current quarterly MDS (minimum data set) assessment dated [DATE] described the resident as having no short or long term memory problems, had intact cognitive skills for daily decision making, and had no mood, [MEDICAL CONDITION], or behavioral problems. During the initial tour on 9/26/16, a licensed facility staff (LN6) described the resident as alert and oriented but non-verbal as a result of the stroke, and able to communicate or make his needs known by gestures. Review of the quarterly MDS (dated 8/04/16) revealed that Resident 3 was noted to weigh 119 lbs (with height of 65 ins). Review of dietary notes including dietary tech notes dated 8/24/16 revealed that Resident 3 consumed between 75 - 100% of his meals. During two meal observations conducted on 9/27/16 and 9/28/16, the resident was observed eating without need for any assistance and consumed most of his meals, a 2000 Kcal, 75-gm carbohydrate controlled diet. In an interview on 9/27/16, a dietary staff member (DT10) stated that Resident 3 had no problem eating in spite of his [MEDICAL CONDITION] and usually consumed most of his meals. Review of the medical record revealed that while weights were being taken and recorded, there was no documentation during the current admission that an acceptable parameter for determining nutritional adequacy, such as body weight, was established for Resident 3. Review of the dietary tech note dated 7/13/16, for example, noted Resident 3's weight as being 127 lbs on 3/02/16; 122 on 4/16/16; 138 on 4/26/16; 130 on 6/01/16; 118 on 6/16/16; and 123 lbs on 7/09/16. While the same note added t… | 2020-09-01 |
| 33 | 33 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2016-09-29 | 329 | D | 0 | 1 | H7FJ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure that each resident's drug regimen was free from unnecessary drugs. An unnecessary drug is any drug when used without adequate monitoring or without adequate indication for its use or in the presence of adverse consequences which indicate the dose should be reduced or discontinued, or any combinations of the reasons above. (Reference Residents 4 and 8) Findings include: 1. Resident 8 was admitted to the facility on [DATE] with the [DIAGNOSES REDACTED]. Review of the discharge summary from the hospital dated 5/17/16 revealed that the resident had a history of [REDACTED]. One of the discharge medications listed from the hospital was [MEDICATION NAME] (an antipsychotic drug) 1 milligram (mg.) three times a day as needed for agitation. Review of the initial admission minimum data set (MDS) - an assessment tool dated 5/24/16 revealed that the resident had short and long term memory problems, and that his cognitive skills for daily decision making was severely impaired. The resident had unclear speech and was rarely/never understood, however, he sometimes understands. He also had severely impaired vision and had no corrective lenses. The resident exhibited no mood or behavior problems. The resident was identified as totally dependent with one person physical assist for all activities of daily living (ADL). He was also noted as always incontinent of bowel and had an indwelling urinary catheter due to Stage IV pressure ulcer in the sacrum. He was admitted with multiple pressure ulcer acquired from home and had post debridement of the ulcer from the hospital. The latest quarterly MDS dated [DATE] revealed no significant change from the admission MDS. On 9/26/16 at 10:40 a.m., during the initial tour, Resident 8 was in bed and non-verbal and had an indwelling urinary catheter with clear urinary output. LN1 indicated that the resident was getting ready for discharge to home… | 2020-09-01 |
| 34 | 34 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2016-09-29 | 354 | F | 0 | 1 | H7FJ11 | Based on observation, interviews and record review, the facility failed to designate a registered nurse as the director of nursing of the skilled nursing unit (SNU) on a full time basis as required. Finding includes: On 9/26/16 at 9:00 a.m. during the entrance conference, an administrative staff member (AA1) identified the associate administrator of nursing services (AANS1) as the director of nursing at the facility (skilled nursing unit) which was about 7 miles away from the hospital. On 9/27/16 at 10:00 a.m., the AANS1 introduced herself to the survey team as the SNU's director of nursing and provided her business card with an official title as the Associate Administrator of Nursing Services. Further interview revealed that she had oversight responsibility of nursing services at the acute hospital and at the skilled nursing unit. AANS1 added that she also oversaw the unit supervisor of the SNU because the unit supervisor (LN1) was new at her position. Review of facility documents however revealed the lack of documented evidence of the appointment. In addition, while a registered nurse, AANS1 was hospital-based and worked full-time at the hospital as an assistant administrator for hospital nursing services. In addition, review of the facility's brochure given to newly admitted residents to the SNU made reference about the SNU Inter-disciplinary team; however, the composition of the team did not identify a director of nursing (as member) but the SNU's unit supervisor which also had the title of SNU Hospital Supervisor of Nursing. Further, review of the facility's Daily Assignment sheet revealed the name SNU's unit supervisor listed as SNU Head Nurse. On 9/28/16 at 10:00 a.m., interview with the SNU's unit supervisor (LN1) revealed that she had several responsibilities since the former DON left the SNU. She added that some of her responsibilities included coordination and supervision of nursing services at the SNU, conducting weekly meetings with other members of the interdisciplinary team, creating staffing work … | 2020-09-01 |
| 35 | 35 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2016-09-29 | 361 | F | 0 | 1 | H7FJ11 | Based on observation, interview, and record review, the facility did not designate a person as food service director who received frequently scheduled consultation from a qualified dietitian. Findings include: 1. During the initial kitchen tour at 9:10 a.m. on 9/26/16, a dietary staff (DS11) stated that while he was the designated individual in charge of the kitchen for the day, he was, however, not the director of food service. In the same interview, DS11 added that the facility had dietary technicians available two times a week, as well as a registered dietitian who worked part time and was available only on Saturdays. During a separate interview at 10:45 a.m. on 9/26/16, a dietary technician (DS12) stated that she and another technician (DS13) shared coverage and that one of them was available in the facility two days a week on Monday and Wednesday. DS12 stated that she allocated some time in the kitchen but most of her time was spent on direct patient care conducting screening and follow-ups. Review of the position description (PD) revealed that while the dietary technician can assist in the supervision of the department, it did not identify either technicians (DS12, DS13) as director of food service with inherent duties and responsibilities. 2. While the position description noted that the dietary technician could perform basic nutritional screening of patients under the supervision of the clinical dietitian, there was no documentation available indicating that the screening process as well as the provision of nutritional care were being supervised by the registered dietitian. In addition, there was no documentation that consultations were being regularly scheduled between dietary technicians and the registered dietitian. While the facility maintained a communication log documenting tasks by the dietary technicians that were accomplished or were pending, there was no indication that the log was being reviewed by the registered dietitian to ensure that screening or progress notes, for example, were conducted … | 2020-09-01 |
| 36 | 36 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2016-09-29 | 441 | E | 0 | 1 | H7FJ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews and record review, the facility did not establish and maintain an infection control program designed to provide a safe, sanitary, and comfortable environment to prevent the development and transmission of diseases and infection. Findings include: 1. Random Sample Resident (RSR)11 was admitted to the facility on [DATE] with the [DIAGNOSES REDACTED]. Review of the physician's order dated 9/13/16 revealed an order for [REDACTED].; 0.125% IR starting on 9/13/16 twice daily for 30 days. Special Instructions: wet to dry dressing change with Dakin's solution 0.125% twice a day (BID) after cleaning with Normal Saline Solution (NSS) on sacrum and back area. Review of the Medication Administration Record from 9/19/16 to 9/27/16 revealed that wet to dry dressing change with Dakin's solution 0.125% BID after cleaning with normal saline solution on sacrum and back BID On 9/27/16 at 9:45 a.m., a licensed nurse (LN)2 was observed for pressure ulcer dressing change for Random Sample Resident (RSR)11. The nurse wore an isolation gown, pair of clean gloves and mask. She stated the resident is currently on contact isolation due to MRSA of the wound. she then prepared the two packs of 4x4 gauze she was going to use. The first pack of gauze was opened in the top and the nurse poured normal saline solution to wet the gauze and the second pack of gauze was opened to the top and Dakin's solution was poured in the gauze inside the packet. The resident's pressure ulcers were observed to be located in the sacral and mid lower back. LN2 changed the dressing one site at a time. She removed the old dressing with minimal to moderate amount of bloody drainage and proceeded to the sink area to remove the used gloves. She proceeded to use the hand sanitizer before wearing a new pair of gloves. She proceeded to clean the pressure sore area with one of 4x4 gauze in the packet that was observed to be slightly wet and not soaked with normal saline… | 2020-09-01 |
| 37 | 37 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2016-09-29 | 456 | F | 0 | 1 | H7FJ11 | Based on observation, interview, and record review, the facility did not maintain all essential mechanical and electrical equipment in safe operating condition. Findings include: 1. During the initial tour on 9/26/16, a dietary staff (DS11) stated that the kitchen's dishwasher, a high temperature washer, was out of service. DS11 added that as a consequence, residents were being served disposable Styrofoam, plates, cups, and plastic eating forks, knives, spoons. According to DS11, the machine been out of order since the beginning of the year (2016) because of a broken booster pump. During an interview on 9/28/16, a maintenance staff member (MS1) stated that the dishwasher had been out of order since (MONTH) (YEAR). MS1 explained that the heater booster was broken and could not reached the (high) temperature required for washing and sanitation. MS1 further added that since the machine was old, a decision was made not to replace the booster but purchase a new unit. Review of maintenance records revealed the lack of documentation evidencing inspection and/or service maintenance provided on the dishwasher. In the same interview, MS1 stated that preventive maintenance was provided by a vendor regularly but was discontinued in 2012 when the contract was not renewed because of the lack of funds. Since then, according to MS1, maintenance staff did what they could do, replacing parts that were broken. In the interview, MS1 added that the contract agreement would have been for the inspection, testing, maintenance, troubleshooting, and repairs for its (the facility's) commercial cooking equipment and ice machine at the skilled nursing unit. Review of the document however did not include the dishwasher. (Cross-refer to F490.) 2. During the initial tour of the kitchen on 9/26/16, a sign on the cover of the ice machine noted, Not available for consumption. In an interview during the tour, DS11 stated that dietary staff were waiting for the results of a laboratory test on a culture that was recently obtained. Review of test resu… | 2020-09-01 |
| 38 | 38 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2016-09-29 | 490 | F | 0 | 1 | H7FJ11 | Based on observation, interview and record review, the facility was not administered in a manner that enabled it to use its resources effectively and efficiently to enable residents to maintain their highest practicable level of physical, mental, and psychosocial well-being. Findings include: 1. During the survey, a food services director was not hired by the facility to ensure oversight and supervision of dietary services. Interview with staff revealed that while two dietetic technicians were available to the facility to provide coverage for two days of the week on Monday and Wednesday, it was unclear as to whether the technicians fulfilled the position of food services director. In addition, there was no documentation available to indicate that the technicians had adequate training and experience; that a food services director position description (or its equivalent) had been developed, and whether the dietetic technicians met the requirements. Further, while the facility had the services of a registered dietitian one day a week on Saturdays, there was no documentation that there was regularly scheduled consultations between the dietetic technicians and the registered dietitian to ensure effective communication; and that the needs of residents were being assessed and identified, and dietary outcomes were being met. (Cross-refer to F325 and F363.) 2. There was no indication that the facility had used its resources to ensure that vital appliances used in the kitchen to cook, prepare, and store food were in good operating condition. The kitchen's dishwashing machine, for example, had been out of order according to dietary staff, since the beginning of the year because of a broken booster pump. Review on 9/28/16 of the departmental requisition (dated 3/28/16) for the replacement of the dishwasher revealed that it was unprocessed and was returned (to Admin5) because of incomplete documentation and the amount of money requested that required additional information. During an interview on 9/28/16, an administrative st… | 2020-09-01 |
| 39 | 39 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2016-09-29 | 493 | F | 0 | 1 | H7FJ11 | Based on observation, record review, and interview, the governing body did not appoint an administrator who was responsible for the management of the facility. Finding includes: Review of hospital documents pertaining to governing body responsibility specific to the skilled nursing unit revealed that the governing body appoints the Administrator that is responsible for the management of the facility. While facility staff interviewed during the survey identified the hospital CEO as the administrator of the facility, the position description (of the hospital administrator) did not include specific duties and responsibilities by the CEO to ensure that facility was administered in a manner that enabled it to use its resources effectively and efficiently to ensure that residents attained or maintained their highest practicable level of physical, mental, and psychosocial well-being. (Cross-refer to F241, F354, F361, F456 and F490.) | 2020-09-01 |
