rowid,facility_name,facility_id,address,city,state,zip,inspection_date,deficiency_tag,scope_severity,complaint,standard,eventid,inspection_text,filedate
8195,CHERAW HEALTHCARE,425005,400 MOFFAT ROAD,CHERAW,SC,29520,2013-06-12,281,D,1,0,YGJV11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the complaint inspection, based on interviews, record reviews and facility policy review, the facility failed to provide the correct insulin coverage for 1 of 4 residents reviewed for insulin administration. Resident #1 did not receive the correct insulin coverage for 3 elevated blood sugar readings during the month of February 2013. The findings included: Resident #1 was admitted to the facility with [DIAGNOSES REDACTED]. A review of the quarterly assessment dated [DATE] revealed that Resident #1 was coded as having a short-term and long-term memory problems with severely impaired cognitive skill for daily decision-making. The MDS (material data set) also coded the resident as needing a one-person assist for ADL (activity of daily living) care. The resident height was documented at 59 inches with a weight of 106 pounds. A review of the closed record on 6/12/13 at 9:15 AM revealed that Resident #1 received sliding scale [MEDICATION NAME] for blood sugars beyond the parameters set by the physician. The physicians order for the sliding scale parameters were as follows: for blood sugars above 200 milligrams/deciliter (mg/dl) give 2 units of [MEDICATION NAME]; above 250 mg/dl give 4 units of [MEDICATION NAME]; above 300 mg/dl give 6 units of [MEDICATION NAME]; above 350 mg/dl 8 units of [MEDICATION NAME]; above 400 mg/dl give 10 units of [MEDICATION NAME]. A review of the MAR (medication administration record) for February 2013 revealed blood glucose readings with incorrect insulin coverage based on the physicians orders: 2/11/13 at 9 PM blood glucose level=362, the resident received 6 units of [MEDICATION NAME] 2/12/13 at 9 PM blood glucose level=377, the resident received 6 units of [MEDICATION NAME] 2/16/13 at 9 PM blood glucose level=377, the resident received 6 units of [MEDICATION NAME] The blood glucose levels were above the 350 mg/dl level and the resident should have received 8 units of [MEDICATION NAME] instead of the 6 units received. A review of the facility's policy for standing orders, provided by the DON (director of nursing) states, Follow sliding scale as ordered for blood sugars and was signed by the physician. A review of the Physician Notification Parameters, provided by the DON read -below 50 mg give [MEDICATION NAME] per protocol; above 250 follow sliding scale order, if MD ordered. An interview with the DON on 6/12/13 at 2:00 PM revealed that the nurses are expected to follow the parameters ordered by the physician when administering sliding scale insulin. If a resident is getting scheduled insulin there are no parameters, unless ordered by the physician. The nurses would track the blood sugar levels and call the physician if there was a problem/pattern or if the resident had a very high blood sugar then they would notify the physician.",2016-06-01
8196,HEARTLAND OF COLUMBIA REHAB AND NURSING CENTER,425008,2601 FOREST DRIVE,COLUMBIA,SC,29204,2013-02-21,329,D,0,1,CSJ811,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the Complaint and Recertification Survey, based on limited record review and interviews, the facility nursing staff failed to appropriately document behaviors for Resident #13 (1 of 16 sampled residents reviewed with psychoactive medications) relative to the administration of one time doses of Intramuscular (IM) [MEDICATION NAME] and [MEDICATION NAME] along with PRN (As Needed) doses of [MEDICATION NAME]. Resident #13 did not receive [MEDICATION NAME] as ordered x 2 doses after an ordered increase in dosage. The findings included: The facility admitted Resident #13 with [DIAGNOSES REDACTED]. While in the facility, Resident #13 was diagnosed with [REDACTED]. Resident #13 was discharged home from the facility on 12/19/12. The closed chart was reviewed. Record review on 2/20/12 revealed a Physician's Telephone Order dated 11/22/12 at 1:00 PM which stated [MEDICATION NAME] 5 mg/ml (milliliter) IM now. The indication for the use of the [MEDICATION NAME] was documented on the order as having been for agitation. Review of the November 2012 Medication Administration Record [REDACTED]. Review of facility Progress Notes revealed a note dated 11/22/12 at 1:42 PM which stated, Resident is alert, responsive and up in w/c (wheelchair) at this time. No adverse reactions to medications, no c/o (complaints of) pain or distress noted on shift. Tx (Treatment) completed with no complications noted. No falls noted on shift. Peg tube patent, flushing and running at this time. VS (Vital Signs) 111/57, 98.7, 80, 20. RP (Responsible Party) notified of new order: [MEDICATION NAME] 5 mg/ml IM now, RE: agitation. There were no Progress Notes prior to this entry that documented any behaviors the resident was exhibiting, the severity of behavior, or an escalation in behaviors to indicate a need for the [MEDICATION NAME]. There was no documentation of any other interventions that had been attempted prior to the administration of the [MEDICATION NAME]. The resident had an order for [REDACTED]. Further review revealed a Physician's Telephone Order dated 11/22/12 at 7:00 PM which stated [MEDICATION NAME] 50 mg/ml now IM. The indication for use for the [MEDICATION NAME] was documented on the order as having been for agitation. Review of the November 2012 Medication Administration Record [REDACTED]. Review of Progress Notes revealed a note dated 11/22/12 at 9:58 PM which stated Resident is alert and responsive. HOB (Head of Bed) elevated to 45 degree angle. TF (Tube Feeding) infusing as ordered. Peg patent and flushes well. Resident ate 25% of meal on shift. No noted distress, no discomfort, no c/o (complaints of) pain. Tolerated meds by peg w/o (without) problems. No concerns voiced on shift. FSBS (Finger Stick Blood Sugar) -261, 4 units of [MEDICATION NAME] per ssi (sliding scale insulin). N.O. (New Order) [MEDICATION NAME] 50 mg/ml IM now given at 7 pm. There was no documentation in the Progress Notes to indicate the resident had exhibited any behaviors or what the agitation had been. During an interview on 2/20/13 at 1:30 PM, RN #1 (the Unit Manager) stated the resident had been sundowning and had been having behaviors right after dinner. After reviewing the above documentation with the surveyor, RN #1 verified that IM [MEDICATION NAME] and [MEDICATION NAME] had been given 11/22/12 for agitation (noted on the telephone orders) with no clear documentation that any behaviors had occurred. Review of a Behavior Assessment form in the hybrid medical record (computer) revealed a blank assessment (nothing documented) dated 11/21/12. Further review with RN #1 revealed there was no Behavior Assessment that addressed behaviors for 11/22/12. When asked, RN #1 stated that the Progress Notes, Medication Record, and the Behavior Assessments were the only behavior documentation the facility used. Review of Progress Notes revealed an entry dated 12/4/12 at 3:09 AM which stated Resident attempting to get up out of bed, [MEDICATION NAME] 0.5 mg one per peg given, brief wet assisted with adl (activities of daily living) care and did lie down, peg tube patent with Glucerna 1.5 infusing. Bed in lowest position. According to the Medication Administration Record, [REDACTED]. However, there was no clear documentation in the note that agitation had occurred and that the redirection of the resident with the brief change had not been a sufficient intervention in itself to get the resident to lie down. Further review revealed a Progress Note dated 12/18/12 at 12:28 AM which stated Alert and restless, legs hanging off bed, adl care given by cna (Certified Nursing Assistant), stated I'm going to my truck, [MEDICATION NAME] 0.5 mg one tab per peg given. Bed in lowest position. According to the MAR, an As Needed dose of [MEDICATION NAME] 0.5 mg had been given at 12:00 AM on 12/18/12. The Progress Note did not paint a clear picture of an agitated resident. The effectiveness of the [MEDICATION NAME] was not documented in the notes or on the Medication Record. During an interview on 2/20/13 at 2:15 PM, RN #1 agreed with the surveyor that the Progress Notes dated 12/4/12 and 12/18/12 were not clear pictures of an agitated resident. After reviewing the December 2012 Medication Administration Record, [REDACTED]. According to RN #1, (in reference to the Progress Note dated 12/18/12), when Resident #13 was focused on going somewhere, he/she was going. During an interview on 2/21/13 at 11:10 AM, the Director of Health Services (DHS) stated that nursing staff are so used to the residents having behaviors that they are not showing these behaviors through their documentation. Record review on 2/20/12 revealed a Physician's Telephone Order dated 11/27/12 which stated D/C (Discontinue) previous [MEDICATION NAME] orders. [MEDICATION NAME] 0.5 mg (milligrams) PO (By Mouth) or via peg (Percutaneous Endoscopic Gastrostomy) at AM (morning) and 1 mg PO or via peg at bedtime. The Indication-Dx (Diagnosis) listed on the order was Agitation/[MEDICAL CONDITION]. Review of the 11/20 - 11/30/12 Medication Administration Record [REDACTED]. There was nothing on the back of the Medication Record to indicate why the doses of [MEDICATION NAME] had not been initialed as having been given. During an interview on 2/20/13 at 2:08 PM, RN #1 stated that the Psychiatrist had written the order for the increased dosage of [MEDICATION NAME] on the evening of 11/27/12. She/He verified there were no initials to indicate that [MEDICATION NAME] 0.5 mg had been given for the morning of 11/28/12 or 11/29/12. RN #1 stated that since the order had been written on the evening of 11/27/12, the medication would not be sent to the facility by the pharmacy until the night of November 28th. The surveyor brought it to the nurse's attention that the medication had not been initialed as having been given on the morning of November 29th either. When asked if the nursing staff could have used the backup pharmacy to obtain the medication, RN #1 agreed that the nurses should have known to use the backup pharmacy. RN #1 stated an order should have been written to start the medication when available or the backup pharmacy should have been called to obtain the medication. According to RN #1 and the DON, the facility did not keep [MEDICATION NAME] in their emergency kit in the facility. The surveyor requested a pharmacy invoice to determine when the medication had been sent to the facility by the pharmacy, but this was not provided prior to exit.",2016-06-01
8197,HEARTLAND OF COLUMBIA REHAB AND NURSING CENTER,425008,2601 FOREST DRIVE,COLUMBIA,SC,29204,2013-02-21,371,E,0,1,CSJ811,"On days of the survey, based on observation, interviews and review of facility policy, the facility failed to ensure food was prepared, distributed and served under sanitary conditions, kitchen staff were not wearing proper hair restraints and food was not served at the correct temperature. The findings included: On all days of the survey Food Service Worker #1 did not use a beard protector. Food Service Worker #2 was observed wearing a ball cap but hair was touching below the collar and not restrained. Interviews on 2/9/13 at approximately 11:00 AM and again on 2/21/13 at approximately 8:39 AM with the Operations Manager, verified no proper hair restraints were used. Steam table temperatures of the lunch meal on 2/20/13 at approximately 12:10 PM by Food Service Worker #1 revealed Macaroni Salad , the menu alternate, was at 51 degrees Fahrenheit. An interview with Food Service Worker #1 verified that the Macaroni Salad, the menu alternate, was not 41 degrees Fahrenheit. He/she stated the Macaroni Salad was just put in the refrigerator.",2016-06-01
8198,FAITH HEALTHCARE CENTER,425009,617 WEST MARION STREET,FLORENCE,SC,29501,2012-08-22,174,E,0,1,RTYQ11,"On the days of the survey, based on the Group Meeting concerns and interviews, the facility failed to provide a portable phone that would function adequately throughout the building or in the 3 of 3 nursing unit halls . The findings included: During the Resident Group Meeting on 8/21/12 at 3:30pm, 2 of 3 Residents who attended the meeting voiced concerns related to portable phone usage. The facility had portable phones on all 3 nursing units. The Resident's stated the Staff bring the portable phone to you, but it will not work everywhere in the building. During an interview with Gwendolyn Turner, Social Worker (SW) on 8/22/12 at 9:45am, Surveyor reviewed the Resident's concerns discussed at the Group Meeting. The SW was not aware that the portable phones would not work throughout the building. During an interview with the SW on 8/22/12 at 2:30pm, the SW verified that the portable phones on all 3 nursing units worked half way down the hall then would shut off. The SW stated the Administrator verified the portable phones did not work in all areas of the building and was working on replacing the portable phones at this time. Review of the Resident Concern/Grievance Response Form, on 8/22/12 at 2:45pm, verified The facility replaced all cordless phones at each nurses station for the residents to use when in room.",2016-06-01
8199,FAITH HEALTHCARE CENTER,425009,617 WEST MARION STREET,FLORENCE,SC,29501,2012-08-22,253,E,0,1,RTYQ11,"On the days of the survey based on observations, the facility failed to provide housekeeping and maintenance services to maintain a sanitary, orderly, and comfortable interior for 3 of 4 Units reviewed. Stained/soiled tablecloths and chairs were noted on the Skilled Wing, C-Wing, and AB Wing dining areas. Stained and soiled shower stalls/equipment were noted on 1 of 3 Units with showers. The findings included: On 8/21/12 at 3:30 PM, observation of the Restorative Dining Area on the C-Wing revealed tablecloths with stains and food particles. At 3:45 PM, observation of the C-Wing dining area revealed three stained upright chairs and two stained tablecloths. Observation of the AB Hall revealed two stained upright burgundy chairs noted in the small TV/Dining area. Observation of the Skilled Dining Room revealed three stained upright chairs and eight stained tablecloths. During initial tour on 8/20/12, observation of the Skilled Unit revealed a shower room on the West Hall that contained a shower trolley. Lifting the shower trolley pad, small particles of debris and a small cotton pad was observed. A purple/teal colored shower curtain was torn and the plastic liner was noted with several tears. The shower trolley was observed again on 8/22/12. On 8/22/12 at 2:30 PM, during environmental rounds with the Administrator, he confirmed the condition of the trolley and the torn shower curtain. During and interview with the Administrator on 8/22/12, it was revealed that Housekeeping was responsible for cleaning the shower trolleys weekly and that the Certified Nursing Assistants were to clean them after every use. During the interview with the Administrator on 8/22/12, it was also revealed that the Dietary Supervisor was to change tablecloths twice a week and as needed.",2016-06-01
8200,FAITH HEALTHCARE CENTER,425009,617 WEST MARION STREET,FLORENCE,SC,29501,2012-08-22,279,E,0,1,RTYQ11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on record reviews, the facility failed to ensure that comprehensive care plans were developed for residents with tracheostomies related to type and size of cannulas needed, availability of back-up [MEDICAL CONDITION], and emergency procedures in the event of decannulation for 2 of 2 residents reviewed who had tracheostomies (#2 and #13). The findings included: Review of the plans of care for resident #2 and resident #13 revealed that their [MEDICAL CONDITION] status was included in various problems, however, the care plans did not address what types of cannulas the residents required, the size needed, the location of emergency replacement cannulas, or emergency procedures to be used in the event of decannulation. Cross refer to F-328.",2016-06-01
8201,FAITH HEALTHCARE CENTER,425009,617 WEST MARION STREET,FLORENCE,SC,29501,2012-08-22,281,D,0,1,RTYQ11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on record review, interview, and review of the FSBS/SS(Fingerstick Blood Sugar/Sliding Scale) Tool, the facility failed to ensure services provided by the facility met professional standards of quality. Sliding scale insulin was not given as ordered for 1 of 3 residents receiving sliding scale insulin.(Resident #18) The findings included: The facility admitted Resident #18 with [DIAGNOSES REDACTED]. Record review on 8/22/12 revealed the resident had an order for [REDACTED]. On 8/22/12, during an interview with LPN(Licensed Practical Nurse)#3, she stated that due to the resident receiving a scheduled PM dose of [MEDICATION NAME] at 5:00 PM, that was probably why the sliding scale insulin was not given. During an interview with the Unit Manager for C-Hall on 8/22/12, she stated that due to the PM scheduled dose of insulin that was probably why nurses did not give the coverage. There was no evidence presented that the resident's physician was contacted to clarify the order. On 7/24/12, blood sugars had been added to the facilitys Quality Assurance due to multiple holes, incorrect dosages, orders without parameters. On 7/25/12, Unit Managers, DON(Director of Nursing), and ADON(Assistant Director of Nursing) were inserviced on blood sugar policy and audit tools. Audit tools were put into place and to be done daily per Unit Managers/ADON/DON, and week-end supervisor. An audit for this resident was not presented during the survey and no evidence was presented that the Unit Manager had recognized a problem with the resident not receiving the sliding scale coverage. The Unit Manager stated that the audit tool indicated the same as the resident's MAR.",2016-06-01
8202,FAITH HEALTHCARE CENTER,425009,617 WEST MARION STREET,FLORENCE,SC,29501,2012-08-22,314,E,0,1,RTYQ11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on record review and observation, the facility failed to ensure that residents having pressure ulcers received necessary treatment and services to promote healing for 2 of 5 residents reviewed for pressure ulcers (#2 and #15). Resident #2 had the wrong treatment to his wound on 8/21/12. Resident #15 showed signs of decline in his wound that were not communicated to his physician for possible change of treatment. The findings included: Resident #2 entered the facility with a pressure ulcer on his upper left back, over the scapula. Licensed Practical Nurse (LPN) #2 did wound care to the ulcer on 8/21/12 at approximately 3:30 PM. She was assisted by the RN Unit Manager. LPN #2 stated the treatment included cleansing the pressure ulcer with wound cleanser, applying Hydrogel, and then covering the area with [MEDICATION NAME] dressing. The Unit Manager left the resident's room to check the treatment order and returned saying that was the treatment ordered by the physician. LPN #2 provided the wound care with appropriate technique. Review of the medical record revealed that on 8/7/12, the physician changed the treatment order from Hydrogel once a day to: Cleanse (L) upper back (with) wound cleanser, apply wet to dry dressing BID (twice a day). Review of the Treatment Record for August 2012 showed the treatment ordered on [DATE] was not started until 8/21/12 at 8 PM. Resident #15 arrived at the facility with a pressure ulcer on his left outer ankle, a Stage II. the admitting nurse's note stated it measured 2.5 by 2.5 centimeters (cm) and had yellow drainage. The wound bed had slough and beefy red tissue. Review of the medical record revealed the resident had a number of comorbidities and behaviors that compromised his ability to heal. Review of the Nurse's Notes (NN) and Wound Management Program Weekly Wound Documentation (WWD) revealed the following information: NN, 6/13/12, left ankle, Stage II, 2 by 2.4 cm with slough around the edges and 100% granulation wound bed tissue. The nurse notified the physician who ordered treatment with Santyl to the slough and Hydrogel to the wound bed covered with [MEDICATION NAME] dressing daily. NN, 6/27/12, left ankle 2 by 2.3 cm with little slough noted and no odor. WWD, 7/12/12, the wound measured 2 by 1.6 by WWD, 7/18/12, the wound was not assessed due to the resident's one day hospitalization for a surgical procedure for [MEDICAL TREATMENT] in the right arm. WWD, 7/26/12, the wound measured 2.5 by 2.0 by WWD, 7/25/12, the wound measured 3 by 2 by 0 cm. It was now 80% granulation with 20% slough tissue. A large amount of creamy beige drainage was noted. There was no odor. The resident was noted to have a faint pedal pulse. NN, 8/1/12, left ankle 2.5 by 1.5 cm with moderate amount of drainage. Review of the medical record failed to show that the facility consulted with the resident's physician since 6/13/12 about the condition of the pressure ulcer. The data in the WWD showed increased drainage from small amount to large amount, and a change in the drainage quality to creamy beige. An interview with the Director of Nurses (DON) and the Skilled Unit Manager (UM)on 8/22/12 at 11:45 AM revealed the resident arrived at the facility with beige drainage. His ulcer was superficial, had no odor, and did not show any signs of infection. Therefore, there was no reason to notify the physician. The resident was admitted to the hospital on [DATE] with coffee grounds emesis, an infected wound of the right forearm, and an infected left foot wound. When he returned to the facility on [DATE] the pressure ulcer measured 11 by 10.8 by During the interview with the DON and UM, they stated the wound had been debrided at the hospital resulting in the increased size of the open area.",2016-06-01
8203,FAITH HEALTHCARE CENTER,425009,617 WEST MARION STREET,FLORENCE,SC,29501,2012-08-22,328,E,0,1,RTYQ11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on record reviews, observations, interviews, and review of facility policies and procedures, the facility failed to ensure that residents with tracheostomies had appropriate equipment and emergencies procedures in place in the event of decannulation for 2 of 2 residents observed with tracheostomies (#2 and #13). The findings included: Resident #2 arrived at the facility with a #10 cuffless [MEDICAL CONDITION]. He had had his [MEDICAL CONDITION] since 1998. The information about type and size of the [MEDICAL CONDITION] was documented on the hospital transfer forms at his admission in April 2012 and on his return from a hospital stay at the end of July 2012. The information was also included in the admitting nurse's note, and randomly throughout the nurses' notes by one particular nurse. It was not included in the physician's orders [REDACTED]. An observation of the resident's room at approximately 4:55 PM, in the company of a CNA revealed no evidence of a back-up [MEDICAL CONDITION]. At 5 PM, Licensed Practical Nurse (LPN) #3 was asked to show where the back up [MEDICAL CONDITION] was located. She stated that she had to call the Security Officer to unlock the storage room on the D wing. LPN #3 was asked if there was a back-up [MEDICAL CONDITION] in the resident's room, and she stated there was not. A search of the supply room revealed no back-up [MEDICAL CONDITION] for the resident. Only disposable inner cannulas in size 6 were noted. At 5:07 PM, LPN #3 returned to Unit C and in response to the question of what size tube was required, browsed through the resident's chart looking for the size and type of his [MEDICAL CONDITION]. LPN #3 paged the Unit Manager (UM) for Units AB and C. The RN UM responded to the page at 5:17 PM. Both she and LPN #3 searched the resident's room for the back-up [MEDICAL CONDITION]. At 5:30 PM, the RN UM was still looking. At 5:45 PM, the RN UM stated there was no back-up [MEDICAL CONDITION] for the resident. At 6:15 PM, LPN #3 was observed bringing the resident to the dining room. She stated they had taken him from the dining room to his room so they could check his [MEDICAL CONDITION] for size. It was size 10, just like he said. During the search of the resident's room, LPN #3 was asked if the resident pulled out his [MEDICAL CONDITION]. She replied that the nurses would sometimes find him at the sink in his room, brushing out his inner cannula. Review of the Nurse's Notes revealed two incidents in which the resident removed his inner cannula. A nurse's note on 7/20/12 at 5 PM stated the resident pulled out his inner cannula. A mucous plug was found and removed. The resident was provided with [MEDICAL CONDITION] care and suctioned. The pulse oximeter showed a reading of 96%. The next incident was noted in the 7/28/12 nurse's note at 10 PM. The resident had thick yellowish-green secretions and had been suctioned five times and provided with [MEDICAL CONDITION] care. . Pt (patient) has the tendency to be noncompliant (with) safety rules, with taking out the inner cannula of his trach. Pt pulled out his inner cannula on his own. Informed pt @ the beginning of the shift -> 7P, and throughout night, not to pull out his inner cannula & explained why. Review of the physician's orders [REDACTED]. The resident could also be suctioned as needed. The resident was hospitalized from 7/29 to 8/1/12 for pneumonia. Review of the resident's plan of care revealed three problems including the [MEDICAL CONDITION]. The resident had a potential for respiratory distress related [MEDICAL CONDITION] USE OF OXYGEN. Facility staff were directed to monitor for symptoms; do lung assessments as indicated; administer medications; check pulse oximeter readings as indicated; apply oxygen; and provide non-sterile [MEDICAL CONDITION] care. The resident had agitated behaviors, Resident will take out inner cannula of trach. Approaches to this problem included update physician; be supportive; be patient; explain why he should not exhibit these behaviors; inform family; and administer medications. The third problem stated Resident unable to speak related to [MEDICAL CONDITION]. Resident had a trach. Interventions for this problem included to ask the resident to speak slowly; ask him to repeat communications; remove him to a quiet location; be supportive; ask yes/no questions; ask other staff members to assist; have speech therapy work with him and communication book; and use pad and pen to write. The care plan did not state the resident's type and size of [MEDICAL CONDITION] or what to do in the event of decannulation. Resident #13 came to the facility with a stainless steel [MEDICAL CONDITION] in place. Review of the hospital discharge summary and the medical record failed to show documentation regarding the size of the resident's [MEDICAL CONDITION] or how long the resident had her [MEDICAL CONDITION]. No back-up cannula was noted in the resident's room on 5/20/12. Facility staff could not locate a back-up [MEDICAL CONDITION] for the resident. LPN #4 confirmed the resident had no back-up [MEDICAL CONDITION] at 7:15 PM on 5/20/12, and the company's MDS (Minimum Data Set) consultant confirmed at 7:30 PM on 8/20/12 that the size of the [MEDICAL CONDITION] was unknown. An interview with LPN #5 on 8/21/12 at 10:30 AM revealed the resident did remove her inner cannula, usually after [MEDICAL CONDITION] care. One time, the resident repeatedly removed the inner cannula when she was angry. Review of the medical record revealed the resident was found with her inner cannula in her hand on 6/24/12 at 6:30 PM. She initially refused to allow the nurse to reinsert it but after a few minutes and cleaning of the cannula, she did allow it to be reinserted. The inner cannula was found later that evening, according to the 7:10 PM nurse's note, lying on the bedside table. No respiratory distress was noted. The resident's [MEDICAL CONDITION] collar was adjusted and [MEDICAL CONDITION] care was provided. According to the 7:10 PM nurse's note, the resident pulled it out several more times. The next incident was recorded on 7/24/12 at 1:45 PM when the resident was noted to have removed her inner cannula and placed it on the bedside table. The resident had no complaints and allowed [MEDICAL CONDITION] care and reinsertion of the inner cannula. an order for [REDACTED]. Review of the plan of care for the resident revealed the information that she had a [MEDICAL CONDITION] was included in various problems, but there was no specific problem noting what size and type of [MEDICAL CONDITION] she used, the location of a back-up [MEDICAL CONDITION], or what to do in the event of decannulation. The resident had a potential for respiratory distress because of her [MEDICAL CONDITION] and history of airway obstruction related to stroke. Facility staff were to do lung assessments as indicated; monitor oxygen status; give support when experiencing shortness of breath or air hunger; administer medications and update physician; monitor for signs and symptoms of infection; perform vital signs as indicated; aerosol breathing treatments as indicated; change tubing and water bottle; administer oxygen; and use non-sterile technique for [MEDICAL CONDITION] care. The resident was unable to speak R/T (related to) Trach. [MEDICAL CONDITION]. Approaches included asking the resident to repeat; being supportive; asking yes/no questions; asking other staff to help; and allowing the resident to use gestures. The resident resisted care at times ([MEDICAL CONDITION] care, therapy, personal care) related to her desire to go smoke. Interventions included a calm and gentle approach; informing the resident of the next event prior to beginning care; reapproaching at a later time; updating the physician; and informing the resident of smoking times. As a result of the findings on 5/20/12 that 2 of 2 residents with tracheostomies had no back-up [MEDICAL CONDITION] cannulas available in the facility, the facility obtained [MEDICAL CONDITION] kits from the hospital that contained a range of cannula sizes. One kit was placed at each resident's bedside for emergency use. Since the size of resident #13's [MEDICAL CONDITION] was unknown, directions were given by the medical director to use a smaller size that would fit the stoma and send her immediately to the emergency room in the event of decannulation. During an interview with the DON and MDS Consultant, they stated that nursing staff had been through a skills check-off for care of residents with tracheostomies. The staff check-offs could not be located. As a result, the DON stated she would inservice the 7P to 7A staff on emergency decannulation procedures before leaving the facility on 8/20/12 and she would inservice the 7A to 7P staff on the morning of 8/21/12. Nursing staff not on duty would be required to have the training prior to taking care of residents with tracheostomies. Review of the facility's [MEDICAL CONDITION] Cannula Change policy presented to the survey team on 8/20/12 revealed under the heading Equipment: [MEDICAL CONDITION] cannula (size as ordered) and one size smaller needed to be available. Under the heading Procedure was 17. Maintain another [MEDICAL CONDITION] cannula (same size) on standby at resident's bedside. and 18. Maintain another [MEDICAL CONDITION] cannula one size smaller in the facility.",2016-06-01
8204,FAITH HEALTHCARE CENTER,425009,617 WEST MARION STREET,FLORENCE,SC,29501,2012-08-22,431,D,0,1,RTYQ11,"On the days of the survey, based on observation, review of the facility policy Drug and Biological Storage and interview, the facility failed to store drugs in locked compartments. A package of Methotrexate was noted within the pages of the Medication Administration Record(MAR) on the Skilled Unit. The findings included: On 8/21/12 after observing a tube flush at 5:35 PM, this surveyor exited the room to observe the MAR . Within the pages of the MAR a small plastic bag containing 32 Methotrexate 2.5 milligrams pills was discovered. After the Unit Manager exited the room, she was shown the bag containing the Methotrexate. She stated at that time that she had not placed the bag within the pages of the MAR and she did not know who had placed the bag there. She stated that when a drug is received from the pharmacy, it was to be locked up for safety. Cognitively impaired mobile residents were noted on the Unit. Review of the facility policy titled Drug and Biological Storage revealed drugs were to be stored in an appropriately lighted, locked storage area accessible to authorized personnel only.",2016-06-01
8205,FAITH HEALTHCARE CENTER,425009,617 WEST MARION STREET,FLORENCE,SC,29501,2012-08-22,441,D,0,1,RTYQ11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on observation and review of facility policy Procedure for Clean Dressing Change, the facility failed to provide a safe, sanitary environment to help prevent the development and transmission of disease and infection. Inappropriate infection control practices were noted during and after observing wound care. (Resident #8). The findings included: The facility admitted Resident #8 with [DIAGNOSES REDACTED]. During observation of pressure sore treatment on 8/21/12 at 10:50 AM, Licensed Practical Nurse(LPN)#2 was observed after donning gloves to cleanse the wound; dry the wound; place a dry 4 X 4 in the wound; place 4 x 4's over the area; tear several strips of tape from a roll and place them over the 4 x 4's. After washing her hands and exiting the room, LPN #2 was followed to the treatment cart. After opening the treatment care, LPN #2 was asked if the resident had a drawer specific for his supplies in which she stated no. After describing the treatment to LPN #2, she stated that she would dispose of the tape. Review of the facility policy titledProcedure for Clean Dressing Change, revealed the following: 12. Clean wound as ordered .;13. Screen the wound and determine if the treatment continues to be appropriate; 14. Remove gloves and wash hands; 15. Apply new gloves; 16. Dress as ordered .17. Remove gloves and wash hands.",2016-06-01
8206,FAITH HEALTHCARE CENTER,425009,617 WEST MARION STREET,FLORENCE,SC,29501,2012-08-22,496,D,0,1,RTYQ11,"On the days of the survey, based on review of employee files and interview, the facility failed to ensure that information was obtained from every State Certified Nursing Assistant (CNA) Registry before allowing an individual to serve as a nurse aide for 1 of 1 CNA hired who was certified in another state. The findings included: Review of five employee files, three of whom were CNAs, hired in the past four months, revealed one of the CNAs hired was also certified in the state of Georgia. The facility was unable to show evidence that the Georgia state registry was contacted for information prior to allowing the CNA to work with residents at the facility. An interview with the facility's Human Resources manager on 8/21/12 at 10:15 AM confirmed this finding.",2016-06-01
8207,FAITH HEALTHCARE CENTER,425009,617 WEST MARION STREET,FLORENCE,SC,29501,2012-08-22,514,D,0,1,RTYQ11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on record reviews and interviews, the facility failed to maintain clinical records on each resident in accordance with accepted professional standards and practices that are complete and accurately documented for 3 of 13 sampled residents' records reviewed. Residents #1, #3, and #4 Cumulative physician's orders [REDACTED]. The findings included: The facility admitted Resident #3 with [DIAGNOSES REDACTED]. Record review on 08-21-12 at 11:50 AM of the Cumulative physician's orders [REDACTED]. During an interview on 08-22-12 at 8:55 AM with the Director of Nursing, after record review, verified the above as noted and revealed the Unit Manager had been responsible to ensure the July Cumulative physician's orders [REDACTED]. Resident #4 had [DIAGNOSES REDACTED]. During a record review on 8/21/12 at 10:40am, the cumulative Physician Orders revealed 2 different sacral wound treatments listed below: - Clean left buttock with wound cleanser/pack lightly with [MEDICATION NAME] Calcium Alginate/apply skin prep to wound edges/cover with gauze and secure with tape/change every 2-3 days and as needed for drainage. - Cleanse area on coccyx with wound cleanser/wipe dry/apply hydrogel and cover with stratsorb dressing twice daily until healed (Stage II)/Medispetic to surround area. During a record review on 8/21/12 at 10:42am, the Report of Consultation for 6/25/12 report stated, change left buttock treatment to: thin layer of hydrogel, pack lightly with damp saline gauze, cover with dry gauze, secure with tape and change twice daily. During an interview on 8/21/12 at 12:45am, Licensed Practical Nurse #4 verified the dated 8/1/12 cumulative physician's orders [REDACTED]. on the Treatment Administration Record for the order. The facility admitted Resident #1 with [DIAGNOSES REDACTED]. Record review on 8/21/12 revealed a diet was not listed on the current cumulative orders for August 2012.",2016-06-01
8208,WHITE OAK MANOR - SPARTANBURG,425024,295 EAST PEARL STREET,SPARTANBURG,SC,29303,2012-05-16,224,D,0,1,YFIO11,"On the days of the survey, based on observations, interviews and review of the Resident Council Minutes, the facility failed to meet the needs of a resident timely as evidenced during a random observation of neglect when a resident requested the facility staff to toilet her. Three of 7 residents in a group interview, monthly Resident Council Minutes, and this random observation made during the survey, indicated there was a concern with a delay in response to meet resident needs, timely. The findings included: A random observation on 5/15/12 at approximately 3:25 PM on Unit 1 revealed a resident seated in a reclined chair near the nurse's station with two licensed nurses and 2 CNA's standing or seated around the nurse's station. The resident seated in the reclined chair stated, I need to go to the bathroom. No staff member positioned at the nurse's station responded to the resident. The resident in the reclined chair repeated the statement, I need to go to the bathroom. The facility staff at the desk continued to work without acknowledging the resident's request or that the resident had spoken. The surveyor informed Licensed Practical Nurse (LPN) #1 at the desk that the resident stated she needed to go to the bathroom. LPN #1 asked the resident what she said and the resident repeated, I need to go to the bathroom. LPN #1 asked a Certified Nursing Assistant (CNA), also at the nurse's station, to assist the resident. The CNA walked past the resident, down the hall, then returned after a short period of time. The CNA then took the resident to her room and returned to the nurse's station after a brief period of time. At that time the CNA that was asked by LPN#1 to assist the resident with her request of toileting was observed going down a different hallway away from the resident's room. This surveyor again approached LPN #1 and asked if the services requested by the resident had been provided since the CNA that removed the resident was observed leaving the area. LPN #1 stated she would find out. An interview on 5/15/12 at approximately 3:40 PM with LPN #1 revealed the CNA was informed by another facility nurse to find the resident's assigned CNA to provide the care. LPN#1 stated she would assist the CNA originally approached in providing care to the resident. An interview on 5/15/12 at approximately 3:45 PM with Registered Nurse (RN) #1 revealed her process/procedure was to let the assigned CNA provide resident care and if the assigned CNA was not available the CNA present would provide the care. Neglect means failure to provide goods and services necessary to avoid physical harm or mental anguish. (42 CFR 488.301) On 5/15/12 at approximately 11 AM Review of the Resident Council Minutes for 1/10/12 under New Business there was notation that the residents reported call lights were not being answered. Review of the Resident Council Minutes for 2/14/12 under New Business the residents reported: They are waiting longer for call lights to be answered especially during lunch and dinner. Review of the Resident Council Minutes for 3/13/12 revealed no New Business was discussed. Review of the Resident Council Minutes for 4/10/12 revealed under New Business an area of concern call lights being turned off prior to need being met. Review of the Resident Council Minutes for 5/09/12 revealed under Old Business call lights being answered timely and resident indicated that call lights are better. On 5/16/12 at approximately 1:45 PM during group interview 3 of 7 group members stated that they still have concerns related to the staff response to call light. One group member stated she has to wait a long time for the staff to respond to call lights just before lunch. One group member stated on weekends they have to wait a long time for the staff to respond to call lights. One group member stated the biggest concern was that the staff would tell residents that you have to wait for the Certified Nursing Assistant (CNA) assigned before needs could get met. The residents further stated that staff continued to turn the call lights off before needs are met and tell the residents they will inform the assigned CNA. The residents stated that sometimes no one would return provide the care. The group member further stated that they addressed their concerns with the facility's administrative staff.",2016-06-01
