| 10210 |
KEARNEY COUNTY HEALTH SERVICES |
2.8e+298 |
727 EAST 1ST STREET |
MINDEN |
NE |
68959 |
2012-08-01 |
318 |
H |
0 |
1 |
NRZX11 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE 175 NAC 12-006.09D1, 12-006.09D1a Based on observation, record review and interview the facility failed to provide restorative services to residents with limited range of motion in order to prevent the further decline in range of motion. The facility had a census of 30 and a survey sample of 26. This affected Residents 12, 06 and 32. Findings are: A. According to the 6/18/12 ADMISSION and DISCHARGE SUMMARY Resident 12 was admitted to the facility on [DATE]. The following [DIAGNOSES REDACTED]. Observation on 07/23/2012 at 9:44 AM revealed that Resident 12 had bone deformities of the fingers and hands bilaterally. Review of the 2/17/12 MDS (Minimum Data Set -a federally mandated comprehensive assessment tool used for care planning) revealed the following assessment of Resident 12's ability: Toilet use - extensive assistance of one person, Personal Hygiene - extensive assistance of one person. Review of the 5/19/12 MDS revealed the following assessment of Resident 12's ability: Toilet use - limited assistance of one person, Personal Hygiene - limited assistance of one person. Resident 12 had improvement in toilet use and personal hygiene from 2/17/12 to 5/19/12. Review of an ADL FLOWSHEET (Activities of Daily Living) for the period of time 7/17/12-7/25/12 confirmed that the nurse aides were providing the following assistance for Resident 12: Toilet use - full staff performance of one person, Personal Hygiene - full staff performance of one person. Interview on 7/26/12 at 10:19 AM with MA-JM (Medication Aide) confirmed that Resident 12 was dependent on staff to assist with toileting, incontinence care and brushing teeth. Resident 12 required the assistance of one person for dressing. Resident 12 had decline in toilet use and personal hygiene from the 2/17/12 and 5/19/12 MDS assessments to the 7/17/12 documentation of actual care provided by the nursing staff. Review of the 6/1/11 CARE PLAN for Resident 12 revealed that Resident 12 was identified as a risk for development in functional joint mobility related to [MEDICAL CONDITION] Arthritis. The identified goal was for the resident to maintain current level of functional ability through the next review - 9/6/12. The interventions included: restorative program 1-5 times weekly, passive ROM (Range of Motion) to upper extremities 10 repetitions, Nu-step 10 minutes, monitor for increased pain with exercise, medicate as needed, praise the resident, report and document decline in abilities, refer to therapy as needed and may vary activities. The CARE PLAN had been revised and updated 3/8/12 and 6/6/12. Interview on 7/25/12 at 9:07 AM with Resident 12 about the CARE PLAN interventions revealed the resident was doing the following: ride the Nu-step twice a week (about 45 minutes each time), whirlpool two times a week, walk a mile twice daily, put hands under hot water and pull on the fingers to exercise them (unassisted by staff), fold aprons and exercise to the music at meals. The activities reported by Resident 12 did not match the CARE PLAN. Interview with NA-TB (Nurse Aide doing Restorative Care) on 7/25/12 at 7:47 AM confirmed that Resident 12 was on a restorative program. NA-TB reported that the documentation of implementing the restorative program was on RESTORATIVE CARE sheets. Review of the May, June and July, 2012 RESTORATIVE CARE sheets confirmed the following were being monitored and documented by NA-TB: Restorative Care 1-5 times a week, Chair Dance Tape, ROM to upper extremities - times 10 repetitions, Nu-Step for 10 minutes, Aprons, and Total minutes spent in restorative. The RESTORATIVE CARE monitoring and documentation did not match the CARE PLAN or the plan stated by the resident. The Chair Dance Tape was being monitored, however, Resident 12 reported on 7/25/12 at 9:07 AM that the resident had not watched a dance/exercise tape for 4-5 years. NA-TB reported that slash marks on the RESTORATIVE CARE sheets represented times when the activities did not occur. For the three months reviewed, the Chair Dance Tape never occurred, and the Apron folding occurred 4 times. The resident went without having ROM from May 1-21, June 1-19 and June 21-July 9. The facility failed to implement any of the restorative program on July 1-9. Interview with NA-TB on 7/25/12 at 7:47 AM confirmed that NA-TB was on vacation for the first 9 days of July and the facility had no staff assigned to implement the restorative programs when NA-TB was gone from the facility for any reason. Interview on 7/26/12 at 11:11 AM with the DON (Director of Nursing) confirmed that the facility had no method of ensuring that restorative programs were implemented