cms_GU: 90
Data source: Big Local News · About: big-local-datasette
| rowid | facility_name | facility_id | address | city | state | zip | inspection_date | deficiency_tag | scope_severity | complaint | standard | eventid | inspection_text | filedate |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 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, Resident 3 was observed in bed and when awake 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. 2. 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;" and that she was "verbally responsive but confused." Throughout the survey, Resident 7 was observed in her room never leaving her bed. Information provided by the facility concerning Resident 7 noted that she was "bedfast." Review of the medical record however revealed the lack of contraindication for her getting out of bed. Indeed, admission orders [REDACTED]." In spite of this, Resident 7 was not observed assisted out of her room to any organized activity. A recreational therapy evaluation dated 9/08/10 described Resident 7 as able to interact "with staff to express needs, (patient) is pleasant towards peers, but would need to attend group to observe peer interaction." The evaluation further noted therapy goals which included participating "in a 1:1 activity with staff..;" that she will be "brought out of the room via (wheelchair) for Sunshine and Socialization to increase Leisure performance;" and "will participate in light (wheelchair) Exercise group to increase strength and endurance. Interventions to meet the goals included providing emotional and spiritual support and providing Resident 7 "with Arts and Crafts and Card Games;" "attend group at least 1 - 2 (times) a week," and will be "brought out of the room at least 2 - 3 (times) a week, and participate in a 1 to 1 activity at least once a week. " During the survey however, Resident 7 was always observed in bed neither engaged in Arts and Crafts and Card Games nor brought out of the room to attend group activities as planned. 3. Resident 5 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. The resident's minimum data set ((MDS) dated [DATE] revealed that the resident was awake, alert, and verbally responsive. The resident's activity pursuit patterns included her preferred activity settings as her room and the activity room. The MDS revealed that the general activity preferences of Resident 5 include the following: cards/other games, crafts/arts, exercise/sports, music, reading/writing, spiritual/religious activities, trips/shopping, walking/wheeling outdoors, watching tv, gardening or plants, talking or conversing, and helping others. The progress notes by the recreational therapy staff dated 8/26/10 identified an issue of "decreased leisure activity performance" The progress note further revealed a plan for the resident to be brought to a group activity via wheelchair to participate in exercise activity and sunshine stroll at least three times a week and 1-1 activity at least once a week. A social services summary form dated 9/1/10 revealed that the social worker was informed by the facility's unit nursing supervisor that the resident was on "suicidal watch." The social worker met with the resident who assured her that she would not harm herself and that she was joking with one of the nurse aides that she would kill herself using the cord line in her room. The social worker noted the resident was emotional during the interview and stated that she was depressed and was concerned about her placement upon discharge. A review of the physician orders [REDACTED]. one tablet daily for depression. A patient note dated 9/6/10 stated, "Resident is being treated for [REDACTED]." A plan of care last updated on 8/31/10 noted a mood state problem with a goal that the resident would have improved mood with an approach to encourage her to participate in diversional recreational activities for socialization with groups. Interview with the recreational therapy staff on 9/16/10 indicated that the resident was brought to the day/activity room for group activities and stayed outside when she has visitors. Review of the progress notes and plan of care showed no documentation that the activities provided were designed to meet the interests of Resident 5 whose depressed mood had deteriorated to suicidal thoughts within a one-month period. Also there was no provision for adapting the recreational needs of the resident when she was placed on contact isolation on 9/15/10 the first day of the survey. Review of the activity calendar for September 2010 revealed scheduled activities twice a day at 10 or 10:30 a.m.; and the second activity at 1:30 p.m. or 2:00 p.m. In an interview with two facility staff member acting as recreational therapy staff, they have stated that there had been no recreational therapy director for two years. Both revealed that they work together with a recreational therapy consultant to create an activity calendar that best addressed the recreational needs of the residents in the facility. 4. Resident 6 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. On 9/15/10 at 10:20 a.m., during the initial tour, the Resident 6 went out of the facility for her [MEDICAL TREATMENT] treatment in an acute hospital facility. The resident room had contact isolation precautions posted outside the door. Interview with the licensed nurse indicated that she was not sure of the cause of isolation. The licensed nurse added that the resident has either (MRSA) [MEDICAL CONDITION]-resistant staphylococcus aureus or (MDR) multi drug resistant infection from the wound in the right stump. A review of the MDS dated [DATE] revealed that Resident 6's cognition was moderately impaired and with periods of lethargy, e.g. sluggish staring into space, difficult to arouse with little body movements. The resident's preferred activity settings include her own room and the day/activity room. The MDS also revealed that the resident's general activity preferences include cards/other games, crafts/arts, exercise/sports, music, reading/writing, spiritual/religious activities, trips/shopping, walking/wheeling outdoors, watching tv, gardening or plants, talking or conversing, and helping others. The plan of care related to a problem with communication revealed a goal for the resident to maintain communication skills as evidence by making sounds, pointing, using gestures, responding with appropriate yes or a head nod. The plan of care related to cognitive loss included approaches such as provision of program of activities that accommodates patient problem. Also provision of reality orientation validation therapy: use of communication technique such as using patient's name, using smile and simple brief words. On 9/15/10 at 2:30 p.m. Resident 6 was observed resting in bed after coming back from [MEDICAL TREATMENT] unit. At 4:45 p.m., the resident was observed in bed radio was on with music playing. Except for this music, there were no other activities that were offered to the resident on the days of the survey. 