| 313 |
SERVICIOS INTEGRADOS DE REHABILITACION (SIRO) INC |
405029 |
CALLE 4-L-10 URB COLINAS DEL OESTE |
HORMIGUEROS |
PR |
660 |
2015-05-22 |
156 |
F |
0 |
1 |
1WB711 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews with the Social Worker (employee #15), resident's family members, the Administrator (employee # 13), the Owner and President of the Governing Body (employee # 1), administrative documents, policies and procedures (P&P's) and record reviews performed on the recertification survey on 5/19 thru 5/22/15, it was determined that the facility failed to provide services according to residents needs for 2 out of 8 sample residents (RR #1 and #6). Findings include: 1. The facility is requiring prior to admission, that resident to be admitted and who are disoriented must be accompanied by a family member to observe and to prevent resident ' s falls. During the admission process, the residents must bring with them all maintenance medications that are taking at home, (Cross reference TAG 323). a. According to interview with the Social Worker (employee # 15) performed on 5/21/15 at 11:45 am, she stated: There are two coordinators that goes to the hospitals to interview residents that are going to be admitted to our facility. During the interview, the coordinators give them a form named What to bring? , where it mention the personal items, clothes that they have to bring to our facility during the admission process and includes to bring their maintenance medications that they take at home. Also, the coordinator give orientation to family members that residents who are disoriented needs company during his/her stay at the facility, to give assistance and to watch them to prevent falls. b. During the review of the admission packet performed on 5/21/15 at 1:30 pm, it was found the form named What to bring? On step #4 of this form, establishes that maintenance medications must be brought to the facility in their bottles, not on pill boxes. This form is given to family members during the pre screening process that the coordinator performs prior to admission. c. According to interview with the Administrator (employee # 13) performed on 5/22/15 at 9:30 am, she stated: We recently reviewed the policy related to falls prevention. There is a form with a questionnaire that the coordinator fills out when performs the pre screening of residents before they are admitted to the facility. If the resident shows three or more negative answers is at high risks of falls. During the orientation given to resident or family members it is require that residents have to bring with them their maintenance medications and if it is identified that a resident is disoriented, is required that the resident must be accompanied by a family member to prevent falls. d. During the review of the form with the questionnaire, it was found the following phrases which are cited as follows: SIRO staffs do not offer services of direct supervision. The staff only offers frequently tours to the residents and offers nursing care as required. Do not offer a custodial service that means direct observations to residents. I accept that I have been oriented about the recommendation of providing direct supervision to residents during their admission at the facility with the purpose to prevent falls. e. During interview with the President of the Governing Body (employee #1) performed on 5/22/15 at 10:15 am, she stated the following: I have designated two coordinators that perform the pre screening interview while the resident is at the hospital. They use a questionnaire to identify which resident is at high risk of falls. The coordinator gives the family member a list of things to bring at this facility during the admission process. That includes those medications that the patient is taking at home or if the physician changes some medications we have to wait until the discharge date to obtain the medications that the resident will use. I do not have enough nurses to put in every shift in a 1:1 observation. If a family member stays with the resident, especially during night hours, it helps to prevent falls because the relative is always there watching. f. During RR#1 performed on 5/20/15 at 9:00 a.m. it was found that the facility has develop a standardized plan of care for falls precautions where there are 8 risks factors, such as: has fallen or almost recently has fallen, cognitive condition, visual status, urinary continence, mobility/balance/ transfer, altered vital signs, medical conditions and medications in use. Each risk factor has some interventions where the registered nurse has to identify and perform according to resident's health condition, sign and symptoms that are present at the admission process. On 5/12/15 resident #1 was admitted due to low extremities weakness after a Cerebro Vascular Accident ([MEDICAL CONDITION]). During RR it was found that the registered nurse identified on the cognitive condition, to perform an intervention of requesting company of a family member for 24 hours. This intervention is related to the instructions given by the coordinators to family members during the pre screening process prior to the admission at the facility. g. During interview with the president ' s daughter performed on 5/20 /15 at 10:00 am she stated the following: When mom arrived to the facility she was disoriented. On the admission process, my aunt was with mom and someone of this facility told her to bring someone that can stay some days with her. I was in USA where I live, so I had to call my aunt and give her instructions to search for a caregiver that we know and has taken care of mom at home. The caregiver stayed during night shifts to provide assistance and watch her for falls precautions. I had to pay for the caregiver services for some nights until I arrived to the island. The last two days mom spent the nights alone because she told me that she did not need the caregiver to take care of her. 2. The facility failed to develop a mechanism where the nursing staffs identify residents with falls risks, to establish a 24 hour surveillance, to designate responsibilities to the professional staff that is assigned in every work shift and keep informed the physician in those cases that need medications to control anxiety. 3. The facility failed to have available medications that are commonly used for treating high blood pressure, glucose control, anticoagulants and others that are needed and that are authorized to be at the facility according to the Licencia de Botiquin Medicine Case License which was issued by the Department of Health for this facility. 4. The facility failed to ensure that residents show knowledge of the process to appeal their discharge. a. The group interview was performed on 5/19/15 at 2:50 pm with a participation of 5 residents. During the discussion of some procedures established by the facility it was found that 5 out of 5 residents could not explain the appeal process. b. Resident #6 talked about her concern related to the discharge date . This resident was on rehabilitation treatment after surgery on the cervical area. The health insurance posted the discharge date two days after the resident's admission to the facility. The resident said during group interview that her big concern was that she lives alone and does not have family members that can help her with assistance for Activities of Daily Living (ADL's) and the administration of her medications. She referred that was anxious and with fears that she could have an accident at home due to dizziness and headaches that she is having after surgery. She stated the following: I talked with the physician and she said that I will be feeling better with the treatment that I am receiving here. However, no one talked me about the appeal procedures for my discharge date . Can I do that? |
2018-09-01 |