| 12904 |
MILLER MEMORIAL CARE CENTER |
2.8e+296 |
P O BOX 428, 589 VINCENT AVENUE |
CHAPPELL |
NE |
69129 |
2011-03-02 |
323 |
E |
|
|
Z96X11 |
Licensure Reference Number 175 NAC 12-006.09D7a Based on observations and staff interviews, the facility failed to 1) ensure that chemicals were secured to reduce the risk of accidental exposure to residents and 2) ensure that a door to a staircase was kept locked to reduce the risk of accidents for 9 current residents identified as confused and wandered in the facility (Resident 30, Resident 2, Resident 6, Resident 26, Resident 16, Resident 4, Resident 19, Resident 20, and Resident 24). The facility census was 24 with a Stage 2 sample of 18 residents. Findings are: 1. Observation on 3/1/11 at 2:30 PM in the unlocked utility/storage room revealed a can of "San-Aire" spray on the the counter, a spray bottle 1/3 full of "Oasis Germicidal Non- Acid Cleaner" in the unlocked counter under the sink, and a container of "Ind/Com Deodorizer" and a can of "San-Aire" spray in an unlocked cupboard. Interview on 3/1/11 at 2:50 PM with the DON (Director of Nursing) and the Administrator confirmed that these products were to be kept locked up to minimize the risk of accidental exposure and potential injury to the residents and the chemicals were removed. Further interview with the DON revealed that residents who were confused and wandered on the unit included Resident 30, Resident 2, Resident 6, Resident 26, Resident 16, Resident 4, Resident 19, Resident 20, and Resident 24. Review of the MSDS (Material Safety Data Sheets) revealed the following health hazard data for these products: "San- Aire" - eyes, flush with water and see physician; inhalation, remove to fresh air and see physician; "Oasis Germicidal Non- Acid Cleaner" - eyes, immediately flush eyes with cool running water, remove contact lenses and continue flushing with plenty of water for at least 15 minutes, get medical attention immediately; inhalation, remove to fresh air, if exposed person is not breathing, give artificial respiration or oxygen applied by trained personnel, get medical attention immediately; "Ind/Com Deodorizer" - eye contact, flush with large amounts of water, may cause corneal damage on prolonged contact, seek medical attention; ingestion, do not give anything by mouth to an unconscious person, seek medical attention; inhalation, remove person to fresh air, seek medical attention. 2. Observation on 3/2/11 at 8:15 AM and at 8:30 AM, during the environmental tour accompanied by the Maintenance Director and the Administrator, revealed that the door on the unit which leads to the basement was unlocked. Further observation revealed a sign posted on the door "Notice - Please keep this door locked at all times". Interview on 3/2/11 at 8:30 AM with the Maintenance Director and the Administrator confirmed that the door was to be kept locked to minimize the risk of falls or potential injury to the residents. Interview on 3/2/11 at 9:00 AM with the DON revealed that residents who were confused and wandered on the unit included Resident 30, Resident 2, Resident 6, Resident 26, Resident 16, Resident 4, Resident 19, Resident 20, and Resident 24. |
2014-03-01 |