cms_NH
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| Link | rowid | facility_name | facility_id | address | city | state | zip | inspection_date | deficiency_tag | scope_severity | complaint ▼ | standard | eventid | inspection_text | filedate |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 2080 | 2080 | KINDRED TRANSITIONAL CARE & REHABILITATION-GREENBR | 305005 | 55 HARRIS ROAD | NASHUA | NH | 3062 | 2011-01-06 | 278 | B | CBQB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview the facility failed to ensure that MDS (Minimum Data Set) Assessments were accurate for 2 of 30 sampled residents. (Resident identifiers are #1 and #11.) Findings include: Resident #1. Review, of this resident's 3.0 Quarterly MDS Assessment which has an Assessment Reference Date of 11/10/10, shows that the facility staff coded Section M Skin Conditions number M0300 C 2 = 1 to indicate that the resident had a Stage 3 unhealed pressure ulcer present upon admission/reentry - 5/19/10. Review, of this resident's 2.0 Significant change in status assessment/Medicare 5 day MDS Assessment which has an Assessment Reference Date of 5/26/10, shows that as of the resident's 5/19/10 readmission to the facility from the hospital, the facility staff coded the 5/26/10 MDS - Section M. Skin Condition as M1b = 3 to indicate that the resident has 3 Stage 2 pressure ulcers present at the time of the 5/26/10 MDS. Staff F, RN MDS Coordinator, was interviewed on 1/6/11 at 12:25 p.m. about the coding of Section M for these two MDSs. Staff F reviewed the MDSs and the medical record and stated that the Quarterly MDS 3.0 was not accurately coded when the coding indicated that the resident had a Stage 3 unhealed pressure ulcer upon admission/reentry - 5/19/10. Resident #11 During review of Resident #11's record a physicians order was written dated 11/5/09 which states "Lap buddy on when in wheelchair for wheelchair postioning and improved balance (related to) cognitive impairment release (every 2 hours) for repositioning and toileting". On review of the last two MDS dated [DATE], and 11/30/10 under Section P0100 Physical Restraints G was coded, chair prevents rising. When reading the instructional guidance Section for P0100 Physical Restraints Section E. Trunk restraint should have been coded. | 2014-04-01 | ||
| 2081 | 2081 | KINDRED TRANSITIONAL CARE & REHABILITATION-GREENBR | 305005 | 55 HARRIS ROAD | NASHUA | NH | 3062 | 2011-01-06 | 514 | D | CBQB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation and interview the facility failed to ensure the the medical records of 6 of 30 sampled residents were completely and/or accurately documented and legible. Resident identifiers are #1, #2, #6, #7, #27 and #29.) Findings include: Resident #1. Review of Resident #1's MD's (Medical Doctor's) orders in effect for this resident for 1/1/11 to 1/31/11 shows that the MD ordered [MEDICATION NAME] w (with)/[MEDICATION NAME] - [MEDICATION NAME] 5/500 mg (milligram) tab, give 1 tab po (by mouth) Q (every) 6 H (hours) prn (as needed) > (increased) pain. Review of the resident's Medication Record form used by the nursing staff to record the administration of this prn [MEDICATION NAME] medication shows that the nurses recorded on the front of the Medication Record only the times for the following dates; 1/1/11 - 1550, 1/3/11 - 1200, 1/4/11 - 1020 and 1/5/11 - illegible numbers for the time, and that the nurses did not record their initials together with the above times on the front of the MAR to be accountable for the care that was delivered to the resident. Review, of the back of the MAR for the administration of the above [MEDICATION NAME] dosage for the date 1/3/11 at 1200, shows that the nurse made an entry on the back of the MAR after a 1/4/11 entry and entitled it "late entry" in order to record the reason for the 1/3/11 [MEDICATION NAME] administration and the resident's response to the 1/3/11 [MEDICATION NAME] administration. The nurse who wrote the "late entry" did not include the actual date the late entry was written. Review of the Narcotic Book page #167 for this resident's [MEDICATION NAME] 5/500 1 tab po q (every) 6 hr prn pain shows that on 1/5/11 - illegible time and 1/5/11 1945 one tab of [MEDICATION NAME] was removed from the narcotic box to be administered to this resident. Review of the front of the MAR shows a 1/5/11 administration of [MEDICATION NAME] - illegible time and review of the back of… | 2014-04-01 | ||
| 2082 | 2082 | KINDRED TRANSITIONAL CARE & REHABILITATION-GREENBR | 305005 | 55 HARRIS ROAD | NASHUA | NH | 3062 | 2011-01-06 | 157 | D | CBQB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview the facility failed to consult with the physician and failed to notify the family after a change in resident condition for 1 resident in a standard survey sample of 30. (Resident identifier is #14.) Findings include: Resident #14 Medical record review on 1/4/11 - 1/6/11 revealed this resident had a fall on 8/29/10 in the dining room and sustained a laceration on the hand. Review of the nursing note dated 8/29/10 at 2200 revealed this witnessed fall of an ambulatory resident had occurred at 1900 when the resident "tripped over own feet." Per interview and documentation review with Staff B (RN/Unit Manager) on 1/6/11 in the morning, it was confirmed Staff D (LPN) who witnessed the fall and Staff E (RN) who was the supervisor on duty both appropriately assessed the resident at the time of the fall and found no further injury. A nursing note in Resident #14's record dated 8/29/10 at 2245 (45 minutes after the fall), documents "During ambulation resident grabbin (sic) left leg and crying in pain. Leg not swollen or discolored. PRN (as needed) Tylenol given. Spoke with supervisor and told to wait until the a.m. to notify MD to see if x-ray needed. Will monitor through the night." Per interview with Staff B on 1/6/11 in the morning, it was confirmed that from 2245 on 8/29/10 when the resident started to exhibit increased pain until 0045 on 8/30/10 the physician was not consulted and the family was not notified. No documented evidence of any further nursing assessments of the range of motion of the hip or assessment of the rotation or length of the legs was found at the 2245 "During ambulation resident grabbin (sic) left leg and crying in pain." Review of the MAR for 8/29/10 - 8/30/10 reveals the resident had an order for [REDACTED]. Another nursing note written 8/30/10 at 0045 reads "Resident appears to be in increased pain. ....11- 7 supervisor notified. On call MD paged. Gave order to send to ...hospital … | 2014-04-01 | ||
| 2083 | 2083 | KINDRED TRANSITIONAL CARE & REHABILITATION-GREENBR | 305005 | 55 HARRIS ROAD | NASHUA | NH | 3062 | 2011-01-06 | 281 | D | CBQB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interview and review of the facility policy and procedure it was determined that the facility failed to develop an interim care plan at the time of admission for 2 residents in a standard survey sample of 30, failed to accurately complete the pain assessment for 2 residents in a standard survey sample of 30, and failed to follow the professional standard of practice for the administration of medication for 2 residents in a standard survey sample of 30 residents. (Resident identifiers are #1, #6, #7 and #27.) Findings include: Review of the facility policy and procedure titled "Pain Management" dated "04/28/09" revealed the following: - "Procedure, Admission/Readmission ... - Identify residents who are newly admitted or readmitted for indicators of pain. Include: ... - Characteristics of pain, such as ... - i. The resident's goals for pain management and his or her satisfaction with the current level of pain control ... - Quarterly, New Complaints of Pain or Significant Change Resulting in Pain - 6. If resident complains of pain or exhibits signs of pain, assess resident to identify if resident has developed a problem that may cause pain ... - 11. Assess the resident using the Pain Scale while in a Pain Management Program: - a. Prior to administration of pain medication - b. At an acceptable interval post pain medication administration ... - c. At each verbalization and/or exhibition of signs and symptoms of pain. - d. Daily when on a scheduled pain medication for pain management program. - 12. Monitor effectiveness of interventions within the prescribed length of time or within 1 hour as evidenced by controlled, reduced or elimination of pain until the resident's pain is controlled. - ... What Level is Your Pain? (Wong-Baker FACES Pain Rating Scale) .... - Use Medication Administration Notes on the MAR to document p.r.n. medication given for break through pain. - Education - 25. Provide education to staff regarding rec… | 2014-04-01 | ||
| 2084 | 2084 | KINDRED TRANSITIONAL CARE & REHABILITATION-GREENBR | 305005 | 55 HARRIS ROAD | NASHUA | NH | 3062 | 2011-01-06 | 272 | D | CBQB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interview and review of facility policy and procedures it was determined that the facility failed to utilize a pain rating prior to and following the administration of pain medications for 2 residents in a standard survey sample of 30 residents. (Resident identifiers are #6 and #27.) Findings include: Review of the facility policy and procedure titled "Pain Management" dated "04/28/09" revealed: - "Procedure, Admission/Readmission ... - Identify residents who are newly admitted or readmitted for indicators of pain. Include: ... - Characteristics of pain, such as ... - i. The resident's goals for pain management and his or her satisfaction with the current level of pain control ... - Quarterly, New Complaints of Pain or Significant Change Resulting in Pain - 6. If resident complains of pain or exhibits signs of pain, assess resident to identify if resident has developed a problem that may cause pain ... - 11. Assess the resident using the Pain Scale while in a Pain Management Program: - a. Prior to administration of pain medication - b. At an acceptable interval post pain medication administration ... - c. At each verbalization and/or exhibition of signs and symptoms of pain. - d. Daily when on a scheduled pain medication for pain management program. - 12. Monitor effectiveness of interventions within the prescribed length of time or within 1 hour as evidenced by controlled, reduced or elimination of pain until the resident's pain is controlled. - ... What Level is Your Pain? (Wong-Baker FACES Pain Rating Scale) .... - Use Medication Administration Notes on the MAR indicated [REDACTED].n. (as needed) medication given for break through pain." Resident #6. Record review on 1/6/11 of the "Medication Record" for Resident #6 dated "1/1/2011 THRU 1/31/2011" showed a physician order for [REDACTED].> SEVERE PAIN." Review of this "Medication Record" showed that Resident #6 was given [MEDICATION NAME] 1 tablet on 1/2/11 at "2115"… | 2014-04-01 | ||
| 2085 | 2085 | KINDRED TRANSITIONAL CARE & REHABILITATION-GREENBR | 305005 | 55 HARRIS ROAD | NASHUA | NH | 3062 | 2011-01-06 | 431 | D | CBQB11 | Based on observation and interview it was determined that the facility failed to lock a medication cart. Findings include: Observation on 1/6/11 at approximately 3:00 p.m. showed an unattended and unlocked medication cart located in the resident hallway within the resident dinning area on the Building 3E unit. At the time of this observation multiple medication cart drawers were opened and the top medication drawer was left open for staff to confirm this access and observation. During interview on 1/6/11 with Staff E (Registered Nurse) at approximately 3:00 p.m., Staff E confirmed that the above listed medication cart was left unlocked in the resident hallway within the resident dinning area on Building 3E. | 2014-04-01 | ||
| 2086 | 2086 | HANOVER HILL HEALTH CARE CENTER | 305009 | 700 HANOVER STREET | MANCHESTER | NH | 3104 | 2011-02-11 | 309 | J | 0JH011 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based upon record review, interview with facility staff, the facility failed to provide a comprehensive assessment to determine appropriate interventions for 1 resident who experienced choking and swallowing difficulties, and subsequently had a choking episode that required immediate emergency medical care and transport to the hospital where the resident expired. (Resident identifier is #17). Findings include Review on [DATE], of the facility's "Aspiration Precautions", policy and procedure reveals, Policy Statement: Facility will maintain optimal safe swallow in patients/residents with identified risk for aspiration. Facility will initiate prompt identification of signs or symptoms of aspiration, changes in swallowing function and sign and symptoms of aspiration pneumonia. " " Policy Interpretation and Implementation: 8. Encourage residents to eat in supervised setting. Provide supervision in residents preferred eating environment if resident does not choose to attend supervised dining areas. 9. Report changes in signs/symptoms of dysphagia to physician. " Record review on [DATE] of Resident #17 reveals that Resident #17 was readmitted to the facility on [DATE] and was on a 2gm (gram), Na (sodium), low cholesterol, regular texture diet. Review of the nurses notes dated [DATE] reveals that at 12:30 p.m. Resident #17,"was found choking on lunch, nurse came in and provided two pumps of [MEDICATION NAME] maneuver, airway cleared." Review of the facility's Interdisciplinary Progress Notes dated [DATE] at 12:55 p.m. reveals a Speech Therapy evaluation note, Nsg, (nursing) reported to this writer that Resident choked during lunch meal this date and required the [MEDICATION NAME] maneuver. Resident observed consuming a regular texture with thin liquids. Resident tolerating without overt signs/symptoms of aspiration/choking. No coughing, throat clearing or change in subsequent vocal quality. Choking episode appears to be an isolated event. Recommende… | 2014-04-01 | ||
| 2087 | 2087 | HANOVER HILL HEALTH CARE CENTER | 305009 | 700 HANOVER STREET | MANCHESTER | NH | 3104 | 2011-02-11 | 224 | J | 0JH011 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, review of facility policies and procedures and review of facility documentation and interview the facility failed to ensure that it implements policies and procedures to prohibit neglect of a resident with a known history of choking that resulted in the need for immediate emergency medical care and transport to the hospital where the resident expired. Resident identifier is #17. Findings include: Review on [DATE], of the facility's "Aspiration Precautions", policy and procedure reveals, Policy Statement: Facility will maintain optimal safe swallow in patients/residents with identified risk for aspiration. Facility will initiate prompt identification of signs or symptoms of aspiration, changes in swallowing function and sign and symptoms of aspiration pneumonia. " " Policy Interpretation and Implementation: 8. Encourage residents to eat in supervised setting. Provide supervision in residents preferred eating environment if resident does not choose to attend supervised dining areas. 9. Report changes in signs/symptoms of dysphagia to physician. " Review of Resident #17's physician's orders [REDACTED]. Review of the nurses notes dated [DATE] reveals that at 12:30 p.m. Resident #17,"was found choking on lunch, nurse came in and provided two pumps of [MEDICATION NAME] maneuver, airway cleared." Review of the facility's Interdisciplinary Progress Notes Dated [DATE] at 12:55 p.m. reveals a Speech Therapy Screening note, Nsg, (nursing) reported to this writer that Resident choked during lunch meal this date and required the [MEDICATION NAME] maneuver. Resident observed consuming a regular texture with thin liquids. Resident tolerating without overt signs/symptoms of aspiration/choking. No coughing, throat clearing or change in subsequent vocal quality. Choking episode appears to be an isolated event. Recommended to nursing that resident be supervised for next few shifts. Resident without history of dysphagia. Review of the nur… | 2014-04-01 | ||
| 2088 | 2088 | HANOVER HILL HEALTH CARE CENTER | 305009 | 700 HANOVER STREET | MANCHESTER | NH | 3104 | 2011-02-11 | 225 | D | 0JH011 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based upon record review and review of a facility's investigation report and review of the State survey agency Intake Information sheet the facility failed to report the results an allegation of neglect within 5 working days to the required state officials including the State survey agency. (Resident identifier is #17). Findings include: On [DATE] at 10:07 a.m. the State survey agency received from Staff F Administrator a copy of the facility Incident/Accident Report dated [DATE], a copy of Resident #17's facility Record of Admission face sheet dated [DATE] and information that on [DATE], Resident #17 was in distress which initiated the [MEDICATION NAME] maneuver and resulted in Resident #17 requiring emergency medical care and transport to the hospital at 8:35 p.m. The result of the facility ' s investigation of the above incident was not provided to the State survey agency until [DATE] when it was revealed that Resident #17 expired as result of this incident. Cross Reference F309 | 2014-04-01 | ||
| 2089 | 2089 | HANOVER HILL HEALTH CARE CENTER | 305009 | 700 HANOVER STREET | MANCHESTER | NH | 3104 | 2011-02-11 | 226 | D | 0JH011 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of the facility's investigation report of an incident the facility failed to implement it's Abuse policy and procedure by failing to report the results of the investigation within 5 working days. (Resident identifier is #17) Findings include: Review of the facility's undated "Abuse Investigation" policy states that the administrator, or his/her designee will complete a preliminary report form with twenty-four hours and a preliminary investigation within five (5) days." This policy also states that the "administrator, or his/her designee shall report the results of such preliminary report and investigation within 5 working days to the State survey agency " . On [DATE] at 10:07 a.m. the State survey agency received from Staff F Administrator a copy of the facility's Incident/Accident Report dated [DATE], a copy of Resident #17's facility Record of Admission face sheet dated [DATE] and information that on [DATE], Resident #17 was in distress which initiated the [MEDICATION NAME] maneuver and resulted in Resident #17 being taken to the hospital at 8:35 p.m. A review of the State survey agency Intake Information sheet revealed that the facility reported the initial incident to the State Survey Agency on [DATE] but did not report the results of the facility's investigation to the State Survey Agency within the 5 working days as required. The results of the facility investigation was not provided to the State survey agency until [DATE] when it was revealed that Resident #17 had expired at the hospital on [DATE]. Cross Reference F309 | 2014-04-01 | ||
| 2090 | 2090 | HANOVER HILL HEALTH CARE CENTER | 305009 | 700 HANOVER STREET | MANCHESTER | NH | 3104 | 2011-02-11 | 280 | D | 0JH011 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based upon record review and review of a facility's investigation report the facility failed to update the comprehensive care plan for 1 of 24 sampled residents (Resident identifier is #17). Findings include: On [DATE] Staff B LPN (Licensed Practical Nurse) compeleted a facility quarterly [MEDICAL CONDITION] Risk Assessment at 2:13 p.m. which revealed that Resident #17 had a score of ,[DATE] which indicates that Resident #17 was now assessed as a high risk because of becoming "Lethargic, disoriented x2" and for experiencing "difficulty swallowing and frequent choking" episodes. A review of Resident #17's care plan revealed that as a result of the facility quarterly [MEDICAL CONDITION] Risk Assessment of [DATE] Resident #17's care plan was not updated to address the increased nutritional risk to Resident #17 and did not have any alteration in the regular consistency of their diet. Review of the facility's undated policy for "Monitoring Residents/Patients AS Having Significant or Health Altering Nutrition Issues", indicates that the Nutrition-At-Risk Committee will review patients who score 10 or above on the [MEDICAL CONDITION] risk assessment. There was no documentation in Resident #17's record that the facility Nutrition-At-Risk Committee addressed the quarterly [MEDICAL CONDITION] Risk Assessment of [DATE] which scored Resident #17 a total of 13 out of 30 points. On [DATE] interview with Staff C PT (Physical Therapist, Director of Rehabilitative Services) and Staff D ST (Speech Therapist) revealed that once the facility quarterly [MEDICAL CONDITION] Risk Assessment was completed it was also supposed to be referred to the dietician. There was no documentation in Resident #17's record that the dietician responded to the findings of the facility quarterly [MEDICAL CONDITION] Risk Assessment of [DATE]. Staff C and Staff D also revealed that there was no further referral made to their department after the initial [DATE] swallowing assessment. On… | 2014-04-01 | ||
| 2091 | 2091 | HANOVER HILL HEALTH CARE CENTER | 305009 | 700 HANOVER STREET | MANCHESTER | NH | 3104 | 2011-02-11 | 490 | F | 0JH011 | Based upon the survey concluded on 2/11/11 it was determined that the facility was not being administered in a manner that enables it to provide the highest practicable physical and well-being of each resident. Findings include: As a result of the survey it was it was determined that the facility has immediate jeopardy with substandard quality of care being identified in the area of facility practices, 42 CFR 483.13(c) - Neglect, and in the area of quality of care, 42 CFR 483.25- Providing care/services for highest well being. Cross refer to F224 and F309 | 2014-04-01 | ||
