cms_ID: 31
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 31 | BINGHAM MEMORIAL SKILLED NURSING & REHABILITATION | 135007 | 98 POPLAR STREET | BLACKFOOT | ID | 83221 | 2016-06-17 | 240 | E | 0 | 1 | J25411 | Based on observations, record review, and resident and staff interviews, the facility failed to ensure the dining experience in the main dining room promoted the enhancement of quality of life for residents. This directly impacted 12 of 20 sampled residents (#3, #6, #8 - #10, and #14 - #20) who resided in the facility at the time of survey and 6 of 7 residents in the group interview. It also had the potential to impact all residents who ate in the main dining room. Specifically: residents waited lengthy time frames to be served; meals were not always served on time; condiments such as salt and pepper and sugar were not easily accessible to residents who dined in the main dining room; a sufficient amount of beverages was not consistently served, including water; and beverages were served in cans, cartons and plastic bottles without residents being offered the option of having the beverages poured into cups. Findings include: 1. Meal service start times were posted on the wall adjacent to the primary entrance into the main dining room as follows: breakfast 7:20 am, lunch 12:20 pm, and dinner 5:20 pm. Between 30 to 35 residents were observed to eat their meals in the main dining room during the survey. a. On 6/13/16, breakfast observations were made in the main dining room beginning at 7:05 am. At this time, approximately 20 residents were present in the dining room, sitting at their tables. The remaining residents (approximately 10 residents) arrived and were present in the dining room by 7:15 am. Although most residents had one beverage at their places on the tables, breakfast meal service did not start until 7:40 am. This was 20 minutes after the posted meal time and 40 minutes after two thirds of the residents had been present. Meal service concluded at 7:55 am. Approximately 20 of the residents had been in the dining room since prior to 7:05 am, when observations began. Specific examples include: * At 7:15 am, Resident #20 stated (in regards to meal service) It takes a while. * At 7:45 am, 3 of the 4 residents sitting at the assistance table (Residents #9, #15 and #16), were observed with their heads slumped and their eyes closed. The remaining resident, Resident #3, was observed intermittently fidgeting with her silverware and sitting and staring off from the time she was first observed seated in the dining room at 7:05 am, until she was served her meal. This table was served last at 7:55 am. * Resident #17 was in the dining room sleeping with her tray in front of her at 8:02 am. She continued to sleep and ate nothing. She was aroused by staff at 8:15 am, and wheeled out of the dining room for a scheduled hair appointment. b. Almost all the residents were present in the dining room at 12:20 pm, when the observations began. Lunch meal service started at 12:25 pm. Service was finished at 12:40 pm. During meal service there were two dietary staff behind the tray line serving meals. One staff served hot items and the other cold items. There were 6 nursing staff members taking residents' trays from the tray line and serving the meals to the residents. There were frequently 4 to 6 nursing staff members waiting at the tray line for dietary staff to dish up the plates. Dietary staff did not keep up with the pace of the nursing staff who were available to serve the meals. Another factor that slowed the meal service had to do with the option for residents to walk, wheel, or be wheeled up to the tray line to select the specific foods they wanted. Four residents were observed to go to the tray line to select their meals; it took between 2 and 5 minutes each for the residents to get through the tray line with their food selected. Meal service backed up more during these times with up to 6 nursing staff waiting at the tray line for dietary staff to serve additional trays. Four residents complained about waiting too long for meals. Specific examples include: * At 12:40 pm, Resident #19 was beginning to eat her meal. She stated, All meals are a half hour late. * At 12:40 pm, Resident #18, who was sitting near Resident #19, agreed with Resident #19's statement that the meals were served a half hour late. * At 12:40 pm, Resident #6, newly admitted and sitting near Residents #18 and #19, stated she did not understand why they waited. She stated they (residents) were in the dining room and ready to go at noon. * At 12:43 pm, Resident #8 stated all meals were late and that she was just served her meal at 12:40 pm. She stated part of the problem was that staff brought residents to the dining room quite a while before the meals were served. She stated she no longer allowed staff to bring her to the dining room early. The Dietitian was interviewed on 6/15/16 at 9:40 am, and stated nursing