8209,WHITE OAK MANOR - SPARTANBURG,425024,295 EAST PEARL STREET,SPARTANBURG,SC,29303,2012-05-16,250,D,0,1,YFIO11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on record review and interview, the facility failed to provide medically related social services for a resident with an uncertain discharge. Resident #25 was noted with inconsistent documentation for discharge planning. (1 of 3 closed charts reviewed) The finding included: The facility admitted Resident #25 on 3/12/12 with [DIAGNOSES REDACTED]. Record review revealed an Admission MDS (Minimum Data Set) dated 3/19/12 that indicated the resident had short and long term memory problem with cognitive impairments. Review the care plan with an identified problem date of 3/21/12 indicated the resident discharge plan was uncertain at that time but resident may remain in facility long term care related to dementia. Review of an Admissions Coordinator note dated 3/12/12 indicated spouse and other members of the family hoped for resident to return to the home environment. A Social Services note dated 3/20/12 indicated resident was new admission to facility with uncertain discharge plan. The Social Services note further indicated the resident had Dementia and was not aware of his circumstance. A Social Services note dated 3/27/12 indicated resident had problems related to uncertain discharge date . A care plan with an identified problem date of 4/08/12 indicated the resident required use of restraints related to unassisted transfer attempted/poor safety awareness. A Social Services note dated 4/10/12 indicated resident had problem with uncertain discharge date and Dementia. The Social Services note further indicated the resident had Dementia and was not aware of his circumstance. A Social Services noted dated 4/24/12 indicated the resident had problems with an uncertain discharge. There were no further Social Services notes related to discharge planning. A Licensed Nurse note dated 4/27/12 indicated the resident was to go to an Assistive Living Facility on Monday (4/30/12). An interview on 5/16/12 at approximately 10:30 AM with the Social Services Director (SSD) revealed after reviewing the medical record that 3/20/12 was the first noted documentation related to discharge. The SSD further stated she will check and see if there was further Social Services documentation related to discharge planning prior to 3/20/12. On 5/16/12 at approximately 11:30 AM the Administrator indicated there were no prior Social Services notes related to discharge planning. There was no documented social services notes to assure the resident's needs were met post discharge. Although information was provided of a synopsis of ongoing meetings with the family concerning the resident's stay, insurance coverage, alternative discharge options, there was no evidence of documentation in the social service notes of her knowledge of this process, family/resident support and the ultimate discharge from the facility.",2016-06-01
8210,WHITE OAK MANOR - SPARTANBURG,425024,295 EAST PEARL STREET,SPARTANBURG,SC,29303,2012-05-16,441,D,0,1,YFIO11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on observation, interview, and review of the facility provided policy on Hand Hygiene, the facility failed to maintain a sanitary environment. Following a [DEVICE] flush the nurse failed to wash her hands prior to touching another resident. ( 1 of 3 gastric tube flushes observed for infection control practices - Resident #4.) The findings included: The facility admitted Resident #4 with [DIAGNOSES REDACTED]. After observing a tube flush treatment on 5/15/12 at 12:15 PM, LPN # 3 took a plastic bag of trash to the soiled utility room on 400 Unit. The nurse placed the bag of trash into a trash barrel, replaced the lid on the barrel, and exited the room. She proceeded down the hall to the laundry, entered and placed the other plastic bag of soiled linen into the receptacle for soiled linen. The nurse exited the laundry area and started down the hall. A resident said something and the nurse entered the resident 's room, walked over to the resident, placing her hands on the resident's shoulder and wheelchair. The nurse had not washed her hands prior to leaving the soiled utility room or laundry room, prior to touching the resident During an interview with the ADON ( Assistant Director of Nursing) on 5/16/12 at 9:10 AM, The ADON confirmed the nurse should have washed her hands before leaving the soiled utility room and before leaving the laundry. Additionally, the nurse should have washed her hands before direct contact with the resident. Review of the facility's policy on Hand Hygiene documented Hand Hygiene should be done: before and after direct resident contact and after contact or handling of soiled linens or equipment.",2016-06-01
8211,CHESTER NURSING CENTER,425061,1 MEDICAL PARK DRIVE,CHESTER,SC,29706,2012-05-03,223,L,0,1,WII411,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** July 17, 2012 - Ammended to reflect change of original Scope and Severity Lowered to K and lowered Scope and Severity to E On the days of the Recertification and Extended Survey, based on observations, record review, and interviews, the facility failed to ensure the staff monitored visitors/sitters interactions with residents to ensure the safety and well being of residents in the facility. Resident #18 was allegedly verbally abused by Resident #11's visitor/sitter. The findings included: Cross refers to F-226 as it relates to the failure of the facility to follow policy to identify abuse and neglect, report allegations of abuse/neglect as well as protect residents from further abuse/neglect once an allegation was reported. Cross refers to F-490 as it related to the failure of the facility Administration to provide the necessary oversight to ensure policies and procedures related to protecting residents from abuse/neglect by reporting and intervening to prevent further abuse/neglect was implemented properly. The Administration was not aware paid sitters were operating in the building and the facility had no policies in place to ensure sitters were aware of facility policies and procedures and met regulatory requirements. Cross refers to F-520 as it relates to the failure of the facility to be aware that paid sitters were operating in the building and the facility had no policies in place to ensure sitters were aware of facility policies and procedures. The facility admitted Resident #18 with [DIAGNOSES REDACTED]. Record review revealed an Annual MDS (Minimum Data Set) dated 6/17/11 that indicated the resident had a BIMS (Brief Interview for Mental Status) of 3 indicating she was cognitively impaired. Review of the MDS dated [DATE] indicated Resident #18 had long and short-term memory with severe cognitive impairment in daily living skills. The MDS further indicated the resident had the ability to respond adequately to simple direction; no behavior problems were noted. On 5/01/12 at approximately 4 PM this surveyor heard loud yelling on the Gaston Unit. At least four staff members were observed on the unit at the time of yelling. As the surveyor approached the room from which the yelling was coming, she observed a tall, large male, believed to be a family member of Resident #11, standing over, yelling and pointing his finger at Resident #18 who was seated in a Geri chair. The male looked directly at Resident #18 and stated, You don't talk to her. You don't say anything to her. You all better move her. Prior to the surveyor approaching the room a hospice nurse was observed standing outside the door while the family member yelled at Resident #18. The surveyor in the hallway observed four facility staff members, fail to respond to the family member yelling at Resident #18. The surveyor approached the staff in the hallway and asked, Can anyone hear the yelling going on down the hall? What are you going to do about the family member yelling at the resident? The staff looked at the surveyor and hesitated. CNA (Certified Nursing Assistant) #3 entered the room and the family member and Resident #11 exited the room. The nurse at the medication cart did not attempt to protect Resident #18 from the angry family member. At approximately 4:08 PM the surveyor overheard Licensed Practical Nurse (LPN) #1 asking Registered Nurse (RN) #1 What should I do? Should I write a report? The State Agency surveyor reported to the Administrator at 4:35 PM on 5/01/12 the staff 's failure to respond immediately to protect Resident #18 from the alleged family member. In addition, the family member/sitter that was observed verbally abusing Resident #18 was allowed by staff to remove Resident #11 from the room via wheelchair and go to an unsupervised area of the skilled nursing facility without intervention by staff. In an interview with the surveyor on 5/02/12 at approximately 3:35 PM CNA #1 stated Resident #18 was confused and always made statements like This is my house. The CNA stated the visitor had been observed having conversations with himself but that 5/01/12 was the first time I have seen him in this rage. CNA #1 stated the visitor was loud and had been observed fussing with the staff last week. She stated that she did not respond to the yelling because the visitor was generally loud. The surveyor interviewed CNA #3 at approximately 3:50 PM on 5/02/12; she stated that she did not pay attention to the visitor's loud talking because he generally spoke loudly. In an interview with the surveyor on 5/02/12 at approximately 4:05 PM RN #1 stated the visitor was generally loud and sometimes he would get upset about clothes. In an interview with the surveyor on 5/02/12 at 8:30 AM the Administrator stated he was not aware of the Elder Justice Act (Affordable Care Act 2012), which requires long-term care facilities to report any reasonable suspicion of crimes. On 5/2/12 at 5:05 PM the Administrator stated the visitor was not a family member but a private sitter. The Administrator stated he was unaware the visitor was not a relative until today. The facility had no policy and procedures in place related to paid sitters and their role in the facility. On 5/2/12 at 1:55 PM, the Administrator and the Director Of Nursing were notified of a second Substandard Quality of Care and/or Immediate Jeopardy existing in the facility when an observation was made of a visitor verbally abusing a resident with no staff intervention to protect the resident. Documentation of inservices, observations, and interviews revealed the Allegation of Compliance submitted by the facility on 5/3/2012 had been implemented by the facility and was in practice removing the immediacy of the deficient practice. Facility nursing staff had been educated and were knowledgeable of abuse policies and facility procedures. The Administrator was informed of this on 5/3/12. The citation at F-223 remained at a lower scope and severity of E.",2016-06-01
8212,CHESTER NURSING CENTER,425061,1 MEDICAL PARK DRIVE,CHESTER,SC,29706,2012-05-03,225,L,0,1,WII411,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** July 17, 2012 - Ammended to reflect change to original Scope and Severity to J and lowered Scope and Severity to D On the days of the Recertification and Extended survey, based on record reviews, interviews and incident logs, the facility failed to ensure that all alleged violations involving mistreatment, neglect, or abuse, were reported immediately to the administrator of the facility and to other officials in accordance with State law through established procedures (including to the State survey and certification agency). Application of heat by a licensed staff member to the leg of Resident #11, 1 of 3 residents reviewed for heat treatments, was applied improperly and not monitored resulting in a second degree burn to the resident. The incident was not reported as possible neglect to the State Agency. The findings included: Cross refers to F-226 as it relates to the failure of the facility to follow policy to identify neglect, report allegations of neglect as well as protect residents from further neglect once an allegation was reported. Cross Refers to F-281 as it relates to the failure of the facility Nursing staff to verify the physician's orders [REDACTED]. The failure placed Resident #11 at risk of serious harm. Cross Refers to F-323 as it relates to the failure of the facility to provide necessary care for Resident #11 when a licensed staff member used a microwave to heat a compress and placed the heated compress directly on the resident's leg without using a barrier between the resident's leg and the compress. This action resulted in a second degree burn to the resident's leg. Cross Refers to F-490 as it relates to the failure of the Administrator to ensure the facility was administered in a manner that enabled it to use its resources effectively and efficiently to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident. The administrator was aware that a licensed nurse used a microwave to heat a compress and apply it directly to a resident's leg that resulted in a second degree burn and failed to implement corrective action to ensure resident safety. Cross Refers to F-520 as it relates to the failure of the facility to ensure that the Quality Assurance process was utilized to identify, monitor and implement a plan of correction related to an injury that was the result of applying heat to a resident incorrectly. The facility admitted Resident #11 on 11/18/2011 with [DIAGNOSES REDACTED]. Review of the Physician's Telephone Orders (TO) revealed that Resident #11 had a TO (telephone order) dated 3/11/12 for Heat to knee and a clarification order on 3/11/12 for heat to knee q (every) shift. On 3/27/12 a new TO was written to D/C (discontinue) heat to left knee and orders were given for a treatment to the knee. Review of the facility's Event Report indicated that on 3/27/12 at 10:30 AM the nurse was called to resident's room by (CNA), observed red area with two intact blisters to lt (left) knee. Also on mattress beside resident was a biohazard bag with two washclothes (sic) inside and a pillowcase covering it. Resident currently has tx (treatment) of heat to lt knee q (every) shift. Called 11p-7a nurse on duty last night, ask her how she did heat tx. to resident's knee. She stated 'I wet two washclothes (sic), put them in microwave for 2 minutes then put inside a biohazard bag and wrapped a pillowcase around it and laid it on resident's knee'. On 5/2/2012 at 9:05 AM, during an interview with the Assistant Director of Nursing (ADON), she stated the incident had not been reported because the injury was not of unknown origin and the facility did not feel like the nurse intended to cause harm to the resident. On 5/3/2012 at 10:30 AM, the Administrator, Director of Nursing and the Assistant Director of Nursing were notified that Substandard Quality of Care and/or Immediate Jeopardy were identified. The Substandard Quality of Care and/or Immediate Jeopardy existed in the facility on 3/27/2012 when Resident #11 received a burn from a heat treatment, which was executed and applied incorrectly. Documentation of inservices, observations, and interviews revealed the Allegation of Compliance submitted by the facility on 5/3/2012 had been implemented by the facility and was in practice removing the immediacy of the deficient practice. Facility nursing staff had been educated and was knowledgeable of abuse policies and procedures and the proper use of heat treatments. The Administrator was informed of this on 5/3/12. The citation at F-225 remained at a lower scope and severity of D.",2016-06-01
8213,CHESTER NURSING CENTER,425061,1 MEDICAL PARK DRIVE,CHESTER,SC,29706,2012-05-03,226,L,0,1,WII411,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** July 17, 2012 - Ammended to reflect change to original Scope and Severity to K and lowered Scope and Severity to E On the days of the Recertification and Extended survey, based on interviews, record reviews, and review of the facility Abuse and Neglect Policy the facility failed to follow its policies and procedures that prohibit mistreatment, neglect, and abuse of residents. The facility staff failed to report neglect involving Resident #11 who suffered a burn related to a heat treatment which was applied incorrectly. The incident was not investigated and reported to the State Agency. The facility staff failed to respond when a sitter for Resident #11 yelled at her roommate Resident #18; multiple staff members were observed by the surveyor standing by when the incident occurred. The findings included: Cross Refers to F-223 as it relates to the failure of the facility to ensure that staff monitored visitors/sitters interactions with residents to ensure the residents safety and well being in the facility. Resident #18 was allegedly verbally abused by Resident #11's visitor/sitter. Cross Refers to F-225 as it relates to the failure of the facility to report and thoroughly investigate an incident in the facility as possible neglect due to a nurse's inappropriate approach to applying heat to Resident #11's leg that resulted in a burn. Cross Refers to F-281 as it relates to the failure of the facility Nursing staff to verify the physician's orders [REDACTED]. The failure placed Resident #11 at risk of serious harm. Cross Refers to F-323 as it relates to the failure of the facility to provide necessary care for Resident #11. The resident was burned when a nurse used a microwave to heat a compress and placed it directly on the resident's leg without using an appropriate barrier between the resident's leg and the heated compress. This action resulted in a second degree burn to the resident's leg. Cross Refers to F-490 as it relates to the failure of the Administrator to ensure the facility was administered in a manner that enabled it to use its resources effectively and efficiently to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident. The administrator was aware that a licensed nurse used a microwave to heat a compress and apply it to a resident's leg that resulted in a second degree burn and failed to implement corrective action to ensure resident safety. In addition, the Administration was not aware paid sitters were operating in the building and the facility had no policies in place to ensure sitters were aware of facility policies and procedures. Cross Refers to F-520 as it relates to the failure of the facility to ensure that the Quality Assurance process was utilized to identify, monitor and implement a plan of correction related to an injury that was the result of applying heat to a resident incorrectly. In addition, the Administration was not aware paid sitters were operating in the building and the facility had no policies in place to ensure sitters were aware of facility policies and procedures and met regulation. The facility admitted Resident #11with [DIAGNOSES REDACTED]. Review of the Physician's Telephone Orders (TO) reveled that Resident #11 had a TO (telephone order) dated 3/11/12 for Heat to knee and a clarification order on 3/11/12 for heat to knee q (every) shift. On 3/27/12 a new TO was written to D/C (discontinue) heat to left knee and orders were given for a treatment to the knee. Review of the facility's Event Report indicated that on 3/27/12 at 10:30 AM the nurse was called to resident's room by (CNA), observed red area with two intact blisters to lt (left) knee. Also on mattress beside resident was a biohazard bag with two washclothes (sic) inside and a pillowcase covering it. Resident currently has tx (treatment) of heat to lt knee q (every) shift. Called 11p-7a nurse on duty last night, ask her how she did heat tx. to resident's knee. She stated 'I wet two washclothes (sic), put them in microwave for 2 minutes then put inside a biohazard bag and wrapped a pillowcase around it and laid it on resident's knee'. On 5/2/2012 at 9:05 AM, during an interview with the Assistant Director of Nursing (ADON), she stated the incident was not reported because the injury was not of unknown origin and the facility did not feel like the nurse intended to cause harm to the resident. No further investigation was done by the facility. The facility admitted Resident #18 on 6/10/11 with [DIAGNOSES REDACTED]. On 5/01/12 at approximately 4 PM the surveyor heard loud yelling on the Gaston Unit. At least four staff members were observed on the unit at the time of yelling. As the State Agency surveyor approached the room from which the yelling was coming, she observed a tall, large male, believed to be a family member of Resident #11, standing over, yelling and pointing his finger at Resident #18 who was seated in a Geri chair. The male looked directly at Resident #18 and stated, You don't talk to her. You don't say anything to her. You all better move her. Prior to the surveyor approaching the room a hospice nurse was observed standing outside the door while the family member yelled at Resident #18. The surveyor in the hallway observed four facility staff members who failed to respond to the family member yelling at Resident #18. The surveyor approached the staff in the hallway and asked, Can anyone hear the yelling going on down the hall? What are you going to do about the family member yelling at the resident? The staff looked at the surveyor and hesitated. CNA (Certified Nursing Assistant) #3 entered the room and the family member and Resident #11 exited the room. The nurse at the medication cart did not attempt to protect Resident #18 from the angry family member. Review of the facility's Policy & Procedure Manual Subject: Abuse and Neglect last revised on July 2010 stated, Policy: .Failure to report shall be cause of disciplinary action . All allegations will be reported to appropriate agencies and services as required by applicable state and federal regulations. The DHEC Certification Division shall be notified within 24 hours of the allegation . Procedure: . 1. Any person having information, either by direct observation or by report, or any act or suspected act that he/she considers may be abuse, neglect or mistreatment of [REDACTED]. Initial reports are to be completed verbally and in a written form on an Incident Report. This Incident Report should be given immediately or as soon as practically possible to the Health Facility Administrator, the Director of Nursing, or his/her designee. The Health Facility Administrator . will initiate an Investigation. 2. Any employee who reports or who receives a report of abuse or neglect must take whatever actions are appropriate to protect the resident from further alleged abuse or neglect. 3. The resident's physician and agent will be notified . A resident who is a victim of alleged abuse or neglect must be immediately assessed by a Licensed Nurse . The clinical record of the resident for whom a suspected abuse/neglect report is completed must contain objective information, facts NOT speculation. 4. The investigation Report is considered a confidential facility report and should include: a. The date, time, location of the alleged incident; b. A complete description of the event . e. A description of any injuries sustained and/or any changes in resident's mental state . h. Action taken . 6. If a family member or other visitor is suspected of abuse, they may not be allowed to visit the resident, or may be required to visit only if a staff member is present . 8. The results of all investigations of substantiated incidents of abuse or neglect will be reported to the Department of Health Licensing and Certification and to all other agencies in accordance with state law within five (5) working days . DEFINITIONS 1. Abuse means the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain or mental anguish, or the deprivation by care custodian of goods or services that are necessary to avoid physical harm or mental suffering . 3. Verbal refers to any use of oral, written or gestured language that includes disparaging and derogatory term to residents or their families, or within their hearing distance, to describe residents, regardless of their age, ability to comprehend, or disability . 15. Neglect means failure to exercise that degree of care which a reasonable person in a like position would exercise. It includes failure to assist in personal hygiene or the provision of food and clothing, failure to provided medical care for physical and mental health needs, failure to protect from health and safety hazards . Reporting/Response: .All substantiated incidents of abuse or neglect will be reported to the Quality Assurance Committee . On 5/3/12 at 10:30 AM, the Administrator, Director of Nursing, and the Assistant Director of Nursing were notified that Substandard Quality of Care and/or Immediate Jeopardy was identified. The Substandard Quality of Care and/or Immediate Jeopardy existed in the facility on 3/27/2012 when Resident #11 received a burn from a heat treatment which was executed and applied incorrectly. On 5/2/12 at 1:55 PM, the Administrator and the Director Of Nursing were notified of a second Substandard Quality of Care and/or Immediate Jeopardy existing in the facility when an observation was made of a visitor verbally abusing a resident with no staff intervention to protect the resident. Documentation of inservices, observations, and interviews revealed the Allegation of Compliance submitted by the facility on 5/3/2012 had been implemented by the facility and was in practice removing the immediacy of the deficient practice. Facility nursing staff had been educated and were knowledgeable of abuse policies and facility procedures. The Administrator was informed of this on 5/3/12. The citation at F-226 remained at a lower scope and severity of E.",2016-06-01
8214,CHESTER NURSING CENTER,425061,1 MEDICAL PARK DRIVE,CHESTER,SC,29706,2012-05-03,242,E,0,1,WII411,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on group interview and review of the facility's menus, the facility failed to plan a menu that residents did not feel was repetitive. (i.e. tomato soup and green beans served frequently). Five of 5 group members stated food preferences are not honored. Resident #8's food choices were not honored during two meal observations The findings included: Based on concerns expressed during the group interview of repeatedly receiving tomato soup and green beans, the facility's menus were reviewed for repetitiveness. On 5/1/12, review of the 3 week CMRC (Chester Regional Medical Center) Menus revealed the Sunday evening meal for weeks #1, 2 and 3 was tomato soup, saltine crackers, grilled cheese, banana foster bread pudding. The Wednesday evening meal for weeks #1, 2, and 3 was fried chicken, macaroni and cheese, seasoned greens, cornbread, carmelicious brownies. The Friday lunch meal for weeks #1, 2, and 3 was chicken wings, baked fries, walking salad, wheat dinner roll. The Friday evening meal for weeks 1, 2, and 3 was crusted/breaded fish with tartar sauce, half baked potato, cole slaw, hush puppies, cornbread, lemon coconut cake. For week # 3, supper on Wednesday, Thursday, and Saturday and the week 1 Sunday lunch, (which follows week 3 Saturday) green beans were served. An interview was conducted on 5/2/12, at approximately 10:00am, with the Food Service Director (FSD) and the Registered Dietitian (RD). The surveyor reviewed the above information with the FSD and RD. The FSD and RD acknowledged that the menus were written in such a way that single food items (tomato soup, green beans) and entire meals were being duplicated repeatedly throughout the menu. The facility admitted Resident #8 on 4/20/10 and readmitted the resident on 2/06/12 with [DIAGNOSES REDACTED]. Record review revealed a Quarterly MDS (Minimum Data Set) dated 4/10/12 which indicated the resident had a Brief Interview Mental Status (BIMS) score of 15 (cognitively intact). A random meal observation on 4/30/12 at approximately 12:20 PM revealed the resident was served a pimento cheese sandwich A meal observation on 4/30/12 at approximately 5 PM revealed revealed the resident was served a large roll, mashed potatoes, pork chop and broccoli. Review of the meal card revealed documentation that the resident disliked sandwiches and bread. In a group interview on 5/01/12 at approximately 10:15 AM 5 of 5 group members identified by the facility as interviewable, stated they consistently received food on their food tray that they do not like. The group members further stated at times they just leave the food on the tray and did not ask for anything else Five of 5 group members stated they receive green beans and tomato soup too often. The group members further staff they had shared their concerns related to food during Resident Council Meeting. Review of Resident council meeting notes revealed the residents had shared dietary concerns during the months of April 2012, March 2012, and February 2012.",2016-06-01
8215,CHESTER NURSING CENTER,425061,1 MEDICAL PARK DRIVE,CHESTER,SC,29706,2012-05-03,281,J,0,1,WII411,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the Recertification and Extended survey, based on observations, interviews, record reviews and review of the facility's policies entitled Applying A Warm Compress Or Soak and Standing Orders for Chester Regional Nursing Center, and the facility Event Report, the facility failed to provide services that met professional standards of quality for 3 of 16 sampled residents reviewed for professional standards of care. Resident #11 received a burn due to improper application by a licensed staff member, failure to monitor the heat treatment, and failure to consistently assess and monitor healing of the burn, Resident #16 with a low body temperature reading had no recheck of temperature delaying treatment, and the facility allowed untrained Licensed Practical Nurses (LPN) to administer medications through a Peripherally Inserted Central Catheter (PICC) or did not have a Registered Nurse present in the facility during the medication administration via the PICC line for Resident #1. The findings included: Cross Refer to F323 as it relates to a licensed staff member applying heat improperly to Resident #11 resulting in a second degree burn to the resident's leg. The facility admitted Resident #11 with [DIAGNOSES REDACTED]. On 5/1/2012 at 3:40 PM, during review of the medical chart for Resident #11, a telephone order dated 3/11/12 indicated that the resident had an order for [REDACTED]. The Nurse's Notes (NN) dated 3/8/12 indicated that the resident had complained of left knee pain and a pain medication was given. On 3/11/12 the NN again indicated that the resident had left knee pain and the physician was in the facility and ordered heat to the knee every shift. The NN contained no documentation related to clarifying the order for moist or dry heat. The Treatment Record indicated that heat was applied to the resident's knee every shift as ordered until it was discontinued on 3/27/11. The NN for 3/27/12 at 11:00 AM revealed that the facility received new orders to discontinue the heat to the resident's left knee and an order for [REDACTED]. On 3/28/12 at 10:00 AM, the NN stated that blisters and redness were noted. On 3/29/12 at 2:30 PM the NN indicated that an increase in the size of the blisters was noted and that the blisters were intact. On 3/29 at 5:00 PM the nurses documented continue to monitor. dressing dry and intact and on 3/30 12 at 1:45 AM, dry and intact. On 4/1/12, 4/3/12, 4/4/12 and 4/7/12 the Nurse's Notes indicated that the dressing was dry and intact. On 4/14/12 at 1:00 PM a new order was received to change the treatment to Resident #11's left knee. On 4/15/12 at 10:00 AM the nurses documented that the physician was in to see Resident #11. No other NN related to the left knee were noted. The Nurse's Notes contained no measurement of the blisters or how many blisters were present. During the survey on 5/1/12 at 3:50 PM, LPN #1 removed the resident's knee dressing. The area of the resident's knee cap was discolored and purple. Three areas were noted on the knee, 1 area was approximately 1 inch long by 1/2 inch wide, 1 was approximately 1/2 by 1/2 inches and 1 was approximately 1/4 by 1/4 inches. There were no intact blisters observed on the knee. All 3 areas contained sloth in the wound bed and all 3 were bright red in color around the sloth. No odors were noted. Further review of the resident's record revealed no documentation in the Physician's Progress Notes related to the burn. The facility's skin sheets were also reviewed. The skin sheet had documentation on 3/31/12 that blisters were present-treatment in progress, on 4/14/12: left knee blisters, treatment in progress bandage intact, on 4/21/12- left knee in progress and a skin sheet with no date stated that left knee wound treatment was in progress. The skin notes contained no entries related to Resident #11's knee wound. In an interview with Registered Nurse (RN) #1, she verified that there were no other places where wound/skin notes were documented and that there was no documentation of measuring the knee wounds. Review of the facility's Event Report indicated that on 3/27/12 at 10:30 AM the nurse was called to resident's room by (CNA), observed red area with two intact blisters to lt (left) knee. Also on mattress beside resident was a biohazard bag with two washclothes (sic) inside and a pillowcase covering it. Resident currently has tx (treatment) of heat to lt knee q (every) shift. Called 11p-7a nurse on duty last night, ask her how she did heat tx. to resident's knee. She stated 'I wet two washclothes (sic), put them in microwave for 2 minutes then put inside a biohazard bag and wrapped a pillowcase around it and laid it on resident's knee'. In an interview on 5/2/12 at 9:05 AM with the Assistant Director of Nursing (ADON), the ADON stated that the facility uses moist heat unless the physician orders heat packs but the order should have been clarified as to which type of heat to use. When asked if the treatment should have been checked and documented every 5 minutes as written in the policy for moist heat, the ADON stated that the facility does not have check sheets but if the policy indicates every 5 minute checks they should have been done and documented. When asked if it was normal practice at the facility to heat moist cloths in the microwave for heat treatments, the ADON stated that it was not the normal practice to use a microwave. On 5/2/12 from 9:30 AM to 9:42 AM, 4 nurses were interviewed related to how to use heat for a treatment. RN #2 stated that she would use a heat pack wrapped in a towel. LPN #4 stated she would call the physician to verify the type of heat source to use. LPN #5 stated she would use a heat pack and LPN #6 stated that she would warm moist cloths in the microwave. In an interview on 5/2/12 at 12:35 PM, the physician stated that he was informed of the incident stating it was a burn 2nd degree. The physician stated that he would expect the nurses to use moist heat when he ordered heat. He stated that he would expect the wound nurse to monitor, measure and document the progression of blisters, pressure ulcers and surgical sites. He also stated that he would expect the facility to in-service the staff after any incident. Review of the facility's policy entitled Applying A Warm Compress Or Soak indicated .Preparation 1. Verify that there is a physician's order for this procedure .2. Check the resident's skin often. Look for: a. Too much redness b. Skin discoloration .Equipment and Supplies .4. If applying a warm compress: . c. Pitcher of warm water (115 degrees F) .k. Unless otherwise instructed, check the skin of the limb being soaked every five (5) minutes . Resident #1 was admitted with [DIAGNOSES REDACTED]. Record review on 4/30/12, at approximately 12:15PM, revealed an admitting Physician's order for Flush PICC (Peripherally Inserted Central Catheter) line with NS (Normal Saline) 5 ml (milliliters) prior to and after med (medication) administration. Further review revealed a Physician's order dated 4/17/12 to D/C (Discontinue) PICC line. Review of the April Medication Administration Record [REDACTED]. Interview on 4/30/12 with the Gaston Unit Manager indicated that all the nurses who signed off as doing the PICC line flushes were Licensed Practical Nurses (LPN). Review of The South Carolina State Board of Nursing Advisory Opinion #28 Revision revealed that the Board of Nursing for South Carolina acknowledges it is within the extended role practice of the selected LPN to perform procedures and to administer ordered treatments via peripheral and central venous access devices and lines according to the following stipulations: 2. LPN's must complete specialized education and training relative to arterial and central access lines. A registered nurse must be immediately available for supervision. Review of the Facility's Policy# B-261 titled Picc (Peripherally Inserted Central Catheter) states under III. RESPONSIBILITY, A. Nursing:, 2. The special selected LPN must complete an intravenous therapy course relative to the administration of fluids and medications via peripheral and central venous access devices and perform the necessary skills checklist. These skills will be performed under the immediate availability and supervision of a Registered Nurse. Interview on 5/1/12, at approximately 3:00pm, with the Director of Nursing (DON) and the Assistant Director of Nursing (ADON) revealed three of the LPNs who signed off as doing the PICC line flushes did not have the required specialized education and training. In addition, during review of the daily nursing staffing sheets for 4/6/12 through 4/17/12 when the PICC line was discontinued, the DON and ADON confirmed that for eleven of thirty-three shifts reviewed there was no registered nurse immediately available for supervision. The facility admitted Resident #16 with [DIAGNOSES REDACTED]. Record review on 5/01/12 revealed nurse's notes dated 4/12/12 at 1:45 PM that stated: resident alert and verbal with respiratory even and unlabored no distress noted. A nurse note dated 4/13/12 at 4 AM vital sign 97 Temperature, 98 Pulse, 20 Respiration with 104/76 Blood Pressure. Nurse note (NN) dated 4/13/12 at 7 PM indicated resident alert with nasal cannula. Assisted with all activities of daily living (ADLs), no sign and symptom of pain or distress. NN dated 4/14/12 at 1:30 AM indicated vital signs 125/68 Blood Pressure, 81 Pulse, 98.8 Temperature, 20 Respiration. No sign and symptom of distress with breathing even and unlabored. Resting quietly with continue to monitor. NN dated 4/14/12 at 10 AM indicated noted increased foul smelling drainage from left hip wound. Medical Doctor on call with new orders for C&S (culture and sensitivity) [MEDICATION NAME] 500 mg every day for 7 days. NN dated 4/14/12 at 5:15 PM vital sign 92 Temperature, 60 Pulse, 20 Respiration, 90/62 Blood Pressure with resident resting quietly in bed at present. Noted to be alert with confusion. No complaints voiced and requires total care with ADLs. NN dated 4/15/12 at 12 Noon indicated resident was alert, non verbal and denies pain with Respiration up 28, no Blood Pressure reading, 64 Pulse, Temperature of 90 with no oxygen statistics. Finger nails noted to be purple and hands very cold to touch with Medical Doctor called. NN dated 4/15/12 at 12:40 PM Resident transported to emergency room . An interview on 5/03/12 at approximately 1:30 PM with the Assistant Director of Nursing (ADON), after reading the nurses' notes dated 4/12/12 to 4/15/12 the ADON stated 02 should have been started and that the facility has standing orders as to when to provide oxygen and notify the physician. On 5/2/12 at 10:30 AM, the Administrator and the Director Of Nursing were notified that Substandard Quality of Care and/or Immediate Jeopardy was identified. The Substandard Quality of Care and/or Immediate Jeopardy existed in the facility on 3/27/2012 when Resident #11 received a burn from a heat treatment which was executed and applied incorrectly. Documentation of inservices, observations, and interviews revealed the Allegation of Compliance submitted by the facility on 5/3/2012 had been implemented by the facility and was in practice removing the immediacy of the deficient practice. Facility nursing staff had been educated and were knowledgeable of abuse policies and procedures and the proper use of heat treatments The Administrator was informed of this on 5/3/12. The citation at F-281 remained at a lower scope and severity of D.",2016-06-01
8216,CHESTER NURSING CENTER,425061,1 MEDICAL PARK DRIVE,CHESTER,SC,29706,2012-05-03,314,D,0,1,WII411,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the Recertification and Extended survey, based on observations, interviews and review of the facility's policy entitled Aseptic Technique For Changing Dressings, the facility failed to provide necessary treatment and services to promote healing and prevent infection for 1 of 2 residents observed for Pressure Ulcer Treatment. Licensed Practical Nurse (LPN) #1 failed to properly cleanse the pressure area for Resident #2. The findings included: The facility admitted Resident #2 with [DIAGNOSES REDACTED]. On 5/1/2012 at 11:50 AM, during observation of a Pressure Ulcer treatment for [REDACTED].#1 used a saline soaked 4X4 to cleanse the wound. The LPN patted the wound bed and the peri-wound area multiple times using the same 4X4 and the same area of the 4X4. LPN #1 then, using a new 4X4, patted the wound bed and peri-wound area multiple times with the same side of the 4X4 to dry the wound before applying the new dressing. On 5/15/12 at 5:15 PM, during an interview with LPN #1, the surveyor reviewed her observations on the wound care. The LPN did not disagree with the surveyors observations. Review of the facility's police entitled Aseptic Technique For Changing Dressings revealed .Work from center outward in small [MEDICAL CONDITION], using a clean gauze for each stroke .",2016-06-01