| 40 | 40 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2016-09-29 | 501 | F | 0 | 1 | H7FJ11 | Based on record review and interview, the facility failed to designate a physician to serve as medical director for the facility who was responsible for implementation of resident care policies, and the coordination of medical care in the facility. Finding includes: On 9/28/16 at 9:15 a.m., interview with LN1 revealed that there was no position description for the current medical director assigned to skilled nursing unit (SNU). During the survey, an interview with the medical director was not conducted because he was off-island, according to LN1. On 9/28/16 at 2:15 p.m., following a request to review the position description for the medical director of the SNU, a human resources staff person responded with a note to the surveyor indicating that the facility did not have position description. The following day on 9/29/16 at 9:00 a.m., a document, Hospital Staff Physician - Skilled Nursing Unit (SNU) with collateral duties and work tasks as Director, Skilled Nursing Unit, Responsibilities was provided by the administrative assistant (AA1). The document described the scope of work for the facility's medical director to include the following: Directs the day-to-day functions of the Skilled Nursing Facility/Skilled Nursing Unit (SNF/SNU) in accordance with current federal, state and local standards, guidelines, and regulations that govern, hospital-based long term care units to assure the highest degree of quality of care is provided to all residents, at all times. Assures that there is continuous monitoring and evaluation of the quality and appropriateness of the medical care provided as part of the overall quality assurance program. Develops and directs educational programs related to medical activities such as, but not limited to, results from Quality Assurance monitoring and evaluation activities. Provides consultation to the Medical Records Department on the development and maintenance of an adequate medical record. (Cross-refer to F322, F329, F441 and F520.) | 2020-09-01 |
| 41 | 41 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2016-09-29 | 514 | F | 0 | 1 | H7FJ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interviews, the facility failed to maintain clinical records on each resident in accordance with accepted professional standards and practices that are complete; accurately documented; readily accessible; and systematically organized. The clinical record must contain sufficient information to identify the resident; a record of the resident's assessments; the plan of care and services provided; and progress notes. Findings include: 1. On 9/26/16 to 9/27/16, access to electronic medical record was not readily accessible. Interview with administrative and nursing unit supervisor on 9/26/16 at 2:00 p.m. revealed that surveyors will not be allowed to access the electronic records unless the Optimum RN/LPN Clinical User Request Form was signed to ensure privacy and protection of Patient Information, under the Health Insurance Portability and Accountability Act (HIPAA) of 1996. Multiple exchanges of information with the hospital's Information Technology (IT) staff were held to explain that surveyors were exempt from the HIPAA law. Access was granted only on 9/26/15 at 3:00 p.m. On 9/27/16 at 9:00 a.m. Minimum Data Set (MDS) information - an assessment tool for residents in skilled nursing facilities, was requested from nursing staff to evaluate facility's regulatory compliance. The surveyors were granted limited access to electronic record until requests were made to print all the MDS and resident care plans that needed to be reviewed. 2. Resident 3 was admitted to the facility on [DATE] with several [DIAGNOSES REDACTED]. Review of the medical record on 9/27/16 revealed that Resident 3 had a progress note dated 8/09/16 by the attending physician describing the resident as still intubated, was off pressors, and being on a [MEDICATION NAME] drip for pain. Interview with a licensed staff (LN1) on 9/27/16 revealed that the progress note entry was not applicable to Resident 3 following her admission to the facility, and not for… | 2020-09-01 |
| 42 | 42 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2016-09-29 | 517 | F | 0 | 1 | H7FJ11 | Based on observation, interview, and record review, the facility did not have a detailed plan and procedures to meet all potential emergencies and disasters. Finding includes: During the survey, several documents were presented evidencing the facility's emergency/disaster preparedness plan. A review of the the facility's emergency preparedness contingency plan for a tropical cyclone (revised (MONTH) (YEAR)) which defined the role dietetic services for the skilled nursing facility was conducted. While the document outlined responsibilities of dietetic staff as well as for the cook to conduct a preliminary assessment of food supplies on hand; and coordinating at least a 2-day food supply to supplement the existing 3-day emergency food supply already kept stocked and rotated at the facility, the plan did not include the amount of drinking water allocations for the number of residents, staff, and other individuals who may be at the facility; as well as for the number of days of the emergency or disaster. Review of the facility's emergency water distribution plan also revealed that dietetic services shall support the provision of drinking water supply for patients and emergency responders during times of emergency at the hospital. Admin5 stated that the policy was a revision and was unsigned, but being circulated for signatures. The policy did not include contingency plans for an emergency or disaster but outlined procedures to be undertaken during an emergency. The policy (emergency water distribution) revealed that while procedures were outlined including conducting an inventory of available bottled drinking water at the SNU, completion of requisition forms, ordering and anticipating delivery of bottled drinking, and rationing of drinking water to patients and first responders, the policy also did not specify the amount of drinking water to be stored on-site, including at the SNU which was located about 7 miles away from the hospital, especially when the emergency or disaster involved road closures causing delivery … | 2020-09-01 |
| 43 | 43 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2016-09-29 | 520 | F | 0 | 1 | H7FJ11 | Based on interviews and record review, the facility failed to maintain a quality assessment and assurance (QAA) committee consisting of the director of nursing services; a physician designated by the facility; and at least 3 other members of the facility's staff. The quality assessment and assurance committee failed to meet at least quarterly to identify issues with respect to which quality assessment and assurance activities are necessary; and failed to develop and implement appropriate plans of action to correct identified quality deficiencies. Findings include: On 9/28/16 at 10:00 a.m. during an interview with licensed nurse (LN1), it was revealed that the facility did not have a quality assurance program although she represented the SNU in program improvement (PI) meetings at the hospital on a monthly basis. According to LN1, quality assurance consisted of collecting SNU-specific data and reporting this to the hospital PI meetings. LN1 added that the SNU was part of the hospital's overall PI meetings. LN1 further explained that ever since the last SNU's director of nursing/administrator left last May, (YEAR), the facility had not conducted a formal quality assessment and assurance (QAA) meeting exclusive to SNU. LN1 added that while each licensed nurse was assigned a specific quality indicator to monitor, such as incidence of pressure sores, the data collected was sent to the facility's administrative assistant for compilation. Target goals not met continue to be monitored on the list of key indicators. There was no evidence if analysis of data collected was conducted or not. In another interview on 9/29/16 at 1:30 p.m. the administrative assistant (AA1) stated that she worked closely with LN1 to establish and maintain the SNU's QAA program. She stated that while quarterly QAA meetings were held with the medical director and the department heads, no other meetings were convened since March, (YEAR) when the former director of nursing/acting administrator left and the former medical director retired. She recall… | 2020-09-01 |
| 44 | 44 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2014-09-19 | 164 | B | 0 | 1 | OCYD11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and interview the facility failed to ensure that residents were afforded personal privacy when nursing staff failed to announce or knock before entering three resident rooms (resident rooms [ROOM NUMBER]). Failing to announce or knock before entering into a resident's room is an infringement of the resident's right to privacy. Finding includes: During the meal service observation on 9/16/2014, one certified nursing assistant (CNA) was observed walking into 3 residents rooms without knocking or announcing their entrance into the rooms. Later, after being questioned, the CNA acknowledged that knocking or announcing their entrance into the resident room was what should have occurred rather than just entering into the resident rooms. | 2019-04-01 |
| 45 | 45 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2014-09-19 | 279 | E | 0 | 1 | OCYD11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to ensure ongoing resident's assessment data was used to develop and revise the comprehensive plan of care for 2 of 8 sample residents (Residents 1 and 4). Failing to use ongoing assessment data to develop and revise the resident's plan of care can lead to potential declines in resident functioning. Finding include: 1. The medical records of Resident 1 were reviewed on 9/18/2014. The resident sustained [REDACTED]. The nursing documentation for that incident reads, Was informed by assigned nurse that patient was found on floor near bed at around 2020. No injuries noted. Assisted patient back to wheelchair by three staff members. MD informed. No new orders obtained. During two separate interviews and record reviews with licensed nurses (LN1 and LN2) it was determined that the records did not reflect an investigation for the circumstances surrounding or contributing to the fall. The licensed nurses acknowledged that investigating or assessing the circumstances contributing to the fall could potentially prevent future falls. Additionally, both nurses acknowledged the fall occurred on 7/22/14 and that the last time the Potential for Fall care plan had been updated was 7/03/2014; 19 days before the fall. 2. Resident 4 was admitted to the facility on [DATE] with a medical [DIAGNOSES REDACTED]. The Minimum Data Set (MDS) assessment Section D (Mood) was completed by the facility social worker. The resident was assessed to be feeling down, depressed, or hopeless. During an interview with the Resident and family member, he stated that he was tired of being at the facility, and tired of being in the shape I am now. The family member stated that the resident was depressed about his condition because he wants to enjoy his retirement like everyone else, not like this. The Resident added I am tired of the pain, and just feel frustrated about having to be here (in the facility), and I just want to go ho… | 2019-04-01 |
| 46 | 46 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2014-09-19 | 309 | D | 0 | 1 | OCYD11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility did not ensure that the resident received care and services to enable him to meet the highest practicable physical and psychosocial well-being. Finding includes: Resident 2 was admitted to the facility on [DATE] with several [DIAGNOSES REDACTED]. The resident was also noted as having a right below-knee amputation and described in the initial minimum data set ((MDS) dated [DATE] as having no cognitive impairments and dependent on staff for most activities of daily living with one-person physical assist. During an interview on 9/16/14 at about 3:20 p.m., Resident 2 stated that he had been having irregular bowel movements and that while he receives milk of magnesia (MOM) when he hasn't had a bowel movement for several days, he added that by the time, he feels loaded and uncomfortable. Review of the electronic medical record revealed that while Resident 2's bowel movements were being monitored, the frequency however was such that he would have none for three or more days, including on 9/14/14 - 9/16/14 (3 days); 8/28/14 - 9/01/14 (5 days); and 8/16/14 - 8/19/14 (4 days). In light of this, there was no documentation that Resident 2 was always given MOM as needed. Review of the Medication Administration Record [REDACTED]. During an interview on 9/18/14 at 11:00 a.m., a licensed staff (Admin 1) stated that facility protocol was to give 30 ccs of MOM if a resident had no BMs for 3 days. Further record review revealed that while the facility developed a plan of care dated 4/23/14 for constipation with the goal to maintain regular bowel pattern, there was no indication that the care plan was reviewed to determine if interventions were being implemented, were effective, or needed to be revised. While the care plan, for example, noted encourage high fiber intake and coordinate with the dietitian, there was no evidence of any coordination or that the resident's diet order (Cardiac 2000 cal bite-sized) was… | 2019-04-01 |
| 47 | 47 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2014-09-19 | 329 | D | 0 | 1 | OCYD11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview the facility failed to ensure that each resident's drug regimen must be free of unnecessary drugs for 2 of 8 sampled residents (Residents 1 and 2). Failure to secure appropriate physician orders [REDACTED]. Findings include: 1. On 9/17/14, Resident 1's medical records were reviewed with licensed nurse (LN) 1 and 2. Both nurses acknowledged the resident's current medications orders included [MEDICATION NAME] and [MEDICATION NAME]. The current [MEDICATION NAME] order dated 9/01/14 was written as [MEDICATION NAME] 2 mg orally twice to day. The current [MEDICATION NAME] order dated 9/09/14 was 0.5 mg orally twice a day. Both licensed nurses acknowledged the [MEDICATION NAME] nor the [MEDICATION NAME] contained indications for the use of the medications. During further investigation it was determined that Resident 1 was receiving the [MEDICATION NAME] and [MEDICATION NAME] related to behaviors. The minimum data set for Resident 1 listed behaviors such hitting, scratching, and screaming. When the licensed nurses were questioned how staff would document the number of behaviors per day, week, or month, the licensed nurses stated one would have to read all the nurses notes for the day, week, or month to quantify the number of behaviors for any specific time period. When the licensed nurses were questioned how they would document and quantify the number of adverse events for the [MEDICATION NAME] or [MEDICATION NAME] it was determined that once again one would have to read the nurses notes for that specific period of time. Furthermore, LN 1 stated that the facility was relying on the nurse's professional judgment to determine if adverse effects were occurring or not. That is, there was no list of specific adverse effects that may be associated with [MEDICATION NAME] or [MEDICATION NAME] that may facilitate a nursing action if a specific adverse affect was noted to be occurring. The licensed nurses concurred the curr… | 2019-04-01 |
| 48 | 48 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2014-09-19 | 371 | C | 0 | 1 | OCYD11 | Based on observations and interviews, the facility failed to store and prepare food under sanitary conditions. Findings included: 1. During an observation of the lunch meal preparation on 9/17/14 at approximately 10:50AM, the top service of the steamer/oven located next to the stove had a notable thick layer of grease/grime build-up that included dust debris. The cook looked at the top of the steamer/oven and concurred that there was a build-up of debris, and stated that it should be cleaned. Yeah, that should not be there, and be cleaned. He stated he did not recall when the surface had been cleaned. 2. During the initial tour a cup was observed to be in the dry macaroni storage bin. The Dietary Food Service manager acknowledged the cup should not be stored with the dry cereal/macaroni and removed the cup. | 2019-04-01 |
