| 25 |
GREENBRIAR HEALTHCARE |
305005 |
55 HARRIS ROAD |
NASHUA |
NH |
3062 |
2019-10-28 |
656 |
B |
0 |
1 |
TYS711 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, it was determined that the facility failed to develop and implement a comprehensive person-centered care plan that would include measurable objectives and time frames to meet the residents' needs for 3 residents who were smokers and 2 residents with other care needs out of a final survey sample of 35 Residents. (Resident identifiers are #49, #88, #340, #341 and #540). Findings include: Resident # 49 Interview on 10/23/19 at 01:03 p.m. with Resident #49 resulted in Resident #49 stating I get my cigarettes from the nurse. There's a sign out book at the nurse's station. I sign out the book and the nurse gets me my smoking materials. Then I go outside and smoke off the property. We have to smoke off the facility property, out on the sidewalk. When I'm done, I go back to the nurse's station to turn in my smoking materials to the nurse and then I sign back in. If no one is there to take my smoking materials, I keep them on me until I can find a staff member to give them to. This is what they tell me I have to do. Review of the Facility's Tobacco Free Environment Policy on 10/23/19 at 1:35 p.m. revealed that: (Summarized): *The facility will educate prospective admissions on the Tobacco Free Environment Policy. *The prospective resident will agree not to smoke at the facility or on the premises and will be offered smoking cessation information. *On admission, resident or resident representative will sign indicating that there is understanding that the resident will not smoke in the facility or on the premises. *Any residents who were smokers prior to the implementation of this policy will be allowed to smoke in a designated area and will receive a smoking safety assessment to determine the level of supervision to be provided and interventions to mitigate risk of injury. *Residents new to the facility will not receive a smoking assessment. *Policy will be placed in areas that are highly visible. Enforcement of the Tobacco Free Policy will consist of: *Requesting that visitors leave if they fail to comply; *Asking residents to immediately comply, and, * assessing residents for related distress; and, *confiscating tobacco products and lighting materials found in the facility and returning such materials to the resident/owner upon the resident's discharge from the facility. Review on 10/28/19 at approximately 9:00 a.m. of record and Smoking Care Plan for Resident #49 revealed that the Care Plan includes the following (summarized) verbage: *Resident has a history of noncompliance with following the facility's non-smoking policy and chooses to make independent choices to smoke. *Declines smoking cessation programs. There are no individualized interventions in the smoking care plan for Resident #49 that are measurable, include safety goals and ongoing assessments, smoking cessation opportunities, or that meet Resident # 49's needs for smoking safety. Interview on 10/28/19 at approximately 10:48 a.m. with Staff A (Registered Nurse, Unit Manager) confirmed that residents who smoke are to come to the Nurse's Station to sign out, pick up their cigarettes and lighter and leave the facility grounds to smoke. The residents then return to the nurses station, sign back in, and turn in the cigarettes and lighter. If there is no staff covering the nurses station upon return of the resident, then the resident keeps the smoking paraphenalia with them until they can find a staff member they can give them to. Observation on 10/28/19 at 10:56 a.m. revealed that Resident #49 was seen to approach the nurse's station, sign out, obtain smoking materials and then proceed to go outside to smoke. This observation of Resident #49, and interview with Staff A, (as written in above paragraphs), demonstrate that the facility is keeping cigarettes and lighters at the nurse's station for resident use. This process is not reflected in the resident's care plan. Resident #88 Interview on 10/23/19 at 9:30 a.m. with Resident #88 revealed that Resident #88 is a smoker and goes out to the bus stop to smoke. Resident #88 stated that he/she does not smoke in the building, and that smoking materials are kept in Resident #88's drawer. It was observed that resident keeps the cigarettes on his/her person. Resident #88 is alert and oriented and states that the facility is aware of this process for smoking used by Resident #88. Review on 10/28/19 at approximately 1:00 p.m. of care plan for Resident #88 revealed that the care plan has the following items listed for Resident #88: * Discourage resident from providing smoking items to other residents. * Educate and remind resident to check self out on Leave of Absence (LOA) when leaving facility property and inform staff/nurse as needed (PRN). *Offer 1:1 education with Respiratory Therapist (RT) on adverse effects of smoking and support for smoking cessation PRN. * Offer resident a smoking cessation program. *Smoking Policy is reviewed with resident and/or responsible party. Interview on 10/28/19 at approximately 2:00 p.m. with Staff B (Director