8217,CHESTER NURSING CENTER,425061,1 MEDICAL PARK DRIVE,CHESTER,SC,29706,2012-05-03,315,D,0,1,WII411,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the Recertification and Extended survey, based on observation, interviews and review of the facility's policy entitled Catheter Care, the facility failed to ensure that a resident who is incontinent of bladder receives appropriate treatment and services to prevent urinary tract infections and to restore as much normal bladder function as possible for 1 of 1 resident reviewed with a Foley Catheter. Licensed Practical Nurse (LPN) #3 failed to properly cleanse Resident #8's labia, meatus and tubing during catheter care. LPN #3 also failed to wash her hands and change gloves properly during and after the procedure. The findings included: The facility admitted Resident #8 on 4/20/2011 and readmitted her on 2/6/12 with [DIAGNOSES REDACTED]. On 5/1/2012 at 3:05 PM, during observation of catheter care for Resident #8, LPN #3 assembled supplies on the resident's bedside table, washed her hands and gloved. She removed the resident's brief, then LPN #3 removed her gloves, washed her hands and put on clean gloves. LPN #3 placed a towel under the resident and assisted her into position. LPN #3 then removed her gloves and put on new gloves without washing her hands. After wetting a wash cloth, LPN #3 spread the resident's labia slightly without exposing the urinary meatus. LPN #3 wiped the edge of each side of the resident's labia and down the center, not reaching the meatus, using a new cloth for each wipe. LPN #3 then grasp the catheter tubing at the point where it met the labia and wiped the tubing one time. The LPN wiped the resident front to back on the exterior center of the labia three times and again grasp the tubing at the exterior of the labia and wiped it one time with the same area of the cloth. She then used a towel to pat the area dry. Without removing her gloves or washing her hands, LPN #3 assisted the resident to her right side, removed the towel, opened the resident's closet, took a new brief from the closet and assisted a Certified Nursing Assistant with placing the brief on the resident. She then assisted with repositioning the resident, pulling her up in the bed and repositioning her linens. After repositioning the resident, LPN #3 rinsed and dried the basin and placed it in a drawer in the residents night stand. At that time LPN #3 removed her gloves and washed her hands. During the procedure Resident #8 stated that they don't do catheter care here, we used to spread the labia and clean around the tube at the meatus, they don't do that here. On 5/1/2012 at 4:40 PM, during an interview with LPN #3, the surveyor reviewed her observations with LPN #3. LPN #3 did not disagree with the surveyors observations. LPN #3 stated that it is hard to wash your hands in that room because the resident has too much stuff in it and it's hard to spread her labia because she is a large person. Review of the facility's policy entitled Catheter Care, revealed .Procedure .5 .b) Separate labia and inspect meatus for redness, swelling and/or drainage. c) With other hand, use washcloth, soap and water to gently cleanse meatus around catheter: Wipe downward over left side, right side, and middle, refolding to a clean area of the cloth after each stroke. d) .Hold the catheter near the insertion point .e) Using a clean washcloth, rinse by wiping down the left side, right side, and middle, refolding the washcloth after each stroke. Rinse the catheter tubing as above .",2016-06-01
8218,CHESTER NURSING CENTER,425061,1 MEDICAL PARK DRIVE,CHESTER,SC,29706,2012-05-03,323,J,0,1,WII411,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the Recertification and Extended survey, based on observations, interviews, record reviews and review of the facility's policy's entitled Applying A Warm Compress or Soak, Event Report, and Abuse and Neglect, the facility failed to ensure that the resident environment remains as free of accident hazards as is possible; and each resident receives adequate supervision and assistance devices to prevent accidents for 1 of 1 resident reviewed for burns. Resident #11 received a burn when a heat treatment was administered incorrectly and not monitored during the treatment. In addition 3 of 4 units were noted to have high hot water temperatures and one of 4 units was noted to have low cool water temperatures. The findings included: Cross Refer to F281 as it relates to the facility failure to ensure resident treatments were performed safely and failure to consistently assess and monitor progress should any harm occur. The facility admitted Resident #11 on 11/18/2011 with [DIAGNOSES REDACTED]. Review of Resident #11's medical record revealed a facility's Event Report that indicated on 3/27/12 at 10:30 AM the nurse was called to resident's room by (CNA), observed red area with two intact blisters to lt (left) knee. Also on mattress beside resident was a biohazard bag with two washclothes (sic) inside and a pillowcase covering it. Resident currently has tx (treatment) of heat to lt knee q (every) shift. Called 11p-7a nurse on duty last night, ask her how she did heat tx. to resident's knee. She stated 'I wet two washclothes (sic), put them in microwave for 2 minutes then put inside a biohazard bag and wrapped a pillowcase around it and laid it on resident's knee'. Further documentation reviewed at the facility did indicate the LPN did not check the progress of the treatment after she became busy with other tasks. In an interview on 5/2/12 at 9:05 AM with the Assistant Director of Nursing (ADON), she stated that the facility uses moist heat unless the physician orders heat packs but the order should have been clarified as to which type of heat to use. When asked if the treatment should have been checked and documented every 5 minutes as written in the policy for moist heat, the ADON stated that the facility does not have check sheets but if the policy says every 5 minute checks they should have been done and documented. When asked if it was normal practice at the facility to heat moist cloths in the microwave for heat treatments, the ADON stated that it was not the normal practice to use a microwave. On 5/2/12 from 9:30 AM to 9:42 AM, 4 nurses were interviewed related to how to use heat for a treatment. RN #2 stated that she would use a heat pack wrapped in a towel. LPN #4 stated she would call the physician to verify the type of heat source to use. LPN #5 stated she would use a heat pack and LPN #6 stated that she would warm moist cloths in the microwave. In an interview on 5/2/12 at 12:35 PM, the physician stated that he had been informed of the incident stating it was a burn 2nd degree. The physician stated that he would expect the nurses to use moist heat when he ordered heat. He stated that he would expect the wound nurse to monitor, measure and document the progression of blisters, pressure ulcers and surgical sites. He also stated that he would expect the facility to re-train/in-service the staff after any incident. Review of the facility's policy entitled Applying A Warm Compress Or Soak indicated .Preparation 1. Verify that there is a physician's order for this procedure .2. Check the resident's skin often. Look for: a. Too much redness b. Skin discoloration .Equipment and Supplies .4. If applying a warm compress: . c. Pitcher of warm water (115 degrees F) .k. Unless otherwise instructed, check the skin of the limb being soaked every five (5) minutes . During the initial tour of the facility on 4/30/12 at approximately 10:45 AM, it was noted the hot water temperature in rooms #22 and #31 on Hall 1 were excessively hot to the touch. The surveyor checked random rooms at approximately 12:20 PM on 4/30/12 with a digital thermometer and the following temperatures were revealed: Room # 29: 122.0 degrees Fahrenheit Room #58: 127.5 degrees Fahrenheit Room #54: 122.4 degrees Fahrenheit Room #20: 122.5 degrees Fahrenheit Room #33: 123.5 degrees Fahrenheit Room #43: 124.3 degrees Fahrenheit On 4/30/12 at approximately 1:50 PM, the surveyor toured with Maintenance Technician #1, the following areas and temperature results were noted as: Hall #1 Shower room sink: 123.0 degrees Fahrenheit Room #26 124.5 degrees Fahrenheit Room #20 125.6 degrees Fahrenheit Room #30 123.0 degrees Fahrenheit Hall #2 Shower room sink: 124.3 degrees Fahrenheit Room #45 123.2 degrees Fahrenheit Room #36 125.7 degrees Fahrenheit Room #38 126.1 degrees Fahrenheit Hall #3 Room #55 128.1 degrees Fahrenheit Room #52 120.0 degrees Fahrenheit Room #59 127.9 degrees Fahrenheit Room #54 122.9 degrees Fahrenheit During an interview with Maintenance Technician #1 on 4/30/12 at approximately 1:50 PM, the Maintenance Technician #1 confirmed he did not know if water temperature checks were routinely performed in residents rooms. On the same day at approximately 2:48 PM, an interview with the Maintenance Director revealed that no one in the maintenance department had checked the main domestic supply temperature that morning. He also stated the facility had not been recording random resident room temperatures since December, 2011 and the facility policy was to have the hot water temperatures be at 115 degrees Fahrenheit or less. He confirmed that the temperature at the main domestic supply was 126.3 degrees per computerized recording early this morning. The Maintenance Director stated he had already turned the steam valve down and will recheck the temperature at the valve and also in the resident rooms throughout the rest of the evening. On 4/30/12 at approximately 3:50 PM, the Maintenance Director stated he checked the actual temperature at the main boiler, recorded at 140 degrees Fahrenheit, and he had reduced the temperature setting to 115 degrees Fahrenheit. Interview with a facility CNA and a resident was held on 4/30/12 at 3:45PM related to the water temperatures. Both stated that whenever the water was used they mixed the cold with the hot to ensure that the temperature was not at a level that a resident would receive a burn. On 4/30/12 at approximately 1:30 PM, during random resident room water temperature checks, the surveyor noted in the Gaston Wing, Room #64, the hot water temperature was 85.1 degrees Fahrenheit. On the same day at approximately 2:27 PM, the resident in this private room stated, It's always too cold in the shower and my sink. Random hot water temperature checks continued in the Gaston Wing at approximately 2:30 PM and revealed the following temperatures: Room #61 89.0 degrees Fahrenheit Room #64 88.3 degrees Fahrenheit Room #72 93.3 degrees Fahrenheit Room #77 92.8 degrees Fahrenheit On 4/30/12 at approximately 4:30 PM, the surveyor toured the Gaston Wing with Maintenance Technician #1, and revealed the following hot water temperatures: Room #61 88.1 degrees Fahrenheit Room #72 97.1 degrees Fahrenheit Room #77 104.1 degrees Fahrenheit While observing the Maintenance Director checking the hot water temperature in Room #77, the resident of this room questioned, Is it warm enough to shave now?. The Maintenance Director revealed on 5/1/12 at approximately 8:50 AM that he did not have a policy in place to perform routine water temperatures in resident room to ensure safe and/or comfortable water temperatures. On 5/2/12 at 10:30 AM, the Administrator and the Director of Nursing were notified that Substandard Quality of Care and/or Immediate Jeopardy was identified. The Substandard Quality of Care and/or Immediate Jeopardy existed in the facility on 3/27/2012 when Resident #11 received a burn from a heat treatment which was applied incorrectly. Documentation of inservices, observations, and interviews revealed the Allegation of Compliance submitted by the facility on 5/3/2012 had been implemented by the facility and was in practice removing the immediacy of the deficient practice. Facility nursing staff had been educated and were knowledgeable of abuse policies and procedures and the proper use of heat treatments. The Administrator was informed of this on 5/3/2012. The citation at F-323 remained at a lower scope and severity of D.",2016-06-01
8219,CHESTER NURSING CENTER,425061,1 MEDICAL PARK DRIVE,CHESTER,SC,29706,2012-05-03,363,F,0,1,WII411,"On the days of the survey, based on observation, interview, and review of the menus, the facility failed to serve the menu as written. The menu stated 6 ounces (oz) of chili and 3 oz or 4 oz of mashed potatoes was to be served. The staff served 4 oz of chili and 2 and 2/3 oz of mashed potatoes. The findings included: Observation on 5/1/12, at approximately 11:40am revealed Cook #1 serving 4 oz of chili and 2 2/3 oz of mashed potatoes for all diet types. The State Agency surveyor and Cook #1 checked the ladle and scoops sizes together and confirmed that a 4 oz ladle was being used to portion the chili and a #12 (2 2/3 oz) scoop was being used to portion the mashed potatoes. This surveyor then asked the Registered Dietitian (RD) to provide the surveyor with the menu the staff was using to determine the portion sizes to be served. The RD and surveyor reviewed the menu together and verified that all diet types were to receive 6 oz of chili, Pureed diets were to receive 4 oz of mashed potatoes, and all other diet types were to receive 3 oz of mashed potatoes. The RD and Cook #1 confirmed that the required amount of chili and mashed potatoes were not being served at that time.",2016-06-01
8220,CHESTER NURSING CENTER,425061,1 MEDICAL PARK DRIVE,CHESTER,SC,29706,2012-05-03,367,D,0,1,WII411,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on observation, interview, and record review, the facility failed to provide a mechanical soft diet as prescribed by the physician for 1 of 3 residents with physician ordered mechanically altered diets. (Resident #1) The findings included: Resident #1 was admitted on [DATE] with [DIAGNOSES REDACTED]. Record review on 4/30/12, at approximately 12:15pm revealed a physician's orders [REDACTED]. Observations on 4/30/12 at approximately 12:30pm revealed Resident #1 eating a lunch of pureed pimento cheese, pureed cottage cheese, pureed fruit, soup, ice cream, and tea. Observation on 4/30/12 at approximately 5:00pm revealed the resident eating a supper of pureed meatloaf, mashed potatoes, pureed broccoli, pureed pineapple upside down cake, and tea. Observations on 5/1/12 at approximately 12:15pm revealed the resident eating a lunch of pureed chili, mashed potatoes, and tea. Review of the tray card for each meal indicated that the resident should receive a pureed diet. Interview with the Registered Dietitian on 5/1/12 at approximately 3:15pm confirmed that the physician's orders [REDACTED]. The RD confirmed that a pureed diet was not the same texture as a Soft diet and the resident was not receiving the appropriate textured diet.",2016-06-01
8221,CHESTER NURSING CENTER,425061,1 MEDICAL PARK DRIVE,CHESTER,SC,29706,2012-05-03,371,E,0,1,WII411,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on observation and interview, the facility failed to store and prepare food under sanitary conditions as evidenced by lids off trash cans, food stored in opened bags in bins without covers, food not covered in the freezer, hand sink without a pedal trash can available, and tiles missing around a drain in the floor. The findings included: Observations on 4/30/12 at approximately 10:30am revealed lids off the trash cans in the dishroom, which was not being used at the time. Lids off the trash cans by both coolers. In the freezer were open boxes of breaded meat, chicken, and ravioli. There was a bin containing an open bag of flour with no lid. Under a prep table there was a bin containing an open bag of rice with no lid and a bin with an open bag of flour with no lid. The hand sink by the trayline had no trash can with a foot pedal available. Under the raw meat prep table was a drain where there were no tiles for approximately 8 inches around the drain exposing a porous surface and impeding free flow of liquids to the drain. Observations on 5/1/12 at approximately 11:50am revealed that the above findings continued to be in existence with the addition of an observation of staff washing their hands at the hand sink and having to open the lid of a trash can with their clean hands to dispose of used paper towels. Observations on 5/2/12 at approximately 10:00am with the Food Service Director and the Registered Dietitian revealed that the above findings continued to exist. Interviews with the Food Service Director and the Registered Dietitian confirmed that the trash can should be covered at all times, food in bins should not be stored in open bags and the bins should be covered, the food in the freezer should be tightly covered, there should be a trash can with a foot pedal at the hand sink, and the surface area around the drain should be of a non porous surface to allow free flow of liquids into the drain. Observations of the Gaston Nourishment refrigerator on 4/30/12, at approximately 12:05pm and again at 2:00pm and 4:15pm revealed 2 honey thick [MEDICATION NAME] containers with an expiration date of 3/13/12 in a crisper drawer. In storage area of the door were: (1) container of honey thick milk with an expiration date of 10/25/11, (1) container of honey thick milk with an expiration date of 2/12/12, and (1) container of honey thick milk with an expiration date of 4/27/12. On the shelving were: (2) containers of nectar thick milk with an expiration date of 3/9/12, (2) containers of nectar thick cranberry juice cocktail with an expiration date of 4/26/12, (1) container of honey thick tea with an expiration date of 3/25/12, (1) container of honey thick [MEDICATION NAME] with an expiration date of 3/13/12, (1) container of honey thick [MEDICATION NAME] with an expiration date of 4/18/12, and (1) container of honey thick cranberry juice cocktail with an expiration date of 4/1/12. Interview with the Registered Dietitian on 5/2/12 at approximately 8:40am indicated that the dietary department is responsible for stocking the Gaston Nourishment refrigerator with thickened liquids and is responsible for checking expiration dates of the thickened liquids and removing as needed. The RD confirmed that the above items were stored in the refrigerator on 4/30/12.",2016-06-01
8222,CHESTER NURSING CENTER,425061,1 MEDICAL PARK DRIVE,CHESTER,SC,29706,2012-05-03,441,E,0,1,WII411,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the Recertification and Extended survey, based on observations and interviews, the facility failed to maintain an Infection Control Program designed to provide a safe, sanitary and comfortable environment and to help prevent the development and transmission of disease and infection. Licensed Practical Nurse (LPN) #2 failed to wash/sanitize her hands during observation of medication pass. LPN #1 and LPN #2 failed to properly clean and store tube flush syringes after the procedures were completed for Resident #2 and #3. (2 of 2 tube flushes observed.) The findings included: The facility admitted Resident #3 with [DIAGNOSES REDACTED]. On 5/1/2012 at 12:45 PM, during an observation of Resident #3's tube flush, LPN #2 completed the flush, rinsed the plunger and barrel of the syringe and placed the syringe into a measuring container which contained water standing in the bottom of the container. The syringe was placed in a way that the tip of the syringe and the rubber gasket of the plunger was standing in water. On 5/1/2012 at 4:00 PM the surveyors observations were reviewed with LPN #2. She did not dispute the observations. The facility admitted Resident #2 with [DIAGNOSES REDACTED]. On 5/1/12 at 12:55 PM, during an observation of Resident #2's Tube Flush, LPN #1 aspirated stomach contents to check for tube placement before instilling the prescribed amount of water. While instilling the water, water and stomach contents backed up into the syringe barrel. LPN #1 reinserted the contents of the syringe. After the treatment, LPN #1 disconnected the syringe, placed it tip side down on the barrel and rubber side down on the plunger into a measuring container without washing and drying the syringe. At 5:15 PM on 5/1/12, the surveyor reviewed her observations with LPN #1. The LPN Stated that she did remember not washing the syringe or the barrel before placing it in the container. On 5/1/2012 at 8:00 AM, during observations of medication pass, LPN #2 failed to wash or sanitize her hands prior to, between or after administering medications to two residents. On 5/1/12 at 9:37 AM, the surveyor reviewed her observations with LPN #2. LPN #2 did not dispute the observations.",2016-06-01
8223,CHESTER NURSING CENTER,425061,1 MEDICAL PARK DRIVE,CHESTER,SC,29706,2012-05-03,490,L,0,1,WII411,"July 17, 2012 - Ammended to reflect changes to the original Scope and Severity to K and lowered Scope and Severity to E. On the days of the Recertification and Extended survey, based on record reviews, interviews and review of facility policy and procedures related to providing heat treatments, the facility administration failed to effectively and efficiently utilize resources to prevent one of one sampled resident from harm due to inappropriate application of a warm compress treatment. The facility failed to obtain clarification orders related on how to apply heat to a resident and failed to monitor the treatment which resulted in a burn to a resident. The facility failed to complete a thorough investigation of the burn incident and failed to report the injury as neglect to the State survey and certification agency. In addition the facility failed to develop policies on using paid sitters in the facility and were unaware of sitters currently working in the facility at the time of survey. The findings included: Cross Refers to F-223 as it relates to the failure of the facility to ensure that staff monitored visitors/sitters interactions with residents to ensure the residents safety and well being in the facility. Cross Refers to F-225 as it relates to the facility's failure to report an allegation of neglect to the State survey and certification agency. Cross Refers to F-226 as it relates to the facility's failure to ensure that staff was adequately trained to define, recognize and report allegations of abuse/neglect. Cross Refers to F-281 as it relates to the facility's failure to ensure that the licensed staff received adequate training to request clarification orders on applying a warm compress treatment and the monitoring of the treatment to prevent injury. Cross Refers to F-323 as it relates to the facility failure to prevent accidents and hazards for a resident that was burned during a warm compress treatment. Cross Refers to F-520 as it relates to the facility's failure to ensure each resident receiving warm compress treatments was adequately and accurately assessed for burns/injury due to warm compress treatments. The systemic failure of the facility to identify, accurately assess, and monitor residents receiving a warm compress treatment, after having knowledge a resident in the facility was harmed, placed other residents at risk for additional injury and/or harm. At the time of the survey, there was no evidence that the facility provided training to staff in order to prevent inappropriate heat treatments after a resident was harmed during an incident resulting in a burn noted on 3/27/12. There was no evidence that the incident was thoroughly investigated and reported as possible neglect to the State survey and certification agency. An interview on 5/02/12 at approximately 12:10 PM with the facility Administrator revealed the burn incident was not reported as abuse/neglect because he thought it was an isolated incident. The Administrator stated the facility wrote an incident report and the nurse that performed the treatment incorrectly was released from the nursing home as an employee. The Administrator further stated no re-education of the staff was provided due to the 3/27/12 burn incident. A visitor was observed during the survey yelling at a resident with no staff intervention. It was later learned by the facility that the perpetrator was not a visitor but a paid sitter. The Administrator failed to ensure the safety of residents due to being unaware of private sitters currently working within the facility. The facility had no policies in place related to the private sitters role while in the facility. On 5/2/12 at 10:30 AM, the Administrator and the Director of Nursing were notified that Substandard Quality of Care and/or Immediate Jeopardy was identified. The Substandard Quality of Care and/or Immediate Jeopardy existed in the facility on 3/27/2012 when Resident #11 was noted with a burn from a heat treatment which was executed and applied incorrectly. On 5/02/12 at 1:55 PM, the facility was notified that a second Immediate Jeopardy/Substandard Quality of Care had been identified. The Jeopardy existed on 5/01/12 when a routine visitor at the facility was observed standing over, yelling and pointing his finger at a resident without any facility staff intervening to protect the resident from further abuse. Interviews with licensed nurses, certified nursing assistants, admissions staff, activity staff and other facility staff revealed the visitor talked loud all the time. The three certified nursing assistants and licensed nurse on the unit at the time of the incident stated the visitor generally talked loud and they did not think any thing was wrong. The investigation of the incident found the alleged perpetrator was not a visitor but a sitter for the roommate of the resident allegedly abused. The facility staff were not aware the visitor had been employed by a resident's family and was in the building for that purpose. Documentation of inservices, observations, and interviews revealed the Allegation of Compliance submitted by the facility on 5/3/2012 had been implemented by the facility and was in practice removing the immediacy of the deficient practice. Facility nursing staff had been educated and were knowledgeable of abuse policies and procedures and the proper use of heat treatments The Administrator was informed of this on 5/3/12. The citation at F-490 remained at a lower scope and severity of E.",2016-06-01
8224,CHESTER NURSING CENTER,425061,1 MEDICAL PARK DRIVE,CHESTER,SC,29706,2012-05-03,520,L,0,1,WII411,"July 17, 2012 - Ammended to reflect changes to the original Scope and Severity to K and lowered Scope and Severity to E. On the days of the Recertification and Extended survey, based on record reviews and interviews, the facility failed to develop, implement and monitor an action plan for identified concerns related to a nurse placing a hot compress in a microwave, placing it on a resident's skin without monitoring progression of the treatment and resulting in a second degree burn to the resident. The injury noted on 3/27/12 and no review of current policy or re-education was provided to nursing staff to prevent further injuries related to heat treatments. The facility staff failed to recognize verbal abuse and failed to act to protect the resident at the time the abuse took place. In addition, the facility failed to have any policies on using paid sitters in the facility and were unaware of sitters currently working in the facility at the time of survey. The findings included: Cross Refers to F-223 as it relates to the facility's failure to recognize verbal abuse, protect the resident abused, and have policies in place for paid sitters in the facility. Cross Refers to F-225 as it relates to the facility's failure to report an allegation of neglect to the State survey and certification agency. Cross Refers to F-226 as it relates to the facility's failure to ensure that staff was adequately trained to define, recognize and report allegations of abuse/neglect. Cross Refers to F-281 as it relates to the facility's failure to ensure that the licensed staff received adequate training to request clarification orders on applying a warm compress treatment and the monitoring of the treatment to prevent injury. Cross Refers to F-323 as it relates to the facility failure to prevent accidents and hazards for a resident that was burned during a warm compress treatment. Cross Refers to F-490 as it relates to the failure of the facility's Administration to provide the necessary oversight to ensure policies and procedures related to applying a warm compress was implemented properly. The Administration was aware of the resident's injury due to inadequate treatment since 3/27/12. An interview on 5/02/12 at approximately 12:10 PM with the Administrator revealed no in-services were provided related to the nurse's failure to get a clarification order in applying a heating treatment and monitoring the treatment. The Administrator stated no in-services/re-education was provided to the nursing staff after the 3/27/12 burn incident because it was an isolated incident. The Administrator acknowledged no Performance Improvement Plan was put in place after the incident. In addition, Administration was not aware paid sitters were operating in the building and the facility had no policies in place to ensure sitters were aware of facility policies and procedures. On 5/2/12 at 10:30 AM, the Administrator and the Director of Nursing were notified that Substandard Quality of Care and/or Immediate Jeopardy was identified. The Substandard Quality of Care and/or Immediate Jeopardy existed in the facility on 3/27/2012 when Resident #11 was found with a burn from a heat treatment which was executed and applied incorrectly. On 5/02/12 at 1:55 PM, the facility was notified that a second Immediate Jeopardy/Substandard Quality of Care had been identified. The Jeopardy existed on 5/01/12 when a routine visitor at the facility was observed standing over, yelling and pointing his finger at a resident without any facility staff intervening to protect the resident from further abuse. Interviews with licensed nurses, certified nursing assistants, admissions staff, activity staff and other facility staff revealed the visitor talked loud all the time. The three certified nursing assistants and licensed nurse on the unit at the time of the incident stated the visitor generally talked loud and they did not think any thing was wrong. The investigation of the incident found the alleged perpetrator was not a visitor but a sitter for the roommate of the resident allegedly abused. The facility staff were not aware the visitor had been employed by a resident's family and was in the building for that purpose. Documentation of inservices, observations, and interviews revealed the Allegation of Compliance submitted by the facility on 5/3/2012 had been implemented by the facility and was in practice removing the immediacy of the deficient practice. Facility nursing staff had been educated and were knowledgeable of abuse policies and procedures and the proper use of heat treatments The Administrator was informed of this on 5/3/12. The citation at F-520 remained at a lower scope and severity of E.",2016-06-01
8225,MAGNOLIA MANOR - SPARTANBURG,425091,375 SERPENTINE DRIVE,SPARTANBURG,SC,29305,2012-04-18,252,E,0,1,KT9K11,"On the days of the survey, based on random observations and interview, the facility failed to provide a clean homelike environment as evidenced by the strong smell of urine within the facility during the days of the survey. The findings included: Upon entering the facility on 4/16/12 at 10:30 AM, strong urine odors were detected from the entrance, Units 1,2,and 3, including the elevator. These urine odors remained through out the 3 days of the survey. The District Housekeeping Manager confirmed there were some odors. He stated, We have some challenging residents, and this is an old building. The Maintenance Supervisor also acknowledged the urine odors. On initial tour of the facility on 4/16/12 at approximately 10:30 AM a strong urine odor was noted on the hall for rooms 101 to 122. The strong urine odors remained through out the day. At approximately 11:15 AM, housekeeping staff was observed mopping with bucket of dark water in room 122. On 4/16/12 at approximately 1:30 PM a strong urine smell was still noted near rooms 101 to 113. On 4/17/12 though out the day (approximately 9 AM to 5 PM) , urine odors were evident near room 114 through 122. On 4/18/12 at approximately 9:50 AM staff was over-heard reminding housekeeping staff to use fresh water when mopping. On 4/16/12 upon entering the facility, a strong urine odor was noted in the entry way. As the elevator was entered to go to the conference room, a strong urine odor was also noted in the elevator. Each time during the survey when the elevator was used, a strong urine odor remained. During random observations on 4/16/12 through 4/18/12 strong urine odors were noted when entering the front main entrance to the facility and on Unit 3. During an observation on 4/16/12 at 10:35am, there were strong urine odors on Unit 3 which were remained present at 6:00pm. During an observation on 4/16/12 at 4:35pm, there were strong urine odors in the room of Resident #10. During an observation on 4/17/12 at 8:30am, strong urine odors were present on Unit 3. During an observation on 4/17/12 at 9:15am, an employee was observed spraying a solution from a spray bottle which minimally decreased the urine odors temporarily. During an observation on 4/17/12 at 10:57am, there was a strong urine odor noted in Resident #10's room. During an observation on 4/17/12 at 4:30pm, strong urine odors continued on Unit 3. During an observation on 4/18/12 at 8:15am, strong urine odors were noted in the lobby when entering the building through the front main entrance.",2016-06-01
8226,MAGNOLIA MANOR - SPARTANBURG,425091,375 SERPENTINE DRIVE,SPARTANBURG,SC,29305,2012-04-18,284,D,0,1,KT9K11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on closed record review and interview, the facility failed to provide evidence of post discharge planning for 1 of 2 sampled residents discharged home. Resident #16 had no documented discharge planning to ensure individual needs were addressed. The finding included: The facility admitted Resident #16 on 11/14/11 with [DIAGNOSES REDACTED]. Record review on 4/17/12 at approximately 1:55 PM revealed an Admission MDS (Minimum Data Set)dated 11/29/11 that indicated the resident was severely impaired cognitively in daily decision making skills. There was no documented discharge planning to ensure the resident's needs were addressed after discharge from the facility. Further record review revealed Social Services Progress Notes dated 11/29/11 that resident was receiving supervised visits with family while at the facility. Social Services Progress Notes dated 12/01/12 and 12/30/12 revealed a supervised visit between resident and family took place while the resident was in the facility. An undated discharge summary indicated resident was discharged home with family. There was no documentation related to which family member the resident was discharged with (especially since resident was receiving supervised family visits while in the facility). An interview on 4/17/12 at approximately 3:15 PM with the Social Services Director (SSD) confirmed the finding that there was no post discharge planning documentation. The SSD stated discharge planning was done but could not find the documentation. An interview on 4/17/12 at approximately 3:45 PM with the Medical Records Director confirmed there was no documentation related to post discharge planning.",2016-06-01
8227,MAGNOLIA MANOR - SPARTANBURG,425091,375 SERPENTINE DRIVE,SPARTANBURG,SC,29305,2012-04-18,312,E,0,1,KT9K11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on observations, record review and interviews, the facility failed to provide grooming and personal hygiene care for 1 of 1 sampled diabetic residents reviewed for finger nail care concerns and random observations of other residents in need of fingernail care. Resident #8 was observed on 2 days of the survey with long, jagged nails with a black substance under the finger nails. The findings included: The facility admitted Resident #8 on 11/28/11 with [DIAGNOSES REDACTED]. During initial tour on 4/16/12, observation revealed the resident seated in his room with long, jagged finger nails and a dark substance under the finger nails. A later observation on 4/16/12 at approximately 1:35 PM revealed no change had occurred in the condition of the resident's fingernails. An interview on 4/17/12 at approximately 8:48 AM with Licensed Practical Nurse (LPN) #2 revealed the Certified Nursing Aides (CNAs) were responsible for cutting resident finger nails. When asked about who was responsible for cutting diabetic resident finger nails, LPN #2 stated nurses. When asked if there was a finger nail care schedule for diabetic residents, LPN #2 stated there was no schedule. An interview on 4/17/12 at approximately 8:50 AM with the Assistant Director of Nursing (ADON) revealed the CNAs were to keep the nurses informed of residents needing nail care. The ADON then observed and confirmed resident 8's fingernails to be long, jagged with a dark substance under the finger nails. The ADON stated there was no documentation to indicate when Resident #8 last had finger nail and that Resident # 8 sometimes refused finger nail care. There was no documentation to indicate resident refused finger nail care. The ADON then referred this Surveyor to LPN #3 for information related to finger nail care for Resident #8. An interview on 4/17/12 at approximately 9 AM with LPN #3 revealed diabetic residents finger nails are cut as they grow. On 4/16/12, during observation of the evening meal for the residents, a random male resident was noted to be eating (picking up food with his hands) which had long, uneven fingernails with a blackish brown substance under his nails. On 4/17/12 at 11:45 AM, the same male resident was again observed at a table waiting on the lunch meal with his nails remaining long, uneven and the blackish/brown substance remained under his nails. On 4/18/12 at 9:30 AM, during an interview with Certified Nursing Assistants (CNAs) #1 and #2, they were asked how often the resident's have their nails trimmed and cleaned? Both stated on shower days. When asked when this male resident's shower days were, they stated Saturday and Wednesday. The surveyor then asked CNA #1 to look at the resident's nails. Both CNAs examined the resident's hands. CNA #1 stated the resident should have had his nails cleaned and trimmed on Saturday with his shower. When asked how the staff knew they were supposed to groom the nails on shower days, CNA #1 provided the shower schedule for 4/14/12 and 4/18/12. Both schedules had the resident's room number listed on the 7:00 AM to 3:00 PM schedule. The schedule contained documentation which stated Baths-Don't forget nail care. Licensed Practical Nurse (LPN) #1 overheard the conversation and stated that the resident frequently refused care. The surveyor then asked if they documented the refusal. The LPN stated yes. The Nurse's Notes for 4/14/12 and 4/18/12 contained no documentation related to the resident refusing care and was verified by LPN #1. During the Group Interview on 4/17/12 at 2pm, an observation was made regarding a Resident's fingernails which were very long with ragged uneven edges. The Resident stated, I was in the hospital before coming here. I am only here a few weeks.",2016-06-01