| 2092 | 2092 | HANOVER HILL HEALTH CARE CENTER | 305009 | 700 HANOVER STREET | MANCHESTER | NH | 3104 | 2011-02-11 | 501 | D | 0JH011 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based upon record review, review of facility policy and procedures and interviews the medical director failed to ensure the that care and services be provided to a resident with a history of choking episodes. (Resident identifier is #17). Findings include: Review on [DATE], of the facility ' s " Aspiration Precautions, policy and procedure reveals, Policy Statement: Facility will maintain optimal safe swallow in patients/residents with identified risk for aspiration. Facility will intitiate prompt identification of signs or symptoms of aspiration, changes in swallowing function and sign and symptoms of aspiration pneumonia. Policy Interpretation and Implementation: 8. Encourage residents to eat in supervised setting. Provide supervision in residents preferred eating environment if resident does not choose to attend supervised dining areas. 9. Report changes in signs/symptoms of dysphagia to physician. " Review of the nurses notes dated [DATE] reveals that at 12:30 p.m. Resident #17,"was found choking on lunch, nurse came in and provided two pumps of [MEDICATION NAME] maneuver, airway cleared." Review of the facility's Interdisciplinary Progress Notes Dated [DATE] at 12:55 p.m. reveals a Speech Therapy Screening note, Nsg, (nursing) reported to this writer that Resident choked during lunch meal this date and required the [MEDICATION NAME] maneuver. Resident observed consuming a regular texture with thin liquids. Resident tolerating without overt signs/symptoms of aspiration/choking. No coughing, throat clearing or change in subsequent vocal quality. Choking episode appears to be an isolated event. Recommended to nursing that resident be supervised for next few shifts. Resident without history of dysphagia. Review of the nurse ' s notes from [DATE] through [DATE] Reveals documentation that Resident #17 experienced 2 episodes of choking while eating food one on [DATE] and the second on [DATE] and and experienced 2 episodes of difficulty swallowi… | 2014-04-01 | ||
| 2093 | 2093 | ROCHESTER MANOR | 305024 | 40 WHITEHALL ROAD | ROCHESTER | NH | 3867 | 2011-05-12 | 279 | D | WENK11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and interview it was determined that the facility failed to ensure that comprehensive care plans were in place for 2 residents out of a standard survey sample 16. (Resident identifiers are #4 and #5.) Findings include: Resident #5 Review on 5/10/11 of Resident #5's significant change MDS (Minimum Data Set) Section V. Care Area Assessment Summary (CAAS) with an ARD (Assessment Reference Date) of 3/24/11 revealed that Resident #5 triggered for Pressure Ulcer. Review of Resident #5's CAAS dated 3/31/11 revealed Pressure Ulcer would be addressed in the care plan. Review of Resident #5's care plans revealed that there was a care plan dated 3/17/11 for "Skin Integrity", but the whole care plan had been yellow highlighted. Interview on 5/10/11 at approximately 1:00 p.m. with Staff A (DON) revealed that when a care plan is yellow highlighted out that those areas highlighted are no longer being used. Resident #5's "Skin Integrity" care plan revealed that Resident #5 had a history of [REDACTED].#5's previous care plan for "Skin Integrity" revealing on 11/5/09 a pressure reducing mattress was put in as an intervention. On the current care plan this area was yellow highlighted out. Staff A and surveyor observation confirmed this area should not be yellow highlighted out since this intervention is still being used for Resident #5. Medical record review of Resident #5's care plans confirmed there were no other interventions included in the current yellow highlighted out care plan for the triggered care area of pressure ulcers. Resident #4 Review of the current medical record on 5/10/11 at 1:00 p.m. for Resident #4 reveals a copy of the HISTORY AND PHYSICAL report from (Hospital) dated 2/24/11. This report indicates under PAST MEDICAL HISTORY the following: 1. Pacemaker placed 2007 secondary to first degree AV ([MEDICAL CONDITION]-Ventricular) block with [MEDICAL CONDITION]. Review of the current care plans on 5/10/11 at 1:05 … | 2014-04-01 | ||
| 2094 | 2094 | ROCHESTER MANOR | 305024 | 40 WHITEHALL ROAD | ROCHESTER | NH | 3867 | 2011-05-12 | 159 | B | WENK11 | Based on the Resident Trust Fund review and interview the facility failed to maintain a system which managed and accounted for Resident Trust Fund money for the 60 of 80 current residents with accounts according to accepted accounting principles by not offering receipts for all resident deposits and withdrawals to the Resident Trust Fund Account. Findings include: During the Resident Trust Fund Review conducted at 10:15 a.m. - 11:00 a.m. on 5/11/11, Staff B (Business Office Assistant) and Staff C (Business Office Manager) reviewed the system in use for resident withdrawals and deposits. During interview with Staff B and Staff C at the time of the review, it was revealed that 60 residents of the 80 current residents residing at the facility have resident trust fund accounts. Per Staff B and Staff C during interview on 5/11/11, a loose leaf book with a listing of resident deposits and withdrawals is used and kept for the facility records but not all residents are given receipts for withdrawals and deposits. A review of the April 2011 withdrawals and deposits of resident money to their accounts revealed not all residents received receipts for these transactions. Staff B and Staff C confirmed that not all residents making deposits or withdrawals for April 2011 received receipts for these transactions. | 2014-04-01 | ||
| 2095 | 2095 | ROCHESTER MANOR | 305024 | 40 WHITEHALL ROAD | ROCHESTER | NH | 3867 | 2011-05-12 | 278 | D | WENK11 | Based on record review and interview the facility failed to ensure that an MDS (Minimum Data Set) Assessment was accurate for 1 of 16 residents in the survey sample. (Resident identifier is #2.) Findings include: Resident #2. This resident's quarterly MDS Assessment with an ARD (Assessment Reference Date) of 4/28/11 was reviewed on 5/11/11. Review of Section G0110 Activities of Daily Living (ADL) Assistance shows that the facility staff coded the resident to be independent in bed mobility - G0110. 1. A. 1. ADL Self-Performance = 0 and G0110. 1. A. 2. ADL Support Provided = 0. Review of the computerized LNA documentation sheets, entitled the Look Back Report, for bed mobility status for the last seven days of the MDS Assessment period - 4/22/11 through 4/28/11 - shows that the LNAs recorded that the resident's self-performance was coded "O" Independent for 6 of 20 shifts, "1" Supervision for 1 of 20 shifts, "2" Limited assistance for 7 of 20 shifts and "3" Extensive assistance for 6 of 20 shifts. The staff did not document in the computerized Look Back Report for the 3-11 shift on 4/28/11. Review of these MDS codings shows the resident was only independent in bed mobility for 6 of the 20 shifts recorded and the resident required the most assistance - extensive assistance - for 6 of the 20 shifts during the assessment period. Staff F, RN MDS Coordinator, was interviewed on 5/12/11 at 10:27 a.m. about where the information for the coding of this 4/28/11 MDS section was obtained. Staff F stated that the information for this section should be obtained from the recordings on the LNA Look Back Report. Staff F looked at the Look Back Report for the 4/22/11 to 4/28/11 look back period and stated that Staff K, RN, completed the section and did not code the bed mobility accurately based on the documentation on the LNA Look Back Report. | 2014-04-01 | ||
| 2096 | 2096 | COURVILLE AT NASHUA | 305037 | 22 HUNT STREET | NASHUA | NH | 3060 | 2011-04-21 | 514 | B | 28KU11 | Based on record review and staff interview the facility failed to ensure consultation reports by a contracted provider found in the clinical record of 1 of 19 residents were complete including identification of the provider and the individual doing the assessment. (Resident identifier is #4.) Findings include: Resident #4 Medical record review was conducted for this resident on 4/19/11 - 4/20/11. Review of wound documentation dated 1/14/11, 2/10/11, 3/8/11 and 3/31/11 revealed there is no identifying information detailing the name or credentials of the person writing these notes or their signature. During an interview with Staff A (RN/Case Manager) on 4/20/10 in the afternoon, Staff A explained the facility wound management program included the option of referral to consulting services from a contracted agency which provides an RN who is a clinically certified specialist for wound care management. Staff A stated the person who did these four notes/assessments (dated 1/14/11, 2/10/11, 3/8/11 and 3/31/11) on Resident #4 was Staff B (RN/CWCA/Certified Wound Care Associate). Staff A reviewed of these notes with the State surveyor at the time of the interview, the wound notes/assessments identified above were unsigned with no identifying information for the consultant services company or consultant found in the medical record. | 2014-04-01 | ||
| 2097 | 2097 | COURVILLE AT NASHUA | 305037 | 22 HUNT STREET | NASHUA | NH | 3060 | 2011-04-21 | 280 | D | 28KU11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to update the comprehensive care plan for 1 resident in a survey sample of 19 residents. (Resident identifier is #3.) Findings include: Review of the care plan for Resident #3 dated 6/10/10 under "problem" states "Skin Integrity, Risk for Impairment Related To:" 1. Dry and fragile skin 2. Decline in independent mobility 3. Incontinence 4. [DIAGNOSES REDACTED]. Under Goal it states Resident #3 will have no skin break down or impairment thru next review with the most recent revised target date through 6/10/11. Interventions include the following: 1. Braden scale at admission, every 3 months and prn. 2. Monitor skin daily with care; target pressure areas and bony prominences. 3. Report change in skin texture, color or open areas promptly. 4. Report to NSG (Nursing) and PCP (Primary Care Provider) to obtain tx (treatment)- see TAR (Treatment Administration Record). 5. Therapeutic mattress to bed... On review, Nurse's Notes for Resident #3 state on 4/16/11 (7 a.m. - 3 p.m.) that the supervisor was notified by an LNA (Licensed Nurse Assistant) of a reddened area on the great toe for Resident #3. The nurse's note dated 4/16/11 continues to describe a blanchable area of the left malleolus that was not open. The right foot had an unstageable wound of the big toe and a right inner heel blister. The physician was notified and treatment orders obtained. A review of the comprehensive care plan on 4/19/11 revealed that it was not updated to include interventions for the care and treatment being provided for the 3 skin issues that were identified on 4/16/11. Interview with Staff C (Unit Manager) on 4/19/11 at 12:30 p.m. confirmed the care plan had not been updated to include the 3 skin issues that were identified on 4/16/11. | 2014-04-01 | ||
| 2098 | 2098 | COURVILLE AT NASHUA | 305037 | 22 HUNT STREET | NASHUA | NH | 3060 | 2011-04-21 | 371 | E | 28KU11 | Based on observation during tour of the facility's kitchen and interview with Staff E (Director of Food Services) it was found that the facility failed to properly clean equipment that was staged as ready for use. Findings include: During the initial tour of the kitchen on 4/19/11 at 9:05 a.m. with Staff E it was observed that the meat slicer that was covered with a plastic bag meaning it was ready for use which was confirmed by interview with Staff E, had food product in and around the cutting blade. Staff E observed this finding on 4/19/11 and confirmed on interview that the person who had used meat slicer last failed to properly clean it according to the facility's procedures. Additionally, it was observed that the can opener that was placed in the ready to use position had food product on the cutting blade. The placement of the can opener was confirmed through interview with Staff E that the opener was ready to be used as identified by it's position and the blade was dirty. Both observations were shown to Staff E at the time of the findings who confirmed by interview that neither piece of equipment was properly cleaned. | 2014-04-01 | ||
| 2099 | 2099 | PLEASANT VALLEY NURSING CENTER | 305039 | 8 PEABODY ROAD | DERRY | NH | 3038 | 2011-01-13 | 281 | D | FPTF11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, medical record review and interview the facility failed provide services necessary to meet professional standards for performing nursing assistant responsibilities for 2 residents dependent on staff for care of physical needs and failed to ensure the security of emergency code cart medications/supplies and a treatment cart from unauthorized personnel. (Resident Identifiers are: #1 and #2) Findings include: Review of "Mosby's Textbook for Nursing Assistants," Mosby's 6th edition, pg. 588, Box 28-3 Measures to Prevent Pressures Ulcers Follow the repositioning schedule in the person's care plan. The person is repositioned at least every 2 hours. Some persons are repositioned every 15 minutes. Position the person according to the care plan... Minimize skin exposure to moisture. Check incontinent persons (those without bowel and bladder control) often...Change linens and clothing as needed, and provide good skin care... Keep linens clean, dry and free of wrinkles... Review of the Lippincott "Textbook for Long-Term Care Nursing Assistants" copyright 2010 reveals the following: On page 30: As a nursing assistant in a long term care facility, most of your responsibilities will relate to meeting the basic physical needs of residents, which include hygiene, safety, comfort, nutrition, exercise and elimination. On page 81: Guidelines for Recording, under column "What you do" it states "Only record observations that you have made, or care that you have given. Do not make entries for another person." Rational under column "Why you do it" states "By making an entry in a medical record, you accept legal responsibility for that entry. Therefore, it is best to record only information that you, personally can vouch for." Also under column "What you do" it states Do not record care as given or procedures as performed before you have provided the care or performed the procedure. Only document after the fact." Rational under column "Why you … | 2014-04-01 | ||
| 2100 | 2100 | PLEASANT VALLEY NURSING CENTER | 305039 | 8 PEABODY ROAD | DERRY | NH | 3038 | 2011-01-13 | 282 | D | FPTF11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview it was determined that the facility failed to ensure the implementation of the care plan for 2 of 2 residents. (Resident identifiers are #1 and #2.) Findings include: Resident #1 Review of Resident #1's medical record on 1/13/11 reveals that Resident #1 is severely cognitively impaired and requires 1 to 2 staff assist in ADL's with incontinence of bowel and bladder. Resident #1's care plan indicates at risk for skin breakdown related to incontinence, impaired bed mobility, altered nutrition and cognitive impairment. Care plan approaches include to monitor for incontinence every 2 hours and as needed, change promptly and to turn and reposition every 2 hours. Interview on 1/13/11 with Staff A and Staff B, DON revealed that Staff O, LNA reported that Resident #1 was found at 7 a.m. on 11/15/10 in bed with the same street clothes on as 11/14/10 and incontinent of feces some of which was dried on. Staff A and B also indicated that through the investigation Staff O had placed Resident #1 in bed at 2 p.m. on 11/14/10. Staff B indicated that Staff I, LNA on the 3 p.m. to11 p.m. shift and Staff G, LNA on the 11 p.m. to 7 a.m. shift were assigned to care for Resident #1. During the facility investigation Staff I and G both indicated to Staff A and B that they did not provide care to Resident #1 other than empting the Foley catheter bag. Resident #2 Review of Resident #2's medical record revealed that Resident #2 had [DIAGNOSES REDACTED]. Review of Resident #2's at risk for Skin breakdown care plan with an review date of 9/2/10 reveals under the "Approachs" column, 1. Monitor for incont. AC/PC/HS Q 2 hrs @ noc and prn, change promptly. (Before meals, after meals, hour of sleep, every 2 hours at night and when needed.) 2. Assist with repositioning as needed, using padding between pressure areas. 3. Encourage p.o. and fluid intake. 8.) Turn and reposition AC/PC/HS Q2rs @ noc and prn.11. Keep bed free of wrinkles, crumb… | 2014-04-01 | ||
| 2101 | 2101 | PLEASANT VALLEY NURSING CENTER | 305039 | 8 PEABODY ROAD | DERRY | NH | 3038 | 2011-01-13 | 514 | D | FPTF11 | Based on record review and interview it was determined that the facility failed to maintain complete and accurate documentation of clinical information in the resident record for 2 residents. (Resident identifiers are #1 and #2.) Findings Include: Resident #1 Review of Resident #1's medical record on 1/13/11 reveals a "C.N.A. ADL Tracking Form" for the month of November 2010. On the 3 p.m.- 11p.m. shift on11/14/10 Staff I initialed completing the following for Resident #1: bed mobility- total assist with 2 or more persons, dressing- total assist with 1 person, toilet use- total assist with 1 person, incontinent and continent of bladder and no episodes of bowel movements, personal hygiene- total assist with 1 person and bathing- total assist with 1 person with type of bath recorded as partial. On the 11 p.m. to 7 a.m. shift for 11/15/10 Staff G initialed completing the following for Resident #1: bed mobility- total assist with 2 or more persons, snack offered, toilet use- total assist with 1 person, incontinent of bladder and bowel without indication of number of episodes of bowel movements. Review of the facility reporting tool completed by Staff A, Administrator dated 11/15/10 indicates that Resident #1 was found on 11/15/10 at 7 a.m. in bed with street clothes on and incontinent of feces. Interview on 1/13/11 with Staff A and Staff B, DON revealed that Staff O, LNA reported that Resident #1 was found at 7 a.m. on 11/15/10 in bed with the same street clothes on as 11/14/10 and incontinent of feces some of which was dried on. Staff A and B also indicated that through the investigation Staff O had placed Resident #1 in bed at 2 p.m. on 11/14/10. Staff B indicated that Staff I, LNA on the 3 p.m. to11 p.m. shift and Staff G, LNA on the 11 p.m. to 7 a.m. shift were assigned to care for Resident #1. During the facility investigation Staff I and G both indicated to Staff A and B that they did not provide care to Resident #1 other than empting the Foley catheter bag with Staff I and G also admitting to signing the ADL t… | 2014-04-01 | ||
| 2102 | 2102 | PLEASANT VALLEY NURSING CENTER | 305039 | 8 PEABODY ROAD | DERRY | NH | 3038 | 2011-01-13 | 431 | D | FPTF11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and interview it was determined that the facility failed to ensure and identify the hazard of not securing the facility crash cart medications and treatment cart from unauthorized personnel. Findings include: Observation on 1/13/11 at approximately 1:30 p.m. revealed an emergency code cart with a breakaway lock kit located in the resident/visitor hallway outside of room [ROOM NUMBER] on the MSU (medical surgical unit) Wing noted to have the bottom door partially opened which was able to be opened fully as well as all drawers. The plastic breakaway lock has "12/15 MG" written on it and was stretched out and not allowing the vertical bar to secure the drawers and door. The door and drawers could be fully accessed. The first drawer of this cart contained 2 Epinephrine (EpiPen) medications (some adverse reactions include impact to the cardiovascular and central nervous systems), 2 Glucagon kits (adverse reactions include nausea, vomiting, rash, itching, difficulty breathing and loss of consciousness.) and IV (intravenous) start kits with 4 syringes with needles. Staff A, Administrator arrived on the MSU wing and also observed the emergency code cart and confirmed that the plastic breakaway lock was not securing the cart. It was also observed on the MSU a treatment cart located by the nurse ' s station that was unlocked and contained various creams such as barrier and hydrogel creams. While with Staff A a staff nurse indicated that this staff nurse usually does not lock the treatment cart because it only contains Band-Aids and dressings. Staff A acknowledged and informed the staff nurse that the treatment cart needed to be locked. During interview with Staff A and Staff B (Director of Nursing) on 1/13/11 Staff A confirmed on the MSU the emergency code cart was not securely locked and that the treatment cart was not locked. | 2014-04-01 | ||
| 2103 | 2103 | ROCKINGHAM COUNTY NURSING HOME | 305046 | 117 NORTH ROAD | BRENTWOOD | NH | 3833 | 2011-08-11 | 281 | D | LD5H11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, review of the facility narcotic log and staff interview the facility failed to ensure that nursing staff followed professional standards regarding the administration of medication for 3 of 30 residents in a standard survey sample (Resident identifiers are #4, #9,and #23), failed to clarify and accurately transcribe a physician's orders [REDACTED].#28) and failed to have an interim care plan for an infection for 1 of 30 residents in a standard survey sample. (Resident identifier is #26.) Findings include; Review of Patricia A. Potter and Anne Griffin Perry, "Fundamentals of Nursing", 7 th Edition, (St. Louis, Missouri, Mosby, Inc., 2009), page 713 reveals under medication administration standard for Recording Medication Administration, "After administering a medication, record it immediately on the appropriate record form.... Recording immediately after administration prevents errors ... ". Also on page 713 of the same reference listed above, Chapter 35 Medication Administration - Correct Transcription and Communication of Orders states, "Sometimes the nurse or designated unit secretary writes the prescriber's complete order on the appropriate medication form, (e.g., the MAR (Medication Administration Record)) or enters the order into the client's electronic medical record." Review of Potter Perry, 2005, Fundamentals of Nursing 6 th Edition, St. Louis, Missouri: Mosby, Chapter 34 Medication Administration standard Correct Transcription and Communication of Orders on pages 846 and 847 states "A registered nurse checks all transcribed orders against the original order for accuracy and thoroughness. If an order seems incorrect or inappropriate, the nurse consults the prescriber. ...". Also on page 419 of the same reference listed above is stated "...all orders must be assessed, and if one is found to be erroneous or harmful, further clarification from the physician is necessary." Also on page 327 of the same refere… | 2014-04-01 | ||
