| 6300 |
PRESTIGE CARE & REHABILITATION - THE ORCHARDS |
135103 |
1014 BURRELL AVENUE |
LEWISTON |
ID |
83501 |
2010-10-22 |
311 |
D |
|
|
KBBS11 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, it was determined that the facility failed to provide restorative nursing services as physician ordered and care planned. This was true for 2 of 6 residents sampled for ADL decline (#s 2 and 3). Findings include: 1. Resident #2 was admitted to the facility on [DATE], and readmitted on [DATE], with [DIAGNOSES REDACTED]. The resident's most recent quarterly MDS assessment, dated 8/17/10, documented the following: * Bilateral range-of-motion limitations of the legs * Extensive assistance of at least two staff members required for bed mobility and toileting * Total dependence on at least two staff members for transfers * Total dependence on one staff member for locomotion on the unit Resident #2's recapitulated physician orders [REDACTED]. * "(RNA) (Restorative Nursing Aides) Heel slides 5-10 reps each side 5 times per week. Once a day on Sun(day), Mon(day), Tue(sday), Wed(nesday), Sat(urday); Shift 1." Start date: 4/2/10. * "(RNA) Manually assist hip and knee extinsion (sic) 5-10 reps each leg 5 times per week. Once a day on Sun, Mon, Tue, Wed, Sat; Shift 1." Start date: 4/2/10. * "(RNA) Quad sets 5-10 reps 5 times per week. Once a day on Sun, Mon, Tue, Wed, Sat; Shift 1." Start date 4/2/10. The resident's Care Plan in effect for October 2010 documented the following: * "Problem: Resident has a history of conflict with staff, as she has routinely been non-compliant with cares and treatment modalities (weights, prescribed diet, fluid restriction, therapy, etc.)." Problem Start Date: 8/17/10. * "Goal: Resident will maintain compliance with cares and treatment modalities, as evidenced by interviews with resident and direct care staff." Goal Target Date: 11/17/10. * "Approach: Resident will be compliant with CNA and Nursing cares. Resident will comply with ordered therapies." Approach Start Date: 8/17/10. Restorative Flowsheets for July 2010 through October 2010, and related Progress Notes (PN), were reviewed. Those flowsheets and PN documented the following: July 2010 * No RNA therapies or resident refusals documented for 7/5, 7/11, 7/13, and 7/21 PN: * 7/11/10 - "I was unable to get to Prog(ram) due to other problems on (the) floor." * 7/13/10 - "No (illegible) prog(ram) today. Did 4 reps (with) sit to stands ..." August 2010 * No RNA therapies or resident refusals documented for 8/15-16, 8/22-23, and 8/30 PN: * 8/16/10 - "Was unable to do prog(ram)." * 8/23/10 - "Was unable to do prog(ram)." * 8/31/10 - "Unable to do program." September 2010 * No RNA therapies or resident refusals documented for 9/6, 9/12-13, 9/19-20, and 9/26 * No related PN notes provided by facility October 2010 (through 10/19/10) * No RNA therapies or resident refusals documented for 10/3, 10/10, and 10/17. * No related PN notes provided by facility 2. Resident #3 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. The resident's most recent quarterly MDS assessment, dated 9/29/10, documented the following: * Repetitive physical movements * Extensive assistance of at least two staff members required for bed mobility, transfers, and toileting * Extensive assistance of one staff member required for locomotion on the unit, dressing, and personal hygiene Resident #3's recapitulated physician orders [REDACTED]. * "(RNA) Ambulate to tolerance with FWW (front wheel walker), gait belt, SBA (stand-by assist) five days per week. Once a day on Sun, Wed, Thu, Fri, Sat; Shift 1." Start date: 7/30/10. * "(RNA) Biodex bike X (for) 10 minutes. This is to be done if resident is non compliant with ambulation program. PRN - as needed ..." Start date: 7/30/10. The resident's Care Plan in effect for October 2010 documented the following: * "Problem: Resident is at risk for skin breakdown r/t (related to) decreased mobility, cognitive deficits, frequent incontinence. Problem Start Date: 07/07/2010." * "Goal: Resident will not sustain a preventable skin injury through 90 day eval(uation). Goal Target Date: 12/27/2010." * "Approach: Encourage physical activity, mobility, and range of motion to maximal potential. Approach Start Date: 07/07/2010." Restorative Flowsheets for August 2010, and related PN, were reviewed. Those flowsheets and PN documented the following: August 2010 * No ambulation of resident to tolerance with FWW, or resident refusal, documented for 8/5-6, 8/12, 8/15 and 8/22 * Resident refusals to ambulate to tolerance with FWW documented for 8/1, 8/7, 8/11, 8/13-14, 8/18, 8/21, 8/25, and 8/27-28 * No provision of Biodex bike therapy or resident refusal of alternative therapy documented for 8/1, 8/5-7, 8/11-15, 8/18, 8/21-22, 8/25, and 8/27-28 PN: * 8/1/10 - "Res(ident) (refused) prog(ram)." * 8/7/10 - "Res(ident) (refused)." * 8/11/10 - "Res(ident) refused program (three times) ..." * 8/13/10 - "Res(ident) (refused)." * 8/27/10 - "Res(ident) (refused)." * 8/28/10 - "Res(ident) (refused)." On 10/20/10, at 3:27 p.m., the DON and the Charge Nurse/Restorative Nurse (CNRN), who stated she "oversaw" RNAs providing therapies to residents, were interviewed. When asked to explain those areas of Resident #2's and 3's Restorative Flowsheets that did not document participation, or refusal to participate, in the restorative program, the DON stated, "It would say to me that the program was not done or was not documented." When asked how she determined whether the program was not done or not documented, the CNRN stated she spoke directly with RNAs and noted, "They've told me they've (therapies) been done or they (residents) refused." The CNRN was then asked what it meant when resident participation or refusals had been documented on some areas of the Restorative Flowsheets while other areas were left blank and whether surveyors could assume the charting was accurate. The CNRN stated, "Correct." |
2014-04-01 |