8228,MAGNOLIA MANOR - SPARTANBURG,425091,375 SERPENTINE DRIVE,SPARTANBURG,SC,29305,2012-04-18,314,E,0,1,KT9K11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey based on observations, interviews and review of the facility's policy entitled Application of Dressing-Absorption Dressing on pressure ulcer care, the facility failed to assure that 2 of 2 sampled residents observed for wound care received treatment to promote healing and infection. The Unit #3 Manager did not properly wash her hands during wound care for Resident #10. For Resident #1 Licensed Practical Nurse #1 did not properly clean one wound, did not clean another wound, and failed to use proper hand washing technique. The findings included: The facility admitted Resident #10 on 12/12/11 with [DIAGNOSES REDACTED]. During wound care observation on 4/16/12 at 3:15pm, the Unit Manager completed wound care but failed to wash her hands prior to leaving the Resident's room. The Unit Manager used hand sanitizer before and after the wound care treatment. However, after completing wound care, the Unit Manager replaced items on the Resident's overbed table, raised the Resident's head of the bed, and repositioned the Resident to ensure the Resident was comfortable. The Unit Manager did not wash her hands before exiting the room. She then walked down the hall and placed treatment supplies in the treatment cart next to the nurse's station and then recorded the treatment in the Treatment Administration Record next to the sink. The Unit Manager then washed her hands at the sink behind the nurse's station. During an interview on 4/18/12 at 11:50am, the Unit Manager confirmed that she had left the Resident's room after completing the treatment, replaced supplies in the Treatment Cart, signed off the order in the Treatment Administration Record and then washed her hands. During an interview on 4/18/12 at 12:00 noon, the Staff Development Coordinator also confirmed that the Unit Manager did not wash her hands before leaving the Resident's room. and that the SDC had already told the Unit Manager she should have washed her hands prior to leaving the Residents room. Review of the facility's policy entitled Application of Dressing-Absorption Dressing provided by the Staff Development Coordinator on 4/17/12 at 12:00 noon stated hands are to be washed at intervals throughout the procedure. The facility admitted Resident #1 on 3/23/12 with [DIAGNOSES REDACTED]. On 4/17/12 at 10:55 AM, during observation of wound care for Resident #1, Licensed Practical Nurse (LPN) #1 washed her hands and entered the room. The surveyor and the Staff Development Coordinator were present for the treatment observation. LPN # 1 cleaned the bedside table, closed the door and moved the fall mat from the resident's bedside. LPN #1 explained the procedure to the resident, raised the bed and put on gloves. At that time, she assisted the resident to her right side. The LPN unfastened the resident's brief, removed the old dressing and placed it and her gloves in a biohazard bag. She washed her hands, applied saline to a 4X4 and twice patted the wound with the gauze using the same area of the gauze. She removed her gloves, removed a pair of scissors from her pocket, cleaned them, placed them on the barrier, and then washed her hands. While the LPN washed her hands the resident rolled back onto the brief. LPN #1 stated that the brief was clean and had just been changed prior to the wound care. The brief did not appear to be soiled. After washing her hands and putting on gloves, the LPN cut Calcium Alginate, placed it in the wound bed, covered it with gauze and applied tape. LPN #1 then stated that she was going to change the dressing on the second wound. The surveyor asked where the second wound was located as it had not been visible during the previously observed wound care and she was not aware of a second wound. The nurse stated it was on the resident's right ischial area and that she had removed the dressing earlier because it was soiled with urine. While the nurse washed her hands, the resident rolled partially to her back placing the exposed wound against the brief. The LPN returned, gloved and assisted the resident back onto her right side exposing the second wound. LPN #1 cut and placed Calcium Alginate into the second wound bed, covered with gauze and tape without cleansing the wound. The nurse removed her gloves, regloved and replaced the resident's brief with a new brief retrieved from the closet and repositioned the resident without washing her hands. LPN #1 then removed her gloves, cleaned the scissors with alcohol pads and placed them back into her pocket. She gathered used items and the biohazard bag. She took the biohazard bag to the housekeeping closet, placed it in a biohazard box and entered the soiled linen area, touching door knobs, and placed the used linens in a hamper. She returned to the nurse's station to wash her hands and sign the Treatment Record. On 4/18/12 at 9:20 AM, during an interview with LPN #1, she did not dispute the surveyors observations related to hand washing, gloving or touching items and the resident while gloved and using the same gloves during the treatment. The LPN did not disagree with the observation of patting the wound bed of the first wound with the same area of the gauze. When the LPN was informed that the surveyor had not observed her cleansing the second wound, the LPN stated that she had cleansed it when she cleansed the first wound. On 4/18/12 at 9:45 AM, during an interview with the Staff Development Coordinator (SDC), who was also present during the wound care for Resident #1, the surveyors observations were reviewed. The SDC agreed with the surveyor observations and stated that the nurse did not cleanse the ischial wound prior to placing the Calcium Alginate, gauge and tape. She also stated that the nurse patted the first wound instead of using a circular motion cleansing from the inside to the outside. Review of the facility's policy entitled Nursing Competency: Dressing-Absorption Dressing-Application of did not address the procedure to cleanse wounds. The SDC stated that they did not have any other wound care procedures.",2016-06-01
8229,MAGNOLIA MANOR - SPARTANBURG,425091,375 SERPENTINE DRIVE,SPARTANBURG,SC,29305,2012-04-18,425,E,0,1,KT9K11,"On the days of the survey, based on observation, interview, and the Drug Facts and Comparisons book (updated monthly), the facility failed to follow a procedure to ensure that expired medications were removed from medication storage in the Unit 3 medication storage area. The findings included: On 4/18/12 at 11:49 AM, observation of the Unit 3 Medication Room refrigerator revealed one 5 milliliter (ml) vial (50 tests) Tuberculin Purified Protein Derivative (PPD), (Mantoux), Tubersol, opened with a puncture date of 3/10/12. The Drug Facts and Comparisons book, page 2001, states (in reference to Tuberculin Purified Protein Derivative): Discard vials in use for more than 30 days because of possible oxidation and degradation that may affect potency. During an interview on 4/18/12 at 11:57 AM, Licensed Practical Nurse (LPN) #5 confirmed the puncture date (3/10/12) and stated that a punctured vial of PPD should not be kept longer than 30 days --- then toss it.",2016-06-01
8230,MAGNOLIA MANOR - SPARTANBURG,425091,375 SERPENTINE DRIVE,SPARTANBURG,SC,29305,2012-04-18,441,D,0,1,KT9K11,"On the days of the survey, based on observation record review and interview, the facility failed to maintain a sanitary environment to help prevent the transmission of disease and infection related to the cleaning of glucometers used between residents. The findings included: On 4/17/12 at 3:48 PM Licensed Practical Nurse (LPN) #4 was observed to perform a fingerstick blood sugar (FSBS) test on Resident A. Prior to the procedure, LPN #4 cleaned the glucometer with an alcohol wipe and after the procedure she cleaned the glucometer with an alcohol wipe. Review of the facility's policy entitled Performing a Blood Glucose Test revealed under Step 1: Clean glucometer with purple top wipe and after the FSBS test under Step 6: Clean glucometer with purple top wipe. Purple top wipes come from a container with a purple top and the wipes contain chlorine. During an interview on 4/17/12 at 4:33 PM, LPN #4 was asked to state the procedure for for doing a FSBS. She stated: Clean the meter with an alcohol wipe. Do the FSBS. Remove the test strip from the glucometer. Clean the glucometer with an alcohol wipe. When asked about the use of the wipes in the purple top container, LPN #4 stated that they were used to clean equipment and that she did not use them to clean glucometers. Further review revealed that on 3/12/12, the facility had an in-service on glucometers which included cleaning the meters with chlorine wipes. LPN #4 is a PRN (as needed) nurse and review of the IN-SERVICE ATTENDANCE RECORD SIGNATURE SHEET revealed that she was not present for the in-service.",2016-06-01
8231,WINDSOR MANOR,425114,5583 SUMMERTON HIGHWAY,MANNING,SC,29102,2013-06-06,272,E,1,0,43K911,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on record review, interview and review of the facility provided policy for restraints, the facility failed to accurately and timely assess Resident # 51 related to the the use of restraints. (1 of 4 sampled residents reviewed for fall assessments and 1 of 3 sampled residents reviewed for restraint assessments) The findings included: Resident # 51 was admitted on [DATE]. A siderail assessment was completed on 12/18/12 for the resident who had a known history of falls and behaviors. The siderail assessment deemed the resident required the use of siderails for turning and positioning. It also documented the resident was at great risk for falls from the bed, required assistance to turn and move and the resident was unable to use the call system. On 12/19/12 a order was received for a low bed as the resident was unsafely crawling over the siderails. A new assessment was not completed. On 3/27/13, the siderails were reassessed and the assessment stated quarterly review- no changes. However, the siderails had been discontinued once the low bed was put in place on 12/20/12. The inaccurate assessment was verified by the Minimum Data Set Coordinator (MDS) on 6/6/13 who stated, I missed it. On 6/5/13 at 1:41 PM, during an interview with the MDS Coordinator, s/he stated that restraint assessments are only completed for comprehensive assessments by him/her. S/he was unsure as to who completed the quarterly assessments. However, no restraint assessment for any device documented as having been used was located in the medical record. On 6/5/13 at 1:58 PM, the MDS Coordinator stated no assessment was located and the chart has not been thinned. At approximately 4:40 PM, assorted pages from a thinned record were located in a file cabinet but did not include any assessments related to the use of restraints including a gerichair with a table, broda chair, lap belt, soft waist restraint, abdominal binder or leg restraint. One assessment form with the resident's name was located but was incomplete except for the resident's name. The facility provided policy related to restraints documented : The need for restraints will be evaluated at least quarterly to determine their continued need. The physical restraint assessment form stated: This assessment is to be completed anytime a comprehensive reassessment requiring RSP review is conducted or an order for [REDACTED].>. : .",2016-06-01
8232,WINDSOR MANOR,425114,5583 SUMMERTON HIGHWAY,MANNING,SC,29102,2013-06-06,280,E,1,0,43K911,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on record review and interview, the facility failed to review and revise the plan of care for Resident # 51 related to repeat falls and multiple use of restraints. The plan of care did not accurately reflect the interventions used. (1 of 4 sampled residents reviewed for falls and 1 of 3 sampled residents reviewed for restraints and the revision of the plan of care. ) The findings included: Resident # 51 was admitted to the facility on [DATE]. Record review on the days of the survey revealed the resident had multiple falls, with and without injury, and multiple restraint devices had been attempted. On 6/5/13, review of the two careplan's (Admission and quarterly) completed for the resident revealed the following concerns: Padded siderails that were discontinued on 12/12/12 continued to be listed on the plan of care Provide Broda chair for locomotion (discontinued 5/15/13), remained on the careplan The use of a Geri chair with a table (12/20/12), abdominal binder (12/23/12), reclining chair (12/19/12), Broda chair with leg restraints (discontinued 1/28/13 ) were not noted on the careplan. The residents unsafe behaviors of climbing over the siderails, sliding under the waist restraint and trying to slide the restraint over his/her head were not addressed. The last fall recorded on the careplan provided for review on 6/5/13 was 5/1/13 which stated send to ER (emergency room ) for evaluation as ordered Record review indicated the resident either fell or was found on the floor on 5/18,5/20,5/27/13. There was repeated documentation of the resident pulling out or otherwise tampering with his/her feeding tube. The concern nor preventives measures were not included on the plan of care for the feeding tube. The resident was assessed as being unable to use the call light system and was documented as having severe cognitive impairment with a BIMS (Brief Interview Mental Status) of 5. However, careplan approaches included the following: answer call light promptly, keep call light in easy reach, allow resident to make as many choices as possible, encourage resident to report to nurse if feels upset, angry, encourage resident to express fears and concerns, provide clock (clock in residents room over doorway was non functional), instruct resident on how to use call bell, give resident update on news 2 times a week. Under the fall prevention careplan it was noted that the same approaches were used including use diversional activities, continues low bed and mat on floor, continue Broda chair, continue to encourage resident to ask for assistance and use call light re-instructed resident to use call light for assistance, continue low bed, alarming pad, bed/chair alarm, Broda chair. On 6/6/13 at approximately 8:30 AM an interview with the Care Plan Coordinator was conducted. S/he stated s/he had assumed careplan duties on 3/4/13 at the facility. S/he stated the careplan were not to his/her liking. S/he verified the use of inappropriate and repeated approaches, missing falls and all the restraint devices that were used were not included in the plan of care. When asked how Certified Nursing Assistants would know the type of care a resident required, s/he stated the information was provided in daily report and although unlikely, the CNA's could always look at the plan of care. At that time, s/he confirmed how Resident # 51 transferred was not listed on the careplan. The MDS (Minimum Data Set) assessment indicated the resident was transferred with assistance of one, the Unit Manager when asked, stated s/he would like the resident transferred with assistance of 2. Both types of transfers were observed during the days of the survey.",2016-06-01
8233,WINDSOR MANOR,425114,5583 SUMMERTON HIGHWAY,MANNING,SC,29102,2013-06-06,490,E,1,0,43K911,"On the days of the survey, based on record review and interview, the facility failed to be administered in way that effectively and efficiently enabled the residents to attain or maintain the highest practicable physical, mental and social well-being of each resident. Facility Administration failed to identify the use of multiple restraints without assessments, continued use of restraint as the resident demonstrated unsafe behaviors, the use of restraints without an order, and a careplan that did not accurately reflect the resident for Resident # 51. Additionally, the facility Administration failed to identify the lack of a documented and active grievance policy and failed to identify Licensed Practical Nurses were required to have advanced documented training prior to changing gastrostomy tubes. The findings included: A pattern of concerns was identified for Resident # 51 during chart review on the days of the survey. Included in the concerns were the the use of multiple restraints without assessments, continued use of restraints as the resident demonstrated unsafe behaviors, the use of restraints without an order, and a careplan that did not accurately reflect Resident # 51. Additionally, the facility Administration failed to identify the lack of a documented active grievance policy. When interviewed on 6/6/13, the Administrator stated s/he did not find it unusual that the facility had not had any grievances since the arrival of the new social services representative or since the last survey. The Administrator later confirmed a resident had expressed concern related to missing money and s/he replaced the missing money. However, there was no documentation to show the concern, the investigation or the resolution. When the Administrator conducted the personnel evaluation of the social services representative in December 2012, s/he did not identify the lack of documented grievances. The facility administration was unaware and failed to develop a program to assure Licensed Practical Nurses were aware not to change newly placed gastrostomy tubes and failed to provide and document the mandated training per regulatory requirement as verified on 6/6/13 by the facility consultant.",2016-06-01
8234,KINGSTREE NURSING FACILITY,425117,401 NELSON BOULEVARD,KINGSTREE,SC,29556,2013-06-07,280,E,1,0,8GKN11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the recertification and complaint surveys, based on record review and interviews, the facility failed to ensure that the care plan was reviewed and accurately updated to concur with physician's orders [REDACTED]. The facility failed to update the care plan for Resident #20 to consistently provide interventions to minimize injury in the event of falls. The findings included: On 9-19-12, an Initial 24 Hour Report was received by the State Agency related to an injury of unknown origin or possible abuse. Resident #20 sustained a hematoma to the right forehead, right side of the head, and behind the right ear, which had been reported to facility staff by a Hospice Certified Nursing Assistant (CNA) at 8 AM that morning. The physician and family were notified and the resident was sent to the hospital for evaluation and treatment. An investigation was begun and the Kingstree Police Department was notified. Review of the facility's Five-Day Follow-Up Report dated 10-1-12 revealed that the Hospice CNA noted blood in the resident's hair on 9-19-12 while in the shower. S/he noted a bruise and notified Licensed Practical Nurse (LPN) #1 who checked the resident and found her/him with a second area of bruising as well. The physician and family were notified in a timely manner and the resident was transported to the emergency room for evaluation. An investigation was conducted immediately including staff and resident interviews. No blood was found in the shower or resident's room. No falls were reported or heard on the 11-7 shift on 9-18-12. At change of shift, neither the 11-7 nor 7-3 CNA noted any injury. The 7-3 nurse (LPN #1) and CNA #1 observed the resident being ambulated to the shower with no evidence of injury. Facility staff was unaware of any injury until the Hospice CNA called for the nurse's assistance related to a [MEDICAL CONDITION] and hematoma. During interviews, the Hospice CNA denied any occurrence in the shower. The facility was unable to substantiate abuse. Review of the medical record on 5-3-13 revealed that the facility admitted Resident #20 on 5-7-12 with [DIAGNOSES REDACTED]. Review of the 5-16-12 Admission Minimum Data Set (MDS) and the 8-12-12 Quarterly MDS revealed that the resident had a Brief Interview for Mental Status (BIMS) score of 3, indicating the resident's cognitive function was severely impaired. The Quarterly MDS noted her/him as totally dependent for dressing, toileting, hygiene, and bathing. Bed mobility and eating required extensive assistance. Balance was steady. There was no limitation in range of motion. Multiple falls were coded on both assessments. Transfers and ambulation required supervision only. Behaviors initially included inattention, disorganized thinking, and wandering. The Quarterly assessment added behavior directed at others. Incident Reports from admission to 9-19-12 were requested at 12:55 PM on 5-3-13 and supplied by the Director of Nurses for review at 2:30 PM. Review of the Incident/Accident Reports and Nurse's Notes revealed the following. (1) On 5-8-12, the resident fell in the hallway in the process of attempting to pick up items from the floor. A laceration/contusion above the right eye was treated with first aid. The physician and family were notified in a timely manner. Redirection and 1: 1 activity was provided. (2) On 5-9-12, the resident attempted to sit on the elevated legrest of a gerichair and fell to the floor. First aid was administered to a laceration/ abrasion on the right ear. The physician and family were notified in a timely manner. On 5-9-12, a gerichair was ordered as needed for rest periods and [MEDICATION NAME] was discontinued. Trazadone 100 mg (milligrams) was ordered at bedtime for restlessness/sleep on 6-6-12. (3) On 6-23-12, the resident pushed away from another resident in the day room, stumbled backward and sat on the floor. First aid was administered to a hematoma. The physician and family were notified in a timely manner. On 6-25-13, Trazadone was increased to 150 mg daily [MEDICATION NAME] mg was added at bedtime. (4) On 6-26-12, the resident was noted sitting on the floor in her/his room. S/he was transported to the emergency room complaining of hip pain. The physician and family were notified in a timely manner. After the resident returned from the hospital, a physician's orders [REDACTED].[MEDICATION NAME] Trazadone administration times were adjusted to be given after the evening meal instead of at bedtime. On 6-27-12, an order was written to wear soft helmet at all times. A low bed and mats were ordered as well (5) On 6-27-12, the resident was noted on the floor in the dayroom. First aid was applied to a skin tear on the left cheek and top of left hand. A soft helmet was in place. The physician and family were notified in a timely manner. On 7-1-12, a sensor pad was added to the low bed. On 7-2-12, gerisleeves were ordered, to be worn as tolerated. On 7-2-12, the resident was sent to the emergency room for evaluation due to a (nonspecific) change in mental status. Bactrim DS was ordered for 7 days for a Urinary Tract Infection. A CT scan of the head was done which showed no intercranial hemorrhage, fracture, or mass effect. Diffuse deep white matter changes. On 7-3-12, the resident was transferred to room [ROOM NUMBER]A, closer to the nursing station. On 7-6-12, evening medication time ([MEDICATION NAME]) was changed to 7 PM. (6) On 7-9-12, the resident attempted to sit on the couch in the dayroom, but slid to the floor. No injuries were noted. The physician and family were notified in a timely manner. A Physical Therapy referral was done, the physician was requested to review the medication regimen, and a UA (Urinalysis) C (ulture)&S (ensitivity) was collected (negative report 7-12-12). (7) On 7-9-12 at 4:15 PM, the resident was noted lying on the floor by the sofa where s/he had been sleeping. No injuries were noted. The resident was toileted and required 1:1 supervision because of continued walking. The physician and family were notified in a timely manner. The physician ordered [MEDICATION NAME] 0.25 mg to be given twice daily as needed. Then on 7-11-12, the [MEDICATION NAME] was discontinued and [MEDICATION NAME] ordered at bedtime. On 7-12-12, the physician ordered a Broda chair with thigh straps PRN (as needed) for rest periods x 72 hours trial period. (8) On 7-31-12, a bruise was noted to the right wrist. Ice and longer gerisleeves were applied. The physician and family were notified in a timely manner. (9) On 8-14-12, the resident was noted in the sitting position in front of the sofa in the dayroom. No injuries were incurred from this unwitnessed fall. The physician and family were notified in a timely manner. Occupational Therapy screened the resident on 8-15-12 and found her/him with steady ambulation. The OT (Occupational Therapist) provided the resident with a baby doll to see if this helps occupy her (him). (10) On 8-22-12, the resident was noted on the floor in the dayroom. First aid was administered to a bruise and small skin tear on the left elbow. The resident was placed at the nurse's desk for closer supervision. The physician and family were notified in a timely manner. (11) On 8-31-12, the resident was found sitting on the floor in the day room. No injuries were incurred. The physician and family were notified in a timely manner. (12) On 9-3-12, the resident was ambulating in the hallway and fell near her/his room. No injuries were noted. The resident was placed in a reclining gerichair with a tabs alarm per physician's orders [REDACTED]. The physician and family were notified in a timely manner. On 9-3-12, the physician ordered Trazadone decreased to 100 mg at bedtime and [MEDICATION NAME] be given two hours later if still awake as a follow-up to the pharmacist's recommendation. He/she also decreased [MEDICATION NAME] to 1 mg three times daily and discontinued the [MEDICATION NAME]. (13) On 9-5-12, a family member pushed the resident's chair up to the table and caught the resident's hand between the chair arm and table resulting in a skin tear to the right hand. First aid was administered. The physician was notified in a timely manner. On 9-11-12, the physician decreased the resident's [MEDICATION NAME] to 0.5 mg three times daily. (14) On 9-12-12, the resident was noted with a skin tear to the back of her/his leg where the Wanderguard bracelet was rubbing the area. First aid was applied. The physician and family were notified in a timely manner. (15) On 9-19-12, CNA notified nurse of resident's condition, hematoma present to right forehead, side of head, and behind right ear. The physician and family were notified in a timely manner and the resident was sent to the hospital for evaluation. Review of the care plans and Social Services Progress Notes revealed that the family had been involved with each interdisciplinary care plan meeting (5-22-12, 7-3-12, 8-13-12). The care plan included problems related to dementia/behaviors, fragile skin/ tears, and falls with measurable goals and viable approaches. The Care Plan was updated with falls and interventions to prevent falls and/or minimize injury while keeping the resident as mobile as possible. Further review of the interventions for falls revealed that, although the 6-27-12 physician's orders [REDACTED]. Review of Hospice information revealed that the initial referral/coverage date was 12-13-11, prior to nursing home admission. The primary coverage [DIAGNOSES REDACTED]. The most recent care plan included provision of aide services four times per week and nursing services twice weekly. Renew of the biweekly care plans revealed that Hospice had been kept updated on the resident's condition. On 9-19-12, her/his regular Hospice caregiver saw the resident. S/he noted on the Hospice report that the resident was up in the chair, and that s/he assisted with range of motion exercises, took vital signs, provided homemaking activities, assisted with a meal, encouraged fluids, and provided personal care including skin care, shower, shampoo, oral hygiene, linen change, brushed hair, and assisted with dressing. In the visit notes, the Hospice Aide did not identify any concerns with Resident #20 until s/he became combative when I shampooed her/his hair. According to her/his written statement, the Hospice CNA did not notice anything until s/he began to towel dry the resident's hair. Then, I noted a small amount of blood on a piece of hair lying on her/his forehead. I then noticed a bruise on the right portion of her/his forehead, about 1 inch from her/his hairline. At this time, s/he notified the nurse of the resident's condition. There was no mention of bruising prior to entry into the shower, though the report indicated a number of activities had been done with the resident prior to going to the shower. Review of Nurse's Notes, in addition to the above, revealed that the resident was admitted with multiple bruises and a history of wandering. On 5-14-12, after the resident had sustained falls on 5-8-12 and 5-9-12, the resident's sons were noted taking pictures of the resident. On 5-28-12, it was noted that the resident needed monitoring for wandering. Will go in other residents' rooms at times. On 5-29-12 at midnight, s/he was restless with lots of anxieties. Multiple entries were made related to continued pacing and being up all night. Interventions included engaging the resident on a 1: 1 basis and keeping her/him near the nursing station. On 6-26-12, it was noted that the resident follows very few verbal requests. On 6-27-12, an entry noted that a meeting was held with the family to discuss falls, pacing, and interventions. Restraints were also discussed. On 7-3-12, a Care Plan meeting with the family resulted in the resident being moved into a room closer to the nursing station. On 8-10-12, an entry noted that the resident was agitated and slaps staff when try to redirect resident. Again on 8-15-12 and 9-11-12, the resident was combative when attempts were made to redirect her/him. On 9-18-12, the 11-7 shift nurse documented vital signs within normal limits. Resident asleep. Arouses to stimuli. But returns to sleep very easy. No cough or congestion turn and reposition every 2 hours. On 9-19-12 at 8 AM: Hospice CNA called this nurse to shower room. Resident was sitting in shower chair outside of 2nd shower stall, noticed hematoma with bleeding to right side of resident's forehead. Resident alert, responding to verbal stimuli, attempting to stand from shower chair while collecting data to report to MD (medical doctor) & ER (emergency room ), also noted hematoma to right side of head and behind right ear. VS (Vital Signs): BP (Blood Pressure) 112/64, p (ulse) 101, T (emperature) 98.4, R (espirations) 20; MD notified- orders to send to ER for evaluation & treatment. 911 called-report given . Responsible Party made aware . At 8:15 am, the resident was transported continues to be alert & responsive. At 12:45 PM, the Administrator was questioned as to how CNAs were made aware of special needs related to resident care. S/he stated that the facility did not use a kardex type system but that an information sheet was placed on the inside of the closet door. The posting included such things, as transfer assistance needed, ambulation, feeding, bowel & bladder status, and special instructions such as alarms, helmet, etc. In reference to Hospice, s/he stated that the Staff Development Coordinator went over policies and procedures when the staff was first assigned to the resident. During an interview at 11: 50 AM on 5-3-13, Registered Nurse #1, who assessed the resident prior to transport, read and verified her/his written statement which had been part of the facility's investigation. The nurse described the knot on the resident's forehead that s/he had observed as golf ball size. When asked if s/he could tell if the injuries had just happened, the nurse stated, It did not look days old. It was very obvious. S/he stated that if the resident had not had the helmet on, it should have been visible to anyone in the hall. Review of the nurse's written statement revealed that s/he found the resident's helmet in her/his room on the overbed table with no signs of blood on it. During an interview at 1 PM on 5-3-13, CNA #1 stated that at approximately 6:55 AM on 9-19-12, s/he made rounds with the 11-7 CNA. S/he stated they did not disturb the resident because s/he was a fighter. S/he just stepped inside the room and saw the resident sleeping with her (his) helmet on. As s/he was not yet ready to work with the resident, s/he continued with other duties. Between 7 & 7:30 AM, the CNA noticed the resident's call light come on. When s/he answered the light, the Hospice Aide was getting clothes together by the closet. The CNA stated s/he was at the door and the resident was sitting up in bed with her (his) helmet in her (his) hand. The CNA went to get linen for the Hospice Aide and returned to the room. At this point, CNA #1 stated s/he bent down to talk to the resident. S/he was very close to the resident's face and would have noticed any injury. S/he said s/he later saw Hospice walking the resident to the shower with no helmet. The CNA noted that the resident was supposed to have the helmet on at all times. At 1:25 PM on 5-3-13, a telephone interview was conducted with LPN #1, who had been the 7-3 nurse at the time of the incident. S/he verified the written statement given at the time of the facility investigation that s/he was standing at med cart saw resident ambulating in hallway with Hospice CNA walking toward me to shower room, her (his) helmet was off at this time During an interview at 1:35 PM on 5-3-13, CNA #2 stated, In the shower. The resident would sit and get right backup. S/he thought the resident might have fallen in the wet shower. All someone would have to do is turn away for a minute to get the soap or something. The CNA further stated that the resident was supposed to have the helmet on at all times.",2016-06-01
8235,KINGSTREE NURSING FACILITY,425117,401 NELSON BOULEVARD,KINGSTREE,SC,29556,2013-06-07,309,E,1,0,8GKN11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the recertification and complaint surveys, based on record review and interviews, the facility failed to provide evidence of consistent and coordinated care and services to one of two sampled residents reviewed for provision of Hospice services. Hospice and the facility failed to adequately communicate to develop a fully integrated plan of care so as to consistently provide needed services for Resident # 20. Although Hospice provided services in the home prior to Resident #20's skilled nursing facility admission, the initial assessment and interdisciplinary care plan failed to reflect known behaviors, thus limiting the extent to which a comprehensive care plan could be developed to address these behaviors and maintain the safety of the resident to the extent possible. There was no evidence of a collaborative care plan meeting until 7-3-12, almost two months after the resident was admitted to the skilled facility. The findings included: Record review on 5-3-13 revealed that the facility admitted Resident #20 on 5-7-12 with [DIAGNOSES REDACTED]. Review of Hospice information revealed that the initial referral/coverage date was 12-13-11, approximately five months prior to the nursing home admission. The primary coverage [DIAGNOSES REDACTED]. The most recent Hospice care plan included provision of aide services four times per week and nursing services twice weekly. Renew of the biweekly care plans revealed that Hospice had been kept updated by the facility on the resident's condition. However, there was no evidence of Hospice communication with the facility regarding pre-admission concerns/problems dealt with in the home environment. Review of March, 2012 Hospice certification documentation faxed to the State Agency on 6-6-13 revealed information that was not reflected in the Admission Assessment or Care Plan or in subsequent interdisciplinary Plans of Care: Functional Limitations noted moderate assistance required for feeding, toileting, ambulation, and transfers. Maximum assistance was noted as required for dressing and bathing. S/he (Resident #20) is not answering questions appropriately (n) or is s/he finishing sentences, is showing s/sx. (signs & symptoms) of hallucinations . between 4 and 7 PM, patient gets agitated, combative, restless, and uses profanity. Mental status notes included Anger .Forgetful, Disoriented (place and time), Agitated .seeing things that are not there . Physician Narrative included: .weak and very unsteady gait .violent and psychotic behaviors have escalated . attempts and does strike hospice aides . incontinent of B&B (bowel and bladder) and paints with her/his feces. Information obtained via fax from the facility administrator on 6-6-13 revealed that Hospice provided the same caregivers (nurses and Certified Nursing Assistants) in the skilled facility as they had in the home prior to admission. There was no evidence that these caregivers communicated with the facility to accurately assess and establish a fully-integrated, coordinated plan of care for both providers. Review of the 5-16-12 Admission Minimum Data Set (MDS) revealed that the resident had a Brief Interview for Mental Status (BIMS) score of 3, indicating the resident's cognitive function was severely impaired. The MDS noted her/him as requiring supervision only for bed mobility, transfer, ambulation, and eating. dressing, toileting, hygiene, and bathing required extensive assistance. Balance was steady. There was no limitation in range of motion. Behaviors initially included inattention, disorganized thinking, and wandering. Incidence of falls was noted as unknown prior to admission. Review of the 5-7-12 Resident Admission Care Plan revealed a non-specific problem of Behavior (with the word 'potential' handwritten) Dx (Diagnosis): Dementia and a problem of Wandering. There was no entry to indicate that the resident was receiving Hospice services at the time of admission, nor was there any evidence of Hospice input or review of the initial care plan. Review of Social Service Progress Notes revealed no mention of provision of Hospice services or Hospice participation in the Care Plan Review. Examination of the 5-22-12 (interdisciplinary) Plan of Care (last reviewed/updated 8-13-12) and Care Plan Review Form revealed that meetings were held on 5-22-12, 7-3-12, and 8-13-12 with Hospice representative's only reviewing/participating in the plan on 7-3-12. The 5-22-12 Plan of Care included approaches that failed to agree with the amount of assistance required in activities of daily living as stated by Hospice. Although Potential for behavior problems related to dementia and anxiety was listed as a problem, the 5-22-12 Plan of Care failed to address specific behaviors that might only have been identified through collaboration between Hospice and facility staff. Actual incidents of displayed anger, agitation, combativeness, restlessness, socially inappropriate behavior, and verbal and physical behavior directed toward others demonstrated prior to admission to the skilled facility were not addressed, indicating lack of appropriate collaboration. Hospice staff also identified hallucinations and escalation of behaviors at certain times of the day but this was not reflected in the interdisciplinary Plan of Care.",2016-06-01
