| 52 |
HOMESTEAD REHABILITATION CENTER |
285049 |
4735 SOUTH 54TH STREET |
LINCOLN |
NE |
68516 |
2017-05-25 |
315 |
D |
1 |
1 |
18U611 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Licensure Reference Number 175 NAC: 12-006.09D3 (1 and 2) Based on observation, interview, and record review; the facility failed to identify the need for an individualized toileting program to restore urinary continence (ability to control bladder)for one (Resident 194) of three sampled residents and the facility failed to provide pericare (washing the genitals and anal area which prevents skin breakdown of perineal area, and infections) in a manner to prevent the potential for cross contamination for two (Residents 187 and 194) of three sampled residents. The facility census was 131. Findings are: [NAME] A review of MDS (Multidisciplinary Data Set-a mandatory comprehensive assessment tool used for care planning) information for Resident 194 revealed full assessments completed on 10/28/17 for admission, and on 1/31/17 for a significant change in condition. The CAA (Care Area Assessment) page of both assessments indicated urinary incontinence triggered as an area of concern and needed to be included on the resident's care plan. A review of Resident 194's Care Plan (CP), last reviewed/revised on 5/6/17, revealed the resident was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. An entry on the CP indicated a problem identified on 11/01/2016 documented Resident 194 exhibited 'Functional' urinary incontinence, with the goal of 'will not develop skin breakdown related to incontinence. The interventions included to use pull ups or briefs when in and out of bed. Another problem identified on 11/01/2016 indicated Resident #194 had a Self-care deficit related to [DIAGNOSES REDACTED]. Resident 194 required assistance from 2 staff members for transferring and toileting. The CP indicated on 2/8/17, the resident experienced bladder incontinence related to diuretic (medication used remove excess fluid) therapy and decreased mobility. Interventions included: incontinence care with each incontinent episode, provide minimal assist with toileting, and obtain labs as ordered. The CP did not include an individualized toileting plan or interventions to prevent or improve incontinence status. A review of the electronic medical record for Resident 194 revealed a document titled DISCHARGE & TRANSFER-MEDICARE DISCHARGE PLANNING MEETING dated 10/25/16. The document revealed the resident required physical assist from 1-2 people for toileting, without a documented goal related to the concern. The section of the document titled BOWEL/BLADDER MANAGEMENT indicated Resident 194's previous level of bowel/bladder control and management was continent (able to control) of bowel and bladder. The documentation was incomplete and did not include information related to the resident's current level or goals and interventions related to toileting concerns. An interview on 05/23/2017 at 9:58 AM with Nursing Assistant (NA)-H revealed Resident 194: required assistance from 2 staff for transfers using a sit-stand lift (mechanical device used to move residents from one surface to another), was incontinent of bowel and bladder, was able to let staff know of need to use the bathroom, was toileted with staff assistance every 2 hours and as needed. An interview on 05/24/2017 at 8:41 AM with Registered Nurse (RN)-J, revealed Resident 194 was incontinent while receiving Medicare Services and residing on the Skilled Unit of the facility, 10/21/16-1/7/17, but was not on a toileting program. The RN reported that a Bowel and Bladder Voiding Diary was not completed upon admission for the resident. An interview on 05/24/2017 at 10:45 AM with RN Unit Manager-F revealed a bowel and bladder (B & B), three day diary/observation had not been completed for Resident #194 since moving to Unit 3 on 1/8/17. The RN confirmed the resident's CP did not include individualized interventions related to toileting/incontinence issues. A review of an undated facility document titled BOWEL AN BLADDER GUIDELINE revealed: all residents have a B & B observation completed on admission, quarterly, change in condition, and in the instance of a change in continence; if B&B observation shows resident is both continent and incontinent of either bladder or bowel, a 3 day tracking/voiding diary shall be initiated; Care Plan needs to include individualized toileting schedule/program or reason one is not appropriate; the facility should observe that incontinent residents have pericare completed at least every 2 hours. B. An observation on 5/23/17 at 10:02 AM of NA-H and NA-I assisting Resident 194 with toileting needs revealed a sit stand lift (a mechanical device used to move residents from one surface to another) was used to transfer the resident from a wheel chair to the bathroom and toilet with no concerns identified. NA-I was noted to apply gloves prior to assisting the resident to lower pants and remove a soiled brief. Soiled gloves were not removed prior to NA-I assisting NA-H to manipulate and reposition the mechanical lift and lower Resident 194 onto the toilet. Privacy was provided and when Resident 194 indicated completion of elimination needs, the lift was used to bring the resident to a standing position. NA-I was observed to use disposable wipes to cleanse the resident's genital area, and a different wipe was used to complete back pericare. NA-I then applied a clean brief for the resident and assisted NA-H to move the lift out into the resident's room. Resident 194 was lowered into a wheel chair in order to remove wet trousers and apply a clean pair. Neither NAs were noted to change gloves or sanitize hands throughout the provision of care for Resident 194. Interviews on 5/23/17 at 10:15 AM with NA-H and NA-I revealed the NAs did not remove soiled gloves prior to making contact with items considered clean or sanitize their hands, during the provision of toileting and incontinence care for Resident 194. A review of Lab Reports for Resident 194 revealed urine specimans tested positive for symptoms of urinary tract infection on 1/13/17 and 2/7/17. A review of the Basic Nursing Assistant Training Manual, 4th Edition dated 2009 revealed to prevent the potential for cross contamination, gloves were to be removed and hands sanitized following the completion of pericare and before touching clean clothing items. C. Review of Resident 187's Minimum Data Set (MDS, a federally mandated assessment tool used for care planning) dated 4/7/17 revealed Resident 187 had severely impaired cognition, required extensive assist with toileting, and was always incontinent of bowel and bladder. Review of Resident 187's (MONTH) Medication Administration Record [REDACTED]. Observation of incontinent care on 05/23/2017 at 10:40 AM revealed Nursing Assistants (NAs) R, S, and T assisting Resident 187. NA S put on gloves, removed the dirty brief and providing hygiene to Resident 187's buttocks as Resident 187 was having an incontinent stool. NA S continued to wipe away the stool from Resident 187 four additional times and then assisted Resident 187 over to Resident 187's back. NA S did not remove gloves and proceeded to provide care to Resident 187's vaginal area while wearing the same gloves. Interview with NA S and Registered Nurse (RN) U on 5/23/17 at 10:55 AM revealed RN U agreed that NA S did not change gloves after providing care for incontinent stool. Review of the facility's undated Peri-Care Competency Checklist revealed staff should use a tissue/disposable peri-wipe and remove any stool that is present, then remove gloves and sanitize hands before proceeding with perineal care. |
2020-09-01 |