5. Resident 2 is a [AGE] year old male admitted on [DATE]. His primary [DIAGNOSES REDACTED]. Review of the medical record revealed that he had a stroke on 7/16/10 and had made some recovery from a previous vegetative state. According to his minimum data set ((MDS) dated [DATE], Resident 2 was identified as being totally dependent for most physical functioning and had some involvement in activities. His preferred activities were assessed to be in the room or within the activity/day room and the activities generally occurred within the nursing home. His recreational therapy evaluation identified a problem of "Decreased participation in leisure activity." Expected outcomes/goals based on the recreational therapy evaluation indicated the resident "will participate in sunshine stroll, group conversation for socialization." Specific interventions identified for the problem were: "staff to offer and organize a group/small setting for cooking and encourage the pt. (patient) to join and staff to provide some materials for him to use, or any activity functional depending on his level of function." The document indicated that "the pt. (patient) will attend group activity at least 3X a week and 1:1 activity at least 2X/week." A review of the facility September 2010 resident activity calendar showed that for most day of the month there were 2 group activities per day; one activity occurring in the morning and one activity in the afternoon. Several in-room care observations were made for Resident 2 between survey dates of 9/15/10 and 9/17/10. No activity calendar was observed to be posted in the room. The brother of Resident 2 was noted to be visiting and assisting with care during the morning and the wife was visiting and assisting with care in the afternoon. Resident 2 was not observed to participate in any in-room or group activities during the observation period. During an interview on 9/16/10, the wife stated that during the afternoons when she was present she had not observed the staff provide her husband any form of reorientation or divisional activity aside from regular care. On 9/17/10, during an interview with the brother he stated during the mornings when he was present that he had not observed his brother participate in any form of in-room or group activity aside from the expected care such as turning, cleaning, or feeding. Neither the bother nor the wife acknowledged seeing the September 2010 activity calendar. On 9/16/10, Resident 2's medical record was reviewed with the facility activity representatives. The recreational therapy evaluation dated 8/20/10 was reviewed for assessment data, problem identification, goals, interventions, and frequency (i.e., plan of care). The daily treatment record was reviewed as well. The activity representative acknowledged that from 9/01/10 to 9/07/10 the form lacked documentation demonstrating group or in-room activities occurred for the resident. Additionally, she acknowledged the resident's assessment did not take into consideration the resident's [DIAGNOSES REDACTED]. 6. Resident 9 is a [AGE] year old male admitted into the facility on [DATE]. His [DIAGNOSES REDACTED]. The medical record reflected that "the Mom is the primary caregiver" of the patient. According to his minimum data set ((MDS) dated [DATE], he was identified as being totally dependent for most of his physical functioning and had some involvement in activities. His communication pattern was assessed as having unclear speech, rarely/never understood, rarely/never understands and speaks with signs/gestures/sounds. His preferred activities were assessed to be in the room or within the activity/day room. His recreational therapy evaluation form dated 8/23/10 was reviewed. It identified a problem of "Decreased leisure activity participation." The evaluation identified the expected outcome/goal as, "Pt (patient = resident) will participate in group activity to increase his strength and safer mobility. Pt will participate in sunshine stroll, group conversation for socialization to increase social participation." Specific interventions identified for the problem included "staff to inform patient and family of current events, recreational therapy (RT) staff to offer the pt to try to use the piano in RT room to play and RT staff to offer or provide different functional activities appropriate for his level." The document indicated that "the pt will attend group activity at least 3X a week and 1:1 activity at least once a week." Several in-room care observations were made for Resident 9 between survey dates of 9/15/10 and 9/17/10. No activity calendar was observed to be posted in the room. of Resident 9. Both the mother and father were observed interacting with the resident during most of the observation period. Resident 9 was not observed to participate in any in-room or group activities during the observation period. During an interview with the mother and father on 9/17/10, they stated that they had not observed the staff provide their son any form of individualized divisional activity aside for regular care. Neither of the parents acknowledged receipt of the September activity calendar. Three activities were documented on the recreational therapy daily treatment record for the week of 9/09/10 through 9/16/10. During the aforementioned time period the activities were documented as (1) Dining, (2) Being wheeled around in wheel chair by mother, and (3) watching TV in room. The goals, frequency and types of interventions specific to the facility identified problem for this resident were not met. | 2014-12-01 |