| 38 |
KULA HOSPITAL |
125003 |
100 KEOKEA PLACE |
KULA |
HI |
96790 |
2018-06-22 |
725 |
D |
0 |
1 |
GCA011 |
Based on observation, record review and interview, the facility failed to ensure it has sufficient nursing staff to provide nursing and related services to assure resident safety and for each resident to attain or maintain the highest practicable physical, mental and psychosocial well-being for 11 of 24 residents (R56, R71, R31, R46, R75, R6, R39, R16, R30, R40 and R44) on one of the 4th floor nursing units. Findings Include: Cross-reference to findings at F689. On 06/19/18 at 10:55 AM, R56 was found in the hallway yelling out loud that she wanted to go to the activity room. Even after two minutes of yelling, no staff attended to her. At 10:57 AM, surveyor approached S15 who was standing by a medication cart at the end of the hallway. S15 stated S90 had just brought R56 into the hallway after toileting her. However, the resident remained yelling while trying to push her wheelchair forward, but could not move. S90 then attended to the resident and wheeled her into the activity room. The nursing unit's census included 24 residents. On 06/19/18 at 11:28 AM, there were ten residents in the activity room. There was one certified nurse aide (S94) who was attending to R75 at the time. One resident, R6, was loudly mumbling words over and over and tried to reach out and grab other people while sitting at her table. R71 was observed touching the wall, touching the building blocks in front of her and/or sat trying to move her wheelchair around. S94 was not able to either calm or attend to these residents one to one, as they were spread out in two of the adjoining rooms. Then after the incident with R56 whereby she was found trying to insert the large building blocks into her mouth, S94 stated, We only have one staff in here usually and it's really hard with just one staff. On 06/19/18 at 12:30 PM, during the lunch observation, it was found that R31 was able to feed herself. By 12:39 PM however, the spinach and beans were pushed toward the edge of her plate and ready to come off. The same observation was made earlier for R46 at 12:23 PM. R46 was using her left pointer finger to push her food onto her spoon so the food would not come off the edge of her plate. S15 observed this and concurred that these residents could benefit from a lipped or divided plate. No staff had observed R31 and R46's food coming off the edge of the plate as they were focused on delivering the meal trays to the residents and trying to feed those residents who needed closer monitoring and assistance. On 06/20/18 at 08:55 AM, observed R56 rocking back and forth in her wheelchair as if she wanted to move, but could not. R56 yelled out occasionally, and then quieted down. S97 said R56 rocks for comfort and liked to be by the window in the low stim room. However, during random observations of R56, she was often left alone with no meaningful activity. The low stim room however, was found to be a room where certain residents were left unsupervised because staff said it was to provide for a low stimulation environment. Yet, the observed outcome was that these residents (R56 and R39) were often left unattended with their needs not being assessed. At 09:07 AM, S97 stated in their activity room they had a lot of residents with dementia.with behavioral. S97 expressed that it was really hard to monitor them. S97 said they separated the residents out, such that the TV room had six residents, the middle room had two residents and the other adjoining low stim room had two residents, including R56. S97 said due to her own health status, she would have to call for back-up help, which would then leave the floor staff short of one more aide. On 06/21/18 at 09:38 AM, S5 said they have one person to monitor the three adjoining activity rooms. S5 acknowledged their activity room floor plan did not allow for visibility from one side to the other because of the walls. S5 said some of their residents who were known to be socially disruptive, made it difficult for only one staff to attend to all of these residents congregated in those rooms. S5 said because their unit had these socially disruptive residents, they were not brought up to attend the 5th floor group activities which residents of the other floors enjoyed. On 06/21/18 at 03:18 PM, an interview with S94 was done. S94 said often only about three of their residents attended the 5th floor large group activities. S94 said as soon as they (the three 4th floor residents) make noise they were brought down to the 4th floor right away due to their behaviors. S94 said as a result, one staff on their unit is always locked down to monitoring. S94 said although they may have four aides scheduled, only three aides could provide direct care since one person was assigned to the activity room to do unit activities