| 1434 |
LIFE CARE CENTER OF OMAHA |
285137 |
6032 VILLE DE SANTE DRIVE |
OMAHA |
NE |
68104 |
2018-03-19 |
689 |
K |
0 |
1 |
93SH11 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Licensure Reference Number: 175 NAC 12-006.18E Based on observation, interview and record review, the facility failed to evaluate the safety and provide supervision for smoking for Residents 49 and 85 and failed to ensure that a stationary fireplace did not reach a temperature that had the potential to cause [MEDICAL CONDITION] 12 residents that were identified as self-mobile with poor safety awareness (Residents 64, 25, 43, 81, 67, 13, 65, 21, 34, 32, 23 and 62). The facility Census was 92. Findings are: [NAME] Review of the facility policy dated as effective (MONTH) 2011 revealed the facility is a nonsmoking facility for residents. Residents may not smoke on the campus. The facility will provide residents with smoking cessation assistance such as Nicotine patches to assist in their smoking cessation efforts. Interview on 3/13/2018 at 10:00 AM with the administrator revealed the facility was a non-smoking facility and residents awee required to leave the property to smoke and were not monitored by staff. Review of Resident 85's medical record revealed Resident 85 was admitted to the facility on [DATE] . Review of Resident 85's medical record revealed Resident 85 had a [DIAGNOSES REDACTED]. Review of the Social Services admission assessment dated [DATE] revealed Resident 85 wanted to smoke. Resident 85 had a BIMS (Brief Interview for Mental Status-a tool used to measure cognitive function) score of 15/15 which indicates the resident is cognitively aware. Observation on 03/20/18 at 06:30 AM revealed Resident 85 sitting in a wheelchair just outside of the facility front door. Resident 85 was wearing a coat with a loose hood and cloth gloves smoking a cigarette. Resident 85 had an oxygen tank on the back of the wheelchair. Interview on 03/20/18 at 6:35 AM with Registered Nurse (RN) - J revealed Resident 85 was allowed to go outside to smoke but was not to be smoking on the facility grounds. RN-J stated Resident 85 would be educated but continued down the hall and did not address Resident 85's smoking. Review of Resident 85's care plan dated 2/27/2018 revealed a care plan for smoking. The problem statement was I frequently go outside to smoke. The goal was to not have injuries related to smoking and an intervention was to notify the doctor if Resident 85 sustained an injury while smoking. There was no mention of a smoking safety assessment. Review of Resident 85's medical record revealed no smoking assessment was completed to determine if Resident 85 was safe to smoke independently without supervision. Review of progress notes dated 3/6/2018 revealed Resident 85 did smoke and did not desire to stop smoking or use any type of smoking cessation assistance. Interview on 03/20/18 at 7:50AM with LPN-E (Licensed Practical Nurse) revealed Resident 85 went out to smoke was not supervised. Resident 85 smoked outside and LPN-E had educated Resident 85 not to smoke with oxygen. Interview on 3/20/2018 at 6:45 AM with LPN-E revealed the staff do not keep residents' smoking supplies and was not aware where they were kept. Observation on 3/20/2018 at 6:50 AM revealed Resident 85 in a wheelchair with oxygen on it returning inside the building from smoking outside. No staff had checked on Resident 85 while Resident 85 was outside smoking. Observation on 03/20/18 at 7:57 AM revealed Resident 85 was outside the front door smoking unsupervised. The resident was in a wheelchair with oxygen on it. No staff attempted to intervene. Interview on 3/20/2018 at 9:30 AM with the Administrator revealed the facility does not admit active smokers and the facility is not responsibility for those residents that want to continue to smoke off campus so smoking safety assessments are not completed. B. Record review of Resident 49's MDS (Minimum Data Set) dated 1-12-2018 revealed the facility staff assessed the following about the resident: -BIMS was a 15. -Required limited assistance with transfers with the assistance of 1 person physically assisting. -Required limited assistance off the unit with the assistance of 1 person physically assisting. On 3-20-2018 an interview was conducted with Registered Nurse (RN) I. During the interview RN I identified Resident 49 as a resident who smoked cigarettes at the facility. RN I reported the facility was a smoke free facility and if residents want to smoke, they had to go off facility grounds. When asked if Resident 49 was supervised or if there was a process to evaluate residents for safety, RN I stated no. On 3-20-2018 at 7:40 AM an interview was conducted with Licensed Practical Nurse (LPN) H. During the interview LPN H reported the facility was smoke free and those residents who want to smoke must go off of the facility grounds. When asked if residents were supervised when off the facility grounds, LPN H responded that residents were not supervised. On 3-20-2018 at 7:43 AM an interview was conducted with LPN [NAME] During