of Nurses) confirmed the above findings. Resident #340 Review on 10/25/19 at 12:00 p.m. of Resident #340's medical record revealed Resident #340's care plan states under Focus (Resident #340) has a history of non-compliance with the facility's non-Smoking policy, (Resident #340) declines smoking cessation programs offered. Under Intervention Educate (Resident #340) and family/friends regarding center's NON-smoking policy. Designated smoking areas OFF property, and storage of smoking materials. Review on 10/25/19 of Resident #340's nurses notes reveal multiple entries of none compliance with the facility's policy as written. Nurses notes 10/8/19 reveal (Resident #340) continues to be non-compliant with the facility smoking policy. At time of medication administration this nurse could not find patient, (Resident #340) did not sign the LOA book. This nurse observed patient sitting on (his/her) rollator directly outside the sliding glass door on building 4, (Resident #340) was actively smoking. this nurse had (Resident #340) extinguish (his/her) cigarette and explained again the policy. (Resident #340) states (she/he) knows the policy and before this nurse could finish (Resident #340) told this nurse 100% correctly and policy . Nurses notes dated 10/10/19 (Resident #340) was again noted to be non-compliant with facility smoking policy .nurse asked if (he/she) had recently smoked, (he/she) said (he/she) did, and voluntarily gave this nurse (his/her) cigarettes, lighter and clothes pin (which (he/she) uses to hold the cigarette. Nurses notes dated 10/11/19 (Resident#340) continues to smoke outside with out following the facility policy .sitting on ramp outside building 4; .reminding (Resident #340) needed be off property. Nurses notes dated 10/12/19 (Resident #340) again is noted to not be following the smoking policy . Nurses notes dated 10/14/19 (Resident #340) caught outside several times this evening, (Resident #340) was not willing to give up (his/her) cigarettes or lighter, (Resident #340) states its all done now I already smoked it. Nurses notes dated 10/15/19 (Resident #340) is continuing to smoke on premises, despite staff taking (his/her) smoking items and locking them in the med room (he/she) continues to produce cigarettes and a lighter, not sure where (he/she) is getting this from, (he/she) will not answer when asked. Review on 10/25/19 of Resident #340's Nurses notes 10/16/19 .(Resident #340) went out to smoke a couple of times and continues to smoke on the property and not sign the LOA book at the nurse station . Nurses notes dated 10/19/19 .(Resident #340) was not in (his/her) room or on the unit, (he/she) had not signed LOA book. this nurse went to building 4 and there (Resident #340) was noted to be sitting on (Resident #340) rollator smoking at the slider door . Nurses notes dated 10/22/19 .continues to be non-compliant with smoking policy . Interview on 10/28/19 with Staff D (Administrator) the question was asked in regards to a smoking assessment being completed for the safety and change of condition of residents ability to maintain smoking privileges off campus. Staff D stated the facility dose not do smoking assessments due to the fact the facility is a non smoking facility. Resident #341 Review on 10/25/19 of Resident #341's nutrition note, dated 10/2/19, revealed that Staff L (Registered Dietitian) wrote .resident now with sig. (significant) weight loss . Review on 10/25/19 of Resident #341's nutrition note, dated 10/22/19, revealed that Staff L wrote that Weight of 165.5 is down 9.5 pounds in one month . Review on 10/25/19 of Resident #341's Weight and Vitals summary revealed that on 9/20/19, Resident #341 weighed 175 pounds, and on 10/18/19 Resident #341 weighed 165.5 pounds, which was a 5.4% weight loss. Review on 10/25/19 of Resident #341's current care plan revealed that (Resident #341) has nutritional problem or potential nutritional problem r/t (related to) .need for tube feed .overweight . There was nothing documented in the care plan regarding the actual weight loss that Resident #341 had. Interview on 10/28/19 at approximately 11:40 a.m. with Staff M (Licensed Practical Nurse) confirmed that Resident #341 had a significant weight loss and that it was not documented on Resident #341's care plan. Staff M also confirmed that Resident #341's weight loss should have been documented in their care plan Resident #540 Review on 10/24/19 of Resident #540's active physician orders [REDACTED]. Interview on 10/28/19 at approximately 10:45 a.m. with Staff N (Licensed Practical Nurse) revealed that Resident #540 had a pressure ulcer on their coccyx, which resolved on 10/16/19. Review on 10/28/19 of Resident #540's current and resolved care plans revealed that there was no care plan in place for Resident #540's pressure ulcer on their coccyx and no care plan for dressings changes to the coccyx area. Interview on 10/28/19 at approximately 10:45 a.m. with Staff N confirmed that there was no care plan in place for Resident #540's coccyx pressure ulcer. Staff N also confirmed that a care plan should have been in place for the pressure ulcer and for the dressing changes. |
2020-09-01 |