and social services directed meal times/meal service. She stated residents were able to go through the tray line and select what they wanted and verified meal service took longer when residents did so. She stated the facility was brainstorming how to speed up meal service and still retain the ability of residents to go through the tray line to select food choices. When asked what her expectations were for how many trays per minute should be served, she stated 2 trays per minute was the goal. If two trays per minute were served, all residents would be served within approximately 15 minutes which was not observed to occur during the meal observations noted above. The DNS was interviewed on 6/16/16 at 5:50 pm, and stated that they had tried changing the serving order in the dining room to meet the needs of residents; however, were still in the process of figuring out the best meal service plan. 2. Breakfast was observed on 6/13/16 in the main dining room from 7:05 am until 8:15 am. With the exception of 2 tables that had salt and pepper shakers (one set being provided after Resident #14 requested it), there were no condiments on the remaining 9 tables in the main dining room such as salt, pepper, sugar, etc. Condiments such as salt and pepper were not served unless residents asked for them. Specific examples include: * Resident #14 asked for salt and sugar when his meal was served; staff went and got him a salt and pepper shaker for the table and sugar packets. * An anonymous resident asked for sugar at 7:59 am; a staff member went and retrieved sugar packets for the resident. On 6/14/16 at 12:20 pm, the lunch meal dining room observations began and continued through 1:00 pm. No salt or pepper shakers or sugar was observed on the tables initially. At 12:15 pm, salt and pepper had been placed on one table; the other tables did not have it. Specific examples include: * Resident #8 stated the food was bland; she stated there was no salt available for her to use. No salt and pepper shakers were observed on her table. * An anonymous resident was interviewed at 12:47 pm, and stated salt and pepper were not available on the tables. She stated she could ask for it if she wanted it. The Dietitian was interviewed on 6/15/16 at 9:40 am, and verified salt and pepper were not put on the tables customarily at meals. She stated residents could ask for salt if they wanted it. The Director of Nutrition services was interviewed on 6/16/16 at 11:15 am, and stated the facility used to provide salt and pepper shakers on the tables. She stated the previous Administrator instructed staff to remove the salt and pepper shakers to prevent residents that should not have sodium from accessing it. This practice had continued since that time. 3. On 6/13/16, breakfast meal observations were made in the main dining room beginning at 7:05 am. At this time, approximately 20 residents were present in the dining room, sitting at their respective tables. A staff member was in the process of pushing a cart from table to table and pouring beverages for the residents. At 7:15 am, most residents had been served their beverages with the majority of them having only one beverage served to them. No water was observed to be present on the tables with the exception of 3 residents who had been served cups of water. Some residents were served additional beverages with their meals such as milk for cereal. Resident specific observations revealed the following beverages were served: * Resident #10 was served one chocolate beverage only; no water was served. * Resident #14 was served a cup of water on the table when he arrived at 7:30 am. Resident #14 mumbled that he would like coffee when he was assisted by staff to the table. He asked staff again for coffee when they served his meal at 7:45 am; staff then brought him a cup of coffee. * Resident #16 was served one 4 ounce (oz) beverage. No water or additional beverage was served. * Resident #17 was served one 4 oz beverage with breakfast. No additional beverage was served. The Dietitian was interviewed on 6/15/16 at 9:40 a.m. and stated water should be served at each meal and additional beverages in accordance with residents' preferences. She stated residents should be served a minimum of 2 beverages with meals. The Director of Nutrition services was interviewed on 6/16/16 at 11:15 am, and stated that CNAs served all the beverages to residents at meals. She stated dietary stocked and sent the beverages up in accordance with the menu and preferences from the kitchen in the basement to the first floor for meal service, but dietary staff did not serve beverages directly to residents. She stated she was not sure what the process was for nursing to determine the distribution of beverages to residents. 