| 49 | 49 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2014-09-19 | 428 | D | 0 | 1 | OCYD11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to conduct a drug regimen review monthly for 2 of 8 sample residents (Residents 1 & 2). Failure to complete the drug regimen has the potential subject the residents to unnecessary medications. Findings include 1. On 9/18, 14, during a concurrent interview and record review for Resident 1 with the consulting pharmacist she acknowledged there was no documentation to reflect drug regimen reviews were completed for the months of (MONTH) through (MONTH) 2014. During a concurrent interview and medical record review with a licensed nurse (LN1), there was acknowledgement that the record did not reflect the drug regimen reviews were completed since (MONTH) 2014. The facility policy titled Skilled Nursing Unit Drug Regimen Review, last revised (MONTH) 2012, indicated drug regimen reviews will be conducted monthly to ensure that each resident will not receive unnecessary drugs. 2. Resident 2 was admitted to the facility on [DATE] with several [DIAGNOSES REDACTED]. The resident was also noted as having a right below-knee amputation and described in the initial minimum data set ((MDS) dated [DATE] as having no cognitive impairments and dependent on staff for most activities of daily living with one-person physical assist. Review of the medical record revealed that Resident 2 had a physician's orders [REDACTED]. The Medication Administration Record [REDACTED]. Further review revealed that the medication had been re-ordered monthly since 6/27/14. The medical record revealed that while the pharmacist conducted a review of the resident's drug regimen in (MONTH) and (MONTH) 2014, to identify and report any irregularities, no reviews were conducted monthly thereafter, as required. During an interview on 9/18/14, a pharmacy staff member (PH1) acknowledged that drug regimen reviews were not conducted monthly and that she needed to allocate time amongst other competing workload obligations to conduct and do… | 2019-04-01 |
| 50 | 50 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2014-09-19 | 431 | E | 0 | 1 | OCYD11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and interview, the facility failed to ensure that drugs and biologicals stored in the facility's only medication storage room in use were discarded when expired; and also properly disposed/returned to the pharmacy or resident after discharge. Findings included: During a tour of the medication room on [DATE] at approximately 2:20PM with the LN, the following was observed: 1. A 30cc vial of Heparin flush mixed/prepared and labeled by the facility pharmacy with a label reading that the Heparin flush vial was mixed/prepared on [DATE] with a disposal/expiration date of [DATE] was stored with other medications actively being used by the facility. The LN stated that the vial should have been disposed and/or returned to the pharmacy by the expiration date (,[DATE]) and not stored with other medications. It is unknown if any of the Heparin flush preparation had been administered to a resident after it's expiration date. 2. Seven (7) Lantis insulin pens labeled with the name of a previously discharged resident were being stored in the refrigerator with other medications currently being administered to residents in the facility. The LN stated the pens should have either been sent home with the resident/family when they were discharged , or sent to the pharmacy for disposal. The pens should have been sent home with the resident, or we sometimes will call the resident's family to come pick them up. | 2019-04-01 |
| 51 | 51 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2014-09-19 | 441 | D | 0 | 1 | OCYD11 | Based on interview and record review the facility failed to establish and maintain an infection control program designed to provide a safe, sanitary, and comfortable environment to prevent the development and transmission of disease and infection. Finding includes: On 9/16/14 during the initial tour of Resident 3's room with a licensed nurse (LN3), the nurse acknowledged the normal saline solution and irrigation set use for the dressing changes was not dated nor timed. During further interview the licensed nurse stated that irrigation solution was good for 28 days after the bottle was opened but acknowledged it would be difficult to determine when the current bottle was opened since there was no date or time on it. On 9/17/14 during a wound care observation for Resident 3 with LN 3 the normal saline solution was observed to be labeled with the date and time opened; however the irrigation set was not dated nor timed as to when it was initially opened. The wound for Resident 3 was a large pressure ulcer which extended from above the anus to the coccyx area. LN3 executed the following steps before and during the dressing change: hands were washed and clean gloves applied; the old dressing was removed; original gloves removed and the hands washed then a new set of clean gloves were applied; the wound site was irrigated with normal saline solution; then the wound was pat dried from the anus to the superior aspect of the wound; the gloves were removed, the hands were washed and new set of clean gloves were applied; Hydrogel was applied to the fresh dressing then the wound was covered and tape applied to secure the dressing. The licensed nurse was question about the drying technique and acknowledged the wound should've been dried from the clean superior aspect to the dirtiest aspect of the wound (the anus). On 9/17/14 during an interview with LN1 it was ascertained that the normal saline irrigation solution is good for only 24 hours after being open and that the container of solution should be dated and timed. Furthermo… | 2019-04-01 |
| 52 | 52 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2014-09-19 | 463 | E | 0 | 1 | OCYD11 | Based on interview and record review the facility failed to ensure the resident call system was working in all restrooms (rooms 127, 130, and 131) and in one resident room (room number 101A). Failure to have a functioning call system can put the resident at risk for potential harm when he/she is unable to communicate with the staff during times of need. Findings include: 1. On 9/16/14 during the initial tour with a licensed nurse (LN3), the visual aspect of the call system for rooms 127 and 130 where observed not to be working. LN 3 acknowledged he could hear the call system however the visual component of the system was not working. 2. During the initial tour on 9/16/14, the call light inside the bathroom in room 131 did not activate when the button was pressed. The was no visual indicator observed or audio signal heard to alert staff about the call for assistance. During an interview, a licensed staff stated that once the call light button was pressed, an audio signal should have been heard and an indicator light in the hallway on the wall outside the resident's room should have been lit. 3. During the initial tour, the nursing call light for sampled resident 4 was at his bedside within reach. However, the call light was not functional when the call light button was pressed. The resident stated It's been like that for a while. When I need them (facility staff), and can't call them or let them know I need help, so my (family member) has to go to the nursing station to get help for me if I need to go to the bathroom or need my pain medication. Thank goodness my (family member) stays with me most of the time. | 2019-04-01 |
| 53 | 53 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2014-09-19 | 465 | B | 0 | 1 | OCYD11 | Based on observation and interview, the facility did not provide a safe and functional environment for its staff. Finding includes: During the food storage observation on 9/17/14, a puddle of water was observed inside the walk-in refrigerator's sheet-metal flooring in an area adjacent to the door leading into the walk-in freezer compartment. The puddle which covered an area about a foot-and-a-half from the wall separating the freezer and refrigerator was slippery and could potentially cause anyone to slide and fall, especially in the dim lighting inside the refrigerator that rendered the puddle difficult to notice. There were no warning cones or anti-slip devices noted. During an interview on 7/17/14, a dietary staff member stated that the puddle was from melted ice inside the freezer that had flowed into the refrigerator compartment. The staff who thereafter secured warning cones added that maintenance personnel had recently been inside the freezer to break-up the ice build-up inside the freezer. | 2019-04-01 |
| 54 | 54 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2014-09-19 | 514 | D | 0 | 1 | OCYD11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based upon interview and record review, and the facility failed to ensure that all verbal and telephone orders obtained related to the urgent or emergent situations, and that all clinical records were legible, dated, timed, and signed. Persistent over use of verbal and or telephone orders, that are handwritten or re-transcribed on the monthly basis, has the potential for increased transcription error. Findings include: 1. On 9/19/14 the medical records for Residents 1 and 3 were reviewed with a licensed nurse (LN4). The nurse acknowledged that the monthly reoccurring orders for Resident 1 for the months of (MONTH) and (MONTH) 2014 were telephone orders. The records reflected that there were five physician's orders [REDACTED]. LN 4 acknowledged that the following orders were possibly not related to an emergent or urgent situations: [MEDICATION NAME] 100 milligrams orally two times a day; and [MEDICATION NAME] cream to hemorrhoids two times a day as needed. 2. Resident 3 was admitted on [DATE] with hand written telephone orders. Between 8/23/14 to 8/26/14, there were 8 physician's orders [REDACTED]. 3. On 9/19/14, the Guam Memorial Hospital Authority Nursing Services Manual addressing Physician order [REDACTED]. The policy indicated, All physician orders [REDACTED]. Additionally, The policy reflected Use of verbal and telephone orders must be minimized in all nursing units. Verbal or telephone orders must be taken by an RN only. Use of verbal orders must be limited to urgent and emergent situations 4. Resident 2 was admitted to the facility on [DATE] with several [DIAGNOSES REDACTED]. The resident was also noted as having a right below-knee amputation and described in the initial minimum data set ((MDS) dated [DATE] as having no cognitive impairments and dependent on staff for most activities of daily living with one-person physical assist. Review of the medical record revealed that the resident had a physician's orders [REDACTED]. Review of th… | 2019-04-01 |
| 55 | 55 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2014-09-19 | 517 | B | 0 | 1 | OCYD11 | Based on observation and document review, the facility did not have a written plan and procedure to ensure availability of water supply for all residents, staff, visitors, and family members in the event of an emergency or disaster. Finding includes: Review of the facility's plan regarding availability and storage of drinking water supply during an emergency revealed that forty-five gallons of drinking water would be made available in the dietary department for the use of residents. During an interview on 9/17/18, a dietary staff member explained that the allocated water supply should allow 30 residents (the number of residents being planned for) to each have 2 quarts of drinking water each day for three days of the anticipated duration of the emergency. Further review of the plan however revealed the lack of consideration for the number of employees, visitors, and family members who may be stranded in the facility during the emergency and would therefore have no access to drinking water. During the kitchen tour on 9/17/14, forty-eight gallons of drinking water were observed in the dietary department storage room. In the same interview, the staff member stated that the available water supply was sufficient to meet the drinking water needs of 30 residents for three days of emergency, but not those of staff, family members, and/or visitors. | 2019-04-01 |
| 56 | 56 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2013-09-20 | 157 | E | 0 | 1 | JK1T11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to notify the primary attending physician regarding a change in medical condition for Resident 5 and 8 related to reports of the residents wanting to hurt/harm themselves. 1. Resident #5 was readmitted to the facility on June13, 2013 with a [DIAGNOSES REDACTED]. The resident also had a history of [REDACTED]. According to an interview with LN 1 during the initial tour of the facility on (MONTH) 18, 2013 at approximately 9:23 AM, the resident was recently moved to a room closer to the nursing station because the facility became aware that the resident 'might want to hurt or kill' themselves. During the tour, the resident was not observed to be in their assigned resident room. An interview was done with LN 3 on (MONTH) 19 at approximately 5:10 PM. The staff person stated that she was not the assigned staff for the resident that shift, and that near the end of the shift (3 PM - 11 PM) she took a phone call from the friend of the resident on (MONTH) 13, 2013. Staff 3 said the caller sounded worried and like they were about to cry, and asked for nursing staff to go check on Resident 5 in their room because I (the caller) think (the resident) may have, or may be trying to cut herself with a knife. The caller told LN 3 that they were worried about the resident because they (the caller and the resident) had just been arguing on the phone. LN 3 reported that earlier during the shift they had observed Resident 5 to be restless and about to cry, and looked mad. LN 3 said they then reported this information to the shift Charge Nurse, and then they went to check on the resident and took the knife away from the resident. LN 3 stated that she was not aware of the resident ever doing this in the past to her knowledge. Review of the nursing notes on (MONTH) 13, 2013 timed at 11:20PM read, The (friend) of this patient called and said Can you go see (resident) in her room, she might slice her wrist. CNA a… | 2018-07-01 |
| 57 | 57 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2013-09-20 | 167 | C | 0 | 1 | JK1T11 | Based on interviews, the facility failed to inform residents and their families of their right, or location, to view/examine the results of the most recent survey of the facility conducted by Federal surveyors and any plan of correction with respect to the facility. During the resident group interview that took place on (MONTH) 19, 2013 at 10:00AM, four of four residents in attendance, and a family member of sampled Resident 1 who was not in attendance (total of five responses) verbalized that they were not informed at admission, or anytime subsequent to their respective admitted s, of the location and their right to view the survey results from the previous Medicare recertification survey. Further, three of the four residents and a family member of Resident 1 verbalized their desire to want to view the results of the previous Medicare recertification survey. | 2018-07-01 |
| 58 | 58 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2013-09-20 | 252 | C | 0 | 1 | JK1T11 | Based on observations and interviews, the facility failed to provide a safe, clean, comfortable and homelike environment. Finding 1: During the resident group interview on (MONTH) 19, 2013 at 10 AM, three of four residents and also the family member of a sampled resident not in attendance reported that the outdoor courtyard was frequently overrun with cats, and that they have begun to not go out onto the patio due to the strong odor of cat urine and feces. Respondents stated that they enjoyed going outside for fresh air when able, but cannot do so because of the objectionable odor. Respondents also said that they have previously reported this to facility representatives, but nothing has been done to date. Finding 2: During the same interview, the same respondents stated that they would like to go out onto the courtyard more often, but there are concerned and fearful of their safety (accident hazard) due to the excessive amounts of mold and algae in the courtyard. Unsamped Resident 11 stated that his wheelchair has limited traction on the algae, and also that his visitors are afraid of slipping and falling when pushing him outdoors on the courtyard, it needs a good cleaning and power washing out there . Finding 3: During the initial tour of the facility on (MONTH) 18, 2013, and on subsequent visits to various resident rooms, observations were made of disposable window coverings covering resident room windows. The material of these window coverings were light blue disposable material, and appeared to be modifications of privacy treatment curtains used to provide resident privacy during delivery of care that had been cut to fit the curtain rod and window covering. These window coverings in resident rooms 102, 107, 108, 110, 111, 125, 130, and 131 all had various colored permanent stains of varying sizes. Finding 4: On (MONTH) 19, 2013, there was inclement weather and it rained the entire day. At approximately 5:10 PM that same day during the evening dinner meal service, several water leaks were observed coming from … | 2018-07-01 |