| 2104 | 2104 | ROCKINGHAM COUNTY NURSING HOME | 305046 | 117 NORTH ROAD | BRENTWOOD | NH | 3833 | 2011-08-11 | 431 | D | LD5H11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, and interviews the facility failed to follow the accurate system of records for the disposition and accounting of controlled drugs/narcotics for 3 of 30 residents in a standard survey sample of 30 residents. (Resident identifiers are #4, #9, and #23.) Findings include: Resident #9. Record review for Resident #9 was conducted 8/9/11-8/11/11. Review of the MAR for August 2011 revealed an order for [REDACTED]. Comparison of the above MAR indicated Oxycodone IR 5 mg 1 tab by mouth twice a day/PRN (as needed)" revealed that on 8/7/11 at 11:45 a.m. 1 tablet was signed off as removed from the medication cart but there was no documentation on the MAR indicated [REDACTED]. The MAR for 8/7/11 for the above order was blank. Interview with Staff E (Unit Manager) on 8/11/11 in the afternoon confirmed the above finding. Resident #4 Record review for Resident #4 was conducted 8/9/11 - 8/11/11. Review of the MAR for July 1 - 31, 2011 reveals Resident #4 was prescribed "Oxycodone HCL IR 5 mg (milligram) tab - 1 tab po q (by mouth every) 4 hours prn (as needed) for pain" which was administered by nursing staff as needed from 7/1/11 to 7/14/11 when this order was discontinued. On 7/14/11 a new order was obtained from the physician for "Oxycodone 5 mg po Q 4 hours prn breakthrough pain. May repeat x (times) 1 after 30 min if needed for persistent pain." This dosage was administered from 7/14/11 through 7/31/11. Comparison of the 7/1/11 - 7/31/11 MAR indicated Oxycodone HCL "IR" 5 mg tablet - 1 tab by mouth every 4 hours as needed" reveals the following discrepancies; - On 7/8/11 the narcotic book indicates 2 doses of Oxycodone were signed as removed from the med cart at 0500 and 2000. No documentation was found on the MAR for that date to indicate the Oxycodone removed from the med cart at 0500 and 2000 was administered to Resident #4. - On 7/9/11 the narcotic book indicates 1 dose of Oxycodone was signed as removed from the med cart at 2… | 2014-04-01 | ||
| 2105 | 2105 | ROCKINGHAM COUNTY NURSING HOME | 305046 | 117 NORTH ROAD | BRENTWOOD | NH | 3833 | 2011-08-11 | 441 | E | LD5H11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, and interview the facility failed to maintain a current line listing to include 3 residents infected with[DIAGNOSES REDACTED] on 3 of 6 units, as part of their infection control program. (Resident identifiers are #1, #9, and #26.) Findings include: Note: Survey was conducted from 8/9/11-8/11/11. Interviews with Staff E (RN/Unit Manager) and Staff F (RN/Unit Manager) during the initial tour on 8/9/11 in the a.m. revealed that 2 residents had active[DIAGNOSES REDACTED]. Observations during the tour and on survey revealed that precaution carts were in place and precautions were being maintained. Resident #9. Record review revealed that Resident #9 was readmitted from the hospital with a [DIAGNOSES REDACTED]. Review of the nurses notes for 7/25/11- 7/28/11 revealed that Resident #9 developed diarrhea and a rash. Physician was notified and treatment followed. Nurses notes revealed that Resident #9 developed diarrhea again on 8/8/11 and the resident's ARNP ordered a culture for[DIAGNOSES REDACTED]. Culture was positive for[DIAGNOSES REDACTED] on 8/10/11 (See interview below.) Review on 8/11/11 of the infection Control Program with Staff C (RN/QA/IC) showed detailed line listings of infections from October 2010- August 11, 2011 but there was no listing for Resident #9. Staff C stated that the Lab report for Resident #9 came back on 8/10/11 and was positive for[DIAGNOSES REDACTED]. Resident #26. Record review revealed that Resident #26 was readmitted from the hospital with a [DIAGNOSES REDACTED]. Review of the nurses notes for 7/14/11- 8/10/11 revealed that precautions were maintained. Review of the bowel records for resident #26 revealed an episode of loose stools noted for 7/28/11. Resident #26 did not developed any further diarrhea. Review of the physician progress notes [REDACTED]. Review on 8/11/11 of the infection Control Program with Staff C showed detailed line listings of infections from October 2010- August 11, 2011 … | 2014-04-01 | ||
| 2106 | 2106 | ROCKINGHAM COUNTY NURSING HOME | 305046 | 117 NORTH ROAD | BRENTWOOD | NH | 3833 | 2011-08-11 | 514 | D | LD5H11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to maintain complete and accurate documentation of the medical records for 6 residents in a standard sample of 30 residents. (Resident identifiers are #4, #6, #8, #9, #23, #26 and #28.) Findings include: Resident #28 Review of the record for Resident #28 on [DATE] revealed the re-admission Physician order [REDACTED]. CPR was circled as the current order. Review of the Condition Alert page contained a green "FULL CODE" sticker and a review of the Resident Resuscitation Acknowledgment Form signed and dated on [DATE] documented the resident as "Full Code" status. The facility policy titled "RESIDENT [MEDICAL CONDITION]" revised [DATE] states the procedure for code status is as follows: "Each resident will have in their medical record a physician's orders [REDACTED]." "Resident's with a "Provide CPR" order will have a green "FULL CODE" sticker on the Condition Alert page in the front of their medical record." Review of the physician's orders [REDACTED]. This conflicting order was not clarified by staff when completing the monthly physician order [REDACTED]. Interview on [DATE] at 9:50 a.m. with Staff F (Unit Manager) confirmed that the resident's Condition Alert page and the Resident Resuscitation Acknowledgement Form deemed the resident's current code status was CPR or Full Code and the current transcribed physician orders [REDACTED]. Resident #4 Record review for Resident #4 was conducted [DATE] - [DATE]. Review of the MAR for [DATE] - 31, 2011 reveals Resident #4 was prescribed "[MEDICATION NAME] HCL IR 5 mg (milligram) tab - 1 tab po q (by mouth every) 4 hours prn (as needed) for pain" which was administered by nursing staff as needed from [DATE] to [DATE] when this order was discontinued. On [DATE] a new order was obtained from the physician for "[MEDICATION NAME] 5 mg po Q 4 hours prn breakthrough pain. May repeat x (times) 1 after 30 min if needed for persistent pain." This dosage w… | 2014-04-01 | ||
| 2107 | 2107 | CHESHIRE COUNTY HOME | 305054 | 201 RIVER ROAD | WESTMORELAND | NH | 3467 | 2011-01-13 | 281 | D | MZUU11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview it was determined that the facility failed to follow the professional standard of practice for the administration of medication for 1 resident in a standard survey sample of 24 residents. (Resident identifier is #21.) Findings include: Reference is the "Fundamentals of Nursing, 7 th EDITION, MOSBY/ELSEVIER, EVOLVE, POTTER-PERRY, 2009", pages 699 - 709 and pages 1082 - 1083. -" prn (as needed) Orders. Sometimes the prescriber orders a medication to be given only when a client requires it. This is a prn order. Use objective and subjective assessment and discretion in determining whether or not the client needs the medication.... When administering medications, document the assessment made at the time of medication administration. Make frequent evaluation of the effectiveness of the medication and record findings in the appropriate record... - Many medication errors result from inaccurate documentation. Therefore ensure that accurate and appropriate documentation exists before and after giving medications... - The nurse is also responsible for documenting any preassessment data required of certain drugs... - The name of the medication, the dose, the time of administration, and the route all need to be documented on the MAR (Medication Administration Record). Also document the site of any injections and the client's responses to medications, either positive or negative... - Evaluation of pain is one of many nursing responsibilities that require effective critical thinking. The client's behavioral responses to pain-relief interventions are not always obvious. Evaluating the effectiveness of a pain intervention requires you to evaluate the client after an appropriate period of time. For instance, oral medications usually peak in about 1 hour; whereas IV (intravenous medications) peak in 15 to 30 minutes. Ask the client if the medication alleviated the pain when peaking. Do not expect the client to volunteer the … | 2014-04-01 | ||
| 2108 | 2108 | CHESHIRE COUNTY HOME | 305054 | 201 RIVER ROAD | WESTMORELAND | NH | 3467 | 2011-01-13 | 282 | D | MZUU11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview it was determined that the facility failed to implement the plan of care for 1 resident in a standard survey sample of 24 residents. (Resident identifier is #21.) Findings include: Record review on 1/13/11 of the "Care Plan" for Resident #21 dated "8/15/2010" revealed in the section titled " PROBLEM: Comfort, Alteration: ... MANIFESTED BY: Communication of pain description, ... Assess physical symptoms, Note characteristics of pain, Document pain level, Administer pain meds, med effectiveness ...". Record review on 1/13/11 of the Medication Administration Record [MEDICATION ADMINISTRATION RECORD DETAILS REDACTED]"12/01/10 THROUGH 12/31/10" revealed the following physician orders: - "TYLENOL TAB (tablet) 325 MG 2 TABS BY MOUTH EVERY 4 HOURS AS NEEDED FOR PAIN/ELEV. (elevated) TEMP (temperature) NTE (not to exceed) 4 GM/24 HRS TOTAL APAP PRN (as needed). - [MEDICATION NAME] 1 TAB BY MOUTH EVERY 4 HOURS AS NEEDED FOR PAIN NTE 4 GM/24 H TOTAL APAP PRN." Further review of this MAR indicated [REDACTED]. This MAR indicated [REDACTED]. Review of this MAR indicated [REDACTED]. This MAR indicated [REDACTED]. Record review on 1/13/11 of the MAR for Resident #21 dated "01/01/11 THROUGH 01/31/11" revealed the following physician orders [REDACTED]. - "TYLENOL TAB (tablet) 325 MG 2 TABS BY MOUTH EVERY 4 HOURS AS NEEDED FOR PAIN/ELEV. (elevated) TEMP (temperature) NTE (not to exceed) 4 GM/24 HRS TOTAL APAP PRN (as needed). - [MEDICATION NAME] 1 TAB BY MOUTH EVERY 4 HOURS AS NEEDED FOR PAIN NTE 4 GM/24 H TOTAL APAP PRN." Further review of this MAR indicated [REDACTED]. This MAR indicated [REDACTED]. During interview with Staff B (Licensed Practical Nurse) and Staff C (Registered Nurse) on 1/13/10 at approximately 12:45 p.m. after Staff B and Staff C reviewed the above listed MAR's, pain assessment care plan for Resident #21, Staff B and Staff C confirmed that a pain rating is done before and after the administration of PRN… | 2014-04-01 | ||
| 2109 | 2109 | CHESHIRE COUNTY HOME | 305054 | 201 RIVER ROAD | WESTMORELAND | NH | 3467 | 2011-01-13 | 371 | D | MZUU11 | Based on observation and review of the facility policy and procedure for Standard Precautions it was determined that the facility failed to provide a safe and sanitary environment by not ensuring proper staff hygiene practices. Findings include: Review of the facility policy and procedure titled "Standard Precautions" dated "7/04" revealed the following: - " All employees to utilize standard precautions. - Procedure: - 1. Handwashing is recognized as the most important way to prevent the transmission of infection. All employees are to wash hands after every unprotected contact with blood or other potentially infectious materials and after removing gloves... - 3 ... Hand hygiene is recognized as the most important way to prevent the transmission of infection. All employees are to wash hands after every unprotected contact with blood or other potentially infectious materials and after removing gloves." Review of the facility "Dietary Department Guidelines" revealed the following: - "Employees, All dietary staff must follow proper handwashing techniques at all times." Observation on 1/12/11 at approximately 12:00 noon in the 2nd floor resident dining area revealed six staff members with gloved hands serving the lunch meal to multiple individual residents seated at different tables in this dining area. This observation also showed the same six staff members with gloved hands assembling and preparing individual resident food trays to serve residents who were not in this dining area but on the unit in their rooms. Further observation at this time showed no removal of gloves or handwashing done by the six staff members listed above before, during or after the serving and assembling of the individual resident food and food trays. The following staff observations were made on 1/12/11 during this dining time: - individual staff with gloved hands approach individual residents seated at tables to take meal orders and some staff would write the resident meal order on a piece of paper or would take plastic covered menu from th… | 2014-04-01 | ||
| 2110 | 2110 | CHESHIRE COUNTY HOME | 305054 | 201 RIVER ROAD | WESTMORELAND | NH | 3467 | 2011-01-13 | 441 | D | MZUU11 | Based on observation and review of the facility handwashing policy and procedure it was determined that the facility failed to provide a safe and sanitary environment by not ensuring proper handwashing. Findings include: Review of the facility policy and procedure titled "Standard Precautions" dated "7/04" revealed the following: - " All employees to utilize standard precautions. - Procedure: - 1. Handwashing is recognized as the most important way to prevent the transmission of infection. All employees are to wash hands after every unprotected contact with blood or other potentially infectious materials and after removing gloves... - 3 ... Hand hygiene is recognized as the most important way to prevent the transmission of infection. All employees are to wash hands after every unprotected contact with blood or other potentially infectious materials and after removing gloves." Review of the facility "Dietary Department Guidelines" revealed the following: - "Employees, All dietary staff must follow proper handwashing techniques at all times." Observation on 1/12/11 at approximately 12:00 noon in the 2nd floor resident dining area revealed six staff members with gloved hands serving the lunch meal to multiple individual residents seated at different tables in this dining area. This observation also showed the same six staff members with gloved hands assembling and preparing individual resident food trays to serve residents who were not in this dining area but on the unit in their rooms. Further observation at this time showed no removal of gloves or handwashing done by the six staff members listed above before, during or after the serving and assembling of the individual resident food and food trays. The following staff observations were made on 1/12/11 during this dining time: - individual staff with gloved hands approach individual residents seated at tables to take meal orders and some staff would write the resident meal order on a piece of paper or would take plastic covered menu from the center of the table and… | 2014-04-01 | ||
| 2111 | 2111 | CHESHIRE COUNTY HOME | 305054 | 201 RIVER ROAD | WESTMORELAND | NH | 3467 | 2011-01-13 | 224 | D | MZUU11 | Based upon a review of a facility investigation and staff interview the facility failed to enure that one resident was free from neglect. (Resident identifier is #4). Findings include: On Monday December 6, 2010 at approximately 2:30 p.m., according to a facility investigation report of 12/7/10, Resident #4 was placed on the bedpan upon their request. Staff E (LNA) wrote that they "forgot to pass" this information on "to the next shift." When Resident #4 was removed from the bedpan about 7:30 p.m., according to the facility investigation Resident #4 had "a large red ring shaped like a bed pan on" their "bottom." In a 1/14/11 interview with Staff F(DON) they stated that this mark disappeared by the following shift. | 2014-04-01 | ||
| 2112 | 2112 | OCEANSIDE SKILLED NURSING AND REHABILITATION | 305055 | 22 TUCK ROAD | HAMPTON | NH | 3842 | 2011-01-24 | 224 | J | Q42211 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based upon record reviews, a confidential resident interview, staff interviews, review of the facility policy and procedure for elopement, review of facility investigations and Elopement Risk Book the facility failed to ensure that it ' s residents remained free from neglect as follows: Failed to provide timely Activity of Daily Living (ADL) assistance for 3 of 20 residents in a standard survey sample (Resident identifiers are #3, #5 and #6.) Failed to prevent 1 of 20 residents in a standard survey sample from eloping off the locked unit 2 times and failed to prevent this same resident from eloping out of the facility 3 times (Resident identifier is #10.) Failed to accurately identify the elopement risk status for 2 of 20 residents in a standard survey sample (Resident identifiers are #4 and #12) and two out of sample residents (Resident identifiers are #29 and #30.) Failed to allow 1 of 20 residents in a standard survey sample to exercise one of their rights (Resident identifier is #13.) Findings include: Resident #5 On 1/9/11 at approximately 6:00 a.m., according to a Resident/Patient Incident Report of 1/9/11 and a facility complaint investigation, Resident #5 was heard by Staff N LNA(Licensed Nursing Assistant) yelling for help. Staff N's LNA written statement of 1/9/11 noted finding Resident #5 drenched in urine no sheets on the bed or any blankets on the bed. Staff N LNA continued by stating Resident #5's"pants were down around their ankles. Staff N LNA also noted that Resident #5's bed was found in its most upright position. Resident #5, according to the facility complaint investigation, stated to Staff O LPN (Licensed Practical Nurse) on 1/9/11 after being cleaned up by Staff N LNA that I want something done and I should not be treated like that. The facility complaint investigation determined that Staff P LNA was responsible for Resident #5's care during the third shift on the evening of 1/8/11. Staff P LNA, according to the facility… | 2014-04-01 | ||
| 2113 | 2113 | OCEANSIDE SKILLED NURSING AND REHABILITATION | 305055 | 22 TUCK ROAD | HAMPTON | NH | 3842 | 2011-01-24 | 272 | E | Q42211 | Based on record review and interview it was determined that the facility failed to document a weekly skin assessment for 4 residents in a standard survey sample of 20 residents. (Resident identifiers are #3, #4, #7, and #17.) Findings include: Resident #7. Record review on 1/20/11 of the November 2010 TAR (treatment administration record) for Resident #7 revealed that under the section " SKIN ASSESSMENT WEEKLY ON BATH DAY" 5 Tuesday 7-3 shifts were sectioned off as the days to examine the skin. Of these 5 Tuesdays 1 week showed no documented evidence that a skin check was done on 11/9/10, it was blank. Record review of the December 2010 TAR for Resident #7 revealed that under the section "SKIN ASSESSMENT WEEKLY ON BATH DAY" 4 Tuesday 7-3 shifts were sectioned off as the days to examine the skin. Of these 4 Tuesdays, 3 weeks showed no documented evidence that a skin check was done on these dates: 12/7/10, 12/21/10, and 12/28/10 were blank. The 12/7/10 date was 3 days prior to the development of a Stage II pressure ulcer. The back section of this TAR "SKIN ASSESSMENT" for Resident #7 contained no skin information. Record review revealed that there was no mention of the skin having been assessed on the bath days as ordered on either the TAR or the nurses notes for the above dates. Interview with Staff E (Unit Manager) on 1/21/10 in the a.m. confirmed above findings and that 3 weekly assessments were blank and failed to provide the proper information to reflect Resident #7's skin condition. Resident #17. Record review on 1/22/11 of the December 2010 TAR (treatment administration record) for Resident #17 revealed that under the section "SKIN ASSESSMENT WEEKLY ON BATH DAY" 5 Wednesday 3-11 shifts were sectioned off as the days to examine the skin. Of these 5 Wednesdays, 3 weeks showed no documented evidence that a skin check was done on these dates: 12/8/10, 12/15/10, and 12/29/10 were blank. The back section of this TAR "SKIN ASSESSMENT" for Resident #17 was also blank. There was no mention of the skin having been ass… | 2014-04-01 | ||
| 2114 | 2114 | OCEANSIDE SKILLED NURSING AND REHABILITATION | 305055 | 22 TUCK ROAD | HAMPTON | NH | 3842 | 2011-01-24 | 282 | D | Q42211 | Based on medical record review and interview it was determined that the facility failed to implement interventions indicated for care on resident care plans for 2 resident in a standard survey sample of 20. (Resident identifiers are #3 and #4.) Findings include: Resident #4 Review on 1/20/11 of Resident #4's care plan for skin breakdown initiated on 1/11/10 indicated an intervention of "Weekly skin assessment by license nurse." Review of Resident #4's "TREATMENT SHEET" for December 2010 revealed for the 12/24/10 scheduled check there was no documented evidence that a skin assessment was done. The "TREATMENT SHEET" indicated that the last "SKIN ASSESSMENT ON BATH DAY" was documented as done on 12/17/10 and the next was documented as done on 12/31/10. Review of Resident #4's "Nursing Progress Notes" dated 12/21/10 revealed, "Skin is intact." There was no other documented skin assessment in Resident #4's medical record being done between 12/21/10 thru 12/31/10. Interview on 1/20/11 at approximately 1:00 p.m. with Staff A (Licensed Practical Nurse) confirmed there was no documented evidence that the scheduled skin assessment on 12/24/10 was done or any where else in Resident #4's medical record. Staff A also confirmed that there was no other documented skin assessment in Resident #4's medical record being done between 12/21/10 thru 12/31/10. Resident #3 Review of Resident #3 ' s medical record on 1/19/2011 reveals that Resident #3 has a care plan for at risk for skin breakdown due to decreased mobility initiated on 8/5/2009 and revised on 1/19/2011. The care plan listed weekly skin assessments by license nurse under the interventions section. Review of Resident #3 ' s monthly treatment sheets for the months of September, October, November and December 2010 for Resident #3 reveals that Resident #3 was to have a skin assessment completed weekly on bath day. The weekly skin assessments were not signed off as being completed on September 25, 2010, October 9, 2010, November 1, 2010 and December 19, 2010. | 2014-04-01 | ||
