cms_NM: 5692
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| rowid | facility_name | facility_id | address | city | state | zip | inspection_date | deficiency_tag | scope_severity | complaint | standard | eventid | inspection_text | filedate |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 5692 | MESCALERO CARE CENTER | 325116 | 454 LIPAN AVE | MESCALERO | NM | 88340 | 2011-01-21 | 272 | F | GJSL11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and interview, the facility failed to ensure that 1 (#42) of 28 sampled residents was assessed for dental care upon admission into the facility. This deficient practice had the potential to effect 39 residents currently residing in the facility and any new admissions. The findings are: A. On 01/19/11 at 9:45 am, Resident #42 was observed to have teeth that looked dirty. They were covered in black/brown material, unclean, and a smell was coming from the resident's mouth. She stated, "There is something wrong with my teeth" but had difficulty speaking. She was visibly upset with her hands shaking and her face flushed. B. Review of the Admission Record revealed Resident #42 was admitted on [DATE] and readmitted on [DATE]. Her [DIAGNOSES REDACTED]. C. Review of the Quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed she was "moderately impaired in cognitive skills for decision making, expressed little interest or pleasure, she looked to be feeling or appearing down, appeared tired or as having little energy, poor appetite or overeating, being short-tempered and easily annoyed." For Activities of Daily Living (ADLs), she was assessed as "requiring no assistance with set-up help only for eating and no assistance and able to perform personal hygiene" herself. D. Review of the Care Plan dated 04/29/11 revealed a problem area for dental as follows: "Resident has some/all natural teeth lost - does not have or does not use dentures (or partial plates) R/T (related to) poor dental hygiene before entering facility." The goal for the dental area included, "Resident will not have further tooth loss." The approaches to meet that goal were "Assess condition of oral cavity, teeth, tongue, lips... Monitor adequacy of brushing... Remind resident to brush near gumline... Provide oral care daily if resident is unable to do so." E. Review of the admission nursing assessment dated on 05/27/10 revealed the "Oral" assessment area was blank. F. On 01/21/11 at 11:39 am, during an interview, the Director of Nursing (DON) stated, "We did check her mouth (on 01/21/11) and it looks like she is having trouble with her gums, and she said it hurts when she brushes her teeth." The DON was asked if the resident had gingivitis. The DON replied, "Yes." G. On 01/21/11 at 12:10 pm, during an interview, the Social Services Director (SSD) reported she contacted Resident #42's daughter 01/21/11 and got permission to get an appointment for the resident to see the dentist. When asked why Resident #42 was referred to a dentist, she replied, "The resident has some gingivitis starting and teeth need to be cleaned and it's causing problems and starting to hurt. It has been there for a little while and it appears to have gotten worse." She further stated the daughter told her that Resident #42 had never been to see a dentist before. H. On 01/21/11 at 2:12 pm, during an interview, Certified Nursing Assistant (CNA) #22 was asked if the resident brushes her own teeth. She stated, "Yes." She was asked if she has observed the resident brushing her teeth and how well she did. She reported, "The resident did really good earlier (today). I went ahead and asked her if she brushed her teeth and asked if she could do it again even though she said she did this morning. She got a little irritated that I was there. I observed for a few minutes and she did good and brushed her teeth and I asked her if she wanted to rinse with mouthwash. She didn't want to." CNA #22 was asked if the resident had her own teeth or dentures. She said, "Her own teeth." When asked if the resident had any trouble chewing, CNA #22 replied, "No, but whenever she has food in there, her gum is (sic) a little sore. I told the nurse." When asked if she was aware of what the Care Plan called for regarding Resident #42's teeth and any monitoring, she replied, "I would think so." CNA #22 was asked what would be signs and symptoms of something going wrong in a resident's mouth. She said, "Maybe if (they were) not eating as well." I. On 01/21/11 at 2:19 pm, during an interview, Registered Nurse (RN) #12 was asked if Resident #42 required assistance to brush her teeth. She replied, "She likes to do it herself but we have to put her in front of the sink. She knows exactly where her toothbrush is, she wraps it in a little napkin and she knows where it's at. She'll brush her teeth on her own at times but we have to cue her for the most part." RN #12 was asked to list some of the risk factors for a resident that did not brush their teeth. She replied, "Gingivitis. She could get a tooth infection. She could get poisoning." When asked if Resident #42's Care Plan required staff to monitor the resident's oral health and how often, RN #12 replied, "I think daily is good because then you are looking everyday to make sure." J. On 01/21/11 at 2:34 pm, during an interview, the DON was asked if the facility policy regarding nursing assessments required they be complete. She replied, "Right, yes ma'am." When asked to review the oral section of the admission nursing assessment dated on 05/27/10 for Resident #42, she stated, "It wasn't done." When asked if there was currently a process to assure the assessments have been completed correctly, the DON reported, "Not at this time." The DON was asked how often residents should have their oral status evaluated. She stated, "Given her age, it should have been daily and report to (the) nurse if something came up out of the ordinary." When asked what negative outcomes could result from the gingivitis if it were to continue to be undiagnosed , the DON reported, "Infection." She was then asked if the infection could lead to [MEDICAL CONDITION]. She replied, "Yep, it could." | 2014-01-01 |