8236,KINGSTREE NURSING FACILITY,425117,401 NELSON BOULEVARD,KINGSTREE,SC,29556,2013-06-07,323,E,1,0,8GKN11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the recertification and complaint surveys, based on record review and interviews, the facility failed to ensure that one of four residents reviewed for falls received adequate supervision to prevent accidents and provide devices to minimize injury in the event of falls. Facility staff were aware that a Hospice Certified Nursing Assistant (CNA) ambulated Resident #20 to the shower without a helmet in place as ordered and care planned, though the resident had a documented history of multiple falls and agitation/behaviors related to pacing and being combative/slapping staff when attempts were made to redirect the resident. While in the shower, the resident sustained [REDACTED]. Although facility staff were aware of the fact that the resident was ambulating without the helmet in place to minimize injury in the event of falls, they failed to intervene to ensure that the physician's orders [REDACTED]. The findings included: On 9-19-12, an Initial 24 Hour Report was received by the State Agency related to an injury of unknown origin or possible abuse. Resident #20 sustained a hematoma to the right forehead, right side of the head, and behind the right ear, which had been reported by a Hospice Certified Nursing Assistant (CNA) at 8 AM that morning. The physician and family were notified and the resident was sent to the hospital for evaluation and treatment. An investigation was begun and the Kingstree Police Department was notified. Review of the facility's Five-Day Follow-Up Report dated 10-1-12 revealed that the Hospice CNA noted blood in the resident's hair on 9-19-12 while in the shower. S/he noted a bruise and notified Licensed Practical Nurse (LPN) #1 who checked the resident and found her/him with a second area of bruising as well. The physician and family were notified and the resident was transported to the emergency room for evaluation. An investigation was conducted immediately including staff and resident interviews. No blood was found in the shower or resident's room. No falls were reported or heard on the 11-7 shift on 9-18-12. At change of shift, neither the 11-7 nor 7-3 CNA noted any injury. The 7-3 nurse (LPN #1) and CNA #1 observed the resident being ambulated to the shower with no evidence of injury. Facility staff was unaware of any injury until the Hospice CNA called for the nurse's assistance related to a forehead laceration and hematoma. During interviews, the Hospice CNA denied any occurrence in the shower. The facility was unable to substantiate abuse. Review of the medical record on 5-3-13 revealed that the facility admitted Resident #20 on 5-7-12 with [DIAGNOSES REDACTED]. Review of the 5-16-12 Admission Minimum Data Set (MDS) and the 8-12-12 Quarterly MDS revealed that the resident had a Brief Interview for Mental Status (BIMS) score of 3, indicating the resident's cognitive function was severely impaired. The Quarterly MDS noted her/him as totally dependent for dressing, toileting, hygiene, and bathing. Bed mobility and eating required extensive assistance. Balance was steady. There was no limitation in range of motion. Multiple falls were coded on both assessments. Transfers and ambulation required supervision only. Behaviors initially included inattention, disorganized thinking, and wandering. The Quarterly assessment added behavior directed at others. Incident Reports (admission to 9-19-12) were requested at 12:55 PM on 5-3-13 and supplied by the Director of Nurses for review at 2:30 PM. Review of the Incident/Accident Reports and Nurse's Notes revealed the following. (1) On 5-8-12, the resident fell in the hallway in the process of attempting to pick up items from the floor. A laceration/contusion above the right eye was treated with first aid. The physician and family were notified in a timely manner. Redirection and 1: 1 activity was provided. (2) On 5-9-12, the resident attempted to sit on the elevated leg rest of a gerichair and fell to the floor. First aid was administered to a laceration/ abrasion on the right ear. The physician and family were notified in a timely manner. On 5-9-12, a gerichair was ordered as needed for rest periods and Seroquel was discontinued. Trazadone 100 mg (milligrams) was ordered at bedtime for restlessness/sleep on 6-6-12. (3) On 6-23-12, the resident pushed away from another resident in the day room, stumbled backward and sat on the floor. First aid was administered to a hematoma. The physician and family were notified in a timely manner. On 6-25-13, Trazadone was increased to 150 mg daily and Ambien 5 mg was added at bedtime. (4) On 6-26-12, the resident was noted sitting on the floor in her/his room. S/he was transported to the emergency room complaining of hip pain. The physician and family were notified in a timely manner. After the resident returned from the hospital, a physician's orders [REDACTED]. Ambien and Trazadone administration times were adjusted for after the evening meal instead of at bedtime. On 6-27-12, an order was written to wear soft helmet at all times. A low bed and mats were ordered as well (5) On 6-27-12, the resident was noted on the floor in the dayroom. First aid was applied to a skin tear on the left cheek and top of left hand. A soft helmet was in place. The physician and family were notified in a timely manner. On 7-1-12, a sensor pad was added to the low bed. On 7-2-12, gerisleeves were ordered, worn as tolerated. On 7-2-12, the resident was sent to the emergency room for evaluation due to a (nonspecific) change in mental status. Bactrim DS was ordered for 7 days for a Urinary Tract Infection. A CT scan of the head was done which showed no intercranial hemorrhage, fracture, or mass effect. Diffuse deep white matter changes. On 7-3-12, the resident was transferred to room 162A, closer to the nursing station. On 7-6-12, evening medication time (for Ambien and Lipitor) was changed to 7 PM. (6) On 7-9-12, the resident attempted to sit on the couch in the dayroom, but slid to the floor. No injuries were noted. The physician and family were notified in a timely manner. A Physical Therapy referral was done, the physician was requested to review the medication regimen, and a UA (Urinalysis) C (ulture)&S was collected (negative report 7-12-12). (7) On 7-9-12 at 4:15 PM, the resident was noted lying on the floor by the sofa where s/he had been sleeping. No injuries were noted. The resident was toileted and required 1:1 supervision because of continued walking. The physician and family were notified in a timely manner. The physician ordered Xanax 0.25 mg to be given twice daily as needed. Then on 7-11-12, the Xanax was discontinued and Melatonin ordered at bedtime. On 7-12-12, the physician ordered a Broda chair with thigh straps PRN (as needed) for rest periods x 72 hours trial period. (8) On 7-31-12, a bruise was noted to the right wrist. Ice and longer gerisleeves were applied. The physician and family were notified in a timely manner. (9) On 8-14-12, the resident was noted in the sitting position in front of the sofa in the dayroom. No injuries were incurred from this unwitnessed fall. The physician and family were notified in a timely manner. Occupational Therapy screened the resident on 8-15-12 and found her/him with steady ambulation. The OT (Occupational Therapist) provided the resident with a baby doll to see if this helps occupy her (him). (10) On 8-22-12, the resident was noted on the floor in the dayroom. First aid was administered to a bruise and small skin tear on the left elbow. The resident was placed at the nurse's desk for closer supervision. The physician and family were notified in a timely manner. (11) On 8-31-12, the resident was found sitting on the floor in the day room. No injuries were incurred. The physician and family were notified in a timely manner. (12) On 9-3-12, the resident was ambulating in the hallway and fell near her/his room. No injuries were noted. The resident was placed in a reclining gerichair with a tabs alarm per physician's orders [REDACTED]. The physician and family were notified in a timely manner. On 9-3-12, the physician ordered Trazadone decreased to 100 mg at bedtime and changed Ambien to be given two hours later if still awake as a follow-up to the pharmacist recommendation. He/she also decreased Haldol to 1 mg three times daily and discontinued the Melatonin. (13) On 9-5-12, a family member pushed the resident's chair up to the table and caught the resident's hand between the chair arm and table resulting in a skin tear to the right hand. First aid was administered. The physician was notified in a timely manner. On 9-11-12, the physician decreased the resident's Haldol to 0.5 mg three times daily. (14) On 9-12-12, the resident was noted with a skin tear to the back of her/his leg where the Wanderguard bracelet was rubbing the area. First aid was applied. The physician and family were notified in a timely manner. (15) On 9-19-12, CNA notified nurse of resident's condition, hematoma present to right forehead, side of head, and behind right ear. The physician and family were notified in a timely manner and the resident was sent to the hospital for evaluation. Review of the care plans and Social Services Progress Notes revealed that the family had been involved with each interdisciplinary care plan meeting (5-22-12, 7-3-12, 8-13-12). The care plan included problems related to dementia/behaviors, fragile skin/ tears, and falls with measurable goals and viable approaches. The Care Plan was updated with falls and interventions to prevent falls and/or minimize injury while keeping the resident as mobile as possible. Further review of the interventions for falls revealed that, the 6-27-12 physician's orders [REDACTED]. Review of Hospice information revealed that the initial referral/coverage date was 12-13-11, prior to nursing home admission. The primary coverage [DIAGNOSES REDACTED]. The most recent care plan included provision of aide services four times per week and nursing services twice weekly. Renew of the biweekly care plans revealed that Hospice had been kept updated on the resident's condition. On 9-19-12, her/his regular Hospice caregiver saw the resident. S/he noted on the Hospice report that the resident was up in the chair, and that s/he assisted with range of motion exercises, took vital signs, provided homemaking activities, assisted with a meal, encouraged fluids, and provided personal care including skin care, shower, shampoo, oral hygiene, linen change, brushed hair, and assisted with dressing. In the visit notes, the Hospice Aide did not identify any concerns with Resident #20 until s/he became combative when I shampooed her/his hair. According to her/his written statement, the Hospice CNA did not notice anything until s/he began to towel dry the resident's hair. Then, I noted a small amount of blood on a piece of hair lying on her/his forehead. I then noticed a bruise on the right portion of her/his forehead, about 1 inch from her/his hairline. At this time, s/he notified the nurse of the resident's condition. There was no mention of bruising prior to entry into the shower, though the report indicated a number of activities had been done with the resident prior to going to the shower. Review of Nurse's Notes, in addition to the above, revealed that the resident was admitted with multiple bruises and a history of wandering. On 5-14-12, after the resident had sustained falls on 5-8-12 and 5-9-12, the resident's sons were noted taking pictures of the resident. On 5-28-12, it was noted that the resident needed monitoring for wandering. Will go in other residents' rooms at times. On 5-29-12 at midnight, s/he was restless with lots of anxieties. Multiple entries were made related to continued pacing and being up all night. Interventions included engaging the resident on a 1: 1 basis and keeping her/him near the nursing station. On 6-26-12, it was noted that the resident follows very few verbal requests. On 6-27-12, an entry noted that a meeting was held with the family to discuss falls, pacing, and interventions. Restraints were also discussed. On 7-3-12, a Care Plan meeting with the family resulted in the resident being moved into a room closer to the nursing station. On 8-10-12, an entry noted that the resident was agitated and slaps staff when try to redirect resident. Again on 8-15-12 and 9-11-12, the resident was combative when attempts were made to redirect her/him. On 9-18-12, the 11-7 shift nurse documented vital signs within normal limits. Resident asleep. Arouses to stimuli. But returns to sleep very easy. No cough or congestion turn and reposition every 2 hours. On 9-19-12 at 8 AM: Hospice CNA called this nurse to shower room. Resident was sitting in shower chair outside of 2nd shower stall, noticed hematoma with bleeding to right side of resident's forehead. Resident alert, responding to verbal stimuli, attempting to stand from shower chair while collecting data to report to MD (medical doctor) & ER (emergency room ), also noted hematoma to right side of head and behind right ear. VS (Vital Signs): BP (Blood Pressure) 112/64, p (ulse) 101, T(emperature) 98.4, R(espirations) 20; MD notified- orders to send to ER for evaluation & treatment. 911 called-report given . Responsible Party made aware . At 8:15 am, the resident was transported continues to be alert & responsive. The Emergency Medical Services Patient Care Form was requested and provided at 11:47 AM. The report noted that upon arrival at the facility, the resident was in the shower, fully clothed, hair not wet. Staff with patient stated was not sure how it happened. The resident was noted with a 4 cm (centimeter) hematoma to the right lateral forehead. Face and head stable. Neuro checks were normal. Extremities were noted as normal. The emergency room report was also requested and provided at the same time. It noted contusion X2 head with a traumatic extremities and normal range of motion. Physical exam noted two hematomas, one 3 cm in diameter, another 5 cm in diameter. Fresh blood running down face on arrival at 0830. A laceration, hematoma, and swelling were noted to right of head. A hematoma and skin tear was also noted to the left elbow. Abdomen check showed tenderness and guarding. Numerous bruises were noted to legs. During an interview on 5-3-13 at 10:45 AM, the Administrator provided the same type of helmet used by the resident for the surveyor. It was made of memory-type foam covered with canvas-type fabric with no rough edges. At 12:45 PM, the Administrator was questioned as to how CNAs were made aware of special needs related to resident care. S/he stated that the facility did not use a kardex type system but that an information sheet was placed on the inside of the closet door. The posting included such things as transfer assistance needed, ambulation, feeding, bowel & bladder status, and special instructions such as alarms, helmet, etc. In reference to Hospice, s/he stated that the Staff Development Coordinator went over policies and procedures when the staff was first assigned to the resident. During an interview at 11: 50 AM on 5-3-13, Registered Nurse #1, who assessed the resident prior to transport, read and verified her/his written statement which had been part of the facility's investigation. The nurse described the knot on the resident's forehead that s/he had observed as golf ball size. When asked if s/he could tell if the injuries had just happened, the nurse stated, It did not look days old. It was very obvious. S/he stated that if the resident had not had the helmet on, it should have been visible to anyone in the hall. Review of the nurse's written statement revealed that s/he found the resident's helmet in her/his room on the overbed table with no signs of blood on it. During an interview at 1 PM on 5-3-13, CNA #1 stated that at approximately 6:55 AM on 9-19-12, s/he had made rounds with the 11-7 CNA. S/he stated they did not disturb the resident because s/he was a fighter. S/he just stepped inside the room and saw the resident sleeping with her/his helmet on. As s/he was not yet ready to work with the resident, s/he continued with other duties. Between 7 & 7:30 AM, the CNA noticed the resident's call light come on. When s/he answered the light, the Hospice Aide was getting clothes together by the closet. The CNA stated s/he was at the door and the resident was sitting up in bed with her/his helmet in her/his hand. The CNA went to get linen for the Hospice Aide and returned to the room. At this point, CNA #1 stated s/he bent down to talk to the resident. S/he was very close to the resident's face and would have noticed any injury. S/he said s/he later saw Hospice walking the resident to the shower with no helmet. The CNA noted that the resident was supposed to have the helmet on at all times. At 1:25 PM on 5-3-13, a telephone interview was conducted with LPN #1, who had been the 7-3 nurse at the time of the incident. S/he verified the written statement given at the time of the facility investigation that s/he was standing at med cart saw resident ambulating in hallway with Hospice CNA walking toward me to shower room, her (his) helmet was off at this time . The nurse further stated, I would have noticed any injury. When asked how Hospice would know what care was to be provided to an assigned resident, LPN #1 referenced the sheet on the closet door and stated that Hospice was aware of these information sheets. The nurse reiterated that Hospice had come to the shower door to get her/him to look at the resident. When I went in to check her/him, s/he had blood running down her/his face and a purplish-red area on the right front of her/his head near the hair. During an interview at 1:35 PM on 5-3-13, CNA #2 stated s/he had worked 11-7 shift on 9-18-12. S/he stated s/he had made rounds with the 7-3 CNA at change of shift. The CNA stated the resident had slept all night and s/he remembered looking at the resident who had her/his helmet on. S/he further stated, The helmet goes back when (the resident is) in bed. The CNA demonstrated how it would sit on the resident because s/he has a very small face. S/he said s/he would have been able to see if there was anything there-there was nothing there. The CNA stated s/he woke up the resident on last rounds .and s/he was OK then. When asked how the thought the incident had happened, CNA #2 said, In the shower. The resident would sit and get right backup. S/he thought the resident might have fallen in the wet shower. All someone would have to do is turn away for a minute to get the soap or something. The CNA further stated that the resident was supposed to have the helmet on at all times. CNAs are to check inside the closet every day for any changes. At the bottom are special instructions and Resident #20 had 'helmet at all times' on her/his and 'hipsters at all times.'",2016-06-01
8237,INMAN HEALTHCARE,425122,51 N MAIN ST,INMAN,SC,29349,2012-11-07,333,D,0,1,YTDP11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on observations, record review, interview and the Drug Facts and Comparisons book (updated monthly), the facility failed to ensure that a resident observed during medication pass (Resident A) was free of a significant medication error. The findings included: On 11/6/12 at 8:30 AM, during observation of medication pass, Licensed Practical Nurse (LPN) #1 was observed to administer one [MEDICATION NAME] 5 milligram (mg) tablet and 5 other medications to Resident A. Review of the current physician's orders [REDACTED]. During an interview on 11/6/12 at 8:46 AM, LPN #1 was asked about the resident's respiration rate. She stated that she had not taken it and that she would go back and check the resident's respiration now. The resident's respiration rate was found to be 18. The Drug Facts and Comparisons book (updated monthly), page 793, states (in a black box warning) concerning [MEDICATION NAME] use: Respiratory depression is the chief hazard associated with [MEDICATION NAME] administration.",2016-06-01
8238,INMAN HEALTHCARE,425122,51 N MAIN ST,INMAN,SC,29349,2012-11-07,371,E,0,1,YTDP11,"On the days of the survey, based on random observations of the kitchen and interview, staff were observed with no beard constraint in place, hair not completely covered by a hair restraint, and using serving gloves to move soiled carts, open drawers, and retrieve supplies from the supply room without washing hands or changing gloves while serving food on the tray line. The findings included: During random observation of the kitchen area on 11/6/12, the cook was observed serving food with hair net not completely restraining hair. The CDM (Certified Dietary Manager) did not have a beard restraint on to cover facial hair around mouth and chin. The cook was observed to move a serving cart near the steam table with serving glove and then with the same glove picked up a piece of bread and placed it on a plate to be served to a resident. Later, the cook retrieved Styrofoam products from the storage area and served the tray with the same gloves. A storage drawer was also opened with the serving glove to obtain a serving utensil. Each time the staff member continued using the same gloves to serve plates of food. On 11/7/12 these areas were discussed with the CDM. He was not aware he needed to wear a beard protector while around the food . The kitchen staff were not aware that they needed to wash hands and change gloves if they handled anything else other than the food.",2016-06-01
8239,INMAN HEALTHCARE,425122,51 N MAIN ST,INMAN,SC,29349,2012-11-07,425,D,0,1,YTDP11,"On the days of the survey, based on observations, interview, and the Drug Facts and Comparisons book (updated monthly), the facility failed to follow a procedure to ensure that expired medications were removed from medication storage in the facility's medication refrigerator at the facility's nurses station. The findings included: On 11/6/12 at 11:44 AM, observation of the facility's medication storage refrigerator revealed one 1 milliliter (ml) vial (10 tests) Tuberculin Purified Protein Derivative (PPD), Diluted/Aplisol, 5 TU (tuberculin units)/0.1 ml, opened, with a puncture date of 10/1/12. The Drug Facts and Comparisons book (updated monthly), page 2001, states (in reference to Tuberculin Purified Protein Derivative): Discard vials in use for more than 30 days because of possible oxidation and degradation that may affect potency. During an interview on 11/6/12 at 12:03 PM, Licensed Practical Nurse (LPN) #1 confirmed the puncture date (10/1/12) and stated that night shift medication nurses are responsible for checking the medication refrigerator and medication storage cabinets for expired products. She was not sure if there is a set schedule.",2016-06-01
8240,INMAN HEALTHCARE,425122,51 N MAIN ST,INMAN,SC,29349,2012-11-07,441,D,0,1,YTDP11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on an observation of a wound treatment and interview, the nurse did not provide a safe, sanitary environment to prevent the development and transmission of disease or infection by not washing and or sanitizing his/her hands between changing soiled gloves and applying clean gloves. Resident # 2's brief also touched the clean wound bed. ( 1 of 1 sampled residents observed for wound care.) The findings included: The facility admitted Resident # 2 on 5/21/10 with a [DIAGNOSES REDACTED].# 1 (Licensed Practical Nurse) was observed to change his/her gloves eight times during 2 wound treatments without washing or sanitizing his/her hands between removing soiled gloves and applying clean gloves. The resident's brief also touched the clean wound bed during the treatment. After the treatment was completed, the LPN was asked if this was her normal procedure for changing gloves during wound care. She said ,No. I usually wash my hands or use hand sanitizer each time I change my gloves. I was nervous today. He/she also stated that the brief should have been more secure so as not to touch the wound.",2016-06-01
8241,THE METHODIST OAKS,425131,151 LOVELY DRIVE,ORANGEBURG,SC,29115,2012-02-29,225,D,0,1,5WM211,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey based on interview and record review, the facility failed to report an injury of unknown origin to the appropriate State agency for 1 of 1 sampled residents reviewed with an injury of unknown origin. (Resident #5) The findings included: Resident #5 was re-admitted on [DATE] with [DIAGNOSES REDACTED]. Record review on 2/27/12 at approximately 2:15pm revealed a nursing note dated 1/3/12 which indicated that the resident was seated in wheelchair in doorway of room with skin tears to arms, knot noted on back of head - sent to ER (emergency room ). Review of Incident report on 2/28/12 at approximately 10:30am indicated that a nurse and CNA (Certified Nursing Assistant) entered room after a loud noise was heard. When asked what had happened, the resident stated he was trying to go downstairs to put out the fire. The incident report did not indicate where in the room the resident was located when found. Review of the resident's most recent Minimal Data Set of 2/14/12 indicated a BIMS (Brief Interview for Mental Status) of 7. A BIMS score of 0-7 indicates severe cognitive impairment. Interview on 2/28/12 with the Administrator indicated that the incident had not been reported any State agency. Communication with the Bureau of Certification Compliant Intake Officer verified that the incident had not been reported to the agency. Based on the information in the nursing notes and the incident report, the occurrence met the definition of an injury of unknown origin. Therefore, it should have been reported to the appropriate State agency within 24 hours of its occurrence and a further investigation should have occurred and been documented.",2016-06-01
8242,THE METHODIST OAKS,425131,151 LOVELY DRIVE,ORANGEBURG,SC,29115,2012-02-29,280,E,0,1,5WM211,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on record review and interview, the facility failed to review and revise care plans for 4 of 13 resident care plans reviewed. The facility failed to revise the CNA (Certified Nurses Aide) care plan to reflect implemented interventions to prevent falls for Resident #6, failed to update the comprehensive care plan to reflect a fall for Resident #6, failed to update the comprehensive care plan for Resident #5 to reflect implemented interventions to prevent falls, and failed to revise the care plans for Resident #9 and Resident #13 to reflect treated infections. The findings included: The facility admitted Resident #6 on 12/11/07 with [DIAGNOSES REDACTED]. Review of the Nurse's Notes dated 8/22/11 at 5:55 PM indicated Resident #6 sustained a fall to the floor after rolling out of bed. Review of the fall data provided by the facility entitled Falls Screened by Therapy PAR (Patients at Risk) committee revealed that recommendations following the fall included, Recommend resident not be left alone for meals. Further review of the Nurse's Notes dated 11/18/11 at 11:05 AM indicated Resident #6 was found on the floor in front of the wheelchair. The notation stated, Res (resident) appeared to have slide (sic) out of w/c. Record review indicated Resident #6 sustained a [MEDICAL CONDITION] tibia and fibula as a result of the incident. Review of the Therapy Screen dated 11/22/11 indicated interventions included recommend checking regularly for repositioning needs and Recommend Hoyer lift transfer to protect fx. Review of the Falls Screened by Therapy PAR committee data revealed Recommend not leaving resident alone but in-sight of caregivers to identify repositioning needs .Recommend also Hoyer transfers were recommended interventions to prevent further falls. Review of the Nurse's Notes dated 1/07/12 at 8:30 AM indicated, CNA was transferring res from wheelchair to bed when Res slipped and slid to ground on top of CNA. The Therapy Screen following the incident indicated, Recommend Hoyer transfer. Review of Resident #6's comprehensive care plan revealed the fall on 1/07/12 was not documented and was not included under the problem area entitled Falls. Review of Resident #6's KARDEX contained in the CNA Notebook revealed the recommendations following the falls on 8/22/11 and 11/18/11 were not documented on the KARDEX. These recommended interventions included not leaving the resident alone for meals, checking regularly for need of repositioning, and use of Hoyer lift for transfers. Further review indicated the KARDEX form indicated transfer assistance for Resident #6 was Assist of 1. During an interview on 2/29/12 at approximately 3:00 PM, CNA #3 was asked how CNA staff know what type of assistive device or assistance a resident requires for transfers. CNA #3 stated that this information is documented on the CNA KARDEX located in a notebook at the Nurse's Station. CNA #3 reviewed the KARDEX with the surveyor and confirmed that Assist of 1 was documented under Transfer assistance. CNA #3 stated that Resident #6 was to be transferred using a Hoyer lift and referred to a pink, laminated page in the resident's section of the notebook which contained this information. This signage contained no date to indicate when this information was included in the CNA Notebook. During an interview on 2/29/12 at approximately 11:10 AM, the Director of Nursing (DON) and MDS Coordinator were asked to review Resident #6's KARDEX. Both staff members confirmed that the KARDEX indicated Resident #6 was a transfer assist of 1. In addition, both staff members confirmed that the KARDEX did not include information that Resident #6 was not to be left alone for meals, should be checked frequently for repositioning needs, and should be transferred via a Hoyer lift. The DON and MDS Coordinator were asked to review the page in the CNA Notebook which indicated Resident #6 was to be transferred via a Hoyer lift. When asked when this information was included in the CNA Notebook, the DON stated that this information was included after the fall on 1/07/12 but was not included prior to this incident. During an interview on 2/29/12 at approximately 2:45 PM, the MDS Coordinator was questioned about the process for updating care plans. The MDS Coordinator indicated that information is obtained from physician's orders [REDACTED]. The MDS Coordinator indicated that both the comprehensive care plans and CNA care plans are updated using this information. Resident #5 was re-admitted on [DATE] with [DIAGNOSES REDACTED]. Record review on 2/27/12 at approximately 2:15pm indicated the resident had fallen on 1/3/12, 1/4/12, 1/6/12, 1/10/12, and 1/30/12. Review of the current Care Plan revealed that it did not reflect that the falls had occurred or the interventions that were put into place to prevent further falls. Resident #9 was re-admitted [DATE] with [DIAGNOSES REDACTED]. Record review on 2/28/12 at approximately 10:10am revealed a physician's orders [REDACTED]. A second physician's orders [REDACTED]. Review of current Care Plan revealed that it did not reflect the infection or the interventions put into place. Resident #13 was admitted on [DATE] with [DIAGNOSES REDACTED]. Record review on 2/28/12 at approximately 4:10pm revealed a physician's orders [REDACTED]. A second physician's orders [REDACTED]. A third physician's orders [REDACTED]. Review of the current Care Plan revealed that it did not reflect the infections or the interventions put into place. Interview on 2/29/12 at approximately 11:10am with the MDS Coordinator and Director of Nursing indicated that the above three Care Plans had not been updated to reflect the changes in the residents status or the interventions put into place to correct or prevent future occurrences.",2016-06-01
8243,THE METHODIST OAKS,425131,151 LOVELY DRIVE,ORANGEBURG,SC,29115,2012-02-29,315,D,0,1,5WM211,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on observations, interview and review of the facility's policy Catheter Care, the facility failed to ensure that 1 of 3 residents received appropriate catheter care. For Resident #3, Certified Nurse Assistant (CNA) failed to separate and cleanse the labia. The finding included: The facility admitted Resident #3 on 1-7-09 and was readmitted on [DATE] with [DIAGNOSES REDACTED]. On 2-29-12 at 11:38 AM, during an observation of Resident #3's Foley catheter care, CNA #4 anchored the catheter tubing at the urinary meatus with her left hand. She then used 3 sanitary swabs to wipe only the catheter tubing. The CNA did not separate the labia to assure thorough cleansing. On 2-29-12 at 11:49 AM, during an interview, CNA #4 verified she had only cleaned the catheter tubing. Review of the facility policy entitled Catheter Care states under Procedure, Female Residents: Spread the labia, using the first swab cleanse down the one side of the labia, second swab cleanse down the other side, use third swab, starting at the urinary meatus and clean down catheter tubing rotate swab and clean opposite side of the tubing.",2016-06-01
8244,THE METHODIST OAKS,425131,151 LOVELY DRIVE,ORANGEBURG,SC,29115,2012-02-29,322,D,0,1,5WM211,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the Recertification Survey, based on observation, interview and record review, the facility failed to administer the amount of tube feeding formula and water flush as ordered for 5 feedings over a 2 day period for Resident #2, 1 of 2 residents sampled for Percutaneous Gastrostomy Tube (PEG) feedings. The findings included: The facility admitted Resident #2 on 12/13/11 with [DIAGNOSES REDACTED]. On 2/28/12 at 9:52 AM, Licensed Practical Nurse (LPN) #3 was observed administering the tube feeding and water flush to Resident #2. After checking the Medication Administration Record, [REDACTED]. After washing her hands, donning gloves and verifying placement, the LPN flushed the PEG tube with 30 ml of water. She poured 60 ml of Glucerna 1.5 into the syringe and allowed to flow via gravity. She then poured an additional 60 ml into the syringe and allowed to flow, added an additional 5 ml of formula then followed with an additional 30 ml of water to flush the tube. Record review on 2/28/12 at 3:40 PM revealed a Physician's Telephone Order dated 1/31/12 that read Per Dietary Rec(ommendation) - (Change) TF (tube feeding) to bolus 1 can Glucerna 1.5 @ (at) 9A, 1P and 6P and follow with 125 cc (cubic centimeters) H2O (water) flush. Further review revealed the order had been carried over to the February 1-29 monthly physician's orders [REDACTED]. During an interview on 2/28/12 at 4:45 PM, LPN #3 confirmed that she had given a total of 125 ml of tube feeding and a total of 60 ml of water to flush. After reviewing the MAR indicated [REDACTED].",2016-06-01
8245,THE METHODIST OAKS,425131,151 LOVELY DRIVE,ORANGEBURG,SC,29115,2012-02-29,369,D,0,1,5WM211,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on record review and observation, the facility failed to provide adaptive feeding equipment for 1 of 1 sampled residents with orders for adaptive equipment. The facility did not provide Resident #6 with the angled spoon per physician's orders [REDACTED]. The findings included: The facility admitted Resident #6 on 12/10/07 with [DIAGNOSES REDACTED]. Review of the February 2012 physician's orders [REDACTED]. Further record review revealed a Physician's Telephone Order dated 5/23/11 for an angled spoon. Review of the Nutrition Risk assessment dated [DATE] indicated an angled spoon was listed as an adaptive device to be used for Resident #6. Observation of the lunch meal on 2/28/12 at approximately 12:30 PM and the dinner meal on 2/28/12 at approximately 5:45 PM revealed Resident #6 sitting at a table eating in the dining room. Observation indicated that Resident #6 was provided a built-up fork for both meals. This was the only eating utensil provided by staff for both of the meals. Review of the dietary tray card revealed a photo of adaptive equipment which did not include an adaptive spoon. On 2/29/12 at approximately 4:00 PM, the Certified Dietary Manager (CDM) reviewed the dietary card and order for angled spoon. The CDM confirmed that the dietary card did not correctly indicate that the angled spoon was to be provided.",2016-06-01
8246,THE METHODIST OAKS,425131,151 LOVELY DRIVE,ORANGEBURG,SC,29115,2012-02-29,425,D,0,1,5WM211,"On the days of the survey, based on observation and interview, the facility failed to follow a procedure to ensure that expired medications were not stored in 1 of 3 medication rooms. The findings include: On 2/27/12 at approximately 10:45 AM, inspection of the Riverside (D Wing) medication room refrigerator revealed the following: -One opened vial of Novolog Insulin 100 U (units)/1 ml (milliliter), Lot AZF0366, Prescription 848, dispensed 1-19-12 and belonging to Resident A had not been labelled as to the date it was opened. -One opened vial of Novolog Insulin 100 U/1 ml, Lot AZF0333, Prescription 976, dispensed 12/15/11 and belonging to Resident B had not been labelled as to the date opened. These findings were verified by LPN (Licensed Practical Nurse # 2) who stated that they should have been dated when opened. The manufacturer, Novo Nordisk, states in the package insert that Novolog Insulin should be discarded 28 days after opening.",2016-06-01
8247,THE METHODIST OAKS,425131,151 LOVELY DRIVE,ORANGEBURG,SC,29115,2012-02-29,441,E,0,1,5WM211,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the Recertification Survey, based on observations, interviews and record review, the facility failed to implement all components of the infection control program. The facility failed to have a process to comply with State Laws and Regulations for reporting communicable diseases and outbreaks and failed to monitor that staff observed transmission based precautions. The facility also failed to ensure that expired instant hand sanitizers were not being stored in 2 of 3 medication rooms and were not being used during patient care on 3 of 6 medication carts. The findings included: Review of the facility's Policy and Procedure Manual revealed no list of Reportable Conditions or communicable diseases to be reported in accordance with State Laws and Regulations. During an interview on [DATE] at approximately 11:30 AM, the Infection Control Nurse stated she didn't know where the list might be. She stated she hadn't seen one and did not know what conditions or communicable diseases were reportable. Review of the infection surveillance logs indicated the facility had 4 ESBL (Extended-Spectrum Beta-Lactamase) infections in the month of January, 2012. The Infection Preventionist was not able to state whether that would constitute an outbreak of a communicable disease and stated she would have to research it. On [DATE] during initial tour, Resident #11 was noted to be on transmission-based precautions. Licensed Practical Nurse (LPN) #3 stated the resident was on contact isolation. Record Review on [DATE] at approximately 10:30 AM revealed the resident had a Culture and Sensitivity on [DATE] which was positive for [DIAGNOSES REDACTED] Pneumoniae ESBL and antibiotic therapy and isolation precautions were ordered on [DATE] when the results were received. At 6:15 PM on [DATE], Certified Nursing Assistant (CNA) #2 was observed delivering the evening meal in the resident's room without donning any PPE (Personal Protective Equipment) prior to entering. Observation of the isolation supplies hanging outside the resident's room at that time revealed an unopened package of isolation gowns containing 5 gowns. On [DATE] at 9:30 AM, observation of the isolation supplies outside the resident's room again revealed an unopened package of isolation gowns. At 10:28 AM, CNA #2 was observed entering the room of Resident #11 without donning any PPE. At 12:38 PM on [DATE], Licensed Practical Nurse #3 was observed sitting in Resident #11's room during a nebulizer treatment without a gown. LPN #3 was observed to be wearing gloves. At 12:52 PM, this surveyor opened the package of isolation gowns and donned a gown to conduct an individual interview with the resident. During the Resident Interview, when asked if the staff wore gowns when they came in to provide care, Resident #11 said Some do. At approximately 9:30 AM on [DATE], a package containing 4 isolation gowns was observed outside the resident's room. At 3:40 PM, the same package was observed outside the resident's room and it still contained 4 gowns. Review of the facility's Transmission-Based Precautions - Categories Policy Statement in the section titled Contact Precautions stated a. Examples of infections requiring Contact Precautions include, but are not limited to: (1) . urinary . infections or colonization with multi-drug resistant organisms (e.g.(for example), .ESBL). In the subsection titled c. Gloves and Handwashing, the policy stated (1) .wear gloves (clean, non-sterile) when entering the room. The subsection titled d. Gown stated (1) . wear a gown (clean, non-sterile) when entering the room if you anticipate that your clothing will have substantial contact with an actively infected resident, with environmental surfaces, items in the resident's room . At approximately 11:52 AM on [DATE], during an interview, the Director of Nursing (DON) stated that the facility provided education and in-services on transmission based precautions. She also stated that the facility monitored staff by identifying new cases of an infection in any given staff members case-load but no monitoring of staff practices was done to ensure that staff observe transmission based precautions to prevent infections from occurring. In addition, the DON stated there was no defending observations of staff not observing precautions. On [DATE] at approximately 10:30 AM, inspection of the Piedmont (A Wing) medication room revealed the following: -One unopened 8 ounce bottle of CliniShield Instant Hand Sanitizer ([MEDICATION NAME] 62% (percent), Lot 01, expiration ,[DATE] was found atop a white, plastic storage unit. On [DATE] at approximately 11:30 AM inspection of the Piedmont (A wing) medication carts revealed the following: -Cart 1: One opened 8 ounce bottle of CliniShield Instant Hand Sanitizer ([MEDICATION NAME] 62%), Lot 01. expiration ,[DATE]. -Cart 2: One opened 8 ounce bottle of CliniShield Instant Hand Sanitizer ([MEDICATION NAME] 62%), Lot 01, expiration ,[DATE]. These findings (medication room and medication carts) were verified by LPN (Licensed Practical Nurse) # 1 on [DATE] at approximately 11:35 AM. LPN # 1 stated that Instant Hand Sanitizer was used to sanitize hands during patient care. On [DATE] at approximately 10:45 AM, inspection of the Riverside (D Wing) medication room revealed the following: -Two unopened 8 ounce bottles of CliniShield Instant Hand Sanitizer ([MEDICATION NAME] 62%), Lot 01, expiration ,[DATE]. -One unopened 8 ounce bottle of Clinishield Instant Hand Sanitizer ([MEDICATION NAME] 62%), Lot 01, expiration ,[DATE] These three bottles were stored on the 2nd shelf, right side of a gray metal storage unit. On [DATE] at approximately 10:55 AM inspection of the Riverside (D Wing) medication carts revealed the following: Cart 1: One opened 8 ounce bottle of CliniShield Instant Hand Sanitizer ([MEDICATION NAME] 62%), Lot 01, expiration ,[DATE]. These findings (medication room and medication cart) were verified by LPN # 2 on [DATE] at approximately 11:45 AM. LPN # 2 stated that Instant Hand Sanitizer was used to sanitize hands during patient care.",2016-06-01
8248,THE METHODIST OAKS,425131,151 LOVELY DRIVE,ORANGEBURG,SC,29115,2012-02-29,502,D,0,1,5WM211,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on observation and interview, the facility failed to follow a procedure to ensure that expired laboratory products were not stored in 1 of 3 medication rooms. The findings include: On [DATE] at approximately 10:30 AM, inspection of the Piedmont (A Wing) medication room revealed the following: -Fourteen packages of BBL Culture Swab Collection and Transport System, Lot 029H43 L.YPT233, expiration ,[DATE] were found in a plastic biohazard bag located in the 2nd drawer from the right side of a storage cabinet. This finding was verified by LPN (Licensed Practical Nurse) #1 on [DATE] at approximately 11:35 AM.",2016-06-01
8249,THE METHODIST OAKS,425131,151 LOVELY DRIVE,ORANGEBURG,SC,29115,2012-02-29,520,F,0,1,5WM211,"On the days of the survey, based on an interview with the Administrator and Infection Control Preventionist, the facility's Quality Assurance Committee failed to monitor the effect of implemented changes and making needed revisions to the action plans. The findings included: Interview on 2/29/12 at approximately 10:00am with the Administrator and Infection Control Preventionist concerning the facility Quality Assurance Program revealed that the committee was actively addressing concerns in the area of Falls, Weight Loss, Infections, Skin Tears, Medications among others. However, the committee was reviewing the concerns on a case by case basis. The committee had not developed a formal system wide plan of action addressing monitoring of the interventions put into place and the effectiveness of those interventions in relation to the operation of the facility and how it could benefit all who reside within the facility. The Infection Control Preventionist stated We don't connect the dots.",2016-06-01
