cms_OR: 17
Data source: Big Local News · About: big-local-datasette
| rowid | facility_name | facility_id | address | city | state | zip | inspection_date | deficiency_tag | scope_severity | complaint | standard | eventid | inspection_text | filedate |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 17 | LAURELHURST VILLAGE | 385010 | 3060 SE STARK STREET | PORTLAND | OR | 97214 | 2017-09-11 | 278 | D | 0 | 1 | 8N9P11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review it was determined the facility failed to correctly code the MDS to reflect the urinary incontinence and dental status for 2 of 4 sampled residents (#112 and 181) reviewed for urinary incontinence and dental status. This placed residents at risk for unmet needs. Findings include: 1. Resident 112 was admitted to the facility in 3/2017 with [DIAGNOSES REDACTED]. According to the Long-Term Care Facility RAI 3.0 User's Manual for coding urinary continence, a resident is coded as always incontinent if incontinent of urine on all occasions during the seven-day look-back period. If a resident was continent of urine more than once during the look-back period she/he would be coded as frequently incontinent. According to bladder records on 6/11/17, 6/12/17, 6/13/17 and 6/14/17 the resident was continent of urine. On 6/21/17 the facility completed a quarterly assessment with an assessment reference date of 6/16/17. The quarterly MDS assessment was coded to reflect the resident was always incontinent of urine rather than frequently incontinent. In an interview on 9/11/17 at 12:13 pm Staff 2 (DNS) stated the nurse who completed Resident 112's 6/2017 quarterly MDS assessment no longer worked at the facility. During interview on 9/11/17 at 12:23 pm Staff 3 (RNCM) and Staff 2 acknowledged Resident 112's quarterly assessment was inaccurately coded for urinary continence. 2. Resident 181 admitted to the facility in 8/2017 with [DIAGNOSES REDACTED]. Resident 181's Admission Nursing Data Base form dated 8/10/17 was completed by Staff 15 (RN/Admissions Nurse). Staff 15 identified Resident 181 as having both No natural teeth or tooth fragment(s) (edentulous) and Natural teeth. No dentures were documented. Resident 181's Admission MDS, dated [DATE], was completed by Staff 16 (RN/MDS Coordinator) and she identified the resident as edentulous (having no natural teeth or tooth fragments) in Section L: Oral/Dental Status. The corresponding Dental Care CAA described the resident as having no natural teeth on admission and had a full set of dentures with no concerns. On 9/7/17 at 2:52 pm, Resident 181 reported she/ he had her/his own natural teeth, but had one broken tooth. Resident 181 was observed to have all natural teeth, but one broken upper front tooth with tooth fragments present. Resident 181 denied any pain or discomfort. On 9/8/17 at 9:42 am, Staff 13 (CNA) stated Resident 181 had her/his own teeth, but had one broken tooth in the front. On 9/11/17 at 9:36 am, Staff 14 (RN) reported Resident 181 had her/his own teeth, but one broken tooth in the front. Resident 181 never complained of pain or discomfort. On 9/11/17 at 11:15 am, Staff 15 (RN/Admissions Nurse) stated he would use a combination of observation, interview and record review to complete the Admission Nursing Data Base section on dental status. He reported marking both No natural teeth or tooth fragments and Natural teeth because the resident had one broken tooth, but there was no section on the admission form to code that kind of situation. On 9/11/17 at 11:38 am, Staff 16 (RN/MDS Coordinator) confirmed she assisted the facility in completing MDS assessments, but did not come to the facility in person. She worked remotely and would gather information from the resident's records to complete the MDS. She would call the facility if there were any questions. She reported noting the discrepancy with the Admission Nursing Database form and contacted Staff 12 (MDS Coordinator) to clarify the resident had no teeth and had dentures. On 9/11/17 at 11:46 am, Staff 2 (DNS) reported Staff 12 was an interim MDS coordinator, but no longer worked at this facility. Staff 2 confirmed Resident 181's Admission MDS was not accurately coded for Oral/Dental Status. | 2020-09-01 |