the interview LPN G identified Resident 49 as a resident who smoked cigarettes at the facility. LPN G further reported Resident 49 does own thing. LPN G reported there was no process to evaluate resident's safety for smoking and that staff did not supervise residents while smoking. On 3-20-2018 at 8:45 AM an interview was conducted with Resident 49. During the interview Resident 49 reported that (gender) smoked and goes out front to do it. Resident 49 reported staff do not supervise while Resident 49 was smoking. On 3-20-2018 at 10:05 AM an interview was conducted with the facility Administrator. During the interview; the Administrator reported the facility was a non-smoking facility and reported when residents who smoked were admitted to the facility, they were considered exsmokers. The Administrator reported evaluations were not completed for smoking safety for residents. As outlined by the Administrator of the facility on 3/21/2018 at 2:30 PM the facility initiated the following plan to address the immediacy of the situation. The facility educated all staff regarding the smoking policy prior to them working their next shift. All residents that leave the facility grounds to smoke will be assessed for safety with smoking and the ability to leave the facility grounds. All smoking material will be kept by the facility. All residents will be advised of the non-smoking policy prior to and at admission. The facility will offer smokers that wish to be admitted to the facility a smoking cessation program. Audits will be conducted on new admissions daily for 30 days and weekly for 90 days to assure the residents were educated on the facility non-smoking policy upon admission and sign a written agreement regarding the non-smoking policy. All current residents that want to smoke have been assessed for safe smoking and ability to safely leave the campus. With the above interventions initiated, the scope and severity of the deficiency was lowered to an E. C. Record review of an article http://www.forensic pathologyonline.com/E-Book/injuries/thermal injuries written by Dr. Dinesh Rao revealed that a burn is an injury which is caused by application of heat to the external or internal surfaces of the body, which causes destruction of tissues. The minimum temperature for producing a burn is about 44 degrees Celsius (C) (111 degrees Fahrenheit (F) for an exposure of 5 to 6 hours or about 65 degrees C ( 149 degrees F) for 2 seconds are sufficient to produce burns. A highly heated solid body, when applied to the body for a very short time, may produce only a blister and reddening corresponding in size and shape to the material used. It will cause destruction, or even charring of the parts, when kept in contact for some time. The epidermis (skin) may be found blackened, dry and wrinkled. Record review of Dr. Moritz and Dr Henriques Harvard medical School Temperature /Time Burn Chart revealed the following temperature versus time to produce 1st ( first [MEDICAL CONDITION] only the outer layer of skin, skin may be red and painful), second (The outer and the layer underneath has been damaged, skin will be bright red, swollen and may look wet and shiny and may be blistered) and third [MEDICAL CONDITION](all layers of the skin have been damaged as well as muscles, tendons, ligaments and possibly organs, there is serious damage to nerves): 131 degrees F: 17 seconds for a first degree burn, 30 seconds for a second-3rd degree burn 140 degrees F: 3 seconds for a first degree burn, 5 seconds for a 2nd-3rd degree burn 151 degrees F: instant for a first degree burn, 2 seconds for a 2nd to 3rd degree burn Observation on 03/14/18 at 07:28 AM revealed a stationary electric fireplace present in the main lobby area of the facility. The fireplace was on, blew out warm air and had no protective barrier in front of the fireplace. The temperature of the exterior surface of the fireplace was taken and read 163.8. Observation on 03/14/18 at 09:27 AM with the Director of Nursing (DON) confirmed that the fireplace was on, blew out warm air and had no protective barrier in front of the fireplace. The temperature of the exterior surface of the fireplace was taken and read 156.2. Interview on 03/14/18 at 09:28 AM with the DON confirmed the temperature of the fireplace read 156.2. The DON confirmed that the exterior of the fireplace was hot to the touch and did have the potential to cause a burn if a resident were to touch it or sit closely to it for an extended period of time. Record review of a document received on 03/14/18 at 09:19 AM revealed a list of self-mobile residents with poor safety awareness and wandering behavior. Interview on 3/14/18 at 9:20 AM with the DON confirmed and identified a total of 12 residents (Residents 64, 25, 43, 81, 67, 13, 65, 21, 34, 32, 23 and 62) that had poor safety awareness, exhibited wandering behavior and were self-mobile. The DON confirmed that those residents would be able to access the fireplace in the lobby and could potentially be burned if they were to touch the exterior of the fireplace. |
2020-09-01 |