cms_ID: 55
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 55 | WEISER CARE OF CASCADIA | 135010 | 331 EAST PARK STREET | WEISER | ID | 83672 | 2019-10-04 | 684 | D | 0 | 1 | VWS011 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, policy review, and staff interview, it was determined the facility failed to ensure professional standards of nursing practice were followed for medication administration, bowel care, and skin care. This was true for 3 of 12 residents (#9, #16, and #30) reviewed for quality of care. These failed practices created the potential for harm should residents experience adverse effects from medications, constipation or fecal impaction, and skin breakdown. Findings include: 1. The facility's undated policy for Oral Inhalant Administration, directed staff to instruct residents receiving steroid inhalers to rinse their mouth thoroughly with water immediately following inhalation to wash away steroid residue in the mouth. This policy was not followed. Resident #9 was admitted to the facility on [DATE], with multiple [DIAGNOSES REDACTED]. A quarterly MDS assessment, dated 7/22/19, documented Resident #9 had moderate cognitive impairment. Resident #9's (MONTH) 2019 physician's orders [REDACTED]. The order included special instructions for Resident #9 to rinse their mouth out with water and spit after administration. On 10/3/19 at 7:29 AM, RN #1 was observed when she administered Resident #9's medications which included the inhaled medication Breo Ellipta. Resident #9 was observed to take one puff of the Breo Ellipta orally, and then gave the inhaler back to RN #1. RN #1 then asked Resident #9 to take a sip of water. Resident #9 did not rinse his mouth after inhaling the Breo Ellipta. On 10/3/19 at 9:08 AM, RN #1 said she forgot to ask Resident #9 to rinse his mouth after administering the Breo Ellipta. RN #1 said she should have told Resident #9 to rinse his mouth with water and spit it out. 2. The facility's Bowel Care protocol, updated on (MONTH) (YEAR), documented the following: *Follow specific physician's orders [REDACTED]. * If the resident was 24-48 hours without a bowel movement documented, staff were to administer 30 cc (cubic centimeter) of Milk of Magnesia (MOM) orally. *If the resident was 72 hours without a bowel movement documented, staff were to administer a [MEDICATION NAME] suppository rectally as per physician's orders [REDACTED].>*If no bowel movement was documented by the following morning, staff were to administer a fleet enema rectally as per physician's orders [REDACTED].>*If no bowel movement within 2 hours, staff were to call the physician for additional orders. This policy was not followed. Resident #16 was admitted to the facility on [DATE], with multiple [DIAGNOSES REDACTED]. A quarterly MDS assessment, dated 8/17/19, documented Resident #16 had severe cognitive impairment, required extensive assistance of two people for toileting, and was always incontinent of bowel. Resident #16's physician's orders [REDACTED]. *Fruiteze (laxative) 30 cc as needed for bowel care *MOM suspension, give 30 ml (milliliters) by mouth as needed for bowel care if no bowel movement in 24 - 48 hours. *[MEDICATION NAME] Adult Suppository, insert one suppository rectally as needed for bowel care if no bowel movement in 72 hours. *Fleet Enema 7-19 gm (grams)/118 ml, insert one unit rectally as needed for bowel care if no bowel movement in 72 hours. Resident #16's Bowel Movement Records, dated 9/5/19 through 10/3/19, documented she did not have a bowel movement between 9/5/19 and 9/7/19 (3 days) and between 9/20/19 and 9/22/19 (3 days). Resident #16's Medication Administration Record (MAR), dated 9/1/19 through 9/30/19, documented bowel medications were not administered as ordered when she did not have a bowel movement from 9/5/19 to 9/7/19 and 9/20/19 to 9/22/19. On 10/3/19 at 1:27 PM, LPN #1 said he was not aware of the facility's bowel protocol. LPN #1 said physician's orders [REDACTED]. LPN #1 reviewed Resident #16's MAR and said Resident #16 was not provided the bowel medications as ordered. 3. Resident #30 was admitted to the facility on [DATE] and was readmitted on [DATE], with multiple [DIAGNOSES REDACTED]. Resident #30's (MONTH) 2019 physician's orders [REDACTED]. Resident #30's care plan included interventions for Prevalon boots to each lower extremity when in bed and to have a pillow between her knees. On 10/3/19 at 2:03 PM, CNA #1 and CNA #2 assisted Resident #30 to transfer from her wheelchair to her bed. CNA #1 pulled the bed sheet up to Resident #30's waist and both CNAs left the room. Resident #30 was not provided with a pillow between her knees when she was repositioned in bed, and Prevalon boots were not applied to her lower extremities. On 10/3/19 at 2:27 PM, CNA #2 reviewed the care instructions for Resident #30 and said she did not know Resident #30 needed a pillow between her knees when she was being repositioned in bed. CNA #2 was also not aware Resident #30 also was to wear Prevalon boots while in bed. | 2020-09-01 |