| 2115 | 2115 | OCEANSIDE SKILLED NURSING AND REHABILITATION | 305055 | 22 TUCK ROAD | HAMPTON | NH | 3842 | 2011-01-24 | 323 | J | Q42211 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, review of the facility policy and procedures of facility incident reports and facility Elopement Risk Book and staff interview the facility: Failed to ensure the safety of residents on 1 of 4 units by preventing an elopement which rose to the level of Immediate Jeopardy for 1 resident in a standard survey sample of 20 residents (Resident identifier is #10.) Failed to ensure the facility environment remained free of accident hazards and that each resident received adequate supervision and assistance devices to prevent avoidable incidents for 2 residents in a standard survey sample of 20 residents (Resident identifiers are #3, #6.) Failed to provide the provision of care in a safe manner for 1 resident in a standard survey sample of 20 and one out of sample resident (Resident identifiers are #11 and #31.) Failed to accurately identify residents at risk for elopement for 2 of 20 residents in the standard survey sample and two out of sample residents (Resident identifiers are #4, #12, #29 and #30.) Findings include: Resident #10 Resident #10 eloped from the unit as evidenced by nursing notes documenting those events as follows: - 8/14/10 "Has been exit seeking all shift. Was only able to redirect times 3 and the other times ...(resident) got just outside door and was very hard to get back in...." - 8/21/10, 7-3, "Resident exit seeking all shift exited unit times one without letting staff know (sic.) able to convince resident back into unit after 15 minutes stated 'I want to go home back to ...(town)' ... (sic. security bracelet) intact and functioning, resident watching doors when staff puts code in then attempts to leave/exit. Resident encouraged to stay in common area with staff..." - 9/11/10, 1446 "Alerted by alarm to the door going off the unit, resident had gotten out through the employee entrance door and was standing in parking lot approximately 20 feet from the door." - 9/11/10, 1530 "At 3 p.m. resident had gotten … | 2014-04-01 | ||
| 2116 | 2116 | OCEANSIDE SKILLED NURSING AND REHABILITATION | 305055 | 22 TUCK ROAD | HAMPTON | NH | 3842 | 2011-01-24 | 514 | D | Q42211 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation, and interview it was determined that the facility failed to ensure that the medical record accurately documented residents' condition for 8 of 20 residents in a standard survey sample and 2 out of sample residents. (Resident identifiers are #1, #3, #4, #7, #8, #10, #12, #17, #29, and #30.) Resident #1. Record review on 1/19/11 revealed that this resident was admitted on [DATE] with a Central-Line Catheter. Review of the "Central-Line Catheter Protocol" physician's orders [REDACTED]." Further review revealed under the "Fluid/ Medication Orders/Stop Date" section an order for [REDACTED]." Review of the "Central Line Catheter" protocol tracking sheet revealed that for the month of November 2010 an IV flush of 5 ml NS (normal saline) via "Tunneled/non-Tunneled valved catheter 5 ML(milliliters)" was done daily. No documentation exists that the daily [MEDICATION NAME] flush was administered as ordered. In an interview with Staff E (Unit Manager) on 1/19/11 at the time of the record review Staff E indicated that Resident #1 has not had a PICC line since the resident's admission on 9/27/10 and that the Central Line Catheter has had, "one lumen" that was visible in the "left chest" area. Staff E also indicated that the Central Line had been flushed as ordered daily with the [MEDICATION NAME] and PRN with blood draws. Review on 1/20/11 of the Omnicare "Clinical Infusion Nursing Documentation" sheet dated 12/20/10 used by Staff BB (RN) who was called to administer the procedure "Catheter Clearance" and to draw blood for an INR (International Normalized Ratio) revealed that Staff BB wrote, "Line is a Power PICC NON-Tunneled CVC (central venous catheter) placed in (symbol for left) SVC (Superior Vena Cava)." Observation on 1/20/11 in the morning with Staff E revealed a Central Line (one lumen) catheter covered with a transparent dressing with the lumen capped and dressing labeled per IV protocol. This was not a… | 2014-04-01 | ||
| 2117 | 2117 | OCEANSIDE SKILLED NURSING AND REHABILITATION | 305055 | 22 TUCK ROAD | HAMPTON | NH | 3842 | 2011-01-24 | 225 | E | Q42212 | Based on review of the facility's documentation and staff interview the facility failed to ensure that all alleged violations involving mistreatment, neglect, or abuse are reported to other officials in accordance with State law through established procedures (including to the State survey and certification agency). (Resident identifier is #13.) Findings include: During an interview on 3/28/11 with Staff A, Administrator, Staff A was asked to provide facility incident reports and investigations since 3/18/11. Review of Resident #13's facility investigation dated 3/22/11 reveals that Resident #13 reported to Staff F, LNA (Licensed Nurses Aide) "... she had been depressed and upset all night because the 3-11 girls had been so mean to her ... boy across the hall even tried to get them to help me." Review of Staff E, LNA, written statement, dated 3/22/11 reveals that Resident #13 asked to speak with the nurse/supervisor about the 3-11 aides, " treating me rotten. " Resident #13 was crying while telling Staff E that the 3-11 aides always ignore Resident #13. Review of Staff G, LPN (Licensed Practical Nurse) written statement, dated 3/22/11 reveals that Resident #13 stated " I don't know why they treat me like this." Resident #13 wanted to go to bed and when Resident #13 asked staff the staff just walked by Resident #13. Review of Staff H, RN (Register Nurse) Unit Manager East/West Wing written statement, with no date on statement, reveals that Staff H spoke with Resident #13 the next day and that Resident #13 stated that the staff on 3-11 do not answer or respond to requests and Resident #13 "feels" ignored. Staff H spoke with Staff C, LNA and Staff D, LNA about not responding to Resident #13 and that both Staff C and Staff D stated that the care was given to Resident #13 and that Staff C and D were not ignoring residents. Review of submitted facility reports at the State survey and certification agency reveals no initial report was submitted from the facility regarding the alleged mistreatment, neglect or abuse, invo… | 2014-04-01 | ||
| 2118 | 2118 | OCEANSIDE SKILLED NURSING AND REHABILITATION | 305055 | 22 TUCK ROAD | HAMPTON | NH | 3842 | 2011-01-24 | 226 | G | Q42211 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, records review and review of facility policy and procedure 1.0 NH (Nursing Home) Abuse Prohibition, it was determined the facility failed to implement facility abuse and neglect policies and procedures, in the following areas: Failed to prevent abuse and neglect and misappropriation of funds for 7 out of 20 sampled residents, (Resident identifiers are #3, #5, #6, #10, #11 #13, and #20), and 2 out of sample residents. (Resident identifier includes 1 confidential resident interview, and #31.) Failed to protect residents once an alleged incident occurs for 1 out of 20 sampled residents. (Resident identifier is #11.) Failed to implement reporting procedures both initial (24 hrs) and completed investigation for 6 out of 20 sampled residents, (Resident identifiers are #3, #6, #10, #11,#13, #20), and 2 out of sample residents. (Resident identifiers are #24 and #31.) Failed to investigate allegations of abuse and neglect and misappropriation and injuries of unknown origin, for 4 out of 20 sampled residents, (Resident identifiers are #5, #10, #11, #13), and 1 out of sample resident. (Resident identifier is #24.) Failed to implement training for Abuse and Neglect Policies for 1 out of 5 employee staff files reviewed, Staff identifier is staff DD Findings include: Facility Policy and Procedure entitled " 1.0 NH Abuse Prohibition " Policy, current revision is dated 8/3/09. 5.0 Staff will identify events-such as suspicious bruising of residents, occurrences, patterns, and trends that may constitute abuse- and determine the direction of the investigation. This also includes resident-to-resident abuse. 5.1 Anyone who witnesses an incident of suspected abuse, neglect, exploitation, involuntary seclusion, injuries of unknown origin, or misappropriation of resident property is to tell the abuser to stop immediately and report the incident to his/her supervisor immediately ... 6. Upon receiving information concerning a report of suspected or… | 2014-04-01 | ||
| 2119 | 2119 | OCEANSIDE SKILLED NURSING AND REHABILITATION | 305055 | 22 TUCK ROAD | HAMPTON | NH | 3842 | 2011-01-24 | 490 | F | Q42211 | Based on record review, staff interview and review of the facility policy and procedure it was determined that the facility was not administered in a manner that enables it to provide the highest practical physical well-being of each resident by not ensuring the implementation of plans of action to correct quality deficiencies resulting in the reciting of 10 Federal Regulation Tags. Findings include: As a result of the health certification survey conducted 1/19/11 through 1/24/11 it was determined that the facility has immediate jeopardy with substandard quality of care being identified in the area of Federal tag F323, 483.25 (h) (1) and (2) Accidents and Supervision. As a result of the findings during the present survey conducted 1/19/11 - 1/24/11 and the implementation of corrective action from the 6/22/10 health follow up the following Federal Regulatory tags are being recited: F225, F226, F241, F281, F282, F323, F371, F431, F514 and F520. Cross refer to F323 | 2014-04-01 | ||
| 2120 | 2120 | OCEANSIDE SKILLED NURSING AND REHABILITATION | 305055 | 22 TUCK ROAD | HAMPTON | NH | 3842 | 2011-01-24 | 501 | F | Q42211 | Based on record review, staff interview, review of the facility "Medical Director Consulting Agreement" and review of the facility ' s quality assurance program it was determined that the medical director failed to ensure the implementation of plans of action to correct quality deficiencies resulting in the reciting of 10 Federal Regulation Tags. Findings include: Review of the current Facility "Medical Director Consulting Agreement" dated January 2005, under the section Director/Medical Services' Responsibilities reveals:. ... - 3. Participate in the development of policies, rules and regulations to govern the nursing care and related medical and other health services provided. The Director/Medical Service is responsible for seeing that these policies reflect an aware ness of and provisions for meeting the total needs of the patients. - 4. Ensure that patients receive adequate services appropriate to their needs. .... - 6. Participate in staff meetings, which include ... patient care policies, etc. . ... - 7. Assist in the development and implementation of ...written patient care policies and procedures. .... Interview on 1/22/11 in the afternoon with Staff B (Administrator), Staff D (DON), Staff R (Admissions/CQI (Continuous Quality Improvement) Clerk) during the QA (Quality Assurance) system review, which the facility calls the CQI meeting, revealed that the administration had held CQI quarterly meetings since the last recertification survey of 5/5/10. Staff F (MD/Medical Director) was in attendance. As a result of the findings during the present survey conducted 1/19/11 - 1/24/11 and the implementation of corrective action from the 6/22/10 health follow up the following Federal Regulatory tags are being recited: F225, F226, F241, F281, F282, F323, F371, F431, F514 and F520. Cross refer to F323 | 2014-04-01 | ||
| 2121 | 2121 | OCEANSIDE SKILLED NURSING AND REHABILITATION | 305055 | 22 TUCK ROAD | HAMPTON | NH | 3842 | 2011-01-24 | 151 | D | Q42211 | Based on review of facility generated report and interview the facility failed to allow a resident to exercise their right to use the telephone for 1 resident in a standard survey sample of 20 residents. (Resident identifier is #13.) Findings include: Resident #13 Review of facility generated investigation report dated 12/13/10 reveals that Resident #13 requested to use the telephone during the early morning hours of 12/12/10 and was denied the assistance required by resident to use the phone. Resident did have a telephone at the bedside but required assistance of staff to reach and dial telephone. Staff LL (RN) answered Resident #13's call bell at approximately 7 am on 12/12/10. Resident #13 told Staff LL (RN) that (pronoun omitted) wanted to contact their daughter. Staff member asked if Resident #13 was aware of what time it was. Resident #13 started to cry and asked "Why won't (pronoun omitted) let me call my daughter?". Staff member indicated (pronoun omitted) didn't know if the resident knew what time it was. Staff LL (RN) assisted Resident #13 in contacting daughter. Interview on 1/22/11 at 11:30 a.m. of Staff D (DON) confirmed Resident #13 was delayed in contacting the daughter. Staff D (DON) told surveyor that all nursing staff had been re-educated on resident rights. | 2014-04-01 | ||
| 2122 | 2122 | OCEANSIDE SKILLED NURSING AND REHABILITATION | 305055 | 22 TUCK ROAD | HAMPTON | NH | 3842 | 2011-01-24 | 223 | E | Q42211 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based upon a review of a facility complaint investigation and a staff interview the facility failed to ensure that three residents remained free from verbal and physical abuse.(Resident identifier is #11, #13 and #31). Findings include: Residents #11, #31. On 10/24/10 during the 3-11 shift on the Francouer Unit Staff S RN (Registered Nurse, Charge Nurse), according to a "Report of facility complaint investigation of 10/28/10, noted after being introduced to the other staff on duty that Staff T LNA (Licensed Nursing Assistant) was swearing under their breath and acting annoyed with any resident which needed their assistance, as well as with staff. Also, Staff S's RN written statement of 10/26/10 indicated that Staff T LNA appeared very irritable and was snapping orders at the other LNA's. Staff S RN wrote that Staff T LNA seemed increasingly angry, irritable and was being very harsh in tone and demeanor. Staff S RN asked Staff T LNA what was wrong and Staff T LNA replied that they'd worked a double shift and didn't sleep at all today and now I'm back here. Staff S RN told Staff T LNA to take a break have a cigarette but relax with the residents take it easy. Staff S's RN statement for the facility complaint investigation continued by stating later when people were being put to bed one of the LNA's came to me and said Staff T LNA is flipping people in bed like nothing. Staff S RN asked this unidentified LNA what they meant. This unidentified LNA replied by stating Staff T LNA grabbed an unidentified resident's feet and threw them over into the bed. Staff S RN noted in their statement that they found Staff T LNA and told them to not be so rough with residents. Staff S RN said Staff T LNA then stated don't tell me how to do my job. Staff T LNA remained at the facility in the Francouer Unit for the entire shift. Staff S RN stated that at approximately 9:45 p.m. on 10/24/10 Staff T LNA called Staff S RN to Resident #11's room. Staff T LNA said that… | 2014-04-01 | ||
| 2123 | 2123 | OCEANSIDE SKILLED NURSING AND REHABILITATION | 305055 | 22 TUCK ROAD | HAMPTON | NH | 3842 | 2011-01-24 | 253 | D | Q42211 | Based on observation and interview the facility failed to maintain base of tub and inner tub area in good repair and door frames of resident rooms, resident bathrooms on East wing and tub room door on the Tuck unit free from scrapes and chipped paint. Findings include: Observation of tub room East wing on 1/19/11 at 9:15 a.m. revealed base of tub unit to be cracked and a piece of fiberglass missing. Observation of inner aspect of tub area revealed two locations on the inner aspect of the tub where the tub finish was chipped and porous. Observation of East unit on initial tour of facility on 1/19/11 at 9:15 a.m. revealed all doorways to resident rooms and resident bathrooms on the East wing had multiple areas on both sides of door frame where the paint was chipped. Interview with Staff E (RN, Unit Manager East/West Unit) on 1/19/11 at 9:15 a.m. confirmed the broken area on the base of the tub and the chipped areas on the inner surface of the tub. Staff E also confirmed the chipped areas on the door frames to resident rooms and bathrooms on the East wing. Interview on 1/21/11 at 2 p.m. with Staff B (Administrator) revealed the facility has a quote to renovate the tub room and replace the entire tub unit. The scheduled date of renovation has yet to be determined. Staff B (Administrator) confirmed that the door frames on the East Wing have multiple areas of chipped paint on the room entry door frames as well as the resident room bathroom door frames. Staff B stated the maintenance department has a non project related maintenance schedule for maintaining the facility environment however the facility has had some extensive renovation projects that have delayed the routine maintenance schedule. During a tour of the Tuck Unit on 1/19/11 it was observed that the tub room door was chipped requiring repair. | 2014-04-01 | ||
| 2124 | 2124 | OCEANSIDE SKILLED NURSING AND REHABILITATION | 305055 | 22 TUCK ROAD | HAMPTON | NH | 3842 | 2011-01-24 | 334 | D | Q42211 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview the facility failed to ensure that the medical record includes documentation that the resident received education regarding the benefits and potential side effects of pneumococcal immunization and failed to ensure that the resident had received or did not receive the pneumococcal immunization for 2 residents in a standard survey sample of 20. (Resident identifiers are #9 and #17.) Findings include: Resident #9 Record review on 1/20/11 of Resident #9's medical record revealed that the facility had not determined whether Resident #9 had received the pneumococcal vaccine prior to entering the facility. Resident #9's medical record did not include documentation that the facility had determined if Resident #9 needed to receive education regarding the pneumococcal vaccine and/or receive the pneumococcal vaccine. Interview on 1/20/11 at 3 p.m. of Staff G (RN, Staff Development/Infection Control) confirmed that the record does not contain any documented evidence that Resident #9 received education on the pneumococcal vaccine or that Resident #9 had received the vaccine. Resident #17. Medical record review on 1/22/11 revealed that this resident was originally admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Medical record review revealed no record of the administration of a pneumococcal vaccine for Resident #17. Review of the Immunization section of the Point and Click medical record system for Resident #17 revealed the word, "requested" under the [MEDICATION NAME] column. Review of the facility list of all pneumococcal vaccinations administered to current residents revealed that Resident #17 had the words, "Consent 3/9/10" next to the name indicating that the resident and/or guardian 6 days after admission consented to and requested that the pneumococcal vaccination be given to this resident. Ten months later there is no documented evidence that the vaccine was administered or that education was provi… | 2014-04-01 | ||
| 2125 | 2125 | OCEANSIDE SKILLED NURSING AND REHABILITATION | 305055 | 22 TUCK ROAD | HAMPTON | NH | 3842 | 2011-01-24 | 353 | G | Q42211 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based upon interview with the resident council and review of facility reports the facility failed to provide sufficient staff to meet the needs of the residents.(Resident identifiers include #5, #6 and #13). Findings include: Resident #5 Review of a facility Incident Report dated 1/17/11 reveals that on 1/9/11 at approximately 6:00 a.m, Staff N, LNA heard Resident #5 "yelling for help ". Staff N, LNA ' s written statement indicated that Resident #5 was found by Staff N with their bed in the most upright position with no blankets or sheets on the bed. Staff N, LNA also indicated that Resident #5 was found "drenched in urine with their pants down around their ankles". The facility report also indicated that Resident #5 stated to Staff O, LPN (Licensed Practical Nurse) on 1/9/11 after being cleaned up by Staff N, LNA that "I want something done" and "I should not be treated like that." The facility's investigation determined that Staff P, LNA (Licensed Nursing Assistant) was responsible for the care of Resident #5 during the third shift on the evening of 1/8/11. Staff P LNA, according to the facility ' s investigation, did not respond to repeated facility requests to come in to address this incident and was terminated without providing a statement for the facility investigation. Confidential interview on 1/19/11 reveals that because of a shortage of staff the call bells are not answered in a timely manner and if a resident needs assistance to go to the bathroom the resident may not be able to wait until the staff answers the call bell which causes the resident to have to go to the bathroom in their disposable briefs. This leaves the resident feeling upset and humiliated when this happens. Resident Council meeting conducted on 1/20/11 at 1:30 p.m. was attended by approximately 12 residents. Several residents identified staffing levels being inadequate at times, especially noted during 3-11 shifts, causing delay in answering call lights and toilet… | 2014-04-01 | ||
| 2126 | 2126 | OCEANSIDE SKILLED NURSING AND REHABILITATION | 305055 | 22 TUCK ROAD | HAMPTON | NH | 3842 | 2011-01-24 | 458 | D | Q42211 | Based on observation and interview the facility failed to ensure 80 square feet per resident in a multiple resident bedroom for 1 resident in a standard survey sample of 20. (Resident identifier is #17.) Findings include: Resident # 17 Observation on tour on 1/19/11 at 9:15 a.m. revealed the space allocated to Resident #17 was not 80 square feet. Interview of Staff D (DON) on 1/22/11 at 11 a.m. concerning surveyor observation of allocated square footage for Resident #17 revealed the space allocated to Resident #17 appeared to be less than the required 80 square feet per resident in a multiple resident bedroom. Staff D was requested by surveyor to have the space measured by facility maintenance personnel. Staff K (Corporate Maintenance) measured space for Resident #17 and space was found to be 60 square feet. Interview of Staff K (Corporate Maintenance) on 1/22/11 at 1:30 p.m. confirmed the allocated square footage for Resident # 17 is 60 square feet. | 2014-04-01 | ||