| 59 | 59 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2013-09-20 | 274 | D | 0 | 1 | JK1T11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record reviews, the facility failed to conduct a comprehensive assessment of Resident 5 after there was a significant change in the resident's medical/mental condition. Resident 5 was readmitted to the facility on June13, 2013 with a [DIAGNOSES REDACTED]. The resident also had a history of [REDACTED]. According to an interview with LN 1 during the initial tour of the facility on (MONTH) 18, 2013 at approximately 9:23 AM, the resident was recently moved to a room closer to the nursing station because the facility became aware that the resident 'might want to hurt or kill' themselves. During the tour, the resident was not observed to be in their assigned resident room. Throughout the morning and early afternoon of (MONTH) 18, the resident was observed to be self-propelling herself throughout the facility and outside to the patio located at the front entrance of the facility. An interview with Resident 5 at approximately 1:30 PM on (MONTH) 18, 2013 was done, and they indicated they would be going to an off-campus appointment at 2:30 PM for the remainder of the afternoon. The resident said they felt okay ', and enjoyed going outdoors for fresh air. When asked about their mood, they indicated that they had recently been moved to another room, because a friend called the facility and reported that they (the resident) was trying to cut and kill myself with a knife. She added that it was 'a misunderstanding', and that she was okay now. An interview was done with LN 3 on (MONTH) 19, 2013 at approximately 5:10 PM. The staff person stated that they were not the assigned staff for the resident that shift, and that toward the end of the shift (3 PM - 11 PM) they took a phone call from the friend of the resident on (MONTH) 13, 2013. LN 3 said the caller sounded worried and like they were about to cry, and asked for nursing staff to go check on Resident 5 in their room because I (the caller) think (the resident) may have, or may be t… | 2018-07-01 |
| 60 | 60 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2013-09-20 | 315 | D | 0 | 1 | JK1T11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and medical record review the facility failed to ensure one of eight sample residents (Resident #3) that was admitted into the facility with an indwelling urinary catheter had a medical justification for the catheter. Failure to substantiate the need for the indwelling urinary catheter has the potential to contribute to urinary tract and or other facility acquired infections. Findings include: On (MONTH) 20, 2013 the medical record for Resident #3 was reviewed with LN #5. She acknowledged both Minimum Data Sets for the resident dated (MONTH) 6 and (MONTH) 13, 2013 indicated the resident was admitted into the facility with a foley catheter. On further investigation she acknowledged there was no medical justification for the urinary catheter and there was no plan for bladder training or attempt to discontinue the foley. Later that same day LN#5 obtained physician's orders [REDACTED]. | 2018-07-01 |
| 61 | 61 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2013-09-20 | 319 | E | 0 | 1 | JK1T11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on inerviews and record reviews, the facility must ensure that a resident (Residents 5 and 8) who displays mental or psychosicial adjustment difficulty receives appropriate treatment and services to correct the assessed problem. Resident 5 was readmitted to the facility on June13, 2013 with a [DIAGNOSES REDACTED]. The resident also had a history of [REDACTED]. According to an interview with LN 1 during the initial tour of the facility on (MONTH) 18, 2013 at approximately 9:23 AM, the resident was recently moved to a room closer to the nursing station because the facility became aware that the resident ' might want to hurt or kill ' themselves. During the tour, the resident was not observed to be in their assigned resident room. Throughout the morning and early afternoon of (MONTH) 18, the resident was observed to be self-propelling herself throughout the facility and outside to the patio located at the front entrance of the facility. An interview with the resident at approximately 1:30 PM on (MONTH) 18, 2013 was done, and they indicated they would be going to an off-campus appointment at 2:30 PM for the remainder of the afternoon. The resident said they felt okay' , and enjoyed going outdoors for fresh air. When asked about their mood, they indicated that they had recently been moved to another room, because a friend called the facility and reported that they (the resident) was trying to cut and kill myself with a knife . She added that it was 'a misunderstanding ', and that she was okay now. An interview was done with LN 3 on (MONTH) 19, 2013 at approximately 5:10 PM. The staff person stated that they were not the assigned staff for the resident that shift, and that toward the end of the shift (3 PM - 11 PM) they took a phone call from the friend of the resident on (MONTH) 13, 2013. LN 3 said the caller sounded worried and like they were about to cry , and asked for nursing staff to go check on Resident 5 in their room because I (the c… | 2018-07-01 |
| 62 | 62 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2013-09-20 | 328 | D | 0 | 1 | JK1T11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and document review the facility failed to ensure one of eight sample residents (resident #1) with special needs received the proper [MEDICAL CONDITION] suctioning care in accordance with facility policy. Failure to suction the resident's [MEDICAL CONDITION] in accordance with facility policy could potentially lead to lung tissue damage, [MEDICAL CONDITION], or the collection of [MEDICAL CONDITION] sections near or at the [MEDICAL CONDITION] stoma. Findings include: On (MONTH) 20, 2013 at approximately 12:00PM Resident #1, who has a [MEDICAL CONDITION], was observed having several dressings changed; she was logged rolled during the process. The log rolling activity possibly contributed to the loosening of [MEDICAL CONDITION] sections which could be heard as air moved in and out of the [MEDICAL CONDITION]. LN #7 acknowledged the need to suction the resident and suctioning finally occurred at 12:30PM. According to LN#7, the suction should be between negative 240 to a negative 26 milliliters mercury (mmhg). The nursing supervisor (LN2) was requested to provide the [MEDICAL CONDITION] Suctioning policy. LN#2 provided the Naso-tracheal Suctioning policy and it was reviewed concurrently with her. The facility policy states (sic)Lowes possible vacuum pressures are preferred. The higher the negative pressure the greater the possibility for trauma to the tracheal mucosa. Suction pressure should be set at -60 to -80 mmhg in neonates, and -80 to -100 mmhg in adults. LN#2 acknowledged that LN#7 failed to suction the resident in accordance with facility policy. | 2018-07-01 |
| 63 | 63 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2013-09-20 | 367 | D | 0 | 1 | JK1T11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and record review the facility failed to ensure one random resident (Resident #10) received his therapeutic diet as prescribed by the attending physician. Failure to receive a prescribed therapeutic diet could potentially contribute to chocking and/or aspiration of food products into the lungs. Findings include: On (MONTH) 20, 2013 Medication Pass was being completed for Resident #10 at approximately 8:30AM. He was admitted on (MONTH) 14, 2013 with a [DIAGNOSES REDACTED]. The resident was finishing his breakfast and agreed to take his AM medications. The medications were administered in accordance with the physician's orders [REDACTED]. LN#7 asked the resident to open his mouth several times to ascertain if all the medications had been swallowed. When the resident opened his mouth there were no medications observed in his oral cavity. He had no permanent teeth or dentures but was attempting to chew on a piece of pear from a fruit cup. The pears on his tray were not chopped. The meal card indicated the resident was to receive a Low Salt Mechanical Soft Chopped Diet-Regular Liquids. Nursing staff called the Dietary department and they were requested to bring a cup of mechanical soft pears to the resident. When the dietary staff member arrived she acknowledged original cup of pears was not chopped. The resident was able to eat the cup of chopped pears without difficulty. In a review of the medical record the physician had prescribed a Low Salt Mechanical Soft Chopped Diet- (with) Regular Liquids. | 2018-07-01 |
| 64 | 64 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2013-09-20 | 371 | C | 0 | 1 | JK1T11 | Based on observations and interviews, the facility failed to store, prepare, distribute, and serve food under sanitary conditions. During the initial tour of the facility kitchen on (MONTH) 18, 2013 at approximately 9:05 AM, the following observations were made: 1. An open beverage container and two packages of personal food items belonging to Staff 13 was observed to be opened and partially consumed, and were located on a metal shelf above and to the far right (but not over) the dietary steam table where resident food is stored and kept warm prior to assembling meal trays. Upon observation, Staff 13 removed the personal opened beverage and food items, and placed them in the dietary staff refrigerator. The staff person stated that they realized the opened beverage and food items should not have been placed on the shelf. 2. A container on the shelf in the walk-in refrigerator of cooked white rice that was covered but not dated as to when it had been cooked, when it had been placed in the refrigerator, or an expiration date for discard. Staff 13 stated that the container of cooked rice should have been dated appropriately. 3. A container of peeled ripen bananas was on a shelf in the walk-in freezer was not dated as to when it had been cooked, when it had been placed in the refrigerator, or an expiration date for discard. Staff 13 stated that the container of cooked peeled bananas should have been dated appropriately. 4. During the dietary service observation on (MONTH) 19, 2013 at 4PM, Staff 13 that was preparing for residents of the facility was observed at the stove cooking/heating items for the dinner menu. During the observation Staff 13 repeatedly would put his hands into his pockets and then continue preparing food items without hand washing. 5. During the dietary service observation on (MONTH) 19, 2013 at 4:17PM, Staff 13 was preparing for residents of the facility was observed at the stove cooking/heating items for the dinner menu. The worker would go to the covered trash container located near the stove an… | 2018-07-01 |
| 65 | 65 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2013-09-20 | 441 | E | 0 | 1 | JK1T11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to establish and maintain an infection control program designed to provide a safe, sanitary and comfortable environment to help prevent the development and transmission of disease and infections. Failure to prevent the development and transmission of disease and infections could potentially contribute to facility acquired infections for all residents and staff. Findings include: 1. Resident 5 was readmitted to the facility on June13, 2013 with a [DIAGNOSES REDACTED]. The facility placed the resident of Contact Isolation precautions. These precautions included, per policy and the sign on the door of the resident's room, that gloves and gown be worn when entering the room, as well as hand washing before entering and after exiting. An observation of a wound ulcer dressing change was made on (MONTH) 19, 2013 at approximately 11:50AM. The resident (Resident 5) had bilateral skin ulcers to both feet/lower extremity. LN 6 stated that the resident was on contact precautions due to the ulcer wounds being MRSA positive. LN 6 assembled the items necessary to do the dressing change, placed them in the room on a mayo stand, and then proceeded to wash his hands and don the appropriate protective equipment as stated in the facility policy. As LN 6 was preparing to remove the current wound dressing, he realized that he needed additional supplies, and left the room wearing his gloves and gown without removing them. He went to the medication cart to retrieve an ointment, and then returned to the room to resume the procedure. As LN 6 was trying to remove the current dressing by pulling away the tape securing to the area, he decided to use his personal scissors from a pocket in his uniform, and proceeded to cut away the current dressing covering the wounds with the scissors. As he was changing the dressings on the various ulcers wounds, LN 6 used the same glove to grasp the prescribed ointment… | 2018-07-01 |
| 66 | 66 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2013-09-20 | 456 | D | 0 | 1 | JK1T11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and document review the facility failed to ensure all essential patient care equipment was in safe operating condition. Failure to have safe and operational portable suction equipment could potentially lead to a blocked airway for any resident dependent on staff to clear their airway. Findings include: On (MONTH) 20, 2013 at approximately 12:00PM Resident #1, who has a [MEDICAL CONDITION], was observed having several dressings changed; she was logged rolled during the process. The log rolling activity possibly contributed to the loosening of [MEDICAL CONDITION] sections which could be heard as air moved in and out of the [MEDICAL CONDITION]. LN#7 acknowledged the need to suction the resident and she attempted suctioning by using the wall suction piped into the resident room. The wall suction failed possibly due to the power outages that were occurring related to heavy rains. LN#7 obtained the portable suction equipment as an alternative to the wall suction. The portable suction would not go past five on the suction dial and the nurse acknowledge the portable suction was not working in-spite of several attempts to adjust the suction dial. Careful inspection of the portable suction device revealed the last time the equipment was check for safety was on (MONTH) 12, 2011. The safety inspection sticker revealed the next projected safety check was suppose to occur in (MONTH) 2012. The LN#7 acknowledged the portable suction was not inspected in 2012 nor 2013. The last dated safety inspection sticker on portable suction was dated (MONTH) 12, 2011. The wall suctioning mechanism was finally fixed by 12:30PM and the resident was suctioned by LN#7. | 2018-07-01 |