with the residents. S94 said the unit activities were pretty much the same thing every day such as watching a DVD movie for those who can, and going to the low stim room for others. Random observations found it was the same routine for the residents as S94 described, but without enough staff to oversee the care for the majority of the residents placed in the rooms. On 06/21/18 at 03:42 PM, R39 was observed in the low stim activity room sitting alone in a wheelchair. R39 kept saying, Ah, ah, ah, ah, ah, both moaning and mumbling some illegible words. S51 was in the first large TV room assisting R16, and was unable to see R39. At 03:44 PM, S51 came into the low stim room from the hallway with R16 at her side. She saw R39 and said, what's wrong papa? but walked past R39, through the rooms and out into the hallway. R39's needs were not assessed as S51 did not attend to him with R16 at her side, nor did S51 ask for help. S51 walked into the low stim room again with R16, walked past R39 and had R16 sit at a table in the first room. At 03:48 PM, S51 was observed attending to R31 and to R71. R16 then tried to stand up and surveyor had to let S51 know what R16 was attempting to do. S51 quickly turned around as she was talking to R71, and said, Oh, wait! and then asked R16 if she wanted to walk again. At 03:51 PM, another aide came into the room; then a licensed staff at 03:52 PM. The staff however, were all situated in the first room where R31, R6 and R16 were. The licensed staff then walked into the low stim room where R39 was, but turned around and walked back to the first room. At 03:54 PM, S51 came to R39's side to ask if he was okay. Yet, S51 and other staff failed to attend to R39's needs when he had been moaning and saying things. During an interview with S5 thereafter, S5 was queried whether there was sufficient staff to care for each resident in meeting their highest practicable well being on this unit. S5 said no, because of the type of engagement their residents required which was for more one to one interaction. S5 said their unit had residents with more behaviors, were more dependent and the cognitively lower functioning residents. On 06/22/18 at 07:29 AM, S94 said it was to a point where they were burning out. S94 said their residents were often bypassed and not brought to attend the 5th floor activities. S94 acknowledged that safety too was a concern with just one staff monitoring 10 or more dependent residents with mood and behavioral issues. S94 said their staffing was decreased from five aides to four. S94 stated, We're trying to provide activities, so actually our day shift has three aides for 24 residents since the assigned activity monitor (one of the four aides) cannot toilet the residents. S105 who was feeding R30 at this time, was observed trying to engage R30 during the meal, but had to also watch R16 because she would stand unassisted and unexpectedly. R40 was then seen pouring her orange juice (OJ) into her oatmeal. R71 sat in the middle room eating hurriedly out of her bowls, but S105 could not see her from where she was sitting with R30 because of the side wall. S105 said, it's difficult when you have (R16), (R40), (R44), (and another newly admitted resident) trying to stand all at once--it makes it hard. Observation of the breakfast found S105 trying to keep an eye out for the other residents around her while she was trying to assist and feed R30. But, S105 was not able to prevent R40 from pouring her OJ into the oatmeal, nor could S105 see R56 and R39. These two residents were sitting in their wheelchairs in the low stim activity room unattended and out of S105's view. On 06/22/18 at 07:45 AM, S5 stated their residents were those with advanced dementia with behaviors. S5 said approximately 15 of the 24 residents could be socially disruptive and/or physically/verbally aggressive during care. S5 said this made it hard for their unit staff and for new hires or floaters to work on this unit. S5 acknowledged because their residents were more dependent with ADLs (activities of daily living) and because of their behaviors, they were not included in the large group activities upstairs. S5 said given the needs of these residents, staffing for this unit is not available. S5 concurred the way S105 had to feed R30 while on edge trying to keep an eye out for R16 and the rest of the residents was what their staff endured. S5 also acknowledged that although their fall rates have decreased, she concurred with the surveyor's observations that many of their residents were left unattended, without adequate supervision/engagement due to lack of staff coverage. S5 said it has been difficult to ensure their 14 residents who required assistance with meals and approximately 17 residents who required extensive to total assistance in their ADLs received their highest quality of life as a result. |
2020-09-01 |