4. During observation of the breakfast meal on 6/13/15, it was noted that none of the residents were observed with their canned supplements or milk (in plastic bottles/cartons) poured into cups. These beverages were either not opened, opened with straws placed in the containers, or were opened without a cup or straw being offered, which left the only method of drinking by lifting the can, carton or bottle up and drinking from the container. Specific observations from 7:05 to 8:15 am included: * Resident #15 was served Glucerna supplement in a can, a straw or cup were not offered. She was observed, with some difficulty, lifting the can to her lips and drinking directly from it. Resident #15 sat at a table designated for residents who required meal assistance. * Resident #9 was served Nepro supplement in a can. A straw was placed into the can; Resident #9 was not offered the option of having the supplement poured into a cup. * Resident #14 was served Ensure Clear in the carton. A straw was placed in the carton; Resident #14 was not offered the option of having the supplement poured into a cup. He was also served milk in a plastic bottle with his meal; he was not offered the option of having it poured into a cup. * The table for residents requiring meal assistance was observed at the end of the meal with 2 unopened plastic bottles of milk, that had not been opened during the meal, remaining on the table. During observation of the lunch meal on 6/13/16, it was noted that none of the residents were observed with their canned supplements or milk (in plastic bottles/cartons) poured into cups. These beverages were opened with straws placed in the containers. Specific observations during lunch included: * Resident #15 was served Glucerna supplement in a can, with a straw. Resident #15 was not offered the option of having the supplement poured into a cup. * Resident #9 was served Nepro supplement in a can. A straw was placed into the can; Resident #9 was not offered the option of having the supplement poured into a cup. The Dietitian was interviewed on 6/15/16 at 9:40 am, and stated beverages served in cans, cartons and bottles should be poured into cups in accordance with residents' preferences. The Director of Nutrition services was interviewed on 6/16/16 at 11:15 am, and stated that beverages served in bottles, cans and cartons should be poured into cups. 5. On 6/15/16 at 10:20 am, during a group interview, the group stated there was not enough staff available during meals and during the night shifts. The group stated that after 10 pm, there were only 2 CNAs. The group stated they often had to wait up to 45 minutes for their call lights to be answered. The group stated the 400 and 500 halls were really short of staff. The group stated meal times took too long and did not understand why staff stood around the tray line waiting for trays. They stated that although they liked being able to go to the tray line to pick their meal, the process took too long. The group further stated they usually had to ask or wait for their meals to get something to drink. The group stated water was not served unless asked for, as well, as condiments. The group stated that not all the residents were able to eat what they wanted. If a resident was on a special diet, they could not get anything not on the diet especially if they were not able to voice their wishes. The group further stated fluids were not always offered in a glass or cups. They usually got drinks from a can. Resident Council Grievance meeting minutes from the last three months documented the following: * Review of (MONTH) Concerns - Meal service changed to improve flow and timing of meals and hall trays delivered before dining rooms and staff are unable to address residents' special needs or provide extra assistance due to being so busy. * (MONTH) - Residents need assistance in the rehab dining rooms during meals and in completing menus; too much Mexican food on menus; potatoes and fruit too hard. * (MONTH) - Salt and pepper over used in vegetables and gravies; potatoes under cooked; and meat overcooked and tough; meals cold in dining room; requests for smaller portions not provided; and drinks are not served timely at dinner meals. * (MONTH) - Staff continue to turn off call lights without providing care. They say they will return but often forget. Staff also need to be quicker in answering the red bathroom call lights. Staff are not helping as efficiently in the dining room during tray line as they could be. A Mini Inservice for staff, dated 5/10/16, documented that residents' continue to report drinks are not served timely at the dinner meal in the dining room. Residents are stating there are times they receive their meal and have yet to be served anything to drink. This concern has been expressed during several resident council meetings. The inservice directed that all residents should receive water, as well as, beverages of choice. The inservice stated CNAs are responsible to serve beverages at dinner meals and for staff to be aware of who is in the dining room to ensure drinks are passed prior to meal service. | 2020-09-01 |