in the absence of NA-TB. Review of a 7/11/12 monthly summary, documented by RN-S (Registered Nurse and MDS/Care Plan Coordinator) revealed that Resident 12 had no decline in functional ability and the resident ' s involvement in the restorative program was limited due to the resident's participation in activities. RN-S documented that the facility would continue to encourage and continue the present plan of care. RN-S failed to recognize that Resident 12 had documented declines in functional abilities such as toilet use and personal hygiene. RN-S failed to assess how Resident 12's restorative care could be implemented while allowing the resident to participate in desired activities. Interview on 7/26/12 at 9:06 AM with RN-S confirmed that the assessment of the extent of limited range of motion was evaluated by a medical practitioner and physical/occupational therapist. Resident 12 had the initial assessment of range of motion when admitted to the facility in 2004. Any declines in range of motion would be judged against that initial assessment. Another physical/occupational therapy evaluation could be done if the staff noticed declines in the resident's abilities. RN-S reported that Resident 12 had remained the same for many years so no further assessments from the therapists had been done. RN-S was unaware of the documented decline that Resident 12 had in toilet use and personal hygiene from the 2/17/12 and 5/19/12 MDS assessments to the 7/17/12 documentation of actual care provided by the nursing staff. Interview on 7/26/12 at 11:11 AM with the DON revealed resident 12 had not been evaluated by physical/occupation therapists for a long time. B. Review of an ADMISSION AND DISCHARGE SUMMARY dated 7/10/12 revealed Resident 32 was admitted to the facility on [DATE] and had [DIAGNOSES REDACTED]. Review of Resident 32's CARE PLAN dated 3/8/12 revealed the resident was to receive Restorative care 3-5 x a week or as tolerates. Review of RESTORATIVE CARE for July 2012 revealed no documentation that Resident 32 had received restorative care during the week of July 1-7, 2012. During an interview on 4/26/12 at 8:59 AM, NA-TB revealed no restorative care was done with Resident 32 the first week in July, as NA-TB was on vacation. NA-TB stated there was no one available to do restorative care when NA-TB was no working. C. Review of an 10/12/11 CARE PLAN revealed Resident 06 was admitted to the facility on [DATE]. The CARE PLAN also revealed Resident 06 had [DIAGNOSES REDACTED]. Observations on 7/19/12 at 2:49 PM revealed contractures present at the first joint of the fingers of both Resident 06's hands. During an interview on 7/19/12 at 11:47 AM, Resident 06 stated I don't due any exercises now. I do walk to meals and to activities. They haven't offered any exercises since I've been here, I've always done it myself. Resident 06 revealed arthritis caused the contractures in the fingers & I can't do anything about that. Review of the 11/10/11 MDS revealed the following assessment of Resident 06's ability: - Bed mobility - independent; and - Functional Limitation in Range of Motion - impairment on one side. Review of the 5/12/12 MDS revealed the following assessment of Resident 06's ability: - Bed mobility - limited assistance of one person; and - Functional Limitation in Range of Motion - impairment on one side. Review of an ADL FLOW SHEET for the period of time 5/6/12 - 5/12/12 confirmed Resident 06 received staff assistance with dressing and toilet use. Review of an ADL FLOW SHEET for the period of time 7/17/12 - 7/25/12 confirmed Resident 06 received staff assistance with dressing, toilet use, personal hygiene, and oral hygiene. During an interview on 7/25/12 at 720 AM, Licensed Practical Nurse-D revealed with the contractures in Resident 06's fingers, the resident would probably benefit from some therapy balls. During an interview on 7/25/12 at 8:10 AM, RN-S reviewed restorative services had been discussed with Resident 06 during the care plan meeting on 5/23/12 and Resident 06 had expressed (the resident) did not want to be involved in any therapy, and that Resident 06 did fine on (gender) own. Review of the Care Plan Conference Summary dated 5/23/12 revealed Restorative Therapy: Does not participate per (Resident 06's) choice. The summary did not explain what restorative services were offered to the resident or the reason Resident 06 did not want to participate in restorative. During an interview on 7/24/12 at 11:43 AM, Resident 06 revealed every once in a while the resident had used therapy balls and worked with them. Resident 06 stated it helped my fingers limber up. During an interview on 7/26/12 at 7:30 AM, MA-MJ revealed Resident 06 required assistance with applying poly-grip on (gender) dentures and with putting the resident's shoes and socks on. |
2016-02-01 |