| 67 | 67 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2013-09-20 | 518 | D | 0 | 1 | JK1T11 | Based on interview the facility failed to train all employees on emergency fire procedures. Failure to have all staff trained on fire alarm procedures could potentially compromise all residents and staff. Findings include: On (MONTH) 19, 2013 CNA #15 was interviewed at 4:00PM regarding her response to a situational fire and the use of a fire extinguisher. The facility has wall mounted single action fire alarm boxes that have a key hole. She was not sure how to use the wall mounted single action fire alarm box. She stated she would need to use a key to activate the wall mounted single action fire alarm box. On (MONTH) 19, 2013 CNA #16 was interviewed at 4:20PM regarding her response to a situational fire and the use of a fire extinguisher. The facility has wall mounted single action fire alarm boxes that have a key hole. She was not sure how to use the wall mounted single action fire alarm box. She stated she would need to use a key to activate the wall mounted single action fire alarm box. On (MONTH) 19, 2013 the Maintenance Supervisor as was interviewed at 4:35PM regarding the appropriate use of the wall mounted single action fire alarm boxes which have a key hole. He affirmed no key was needed to activate the wall mounted single action fire alarm boxes. | 2018-07-01 |
| 68 | 68 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2012-01-26 | 157 | D | 0 | 1 | J2NN11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews and record review, the facility failed to immediately inform/consult with the resident ' s physician when there is a significant change in the resident ' s physical status and when there is a need to alter treatment significantly for one sampled and one non-sampled residents. (4 and 11) Findings include: 1. Resident 4 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Review of initial assessment dated [DATE] identified the resident as totally dependent on staff with all activities of daily living except eating. The resident had surgery to repair the fractured left hip (open reduction internal fixation) on 12/18/11. The initial assessment identified the resident with frequent hip pain daily. The admission notes dated 12/21/12 at 22:41 revealed the resident had a surgical wound that measured 15 ? centimeters (cm) scar incision in the left hip/thigh and a sore in the left hand in between the second and third finger. The Braden scale for pressure sore identified the resident as moderate risk to develop pressure sores. Upon admission the resident did not have any pressure sores but the resident was bedfast and required moderate to maximum assistance. Review of the nurses ' progress notes revealed that on 12/25/11 at 21:30, the left inner buttock 3 small 1-0.5 cm next to the sacrum, about an inch below it, small 0.5 cmx0.6 cm and the larger one at the bottom 2.0 cm L(length) x 1.0 cm W(width). dry, no drainage. Duoderm applied. On 1/25/12 at 4:00 p.m. in an interview with the licensed nurse who documented the pressure sore discovery, she revealed that she reported the skin breakdown to the charge nurse and was verbally told to apply the Duoderm. However, she was not sure if the physician was notified on the same day. She indicated that only the registered nurses (RNs) notify the physicians if there is a need to initiate or change a treatment for [REDACTED]. [REDACTED]. Review of the physician's order… | 2017-01-01 |
| 69 | 69 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2012-01-26 | 164 | E | 0 | 1 | J2NN11 | Based on observation, interviews, and record review, the facility failed to ensure the resident's right to personal privacy for three residents in the sample (3, 4, and 11) and confidentiality of his or her clinical records. Findings include: 1. On 1/23/12 at 3 p.m., during the initial tour, a licensed nurse did not provide visual privacy when she checked Resident 3's diaper exposing the resident's lower body to anyone passing in the hallway. 2. On 1/25/12 at 2:45 p.m., during a treatment observation, the blue window drape was partially covering the resident's window in the room. While the licensed nurse treated the Resident 4's sacral pressure ulcer, the resident pointed to the partially draped window upon seeing two male residents pass by in wheelchair to the outside grounds. Interview with the nurse revealed she did not notice the window was partially draped and that the resident refuses male caregivers be assigned to care for her. 3. On 1/26/12 at 9 a.m., the privacy curtain was partially pulled around the resident ' s bed, exposing the resident's upper body to the hallway while a certified nursing assistant was giving Resident 11 a bath while in bed. 4. On 1/26/12 at 8:15 a.m., during medication pass observation, one licensed nurse left the log book that contained the medication administration records (MAR) open to anyone passing in the hallway. This happened a couple of times when the licensed nurse left the medication cart unattended while she administered medications to the residents who were eating breakfast in the dining room. | 2017-01-01 |
| 70 | 70 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2012-01-26 | 242 | D | 0 | 1 | J2NN11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation interview and record review the facility failed to 1. Allow a resident (Resident 5) to make choices regarding her bath time when staff bathed the resident at 5 AM. 2. Ensure the right to choose bathing schedule when Resident 3's wound care was scheduled for staff convenience. The above deficient practices effected the quality of life for 2 of 10 sampled residents (Residents 5 and 3). Findings: 1. Resident 5 was admitted with [DIAGNOSES REDACTED]. The resident had a gastrostomy tube ([DEVICE]) for feeding. The resident was alert and responsive with eye movement and required total care for activities of daily living (ADLs). A family member was with the resident 24 hours per day. During Family interviews on 1/24/2012 at 3:45 PM, Resident 5's family stated they had informed the facility of this on admission that Resident 5 had always preferred bathing later in the day. The facility did not give the resident a bath until the family asked them too, three days after admission, and then the staff woke the resident up at 5 AM to give her a bath. The family said that although the resident was unable to speak and was bedbound as a result of a recent stroke she still knew what was going on. During an interview on 1/26/2012 at 11:15 AM, The head nurse stated the admitting nurse did ask the resident's preference for bathing; however bedbound residents received their baths on the night shift, as the day and evening shift was too busy to bathe everyone. 2. Resident 3 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Recent hospital admission was due to urinary tract infection, dysuria and infected left leg. Urine cultures showed Escherichia (E.) Coli and leg wounds with heavy growth of pseudomonas aeruginosa (1/17/12). On 1/23/12 at 3:10 pm, during the initial tour, Resident 3's left lower leg dressing was observed soaked with bright red drainage. The licensed nurse stated that the physician has just changed the resident'… | 2017-01-01 |
| 71 | 71 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2012-01-26 | 246 | D | 0 | 1 | J2NN11 | Based on observation, interview and record review the facility did not accommodate the resident needs when staff delayed the provision of care for up to 1 hour after 2 of 15 residents (sampled resident 8 and unsampled resident 13) used the call bell system to request assistance for personal needs. Findings: During interviews on 1/24/2012 beginning at 2 PM, Resident 8 stated she needed help to use a walker to get to the bathroom. The night shift staff were slow to answer the call light, which caused the resident distress at getting to the bathroom in time. Resident 13 stated she need help to get to the bathroom. When she used the call light to call for help, the staff would come in and turn off the call light stating they would be return; however she would have to wait for up to one hour to get help. She stated only the CNA's would answer the call lights. During an interview on 1/26/2012 beginning at 11:15 AM, the head nurse stated she expected all staff to answer the call lights and they should be answered within five minutes. Review of the Policy and Procedure titled Use of Call Light #6580 read as follows: Procedure: 1. All facility personnel must be aware of call lighted at all times. 2. Answer ALL call lights promptly whether or not you are assigned to the resident . 6. Answer all call lights in a prompt, calm, courteous manner; turn off the call light as soon as you enter the room. 7. Never make the resident feel you are too busy to give assistance; offer further assistance before you leave the room . 14. Limit the call light response time up to 5 minutes. | 2017-01-01 |
| 72 | 72 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2012-01-26 | 253 | B | 0 | 1 | J2NN11 | Based on observation and interview, the facility did not provide housekeeping and maintenance services necessary to maintain a sanitary, orderly, and comfortable interior. Findings include: 1. During the initial tour on 1/23/12, at 3:15 p.m., two rolls of toilet paper were observed on top of the toilet water tank cover in room 106. Further observation revealed that the roller pin was missing from the toilet paper dispenser that was on the wall adjacent to the toilet. In addition, a hamper for dirty linen was observed inside the bathroom. 2. During the environmental tour on 1/24/12, the ventilator screen in the main hallway above the door leading to the recreation room was observed heavily laden with dust. Another ventilator screen inside the recreation room on the wall adjacent to the door was also noted with a thick accumulation of dust. During an interview on 1/25/11, a maintenance staff stated that the cleaning of ventilator screens were ongoing but that there were other screens in the facility that staff have yet to get to that were not clean. | 2017-01-01 |
| 73 | 73 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2012-01-26 | 279 | D | 0 | 1 | J2NN11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility did not develop a comprehensive care plan for each resident that included measurable objectives and timetables to meet the resident's medical, nursing, and mental and psychosocial needs that were identified in the assessment. Findings include: 1. Resident 2 was admitted on [DATE] with several [DIAGNOSES REDACTED]. Review of the Mini Nutritional Assessment dated 1/07/12, revealed that Resident 2 was nutritionally at high risk and with increased nutrient needs related to severe malnutrition (as evidenced by) severe protein depletion with [MEDICATION NAME], and cachexia . The assessment also noted that his height was 5 feet and 5.75 inches and that he weighed 96 lbs. Initial nutritional recommendations dated 1/07/12 included providing Resident 2 with enteral feedings of [MEDICATION NAME] 1 can every 6 hours for 24 hours increasing to 1 can every 4 hours, and 150 ccs water for flush. This regimen, accordingly, would provide the resident with 1500 kcal and 61 gms of protein per day. The recommendation further noted monitoring of tube feeding residuals, monthly weights, weekly laboratory tests, and hydration status. Further review of the medical record revealed that while a care plan was written for special needs--providing nutritional support, the plan however was developed relative to the risk for aspiration and not the resident's need for nutritional support. The care plan, for example, did not identify goals that needed to be met or indicators that needed to be monitored to help ensure that Resident 2 met established nutritional benchmarks such as weight and [MEDICATION NAME] levels. Further review of the care plan revealed the lack of identification of a desired or target weight and did not specify if the current enteral feeding regimen allowed for weight gain. While the resident was described in a dietary note dated 1/16/12 as being underweight (weight noted on admission was 96 lbs), no other… | 2017-01-01 |
| 74 | 74 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2012-01-26 | 281 | D | 0 | 1 | J2NN11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure that services provided by the facility meet the professional standards of quality for one of non-sample resident (12). Finding includes: On 1/25/12 at 8:30 a.m. a licensed nurse was observed to administer two inhalers for Resident 12: [MEDICATION NAME] 220 mcg. 2 puffs and [MEDICATION NAME] 90 mcg. 2 puffs. The manufacturer's recommendation for [MEDICATION NAME] revealed that after taking the medication, the mouth should be rinsed with water and to spit out the water. There was no evidence that the resident rinsed his mouth after 2 puffs of [MEDICATION NAME] was administered. This was confirmed by the medication nurse. | 2017-01-01 |
| 75 | 75 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2012-01-26 | 309 | D | 0 | 1 | J2NN11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews and record and review, the facility failed to provide the necessary care and services to attain or maintain the highrest practicable physical, mental, and psycho-social well-being, in accordance with the comprehensive assessment and plan of care for two of 10 sampled residents. (4 and 8) 1. Resident 4 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Review of initial assessment dated [DATE] identified the resident as totally dependent on staff with all activities of daily living except eating. The resident had surgery to repair the fractured left hip (open reduction internal fixation) on 12/18/11. The initial assessment identified the resident with frequent hip pain daily. For pain management, Resident 4 was prescribed [MEDICATION NAME] tablets. Also, she was received one tablet of [MEDICATION NAME] 5/325 on 12/22/11 twice that same day and once on 12/24/11. One of the side effects of [MEDICATION NAME] is constipation. The Medication Administration Record [REDACTED]. one tablet daily. Review of the vital signs log and MAR indicated [REDACTED]. On 12/25/11 at 2:15 p.m., the physician ordered [MEDICATION NAME] suppository as needed (PRN) for constipation and milk of magnesia (MOM) 30 milliliters (ml) by mouth three times a day PRN for constipation. Review of the MAR indicated [REDACTED]. The second episode of 3 consecutive days of no BM for 3 shifts was from 12/26/11 to 12/28/11. The MAR indicated [REDACTED]. was administered with results as followed: On 7 a.m.-3p.m. shift, the resident had large BM 3x and on 3 p.m.-11a.m. had one extra large BM. The third episode of no BM episode was from 12/30/11 to 1/2/12. Review of the MAR indicated [REDACTED]. without results. On 1/3/12 at 7:30 a.m., MOM 30 ml was administered. On the same day during the 3p.m.-11p.m. shift, the resident had medium size BM twice and on 1/4/12 during the 3p.m.-11p.m. shift had one large BM. On 1/25/12 at 11:45 a.m., in an int… | 2017-01-01 |
| 76 | 76 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2012-01-26 | 312 | D | 0 | 1 | J2NN11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to provide the necessary services to maintain good personal hygiene for one of 10 sampled residents (Resident 5) and one non-sampled resident (Resident 11) who were unable to to carry out activities of daily living. Findings include: 1. Resident 11 was re-admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. The initial assessment nursing notes revealed no skin breakdown. The initial assessment dated [DATE] revealed that the resident was totally dependent on staff with one person physical support for personal hygiene and bathing. On 1/25/12 at 9 a.m. Resident 11 was observed during morning care rendered by a certified nursing assistant (CNA). During the bedbath, the resident's fingernails were observed an quarter of an inch long with black substance under the nail bed in the right hand. There were also three areas of persistent redness observed in the resident's back: a raised reddened area in the mid-back, flat reddened area on the right side of the back and a blackish red abraded area on the sacrum. The licensed nurse indicated that the resident scratches herself at times. The nurse also indicated the resident had a history of [REDACTED]. The resident's bilateral hands and feet were observed dry and had significant amount of peeling skin. On the same day at 10 am, upon interview, the resident stated that she wanted her fingernails trimmed. On 1/25/12 at 4 p.m. interview with the resident's husband revealed a concern of the reddened raised area on the resident's back if it was a growing cyst. He was also concerned about the resident's peeling skin in the hands and feet from the allergic reactions incurred from antibiotics infused in the hospital. 2. Resident 5 was admitted with [DIAGNOSES REDACTED]. The resident had a gastrostomy tube ([DEVICE]) for feeding. The resident was alert and responsive with eye movement and required total care for activities of daily liv… | 2017-01-01 |