| 2127 | 2127 | OCEANSIDE SKILLED NURSING AND REHABILITATION | 305055 | 22 TUCK ROAD | HAMPTON | NH | 3842 | 2011-01-24 | 174 | D | Q42211 | Based on review of facility generated report and interview the facility failed to allow a resident reasonable access to the use of a telephone for 1 resident in a standard survey sample of 20. (Resident identifier is #13.) Findings include: Resident #13 Review of facility generated investigation report reveals that Resident #13 requested to use the telephone during the early morning hours of 12/12/10 and was denied access to call her daughter. Resident did have a telephone at her bedside but required assistance of staff to reach and dial telephone. Interview of Staff D (DON) confirmed Resident #13 was delayed in contacting her daughter and that nursing staff had been re-educated on resident rights. | 2014-04-01 | ||
| 2128 | 2128 | OCEANSIDE SKILLED NURSING AND REHABILITATION | 305055 | 22 TUCK ROAD | HAMPTON | NH | 3842 | 2011-01-24 | 520 | F | Q42211 | Based on record review, interview and review of the facility's quality assurance program it was determined that the facility failed to maintain the implementation of plans of action to correct quality deficiencies resulting in the reciting of 10 Federal Regulation Tags. Findings include: Interview on 1/22/11 in the afternoon with Staff B (Administrator), Staff D (DON), and Staff R (Admissions/CQI (Continuous Quality Improvement) Clerk) during the QA (Quality Assurance) system review, which the facility calls the CQI meeting, revealed that the administration had held CQI quarterly meetings since the last recertification survey of 5/5/10. As a result of the findings during the present survey of 1/24/11 and the implementation of corrective action from the 6/22/10 health follow up survey the following Federal Regulatory tags are being recited: F225, F226, F241, F281, F282, F323, F371, F431, F514, and F520. | 2014-04-01 | ||
| 2129 | 2129 | OCEANSIDE SKILLED NURSING AND REHABILITATION | 305055 | 22 TUCK ROAD | HAMPTON | NH | 3842 | 2011-01-24 | 157 | D | Q42211 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview the facility failed to notify a change in medication for 1 resident in survey sample of 20. (Resident identifier is #14.) Findings Include: Review of Resident #14's medical record on 1/22/11 reveals that Resident #14 was admitted to the facility from the hospital on [DATE]. Review of the facility's admission MAR (medication administration record) dated 11/9/10 through 11/30/10 reveals an order for [REDACTED]. There is no documented evidence in the medical record to indicate that the DPOA was notified of the physician's orders [REDACTED]. | 2014-04-01 | ||
| 2130 | 2130 | OCEANSIDE SKILLED NURSING AND REHABILITATION | 305055 | 22 TUCK ROAD | HAMPTON | NH | 3842 | 2011-01-24 | 241 | G | Q42211 | Based upon a review of a facility report and a confidential interview the facility failed to care for a resident in a manner which promoted their dignity. (Resident identifier is #5) Findings include: Resident #5 Review of the Resident/Patient Incident Report of 1/9/11 reveals at approximately 6:00 a.m., according to the facility investigation, Resident #5 was heard by Staff N LNA(Licensed Nursing Assistant) yelling for help. Staff N's LNA written statement of 1/9/11 noted finding Resident #5 drenched in urine no sheets on the bed or any blankets on the bed. Staff N LNA continued by stating Resident #5's pants were down around their ankles. Staff N LNA also noted that Resident #5's bed was found in its most upright position. Resident #5, according to the facility's investigation, and stated to Staff O LPN on 1/9/11 after being cleaned up by Staff N LNA that I want something done and I should not be treated like that. The facility investigation determined that Staff P LNA was responsible for Resident #5's care during the third shift on the evening of 1/8/11. Staff P LNA, according to the facility complaint investigation, did not respond to repeated facility requests to come in to address this incident and was terminated without providing a statement for the facility investigation. A Confidential Resident interview on 1/19/11 revealed that this resident requires assistance in being toileted. This resident stated that staff, because of a shortage of available help, routinely fails to timely answer the call bells resulting in them having to go to the bathroom in their diaper. The resident stated that this was upsetting and felt humiliated when this occurred. | 2014-04-01 | ||
| 2131 | 2131 | BEDFORD HILLS CENTER | 305060 | 30 COLBY COURT | BEDFORD | NH | 3110 | 2011-02-17 | 281 | E | BGE911 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, and interview it was determined that the facility failed to follow the professional standard of practice for following a physician's orders [REDACTED].#19, and Resident #20), and failed to follow the professional standard of practice for the administration, documentation, clarification, and transcription of medications for 8 residents in a standard survey sample of 24 residents. (Resident identifiers are #2, #6, #9, #13, #14, #15, #19 and #20.) Findings include: Review of "Fundamentals of Nursing," Patricia A. Potter and Anne Griffin Perry, Mosby, 2009, 7th Edition, revealed the following: On page 336- Physicians' Orders states, "The physician is responsible for directing medical treatment. Nurses follow physician's orders [REDACTED]. Therefore you need to assess all orders, and if you find one to be erroneous or harmful, further clarification from the physician is necessary..." On pages 699-714 "... The prescriber must document the diagnosis, condition, or need for use for each medication ordered...The prescriber often gives specific instructions about when to administer a medication." ...This reference also relates on page 713 that "....a registered nurse compares the list of medications on the MAR against the original orders for accuracy and thoroughness." and "....After administering a medication, the nurse records it immediately on the appropriate record form..." On page 713, under medication administration standard for Recording Medication Administration, "After administering a medication, record it immediately on the appropriate record form ...Recording immediately after administration prevents errors...." "If a client refuses a medication or is undergoing tests or procedures that result in a missed dose, the nurse explains the reason the medication was not given in the nurse's notes." Resident #6. Record review for Resident #6 was conducted 2/15/11 - 2/17/11. Review of this resident's Medication Ad… | 2014-04-01 | ||
| 2132 | 2132 | BEDFORD HILLS CENTER | 305060 | 30 COLBY COURT | BEDFORD | NH | 3110 | 2011-02-17 | 514 | E | BGE911 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation and staff interview the facility failed to maintain an accurately documented medical record for 7 of 24 residents in a standard survey sample. (Resident identifiers are #2, #6, #12, #13, #14, #19 and #20.) Findings include: Resident #14 Record review for Resident #14 was conducted 2/1511 - 2/16/11. Review of the Physician order [REDACTED].#14, reveals an order written [REDACTED].: If first step negative, repeat in 7 days." Review of the Medication Administration Record (MAR)for Resident #14 dated 2/1/11 - 2/16/11 reveals an order written [REDACTED]." The original physician order [REDACTED]. No documented evidence was found that either the original physician order [REDACTED]. Further review of the MAR dated 2/1/11-2/16/11 for Resident #14 reveals an order written [REDACTED]." Handwritten in by an unidentified person is "x 14 days (for/times 14 days)". Review of the POS for Resident #14 entitled "All Active Orders for February 2011" reveals an order signed by the physician on 2/7/11 which reads "[MEDICATION NAME] HCL 12.5 mg tablet by mouth (oral) - PRN,: give 12.5 mg po (by mouth) or IM q 6 hrs prn for nausea and vomiting." No documented evidence was found in the medical record that these orders were clarified with the physician regarding the tablet form being given IM. The order transcribed to the MAR does not match the physician order [REDACTED]. Resident #2 Record review for Resident #2 was conducted 2/15/11. Review of the Physician order [REDACTED].#2, reveals an order written [REDACTED].= 1 gram PO QD." Review of the Medication Administration Record for Resident #2 dated 2/1/11 - 2/15/11 reveals an order written [REDACTED]." The order transcribed to the MAR does not match the original physician order [REDACTED]. Review of the Physician order [REDACTED].#2, reveals an order written [REDACTED].), [MEDICATION NAME] - 40 mg tablet by mouth (oral) - hs Everyday, 2000 po @ qd." The order transcribed t… | 2014-04-01 | ||
| 2133 | 2133 | BEDFORD HILLS CENTER | 305060 | 30 COLBY COURT | BEDFORD | NH | 3110 | 2011-02-17 | 157 | D | BGE911 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, and interview it was determined that the facility failed to notify a physician when an alteration in treatment needed to be reported for 1 resident in a survey sample of 24 residents. (Resident identifier is #6.) Findings include: Resident #6. Review of the February 2011 MAR for this resident revealed a physician's orders [REDACTED]. HOLD IF SBP < (less than) 100 AND CALL MD (physician)." The MAR indicated [REDACTED]. SBP's for above dates were all under 100 for 8 days. Review of the physician's progress notes and nurses notes revealed no documentation that the physician had been notified. In an Interview with Staff D (med nurse) on 2/16/11 during medication pass Staff D stated that Resident # 6's SBP had been under 100 for a week. Staff D also stated that the physician had not been notified. The physician was notified during the survey. Staff C (Unit Manager) on 2/16/11 in the morning confirmed the above findings. | 2014-04-01 | ||
| 2134 | 2134 | BEDFORD HILLS CENTER | 305060 | 30 COLBY COURT | BEDFORD | NH | 3110 | 2011-02-17 | 425 | D | BGE911 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observation, and interview it was determined that the facility failed to provide pharmaceutical services to assure the accurate acquiring, receiving, dispensing, and administering of a non-crushable medication to 1 resident in a survey sample of 24 residents. (Resident identifier is Resident #6.) Findings include: Standard: Nursing Spectrum Drug Handbook 2009. ? 2009 by The McGraw-Hill Companies, Inc. "Administration ... Give P.O. form at least 1 hour before or 2 hours after meals. To enhance absorption, don't give with other drugs. Give delayed-released tablets whole. Don't let patient crush or chew them. Know that pharmacist should mix oral solution before dispensing." "Be aware that drug is teratogenic. Avoid inhaling powder in capsules or letting powder contact skin, mucous membranes, or eyes. If contact occurs, wash skin thoroughly with soap and water or flush eyes with water.Know that delayed-release tablets aren't interchangeable with immediate-release tablets, capsules, or oral suspension." Resident #6. Record review for Resident #6 was conducted 2/15/11 - 2/17/11. Review of the facility Physician order [REDACTED]." Review of this resident's Medication Administration Record [MEDICATION ADMINISTRATION RECORD DETAILS REDACTED]." Observation on 2/16/11 at 8 a.m. during the medication pass revealed a "bingo style" medication administration card for "MYCOPHENOLATE MOFETIL (Cellcept) 500 MG TABLET 1 tab via G- Tube twice a day..." Observation revealed a pharmacy warning label that read, "Medication has boxed warning; Don't chew/crush- swallow whole... " The card had 4 pills missing. On 2/16/11 at the time of the observation with Staff D (Medication Nurse) the MAR indicated [REDACTED]. Interview with Staff D revealed that staff had been crushing the above medication but Staff D had not noticed the warning. Staff D stated that this resident was on the liquid version of this medication at one time. Staff D did not crush… | 2014-04-01 | ||
| 2135 | 2135 | BEDFORD HILLS CENTER | 305060 | 30 COLBY COURT | BEDFORD | NH | 3110 | 2011-02-17 | 465 | D | BGE911 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observation, and interview it was determined that the facility failed to provide a safe environment for residents and staff regarding the handling of a non-crushable medication for 1 resident in a survey sample of 24 residents. (Resident identifier is Resident #6.) Findings include: Standard: Mosby's Medical Dictionary, 8th edition. ? 2009, Elsevier. "[MEDICATION NAME], an immunosuppressant used to prevent rejection of allogeneic cardiac, hepatic, and renal transplants. It is administered orally or intravenously." "indications It is used to prevent rejection of organ transplants and for [MEDICATION NAME] of organ rejection in allogenic cardiac transplants. contraindications Known hypersensitivity to this drug or to [MEDICATION NAME] acid prohibits its use. adverse effects Life-threatening effects are leukopenia, [MEDICAL CONDITIONS], pancytopenia, renal tubular necrosis, and [MEDICAL CONDITION]. Other adverse effects are arthralgia, muscle wasting, and stomatitis. Common side effects are diarrhea, constipation, nausea, vomiting, rash, dyspnea, respiratory infection, increased cough, pharyngitis, [MEDICAL CONDITION], pneumonia, tremor, dizziness, [MEDICAL CONDITION], headache, fever, peripheral [MEDICAL CONDITIONS], [MEDICATION NAME], [MEDICAL CONDITIONS], hypokalemia, [MEDICAL CONDITION], urinary tract infection, hematuria, hypertension, chest pain, and nonmelanoma skin [MEDICAL CONDITION]." Nursing Spectrum Drug Handbook 2009. ? 2009 by The McGraw-Hill Companies, Inc. "Administration ... Give P.O. form at least 1 hour before or 2 hours after meals. To enhance absorption, don't give with other drugs. Give delayed-released tablets whole. Don't let patient crush or chew them. Know that pharmacist should mix oral solution before dispensing." "Be aware that drug is teratogenic. Avoid inhaling powder in capsules or letting powder contact skin, mucous membranes, or eyes. If contact occurs, wash skin thoroughly with soap and … | 2014-04-01 | ||
| 2136 | 2136 | APPLEWOOD CENTER | 305065 | 8 SNOW ROAD | WINCHESTER | NH | 3470 | 2010-12-13 | 309 | J | 0NGB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview the facility failed to ensure that it provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being for a diabetic resident with a non-pressure related wound resulting in the amputation of a toe. (Resident identifier is #1.) Findings include: Review on 12/13/10, of Resident #1 ' s medical record reveals, Resident #1 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Review of Resident #1's physician ' s progress notes reveals the following: 7/16/10 Resident has [MEDICAL CONDITION]. Has diabetic [MEDICAL CONDITION]. Sees podiatrist ... regularly. There is 2+ readily [MEDICAL CONDITION] present at both shins. Plantar pain, left foot. Perhaps marked [MEDICAL CONDITION] is playing a roll. Podiatrist (Md name omitted) is being consulted. Compression stockings to be tried once Ace wraps and [MEDICATION NAME] have brought the [MEDICAL CONDITION] under some degree of control. 8/3/10 Resident is getting regular podiatry follow-up. Has diabetic [MEDICAL CONDITION], but also has had Achilles tendonitis and corns. Review of Resident #1's podiatry note dated 9/14/10, indicates the following The resident returned to the podiatrist office and was " complaining of a very painful right fifth toe. The resident reported to the podiatrist that the resident could not stand anything to touch the toe. The resident had been wearing the compression stockings and had been wearing slippers and not regular shoes. Chronic leg [MEDICAL CONDITION] and diabetic [MEDICAL CONDITION]. Has on going problems with corns of the toes. The right fifth toe has [DIAGNOSES REDACTED] (corn/callous), which is removed to reveal an underlying ulceration over the right fifth toe proximal interphalangeal joint. The wound was gently and minimally debrided. Iodosorb and a dry dressing were applied on the toe and the nursing facility will start Iodosorb and a dry dressing da… | 2014-04-01 | ||
| 2137 | 2137 | APPLEWOOD CENTER | 305065 | 8 SNOW ROAD | WINCHESTER | NH | 3470 | 2010-12-13 | 224 | J | 0NGB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview the facility failed to ensure that it implements policies and procedures to prohibit the neglect of residents requiring wound and pressure ulcer care management that resulted in a toe amputation, for 2 residents. (Resident idnetifiers are: #1 and #2.) Findings include: On 12/13/2010, review on of the facility ' s " Skin Care & Pressure Ulcer Management Program " policy and procedure, dated January 2008, reveals " Section 1: Assessment: Identifying Residents at Risk of Skin Breakdowns " " When a Resident Arrives, the licensed nurse reviews the preadmission screen and completes a head-to-toe assessment, documenting findings on the Nursing Assessment. This process provides the team with an accurate description of the resident ' s actual skin condition. If the resident has a pressure or other wounds at the time of admission, treatment begins promptly in accordance with physician orders. The licensed nurse continues the evaluation process to determine the risk of additional skin breakdown, evaluates rehabilitation and nutritional needs, and prepares a plan of care of the existing condition and prevention of additional skin breakdown. " " Using Standardized Tools to Evaluate Risk of Skin Breakdown. After examining a resident ' s current skin condition, the next step is to evaluate the resident ' s likelihood for future skin breakdown. Evaluating risk is an important step, because once it is determined who may be at risk of developing pressure ulcers, the team may attempt to prevent them. The licensed nurse completes the Norton Plus Pressure Ulcer Scale. " - "SECTION 2 PLANNING, IMPLEMENTATION, AND EVALUATION : CARE PLANNING APIE ... - Putting the Plan Into Action ... - Once the Care Plan is written, it is important to be vigilant. Licensed nurses, nursing assistants, and the entire interdisciplinary team must ensure that all planned interventions and treatments are carried out as written in the Care Plan ... - W… | 2014-04-01 | ||
| 2138 | 2138 | APPLEWOOD CENTER | 305065 | 8 SNOW ROAD | WINCHESTER | NH | 3470 | 2010-12-13 | 282 | G | 0NGB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview it was determined that the facility failed to ensure the implementation of the care plan for 2 of 2 residents. (Resident identifiers are #1 and #2.) Findings include: Review of Resident #1's Skin Integrity care plan with an initial date of 9/24/10 reveals under the "Interventions" column, Administer treatment as ordered. Change Dressing as per order, Observe skin tear for signs/symptoms of infection (redness, warmth, [MEDICAL CONDITION], pain/tenderness, drainage). Notify MD if present. Preventative measures as ordered. Antibiotics per MD order. Review of the weekly Skin Assessment section on the October 2010 TAR indicated that on October 1, 8, 15, 22 and 29th the resident had a head to toe skin assessment performed by a nurse. On each of the above skin assessment dates, there was a Y (Yes) written and the nurse ' s initials. Review of the November 2010, TAR revealed that a skin assessment was performed on November 3, 10,17 and 24. All 4 skin assessments has a Y indicating that resident #1 ' s skin is intact and has no breakdown. Review of Resident #1's 12/2/10 podiatry note reveals the following: " Subjective, resident returns to the office with family member for follow up of ulceration right fifth toe. Resident states that the toe hurts. " Objective: The right fifth toe appears swollen. There is ulceration to the plantar fifth toe sulcus at the metatarsal phalangeal joint that extends to the bone. The bone is visible. The tendon is dry. There is significant malodor and drainage. There is tube foam dressing over the toe, which is deeply adhered plantarly to the bone and tendon. The joint is involved. The foot is moderately swollen compared to the other foot. Radiographs do show osteopenic bone right foot with air pocket and what appears to be erosive change at the metatarsal head." "Assessment: Probable osteo[DIAGNOSES REDACTED] with abscess right foot. Plan: X-rays ordered today, right foot. Discussion w… | 2014-04-01 | ||
| 2139 | 2139 | APPLEWOOD CENTER | 305065 | 8 SNOW ROAD | WINCHESTER | NH | 3470 | 2010-12-13 | 272 | D | 0NGB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** The facility failed to assess one diabetic residents foot for 2 months resulting in a toe amputation. The facility also failed to assess the foot of one resident with a history of skin breakdown resulting in a toe amputation. (Resident identifiers are #1 and #2.) Findings include: Review of Resident #1's medical record on 12/13/10 reveals podiatry notes dated 9/14/10, The resident returned to the podiatrist office and was " complaining of a very painful right fifth toe." The resident reported to the podiatrist that the resident could not stand anything to touch the toe. The resident had been wearing the compression stockings and had been wearing slippers and not regular shoes. Continued review of the podiatry note reveals " Objective: The right fifth toe extending along the right fifth rays are [DIAGNOSES REDACTED]tous with mild increase in warmth. There is hyperkeratoses (corn/callous), which is removed to reveal an underlying ulceration over the right fifth toe proximal interphalangeal joint. It does not track into the joint. It is 2 mm in diameter. There is scant amount of serous fluid within the ulceration itself. The base of the ulceration is pale." " Assessment: [MEDICAL CONDITION] right fifth toe and foot, hammer toe deformity, ulceration right fifth toe. " " Plan: The wound was gently and minimally debrided. Iodosorb and a dry dressing were applied on the toe and the nursing facility will start Iodosorb and a dry dressing daily." Resident and family member instructed to return to podiatrist for follow up appointment in two weeks. Review of the facility ' s Treatment Administration Record (TAR) for the month of September 2010, reveals that the above podiatry orders were transcribed on to the TAR and signed off by the facility nursing staff starting on 9/30/10 indicating that the orders had been carried out as ordered. Review of the podiatry notes dated 9/28/10 reveals: Resident "returned to office today for ulceration right foot with a… | 2014-04-01 | ||
