cms_MT: 114
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 114 | HERITAGE PLACE | 275025 | 171 HERITAGE WAY | KALISPELL | MT | 59901 | 2018-09-18 | 580 | D | 1 | 0 | VB9B11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on interview and record review, the facility failed to notify family members of a resident's transfer to the emergency department and subsequent hospital admission for 1 (#1) of 8 sampled residents. This failure caused undue anxiety for NF1. Findings include: During an interview on 9/17/18 at 4:35 p.m., NF1 said the facility had not called the family when resident #1 was transferred from the facility on 6/9/18. NF1 said the family received notification from a Hospitalist on 6/10/18 at 11:00 a.m. the resident #1 was in ICU. NF1 said the Hospitalist told the family they needed to come to the hospital quickly because resident #1's health was declining rapidly. NF1 said she and her husband, the resident's brother, got the hospital within an hour of the phone call. NF1 said resident #1 was in a coma like state when they got to her room in the ICU. NF1 said the resident did wake up but was not able to communicate with NF1 or the resident's brother. NF1 said resident #1 passed away on 6/12/18. NF1 said if the hospital had not called her, they would not have known resident #1 was not at the facility until NF1 had shown up for the scheduled hematologist appointment on 6/11/18. NF1 said she did not understand why the facility had not contacted them of resident #1's transfer to the emergency department, or the resident's admission to the hospital. NF1 said the facility had called her on 6/8/18 to tell her resident #1 had an appointment on 6/11/18 with a hematologist. NF1 said she or her husband, resident #1's brother, went to every doctor appointment with the resident. NF1 said they both had attended the initial care plan meeting for resident #1. NF1 said resident #1 had been admitted to the facility on [DATE]. NF1 said because of the delay in notification on resident #1's admission to the hospital, her other brother, who lived in Virginia, was unable to get to the hospital prior to the resident's death. NF1 said the whole situation increased her anxiety to unmentionable levels. During an interview on 9/18/18 at 11:45 a.m., staff member B said the family was not notified of resident #1 being transferred to the emergency department, or of the resident's admission to the hospital. Staff member B said resident #1 did not want her family knowing everything about her. Staff member B said that was why the facility did not notify the family of resident #1's transfer for a transfusion or admission to the hospital. The facility was unable to provide any documentation to show this was true. Review of resident #1's progress note, dated 6/9/18, showed the resident had been taken to the ER at 10:00 a.m. via the facility's van. The note further showed the resident was sent for a transfusion. Review of resident #1's progress note, dated 6/10/18, showed, Resident Family came in today upset that they were noted (sic) notified Resident went to the Hospital for a transfusion on Saturday. They only knew when the Hospital called and told them that she was in ICU. Review of resident #1's demographic information, dated 9/17/18, showed NF1 and her husband, the resident's brother, were emergency contacts for the resident. Review of the facility's policy, Resident, Physician and Resident Representative(s) Notification, with a revision date of 11/2016, showed, Procedures: The facility will immediately inform the Resident; consult with Physician/PA/NP; and inform the Resident Representative(s) when there is a change in condition such as but not limited to: C. A need to alter treatment significantly, such as discontinuing an existing treatment or commence a treatment. D. A decision to transfer or discharge the resident from the facility. | 2020-09-01 |