| 77 | 77 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2012-01-26 | 314 | G | 0 | 1 | J2NN11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation , interviews, and record review, the facility failed to ensure that a resident who enters the facility without pressure sores does not develop pressure sores unless the individual's clinical condition demonstrates that they are unavoidable for one of 10 sampled residents, (Resident 4) and one of 5 unsampled residents (Resident (11); and failed to provide necessary treatment to promote healing and prevent infection for one of 10 sampled residents (Resident 6) a resident who entered the facility with pressure ulcers. Findings include: 1. Resident 6 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. The resident had a gastrostomy tube ([DEVICE]) for feeding and a urinary catheter for elimination. The resident required total assistance for activities of daily living (ADLs). The resident's family member was with the resident most of the time. Review of the facility Pressure Ulcer Management Policy # 6301-II C-15 identifies pressure ulcers as follows: Stage 1: An observable, pressure-related alteration of intact skin. Skin changes in one or more of the following parameters: a. Skin temperature (warmth or coolness) b. Tissue consistence (firm or boggy) c. Sensation (pain, itching) d. A defined area of persistent redness in lightly pigmented skin, whereas in darker skin-tones, the ulcer may appear with persistent red, blue or purple hues. Stage 2: Partial thickness skin loss involving epidermis, dermis or both. the ulcer is superficial and presents clinically as an abrasion, or shallow crater. Stage 3: full thickness skin loss involving damage to or necrosis of subcutaneous tissue that may extend down to, but not through underling fascia. The ulcer presents clinically as a deep crater with or without undermining adjacent tissue. Stage 4: full thickness skin loss with extensive destruction, tissue necrosis or damage to muscle, bone or supporting structures (e.g., tendon, joint capsule). Undermining an sinus tracts a… | 2017-01-01 |
| 78 | 78 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2012-01-26 | 315 | G | 0 | 1 | J2NN11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility did not ensure that a resident who was incontinent of bladder received appropriate treatment and services to prevent urinary tract infections [MEDICAL CONDITION] and to restore as much normal bladder function as possible; 1. When the facility did assess or refer a resident for bladder training or adaptive equipment resulting in accidental incontinence for one of 10 residents (Resident 2), and 2. When the facility did not prevent the development of UTIs for one of 10 residents (Resident 6). Findings include: 1. Resident 1 was admitted to the facility on [DATE] with several [DIAGNOSES REDACTED]. Review of the minimum data set ((MDS) dated [DATE] revealed that the resident was alert and oriented, dependent on staff for most activities of daily living, and continent of bladder function. The care area assessment (CAA) summary for the current admission noted that urinary incontinence will not be care planned because the resident is continent. Review of the medical record revealed that on 1/16/12, Resident 2 was described in nurses notes as being incontinent of bladder. On 1/18/12, the resident was also documented in nurses notes as incontinent of bladder and bowel, and on 1/20/12, as being incontinent of urine. In addition, SNU (skilled nursing unit) nurse aide flowsheets dated 1/20/12 through 1/23/12 described Resident 2 as being incontinent of bladder function. Notwithstanding the documentation, review of the medical record revealed the lack of documented evidence that the physician was notified and that an assessment of the resident's bladder status was conducted to identify the cause of the incontinence and determine whether or not the resident could benefit from a bladder training program. In addition, review of the medical record revealed the lack of indication that a care plan was developed to address the change in bladder status which included goals and outcomes as well as interventions to … | 2017-01-01 |
| 79 | 79 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2012-01-26 | 325 | G | 0 | 1 | J2NN11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to maintain acceptable parameters of nutrition for weight for 2 of 10 sampled residents ( resident 2 and 6); when 1.) Resident 6 lost 18.5 % of her body weight due to a leaking gastrostomy tube ([DEVICE]) and 2.) Resident 2 did not receive follow up care for weight maintenance. Findings: 1. Resident 6 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. The resident had a gastrostomy tube ([DEVICE]) for feeding and a Urinary catheter for elimination. The resident required total assistance for activities of daily living (ADLs). The resident's family member was with the resident most of the time. Observations of the resident on 1/24/2012 during personal care revealed the resident was cachectic (ill health and very thin). During an interview on 1/24/2011 at 10 AM, the resident's family member stated the resident had a feeding tube that leaked for a long time before the facility replaced it. The family member stated the resident lost a lot of weight. During an interview and record on 1/24/2011 at 10:45 AM, the day shift charge nurse stated the [DEVICE] had been leaking almost from admission to Christmas. She stated she was not sure why it took so long for the tube to be changed. Review of Resident 6's record from the Monthly Weight Log read as follows: 10/22/2011 - 103 pounds (lbs) 11/14/2011 - 89.6 lbs 12/10/2011 - 85 lbs ([DEVICE] replaced 12/14/2011) 01/10/2012 - 87.9 lbs The resident lost 18 lbs in approximately 2 months. A summary of the review of the staff and physician notes revealed the following time line: 10/22/2011 - Admission; 10/28/2011 - minimal amount of drainage around the feeding tube; 10/29/2011- greenish discharge from the feeding tube. 11/15/2011 - MD noted added suture at the [DEVICE] site to help reduce leakage. 11/16/2011 - MD noted to request surgeon to revise or change the [DEVICE]. 11/28/2011- feeding tube leaking; 11/30/2011- MD noted the… | 2017-01-01 |
| 80 | 80 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2012-01-26 | 334 | E | 0 | 1 | J2NN11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility did not develop policies and procedures that ensured that before offering influenza and/or pneumococcal immunizations, each resident or the resident's legal representative received education regarding the benefits and potential side effects of the immunization; that each resident was offered an influenza immunization October 1 through March 31 annually, unless the immunization was medically contraindicated or the resident had already been immunized during this time period; and that the resident's medical record included documentation that indicated, at a minimum, that the resident or resident's legal representative was provided education regarding the benefits and potential side effects of influenza or pneumococcal immunization. Findings include: 1. Resident 1 was admitted to the facility on [DATE] with several [DIAGNOSES REDACTED]. Review of the minimum data set ((MDS) dated [DATE] revealed that the resident was alert and oriented, and dependent on staff for most activities of daily living. Further review of the MDS revealed that Resident 1 did not receive the influenza vaccine at the facility for this year's influenza season and that it was offered but that the resident had declined. In addition, the MDS noted that the resident's pneumococcal vaccine was not up to date and that it was also offered but that the resident had also declined. During an interview on 1/25/12, Resident 1 stated that he had been informed about the influenza and pneumococcal vaccines but that he declined because he had heard of problems associated with them. When asked to give examples of problems he had previously heard, the resident was unable to state any. When asked if he was given any informational handouts about the influenza (for 2011 - 2012) and pneumococcal vaccines, Resident 1 was unable to respond. In a separate interview on 1/25/12, a licensed nursing staff stated that residents were screened for influenz… | 2017-01-01 |
| 81 | 81 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2012-01-26 | 367 | D | 0 | 1 | J2NN11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and interview, the facility did not ensure that therapeutic diets was prescribed by the attending physician. Finding includes: Resident 1 was admitted to the facility on [DATE] with several [DIAGNOSES REDACTED]. Review of the minimum data set ((MDS) dated [DATE] revealed that the resident was alert and oriented and because of obesity, was dependent on staff for most activities of daily living. Review of the medical record revealed that on admission on 1/04/12, a physician's orders [REDACTED]. On 1/18/12, this diet order was changed to a low sodium. During meal observations conducted on 1/24/12 and 1/25/12, Resident 2's meal tray was observed to be regular and also contained a salt packet. In an interview during the lunch meal observation 1/24/12, Resident 1 stated that he appreciated the salt packet because it helped improve the flavor of his food. During an interview on 1/25/12, a dietary staff was asked to clarify Resident 1's diet order because his meal trays contained a salt packet and his diet order was supposed to be low sodium. The dietary staff went to the facility's electronic database and stated that the regular diet order had not been changed when the new order for a low sodium was made on 1/18/12. When asked if the salt packet would significantly alter a low sodium diet, the staff stated that it would especially depending on the resident's medical condition. | 2017-01-01 |
| 82 | 82 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2012-01-26 | 431 | E | 0 | 1 | J2NN11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and interview, the facility did not store all drugs and biologicals in locked compartments and permit only authorized personnel to have access to the keys. Finding includes: During the environmental observation on 1/24/12, two medication carts identified as 1 and 2 were noted inside the clean linen room which was unlocked. While medication cart 1 was locked, cart 2 however was unlocked so that all medications designated for residents in room [ROOM NUMBER] through 125 were readily accessible to unauthorized individuals. In addition, several house supply medications including Atrovent and Albuterol nebulizer solutions, an injectable vial of Dextrose 50% solution, and an assortment of syringes and needles were kept in other unlocked compartments of the cart. During an interview on 1/24/12, an administrative nursing staff stated that because of the lack of space, the clean linen room was being used to store the medications carts to keep the hallways free from obstruction. The staff added however that the medication carts should be locked at all times when unattended by staff. | 2017-01-01 |
| 83 | 83 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2012-01-26 | 441 | G | 0 | 1 | J2NN11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to maintain an Infection Control Program designed to provide a safe, sanitary and comfortable environment and to help prevent the development and transmission of disease and infection, when the facility did not prevent the development of infections for 3 of 15 residents (sampled Resident 6, 3, and unsampled Resident 14.); failed to provide adequate supplies of PPE to prevent cross contamination where seven resident rooms had contact isolation precautions in place; Staff inconsistently follow infection control techniques; and the infection control designee was not trained for infection control management nor given the time to conduct infection control assignments and the facility did not have an effective tracking and monitoring system to ensure the vaccination status of all residents. Findings include: 1. Resident 6 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. The resident had a gastrostomy tube ([DEVICE]) for feeding and a urinary catheter for elimination. The resident required total assistance for activities of daily living (ADLs). The resident's family member was with the resident most of the time. During the initial tour on 1/23/2012 at 4:30 PM, Resident 6 was observed lying in bed. Her family member was sitting next to the resident's bed without wear Personal Protective Equipment (PPE). When asked what the facility had taught him about the use of PPE, and he looked at the sign, he said he had not noticed the sign and though he did notice the staff usually wore a yellow gown and gloves, they told him he did not need to, just to wash his hands frequently. He stated the staff taught him to feed the resident through the feeding tube and how to clean the resident's privates, and how to change the dressing on the wound. When he did those things he stated he wore gloves, but not a gown. The resident stated he did interact with other residents and visitors… | 2017-01-01 |
| 84 | 84 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2012-01-26 | 490 | E | 0 | 1 | J2NN11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, and interview, the facility was not administered in a manner that enabled it to use its resources effectively and efficiently to enable the residents to attain or maintain their highest practicable physical, mental and psychosocial well-being. Finding includes: 1. The facility failed to ensure that a resident who enters the facility without pressure sores does not develop pressure sores unless the individual's clinical condition demonstrates that they are unavoidable for one of 10 sampled residents, (Resident 4) and one of 5 unsampled residents (Resident (11); and failed to provide necessary treatment to promote healing and prevent infection for one of 10 sampled residents (Resident 6) a resident who entered the facility with pressure ulcers. (Cross-refer to F314.) 2. The facility did not ensure that a resident who was incontinent of bladder received appropriate treatment and services to prevent urinary tract infections [MEDICAL CONDITION] and to restore as much normal bladder function as possible; 1. When the facility did not assess or refer a resident for bladder training or adaptive equipment resulting in accidental incontinence for one of 10 residents (Resident 2), and 2. When the facility did not prevent the development of UTIs for one of 10 residents (Resident 6). (Cross-refer to F315) 3. The facility did not ensure that a resident maintained acceptable parameters of nutritional status, such as body weight and protein levels when the facility did not promptly provide necessary equipment or supplies to ensure that 1 of 10 residents (Resident 6) received adequate nutrition when her feeding tube leaked for six weeks resulting in an 18% weight loss; and Resident 2 did not receive follow up care for weight maintenance. (Cross-refer to F325) 4. The facility did not have an effective infection control program coordinated by a trained and qualified infection control practitioner who was allowed sufficient ti… | 2017-01-01 |
