61 |
SANDIA RIDGE CENTER |
325032 |
2216 LESTER DRIVE NE |
ALBUQUERQUE |
NM |
87112 |
2017-03-20 |
241 |
E |
0 |
1 |
30NH11 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and interview, the facility failed to ensure that residents had the right to a dignified existence for 6 (R #s 5, 9, 13, 103, 161 and 165) of 6 (R #s 5, 9, 13, 103, 161 and 165) residents reviewed for dignity. This deficient practice may result in feelings of frustration, embarrassment and may lower self-esteem. The findings are: [NAME] On 03/14/17 at 9:34 am, Certified Nurse Aide (CNA) #1 entered R #103's room without knocking or asking for permission to enter. B. On 03/14/17 at 10:20 am, CNA #1 entered R #161's room without waiting for permission to enter after knocking once. C. On 03/14/17 at 3:12 pm, CNA #2 entered R #165's room without waiting for permission to enter after knocking. D. On 03/16/17 at 8:38 am, Transportation Aide #1 entered R #165's room without waiting for permission to enter after knocking. E. On 03/14/16 at 4:05 pm, during interview with Unit Manager (UM) #1, he stated that staff should be knocking on the room door, announcing themselves and waiting for the resident to give permission prior to entering the room. UM #1 stated that staff entering the residents' room without requesting permission was unacceptable. F. Record review of the Dignity Policy dated 09/01/13 indicated, (Name of Center) will promote care for patients in a manner and in an environment that maintains or enhances each patient's dignity and respect in full recognition of his or her individuality .knock on doors and request permission to enter . [NAME] On 03/14/17 at 2:19 pm, CNA #3 entered R #13's room without knocking or asking permission to enter. He walked around the resident's bed without acknowleding the resident. H. On 03/14/17 at 2:21 pm, CNA #3 entered R #9's room without knocking or asking permission to enter. He opened the resident's bedside table drawers without acknowledging the resident. I. On 03/17/17 at 9:52 am, during interview with R #5, she stated that CNAs on the 500-unit are sarcastic, nasty and disrespectful They're kids, and they open their big nasty mouth to me and it's just devastating. I was taught to have more respect for older people when I was their age. When I say anything to the higher-ups (about staff attitude), nothing gets accomplished. [NAME] On 03/17/17 at 10:21 am, during interview with the Administrator, she indicated that one way that management monitors staff treatment of [REDACTED]. K. On 03/17/17 at 11:02 am, during interview with R #5, she stated that no one from management checks in with her on any regular basis. L. Record review of the Guardian Angel Assignments document provided by the Administrator on 03/17/17 found that patient rooms were divided into 17 groups, with a manager assigned to each group. Among the facility's managers with room assignments were the Payroll & Scheduling, Medical Records, and Business Office Managers, as well as the Assistant Business Office Manager and the Director of Recreation. A statement on the form stated All Guardian Angel rounds must be made every morning. Fill out Guardian Angel forms and bring to morning meeting. M. On 03/20/17 at 8:30 am, during interview with the Payroll & Scheduling Manager, he stated that he was a new employee. He indicated that he was unaware of the Guardian Angel program, was unaware that there were resident rooms assigned to him for rounds, and was unaware of who, if anyone, might be visiting those rooms until he was fully up-to-speed in his role. N. On 03/20/17 at 8:31 am, during interview with the Medical Records Dept. Manager, she stated that she visited her assigned rooms daily. When asked for the completed forms documenting the visits, she indicated that she had no documentation. She stated We're supposed to be filling out forms, but we haven't been doing it. O. On 03/20/17 at 8:37 am, during interview with the Director of Recreation, she was unable to state which rooms were assigned to her, until she found a copy of the Guardian Angel Assignments document. She stated that she tries to visit her assigned residents once or twice a week, but that it's really hard to squeeze it in. P. On 03/20/17 at 8:42 am, during interview with the Business Office Manager, she was unable to state which were her assigned rooms, until she located a copy of the Guardian Angel Assignments document. She indicated that she has not been doing these visits at all, stating I just found out about this. Q. On 03/20/17 at 8:43 am, during interview with the Assistant Business Office Manager, she denied knowledge of the program of Guardian Angel rounds, stating No, I haven't been doing them. I didn't even know about them. R. On 03/20/17 at 8:49 am, during interview with the Administrator, she conceded that the Guardian Angel program was not the best, and that some of the listed managers weren't doing the rounds. She stated that she hoped to revamp the program, using a different model, but had not yet done so. Reminded of her earlier statement indicating that Guardian Angel rounds were a primary means of ensuring that residents were being treated by nursing staff with dignity and respect, she indicated that, instead, she and her staff informally check with residents when they see them around the facility. |
2020-09-01 |