| 2140 | 2140 | APPLEWOOD CENTER | 305065 | 8 SNOW ROAD | WINCHESTER | NH | 3470 | 2010-12-13 | 157 | D | 0NGB11 | Based on record review and interview it was determined that the facility failed to consult the physician of a change in condition for 1 resident. (Resident identifier is #2.) Findings include: Resident #2. Record review on 12/13/10 revealed no documented evidence that the physician was consulted of a change in skin condition for Resident #2 from 7/30/10 through 9/21/10 for a total of 52 days. Review of the facility "Pressure Ulcer Documentation Form" for Resident #2 dated "9/21" revealed a Stage 2 pressure ulcer on the right 5 th metatarsal. During interview with Staff A (Administrator) and Staff B (Director of Nursing) on 12/13/10 at approximately 1:15 p.m. after both Staff A & B reviewed the above listed findings for Resident #2, Staff A and Staff B confirmed that there was no documented evidence to show that the physician had been notified of a Stage 2 pressure ulcer on the right 5th metatarsal for Resident #2 and no documented evidence of the identification, assessment, monitoring and evaluation of a right 5th metatarsal pressure ulcer prior to 9/21/10. Staff A & Staff B further confirmed that Resident #2 required a surgical intervention with the amputation of the right 5 th metatarsal on 9/29/10 due to the pressure ulcer. | 2014-04-01 | ||
| 2141 | 2141 | APPLEWOOD CENTER | 305065 | 8 SNOW ROAD | WINCHESTER | NH | 3470 | 2010-12-13 | 281 | D | 0NGB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview during a complaint investigation the facility failed to meet professional standards of practice for 2 residents resulting in toe amputation. (Resident Identifiers are #1 and #2) Findings Include: The Potter-Perry, 2009, Fundamentals of Nursing 7th Edition, St. Louis, Missouri: Mosby, Chapter 23 Legal Implications in Nursing Practice, on page 336- Physicians' Orders states, "The physician is responsible for directing medical treatment. Nurses follow physician's order [REDACTED]. Therefore you need to assess all orders, and if you find one to be erroneous or harmful, further clarification from the physician is necessary..." The Potter-Perry, 2009, Fundamentals of Nursing 7th Edition, St. Louis, Missouri: Mosby Chapter 35 Medication Administration-Recording Medication Administration on page 713 states, Administrating a medication, record it immediately on the appropriate record form. Never chart a medication before administrating it. Recording immediately after administration prevents errors. The recording of a medication includes the name of the medication, dose, route, and exact time of administration. Record the site of any injections per agency policy. " " If a client refuses a medication or is undergoing tests or procedures that results in a missed dose, explain the reason the medication was not given in the nurse ' s notes. Some agencies require the nurse to circle the prescribed administration time on the medication record or to notify the physician when a client misses a dose. " The Facility follows " Preparing for Medication Administration " procedure, which indicates initialed and circled medications are " Dose not given " Review of Resident #1 ' s record on 12/13/10, revealed a physician order [REDACTED]. Review revealed no documented evidence on the Treatment Administration Record (TAR) that the nursing staff completed the ordered procedure on the dates of, 10/1/10, 10/9/0, 10/10/10, 10/11/10, 10/… | 2014-04-01 | ||
| 2142 | 2142 | APPLEWOOD CENTER | 305065 | 8 SNOW ROAD | WINCHESTER | NH | 3470 | 2010-12-13 | 314 | J | 0NGB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interview and review of the facility policy and procedure it was determined that the facility failed to ensure that a resident who has a pressure sores receives necessary treatment and services to promote healing and prevent infection that required the amputation of a toe for 1 resident. (Resident identifier is #2.) Findings include: Review of the facility policy and procedure on 12/13/10 titled "SKIN CARE & PRESSURE ULCER MANAGEMENT PROGRAM" dated "January 2008" revealed the following: - "SECTION 2 PLANNING, IMPLEMENTATION, AND EVALUATION: CARE PLANNING APIE... - Putting the Plan Into Action... - Once the Care Plan is written, it is important to be vigilant. Licensed nurses, nursing assistants, and the entire interdisciplinary team must ensure that all planned interventions and treatments are carried out as written in the Care Plan... - Weekly Evaluation - A licensed nurse performs head-to-toe skin check of the resident and documents the findings on the Treatment Administration Record (TAR). The licensed nurse documents using the following notations: 'Y' = skin intact 'N' = not intact - If a licensed nurse documents "N," the licensed nurse writes a note in the narrative section of the TAR describing the area. If skin integrity is comprised, the process moves into the wound management phase, the physician/responsible party is notified, and the care plan is updated with appropriate interventions. - SECTION 4: EVALUATION: EVALUATING OUTCOMES - Clinical Weekly Report - On a weekly basis, the director of nursing service (DNS) gathers information from the center daily report that may also be addressed in the C.A.R.E. process, including: pressure ulcers, acquired pressure ulcers, worsening pressure ulcers, unplanned weight loss, falls, restraints, antipsychotic drugs, hypnotics, new infections, precautions, and other clinical concerns. The purpose of this report is to identify and document actions planned or taken to effect … | 2014-04-01 | ||
| 2143 | 2143 | APPLEWOOD CENTER | 305065 | 8 SNOW ROAD | WINCHESTER | NH | 3470 | 2010-12-13 | 514 | D | 0NGB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview it was determined that the facility failed to ensure that the medical record is complete and accurate for 2 residents. (Resident identifiers are #1 and #2.) Findings include: Resident #1 Review of the Podiatry order sheet sent to the facility dated 9/28/10, reveals the following orders, D/C (Discharge) Wound Care R (right) 5th toe. Begin foam sleeve over toe daily (R (right) 5th toe). Return to compression stocking R (right) leg. Return to shoes. F/U (follow up) in 2 months. Review of Resident #1's October 10 TAR (Treatment Administration Record) reveals the order " Apply foam sleeve to right 5th toe daily " there are no nursing initials to indicate that the physician's order [REDACTED]. The following dates had nursing initials circled which indicated that the treatment was not completed on October 3,5,6,and 16, 2010. The October 2010 TAR also reveals the physician's order [REDACTED]. were put on October 8, AM, 10 AM and PM, 18 PM, 27, 28,29 in AM. The weekly Skin Assessment section on the October 2010 TAR indicated that on October 1, 8, 15, 22 and 29th the resident had a head to toe skin assessment performed by a nurse. On each of the above skin assessment dates, there was a Y (Yes) written and the nurse ' s initials which indicates the resident ' s skin is intact Review of Resident #1's November 2010, TAR reveals the order to apply the foam sleeve to right 5th toe daily. On November 14 and 23 there TAR was blank which indicates that the treatment was not done. The order for Compression stockings on in the AM and off in the PM was also not signed off on November 4 in PM and the 23 in the AM. The November 2010, TAR also indicates that a skin assessment was performed on November 3, 10,17 and 24. All 4 skin assessments has a Y indicating that resident #1 ' s skin is intact and has no breakdown. Review of Resident #1's podiatry note dated 12/2/10 indicates Resident #1 returns to the office with family member … | 2014-04-01 | ||
| 2144 | 2144 | APPLEWOOD CENTER | 305065 | 8 SNOW ROAD | WINCHESTER | NH | 3470 | 2010-12-13 | 501 | D | 0NGB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, review of facility policy and procedure and interviews the medical director failed to ensure the implementation of resident care policies related to Skin Management that resulted in 2 residents receiving a toe amputation. (Resident identifiers are #1 and #2.) Findings include: Review of Resident #1's medical record on 12/13/10 revealed that Resident #1 had a healed ulceration on the right 5th toe on 9/28/10. Review of the Podiatry order sheet sent to the facility dated 9/28/10, reveals the following orders, D/C (Discharge) Wound Care R (right) 5th toe. Begin foam sleeve over toe daily (R (right) 5th toe). Return to compression stocking R (right) leg. Return to shoes. F/U (follow up) in 2 months. Review of the October 2010 TAR reveals the order "Apply foam sleeve to right 5th toe daily "there are no nursing initials to indicate that the physician's orders [REDACTED]. The following dates had nursing initials circled which indicated that the treatment was not completed on October 3,5,6,and 16, 2010. Review of the weekly Skin Assessment section on the October 2010 TAR indicated that on October 1, 8, 15, 22 and 29th the resident had a head to toe skin assessment performed by a nurse. On each of the above skin assessment dates, there was a Y (Yes) written and the nurse ' s initials. Review of the November 2010, TAR reveals the order to apply the foam sleeve to right 5th toe daily. On November 14 and 23 there TAR was blank which indicates that the treatment was not done. Review of the November 2010, TAR revealed that a skin assessment was performed on November 3, 10,17 and 24. All 4 skin assessments has a Y indicating that resident #1 ' s skin is intact and has no breakdown. Review of the 12/2/10 podiatry note reveals the following: " Subjective, resident returns to the office with family member for follow up of ulceration right fifth toe. Resident states that the toe hurts. " Objective: The right fifth toe appears swollen. T… | 2014-04-01 | ||
| 2145 | 2145 | APPLEWOOD CENTER | 305065 | 8 SNOW ROAD | WINCHESTER | NH | 3470 | 2010-12-13 | 490 | G | 0NGB11 | Based on the investigation survey conducted 12/1310 it was determined that the facility was not administered in a manner that enables it to provide the highest practicable physical and psychosocial well-being of each resident. Findings include: As a result of the investigation survey it was determined that the facility has immediate jeopardy with substandard quality of care being identified in the area of resident behavior and facility practices 42 CFR 483.13(c) and in the areas of quality of care 42 CFR 483.25 and 42 CFR 483.25(c) Cross refer to F224, F309 and F314. | 2014-04-01 | ||
| 2146 | 2146 | THE ELMS CENTER | 305068 | 71 ELM STREET | MILFORD | NH | 3055 | 2011-01-20 | 224 | D | G9EW11 | This finding was facility reported and investigated during their Annual survey . Based on record review and interview with Staff C (Administrator) it was found that the facility failed to ensure that 1 of 1 resident in a survey sample of 13 was not neglected, by failing to provide services that are necessary to promote skin integrity. (Resident identifier is #13.) Findings include: Resident #13. During interview with Staff C and on review of the facility's investigation report dated 11/18/10 which states that on 11/11/10 at approximately 1:30 p.m., the staff were doing rounds on the east wing when Resident #13 told staff that she had not been cared for the whole shift. The investigation report provided by the facility states that Resident #13 was found by two LNA's in bed without heel protectors on feet and bed cradle not on bed which were interventions for impaired skin integrity identified on care plan dated 1/4/10. The investigation report goes on to say patient had red marks on the inside of her legs by her knees from rubbing together-she had the same night gown on from the previous day. Cross refer to Tag F 226 | 2014-04-01 | ||
| 2147 | 2147 | THE ELMS CENTER | 305068 | 71 ELM STREET | MILFORD | NH | 3055 | 2011-01-20 | 225 | D | G9EW11 | This finding was facility reported and investigated during there Annual survey. Based on record review and interview with the Staff C (Administrator) it was found that the facility staff failed to report an alleged violation of neglect immediately to the administrator for 1 of 1 resident in a survey sample of 13. (Resident identifier is #13.) Findings include: During review of the incident which occurred on 11/11/10, which was provided to us by the facility, failed to be reported to the state until 11/18/10. Interview with Staff C (Administrator) confirmed that the two LNA's who found Resident #13 neglected on 11/11/10 failed to report what had happened until 11/18/10. Staff C continued to state, once the two LNA's informed the facility what occurred the employee was immediately suspended and later on terminated on 11/19/10. | 2014-04-01 | ||
| 2148 | 2148 | THE ELMS CENTER | 305068 | 71 ELM STREET | MILFORD | NH | 3055 | 2011-01-20 | 226 | D | G9EW11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** This finding was facility reported and investigated during there Annual survey . Based on record review and interview with the Staff C (Administrator) it was found that the facility failed assure that employees adhere to policies and procedures for timely reporting of allegations of abuse, neglect or mistreatment of [REDACTED]. (Resident identifier is #13.) Findings include: Resident #13. During interview with Staff C and on review of the facility's investigation report dated 11/18/10 which states that on 11/11/10 at approximally 1:30 p.m., the staff were doing rounds on the east wing when Resident #13 told staff that she had not been cared for the whole shift. The investigation states that Resident #13 was found by two LNA's in bed without heel protectors on feet and bed cradle not on bed which were skin integrity interventions that were part of the plan of care for this resident from care plan dated 1/4/10. The investigation report goes on to say patient had red marks on the inside of her legs by her knees from rubbing together-she had the same night gown on from the previous day. | 2014-04-01 | ||
| 2149 | 2149 | THE ELMS CENTER | 305068 | 71 ELM STREET | MILFORD | NH | 3055 | 2011-01-20 | 281 | D | G9EW11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, observation and record review the facility failed to ensure that professional standards of practice were followed for carrying out physician orders [REDACTED]. (Resident identifiers are #2, #12, and #13.) Standards: Review of "Fundamentals of Nursing," Patricia A. Potter and Anne Griffin Perry, Mosby, 2009, 7th Edition, revealed the following: On page 336- Physicians' Orders states, "The physician is responsible for directing medical treatment. Nurses follow physician's order [REDACTED]. Findings include: Resident #12 Review of the medical record for Resident #12 on 1/20/11 identified that they had been admitted to the facility with a [DIAGNOSES REDACTED]. Review of the Physicians order section of the medical record for Resident #12 identified an order dated 1/26/10 "May have helmet off when in bed". Resident was transferred to another facility via ambulance for a surgical procedure on 11/15/10, review of the record showed no documented evidence that the resident had her protective helmet on for the ambulance transfer. Interview with Staff C (Administrator) on 1/20/11 confirmed the above findings. Resident #2 Uni Care Health Services Intravenous Therapy Policies and Procedures. Procedure: Catheter Dressing Change: #17 Measure and document any length of catheter exposed from the insertion site. NOTE: This monitors for catheter migration. On 1/11/11 Resident #2 was readmitted back to the facility from the hospital. While in the hospital a Physician order [REDACTED].#2. After insertion of the line into Resident #2 the hospital medical record shows that the external length is (0cms) and the line is secured. Once Resident #2 was admitted back to the facility on [DATE] the external measure for this catheter was 5.5 cm. Once this finding was made Staff A (ADON) and surveyor went to observe Resident #2's PICC line on 1/19/11 which shows the external length of the line is at zero. Staff A stated that the staff will have to be retra… | 2014-04-01 | ||
| 2150 | 2150 | THE ELMS CENTER | 305068 | 71 ELM STREET | MILFORD | NH | 3055 | 2011-01-20 | 514 | D | G9EW11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, investigation review and interview with Staff it was found that the facility failed to accurately document treatment for 2 of 13 residents in the standard survey sample and failed to accurately date 4 of 4 Blood Glucose Monitoring Quality Control Log tracking sheets. (Resident identifiers are #2 and #13.) Findings include: Resident #2 During review of the medical record it was found that Resident #2 was admitted with a PICC (Peripheral Inserted Central Catheter). On review of the hospital transfer sheet it shows that the PICC is 37 cms Long and the external length of the line is zero on 1/11/11. On review of the facility's MAR indicated [REDACTED]. Once this finding was made Staff A (ADON) and surveyor went to observe Resident #2's PICC line on 1/19/11 which shows the line to be at zero. Resident #13 Due to a facility generated complaint on 11/18/10 it was confirmed that Staff B (LNA) failed to provide care during the day shift to Resident #13 on 1/11/10. On review of the LNA care sheet called "Resident Functional Performance Record" Staff B singed off that all services were provided to Resident #13 during this shift. Due to this documentation Staff B falsified medical records. Review of 4 of 4 of the January 2011 (East wing low range and high range and West wing low range and high range) Blood Glucose Monitoring Quality Control Log (Machine Calibration) tracking sheets, dated 1/1/11 through 1/20/11, reveals that several dates have been overwritten, many are illegible and that the numerical date sequence is not consistent (ie. not 1-20). A count of the number of lines utilized reveals only 19 lines have been used to record 20 days of glucometer machine calibration for each of these four pages. | 2014-04-01 | ||
| 2151 | 2151 | COUNTRY VILLAGE CENTER, GENESIS HEALTHCARE | 305076 | 91 COUNTRY VILLAGE ROAD | LANCASTER | NH | 3584 | 2010-10-14 | 221 | D | CHI411 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review it was determined that the facility failed to recognize the use of a broda chair as a restraint for 1 of 16 sampled residents in the standard survey sample. (Resident identifier is #7). Findings include: Resident #7 During review of Resident #7's medical record the nurses notes and LNA flow sheets reveal that Resident #7 was an independent ambulator throughout out the facility. On the evening of 9/9/10 nurses notes state Resident #7 was found crying and complaining of pain in the right groin/hip area. On 9/10/10 Resident #7 had an X-ray done which showed a "Subacute, impacted, subcapital fracture right femoral neck" ([MEDICAL CONDITION]). Prior to the X-ray residents last fall which was stated in the medical record was on 7/21/10 which resulted in a laceration to the head and no other injuries were found. On 9/10/10 a physicians order was written with a nurses note that states "Bed to chair with full mechanical lift, no transfers other than full mechanical lift and no ambulation", at this time the facility placed Resident #7 in a chair that prevents rising when out of bed with no physicians order for the use of Has attempted to get out of chair x3...Needs to be reminded not to get up out of chair". On 10/1/10 nurses notes states "(patient) fell forward out of her broda chair at 1900. She hit her head and called out 'help me'...No new marks were discovered...". At 1950 Resident #7 was transported to the hospital for evaluation, the resident was sent back to the facility at 2045 with no new orders. Review of the medical record identified that Resident #7 failed to have a assessment for restraint use and failed to have a care plan for the use of a chair that prevented the resident from getting up. | 2014-04-01 | ||
| 2152 | 2152 | COUNTRY VILLAGE CENTER, GENESIS HEALTHCARE | 305076 | 91 COUNTRY VILLAGE ROAD | LANCASTER | NH | 3584 | 2010-10-14 | 279 | D | CHI411 | Based on record review and interview the facility failed to ensure that the care plans for 2 of 16 sampled residents were complete. (Resident identifiers are #7 and #10.) Findings include: Resident #10. Review on 10/14/10 of Resident #10's resident assessment protocol summary with the reference date of 7/30/10, revealed that the area Dental Care section L1 was triggered for broken teeth and Carries. The record revealed that the DPOAH was activated and both the DPOAH and physician were aware of the condition of this resident's mouth but no dental intervention was ordered secondary to resident's declining health condition. Resident #10's care plans revealed that there was not any care plan present for the above triggered area to capture the effects of broken teeth, or the potential for mouth pain. Interview on 10/14/10 in the p.m. with Staff C (RN/Unit Manager) confirmed that no care plan for dental problems had been developed for Resident #10. Staff C stated that the resident was assessed daily for pain as evidenced by the signatures on the MAR for pain monitoring. Interview on 10/15/10 in the a.m. with Staff B (DON) confirmed that a care plan for the potential problems related to the dental issues should have been developed for Resident #10. Resident #7 On 9/10/10 a physicians order was written which was transcribed into the nurses notes that states "Bed to chair with full mechanical lift, no transfers other than full mechanical lift and no ambulation". At that time the facility placed Resident #7 in a broda chair that prevents the resident from rising when out of bed. On 10/14/10, it was observed, that the resident was still is using this device. During review of Resident #7's care plans reveals no plan a physical restraint/broda chair. Cross reference F221 | 2014-04-01 | ||
| 2153 | 2153 | COUNTRY VILLAGE CENTER, GENESIS HEALTHCARE | 305076 | 91 COUNTRY VILLAGE ROAD | LANCASTER | NH | 3584 | 2010-10-14 | 272 | D | CHI411 | Based on record review it was determined that the facility failed to complete a comprehensive assessment for 1 of 16 residents in the standard survey sample for physical restraints. (Resident identifier is #7.) Findings include: Resident #7 On 9/10/10 a physicians order was written which was transcribed into the nurses notes that states "Bed to chair with full mechanical lift, no transfers other than full mechanical lift and no ambulation". At that time the facility placed Resident #7 in a chair that prevents rising when the resident is out of bed. On 10/14/10, it was observed, that the resident was still is using this device. During review of Resident #7's care plans it fails to show that a physical restraint/broda chair is being used. Cross reference F221 | 2014-04-01 | ||