| 85 | 85 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2012-01-26 | 493 | E | 0 | 1 | J2NN11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility did not have a governing body that was legally responsible for establishing and implementing policies regarding the management and operation of the facility, and did not ensure that the appointed administrator was responsible for management of the facility. Findings include: 1. The facility failed to ensure that a resident who enters the facility without pressure sores does not develop pressure sores unless the individual's clinical condition demonstrates that they are unavoidable for one of 10 sampled residents, (Resident 4) and one of 5 unsampled residents (Resident (11); and failed to provide necessary treatment to promote healing and prevent infection for one of 10 sampled residents (Resident 6) a resident who entered the facility with pressure ulcers. (Cross-refer to F314.) 2. The facility did not ensure that a resident who was incontinent of bladder received appropriate treatment and services to prevent urinary tract infections [MEDICAL CONDITION] and to restore as much normal bladder function as possible; 1. When the facility did not assess or refer a resident for bladder training or adaptive equipment resulting in accidental incontinence for one of 10 residents (Resident 2), and 2. When the facility did not prevent the development of UTIs for one of 10 residents (Resident 6). (Cross-refer to F315) 3. The facility did not ensure that a resident maintained acceptable parameters of nutritional status, such as body weight and protein levels when the facility did not promptly provide necessary equipment or supplies to ensure that 1 of 10 residents (Resident 6) received adequate nutrition when her feeding tube leaked for six weeks resulting in an 18% weight loss; and Resident 2 did not receive follow up care for weight maintenance. (Cross-refer to F325) 4. The facility did not have an effective infection control program coordinated by a trained and qualified infection control … | 2017-01-01 |
| 86 | 86 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2012-01-26 | 501 | E | 0 | 1 | J2NN11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and interview, the facility did not ensure that the medical director was responsible for the implementation of resident care policies and the coordination of medical care in the facility. Findings include: 1. During the survey, the medical director did not ensure that facility staff complied with and implemented patient care policies and procedures regarding the provision of care and services for residents who were admitted without pressures to ensure that they did not develop pressure sores and for residents with pressure ulcers to promote healing and prevent infection of the pressure sores. (Cross-refer to F314.) 2. The Medical Director did not ensure that a resident who was incontinent of bladder received appropriate treatment and services to prevent urinary tract infections [MEDICAL CONDITION] and to restore as much normal bladder function as possible. (Cross-refer to F315) 3. The Medical Director did not ensure that a resident maintained acceptable parameters of nutritional status, such as body weight and protein levels when the facility did not promptly provide necessary equipment or supplies to ensure that residents received adequate nutrition.(Cross-refer to F325) 4. The medical director did not ensure that facility staff complied with facility policies and procedures on infection control and prevention. (Cross-refer to F441.) Review of the responsibilities of the medical director revealed several specific responsibilities including developing and recommending policies and procedures to ensure that care is appropriately delivered to the patients and to assure a smooth operation; providing consultation to the administrator, administrator of nursing, and social services on the ability of the facility in providing for the psychosocial, medical, and physical needs of the patients; and contributing to assuring a safe and sanitary environment for patients and staff. | 2017-01-01 |
| 87 | 87 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2012-09-27 | 520 | E | 1 | 0 | KXEI11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, medical record and document review, the facility failed to consistently implement and evaluate plans of action related to the identified quality deficiencies in infection control practices to prevent the development and transmission of infection and communicable diseases as evidenced by: 1. Failure to follow posted instructions for residents placed in contact isolation precautions. 2. Failure to inform and educate residents, families, and visitors of the necessary precautions 3. Failure to ensure adequate personal protective equipment was available and accessible when needed. 1. On 9/26/12 at approximately 3:50p.m., an RN staff member was observed going from room-to-room checking on residents. The nurse entered the room of sampled Resident #6 who was identified as being on 'Contact Isolation' precautions as evidenced by the sign posted at the entry outside of the resident's room. The sign stated that a staff member or visitor was to wear a protective gown and gloves (Personal Protective Equipment - (PPE)) when entering the resident room, as well as washing hands before entering and after exiting the room. Upon entering, the staff member did not wash her hands or put on a protection gown or gloves as indicated on the contact isolation precaution sign posted at the doorway. While in the room, the resident complained of left flank discomfort. The staff member proceeded to pull-up the resident's gown and palpated/examined the left side of the resident' s torso. After she finished the encounter with the resident, she left the room without washing her hands and continued to enter other resident rooms interviewing and assessing residents after the start of the evening shift. At approximately 4:32 p.m. the RN staff member was interviewed. She stated that she was doing her 'rounds' to check on residents as she normally does after the start of her shift. The staff member acknowledged that she did not wear a protective g… | 2015-09-01 |
| 88 | 88 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2010-09-17 | 226 | D | 0 | 1 | 7DPX11 | Based on interview and document review, the facility failed to develop and implement policies and procedures that prohibited abuse when one staff member interviewed was unable to identify the different kinds of abuse. Findings include: 1. On 9/16/10, CNA 1 (certified nursing assistant) was interviewed regarding abuse and emergency preparedness. CNA1 stated that she had received abuse training earlier this year (2010) but could not recall the month when the training was conducted. When asked to identify the different forms of abuse she could only recall physical and verbal abuse and not other forms of abuse such as sexual, mental, involuntary seclusion and corporal punishment. 2. A review of the facility's policy and procedure on abuse training revealed that "Hospital/SNU (Skilled Nursing Unit) staff shall be educated regarding recognition of abuse, identification of victims of abuse, and the mandatory reporting duties. Staff education will take place during employee orientation, as well as in unit-specific in-service training programs and other hospital-wide training sessions. These training sessions shall include information on the role of the hospital/SNU staff in situations of abuse, criteria for identifying victims, statutory reporting requirements, and referrals for appropriate services." The "General Orientation Checklist/Agenda" from the education department included watching a video from social services regarding Referrals: Identifying Victims of Abuse (video). A sign-in sheet was provided for an inservice on "Reporting Adult Abuse" conducted by DPHSS Adult Protective Services on 9/3/10. The informational material provided by the educational department regarding the video however was related to "Domestic Abuse." | 2014-12-01 |
| 89 | 89 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2010-09-17 | 244 | E | 0 | 1 | 7DPX11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and interview the facility failed to listen to and act on the views, grievances and recommendations of a resident's family concerning decisions affecting residents care and life in the facility. This failure has the potential impact quality of life for residents and could lead to a potential delay in staff response to an emergent or urgent resident situation in the dining room if a resident started choking. Finding includes: On [DATE], during the noon meal observation there were 3 residents observed eating in the dining room. Two residents were feeding themselves and the other was being fed by a family member. No nursing or dietary staff was observed in attendance during the meal service. On [DATE], during the dinner meal observation there were 3 residents observed eating in the dining room. Two residents were feeding themselves and the other was being fed by a family member. No nursing or dietary staff members were observed in attendance during the meal service. During the meal observation, the nurse call light was activated by this surveyor at 5:00 p.m. From 5:00 p.m. to 5:25 p.m. there was no dietary or nursing staff response to the dining room call light. The call light was deactivated by an upstairs front desk security staff member. On [DATE], A licensed staff (LN3) was interviewed. She stated that there was usually a CNA (certified nursing assistant) or dietary staff member present in the dining room during the meal service; however, the CNAs may return to the rooms to assist the residents in need of feeding assistance. She stated all staff had CPR (cardiopulmonary resuscitation training) with First Aid and therefore the dietary staff should know what to do in the event a resident was choking. LN3 acknowledged a choking resident may not be able to speak and with the doors closed to the dining room, shouts for help by family members or other residents may not be heard by the staff. On further investigation LN3 acknow… | 2014-12-01 |
| 90 | 90 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2010-09-17 | 248 | E | 0 | 1 | 7DPX11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and interview, the facility did not provide for an ongoing program of activities designed to meet the interest and the physical, mental, and psychosocial well-being of each resident for 6 of 10 sample residents (Residents 2, 3, 5, 6, 7 & 9). Failure to provide an ongoing program of activities designed to meet the interests and the physical, mental, and psychosocial well being of each resident has the potential to affect their quality of life. Finding includes: 1. Resident 3 was admitted to the facility on [DATE] with several [DIAGNOSES REDACTED]. The minimum data set ((MDS) dated [DATE] described the resident as having short-term memory problem, with moderately impaired cognitive skills for decision-making, and was dependent on staff for all activities of daily living (ADL). Throughout the survey, Resident 3 was observed in bed and not engaged in any type of activity. Review of the medical record revealed that while there was no contraindication for her getting out of bed, there was no indication that an evaluation was conducted to determine the appropriate type and level of program that Resident 3 could benefit from in consideration of her cognitive status, frequent calling out, and physical limitations. The care plan on cognitive loss dated 8/25/10, for example, noted that staff would "assess, monitor, and record the patient's decision making: memory problem understanding;" and "provide program of activities: that accommodates patient problem." This notwithstanding, review of the medical record revealed the lack of documentation that an individualized program of activities was developed for Resident 3. There was no documentation of "patient problem" or attempts to engage Resident 3 in different types of activities or settings to determine if these could provide for a meaningful diversion, minimize behaviors of repeated calling out, or address her needs for comfort and companionship. Throughout the survey,… | 2014-12-01 |
| 91 | 91 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2010-09-17 | 278 | B | 0 | 1 | 7DPX11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to ensure that the assessment of one of 10 sample residents (Resident 1) accurately reflected the resident's status. Accurate assessment provides the basis for care and failure to obtain accurate assessments could result in inadvertent acts of omission or commission when planning the resident's care. Finding includes: Resident 1 is a [AGE] year old female admitted to the facility on [DATE]. Her admission [DIAGNOSES REDACTED]. Several in-room care observations were made for Resident 1 between survey dates of 9/15/10 and 9/17/10. On 9/15/10, she was observed to be responsive to both tactile and verbal communication with her family. During a skin observation on 9/16/10, her eyes were open and she appeared to acknowledge the verbal direction of her family member and the certified nursing assistant facilitating the skin observation. During the observation attempts were made to communicate with Resident 1, she never communicated clearly with her family or the staff. On 9/16/10, the MDS (minimum data s) dated 8/21/10 and the most recent weekly assessment was reviewed with LN4, a licensed nurse. The MDS identified communication patterns exhibited by Resident 1 during the assessment period were signs, gestures or sounds. The MDS also identified that she makes herself understood, that her speech was clear and that she was independent for cognitive skills for daily decision-making. A review of the facility admission form dated 8/15/10 reflected that the resident was disoriented to time and place and that she had a speech deficit. A review of the weekly assessment dated [DATE] identified the resident's speech as "Signs/Gestures used." LN 4 acknowledged the discrepancies in the assessments provided on the MDS, the admission sheet, and the most recent weekly assessment. | 2014-12-01 |
| 92 | 92 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2010-09-17 | 314 | E | 0 | 1 | 7DPX11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to ensure that residents having pressure sores received the necessary treatment and services to promote healing, prevent infection and prevent new sores from developing for 4 of 10 sample residents (Residents 1, 2, 4, and 6). These failures have the potential to contribute to delayed wound healing or the development of new sores. Findings include: 1. Resident 1 is a [AGE] year old female admitted to the facility on [DATE]. Her admission [DIAGNOSES REDACTED]. The medical record indicated the family/resident was requesting end of life terminal care and that [MEDICAL TREATMENT] had been declined. On 9/16/10, a skin observation was completed and all the skin was intact. On 9/17/10, the medical record was reviewed with LN4. She acknowledged the wound assessment dated [DATE] reflected the previously documented stage II pressure ulcer was recorded as healed. Additionally, she validated the nursing care plan was still being implemented to prevent the development of new pressure ulcers. One of the interventions listed on the potential pressure ulcer care plan was "SNU (Skilled Nursing Unit) - Turn and Reposition every two hours." That is, the facility staff would be turning the resident every 2 hours to help prevent pressure ulcer development. On 9/18/10, the wound assessment data, nursing care plan and certified nurse assistant (CNA) turning schedule was reviewed with LN 5. She acknowledged the turning schedule indicated the turning was to occur every 2 hours. A review of the CNA turning schedule documentation from 8/16/10 to 8/29/10 indicated the resident was being turned every 4 hours not every 2 hours as identified in the nursing care plan. She also acknowledged that the CNA turning documentation from 8/30/10 to 9/11/10 reflected that there were periods where the records noted the failure to turn the resident or document the turning event for the resident. The Pressure Ulcer Man… | 2014-12-01 |