8250,SOUTHLAND HEALTH CARE CENTER,425157,722 SOUTH DARGAN STREET,FLORENCE,SC,29506,2012-05-30,241,D,0,1,ZD5411,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on observations and interview, the facility failed to promote care in a manner that enhances each resident's dignity for 1 of 3 residents reviewed with catheters. The facility failed to provide a cover for Resident #2's catheter bag. The findings included: The facility admitted Resident #2 on 4/05/07 with [DIAGNOSES REDACTED]. Review of the medical record on 5/29/12 revealed a physician's orders [REDACTED]. During the Initial Tour of the unit on 5/29/12 at approximately 11:35 AM, the resident's door was open, and the resident's Foley catheter bag was observed hanging on the side of the bed facing/nearest the door. The catheter bag was observed to contain a small amount of urine, and the bag was uncovered. These findings remained the same during observations of the resident's catheter bag on 5/29/12 at approximately 2:15 PM, 5:20 PM, 6:00 PM and on 5/30/12 at approximately 9:15 AM and 11:45 AM. The resident's door was open and the catheter bag was hanging in the same location during these observations. During an interview with Licensed Practical Nurse (LPN) #2 on 5/30/12 at approximately 11:45 AM, the surveyor asked LPN #2 to view the resident's room from the hallway and to observe if anything would be noticeable to visitors or anyone walking past the room. At that time, LPN #2 stated that the catheter bag was uncovered and should have a cover. When asked if staff had access to catheter bag covers, LPN #2 stated that the covers were available in the unit's supply room.",2016-06-01
8251,SOUTHLAND HEALTH CARE CENTER,425157,722 SOUTH DARGAN STREET,FLORENCE,SC,29506,2012-05-30,431,E,0,1,ZD5411,"On the days of the survey, based on observation and interview, the facility failed to ensure that the drugs used in the facility were labeled in accordance with currently accepted professional principles, which included the expiration date. Three of four medication carts contained medications repackaged by the pharmacy without expiration dates. The findings included: On 05/29/12 at approximately 3:50 pm on the South Unit in medication cart #2, three repackaged medications were noted without expiration dates on the labels. During an interview with Licensed Practical Nurse #1 at the time of the findings, she confirmed no expiration dates were found on the labels. She stated that the medications had been supplied by Hospice. On 05/30/12 at approximately 10:50 am on the North Unit in medication cart #1, and cart # 2 one repackaged medication was found in each cart without an expiration date on the label. During an interview with the Assistant Director of Nurses (ADON) at the time of the finding, she confirmed no expiration date was on the label. She also stated that the medications been supplied by Hospice.",2016-06-01
8252,AGAPE REHABILITATION OF ROCK HILL,425159,159 SEDGEWOOD DR,ROCK HILL,SC,29732,2013-06-18,282,E,1,0,B96711,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the day of the complaint inspection, based on record review, observation and interview, the facility failed to ensure that each resident care plan was followed. The facility failed to follow care planned safety devices to prevent fall for 4 of 5 residents reviewed for falls (Resident #4, #5, #6 and #7). The findings included: Resident #4 was admitted to the facility on [DATE] for rehabilitation after having a hip repair. Review of the Discharge Summary from the hospital revealed Resident #4 was admitted to the hospital on [DATE] for a left [MEDICAL CONDITION] after s/he fell . Review of Resident #4's Fall Risk assessment dated [DATE] revealed the resident had a total score of 14. The Fall Risk Assessment form indicated that a total score above 10 represents high risk for falls. Review of Resident #4's Interim Care Plan revealed the resident was at risk for falls and bed/chair alarms were used as an intervention. Review of the Care Plan revealed a risk for falls was identified as a problem area. Interventions and approaches were listed on the care plan and included to ensure any safety devices ordered were in place and functioning properly every shift. Review of Resident #4's Treatment Record for June 2013 revealed Bed alarm to bed (clip) and Clip alarm to chair. The alarms were not signed for on the 7 AM - 7 PM shift for 6/10/13 when reviewed at 5:05 PM. On 6/10/13 at approximately 4:05 PM Resident #4 was observed to stand up from her wheelchair across from the nurse's station and fall. The surveyor informed Registered Nurse (RN) #2 and Certified Nurse Aide (CNA) #3 at the nurse's station that the resident had fallen. Resident #4 was noted to have a clip alarm dangling from her/his clothing but no alarm was sounding. During interview on 6/10/13 at approximately 4:19 PM RN #2 stated that Resident #4's alarm was not turned on. During interview on 6/10/13 at approximately 4:22 PM CNA #3 stated that if the alarm was turned on it would have sounded. CNA #3 and the surveyor walked to Resident #4's room and CNA #3 demonstrated by turning the alarm on and removing the string with the clip attachment. The alarm sounded when the clip was removed. During an observation on 6/10/13 at approximately 4:55 PM Resident #4 was noted in bed. Resident #4 did not have a clip alarm on. The clip alarm was noted attached to the resident's wheelchair. Review of the Necessary Information for Direct Care Staff form for Resident #4 revealed that a clip alarm was not checked under Safety Devices When Out of Bed or Safety Devices When In Bed. The form indicated the staff was to check the function of the alarm at the beginning of each shift. During an interview on 6/10/13 at approximately 5:25 PM CNA #2 stated that s/he was assigned to Resident #4. CNA #2 stated that s/he did not know that Resident #4 required an alarm while in bed. Resident #5 was admitted to the facility on [DATE]. Review of Resident #5's physician's orders [REDACTED]. Observation of Resident #5 on 6/10/13 at approximately 5:10 PM revealed that the resident was in bed. There was a clip attached to the resident's clothing, but the alarm box was not attached to anything and was lying next to the resident in bed. During interview on 6/10/13 at approximately 5:10 PM RN #2 stated that the alarm box should be attached to the bed rail to anchor the alarm. Resident #6 was admitted to the facility on [DATE]. Review of the History and Physical from Resident #6's hospital stay 5/4/13- 5/8/13 indicated that the resident was admitted after s/he fell out of a wheelchair. Review of Resident #6's Physician order [REDACTED]. Review of Resident #6's Fall Risk assessment dated [DATE] revealed the resident had a total score of 14. The Fall Risk Assessment form indicated that a total score above 10 represents high risk for falls. Observation of Resident #6 on 6/10/13 at approximately 5:15 PM revealed that there was no alarm on the resident. Resident #6 stated that s/he did not have an alarm on. Review of Resident #6's Care Plan revealed resident sustained [REDACTED]. Interventions and approaches were noted on the care plan that included to ensure any safety devices ordered are in place and functioning properly every shift. At approximately 5:25 PM CNA #2 was unable to locate Resident #6's Necessary Information for Direct Care Staff form in the resident's room. Review of Resident #6's Admission Minimum (MDS) data set [DATE] revealed the resident had a Brief Interview for Mental Status score of 15. Review of Resident #7's Treatment Record revealed an alarm to prevent falls. Observation of Resident #7 on 6/10/13 at approximately 5:20 PM revealed the resident was in bed with no alarm. RN #2 stated that Resident #7's alarm was under the resident's bed.",2016-06-01
8253,AGAPE REHABILITATION OF ROCK HILL,425159,159 SEDGEWOOD DR,ROCK HILL,SC,29732,2013-06-18,309,G,1,0,B96711,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the day of the complaint inspection, based on record review and interview, the facility failed to provide the necessary care and services to maintain the highest practicable physical well-being. Resident #1 was found on the floor beside her/his bed with the bed alarm sounding. The x-ray's obtained related to the fall were reported to a nurse as negative for a fracture, the x-ray's in fact showed a fractured wrist and hip. The facility failed to timely address Resident #1's injury. The findings included: Review of the facility investigation summary stated that a nurse received a verbal negative x-ray result called in to her/him for Resident #1. Because s/he received a negative verbal report, s/he did not thoroughly read the written reports when they arrived, instead placing them in the physician's box for review. Review of Resident #1's Nurse's Notes from 5/4/13 through 5/6/13 revealed the following: 5/4/13 8:00 AM indicated the resident was observed lying on his/her right side on the floor in his/her room beside the bed and the bed alarm was sounding. The nurse assessed the resident for injuries and noted the resident cried when moving his/her upper and lower right extremities. A new order for x-ray of the right side was received. 12:00 PM x-ray of resident's right side and the resident was medicated for pain. 3:00 PM x-ray results were back and no fracture was noted to the right side, the resident was medicated for pain. 10:00 PM Resident #1 was medicated for pain to the right side of the body. Tender to touch or move. 5/5/13 4:00 AM attempted to give [MEDICATION NAME] but refused to take. Appears in much pain during ADL's. 6:00 PM Resident in bed resting with eye's closed. Rt (right) side tender to touch. Pt (patient) medicated x 2 @ 7:00 AM and 2:00 PM with some effectiveness. Pt is unable to mover his/her (RLE) right lower extremities without having pain. 5/5/ - 5/6/13 at 8:00 PM medicated for pain and at 1:45 AM the doctor notified of (R) right [MEDICAL CONDITION]. Orders given to call family and tell them we can sent to ER (emergency room ) for evaluation and treatment or make an ortho (orthopedist) appt (appointment) ASAP on Monday. 2:10 AM left voice mail (for the resident's responsible party) have not heard back. 5/6/13 7:00 AM No returned call from family. Note to (staff) to plan on making ortho appt. ASAP. 5 AM [MEDICATION NAME] and [MEDICATION NAME] 1 mg (milligram) give 10:15 AM Off going nurse stated res had rt hip fx had spoken to MD and MD gave TO (telephone order). 9:10 AM order given to send res to ER . Review of Resident #1's Controlled Drug Record revealed the resident received [MEDICATION NAME] 5-500 milligrams on 5/4/13 at 8:00 AM, 2:00 PM, and 10:00 PM. Resident #1 received [MEDICATION NAME] 5-500 milligrams on 5/5/13 at 4:00 AM, 7:00 AM, 2:00 PM, and 8:00 PM. Resident #1 received [MEDICATION NAME] 5-500 milligrams on 5/6/13 at 5:00 AM. Resident #1 had an order for [REDACTED]. Review of Resident #1's Physician's Telephone Orders' dated 5/6/13 indicated at 7:00 AM May send to ER to evaluate and treat if family prefers or make appointment with ortho ASAP. A Physician's Telephone Order dated 5/6/13 at 9:10 AM indicated to transfer the resident to the emergency room for a right [MEDICAL CONDITION] and a right wrist fracture. Review of the Radiology Reports dated 5/4/13 indicated Resident #1 had an acute right [MEDICAL CONDITION] and a distal right radius fracture. Review of the Discharge Summary from the hospital dated 5/10/13 indicated Resident #1 had a right wrist fracture and a right [MEDICAL CONDITION]. Resident #1 underwent surgery for [REDACTED]. Licensed Practical Nurse (LPN) #1's facility-obtained incident statement indicated that Resident #1 had eight x-rays taken of his/her right side. LPN #1 received a phone call from the company that performed the X-rays and was given a verbal report stating that no fractures were found. S/he then retrieved the transmittal from the office fax machine and filed it in the doctor's communication book without reading it. On 5/5/13 LPN #1 updated the Director of Nursing (DON) on the incident and told the DON that s/he truly believed there was a fracture. Throughout the day s/he continued to monitor the resident and keep the resident as comfortable as possible until the end of his/her shift. In a telephone interview with the surveyor on 6/19/13 at approximately 4:55 PM LPN #1 confirmed the accuracy of her/his statement as written. Registered Nurse (RN) #1's facility-obtained statement indicated that s/he was told by the day shift nurse that several x-rays had been taken and they were all negative for fracture for Resident #1. RN #1 found a result of a right [MEDICAL CONDITION] for Resident #1 on the copier near the medication room at 1:45 AM. S/he called the doctor and received orders to send Resident #1 to the emergency room to evaluate and treat if the family preferred or to make an orthopedist appointment ASAP. The oncoming nurse (LPN #2) found a wrist fracture x-ray in the doctor's book. RN #1 did not think to look at those x-rays because s/he had already been told there were no fractures. Licensed Practical Nurse (LPN) #2's facility-obtained statement dated 5/9/13 indicated that on 5/6/13 s/he received report from the off going nurse that Resident #1 had fallen out of bed. The off going nurse stated that s/he had found an x-ray report on the fax machine that stated the resident had a right [MEDICAL CONDITION]. The off going nurse called the physician and received an order to notify the family to see if they wanted the resident sent out and if they didn't to have an orthopedist appointment ASAP. In a telephone interview with the surveyor on 6/19/13 at approximately 4:40 PM LPN #2 confirmed the accuracy of his/her statement as written. LPN #2 stated that the off going nurse noted in his/her statement was RN #1. LPN #2 stated s/he found the wrist fracture x-ray report while looking through the x-rays to show the supervisor the [MEDICAL CONDITION] x-ray report that RN #1 had found.",2016-06-01
8254,AGAPE REHABILITATION OF ROCK HILL,425159,159 SEDGEWOOD DR,ROCK HILL,SC,29732,2013-06-18,328,G,1,0,B96711,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the complaint inspection, based on record review and interviews, the facility failed to ensure that one of one sampled residents reviewed with a [MEDICAL CONDITION] received appropriate care and services. The facility failed to implement interventions timely to prevent dislodgement of the [MEDICAL CONDITION] cannula for Resident #7. The findings included; The facility admitted /readmitted Resident #7 with [DIAGNOSES REDACTED]. Review of the Minimum Data Set assessment dated [DATE] revealed the resident had short and long term memory problems. Review of the hospital Discharge Summary dated 4/23/13 revealed Resident #7 initially was treated at the hospital for a decline in mental status. Imaging on day 2 demonstrated an increase in ventricular size ([DIAGNOSES REDACTED]), and the resident was transferred for neurosurgical care. The resident underwent [REDACTED]. The resident required reintubation within 48 hours for hypoxic [MEDICAL CONDITION] and [DIAGNOSES REDACTED], and subsequently required a [MEDICAL CONDITION] on 4/2/13. According to the summary, On date of discharge, (Resident #7) is alert [MEDICAL CONDITION]. (S/he) is able to speak a few words and follow commands with the LUE (left upper extremity). (S/he) has an old right [MEDICAL CONDITION] as well as facial weakness.[MEDICAL CONDITION] in place with no plans to decannulate given poor functional status and mental status . Review of nursing facility documentation revealed a Daily Skilled Nurse's Note dated 4/26/13 at 10:00 PM, which included information that the suction catheter would not go into [MEDICAL CONDITION] the inner or outer cannula with resistance met at every attempt. Noted [MEDICAL CONDITION] turned to the R(ight) side instead of forward, this was different from 2 days ago. Outer cannula head or neck plate was not flush to the skin and outer cannula was showing protruding out of the [MEDICAL CONDITION] opening in a R(ight) direction instead of straight out. No mucus was found in the inner cannula. (S/he) was coughing mucus into his/her throat and was unable to spit it out easily or swallow it. (S/he) bit the [MEDICATION NAME] suction tube when I attempted to clear his/her throat by suction. I contacted -- NP (Nurse Practitioner) and informed her/him. O2 sats (saturation) 92 % on O2 at 28% . After evaluation of the resident by a Registered Nurse (RN), the NP gave an order to send the resident to the emergency room (ER) for evaluation and treatment for [REDACTED]. Review of the hospital's Admission History and Physical dated 4/27/13 revealed an Admitting [DIAGNOSES REDACTED]. According to the note, vital signs were stable on arrival except for the pulse which was [MEDICAL CONDITION] at 106 with an O2 saturation of 96% with a lot of gurgling and congestion heard in the patient's throat and chest. Respiratory Therapy was called but the catheter could not be advanced more than 4 cm before it hit hard resistance. Review of the CT (Computerized Tomography) scan report and an ENT (Otolaryngology) Consult dated 4/27/13 revealed that the [MEDICAL CONDITION] tip was flat against the anterior wall of the [MEDICAL CONDITION], not positioned well in the trachea. According to the Consult note, the impression was Dislodged [MEDICAL CONDITION]. According to the note, [MEDICAL CONDITION] removed and easily replaced with another. Review of the facility's physician progress notes [REDACTED]. According to the note, the resident's family member was present when the resident had been evaluated by ENT at the hospital. They stated that part of the [MEDICAL CONDITION] apparatus was turned the wrong way inside him. Pt. had pulled out his [MEDICAL CONDITION] set a few times before s/he was readmitted to the hospital. It was thought that floor nursing put it in the wrong way . They mentioned to (the family member) that (the resident) may need a mitten on his/her L(eft) hand . to keep from pulling out his/her [MEDICAL CONDITION] set. According to the Current Plans:, the resident was doing well and [MEDICATION NAME] was ordered to thin secretions. Also noted was- Will see if (facility) is okay with a mitten on L(eft) hand to prevent him/her from pulling out [MEDICAL CONDITION], and future trips to the ER for this. F/U (Follow up) prn (As Needed). Review of the medical record revealed no indication that the possible use of mittens had been discussed or addressed by the facility until 5/11/13. During an interview on 6/18/13, the Director of Nursing (DON) was asked about documentation of an interdisciplinary team meeting relative to any interventions considered for the resident's behavior. The DON stated that they have discussed issues in morning meetings, but stated the facility did not have anything specifically documented for this resident. The surveyor requested to see any documentation in general related to these morning meeting discussions, but the DON did not provide this for review prior to exit. Review of Daily Skilled Nurse's Notes dated 5/1/13 - 5/11/13 revealed the following documentation of continued incidents in which the [MEDICAL CONDITION] was dislodged and/or partially dislodged along with incidents where the resident had removed his/[MEDICAL CONDITION] through which s/he had been receiving Oxygen. There was no evidence that interventions for these behaviors had been implemented by the facility until 5/11/13, when it was documented that orders had been obtained for scheduled [MEDICATION NAME] and hand mitts. 5/1/13 7A-7P .res (resident) takes O2 off + had to be replaced, res reminded to leave it on suctioned several times this shift . Another note dated 5/1/13 at 11:00 PM revealed information that the resident was coughing up a large amount of clear to pink/yellow mucus from trach. Suctioned .S/he removed (trach) collar x 1 . 5/2/13 3:00 PM .suctioned x 2 earlier this shift. ADON (Assistant Director of Nursing) + floor nurse went in to clean trach,[MEDICAL CONDITION] dislodged. ADON able to [MEDICAL CONDITION] obturator .5/2/13 11P- Lethargic but pulling [MEDICAL CONDITION] off periodically .suctioned .Large amount of .phlegm from trach. 5/3/13 9:00 AM .Noted [MEDICAL CONDITION] displaced .Supervisor [MEDICAL CONDITION] in place . 5/3/13 6:00 PM Nurse in to assess pt. Noticed that [MEDICAL CONDITION] lying on his/her chest (with) balloon deflated. Notified Dr. --. New order to send pt to (hospital) for displacement [MEDICAL CONDITION]+ to replace .pt sent to (hospital) via 911 . 5/5/13 3:00 PM Resident pulled [MEDICAL CONDITION] out while sitting (up) in Geri-chair.[MEDICAL CONDITION] (with) obturator .Dr.-- notified. New order refer pt to pulmonologist for [MEDICAL CONDITION] (please try to wean off trach) . 5/6/13 7A-7P .Continues to take O2 mask (off), res reminded to keep mask on, O2 sat (saturation) 96% . 5/6/13 11:00 PM .Takes [MEDICAL CONDITION] off frequently and throws on floor. Found [MEDICAL CONDITION] his abdomen when entered the room . 5/7/13 7A-7P .Continues to pull O2 mask off trach, has to be reminded to leave in place . 11:00 PM .[MEDICAL CONDITION] off and put on floor .O2 [MEDICAL CONDITION] @ 28% . 5/8/13 .No attempt to [MEDICAL CONDITION] continues to [MEDICAL CONDITION] collar .No acute distress . On 5/10/13 Resident #7 had a [MEDICAL CONDITION] consult. Review of the consult note dated 5/10/13 revealed the pulmonologist was asked to give his/her opinion regarding the feasibility for decannulation (removal of the trach). According to the Assessment/Plan, the pulmonologist doubted that the resident could clear secretions or maintain an airway at present and that s/he would not consider downsizing or decannulation of [MEDICAL CONDITION] hospitalized in a facility where immediate emergent airway management was available. A Daily Skilled Nurse's Note dated 5/11/13 at 9:30 AM revealed that at 8:30 AM, the nurse went into the resident's room and found [MEDICAL CONDITION] dislodged laying on the resident's neck. An attempt to put [MEDICAL CONDITION] in was unsuccessful, and 911 was called. EMS was unable to replace [MEDICAL CONDITION] the resident was transported to the hospital. Upon return to the facility at 1:40 PM, it was documented that a size 4 [MEDICAL CONDITION] placed in the ER and the resident was now on 35% Oxygen. At the time of readmission, the DME (durable medical equipment) provider was called to bring in smaller suctioning catheters since the facility only had 14 french catheters. According to the note, the DME provider brought 12 french catheters that the facility was unable to use; and 10 french catheter(s) had been obtained from the hospital's emergency room . Continued review of Nurse's Notes revealed that at 7:00 PM, a sitter was with the resident and at 8:00 PM, s/he had left. The 7:00 PM note documented that a telephone order had been received from the physician for scheduled [MEDICATION NAME] (1 mg every 8 hours) and hand mitts. During an interview on 6/10/13 at 8:00 PM, the DON (Director of Nursing) stated the reason the resident had pulled out [MEDICAL CONDITION] because s/he didn't want it. When asked if any sitters had been provided for the resident, the DON stated that the resident's family member had been referred to a private pay Home Health Agency and had met with them to set up services for a sitter to come at night. According to the DON, since the resident pulled out [MEDICAL CONDITION] the family present, the resident would do the same with a sitter. The DON stated that the family would have to pay for this service, but before it could be started, the resident was sent out to the hospital and [MEDICAL CONDITION] been removed. During an interview on 6/18/13 at 3:10 PM, the DON provided documentation of a contract between Resident #7's RP (Responsible Party) and the home health agency for sitter services (to prevent [MEDICAL CONDITION] being pulled out) to start 5/10/13 at an hourly rate. The DON stated that they had no documentation of when the sitter came or didn't, and that the facility did not have a sign in/sign out sheet for this. The DON stated that the resident was still able to dislodge the [MEDICAL CONDITION] with the mitts on by using hand movements. The DON had been under the impression that [MEDICAL CONDITION] the resident and that s/he would rub it causing it to be dislodged. Further review of Daily Skilled Nurse's Notes revealed the following: 5/12/13 7A-7P .Sitter @ bedside from 4P-8P .Will not keep mitts on hands. Unable to make needs known. 5/15/13 11:00 PM .Continuously removes mittens from hands . 5/16/13 11:00 PM .Continues to take mittens off of hands. No attempts to remove trach/trach collar . 5/17/13 at 10:30 AM stated, Resident pulled [MEDICAL CONDITION]. N.O. (New Order) received to send to (hospital) to [MEDICAL CONDITION]. According to the note, the resident returned to the facility with a 3.5 [MEDICAL CONDITION] place. Review of hospital documentation revealed Resident #7 presented to theER on [DATE] for an evaluation of a dislodged trach. .Patient had a 4.0 Shiley that the patient accidentally pulled out. According to the note, Based on the size of the [MEDICAL CONDITION] opening a 4.0 could not be passed it was replaced with a 3.5 Shiley. Patient will follow up with [MEDICAL CONDITION]. Further review of Nurse's Notes revealed that on 5/17/13 at 3:50 PM, the therapist reported that [MEDICAL CONDITION] out after the resident coughed and that the 3.5 [MEDICAL CONDITION] been reinserted [MEDICAL CONDITION] had been done. At 4:15 PM, it was documented by nursing that the 3.5 [MEDICAL CONDITION] been removed and replaced with a #[MEDICAL CONDITION](with a small amount of blood tinged mucus noted). The note did not indicate why the [MEDICAL CONDITION] been replaced with a #4 trach. At 5:00 PM it was documented that [MEDICATION NAME] 1 mg (milligram) had been given via [DEVICE] (Gastrostomy tube) for increased anxiety and was effective. 5/19/13 at 10:35 PM revealed Resident lying bed, O2 concentrator tubing disconnected (after) looking @ resident [MEDICAL CONDITION] completely out and upside down. Unable to replace trach-911 called and resident sent to ED. Resident had sitter until 9:00 PM . A note timed for 2:00 AM (on 5/20/13) revealed that the resident's family member called the facility to report that they were keeping resident in hospital d/t (due to) swelling [MEDICAL CONDITION] and inability to [MEDICAL CONDITION] consulting pulmonology in am. Review of hospital records revealed a procedure note which documented a [MEDICAL CONDITION], Direct laryngoscopy, and [MEDICATION NAME] through [MEDICAL CONDITION] incision had been completed on 5/23/13. The note stated that The [MEDICAL CONDITION] fell out last week and was not replaced in a timely manner resulting in stenosis of his/her left [MEDICAL CONDITION] site. Since that time, s/he has had intermittent [MEDICAL CONDITION] and replacement of his/her [MEDICAL CONDITION] has been recommended . The note documented a #8 cuffed Shiley [MEDICAL CONDITION] had been inserted into the airway without difficulty. A hospital Progress note dated 5/24/13 documented that the [MEDICAL CONDITION] had been replaced 5/23/13, and that the ENT recommended the patient remain in the hospital until the first [MEDICAL CONDITION] change which would occur after 72 hours. Review of the hospital Discharge Summary dated 5/28/13 (signed 5/31/13) revealed that the resident had been admitted to the hospital after s/he pulled out his/her [MEDICAL CONDITION]. The patient was seen by the ENT who was unable to replace the [MEDICAL CONDITION] at the bedside and it was recommended that the resident be admitted to the hospital for closer monitoring. According to the note, .Patient has been having plenty of airway secretion and is not able to cough adequately to clear his/her secretions. Patient was admitted and had intermittent suctioning. The [MEDICAL CONDITION] was then subsequently changed, but the patient was recommended to be kept in the hospital for reevaluation per the ENT and patient will need another [MEDICAL CONDITION] change within 72 hours. Yesterday, the ENT physician was able to place and change the [MEDICAL CONDITION] to a #6 and s/he has recommended to discharge . The discharge recommendations included, .Recommend closer monitoring of patient to avoid dislodging [MEDICAL CONDITION]. May need continuous sitter or may try an arm immobilizer to see if this reduces the incidence of patient moving to dislodge medical devices, the nursing home to address this and possibly reduce his/her rehospitalization . Review of the nursing facility's medical record documentation from 5/31/13 (when the resident was readmitted ) through 6/6/13 revealed multiple incidents where Resident #7 continued to dislodge his/her trach. Review of Nurse's Notes/Hospice Notes revealed the following: Review of the Hospice notes revealed the following: 5/31/13 (In 11:00 PM, Out 11:59 PM)- .Pt. upon arrival very restless and kicking covers off himself, reaching [MEDICAL CONDITION]. Pt. arrived with wrist restraints which were immediately removed and placed in pt. closet. Verbal cues given to pt. not to place hand [MEDICAL CONDITION].[MEDICAL CONDITION] itching pt. [MEDICATION NAME] applied BID (twice daily).[MEDICAL CONDITION] given by hospice nurse to help alleviate discomfort. Pt. still reaching [MEDICAL CONDITION] 1 mg tid (three times daily) prn (as needed) via g tube . Further documentation in the note stated that the family understood the purpose of hospice but wanted to [MEDICAL CONDITION] g tube and full code status .(Resident) is unable to make sound decisions related to [MEDICAL CONDITION] and stroke in the past . During an interview on 6/18/13 at 1:35 PM, the DON stated that the resident returned from the hospital (readmitted to the facility on [DATE]) on Hospice. The DON stated that s/he told the resident's family member that they didn't do wrist restraints (when it was requested by the resident's family). According to the DON, s/he told the family member that the facility wouldn't take the resident back with restraints. The DON verified when the resident returned to the facility in June there were no restraints ordered. Review of the Nursing Notes for June, 2013 revealed the following related to [MEDICAL CONDITION] care: 6/1/13 Resident [MEDICAL CONDITION]. Res was found by CNA during am care.[MEDICAL CONDITION] by RN on the floor. 8:00 PM Res pulled out trach. Reinserted by RN on 100 hall. Additional Hospice Notes revealed the following: 6/1/13 (In 8:30 PM, Out 9:00 PM)- .FS (Facility Staff) reports that pt. had [MEDICAL CONDITION] two times since early am .Pt. agitated during assessment. S/he keeps tugging [MEDICAL CONDITIONS] gets irritated when verbally cued to leave area alone. Wash cloth placed in pt. right hand to distract pt. from touching trach. Requested FS to give [MEDICATION NAME] for agitation. 6/2/13 3:00 AM Resident [MEDICAL CONDITION]. Site cleaned,[MEDICAL CONDITION] + Reinserted by RN on the floor. 10:30 AM Resident removed trach. Replaced without incident . 6/2/13 (In 5:15 PM, Out 6:15 PM)- .Pt. face flushed and s/he continues to pull [MEDICAL CONDITION] 2 today. Spoke with FS and ascertain(ed) [MEDICAL CONDITION] may be irritating him/her with the straps. Instructed to check on pt. [MEDICAL CONDITION] and to give [MEDICATION NAME] to see if that will help alleviate site agitation .Pt. [MEDICAL CONDITION] times two today .Also discussed using [MEDICATION NAME] to see if pt would [MEDICAL CONDITION] alone. Site is irritated and pt. is going [MEDICAL CONDITION]. Review of Physician orders/Telephone Orders along with the Medication/Treatment Administration Records for June 2013 revealed no orders for [MEDICATION NAME] and no evidence anything [MEDICAL CONDITION] irritation had been ordered/given. Review of the June 2013 Medication Record revealed [MEDICATION NAME] 1 mg TID (three times daily) PRN (As Needed) had been administered once on 6/1/13 (at 6AM); with no documentation of [MEDICATION NAME] having been administered during the early/morning hours on 6/2/13 around the time frames the resident pulled out his/her trach. Review of a 6/3/13 9:38 AM Physician's Progress Note revealed .Pt. admitted to (the facility) under the hospice GIP (General Inpatient) program for anxiety. S/he had recently been hospitalized after s/he pulled out his/her [MEDICAL CONDITION] again .Agitation under control at this point, will discuss with hospice the next step. If hospice finds that s/he does not require GIP status any further, we can shift pt back to LTC (Long Term Care) at (facility) . Hospice notes for 6/3/13 through 6/7/13 indicated the following: (In 4:00 PM, Out 5:30 PM) .Discussed with facility nurse about pt's agitation and attempting to remove trach. RN verbalized s/he had to give pt his PRN [MEDICATION NAME] Facility nurse -- updated on new order of [MEDICATION NAME] and interventions of OOB (out of bed) to gerichair and [MEDICAL CONDITION] band. (Family member) agreed to try pt on [MEDICATION NAME] 0.5 mg in addition to PRN [MEDICATION NAME] 1 mg . A Physician's Telephone Order dated 6/3/13 at 5:15 PM stated, 1) [MEDICATION NAME] 0.5 mg TID Dx Agitation . 6/(4)/13 1:30 AM Sitter states resident needs to be suctioned. Noted [MEDICAL CONDITION] out. Replace [MEDICAL CONDITION]. (In 2:00 PM, Out 3:30 PM)- Pt is oriented to self mainly. Unable to communicate most needs. Able to follow some directions .Pt is very forgetful and must constantly be reminded to [MEDICAL CONDITION]. Facility nurse --- verbalized that pt has not been attempting to pull [MEDICAL CONDITION] today. S/he stated pt continues [MEDICATION NAME] 0.5 mg TID and only had to have one PRN dose of [MEDICATION NAME] since yesterday .(Family member) and --- notified that if pt's symptoms are resolved tomorrow, pt will discharge (from hospice) to the facility as a LTC (long term care) pt .Facility staff also updated that pt will likely come off (hospice) tomorrow if symptoms are resolved. 6/5/13 (SNF (Skilled Nursing Facility) visit- Pt is calm at this time. Facility nurse --- verbalized pt has been calm and has not been attempting to pull out trach. Pt. is up in geri chair at this time. Pt is discharged off GIP (General Inpatient) (hospice) . (Facility staff member) updated on pt's condition. 6/6/13 Resident sent to (hospital) after pulling out trach.[MEDICAL CONDITION] was attempted by RN -- + was unsuccessful .Res transported via (ambulance service) via stretcher Per --- @ (hospital), Res is to be returned to (facility) (with) [MEDICAL CONDITION] place. ---stated they do not have his/her sz (size)[MEDICAL CONDITION]+ that s/he is in no distress @ this time . 6/7/13 Returned from hospital @ 1:20 A (with) no trach. Res states s/he does not [MEDICAL CONDITION]. 6/7/13 8:30 PM- Resident restless, removing Oxygen collar from neck. O2 sat 97%, stoma patent . A Physician's Progress Note dated 6/7/13 revealed, .S/he returned to the facility without [MEDICAL CONDITION].(Family member) stated the ER did not have the size s/he needed (which was an 8), that it was not an emergency, and that s/he should be transferred back to the facility without it (trach). They wanted (the resident) to see a pulmonologist other than Dr. ---, but (family member) wants an appt with Dr. -- ASAP (As soon as possible) to [MEDICAL CONDITION] put back in again . A Physician's Telephone Order dated 6/7/13 at 12:16 PM stated, Refer to Dr. --- (pulmonologist) ASAP, Dx [MEDICAL CONDITION] pt (without)[MEDICAL CONDITION] this point. -O2 sat q (every) day, -change [MEDICATION NAME] to scheduled. An Physician's Progress Note signed by Dr. ---(ENT) dated 6/13/13 at 1:15 PM stated, .f/u (follow up) trach. S/he has pulled it - again on 6/7/13 .(No) airway obstruction. D/C (Discontinue trach) . Further review revealed a Physician's Telephone Order had been written 6/13/13 to discontinue [MEDICAL CONDITIONS] Oxygen. During an interview on 6/18/13 at 3:10 PM, the DON reviewed the ENT Progress note dated 6/13/13. When asked if the resident had seen the pulmonologist, the DON stated the pulmonology appt had been scheduled for late June (6/28/13) when the resident had been discharged from the hospital. Review of Social Services Notes revealed a note dated 6/11/13 which stated, SW (Social Worker) will speak to Dr.-- about a referral to a psychiatrist for resident for behaviors of pulling out his/her medical equipment. There was no documentation of a referral having been made prior to this date. A faxed referral dated 6/11/13 for Psychotherapy services stated, pt keeps pulling out his [MEDICAL CONDITION], likely on purpose, please evaluate for possible depression + apply CBT (Cognitive Behavioral Therapy) . During an interview on 6/18/13, the DON was asked about the Life Source referral and stated that the resident had been referred to this Psychology service on 6/11/13 for cognitive behavioral therapy. The DON stated that they only came once a month and had been here on 6/11/13 when the referral had been made, but did not see the resident at that time. Review of the Interim Care Plan dated 5/31/13 revealed the resident had a trach. There was no information included to indicate any interventions had been put into place to prevent the resident from dislodging his/her [MEDICAL CONDITION]. Review on 6/10/13 of the resident's current Care Plan revealed an entry dated 6/6/13 which stated the resident had a trach, and included information that the resident had repeatedly dislodged [MEDICAL CONDITION] required reinsertion of [MEDICAL CONDITION] readmission on 5/31/13. The entry stated the resident was at risk for significant complications. A handwritten entry dated 6/6/13 stated, #8 [MEDICAL CONDITION] cannula, ambu bag +obturator @ bedside. There was no indication from the Care Plan that the resident had returned to the facility without [MEDICAL CONDITION] place on 6/7/13. Another Care Plan entry dated 6/6/13 stated the resident was at risk for altered mood with [DIAGNOSES REDACTED]. Listed approaches included that the resident will likely attempt to [MEDICAL CONDITION]/or PEG tube if s/he becomes anxious without intervention or diversion/ 1:1 supervision. use calm demeanor and positive tone of voice when trying to redirect any behaviors; s/he responds best to calm approach.",2016-06-01
8255,FLORENCE REHAB & NURSING CENTER,425163,133 WEST CLARKE ROAD,FLORENCE,SC,29501,2013-06-06,271,D,1,0,ZP2D11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the day of the Complaint Inspection, based on record review and review of the facility's policy entitled [MEDICAL CONDITION], BILEVEL AND NPPV (Continuous Positive Airway Pressure, Bilevel Positive Airway Pressure or [MEDICAL CONDITION] and Non Invasive Positive Pressure Ventilation), the facility failed to obtain an admission order and/or prescription for [MEDICAL CONDITION], including the settings, for Resident #4, 1 of 2 residents reviewed with a [MEDICAL CONDITION] or [MEDICAL CONDITION]. The findings included: The facility admitted Resident #4 with [DIAGNOSES REDACTED]. On 6/6/13 at 3:02 PM, review of the Discharge Summary from the hospital revealed the statement S/he is to wear the [MEDICAL CONDITION] if s/he gets in trouble in the daytime. The summary also stated s/he had been ordered for [MEDICAL CONDITION] and the settings of it. The settings were not listed on the discharge summary. Review of the Physicians Orders and Telephone Orders on 6/6/13 at 3:42 PM revealed there were no orders written for administration of the [MEDICAL CONDITION] or the settings. On 6/6/13 at 3:37 PM, review of the admission care plan dated 3/20/13 revealed Potential for Resp (Respiratory) Complications Related to [MEDICAL CONDITION] and [MEDICAL CONDITION] Fibrosis and being Oxygen (O2) dependent was identified as a problem area. Interventions and approaches included give oxygen as ordered; elevate HOB (head of bed); assess for wheezing, SOB (shortness of breath), congestion; break tasks down into small segments; encourage rest periods; serve diet as ordered; vital signs routinely or as ordered; and O2 SATS (saturations) every shift. The care plan did not include any interventions related to the [MEDICAL CONDITION]. Review of the facility's policy, [MEDICAL CONDITION], BILEVEL AND NPPV, revealed Admission Criteria .2. A prescription for the device with the settings. The policy further stated Physician Responsibilities .3. Provide a written, signed physician's prescription . On 6/6/13 at approximately 6:30 PM, The Director of Nursing provided the surveyor with a copy of an in-service conducted on 2/25/13 that included Review of the Bi-Pap procedure and a copy of the facility's policy was attached.",2016-06-01