| 2154 | 2154 | COUNTRY VILLAGE CENTER, GENESIS HEALTHCARE | 305076 | 91 COUNTRY VILLAGE ROAD | LANCASTER | NH | 3584 | 2010-10-14 | 309 | D | CHI411 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based upon group, individual and staff interviews, resident record review and a facility investigation the facility failed to ensure that 1 of 15 sampled residents received their ordered prn pain medication. (Resident identifier is #15). Findings include: Resident #15. During a group interview on 10/13/10, and during an individual interview on 10/13/10, Resident #15 stated that they hadn't received their prn pain medication one evening "a couple of months ago." The facility conducted an investigation on 6/23/10 which revealed that this resident had not received their ordered prn [MEDICATION NAME] IR 5mg po 2 tabs on the evening of 6/22/10 at approximately 10:30 p.m. as requested earlier that evening between 7-8 pm. by Resident #15. This was confirmed through a 10/14/10 interview with Staff A(LPN) who admitted not administering Resident #15's prn pain medication. Staff A stated, during the 10/14/10 interview, that Resident #15's prn pain medication on the evening of 6/22/10 wasn't administered because Staff A believed that there had to be a four hour interval between giving Resident #15 their routine dose of pain medication and administering the prn pain medication. Staff A recalled administering Resident #15's routine dose of pain medication on 6/22/10 somewhere between 7-8 p.m. that evening. Staff A was counseled by Staff B(Director of Nurses), according to the facility investigation the following day on 6/23/10 that prn medications should be administered as ordered by the physician and when requested by residents. Resident #15, said during the 10/13/10 interview that there were no other occasions when they had not received either their routine or prn pain medications. Staff A stated, during the 10/14/10 interview, that after refusing to administer Resident #15's prn [MEDICATION NAME] IR 5mg po 2 tabs this resident went to sleep. There was no documentation, according to a review of this resident's record, that Resident #15 requested any prn … | 2014-04-01 | ||
| 2155 | 2155 | COUNTRY VILLAGE CENTER, GENESIS HEALTHCARE | 305076 | 91 COUNTRY VILLAGE ROAD | LANCASTER | NH | 3584 | 2010-10-14 | 281 | D | CHI411 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based upon resident record review the facility failed to monitor the effectiveness of pain medication for 1 of 16 residents (Resident identifier is #15). Findings include: Standard of Practice (Effectiveness of pain medication) The Potter-Perry, 2009, Fundamentals of Nursing 6th Edition, 2005, St. Louis, Missouri, Chapter 42, page 1267 relates "Effective communication of a client's assessment of pain and his or her response to intervention is facilitated by accurate and thorough documentation." Resident #15 from 6/1/10-6/30/10, according to this resident's medical administration record, received [MEDICATION NAME] IR 10mg po prn. 47 times for pain but there was no documentation on 34 of these occasions regarding the effectiveness of this pain medication. | 2014-04-01 | ||
| 2156 | 2156 | COUNTRY VILLAGE CENTER, GENESIS HEALTHCARE | 305076 | 91 COUNTRY VILLAGE ROAD | LANCASTER | NH | 3584 | 2010-10-14 | 514 | D | CHI411 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based upon resident record review the facility failed to document the effectiveness of a prn pain medication for 1 of 15 sampled residents. (Resident identifier is #15) Findings include: Resident #15, from 6/1/10-6/30/10 according to this resident's medical administration record, received [MEDICATION NAME] IR 10mg po prn. 47 times for pain but there was no documentation on 34 of these occasions regarding the effectiveness of this pain medication. There was no documentation in the resident's record, including the nurses notes from 6/1/10-6/30/10, that Resident #15 was in any pain despite the failure to record the effectiveness of this medication. | 2014-04-01 | ||
| 2157 | 2157 | WOLFEBORO BAY CENTER | 305083 | 39 CLIPPER DRIVE | WOLFEBORO | NH | 3894 | 2010-12-07 | 151 | J | 7Y1L11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview the facility failed to ensure that a residents right to receive cardiopulmonary resuscitation is implemented for 1 resident. (Resident identifier is: #1.) Findings include: Review of Resident #1's medical records on [DATE] reveals that Resident #1 was admitted to the facility on [DATE] and expired on [DATE]. Resident #1 had a physician's orders [REDACTED]. Review of Resident #1's medical record on [DATE] reveals that Resident #1 desired to receive full resuscitative measures. Review of the care plan last reviewed on [DATE] reveals Resident #1 desires CPR. Goal is that CPR (cardiopulmonary resuscitation) will be initiated with the absence of no pulse, no blood pressure, and/or no respiration. Interventions indicate to verify the absence of apical pulse, respirations, and/or blood pressure, initiate CPR, call 911 and notify physician. Nurses note dated [DATE] at 5:20 a.m. by Staff C, LPN indicates that Resident #1 was found lying face down in bathroom unresponsive to any stimulus. A nurses' note dated [DATE] at 5:40 a.m. by Staff D, RN indicates that Resident #1 was assessed with [REDACTED]. The facility failed to initiate CPR to Resident #1. Interviews on [DATE] with Staff A, Administrator, Staff B, Director of Nursing and Staff C confirmed that there was no initiation of CPR to Resident #1. Cross Reference F 224, F282 and F309. | 2014-04-01 | ||
| 2158 | 2158 | WOLFEBORO BAY CENTER | 305083 | 39 CLIPPER DRIVE | WOLFEBORO | NH | 3894 | 2010-12-07 | 224 | L | 7Y1L11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview the facility failed to ensure that it develops and implements policies and procedures to prohibit the neglect of all residents in accordance with the resident's chosen cardiopulmonary resuscitation status resulting in 1 resident not receiving cardiopulmonary resuscitation and was pronounced expired. (Resident identifier is #1.) Findings include: Interview on [DATE] with Staff A, Administrator and Staff B, DON revealed that the facility does not have a written policy and procedure for residents who wish to have CPR (cardiopulmonary resuscitation) or full code status performed. Staff A and Staff B indicated that the facility considers it a professional standard of practice for nursing staff to be aware that if a resident is not DNR (do not resuscitate) then the resident would required CPR in which the resident is assessed, CPR initiated and 911 is called. Staff B also indicated that if a resident chooses to be a DNR then a form is completed and signed by the physician as an order. If the resident is not a DNR then the resident is considered a full code requiring CPR. Review of Resident #1's medical record on [DATE] reveals that Resident #1 was admitted to the facility on [DATE] and expired on [DATE]. Resident #1's physician orders [REDACTED]. During an interview on [DATE] at 1:20 p.m. with Staff C, LPN, Staff C indicated that on [DATE] at 5:20 a.m. Resident #1 was found lying face down on the bathroom floor unresponsive and without a pulse or breathing, feet and legs were blue. Staff C went to get Staff D, RN and Staff D told Staff C to call Staff B, DON to inform about Resident #1. Staff C was asked when did you become aware of Resident #1's code status? Staff C replied when Staff C called Staff B, DON at 5:45 a.m. 25 minutes after finding Resident #1 and Staff B asked about the code status and Staff C indicated not knowing what the status was and had to look for it. Staff C indicated having a difficult tim… | 2014-04-01 | ||
| 2159 | 2159 | WOLFEBORO BAY CENTER | 305083 | 39 CLIPPER DRIVE | WOLFEBORO | NH | 3894 | 2010-12-07 | 282 | J | 7Y1L11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and interview the facility failed to implement the care plan for 1 resident requiring cardiopulmonary resuscitation. (Resident identifier is: #1.) Findings include: Review of Resident #1's medical record on [DATE] reveals that Resident #1 was admitted to the facility on [DATE] and expired on [DATE]. Resident #1 had a physician's orders [REDACTED]. Review of Resident #1's care plan last reviewed on [DATE] reveals that Resident #1 desires CPR. Goal is that CPR (cardiopulmonary resuscitation) will be initiated with the absence of no pulse, no blood pressure, and/or no respiration. Interventions indicate to verify the absence of apical pulse, respirations, and/or blood pressure, initiate CPR, call 911 and notify physician. Nurses note dated [DATE] at 5:20 a.m. by Staff C, LPN indicates that Resident #1 was found lying face down in bathroom unresponsive to any stimulus. A nurses' note dated [DATE] at 5:40 a.m. by Staff D, RN indicates that Resident #1 was assessed with [REDACTED]. Resident #1's medical record reveals no documented evidence that CPR was initiated. Interview with Staff A, Administrator and Staff B, DON indicated that Resident #1 did not receive CPR. | 2014-04-01 | ||
| 2160 | 2160 | WOLFEBORO BAY CENTER | 305083 | 39 CLIPPER DRIVE | WOLFEBORO | NH | 3894 | 2010-12-07 | 309 | J | 7Y1L11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview the facility failed to ensure that it provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being for 1 resident with a full code status that was not implemented and the resident was pronounced expired. (Resident identifier is #1.) Findings include: Review of Resident #1's medical records on [DATE] reveals that Resident #1 was admitted to the facility on [DATE] and expired on [DATE]. Resident #1 had a physician's orders [REDACTED]. Review of Resident #1's care plan last reviewed on [DATE] reveals Resident #1 desires CPR. Goal is that CPR (cardiopulmonary resuscitation) will be initiated with the absence of no pulse, no blood pressure, and/or no respiration. Interventions indicate to verify the absence of apical pulse, respirations, and/or blood pressure, initiate CPR, call 911 and notify physician. Nurses note dated [DATE] at 5:20 a.m. by Staff C, LPN indicates that Resident #1 was found lying face down in bathroom unresponsive to any stimulus. A nurses' note dated [DATE] at 5:40 a.m. by Staff D, RN indicates that Resident #1 was assessed with [REDACTED]. There is no documented evidence of CPR being initiated or 911 called. During an interview on [DATE] at 1:20 p.m. with Staff C, LPN, Staff C indicated that on [DATE] at 5:20 a.m. Resident #1 was found lying face down on the bathroom floor unresponsive and without a pulse or breathing, feet and legs were blue. Staff C went to get Staff D, RN and Staff D told Staff C to call Staff B, DON to inform about Resident #1. Staff C was asked when did you become aware of Resident #1's code status? Staff C replied when Staff C called Staff B, DON at 5:45 a.m. 25 minutes after finding Resident #1 and Staff B asked about the code status and Staff C indicated not knowing what the status was and had to look for it. Staff C indicated having a difficult time trying to find out what Resident #1's status … | 2014-04-01 | ||
| 2161 | 2161 | WOLFEBORO BAY CENTER | 305083 | 39 CLIPPER DRIVE | WOLFEBORO | NH | 3894 | 2010-12-07 | 490 | F | 7Y1L11 | Based on the investigation survey conducted 12/7/10 it was determined that the facility was not administered in a manner that enables it to provide the highest practicable physical and psychosocial well-being of each resident. Findings include: As a result of the investigation survey it was determined that the facility has immediate jeopardy with substandard quality of care being identified in the areas of resident rights 42 CFR 483.10(a), resident behavior and facility practices 42 CFR 483.13(c), resident assessment 42 CFR 483.20(k)(3)(ii) and in the area of quality of care, 42 CFR 483.25. Cross refer to F151, F224, F282 and F309. | 2014-04-01 | ||
| 2162 | 2162 | WOLFEBORO BAY CENTER | 305083 | 39 CLIPPER DRIVE | WOLFEBORO | NH | 3894 | 2010-12-07 | 514 | E | 7Y1L11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview the facility failed to ensure that clinical records on each resident is maintained in accordance with accepted professional standards and practices and is complete and accurately documented for 24 residents. Findings include: On [DATE] Staff G, Social Services compiled a list of the 84 residents residing in the facility and their code status. The list revealed 26 residents desired full code status. Review of the 84 residents MAR's in the area titled advanced directive revealed 30 residents with a blank advance directive section. Staff E, ADON and Staff F, LPN indicated these blanks represent the resident is a full code or CPR (cardiopulmonary resuscitation) status. Resident's #2, #3, #4, #5, #6, #7 and #8. Review of the medical records revealed these residents had physician orders [REDACTED]. Resident 's #9, #10, #11, #12, #13 and #14. Review of the medical records revealed these residents had a physician order [REDACTED]. Resident's #15, #16, #17, #18, #19, #20, #21, #22, #23 and #24. Review of the medical records revealed these residents did not have a physicians order indicating any code status and the MAR was blank. Documentation is present in the social service notes indicates these residents desire for full code/CPR status. Resident #31 Review of medical record on [DATE] reveals Resident #31 admitted on [DATE]. There is no documented evidence addressing code status. There is no physician or social service notes completed in the record. MAR reveals advanced directive section as blank. During interview at 4:30 p.m. with Staff A, Administrator and Staff B, DON it is confirmed that a residents code status is not consistently documented in the medical record or in the MAR and is not consistently ordered by a physician when full code is desired by the resident. | 2014-04-01 | ||
| 2163 | 2163 | AURORA SENIOR LIVING OF DERRY, LLC | 305095 | 20 CHESTER ROAD | DERRY | NH | 3038 | 2011-02-17 | 252 | E | E84811 | Based on observation and interview it was determined that the facility failed to maintain a safe and homelike environment in which doors were in good repair for 19 out of 40 doors and ceilings that were free of water stains for one resident room and two areas in the hallway. Findings include: Observation on 2/16/11 and 2/17/11 revealed scrapped and chipped wood on the side of the door which faces the hallway for resident bedrooms at the level that a wheelchair would hit the door on the following doors: Rooms #1, #2, #3, #5, #7, #9, #11, #15, #16, #19, #20, #25, #28, #29, #30, #31 and #32. It was also observed that there were scrapped and chipped wood on the side of the door which faces the hallway for the 2 resident shower rooms. Interview on 2/16/11 in the morning with Staff A (Administrator) reviewed the scrapes and chips on room #29's resident bedroom door. Staff A agreed that a plastic covering, which they had put over that area which was scrapped and chipped on the dirty utility door, could be put over the same area on room #29. Observation on 2/17/11 revealed water stains on the ceiling in the following areas: 1. Room #17 had 2 water stains on the ceiling near the outside wall of the room to the right had side of the window. 2. In the west hallway there were 4 ceiling tiles between the clean utility room and the shower room. 3. In the west hallway there was 1 ceiling tile at the air vent between Rooms #21 and #28. Interview on 2/17/11 at 2:45 p.m. with Staff A revealed there had been no accidents from the scrapped and chipped wood on the doors. Staff A explained that maintenance works on repairing these areas on the doors especially at rooms #29 and #16 which are damaged due to the electric wheelchairs. Staff A explained that maintenance had worked on these damaged doors in January, but that these areas continue to be an issue. Staff A had explained to the surveyors during the survey that there had been damage to the ceilings in a couple of areas due to dripping water from ice and snow build up on the roof … | 2014-04-01 | ||
| 2164 | 2164 | AURORA SENIOR LIVING OF DERRY, LLC | 305095 | 20 CHESTER ROAD | DERRY | NH | 3038 | 2011-02-17 | 371 | F | E84811 | Based on observation, record review and interview the Facility failed to ensure that the high temperature automatic dishwashing (ADW) machine was operating at the correct temperature during the rinse cycle to properly sanitize the dishes and failed to ensure that the back-up low temperature/bleach system was monitored properly. Findings include: On 2/15/1l at approximately 9:45 a.m. during the initial tour of the kitchen the high temperature dish machine was observed to reach a maximum rinse temperature of 143 degrees F. (Fahrenheit). This information was shared with Staff A, Administrator. A few minutes later, Staff A returned and informed this surveyor that he had achieved a rinse temperature above 180 degrees F.. We immediately returned to the dishwashing area finding the ADW to be in its wash cycle. During the following rinse cycle the ADW reached a maximum temperature of 175 degrees F.. According to the manufacturers specifications, as delineated in the instruction manual for this ADW machine, the target temperature to ensure proper sanitation is 180 degrees F.. At this point Staff A was informed that the sanitation temperature was not appropriate and that they should consider serving lunch on paper products until such time as the sanitation issues were addressed. On interview, 2/15/11, in the morning, with Staff A it was noted that the ADW machine had a bleach sanitizing system in place which operated concurrently with the high temp dishwasher in an attempt to alleviate sanitation concerns in the event that the rinse temperature fell below minimum standards. On 2/15/11, Staff A, Administrator was asked if they could accurately test the parts per million (ppm) of the bleach solution given the higher operating temperatures with the ADW set as a high temperature machine. Staff A stated that the ppm could not be accurately tested at the higher temperatures. On 2/15/11, early afternoon, this was confirmed by the chemical sanitizing solution supplier who stated that above 170 degrees Fahrenheit some of the bleach… | 2014-04-01 | ||
| 2165 | 2165 | AURORA SENIOR LIVING OF DERRY, LLC | 305095 | 20 CHESTER ROAD | DERRY | NH | 3038 | 2011-02-17 | 280 | D | E84811 | Based on record review and interview the facility failed to update the care plan for 1 resident in a standard survey sample of 15 residents. (Resident identifier is #12.) Findings include: Resident #12. Record review on 2/17/11 of the Hospice care plan dated "6/1/10" for Resident #12 revealed in the section titled "PROBLEM" the following: - "Alteration in comfort - Alteration in nutrition and/or hydration, dysphagia - Actual potential alterations in ADL needs - Alteration with coping - Grieving - Social isolation - Alteration in spiritual comfort - Alteration in safety." The above listed Hospice care plan for Resident #12 revealed a review date of "11/15/10" for the "PROBLEM" areas listed. Review of the facility contracted "HOSPICE CERTIFICATION AND PLAN OF CARE" for Resident #12 revealed a recertification period of "12/22/2010 TO 02/19/2011". During interview with Staff C (Registered Nurse) on 2/17/11 at approximately 11:45 a.m. Staff C reviewed the above listed Hospice care plan for Resident #12 and confirmed that the contracted hospice recertification period was "12/22/2010 TO 02/19/2011". Staff C confirmed that the Hospice care plan for Resident #12 had not been updated since "11/15/10". | 2014-04-01 | ||
| 2166 | 2166 | AURORA SENIOR LIVING OF DERRY, LLC | 305095 | 20 CHESTER ROAD | DERRY | NH | 3038 | 2011-02-17 | 281 | D | E84811 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, review of the facility policy and procedure and interview it was determined that the facility failed to follow the professional standard of practice for the administration of medication for 1 resident in a standard survey sample of 15 residents. (Resident identifier is #13.) Findings include: Review of the facility policy and procedure titled "Pain Assessment and Management" dated "1/26/00" revealed the following: - "Procedure: ... - Intensity (use pain scale 0 - 10 for resident who can verbalize, pain behavior for those who are cognitively impaired; and those who are nonverbal use the Wong-Baker Faces Pain Rating Scale.) - When planning care for resident be sure to: - Orient resident/significant other to pain management program, teach use of Pain Scale - Set goal for pain relief with resident/significant other, - Document effectiveness of pain relief measures..." Reference for the professional standard of practice is "Fundamentals of Nursing, 7th EDITION, POTTER-PERRY, MOSBY, ELSEVIER, EVOLVE, 2009", pages "1063 - 1083" shows the following: - " Intensity. One of the most subjective and therefore most useful characteristics for the reporting of pain is its severity, or intensity. A variety of pain scales are available for clients to communicate their pain intensity. Examples of pain intensity scales include the verbal descriptor scale (VDS), the numerical rating scale (NRS), and the visual analog scale (VAS). When using the NRS a report of 0 to 3 indicates mild pain, 4 to 6 moderate pain, and 7 to 10 severe pain, considered a pain emergency. These scales work best when assessing pain intensity before and after therapeutic interventions... In addition to the current pain level, also ask what rating to give the average pain and the worst pain over the past 24 hours... - Evaluation of pain is one of many nursing responsibilities that require effective critical thinking. The client's behavioral responses to pain-relief int… | 2014-04-01 | ||