| 93 | 93 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2010-09-17 | 325 | D | 0 | 1 | 7DPX11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and document review the facility failed to ensure the maintenance of acceptable parameters of nutritional status for 1 of 10 sampled residents (Resident 2). Failure to maintain acceptable parameters of nutrition can contribute to weight loss and low protein levels which may delay wound healing. Finding includes: Resident 2 is a [AGE] year old male admitted on [DATE]. His primary [DIAGNOSES REDACTED]. He experienced the stroke on 7/26/10 but had made some recovery from a previous vegetative state. His medical record indicated he developed a sacral pressure ulcer prior to admission in to the facility and that the pressure ulcer was debrided on 9/02/10. Wound care was observed on 9/16/10 and the nurse described the stage IV wound to be improving after the debridement. On 8/17/10, his diet was ordered as Ensure 1 can every 6 hours via gastric tube. On 8/24/10, his diet was changed to "Fiber-source one can every 6 hours then increase to 1 can every 3 hours as tolerated, then change to 2 cans every 6 hours 2 days prior to discharge." On 8/26/10, his diet gastric tube feeding was changed again to Fiber-source 1 can every 6 hours. On 9/02/10, his diet was changed to Fiber-source 1 can every 6 hours. On 9/15/10, during a tube feeding observation, and concurrent interview, LN6 (licensed nurse) stated Resident 2 was still receiving Fiber-source 1 can every 6 hours. LN6 acknowledged Resident 2 had not been tolerating the increasing volume of the Fiber-source and had residual gastric contents and therefore his tube feedings had never advanced as described in the physician orders. The medical records were reviewed on that same date and LN6 acknowledged Resident 2 had a low [MEDICATION NAME] level. She continued to indicate that the physician had been informed of all lab results. LN6 validated that the [MEDICATION NAME] level on 8/18/10 was sub-therapeutic at 2.8 gm/dl (normal is 3.4 to 5.0 gm/dl) and confirmed that throughout Resident 2'… | 2014-12-01 |
| 94 | 94 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2010-09-17 | 166 | E | 0 | 1 | 7DPX11 | Based on interviews and record review, the facility failed to ensure that prompt efforts were made to resolve grievances the residents may have. Findings include: 1. On 9/16/10 at 10:15 a.m., during the resident group meeting, two of ten residents complained of noise from screaming patients at night. Resident 8 revealed that he was told to to shut his door to reduce the noise level. He also stated that it takes a long time for the nurses to attend to the screaming residents at night resulting his inability to fall asleep. Another resident confirmed that the screaming residents affected her ability to sleep at night. 2. On 9/16/10 during the same resident group meeting, three residents complained about the nurses' slow response to patient calls, especially on the night shift. One patient indicated that the facility needed more staff to attend to patients' needs at night. Also the slow response to residents' calls for assistance occur during early morning when residents needed to use the restroom. A review of the resident council meeting minutes for May - July, 2010 revealed that the same issue of staff's slow response to call lights was identified in the minutes: For example: a. 5/28/10 - "Response time for help calls from nurses is too long. Sometimes more than 10 - 15 minutes which is dangerous if this is a life saving call." The corrective actions documented were: "to conduct test time it takes to answer call lights. All nursing staff instructed to ask patients what they need and inform the patients if they will be delayed in providing care." Another entry in the meeting minutes dated 5/28/10 noted, "There is this one CNA (certified nursing assistant) at the time my sister soiled herself and needed changing that came to the room, then told us she'll have to call the assigned CNA to help her change her. I stood at the door watching her and she walked down to the other end of the hallway but did not inform anyone that we needed help. Why did she even bother to come to our room and then do nothing?" The corrective… | 2014-12-01 |
| 95 | 95 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2010-09-17 | 253 | D | 0 | 1 | 7DPX11 | Based on observations and interviews, the facility failed to maintain maintenance services necessary to maintain the integrity of the roof over the expansion joints located above the double doors in corridor D100 and cleanliness of C115 day room.. Findings include: During the facility tour on 9/16/10 at 2:10 p.m., observations included brownish/yellowish discoloration above the D100 corridor double doors extending down the walls outside the C115 day room and the wall next to room A125. A wall vent located near the double doors on the day room corridor side was removed and exposed a gap between the two walls, observations of the gap inside the two walls included dead insects and moist blackish debris on the floor area. In an interview during the observation, the facilities maintenance supervisor stated that the roof leaks at the expansion joints and the stains on the walls are water marks. The double doors replaced an accordion wall and the area behind the vent was used for the accordion wall. At this approximate time observations of the C115 day room included walls with brownish/yellow stains and a layer of dust over the television set. The above findings were verified with the GMHA safety administrator and SNU facilities maintenance supervisor who accompanied the surveyor during the tour. | 2014-12-01 |
| 96 | 96 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2010-09-17 | 246 | D | 0 | 1 | 7DPX11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and interview, the facility did not ensure that the resident had the right to reside and receive services with reasonable accommodation of individual needs and preferences for two of 10 sampled residents. Findings include: 1. Resident 3 was admitted to the facility on [DATE] with several [DIAGNOSES REDACTED]. Review of the medical record revealed that the resident was admitted from the hospital where she was treated for [REDACTED]. The minimum data set ((MDS) dated [DATE] described the resident as having short-term memory problem, with moderately impaired cognitive skills for decision-making, and was dependent on staff for all activities of daily living (ADL). Throughout the survey, Resident 3 was frequently heard calling out to staff for assistance to get out of bed or to the bathroom. On 9/15/10 at 1:30 p.m. for example, the resident was heard from the hallway calling out "nurse ...nurse" repeatedly. When asked what she wanted, the resident replied, "Help me up ...help me up. I want to go to the bathroom." At 3:30 p.m. on 9/15/10, Resident 3 was again observed calling out, "get me up ...I want to get up." At 10:35 a.m. on 9/16/10, the resident was heard, saying repeatedly, "I want to get up ...I want to get up." When asked what she wanted to do, the resident replied that she wanted to get out of bed. When asked if Resident 3 could get out of bed, a facility staff interviewed stated that she did not know. Review of the medical record revealed the lack of contraindication for Resident 3's requests to get out of bed. physician's orders [REDACTED]." Further review revealed the lack of indication that the facility had considered Resident 3's request and took steps to accommodate her preference. During the survey, Resident 3 was observed in bed and remained bed-bound in spite of her frequent calling out to get out of bed. 2. On 9/16/10 at 10:15 a.m., a resident's family member indicated that the telephone line … | 2014-12-01 |
| 97 | 97 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2010-09-17 | 241 | E | 0 | 1 | 7DPX11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and record review, the facility did not promote care for residents in a manner and in an environment that maintained or enhanced the resident ' s dignity and self-respect. Findings include: 1. During the survey, bed-bound residents were repeatedly heard calling out to staff for assistance before receiving a response. In several instances, staff had to be summoned to the resident's room to ensure that the resident received assistance. For example: a. Resident 3 was admitted to the facility on [DATE] with several [DIAGNOSES REDACTED]. Review of the medical record revealed that the resident was admitted from the hospital where she was treated for [REDACTED]. The minimum data set ((MDS) dated [DATE] described the resident as having short-term memory problem, with moderately impaired cognitive skills for decision-making, and was dependent on staff for all activities of daily living (ADL). Throughout the survey, Resident 3 was frequently heard calling out to staff for assistance to get out of bed or to the bathroom. On 9/15/10 at 1:30 p.m. for example, the resident was heard from the hallway calling out "nurse ...nurse" repeatedly. When asked what she wanted, the resident replied, "Help me up ...help me up. I want to go to the bathroom." At 3:30 p.m. on 9/15/10, Resident 3 was again observed calling out, "get me up ...I want to get up." At 10:35 a.m. on 9/16/10, the resident was heard, saying repeatedly, "I want to get up ...I want to get up." When asked what she wanted to do, the resident replied that she wanted to get out of bed. When asked if Resident 3 could get out of bed, a facility staff interviewed stated that she did not know. b. Resident 7 was admitted to the facility on [DATE] with several [DIAGNOSES REDACTED]. Nursing admission notes dated 9/05/10 described Resident 7 as "alert and oriented (times) 2;" that she was "verbally responsive but confused;" and that she was incontinent of bowel and bladder function and was… | 2014-12-01 |
| 98 | 98 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2010-09-17 | 250 | D | 0 | 1 | 7DPX11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility did not provide medically-related social services to attain or maintain the highest practicable physical, mental, and psychosocial well-being for 1 of three residents in the sample described as receiving psychoactive medications. Finding includes: 1. Resident 3 was admitted to the facility on [DATE] with several [DIAGNOSES REDACTED]. Review of the medical record revealed that the resident was admitted from the hospital where she was treated for [REDACTED]. The minimum data set ((MDS) dated [DATE] described the resident as having short-term memory problem, with moderately impaired cognitive skills for decision-making, and was dependent on staff for all activities of daily living (ADL). Review of the medical record revealed nurses notes that documented Resident 3 as being confused and "restless," including on 8/21/10, 8/29/10, 8/30/10, 9/01/10 and 9/02/10; as well as "yelling"and being "agitated" including on 8/16/10, 8/29/10 and 9/15/10. Review of the medical record revealed that on 8/15/10, physician's orders [REDACTED]. days." Review of the MAR (medication administration record) and nurses notes revealed that Resident 3 was given Haldol for the behaviors. Further record review however revealed that in light of this, there was no evidence of social services participation in assessing the underlying cause of the resident's agitation or restlessness and whether this could be eliminated or minimized. In addition, there was no documentation of social service involvement in the development of interventions to address the behavior or decrease their frequency without the use of antipsychotic drugs (or use of the least dose possible). While a social service summary dated 8/24/10 referenced the resident as being "sometimes confused," there was no mention of any of the behaviors manifested by Resident 3 requiring treatment with antipsychotic drugs. During the survey, Resident 3 was frequently heard cal… | 2014-12-01 |
| 99 | 99 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2010-09-17 | 309 | D | 0 | 1 | 7DPX11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility did not provide the necessary care and services to enable the resident to attain or maintain the highest practicable physical well-being for three of 10 sampled residents. (Residents 3, 5, and 6). Findings include: 1. Resident 3 was admitted to the facility on [DATE] with several [DIAGNOSES REDACTED]. Review of the medical record revealed that the resident was admitted from the hospital where she was treated for [REDACTED]. The minimum data set ((MDS) dated [DATE] described the resident as having short-term memory problem, with moderately impaired cognitive skills for decision-making, and was dependent on staff for all activities of daily living (ADL). Review of the medical record revealed that Resident 3 had undergone a left arm exploration on 8/31/10 for a possible abscess and that after the procedure, the physician had made an order that no dressing on the arm was required. During skin care observation at 10:45 a.m. on 9/17/10, the left arm wound was observed uncovered but the area around it was noted to reddened and had slight swelling. Review of the medical record revealed that while a care plan was available for the prevention and treatment of [REDACTED]. In addition, there was no evidence that continuing assessments were conducted to determine progress or lack of wound healing. The treatment nurse stated that the no treatment orders were made by the physician but observed that the would indeed appeared reddened. Further review revealed that while wound assessments dated 8/15/10 and 8/24/10 noted wounds on the resident's upper buttocks, sacral area, and left hip, there was no evidence that monitoring was being conducted on [MEDICAL CONDITION] that were on the lateral aspect of the resident's lower legs to determine whether or not interventions were necessary. During the same skin care observation, both [MEDICAL CONDITION] appeared to have black eschar that were dry and intact. No measur… | 2014-12-01 |
| 100 | 100 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2010-09-17 | 312 | D | 0 | 1 | 7DPX11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility did not ensure that a resident who was unable to carry out activities of daily living received the necessary services to maintain good nutrition. Findings include: 1. Resident 3 was admitted to the facility on [DATE] with several [DIAGNOSES REDACTED]. Review of the medical record revealed that the resident was admitted from the hospital where she was treated for [REDACTED]. The minimum data set ((MDS) dated [DATE] described the resident as having short-term memory problem, with moderately impaired cognitive skills for decision-making, and was dependent on staff for all activities of daily living (ADL) including eating. Review of the care plan dated 8/15/10 pertaining to "Imbalanced nutrition--less than body requirements" revealed several interventions including "do not hurry patient" when eating; that Resident 3's "head is flexed slightly forward" and that "if not contraindicated, position patient in a chair or elevate head of bed as high as possible." During several meal observations including lunch on 9/15/10 and dinner on 9/16/10, Resident 3 was observed in bed sleeping while her meal tray was at the bedside on the overbed table. Once the tray was delivered, staff were observed setting up the tray and then leave the room to attend to other tasks. On 9/15/10. for example, Resident 3's meal tray was served at 12:15 p.m. while she was sleeping in bed. On one occasion, a staff was observed in the room and asked if the resident wanted to eat. Getting no response, the staff left the room. At 12:40 p.m.. a dietary staff was observed removing the tray which was largely uneaten from the resident's room. When asked how much the resident ate, the staff stated that the resident "refused to eat." During dinner observation at 5:10 p.m. on 9/16/10, an unlicensed staff was observed feeding Resident 3 who was hardly awake in bed. While encouraging the resident to eat and waking her up, the staff however wa… | 2014-12-01 |
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CREATE TABLE [cms_GU] ( [facility_name] TEXT, [facility_id] INTEGER, [address] TEXT, [city] TEXT, [state] TEXT, [zip] INTEGER, [inspection_date] TEXT, [deficiency_tag] INTEGER, [scope_severity] TEXT, [complaint] INTEGER, [standard] INTEGER, [eventid] TEXT, [inspection_text] TEXT, [filedate] TEXT );