8256,FLORENCE REHAB & NURSING CENTER,425163,133 WEST CLARKE ROAD,FLORENCE,SC,29501,2013-06-06,323,D,1,0,ZP2D11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the day of the Complaint Inspection, based on observation, interview, and record review, the facility failed to ensure that a wheel chair alarm was in use as ordered for Resident #2, 1 of 6 residents reviewed with chair and/or bed alarms. The findings included: The facility admitted Resident #2 with [DIAGNOSES REDACTED]. On 6/6/13 at approximately 11:25 AM, during initial tour, Resident #2 was observed in his/her room sitting in his/her wheel chair with oxygen infusing via nasal cannula. The resident was observed again on at 2:30 PM and at 4:16 PM. No alarm was observed on the resident's wheel chair during any of the observations. At 1:54 PM, record review revealed an order dated 5/27/13 for a wheel chair alarm with an order to check function every shift. Further review of the record on 6/6/13 at 2:21 PM revealed a Nurse's Note dated 5/24/13 at 1:15 AM that stated Resident heard hollering out. Went to room (and) found resident sitting on floor in front of w/c (wheel chair). Review of the care plan dated 5/29/13 at 4:10 PM on 6/6/13 revealed the intervention W/C alarm. Check function Q (every) shift . At approximately 4:15 PM on 6/6/13, review of the Treatment Administration Record (TAR) revealed the treatment W/C alarm (check) function q (every) shift had been signed as completed for the 7-3 shift on 6/6/13. During an interview at 4:16 PM, Licensed Practical Nurse #1 confirmed that s/he had signed the MAR on 6/6/13 as having checked the function of the wheel chair alarm. S/he further confirmed that the wheel chair alarm was not on the resident's chair and was unable to locate an alarm in the resident's room. The resident stated at that time if there's an alarm on this chair, I don't know about it.",2016-06-01
8257,"SAINT MATTHEWS HEALTH CARE, LLC",425170,601 DANTZLER STREET,SAINT MATTHEWS,SC,29135,2012-04-11,281,E,0,1,EZCC11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey based on record review and interview the facility failed to meet professional standards of quality related to repeatedly administering a medication that was documented on the resident 's list of allergies [REDACTED]. (One of 16 sampled resident's reviewed for professional standards.) The findings included: The facility readmitted Resident #4 on 10/11/11 with [DIAGNOSES REDACTED]. Record review on 4/9/12 revealed a allergy to [MEDICATION NAME] listed on the Medication Administration Record [REDACTED]. The hand written admission orders [REDACTED]. The Pharmacy Pre-Printed orders for November, December of 2011 and January, February, March and April 2012 had the allergies [REDACTED]. Registered Nurse #1 (RN) stated during an interview on 4/9/12 at 5:20 PM I am the one that does them and I just overlooked it. She also stated the Pharmacy put a semi colon behind the Tylenol so it looks like a separate allergy, but she is not allergic to Tylenol. The resident has a order dated 10/11/11 for Tylenol Extra Strength 500 mg (milligrams) two caplets by mouth twice a day. The MAR indicated [REDACTED]. The RN stated I crossed it (the [MEDICATION NAME]) off on the November, December and January orders but I didn't do it for February, March and April. I just dropped the ball, I guess. When ask if the other nurses signing the MAR brought it to her attention she stated no. The RN then stated: The nurses know this is not a true allergy. When ask what would happen if a new nurse was passing medication that was not familiar with this resident , she stated that could be a problem. The MAR's for February, March and April did not have [MEDICATION NAME] crossed out and the medication was signed as administered twice a day, every day. The January physician's orders [REDACTED].",2016-06-01
8258,"SAINT MATTHEWS HEALTH CARE, LLC",425170,601 DANTZLER STREET,SAINT MATTHEWS,SC,29135,2012-04-11,371,F,0,1,EZCC11,"On the days of the surveys, based on observations and interview, the facility failed to ensure that the insulated tops that cover the plates and foods served to resident's were used under sanitary conditions. The findings included: Observations on 4-10-2012 at 11:45 AM during preparation of the lunch meal revealed insulated covers stacked on a stainless steal counter near the tray line. Further observation of the insulated covers revealed dried- on white spots on the inside of the covers where there was potential for food contact. An interview with the District Manager of dietary services on 4-10-2012 confirmed this observation and he immediately began to sanitize the inside of the covers prior to utilization. He indicated that out of the approximately 150 insulted covers in kitchen inventory about one half were re-sanitized. When asked if the soiled covers would have been continued to be used if not identified by the survey process, he indicated a yes response.",2016-06-01
8259,"SAINT MATTHEWS HEALTH CARE, LLC",425170,601 DANTZLER STREET,SAINT MATTHEWS,SC,29135,2012-04-11,514,E,0,1,EZCC11,**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey based on record review and interview the facility failed to assure that Resident # 4's medical record had accurately documented allergies [REDACTED]. Nursing staff administered the medication twice a day without questioning nor correcting the error. ( 1 of 16 sampled residents reviewed for accuracy of medical records.) The findings included: The facility readmitted Resident #4 on 10/11/11 with [DIAGNOSES REDACTED]. Record review on 4/9/12 revealed a allergy to [MEDICATION NAME] listed on the Medication Administration Record [REDACTED]. A typographical error had been made in November 2011 and was not corrected by either the nursing staff nor the pharmacy.,2016-06-01
8260,HEARTLAND HEALTH AND REHABILITATION CARE CENTER-HA,425289,1800 EAGLE LANDING BLVD,HANAHAN,SC,29406,2016-03-02,164,D,0,1,3A0811,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and review of the facility policy titled, Dressing Change: Nonsterile (Clean) and Sterile (Aseptic), the facility failed to provide privacy during a pressure ulcer treatment for 1 of 2 residents reviewed for pressure ulcers and 1 of 1 pressure ulcer treatments observed. Resident #164. The findings included: The facility admitted Resident #164 with [DIAGNOSES REDACTED]. An observation on 3/2/2016 at approximately 9:44 AM during a pressure ulcer treatment for [REDACTED].#164's bed. A staff member knocked on the door, and came over to the resident's bedside while the dressings were being changed on his/her coccyx. During an interview on 3/2/2016 at approximately 9:44 AM with Licensed Practical Nurse (LPN) #1 he/she confirmed that the privacy curtain was not pulled around Resident #164's bed during a dressing change to a pressure ulcer. LPN #1 stated, the privacy curtain should have been pulled and I should have asked the staff member to wait until the dressing was changed and the resident was covered. Review on 3/2/2016 at approximately 12:09 PM of the facility policy titled, Dressing Change: Nonsterile (Clean) and Sterile (Aseptic), revealed under, Procedure:, number 4. states, Introduce self, explain procedure and provide privacy.",2016-06-01
8261,HEARTLAND HEALTH AND REHABILITATION CARE CENTER-HA,425289,1800 EAGLE LANDING BLVD,HANAHAN,SC,29406,2016-03-02,241,E,0,1,3A0811,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations and interviews, the facility failed to ensure staff knocked on residents doors prior to entering rooms, residents were covered after receiving treatments and each resident requiring assistance with eating were fed while seated at the table with other residents being fed. One of 2 sampled residents reviewed for dignity, 1 of 2 dining rooms observed, 1 of 2 units observed. The findings included: The facility admitted Resident #7 with [DIAGNOSES REDACTED]. During Stage I interview on 2/29/16 at approximately 11:15 AM, Resident #7 was being interviewed in his/her room with the door closed. One Certified Nursing Aide (CNA) knocked on the door once then peeped his/her head in the room without permission and closed the door. A few minutes later, another Certified Nursing Aide opened the door and entered the room without knocking. Resident #7 stated they do that all the time, after the second CNA entered the room without knocking. During random lunch meal observation on 2/29/16 at approximately 11:58 AM multiple residents were seated in the dining room. Two long tables were positioned vertically in the dining room as you entered and smaller tables were positioned around walls on each side of the dining room. The residents seated at the long tables were served and eating while the residents seated at the smaller tables were not served. At approximately 12:14 PM two tables with two residents noted with one staff member at each table feeding one resident while the other resident seated at the same table was not being fed or eating. Further observations revealed four staff members feeding residents without engaging in conversations with the resident. A random observation of lunch meals being delivered on the unit on 2/29/16 at approximately 1:03 PM revealed staff entering residents rooms without knocking. A random observation of breakfast delivery on 3/01/16 at approximately 9:07 AM revealed staff entering Rooms 305, 307 and 308 without knocking. An interview on 3/01/16 at approximately 9:08 AM with Certified Nursing Aide (CNA) #2 confirmed he/she was entering multiple residents rooms without knocking. CNA #2 further stated the CNAs do not have to knock on doors if the resident's door was opened because the resident can see them. A random lunch meal observation on 3/01/16 at approximately 12:03 PM two tables with two residents noted with one staff member at each table feeding one resident while the other resident seated at the same table not being fed or eating. Further observations revealed the staff members were feeding the residents without engaging in conversation with the resident. The residents that required assistance with eating were positioned around the walls while the resident who could feed themselves were seated at the long tables and eating independently or with assistance of staff. Observations were confirmed by the facility Administrator and a Facility Consultant. The facility admitted Resident #164 with [DIAGNOSES REDACTED]. An observation on 3/2/2016 at approximately 9:44 AM during a pressure ulcer treatment for [REDACTED].#164's bed. A staff member knocked on the door, and came over to the resident's bedside while the dressings were being changed on his/her coccyx. During further observation of wound care on 3/2/2016 at approximately 9:44 AM Licensed Practical Nurse (LPN) #1 and the Certified Nursing Assistant (CNA) left Resident #164 uncovered and exposed while they went to the bathroom to wash their hands. During an interview on 3/2/2016 at approximately 9:44 AM with Licensed Practical Nurse (LPN) #1 he/she confirmed that the privacy curtain was not pulled a round Resident #164's bed during a dressing change to a pressure ulcer. LPN #1 stated, the privacy curtain should have been pulled and I should have asked the staff member to wait until the dressing was changed and the resident was covered. The LPN went on to confirm that Resident #164 was left exposed while he/she and the CNA assisting went to the bathroom to wash their hands.",2016-06-01
8262,HEARTLAND HEALTH AND REHABILITATION CARE CENTER-HA,425289,1800 EAGLE LANDING BLVD,HANAHAN,SC,29406,2016-03-02,242,D,0,1,3A0811,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to ensure all residents were afforded the right to make choices about his/her life that are significant to the resident for 2 of 3 residents reviewed for choices. Resident #164's choices were not honored related to bathing, getting out of bed in the morning and going to bed at night and Resident #276's choice was not honored related to bathing. The findings included: The facility admitted Resident #164 with [DIAGNOSES REDACTED]. During an interview on 2/29/2016 at approximately 2:42 PM with Resident #164, he/she stated that he/she was not afforded the opportunity to choose when to get up in the morning, when to go to bed at night, or choices concerning when and what type of bath he/she received. The facility admitted Resident #276 with [DIAGNOSES REDACTED]. An interview on 3/1/2016 at approximately 12:30 PM with Resident #276's family member revealed that Resident #276 did not get bathed daily. Resident #276's family stated that he/she was used to bathing daily and it was Resident #276's preference to receive a bath daily. During an interview on 3/2/2016 at approximately 8:30 AM with the Administrator, he/she stated the he/she was not aware of any documentation or if any, where it would be documented and who was responsible for the documentation on resident choices. An interview on 3/2/2016 at approximately 9:05 AM with the Scheduler/Quality Assurance Coordinator revealed that he/she did not find out resident preferences concerning bathing, and getting up in the mornings and going to be at night. An interview on 3/2/2016 at approximately 9:10 AM with the Social Service worker #1 revealed that he/she too, did not know how the facility found out about resident preferences and choices.",2016-06-01
8263,HEARTLAND HEALTH AND REHABILITATION CARE CENTER-HA,425289,1800 EAGLE LANDING BLVD,HANAHAN,SC,29406,2016-03-02,252,D,0,1,3A0811,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, record reviews and interviews the facility failed to maintain a satisfactory environment for 1 of 1 resident sampled for a safe, clean, comfortable and homelike environment. The findings include: On 3/1/16 at approximately 2:28 PM a visit to the room of Resident #81 revealed a urine-like odor upon entry into the room, but lessened when near the area next to the window where Resident #81 was sleeping. Resident #81 was admitted to the facility and had a BIMS (Brief Interview for Mental Status) of 3 (0-7 = severe impairment) and had [DIAGNOSES REDACTED]. On 3/1/16 at approximately 3:09 PM a second visit to the room of Resident #81 revealed that a strong urine-like odor was originating from the area at/near the bed of Resident #146 which is located next to the door. In addition there were numerous (estimated 30 - 40) stuffed animals on the floor surrounding the bed. On 3/1/16 at approximately 3:17 PM CNA (Certified Nursing Assistant) # 1 and LPN (Licensed Practical Nurse) # 2 went with the Surveyor to the room of Resident #81. CNA # 1 stated that it did not smell good and that there was a strong urine-like odor originating near the bed of Resident #146. LPN # 2 stated that the room had been deep cleaned approximately 2 weeks ago. On 3/1/16 at approximately 3:37 PM the Surveyor informed the Administrator of the findings. The Administrator acknowledged awareness of odors and hoarding by Resident #146 and proceeded to investigate. On 03/1/16 at approximately 5:43 PM the Facility Regional Director stated that the bed of Resident #146 had been stripped, mattress changed and that stuffed animals were being evaluated. On 3/2/16 at approximately 9:20 AM a review of the Medical Record for Resident #146 revealed the following: Admission records from EMS and hospital referred to hoarding and insect infestation No reference by the Facility related to odors or hoarding ADL (Activities of Daily Living) self care deficit as evidenced by needs staff assistance with all ADLs related to weakness, morbid obesity, cognitive deficit; Assist with daily hygiene, grooming, dressing, oral care and eating as needed Supervision with bed mobility, transfers eating and toileting Resistive/non compliant with treatment/care. Allow for flexibility in ADL routine to accommodate mood, preference and customary routine; If resists care leave (if safe to do so) and return later Tasks include ADL Assist: Supervision with bed mobility, eating and toileting, extensive assist with dressing, hygiene and bathing Briefs: bariatric Shower/Bath - Tuesday/Friday evening On 3/2/16 at approximately 10:05 AM the Administrator stated that urine soaked garments had been found under the mattress, pillow and in the bathroom of Resident #146. On 3/2/16 at approximately 10:24 AM a review of room changes provided by the Administrator showed that Resident #146 had been moved into the room on 5/16/14 and Resident #81 had been moved into the same room on 12/21/15. On 3/02/16 at approximately 11:45 AM during an interview, CNA # 2 stated that limited assistance is given to Resident #146 when s/he asks because s/he has an attitude about receiving care. CNA # 2 stated that s/he had noticed odors yesterday and at other times in the past and that it is common knowledge among the staff that there are odors and that Resident #146 oftentimes refuses care.",2016-06-01
8264,HEARTLAND HEALTH AND REHABILITATION CARE CENTER-HA,425289,1800 EAGLE LANDING BLVD,HANAHAN,SC,29406,2016-03-02,280,D,0,1,3A0811,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on Record review and interview the facility failed to review and revise the Comprehensive Care Plan for Resident #71, 1 of 3 sampled residents reviewed for urinary incontinence. The Comprehensive Care Plan was not reviewed and revised after the resident was assessed as having increased Urinary incontinence. The findings included: The facility admitted resident #71 with [DIAGNOSES REDACTED]. Record review of the Minimum Data Set (MDS) - Version 3.0 on 3/1/2016 at approximately 12:38 PM revealed an Admission MDS dated [DATE] that indicated the resident was not having any urinary incontinence. The MDS also indicated that a trial of a toileting program had not been attempted. Review of the Quarterly MDS, dated [DATE], on 3/1/2016 at approximately 12:38 PM indicated that the resident was always incontinent of the Bladder with no episodes of continent voiding. In addition, the 2/8/2016 MDS indicated that a trial of a toileting program had not been attempted. Both MDS assessments revealed that the resident had a BIMS (Brief Interview for Mental Status) score of 14, indicating the resident was cognitively intact. Record review of the Patient Admission/Readmission Screen dated 10/30/2015 on 3/1/2016 at 3:39 PM revealed that the resident did not have Bladder incontinence. Record review of the Patient Admission/Readmission Screen dated 1/6/2016 on 3/1/2016 at approximately 3:39 PM revealed that the resident did have Bladder incontinence. Review of the Comprehensive Care Plan on 3/1/2016 at approximately 1:04 PM revealed that the Comprehensive Care Plan had not been reviewed or revised to indicate the resident had a decline in Bladder function and was having Urinary incontinence. The Comprehensive Care Plan revealed a focus area that the resident was At risk for Urinary incontinence r/t (related to) decreased mobility. The focus area was initiated on 11/11/2015 and last revised on 11/23/2015. During an interview with Registered Nurse (RN) #4 on 3/1/2016 at approximately 1:04 PM, RN #4 confirmed that the resident was assessed as always continent of the Bladder on the Admission MDS and always incontinent of the Bladder on the Quarterly MDS. RN #4 also stated that the resident was having frequent episodes of high blood sugars and declining health status which were likely causing the increased Urinary incontinence. RN #4 stated the staff were toileting the resident more frequently. The Comprehensive Care Plan was reviewed with RN #4 and RN #4 confirmed the Comprehensive Care Plan had not been reviewed and revised related to the resident's decline in Bladder function. RN #4 confirmed that the Comprehensive Care Plan had not been revised to include more frequent toileting. In addition, RN #4 stated the Comprehensive Care Plan should have been revised related to the resident's decline in bladder function.",2016-06-01
8265,HEARTLAND HEALTH AND REHABILITATION CARE CENTER-HA,425289,1800 EAGLE LANDING BLVD,HANAHAN,SC,29406,2016-03-02,315,D,0,1,3A0811,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview the facility failed to provide appropriate treatment and services to restore as much normal Bladder function as possible for Resident #71, 1 of 3 sampled residents reviewed for Urinary incontinence. Resident #71 had a decline in Bladder function with new no interventions implemented to restore or maintain Bladder function. The findings included: The facility admitted resident #71 with [DIAGNOSES REDACTED]. Record review of the Minimum Data Set (MDS) - Version 3.0 on 3/1/2016 at approximately 12:38 PM revealed an Admission MDS dated [DATE] that indicated the resident was not having any urinary incontinence. The MDS also indicated that a trial of a toileting program had not been attempted. Review of the Quarterly MDS, dated [DATE], on 3/1/2016 at approximately 12:38 PM indicated that the resident was always incontinent of the Bladder with no episodes of continent voiding. In addition, the 2/8/2016 MDS indicated that a trial of a toileting program had not been attempted. Both MDS assessments revealed that the resident had a BIMS (Brief Interview for Mental Status) score of 14, indicating the resident was cognitively intact. Record review of the Patient Admission/Readmission Screen dated 10/30/2015 on 3/1/2016 at 3:39 PM revealed that the resident did not have Bladder incontinence. Record review of the Patient Admission/Readmission Screen dated 1/6/2016 on 3/1/2016 at approximately 3:39 PM revealed that the resident did have Bladder incontinence. In addition, the Patient Admission/Readmission Screen read If Bladder Incontinence is checked, initiate bladder diary, complete Urinary Incontinence & Indwelling Catheter Assessment in 72 hrs. and initiate toileting program UNLESS patient is terminally ill, has intractable pain OR is comatose. There was no documentation in the medical record that any further Bladder assessments or a toileting program had been done. Review of the Comprehensive Care Plan on 3/1/2016 at approximately 1:04 PM revealed that the Comprehensive Care Plan had not been reviewed or revised to indicate the resident had a decline in Bladder function and was having Urinary incontinence. The Comprehensive Care Plan revealed a focus area that the resident was At risk for Urinary incontinence r/t (related to) decreased mobility. The focus area was initiated on 11/11/2015 and last revised on 11/23/2015. During an interview with Registered Nurse (RN) #4 on 3/1/2016 at approximately 1:04 PM, RN #4 confirmed that the resident was assessed as always continent of the Bladder on the Admission MDS and always incontinent of the Bladder on the Quarterly MDS. RN #4 also stated that the resident was having frequent episodes of high blood sugars and declining health status which were likely causing the increased Urinary incontinence. RN #4 stated the staff were toileting the resident more frequently. The Comprehensive Care Plan was reviewed with RN #4 and RN #4 confirmed the Comprehensive Care Plan had not been reviewed and revised related to the resident's decline in Bladder function. RN #4 confirmed that the Comprehensive Care Plan had not been revised to include more frequent toileting. In addition, RN #4 stated the Comprehensive Care Plan should have been revised related to the resident's decline in bladder function. During an interview with Registered Nurse (RN) #3 on 3/1/2016 at approximately 4:15 PM, RN #3 stated that a Urinary Incontinence Assessment had not been done after the Bladder incontinence was noted on the 1/6/2016 Patient Admission/Readmission Screen . In addition, RN #3 stated that the resident did not participate in a toileting program. During an interview with Certified Nursing Assistant (CNA) #3 on 3/2/2016 at 11:50 AM, CNA #3 stated she/he had been caring for the resident since his/her admission to the facility. CNA #3 stated that the resident was continent and able to use a urinal for toileting when he/she first came into the facility. CNA #3 stated the resident was no longer able to use the urinal and was usually incontinent of the Bladder 3-4 times during her/his shift. CNA #3 also stated the resident was able to tell her/him when he/she was wet and needed incontinence care, but could no longer call her/him before an incontinent episode. CNA #3 stated she checked the resident at least every 2 hours for toileting and incontinence checks.",2016-06-01
8266,HEARTLAND HEALTH AND REHABILITATION CARE CENTER-HA,425289,1800 EAGLE LANDING BLVD,HANAHAN,SC,29406,2016-03-02,328,D,0,1,3A0811,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and interview the facility failed to provide oxygen as ordered for Resident #273, 1 of 1 sampled resident reviewed for Respiratory Care. The facility did not set the resident's oxygen concentrator per the physician's orders [REDACTED]. The findings included: The facility admitted Resident #272 with [DIAGNOSES REDACTED]. Resident #273 was observed in bed on 1/29/2016 at 12:22 PM and 2:57 PM with oxygen infusing via nasal canula. On both observations the resident's oxygen concentrator was set at 2 liters. The resident was observed in bed on 3/1/2016 at 2:45 PM with oxygen infusing via nasal canula. The resident's oxygen concentrator was set at 2 liters. Record review of the physician's orders [REDACTED]. During an interview with Registered Nurse #3 on 3/1/2016 at 3:55 PM, the resident's orders were reviewed and RN #3 confirmed the resident's oxygen was ordered to be set at 3 liters. Immediately after review of the orders, Resident #273 was observed in bed with RN #3 present, who confirmed the resident's oxygen was set at 2 liters. RN #3 set the oxygen concentrator to 3 liters and checked the resident's oxygen level. The resident's oxygen level was within normal limits.",2016-06-01
8267,HEARTLAND HEALTH AND REHABILITATION CARE CENTER-HA,425289,1800 EAGLE LANDING BLVD,HANAHAN,SC,29406,2016-03-02,431,D,0,1,3A0811,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, record reviews, interviews and manufacturer package inserts and labeling the facility failed to assure that it was free of expired medication in 2 of 4 medication carts and that medications were stored correctly and securely in 2 of 2 medication rooms. The findings include: On [DATE] at approximately 9:52 AM the Unit 500 Medication Room door was found unlocked for approximately 10 minutes and the refrigerator contained one 6 ounce bottle, half full of Lido/Q-dry/MiAcid lot # 6ACZ W with an expiration date of [DATE] belonging to Resident # 53. These findings were verified on [DATE] at approximately 10:10 AM by LPN (Licensed Practical Nurse) # 1. On [DATE] at approximately 10:19 AM inspection of the Unit 100 Front Medication Cart was found to contain in the 3rd drawer one opened, in use bottle of Calcitonin-Salmon 200 Units/dose Nasal Spray by Apotex belonging to Resident # 72 lying on its side. The manufacturer labeling states: Store in use at room temperature .in an upright position. This finding was verified on [DATE] at approximately 10:25 AM by RN (Registered Nurse) # 1. On [DATE] at approximately 10:35 AM inspection of the Unit 100 Medication Room refrigerator revealed in the bottom drawer one opened, in use Novolog FlexPen by Novo-Nordisk belonging to Resident # 96. The manufacturer states: Don't store in use Novolog FlexPen in the refrigerator. This finding was verified by RN # 2 on [DATE] at approximately 10:43 AM. On [DATE] at approximately 2:31 PM inspection of the Magnolia Medication Cart 1 revealed one Levemir Flextouch, not in use belonging to Resident # 15 and labeled by the facility with an expiration date of [DATE]. This finding was verified by RN # 2 on [DATE] at approximately 2:35 PM.",2016-06-01
8268,HEARTLAND HEALTH AND REHABILITATION CARE CENTER-HA,425289,1800 EAGLE LANDING BLVD,HANAHAN,SC,29406,2016-03-02,514,D,0,1,3A0811,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record reviews and interviews, the facility failed to maintain accurate documentation in the medical records for 2 of 16 sampled residents reviewed. Resident #7's medical record had documentation in the social services notes that were in reference to another resident. Resident #273 had blanks/missing documentation on the Treatment Administration Record Sheet (TARS). The findings included: The facility admitted Resident #7 with [DIAGNOSES REDACTED]. A review of the medical record on 3/01/16 at approximately 12:18 PM revealed a social services note dated 9/17/15 that indicated the resident and his/her sister requested to be prepared for discharge home. The social note further indicated that Resident #7 was using adaptive equipment to aid in dressing and needed assistance with a back brace; with another 2 weeks of rehab prior to discharge. A social services note dated 11/25/15 indicated there were no concerns at this time and there were no discharge plans due to physical care needs. There was no documentation to address the change in discharge planning from the 9/17/15 social services note to 11/25/15 social services note. During an interview on 3/02/16 at approximately 9:30 AM with Social Services Staff #1, after reviewing the 9/17/15 social services discharge note that indicated discharge plans were for Resident #7 to leave the facility after 2 weeks of rehab then reviewing the 11/25/15 social services note that indicated discharge was not the plan; the Social Services Staff #1 stated he/she was not sure if the information written on 9/17/15 was correct because there were no plans of discharge for Resident #7. An interview on 3/02/16 at approximately at 10:20 AM with Social Services Staff #1 revealed the 9/17/15 social services documentation should have been written in another resident's medical. The Social Services Staff #1 further stated the documentation was written on the wrong resident. The facility admitted Resident #272 with [DIAGNOSES REDACTED]. Record review of the physician's orders [REDACTED]. Record review of the Treatment Administration Record (TAR) on 3/1/2016 at 2:40 PM revealed that the wound care was not documented as done on the day shift on 2/26/2016, the evening shift on 2/27/2016 and the night shift on 2/29/2016. During an interview with Registered Nurse (RN) #3 on 3/1/2016 at 4:15 PM, RN #3 confirmed the wound care was not documented as done on 2/26 and 2/27/2016. RN #3 stated an agency nurse was working the night shift on 2/29/2016 and could not access the resident's electronic medical record. RN #3 stated the wound care for 2/29/2016 was documented on paper and was located elsewhere in the record. The facility later produced documentation that indicated the wound care was documented as done on the night shift on 2/29/2016. During an interview with Licensed Practical Nurse (LPN) #1 on 3/2/2016 at 11:20 AM, LPN #1 stated she/he completed the wound care on the day shift on 2/26/2015. She/he stated that after completing the wound care she/he was called away and later forgot to document the wound care as done. The facility provided a statement from the nurse working the evening shift on 2/27/2016 indicating that the wound care had been completed.",2016-06-01
8269,PRINCE GEORGE HEALTHCARE CENTER,425295,901 MAPLE STREET,GEORGETOWN,SC,29440,2012-07-25,318,D,0,1,QHNN11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on record review and interview, the facility failed to ensure 1 of 1 sampled resident with limited range of motion received appropriate services to prevent further decline. Resident #3 did not receive Restorative Nursing as recommended by Occupational Therapy. The findings included: The facility admitted Resident #3 with [DIAGNOSES REDACTED]. Review of the Quarterly Minimum Data Set((MDS) dated [DATE] revealed the resident had range of motion limitations of the upper and lower extremities on one side. Review of the Occupational Discharge Note dated 6/22/12 revealed a recommendation for Restorative Nursing for left upper extremity range of motion and to continue with a rolled washcloth in the left hand at all times as tolerated except for patient care. Further review of the medical record revealed no restorative notes on the record. On 7/24/12 the Unit Manager was asked if she could locate documentation related to restorative services. The Unit Manager stated that Restorative Nursing had not been initiated. Further interview with Administrative Staff revealed that Restorative had not been started due to failure of therapy not initiating the paperwork.",2016-06-01
8270,PRINCE GEORGE HEALTHCARE CENTER,425295,901 MAPLE STREET,GEORGETOWN,SC,29440,2012-07-25,325,D,0,1,QHNN11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on observations, record review, and interview, the facility failed to maintain acceptable nutritional status as evidence by not following Physicians order for mighty shake to prevent weight loss for 1 of 5 residents reviewed for nutritional status (Resident #13). The findings included: The facility admitted Resident #13 with [DIAGNOSES REDACTED]. Review of the medical record on 7/23/12 at approximately 6 PM revealed Resident #13 was dependent on others for all ADL's (Activities of Daily Living) which includes eating. Reviewing the medical record for Resident #13 revealed a Physicians order for Mighty Shakes TID (Three times a day) with meals. Review of the Registered Dietitian Nutritional Care Monitoring Notes dated 6/7/12 revealed a problem of involuntary weight loss with a recommended intervention of Shake tid with meals. The RD documented the resident had an [MEDICATION NAME] level of 2.5. Observations of the lunch and supper meal on 7/24/12 revealed that Resident #13 did not receive a mighty shake with either meal. During an interview on 7/24/12 with the Unit Manager for [MEDICATION NAME], she verified that resident did not receive nutritional supplement with meal because the Physicians order for mighty shake for Resident #13 was never sent to Dietary for the weight loss intervention to be implemented.",2016-06-01
8271,PRINCE GEORGE HEALTHCARE CENTER,425295,901 MAPLE STREET,GEORGETOWN,SC,29440,2012-07-25,367,D,0,1,QHNN11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on record review, observations, and interviews, the facility failed to provide a physician ordered diet in the appropriate form for 1 of 2 residents reviewed receiving a Puree diet. Resident #3 continued to receive whole sandwiches after the diet was changed to pureed. The findings included: The facility admitted Resident #3 with [DIAGNOSES REDACTED]. Record review on 7/23/12 revealed a physician's orders [REDACTED]. During observation of the lunch meal on 7/24/12, a staff member delivering the tray was asked what diet the resident was receiving. The staff member stated that the resident was receiving a Puree diet. The staff member was asked if a whole sandwich was on a Puree diet and she stated that she did not think she would feed the sandwich to the resident. Observation of the evening meal revealed LPN(Licensed Practical Nurse)#2 feeding the resident. LPN #2 was asked what diet the resident was on and she responded after reading the tray card that she was on a Puree diet. LPN #2 confirmed a whole sandwich on the resident's tray. Review of the tray card revealed a sandwich was still listed. An interview with the Dietary Manager on 7/25/12 revealed that the sandwich had remained on the tray card after the diet change and that after it had been brought to her attention, it was removed. An interview with the Registered Dietician on 7/25/12 at 11:45 AM revealed that the sandwich was listed as a preference of the resident and when reviewing the resident's diet, she did not review the tray card for accuracy.",2016-06-01
8272,PRINCE GEORGE HEALTHCARE CENTER,425295,901 MAPLE STREET,GEORGETOWN,SC,29440,2012-07-25,425,D,0,1,QHNN11,"On the days of the survey, based on observation, manufacturer package insert, Facts and Comparisons (Updated Monthly) and interview, the facility failed to follow a procedure to ensure that expired medications were not stored in 1 of 3 medication rooms. The findings included: On 7/23/12 at approximately 1:10 PM, inspection of the Indigo Medication Room refrigerator revealed the following: Two opened vials of Tuberculin PPD (Purified Protein Derivative), 5 TU (Test Units)/0.1 ml (milliliter/vial, lots 3 and 7, labelled House Stock had not been labeled as to date opened. The manufacturer (JHD Pharmaceuticals) package insert and Facts and Comparision, page 2001 state, Discard vials in use for more than 30 days because of possible oxidation and degradation that may affect potency. This finding was verified by LPN (Licensed Practical Nurse #1 on 7/23/12 at approxiamtely 1:20 PM.",2016-06-01
8273,CAPSTONE HEALTH & REHAB OF EASLEY,425298,1850 CRESTVIEW ROAD,EASLEY,SC,29642,2012-07-12,157,G,0,1,PSVU11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on record review and interview, the facility failed to notify the physician timely for 1 of 9 residents reviewed with a change in their condition. The facility did not notify the physician when Resident #7, with history of respiratory distress, respiratory status changed. The findings included: The facility admitted resident #7 with [DIAGNOSES REDACTED]. Review of the nurses notes revealed the following documentation: 6/9/12 11:50 (no am or pm), Resident stated I don't feel well and I can't breathe. Resident also stated, Take me to the hospital! VS (vital signs) are as followed (sic): T (temperature) 99.6, P (pulse) 161, O2 (Oxygen) 51%, Resident diaphoretic and RR (Respirations) labored and uneven. Called on call NP (nurse Practitioner) ____ New order to send to ER. 6/12/12, 3:30 PM Resident returned to facility . The nurses notes throughout the resident stay described the resident's respirations as even and unlabored until 6/26/12. 6/26/12, 1230AM (late entry) Resp even and unlabored. 6/26/12, 3:00 AM (late entry) Resp shallow, lying in bed with eyes closed. Sleeping soundly, hard to arouse. O2 @ 2L (liters) NC (nasal cannula). There was no MD notification of shallow respirations or that the resident was difficult to arouse. 6/26/12, 640 AM (late entry) O2 88% inc. (increased) O2 to 3L, O2 increased to 92%. Informed on coming nurse of residents status. VS 156/70, 22, 91, 97.9. Will continue to monitor resident. There was no MD notification of the decreased oxygen saturation level or the decision to increase the oxygen flow rate for the resident with known [MEDICAL CONDITION]. 6/26/12, 8:15 (no am or pm) Resident noted to be diaphoretic, breathing labored, O2 Sat 83% on 3L/M,, increased O2 to 4L/M via N/C (nasal cannula) v/s 168/76 -92-29-98.8. Called NP (Nurse Practitioner) and spoke to her and she said to contact family and send out . The physician or nurse practitioner was not notified until 8:15 AM after the resident was noted to be diaphoretic and the resident's oxygen had again been increased to 4L/M. Review of the Resident's Physician orders revealed Oxygen was ordered at 2L/M. There was no Physician's order to increase the Oxygen rate for the resident with [MEDICAL CONDITION]. The resident was sent to the hospital and required intubation for respiratory distress. A Consultation report dated 6/29/12, contained transfer information from the hospital. The report stated, This patient .admitted on [DATE] with shortness of breath and [MEDICAL CONDITION], had to be intubated and was noted to have pneumonia During an interview with the Director of Nursing on 7/12/12 at approximately 3:00 PM, she provided a statement from the nurse on duty at the time of the transfer which stated the Nurse Practitioner was called at 7:45 AM. Review of the Standing Orders fir Dyspnea/Cyanosis, stated, Obtain resident vital signs, pulse oxygen level, note any [MEDICAL CONDITION], have recent and prior weights available, and then notify MD. If RN available, assess cardiac and lung sounds prior to contacting MD.",2016-06-01