| 2167 | 2167 | AURORA SENIOR LIVING OF DERRY, LLC | 305095 | 20 CHESTER ROAD | DERRY | NH | 3038 | 2011-02-17 | 253 | B | E84811 | Based on observation and interview it was determined that the facility failed to maintain an environment in good repair in which doors were in good repair for 19 out of 40 doors and ceilings were free of water stains for one resident room and two areas in the hallway. Findings include: Observation on 2/16/11 and 2/17/11 revealed scraped and chipped wood on the side of the door which faces the hallway for resident bedrooms for the lower third of the door on the following doors: Rooms #1, #2, #3, #5, #7, #9, #11, #15, #16, #19, #20, #25, #28, #29, #30, #31 and #32. It was also observed that there was scraped and chipped wood on the side of the door which faces the hallway for the 2 resident shower rooms. Interview on 2/16/11 in the morning with Staff A (Administrator) reviewed the scrapes and chips on room #29's resident bedroom door. Staff A agreed that a plastic covering, which they had put over an area which was scraped and chipped on the dirty utility door, could be put over the same area on room #29. Observation on 2/17/11 revealed water stains on the ceiling in the following areas: 1. Room #17 had 2 water stains on the ceiling near the outside wall of the room to the right hand side of the window. 2. In the west hallway there were 4 stained ceiling tiles between the clean utility room and the shower room. 3. In the west hallway there was 1 stained ceiling tile at the air vent between Rooms #21 and #28. Interview on 2/17/11 at 2:45 p.m. with Staff A revealed there had been no accidents from the scraped and chipped wood on the doors. Staff A explained that maintenance works on repairing these areas on the doors especially at rooms #29 and #16 which are damaged due to the electric wheelchairs. Staff A explained that maintenance had worked on these damaged doors in January, but that these areas continue to be an issue. Staff A had explained to the surveyors during the survey that there had been damage to the ceilings in a couple of areas due to dripping water from ice and snow build up on the roof this winter. St… | 2014-04-01 | ||
| 2168 | 2168 | WEBSTER AT RYE | 305099 | 795 WASHINGTON ROAD | RYE | NH | 3870 | 2010-12-16 | 225 | D | ZP1W11 | Based upon a review of a facility investigation and staff interview the facility failed to ensure that an allegation of verbal abuse was immediately reported to the facility administrator and other officials as required by state law (Resident identifier is #13). Findings include: Resident #13 Resident #13 alleged, according to an untitled and undated facility investigation report, that on the morning of either 12/6 or 12/7/10 Staff A(LNA) "came into my room to get me out of bed for breakfast." Resident #13 stated they told Staff A that their "elastic stocking was over on the chair and asked" Staff A to put it on. Staff A, according to Resident #13, responded by stating Resident #13 was "supposed to do this" by themself. Then Resident #13 said "Staff A "grabbed the stocking and put it on" Resident #13. Resident #13 was "very upset about the tone of" Staff A's voice and the way Staff A pointed their finger at Resident #13. Resident #13 concluded their statement by noting Staff B(OT) entered the room after Staff A had left on the morning of either 12/6 or 12/7/10. Resident #13 stated they informed Staff B what had occurred between them and Staff A. Staff B, as acknowledged by Staff C(Social Worker) during a 12/15/10 interview, did not report this allegation until 12/13/10. Staff C who investigated this allegation spoke with Resident #13's roommate, at an unspecified date, who heard but did not see what happened during this incident. Resident #13's roommate stated that Staff A was somewhat "abrasive" toward Resident #13 on the morning of either 12/6 or 12/7/10. According to Staff C no other staff member witnessed the incident. Staff A denied that they had been verbally abusive toward Resident #13. Resident #13, during an interview with Staff C, denied that Staff A had been abusive, neglectful or mistreated them. Staff A, according to an 12/15/10 interview, was counseled by Staff C regarding interacting with residents. | 2014-04-01 | ||
| 2169 | 2169 | WEBSTER AT RYE | 305099 | 795 WASHINGTON ROAD | RYE | NH | 3870 | 2010-12-16 | 226 | D | ZP1W11 | Based upon a review of a facility investigation and staff interview the facility failed to implement their policy regarding the reporting of an allegation of abuse (Resident identifier is #13). Findings include: Resident #13 Resident #13 alleged, according to an untitled and undated facility investigation report, that on the morning of either 12/6 or 12/7/10 Staff A(LNA) "came into my room to get me out of bed for breakfast." Resident #13 stated they told Staff A that their "elastic stocking was over on the chair and asked" Staff A to put it on. Staff A, according to Resident #13, responded by stating Resident #13 was "supposed to do this" by themself. Then Resident #13 said "Staff A "grabbed the stocking and put it on" Resident #13. Resident #13 was "very upset about the tone of" Staff A's voice and the way Staff A pointed their finger at Resident #13. Resident #13 concluded their statement by noting Staff B(OT) entered the room after Staff A had left on the morning of either 12/6 or 12/7/10. Resident #13 stated they informed Staff B what had occurred between them and Staff A. Staff B, as acknowledged by Staff C(Social Worker) during a 12/15/10 interview, did not report this allegation until 12/13/10. Staff C who investigated this allegation spoke with Resident #13's roommate, at an unspecified date, who heard but did not see what happened during this incident. Resident #13's roommate stated that Staff A was somewhat "abrasive" toward Resident #13 on the morning of either 12/6 or 12/7/10. According to Staff C no other staff member witnessed the incident. Staff A denied that they had been verbally abusive toward Resident #13. Resident #13, during an interview with Staff C, denied that Staff A had been abusive, neglectful or mistreated them. Staff A, according to an 12/15/10 interview, was counseled by Staff C regarding interacting with residents. | 2014-04-01 | ||
| 2170 | 2170 | FAIRVIEW NURSING HOME | 305100 | 203 LOWELL ROAD | HUDSON | NH | 3051 | 2011-02-25 | 371 | D | ERTC11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on the initial tour of the facility's kitchen on 2/23/11 at 9:30 am it was found that the facility failed to document and maintain dishwasher machine temperatures for a high temperature machine. Findings include: During [MEDICATION NAME] of the kitchen with Staff A (Director of food services) the high temperature dish machine during its final rinse was running at 167 degrees which is below the standard temperature of 180 degrees. This observation was shown to Staff A at the time the dish machine was running, also the temperature log failed to be completed for this shift which if done would have let staff know the dish machine was not running at the proper temperature for a high temperature dish machine. | 2014-04-01 | ||
| 2171 | 2171 | FAIRVIEW NURSING HOME | 305100 | 203 LOWELL ROAD | HUDSON | NH | 3051 | 2011-02-25 | 329 | D | ERTC11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review the facility failed to ensure 1 of 19 residents in a standard survey sample was adequately monitored for pain. (Resident identifier is #14.) Findings include: Resident #14 Review of the February 2011 MAR for Resident #14 revealed that one [MEDICATION NAME] hcl ([MEDICATION NAME]) "IR" (immediate release) 5 mg tablet was ordered to be given via p.e.g. (percutaneous endoscopic gastrostomy) tube, every 4 hours, as needed, for pain. Further review of the February 2011 MAR for Resident #14 revealed that one [MEDICATION NAME] hcl "IR" 5 mg tablet was documented as given each of 5 times in February to this Resident; on 2/6/11, 2/7/11, 2/16/11, 2/22/11 and 2/23/11. Additional review of the February 2011 MAR for Resident #14 revealed that the effectiveness of the administration of the [MEDICATION NAME] hcl "IR" 5 mg tablet had been documented as assessed on 2/22/11 and 2/23/11 and documented 2/6/11 in the nurses notes. There is no evidence, in the MAR indicated [REDACTED]. | 2014-04-01 | ||
| 2172 | 2172 | FAIRVIEW NURSING HOME | 305100 | 203 LOWELL ROAD | HUDSON | NH | 3051 | 2011-02-25 | 281 | D | ERTC11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interview and review of the facility policy and procedure it was determined that the facility failed to follow the professional standard of practice for the administration of medication for 1 resident in a standard survey sample of 19 residents. (Resident identifier is #19.) Findings include: Reference for the professional standard of practice for the administration of medications is the "Fundamentals of Nursing, 7 th EDITION, POTTER-PERRY, MOSBY ELSEVIER, EVOLVE, 2009", pages 713-785 and pages 1060-1083 showed the following: -" After administering a medication, record it immediately on the appropriate record form... - If a client refuses a medication or is undergoing tests or procedures that result in a missed dose, explain the reason the medication was not given ... - Some agencies require the nurse to circle the prescribed administration time on the medication record .. - Evaluation of pain is one of many nursing responsibilities that require effective critical thinking ... The client's behavioral responses to pain-relief interventions are not always obvious. Evaluating the effectiveness of a pain intervention requires you to evaluate the client after an appropriate period of time. For instance, oral medications usually peak in about 1 hour; ... - Ask client if the medication alleviated the pain when it is peaking. -You need to continually assess whether the character of the client's pain changes and whether individual interventions are effective." Review of the facility policy and procedure titled "Administration of Medication" revealed the following: - "All medications must be administered according to practice guidelines and according to physician orders... - If a medication is held or refused, it shall be circled on the MAR and an explanation of the refusal will be documented in the nurse's notes, or documented on the back side of the MAR. It is necessary to be consistent with one method or another. - If a PRN (… | 2014-04-01 | ||
| 2173 | 2173 | DOVER CENTER FOR HEALTH & REHABILITATION | 305018 | 307 PLAZA DRIVE | DOVER | NH | 3820 | 2011-03-07 | 441 | D | O81X11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and interview it was determined that the facility failed to ensure safe, sanitary practices were implemented to prevent the transmission of infection. (Resident identifier is #18.) Findings include: Observation of Staff E (Rehabilitation Aide) on 3/5/11 at approximately 10:15 a.m. showed that Staff E was assisting another staff member rendering care to Resident #18. A precaution sign posted on the door frame to Resident #18 room indicated to see nurse at nurses station before entering. During the initial tour with Staff C (Licensed Practical Nurse) on 3/5/11 Staff C, confirmed the following [DIAGNOSES REDACTED]." Further observation showed Staff E entered Resident #18's doorway from inside the room with a yellow gown and gloved hands carrying a stack of Resident #18's soiled bed linens. Staff E placed this stack of soiled bed linens on the floor inside the doorway of the resident room. Staff E proceeded to lean forward from inside the resident room doorway into the resident hallway and pulled with gloved hands a double portable laundry hamper closer to the resident doorway. Staff E, with gloved hands removed an individual cardboard tissue box from the top of the covered laundry hamper and placed it on the resident hallway floor. Staff E then lifted one of the individual lids on the double laundry hamper and proceeded to place the soiled linen from the floor into this linen hamper. Staff E was observed at this time to remove the yellow gown and gloves discarding them in a trash receptacle in the resident room. Staff E with bare hands then reached into a pocket of her attire and removed an individually wrapped package, proceeded to open this package and remove a white cloth and wipe both hands with this cloth. Staff E then utilized this cloth to wipe down the outside areas, including the lid of the double laundry hamper located in the resident hallway that was used to discard the soiled laundry from Resident #18. Staff E th… | 2014-03-01 | ||
| 2174 | 2174 | DOVER CENTER FOR HEALTH & REHABILITATION | 305018 | 307 PLAZA DRIVE | DOVER | NH | 3820 | 2011-03-07 | 425 | D | O81X11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview with staff it was determined that the facility failed to provide services for each resident to receive medications and/or biologicals as ordered by the prescriber for 1 resident in a standard survey sample of 17 residents. (Resident identifier is #7.) Findings include: During record review on Resident #7 the nurses notes dated 2/23/11 state "(Patient) did not receive scheduled dose of Metolazone this am. medication was unavailable, pharmacy made aware..." On review of the February 2011 MAR indicated ZAROXOLYN (METOLAZONE) 2.5 MG PO EVERY SUN AND WED DX: DIASTOLIC HEART FAILURE". On 2/23/11, a Wednesday, the MAR indicated [REDACTED]. | 2014-03-01 | ||
| 2175 | 2175 | WILLIAM P CLOUGH EXTENDED CARE CENTER | 305021 | 273 COUNTY ROAD | NEW LONDON | NH | 3257 | 2010-11-24 | 223 | D | 57PH11 | Based upon resident interview and review of a facility Incident/Accident Report and a facility Patient Complaint Reporting Form investigation the facility failed to ensure that 1 of 14 sampled residents was free from abuse(Resident identifier is #6). Findings include: Resident #6 on 9/11/10, according a facility Incident/Accident Report of 9/11/10 at 1600 hours, stated to Staff A(ADON,LPN) that they had been "rushed" by Staff B(LNA) on 9/10/10 during evening care and bumped their arm sustaining an abrasion measuring 0.5cm by 0.6 cm. An interview with Resident #6 on 11/23/10 revealed that they were "pushed" by Staff B while receiving evening care on 9/10/10. Resident #6 said that this resulted in their elbow hitting a wall and receiving an abrasion. In the facility Patient Complaint Reporting Form investigation of 9/15/10 Staff C(LNA) stated that Resident #6 reported being "pushed" or "thrown down" by Staff B resulting in the abrasion. | 2014-03-01 | ||
| 2176 | 2176 | WILLIAM P CLOUGH EXTENDED CARE CENTER | 305021 | 273 COUNTY ROAD | NEW LONDON | NH | 3257 | 2010-11-24 | 225 | D | 57PH11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based upon resident interview, reviews of a facility Incident/Accident Report and a facility Patient Complaint Reporting Form investigation the facility failed to report an incident of alleged abuse for 2 of 14 residents(Resident identifiers are #6 and #7). Findings include: Resident #6 on 9/11/10, according to a facility Incident/Accident Report of 9/11/10 at 1600 hours, stated to Staff A(ADON,LPN) that they had been "rushed" by Staff B(LNA) on 9/10/10 during evening care and bumped their arm sustaining an abrasion measuring 0.5cm by 0.6 cm. An interview with Resident #6 on 11/23/10 revealed that they had been "pushed" by Staff B while receiving evening care on 9/10/10. Resident #6 said that this resulting in their elbow hitting the wall and receiving an abrasion. In the facility Patient Complaint Reporting Form investigation of 9/15/10 Staff C(LNA) stated that Resident #6 reported being "pushed" or "thrown down" by Staff B resulting in the abrasion injury. This incident of abuse was not reported by the facility until 9/15/10. Resident #7. On 11/23/10 a facility Risk Management Quality Assurance Variance Report for a 10/3/10 incident of alleged abuse was reviewed and the review shows that on 10/4/10 the facility reported the 10/3/10 incident of alleged abuse to the State regarding the mistreatment of [REDACTED]. The review shows the facility used the State of N.H. Dept of Health and Human Services Reportable Information form and faxed information to the State. Review of a facility Risk Management Quality Assurance Variance Report dated 10/17/10 provided to the survey team for review on 11/23/10 shows that on 10/17/10 facility staff witnessed a second incident when this resident was again allegedly mistreated by the spouse. Review of the Risk Management Quality Assurance Variance Report and the Variance/Injury/Accident Investigation Procedure for the 10/17/10 incident shows no documentation that the facility reported the 10/17/10 incident to … | 2014-03-01 | ||
| 2177 | 2177 | WILLIAM P CLOUGH EXTENDED CARE CENTER | 305021 | 273 COUNTY ROAD | NEW LONDON | NH | 3257 | 2010-11-24 | 226 | D | 57PH11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on resident interview and reviews of a facility Incident/Accident Report and facility Patient Complaint Reporting Form investigation the facility failed to notify state agencies within twenty-four hours of a reportable incident for 2 of 14 sampled residents. (Resident identifiers are #6 and #7.) Findings include: Resident #6 on 9/11/10, according a facility Incident/Accident Report of 9/11/10 at 1600 hours, stated to Staff A(ADON,LPN) that they had been "rushed" by Staff B(LNA) on 9/10/10 during evening care and bumped their arm sustaining an abrasion measuring 0.5cm by 0.6 cm. An interview with Resident #6 on 11/23/10 revealed that they had been "pushed" by Staff B while receiving evening care on 9/10/10. Resident #6 said that this resulting in their elbow hitting the wall and receiving an abrasion. In the facility Patient Complaint Reporting Form investigation of 9/15/10 Staff C(LNA) stated that Resident #6 reported being "pushed" or "thrown down" by Staff B resulting in the abrasion injury. The facility failed to implement it's own policy requiring the immediate reporting of suspected allegations of abuse as this incident was not reported until 9/15/10. Resident #7. On 11/23/10 a facility Risk Management Quality Assurance Variance Report for a 10/3/10 incident of alleged abuse was reviewed and the review shows that on 10/4/10 the facility reported the 10/3/10 incident of alleged abuse to the State regarding the mistreatment of [REDACTED]. The review shows the facility used the State of N.H. Dept of Health and Human Services Reportable Information form and faxed information to the State. Review of a facility Risk Management Quality Assurance Variance Report dated 10/17/10 provided to the survey team for review on 11/23/10 shows that on 10/17/10 facility staff witnessed a second incident when this resident was again allegedly mistreated by the spouse. Review of the Risk Management Quality Assurance Variance Report and the Variance/Inju… | 2014-03-01 | ||
| 2178 | 2178 | WILLIAM P CLOUGH EXTENDED CARE CENTER | 305021 | 273 COUNTY ROAD | NEW LONDON | NH | 3257 | 2010-11-24 | 250 | D | 57PH11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and interview the facility failed to ensure that 1 resident who needed social services in the survey sample of 14 residents received the necessary medically-related social services. (Resident identifier is #7.) Findings include: Resident #7. Review of Interdisciplinary Progress Notes written by Staff E, (MSW Master of Social Work) revealed that on 2/1/10 the social worker while speaking to the resident found the resident confused over the dates of the spouse's visits and offered to meet with the resident and the spouse when the spouse visited again. A 2/2/10 Interdisciplinary Progress Notes written by this social worker states that the social worker spoke with the resident's spouse about an incident between the resident and the spouse when the spouse was trying to assist the resident to wash up. The resident's spouse made the statement that the resident is not feeling as well as in the past. Review, of nursing progress notes, during the 11/22/10 to 11/24/10 survey showed that on 3/24/10 a nurse wrote in the Nurse's Notes that this resident's spouse expressed the concern that no one asked for the spouse's opinion about the resident's care and that the spouse made a statement about how hard it is to see the resident have disabilities and limitations. Review of the Interdisciplinary Progress Notes shows that there are no further progress notes written by this social worker after the 2/2/10 progress note until 6/18/10 at which time this social worker wrote that services would be provided to the resident to help with communication and that services would be provided to the spouse to keep the spouse informed and help the spouse vent feelings. On 6/23/10 this social worker wrote a progress note showing that the resident was eating less and dropping a little weight over the last few months. On 9/13/10 the social worker wrote an annual review progress note, that states the resident is alert and confused, spouse visits al… | 2014-03-01 | ||
| 2179 | 2179 | WILLIAM P CLOUGH EXTENDED CARE CENTER | 305021 | 273 COUNTY ROAD | NEW LONDON | NH | 3257 | 2010-11-24 | 280 | D | 57PH11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview the facility staff failed to revise the resident care plan for 1 of 14 residents in the survey sample. (Resident identifier is #7.) Findings include: Resident #7. During the recertification survey 11/22/10 to 11/24/10 facility documents entitled Risk Management Quality Assurance Variance Report and Variance/Injury/Accident Investigation Procedure completed on 10/3/10 and 10/4/10 for recording and reporting an incident of alleged resident abuse were reviewed. The review shows that on 10/4/10 the facility reported a 10/3/10 incident of alleged abuse to the State regarding the mistreatment of [REDACTED]. During an interview on 11/23/10 with Staff D, (RN DON), Staff D stated that the facility staff developed a plan to follow for monitoring and reporting any observations or concerns about a recurrence of mistreatment of [REDACTED]. Review of the Care Plan Worksheet for Lamson wing shows that it has directions on it for 18 residents' care and Staff D again stated that it is the LNAs care plan to follow. Review of this resident's comprehensive care plan with Staff D on 11/23/10 showed that the interventions developed for the LNA care plan were not added to the resident's comprehensive care plan as of 11/23/10. Staff D said the interventions had been added to the LNA's plan for care and also stated that the comprehensive care plan had not been revised to include the specific interventions for the staff to follow for monitoring and reporting mistreatment of [REDACTED]. | 2014-03-01 |
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CREATE TABLE [cms_NH] ( [facility_name] TEXT, [facility_id] INTEGER, [address] TEXT, [city] TEXT, [state] TEXT, [zip] INTEGER, [inspection_date] TEXT, [deficiency_tag] INTEGER, [scope_severity] TEXT, [complaint] INTEGER, [standard] INTEGER, [eventid] TEXT, [inspection_text] TEXT, [filedate] TEXT );