8274,CAPSTONE HEALTH & REHAB OF EASLEY,425298,1850 CRESTVIEW ROAD,EASLEY,SC,29642,2012-07-12,328,G,0,1,PSVU11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on record review, observations and interviews, the facility failed to provide appropriate services for 1 of 1 residents with acute change in respiratory status and 2 of 8 residents with oxygen concentrators. Resident #7 with known respiratory distress did not receive timely intervention for changes in her respiratory status. Resident #1 and one additional random resident did not have filters in place in their oxygen concentrators. The findings included: The facility admitted resident #7 with [DIAGNOSES REDACTED]. The resident had a history of [REDACTED]. On 6/26/12, the resident was noted to have shallow respirations and was difficult to arouse at 3:00 AM. There was no assessment done to check breath sounds or vital signs once the resident had been noted to be difficult to arouse and had shallow respirations. At 6:40 AM, the resident oxygen saturations were down to 88%, the nurse increased the oxygen flow and failed to notify the physician. There was no no documentation that an assessment had been done. The physician or nurse practitioner was not notified until 8:15 AM after the resident was noted to be diaphoretic and the resident's oxygen had again been increased for the second time to 4L/M. Review of the Resident's Physician orders revealed Oxygen was ordered at 2L/M. There was no Physician's order to increase the Oxygen rate for the resident with [MEDICAL CONDITION]. The resident was sent to the hospital and required intubation for respiratory distress. Review of Perry and Potter, Clinical Nursing Skills & Techniques, 7th Edition, Copyright 2010, Assessment of Signs and Symptoms Associated with [MEDICAL CONDITION] included: Apprehension, anxiety, behavioral changes, decreased level of consciousness, confusion, drowsiness, altered concentration, increased pulse rate and depth of respiration or irregular respiratory patterns, decreased lung sounds, adventitious lung sounds (e.g., crackle, wheezes), elevated blood pressure evolving to decreased blood pressure, Pulse Oximetry (SpO2) less than 90%, Dyspnea, Use of accessory muscles of respiration, rib retractions, cardiac [MEDICAL CONDITION], Pallor, Cyanosis, increased fatigue, Dizziness and clubbing of nails resulting from prolonged, chronic [MEDICAL CONDITION]. The medical record documented the resident's Oxygen Saturation had dropped below 90%. The nurse increased the Oxygen flow on a resident with [MEDICAL CONDITION] without consulting the physician. There was no indication the resident had been assessed for respiratory status which included breath sounds. There was no description of the residents' inspiration or expiration, skin color, or types of breaths. During an interview with the Director of Nursing on 7/12/12 at approximately 11:15 AM, she confirmed she would have expected an assessment to have been done, when the nurse documented the residents respirations were shallow and she was difficult to arouse. The facility admitted Resident #1 with [DIAGNOSES REDACTED]. Observation during the Initial Tour on 7/9/12 at approximately 6:45 PM revealed Oxygen concentrators in use in rooms [ROOM NUMBERS] that did not have filters in place. There was a white dust like material within the slots where the filter should have been. Observations on 7/11/12 at 9:05 AM and 7/12/12 at 8:55 AM revealed Oxygen in use in room [ROOM NUMBER] for Resident #1 with no filter in place on the concentrator. Observation on 7/12/12 at 8:48 AM revealed Oxygen in use in room [ROOM NUMBER] with no filter in place. On 7/12/12 at approximately 9:00 AM, Licensed Practical Nurse (LPN) #1 verified there were no filters in place for both concentrators in use in rooms [ROOM NUMBERS]. He stated that both of them should have a filter on the back of the concentrator. When asked, he stated that nursing staff usually document the cleaning of the filters on the treatment sheets. Review of the July 2012 Treatment Administration Record for Resident #1 revealed an entry which stated Clean O2 (Oxygen) filter every night, Start Date: 7/07/12. The entry had been initialed as having been completed on 7/10, 7/11, and 7/12. Review of the Treatment Administration Record for the resident in room [ROOM NUMBER] revealed no documentation related to cleaning or changing an Oxygen filter as verified by LPN #1.",2016-06-01
8275,CAPSTONE HEALTH & REHAB OF EASLEY,425298,1850 CRESTVIEW ROAD,EASLEY,SC,29642,2012-07-12,425,D,0,1,PSVU11,"On the days of the survey, based on observation and interview, the facility failed to follow a procedure to ensure expired medication/supplies were removed from available use. Three expired syringes containing .09 % sodium chloride were stored in a box mixed in with unexpired syringes in the medication room. The findings included: On 7/12/12 at 11:46 AM,a review of medications/supplies stored in the medication room revealed (3) three syringes of .09% sodium chloride that expired July 1, 2012. The syringes were stored within a box of 20 of unexpired syringes. Interview with the Assistant Director of Nursing on 7/12/12 at 12:28pm revealed the night shift nurses were responsible for checking for expired products.",2016-06-01
8276,CAPSTONE HEALTH & REHAB OF EASLEY,425298,1850 CRESTVIEW ROAD,EASLEY,SC,29642,2012-07-12,514,E,0,1,PSVU11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on record reviews and interviews, the facility failed to maintain clinical records in accordance with accepted professional standards and practice for 3 of 15 residents reviewed for accuracy and completeness of clinical records. (Residents #4, #7, and #13). Resident 4 and 13 had inaccurate cumulative month physician orders. Resident # 7's nursing documentation did not accurately reflect the resident's care. The findings included: The facility admitted Resident #13 with [DIAGNOSES REDACTED]. Record review on 7/12/12 at approximately 1:50 PM revealed a Physician's Telephone Order dated 6/26/12 which stated 1) (Increase) [MEDICATION NAME] to 0.100 mcg (micrograms) . Continued review revealed the order dated 6/26/12 for the increased dosage of [MEDICATION NAME] had not been carried over to the July 2012 cumulative Physician Orders; and the resident was still ordered to receive [MEDICATION NAME] 0.075 mcg daily. This was verified by Licensed Practical Nurse (LPN) #2. When asked how the monthly orders are compiled, LPN #2 stated that once an order is received by the Physician, the order is written, then the yellow copies go to Care Plans where the monthly Physician order [REDACTED]. Review of the July 2012 Medication Administration Record [REDACTED]. During an interview on 7/12/12 at 2:10 PM, the Health Information Manager was told of the concern about the inaccuracy of the cumulative July 2012 Physician order [REDACTED]. When asked how orders are carried over to the next month, she stated that the cumulative orders are printed out 7 days before the changeover (1st of the month). She stated once printed, the night nurse would check these for accuracy. Upon review of Resident #13's July cumulative Physician Orders, the Health Information Manager stated that the nurse checked the orders on 7/1/12 and indicated the signature next to the entry Above Orders Noted by:. She verified there was a blank in the signature/date space for Nurse Review. The facility admitted Resident #4 with [DIAGNOSES REDACTED]. Review of the resident's Cumulative physician's orders [REDACTED]. Review of the Telephone orders on 6/29/12 included the orders for [MEDICATION NAME] 500 mg (milligrams) one po (by mouth) @ HS (hour of sleep) prn (as needed) for cramps. Vitamin B12 1000 mcg (micrograms) po daily. The orders for 6/29/12 were not carried over to the July Cumulative orders. On 6/26/12 telephone orders were received to 1. D/C (discontinue) previous order to clean incision site with wound cleaner and apply a dressing. 2. Clean the area on Rt (right) hip with wound cleanser & apply sure prep & steri strips, check q shift for placement. D/C when steri strips come off. 3. D/C Treatment with [MEDICATION NAME] to Rt. (right) lower buttocks area has healed. 4. Monitor Rt. lower buttocks q (every) shift x (times) 2 weeks for s&s of breakdown. None of the orders for 6/26/12 were carried over to the cumulative orders. A telephone order dated 6/22/12 to D/C [MEDICATION NAME] secondary to [MEDICAL CONDITION]. The [MEDICATION NAME] remained on the July Cumulative Orders, A telephone order dated 6/16/12, stated, Order Clarification: D/C O2. The July Cumulative orders continued to carry orders for Oxygen and Oxygen Equipment. The resident was observed observed on 7/10/12 and 7/11/12 and had no Oxygen equipment in her room. The facility admitted Resident #7 with [DIAGNOSES REDACTED]. Review of the medical record revealed the nurses notes were difficult to follow. Nurses Notes: 6/20/12, 9:30 AM NP (Nurse Practitioner) here & (and) aware of the Hbg (hemoglobin) 7.6. spoke with daughter R/T (related to ) transfusion. 6/20/12, 1:00 PM Spoke with Transfusion Ctr (Center) , order noted and info (information) faxed to schedule transfusion for 6/25/12 (Monday) 6/22/12, 2:20 PM, Residents appt (appointment) for Blood Transfusion is Sunday (6/24/12) 8:30 appt 6/24/12, 7:45 AM, Resident left facility to have blood transfusion 4:00 PM, New orders - Keflex 500 mg (milligrams) bid (twice a day) x 10 days. Urinalysis with C&S (culture and sensitivity) per on call MD. 6/25/12, 11:00 (no am or pm) Resident has appt for blood transfusion on 6/26/12 at 9:30 6/25/12, 2:00 (no am or pm) Blood Transfusion rescheduled for 6/30/12 @ 9:00 (no am or pm) .Resident on ABT (antibiotics) R/T UTI (urinary tract infection) no adverse effects noted no c/o pain/discomfort with urination. T98. 6/25/12, 3:02 (no am or pm) Resident refused BKF (Breakfast) and lunch today but did eat a snack this afternoon. BS (blood sugar) @ 11:30 was 93. 6/26/12, 8:15 (no am or pm) Resident noted to be diaphoretic, breathing labored, O2 sat (oxygen saturation) 83% on 3L/M (liters per minute) increased O@ to 4L/M via n/c . 6/26/12 8:25 (no am or pm) EMS here for resident transporting to hospital . 6/26/12, 300 AM, late entry Resp shallow, lying in bed with eyes closed. Sleeping soundly, hard to arouse. O2 @ 2L NC. 6/26/12, 6:40 AM, late entry, O2 88% increased O2 to 3L, O2 increased to 92% . 6/26/12 1230 AM, late entry UA collected by in & out Cath using sterile technique. Resident tolerated well The nurses notes did not clarify if the resident had/had not received blood when sent out for the blood transfusion. If the resident did not receive the transfusion there was no documentation as to the reason she did not receive it. There was no indication the facility had been observing the resident for possible side effects from a blood transfusion. Nurses notes were written that did not depict the time of the day the note was written, whether in the am or during the pm. The nurses note of 6/26/12 at 8:15, depicted the resident to have an acute change in condition. It was unable to be determined from the notes if the resident did receive the transfusion or if the acute change in condition resulted from the resident having had a reaction to the transfusion. The resident had a urinary tract infection and received an antibiotic. Another transfusion was scheduled for the next day and then rescheduled for the 30th. The resident had an acute change in condition that started at 3:00 AM (late entry) and continued to 8:15 AM when the physician was notified and the resident was sent to the hospital. The late entry nurses notes were not clear as to whether the time they were dated was the time of the event occurrence or the time of the documentation. During an interview with the Director of Nursing (DON) at 11:15AM on 7/12/12, the above nurses notes were reviewed. The DON stated, On 6/24 she went over for blood transfusion. She was very agitated, unable to manage and they sent her back. The family was unable to go on the 26th. They rescheduled for the 30th so the family could go with her. There was no documentation in the medical record the resident was agitated and was unable to receive the transfusion. The DON was further interviewed related to the concerns about the Cumulative Orders. She stated the Medical Records Nurse puts all orders in the system. She uses the yellow copies of the orders. The third shift nurses do the change over. (Check the orders for correctness.)",2016-06-01
8277,RICHARD M CAMPBELL VETERANS NURSING HOME,425301,4605 BELTON HIGHWAY,ANDERSON,SC,29621,2016-02-12,490,J,0,1,3WCN11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record reviews, interviews and review of the facility Abuse and Reporting Manual, the facility failed to be administered in a manner that enabled it to use its resources effectively and efficiently to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident. Administration failed to ensure that abuse policies were developed and/or implemented related to identification of abuse, investigation of allegations of abuse, protection of the resident, and screening of applicants prior to hire. Administration did not identify and address staff failure to follow established abuse policies related to identification of abuse and protection of Resident #62, one of two sampled residents reviewed for abuse. Administration failed to identify staff actions as abuse and failed to protect Resident #62 when accused employees were allowed to continue to work on the unit where s/he resided. On 2-10-2016 at 8:14 PM, the Administrator and Director of Nursing were notified that Immediate Jeopardy and /or Substandard Quality of Care existed in the facility as of 12/31/2015. The findings included: Cross Refer CFR 483.13(b), 483.13(c)(l)(i) Abuse, F-223 Related to the facility failure to prevent Resident # 62 from being physically abused by two employees on 12/31/15. The employees held the resident and performed incontinent care after the resident had repeatedly refused the care. Cross Refer CFR 483.13(c) F226 Related to facility failure to develop and/or implement policies on identification of abuse, investigation of abuse allegations, resident protection during investigation of allegations. Cross Refer CFR 483.15(g)(1) Provision of Medically related Social Services, F250 The facility failed to provide medically related social services for Resident # 62. Social Services failed to follow-up with the resident related to an incident of alleged abuse leaving the resident fearful of staff reprisal. The facility did not substantiate the allegation of abuse after the facility investigation and both employees returned to work on the Unit Resident #62 resides. The CNA cared for the resident 15 times following the resident's expression of fear. The nurse cared for the resident 6 times following the expression of fear. Facility administration was aware of the resident's expression of fear and failed to act upon the expression. The facility's administration failed to recognize the resident's psychosocial/emotional state following the incident of abuse and provide support. Facility administration did not recognize the incident as abuse. Resident #62 was admitted to the facility with [DIAGNOSES REDACTED]. Review of a 24 hour facility incident report dated 1/1/2016, revealed the following information; Resident (Resident #62 was identified) stated Two men held me down and changed my brief and hurt my back. Investigation initiated, MD and RP notified. Staff involved suspended pending investigation. (Two employees were identified-a Licensed Practical Nurse (LPN) and Certified Nursing Assistant (CNA). A five day follow up report to the incident revealed the following; Resident did not want incontinence care provided most of the night. The CNA went in to provide incontinence care to the resident and he/she was combative and was continuing to refuse care and the CNA notified the nurse. The nurse came in to talk to the resident and encourage him to allow the staff to provide care because he was wet. The resident swung at the nurse and the nurse held his hands in order for the CNA to provide care because the resident was extremely wet. Once they finished the resident continued to curse and they left the residents room. The resident has been referred to the psychiatrist for evaluation. A review of the facility Abuse and Reporting Manual revealed the following: Section One-Abuse 3. Abuse is defined as the willful infliction of injury, unreasonable confinement resulting in pain or mental anguish. Section Two- Components of Abuse: b.Training - Staff will be trained in the following abuse prohibition practices: 5. Appropriate interventions to deal with aggressive resident behaviors. c. Prevention - .2. The facility will identify residents whose personal histories, aggressive behaviors, dependency for daily care, and/or communication needs render them at risk for abuse and/or abusing other residents. 5. Supervisory staff will be responsible for identifying and intervening in situations of inappropriate staff/resident behaviors. f. Protection - 1. With suspected staff to resident abuse, the resident(s) will be protected by removing them from the situation of possible abuse 5. The behaviors and physical condition of the residents will be evaluated with appropriated interventions identified to address the behaviors. A review of the facility Abuse and Reporting Manual notes under Section 2 - Components of Abuse - e. Investigation - Responsibility: Administrator and/or Director of Nursing or Designee. f. Protection - Responsibility: All Staff. During a meeting with the facility Administrator and the Director of Nurses interviewed together on 2-10-2016 at 7:45 PM, they were asked about their expectations of the staff when a resident was refusing care. I expect safety first with the resident and then notify the nurse to assess and evaluate the situation. An Allegation of Compliance (AOC) alleging compliance as of 2/12/16 was received and accepted by the State Agency (SA) on 2/12/16 and included the following: Criterion #1 The social worker met with resident # 62 on 2-9-16 to assess and discuss his voice of fear and to assure his psychosocial needs were met. The plan of care was updated on 2-9-16 to include reassurance of his safety and our concern, nursing and social services; Encourage resident to vent thoughts and feelings. The Administrator and witness met with the resident and assured him he was in a safe environment on 2-10-16 at 1030pm. The alleged employees LPN#I and CNA #1 were removed off the unit that the resident resides on February 10, 2016 and will not be allowed to care for the resident. LPN #1 and CNA #1 were provided education by and RN Supervisor on 2-11-16 on the abuse policy and catastrophic event/reactions how to respond. Catastrophic reactions/events include emotional outbursts, sometimes accompanied by physical acting-out behavior, that seems inappropriate or out of proportion to the situation. Criterion#2 Interviewed or attempted to interview all residents on unit 604 on by Social Worker and Assistant Social Worker on 2-11-16 to identify any alleged abuse or fearfulness. No additional residents were identified as abused or being fearful. Care plans will be developed to reflect resident's needs and social services will be notified to assure psychosocial needs are met. Criterion #3 The Staff Development Coordinator and RN managers will provide education for all staff on the definition of a catastrophic event, defined as emotional outbursts, sometimes accompanied by physical acting-out behavior, that seems inappropriate or out of proportion to the situation, and how to address a resident refusing care and how to respond to the resident to be initiated on 2-11-16. Staff who was not available will be in-serviced as soon as they are available prior to being able to work. Newly- hired staff will be in-serviced during the orientation process. Education on the entire Abuse policy including screening, training, prevention, protection, investigation, identification and reporting will be initiated on 2-11-16 by Staff Development Coordinator and RN Supervisors for all staff. Staff who was not available will be in-serviced as soon as they are available prior to being able to work. Newly hired staff will be in-serviced during the orientation process. Education to be provided to the Social Service Workers on 2-11-16 by the Regional Corporate Nurse Consultant regarding responsibilities when a resident makes a complaint and what to document and how to handle a resident with an alleged allegation and what to document and follow-up. Corporate Regional Vice President provided education to the Nursing Home Administrator, Director of Nursing, Staff Development Coordinator and RN Managers regarding the abuse policy and catastrophic events on 2-11-16. Based on interviews with staff, observations in the facility and review of inservice records, the allegation of compliance was implemented and verified by the survey team on 2/12/16 and the immediate jeopardy was removed. The citations remained at a lowered scope and severity level of D.",2016-06-01
8278,PRUITTHEALTH ESTILL,425315,252 LIBERTY STREET SOUTH,ESTILL,SC,29918,2012-07-18,280,D,0,1,4SFT11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on observations, interviews and record review, the facility failed to update the care plan for 2 of 5 sampled residents receiving oxygen. Resident #4 was observed by staff changing the setting of liters on his concentrator and Resident #8 was not care planned for the use of oxygen. The findings included: The facility admitted Resident #4 with [DIAGNOSES REDACTED]. During an observation of Resident #4 on 7/16/12 at 3:55pm, the Resident's oxygen concentrator was set at 4 liters per minute via nasal cannula. During a record review on 7/16/12 at approximately 4:00pm, the Physician's Interim Orders dated 7/4/12 stated Oxygen at 2 liters per minute via nasal cannula continuously. During an observation on 7/17/12 at 10:27am, Resident #4's oxygen concentrator was set at 4 liters per minute via nasal cannula. During an interview with the Unit Manager #1 on 7/17/12 at 10:27am, she verified the oxygen order was for 2 liters per minute and the current setting on the oxygen concentrator was 4 liters per minute. The Unit Manager then stated, He messes with it. The Resident also stated that the Concentrator gets bumped. During a review of the Resident's Care Plan on 7/17/12 at 10:30am, no evidence was noted that the Care Plan addressed behaviors with readjusting of the oxygen concentrator machine. During an interview with the Unit Manager #1 on 7/17/12 at 10:30am, she confirmed that the Care Plan was not updated to reflect the Resident's behavior related to adjusting the flow on the oxygen concentrator. The facility admitted Resident #8 with [DIAGNOSES REDACTED]. During the days of the survey Resident #8 was observed wearing a oxygen tank. Review of the medical record on 7/16/12 at approximately 4:50 PM which revealed a physician's clarification order dated 6/29/12 for oxygen: O2 (oxygen) 2 l/m (liters per minute) via NC (Nasal Canula) to maintain sats (saturation levels) > (greater than) 92% Review of Resident #8's Care Plan did not identify the use of oxygen. During an interview with the Minimum Data Set Coordinator on 7/17/12 at approximately 11 AM she verified the resident's need/use of oxygen was not on the resident's care plan.",2016-06-01
8279,PRUITTHEALTH ESTILL,425315,252 LIBERTY STREET SOUTH,ESTILL,SC,29918,2012-07-18,328,D,0,1,4SFT11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on observations, record review and interview the facility failed to provide proper treatment and care for 2 of 5 sampled residents reviewed for oxygen administration. Resident #4's oxygen was observed being administered at 4 liters when there was a physician's orders [REDACTED]. Resident #8 portable oxygen tank was observed empty on separate occasions. The findings included: The facility admitted Resident #8 with [DIAGNOSES REDACTED]. During initial tour of the facility on 7/16/12 at approximately 1:30 PM, Resident #8 was observed wearing a portable oxygen tank. The surveyor observed the needle on the tank pointing to the red area which indicated needs refill. Review of the medical record on 7/16/12 at approximately 4:50 PM revealed a physician's orders [REDACTED].> (greater than) 92%. Review of the Daily Skilled Nurses Notes revealed on 6/27/12 at 7:55 PM .Resident yells I can't breathe O2 sats @ 93 on O2 via nasal canula. On 7/17/12 at approximately 10:45 AM, there was an observation of Resident #8's oxygen and the gauge was again pointing at the red area which indicated needs refill. During an interview Licensed Practical Nurse #1 verified that Resident #8 O2 tank was empty and needed to be replaced. The facility admitted Resident #4 with [DIAGNOSES REDACTED]. During a record review on 7/16/12 at approximately 4:00pm, the Physician's Interim Orders dated 7/4/12 verified the order for Oxygen at 2 liters per minute via nasal cannula continuously. During an observation on 7/16/12 at 3:55pm, Resident #4's oxygen concentrator was set at 4 liters per minute via nasal cannula. A second observation on 7/17/12 at 10:27am, revealed Resident #4's oxygen concentrator was set at 4 liters per minute via nasal cannula. During an interview with the Unit Manager #1 on 7/17/12 at 10:27am, she verified the oxygen order was for 2 liters per minute and the current setting on the oxygen concentrator was 4 liters per minute. During an interview on 7/17/12 at 10:48am, the Unit Manager #1 verified the Physician's Interim Orders dated 7/4/12 for Oxygen at 2 liters per minute via nasal cannula continuously. She also verified the Medication Record documented oxygen was being administered at 2 liters per minute via nasal cannula continuously.",2016-06-01
8280,NHC HEALTHCARE - LEXINGTON,425333,2993 SUNSET BLVD,WEST COLUMBIA,SC,29169,2012-04-18,309,D,0,1,98F911,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the Recertification Survey, based on record review, review of the Hospice contract, and interviews, the facility failed to provide documented evidence of hospice aide visits for 2 of 4 residents (Resident #4 and Resident #5) reviewed for hospice. The facility also failed to provide a current hospice treatment plan for Resident #4. The findings included: The facility admitted Resident #5 on [DATE] with [DIAGNOSES REDACTED]. Record review on [DATE] at approximately 11AM revealed Hospice orders for Resident #5. Review of the Hospice Care Plan noted that the Hospice aide was to visit 5 times a week to assist with personal care/ADL's/light housekeeping as needed within 60 day period of time. Further review of the Hospice record on [DATE] revealed no documentation of the Hospice aide visits or provision of planned care for Resident #5. On [DATE] at approximately 1:50 PM, a untitled document was located under the Hospice tab in the resident's medical record which revealed: The following forms need to be in the facility charts * Current Hospice Aide Care Plan and Weekly Progress Notes in separate notebook on each unit. Review of the Hospice contract on [DATE] at approximately 3:10 PM, under Section 5 A. Preparation and Maintenance of Records revealed: The facility shall prepare and maintain medical records for each Hospice patient receiving services pursuant to this Agreement. The medical records shall consist of progress notes and clinical notes describing all patient services and events .The Hospice PLAN OF CARE and other documentation must be maintained in the patient's medical record. On [DATE] at approximately 11:25 AM, during an interview with Registered Nurse (RN) #3, she verified there was no documentation of Hospice aide visits in the medical record or in a separate notebook on the unit. The Hospice aide notes were faxed to the facility on [DATE] at approximately 9:06 AM. During record review for Resident #4 on [DATE] at approximately 1:30 PM, there was no documented evidence that the Certified Nurses Assistants (CNA) for hospice services were providing care and visits as required based on the most recent treatment plan located in the chart. The plan called for CNA visits 5 times per week and Clergy visits as needed (no documentation of visits found). Also, the treatment plan for [DATE] through [DATE], which the hospice staff were using had expired. Interview with Registered Nurse (RN) #3 revealed that she could not locate the CNA visit sheets and would have to try and find them. An interview with CNA #1 on [DATE] at approximately 8:30 AM, revealed that the CNA caring for a hospice resident had a carbon copy care plan and that they were to sign each day that they cared for the resident and at the end of the week the yellow copy went in the hospice binder at the facility and the original went to their hospice office. CNA #1 located the hospice binder at the nurses desk and tried to locate the yellow signature sheets for Resident #4, but stated they were not in the book. Interview with RN #3 on [DATE] at approximately 10:18 AM, revealed that she was having the CNA visit sheets and updated treatment plan faxed over from the hospice service.",2016-06-01
8281,NHC HEALTHCARE - LEXINGTON,425333,2993 SUNSET BLVD,WEST COLUMBIA,SC,29169,2012-04-18,314,D,0,1,98F911,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the Recertification Survey, based on observation, interviews and record review, the facility failed to provide necessary treatment and services to promote healing and prevent infection for Resident # 1, 1 of 2 residents reviewed for wound care. The findings included: The facility admitted Resident #1 on 7/8/10 with [DIAGNOSES REDACTED]. The resident was admitted to the hospital on [DATE] with [DIAGNOSES REDACTED]. On 4/18/12 at 10:18 AM, Registered Nurse (RN) #1 was observed performing wound care to Resident #1. After removing the soiled dressing, removing her gloves and donning clean gloves, RN #1 flushed the wound bed with normal saline which drained out of the wound to the peri-wound. RN #1 used a dry gauze to dry the contaminated normal saline from the peri-wound and then continued around the entire peri-wound with the same gauze. She applied the skin prep and the dressing to the wound. RN #1 did not clean the contaminated normal saline from the peri-wound. At 10:31 AM, RN #1, confirmed that the normal saline that had drained from the wound bed was contaminated and that she had wiped the entire peri-wound area with the same gauze used to dry the contaminated normal saline from the area below the wound. She verified that she should have discarded the gauze after drying the peri-wound of the contaminated normal saline and used a clean gauze and normal saline to clean the peri-wound. During an interview at 12:05 PM on 4/18/12, the Director of Nursing (DON) stated that ideally, the nurse would not have wiped the peri-wound with a contaminated gauze but once she did, she should have stopped the treatment and started over. The DON also verified that the facility's policy did not state how the wound or peri-wound should be cleaned but confirmed that a prudent nurse would have cleaned the peri-wound and that it should be cleaned from the edge of the wound outward.",2016-06-01
8282,NHC HEALTHCARE - LEXINGTON,425333,2993 SUNSET BLVD,WEST COLUMBIA,SC,29169,2012-04-18,323,D,0,1,98F911,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of survey, based on record review, observations and interviews, the facility failed to ensure that 1 of 2 sampled residents reviewed for exit seeking remained free from accident hazards as was possible by not assessing the placement of the Wanderguard and circulation as ordered by the physician for Resident #14. The findings included: The facility admitted Resident #14 on 11-2-11 with a [DIAGNOSES REDACTED]. During an observation of Resident #14 on 4-16-12 at approximately 5:05 PM, the resident was noted to be wearing a Wanderguard on her right ankle. Record review on 4-16-12 at approximately 5:10 PM, revealed that an elopement assessment had been completed on 1-2-12 and an order had been written on 1-3-12 as follows: Place Wanderguard to right ankle. Check placement every shift. Check circulation to right foot every shift. Upon review of Resident #14's Treatment Administration Record (TAR) for the month of April, there were no signatures located by the order on the TAR and no further documentation could be found in the chart indicating that the physicians order for every shift assessments for circulation and Wanderguard placement were being followed. During an interview on 4-17-12 at approximately 10:40 AM, Licensed Practical Nurse (LPN) #1 stated that the staff documented Wanderguard placement and circulation on the TAR's. The LPN reviewed the April TAR for Resident #14 and confirmed that the assessments for placement and circulation, had not been initiated as having been completed as ordered. There was no documented evidence the physician's orders [REDACTED].",2016-06-01
8283,NHC HEALTHCARE - LEXINGTON,425333,2993 SUNSET BLVD,WEST COLUMBIA,SC,29169,2012-04-18,328,D,0,1,98F911,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the Recertification Survey, based on observations, record review and interview, the facility failed to ensure that 1 of 6 sample residents received proper treatment and care for the use of oxygen. Resident #6's oxygen was not administered as ordered. The findings included: The facility admitted Resident #6 on 2/23/12 with [DIAGNOSES REDACTED]. During initial tour of the facility on 4/16/12 at approximately 9:55 AM, Resident #6 was observed sitting in his chair with his oxygen infusing at 2 liters per minute. On 4/16/12 at approximately 4:10 PM while conducting the Resident Interview, the surveyor again observed oxygen set at 2 liters. During the interview, Resident #6 stated that therapy puts his oxygen level on 2 liters and at night, when he wakes up, it's on 1 liter. On 4/16/12 at approximately 5:35 PM, the surveyor again observed the oxygen set at 2 liters. Review of the Admission Minimum Data Set with the Assessment Reference Date of 3/1/12 revealed, Section J Health Conditions (1100-1550) coded Resident #6 as having shortness of breath or trouble breathing with exertion (e.g., walking, bathing, transferring) and when lying flat. Record Review on 4/16/12 at approximately 3 PM, revealed a physician's orders [REDACTED].@ (at) 3 l (liters)/minute via N/C (Nasal Cannula) continuous. Review of the treatment record for 4/1/12-4/30/12 on 4/16/12 at approximately 3:15 PM revealed nurses' signatures documenting on both shifts that the resident's oxygen was at 3L/minute. Review of the Nurse's Notes revealed documentation of various dates and times of the resident's oxygen infusing at 2L/minute: 3/10/12/ 7A-7P: .O2 (Oxygen) sat checked 84% (percent) on room air-O2 replaced in nostrils by N/C at 2l/min. 3/10/12/11:30 PM: O2 at 2l/min via N/C 3/11/12/3:15 PM: O2 in progress @ 2l/min via N/C . 3/13/12/5:30 PM: .O2 in progress at 2l/min via N/C 3/15/12/7P-7A: . O2 on @ 2l/min via N/C . 3/24/12/1:00 PM: .O2 continue @ 2l/min . 4/4/12/11:30 PM: .O2 @2l/min via N/C . On 4/16/12 at 5 PM,-1 review of Resident #6's Physical Therapy Progress Report dated 3/29/12-4/4/12 noted, Patient ambulated with O2 on 2L and O2 sats dropped to 88 with a minute recovery to 95 as patient began pursed lip breathing. On 4/16/12 at approximately 5:35 PM, during an interview with Licensed Practical Nurse #2, she verified Resident #6's oxygen level was at 2L/min and changed it back to 3L/min.",2016-06-01
8284,MARTHA FRANKS BAPTIST RETIREMENT CENTER,425334,ONE MARTHA FRANKS DRIVE,LAURENS,SC,29360,2012-02-08,280,D,0,1,6G5L11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey based on record review, observation, interviews and review of the facility's Wandering/Elopement Risk Policy, the facility failed to review and revise a care plan for 1 of 1 sampled resident with exit seeking behaviors. (Resident #13's care plan was not updated related to placement and location of wanderguard bracelet). The findings included: The facility admitted Resident #13 on 9/16/08 with diagnosed that included Altered Mental Status, [MEDICAL CONDITION], Hypertension and Dementia. Record review on 2/08/12 at approximately 11:30 AM revealed a Nurse's Note dated 10/31/11 that indicated resident was found outside Unit 2 by staff. The Nurse's Note further indicated the resident was not wearing a wanderguard bracelet and the writer immediately placed one on resident's left wrist. A Nurse's Note dated 12/15/11 indicated the resident tried to leave the facility several times. There was no documentation to indicate if the wanderguard was checked or located on the left wrist. Review of the facility's Wandering/Elopement Risk Policy indicated in #2 under procedure With each quarterly, annual, or significant change assessment, the Wandering/Elopement Risk Assessment is to be completed and the care plan revised/updated to reflect the current needs of the resident. An observation on 2/08/12 at 12:30 PM revealed the resident was in his room seated in a chair. There was no wanderguard located on the resident's left wrist. The resident's care plan, incorrectly dated as last reviewed 3/20/12, indicated the resident was at risk for elopement but stated the Resident will not wear a wanderguard; he will remove all that are applied. It had not been revised to reflect the resident was currently wearing a wanderguard or where it was located. Review of the MAR (Medication Administration Records) for November 2011, December 2011, January 2012 and February 2012 did not indicate the location of the wanderguard. An interview on 2/08/12 at approximately 12:45 PM with LPN (Licensed Practical Nurse) #3 revealed the resident was able to remove the wanderguard from his wrist. LPN #3 further confirmed the care plan and the MAR indicated [REDACTED]. During the observation LPN #3 informed resident he wanted to see his bracelet. The LPN checked both of the resident's wrists and could not locate the bracelet. LPN #3 then checked the resident's left ankle and located the wanderguard bracelet. LPN #3 stated she did not know when the bracelet was placed on the left ankle and confirmed there was no documentation to indicate when the bracelet was placed on the left ankle. An interview on 2/08/12 at approximately 1:25 PM with the ADON (Assistant Director of Nursing) revealed the facility did not have an incident report to investigate the 10/31/11 exit seeking behavior. The ADON stated the wanderguard was removed from the resident's wrist because the resident was able to remove it. The ADON further confirmed the care plan was not updated to reflect the placement of the wander guard bracelet.",2016-06-01
8285,MARTHA FRANKS BAPTIST RETIREMENT CENTER,425334,ONE MARTHA FRANKS DRIVE,LAURENS,SC,29360,2012-02-08,309,D,0,1,6G5L11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on record review and interview, intake and output was not recorded each shift per physician order [REDACTED]. The findings included: The facility admitted Resident # 1 on 2/08 and readmitted her on 3/18/10 with [DIAGNOSES REDACTED]. Record review on 2/7/12 revealed documentation of a recent UTI (Urinary Tract Infection) on 12/15/11 for which an antibiotic was ordered. The physician's orders [REDACTED]. The date beside the order was 12/14/10. The last documentation of I & O on the MAR (Medication Administration Record) was during October, 2011 with only initials but no actual amounts of intake or output. During an interview with the Unit Manager (Registered Nurse # 1), she reviewed the resident's record and thinned record. An order to check I & O q (every) shift was found dated 9/2/10. RN #1 continued to review the record but could not locate a discontinuation order for the I & O. She checked the MAR for February and found no documentation that I & O was being recorded. The nurse confirmed the staff were not recording intake and output on this resident per the physician's orders [REDACTED].",2016-06-01
8286,MARTHA FRANKS BAPTIST RETIREMENT CENTER,425334,ONE MARTHA FRANKS DRIVE,LAURENS,SC,29360,2012-02-08,323,G,0,1,6G5L11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on observations, record reviews and interviews, the facility failed to ensure that 2 of 6 sampled residents reviewed for falls remained free from accident hazards by providing adequate supervision and assistance devices to prevent accidents. For Resident #1 the facility failed to implement interventions to prevent recurrence and reduce risk after a fall. Resident #8 sustained 3 falls resulting in a shoulder dislocation and tibial fracture on separate occasions resulting from failure of the facility to provide appropriate training, supervision, and/or changes in the care plan interventions to prevent recurrence. The findings included: The facility admitted Resident #8 on 06/12/06 with [DIAGNOSES REDACTED]. Record review on 02/07/12 at 3:30 PM revealed that an incident report was written on 12/31/11 at 10:10 PM which stated, Resident was laying on floor in front of recliner chair. Staff attempted to use the lift to transfer, no connection was made. Resident slide out of recliner onto floor. The documented equipment being used at the time of the incident was lift. Nurses Notes for 12/31/11 stated that Resident #8 was complaining of right knee pain, left and right ankle pain. Resident #8 was sent to the emergency room for evaluation. Nurses Notes on 1/1/12 at 3:40 AM revealed that Resident #8 returned from the emergency room with a [DIAGNOSES REDACTED]. The second incident report, for Resident #8, which was dated for 10/21/11 at 11:15 AM stated, staff getting res (resident) off toilet on stand-up lift. Res slid out sling lowered to floor by staff. C/O (complaints of) R (right) shoulder pain, cannot move R arm and c/o R knee to ankle pain can move R leg. The documented equipment being used at the time of the incident was a stand-up lift. Nurses Notes revealed Resident #8 was sent to the emergency roiagnom on [DATE] at 12:40 PM for evaluation of right shoulder and right knee pain. Nurses Notes revealed that Resident #8 returned to the facility on [DATE] at 1:00 AM with the [DIAGNOSES REDACTED]. Continued review of the Nurses Notes dated 10/23/12 revealed that Resident #8 was wearing a sling on the right arm and mild discoloration was seen from right shoulder to neck. The third incident report for Resident #8, which was dated for 8/25/11 at 10:00 AM stated, Staff taking res (resident) to bathroom. Started sliding out of harness. Slid to floor. no injuries noted. The documented equipment being used at the time of the incident was a stand-up lift. Review of the Nurses Notes confirmed that Resident #8 slid out of the harness of the stand-up lift while going to the bathroom and that there were no apparent injuries. Upon review of the Therapy Screening Referral dated 8/25/11, regarding Resident #8's fall, it was documented on the referral wrong lift (sling) used for this transfer. Documented on the therapy screening referral dated 10/21/11 regarding Resident #8's fall out of stand-up lift was noted max assist with all transfers use full body lift per safety. Documented on the Rehab Pre-Admission Worksheet dated 10/25/11 was that Resident #8 was total assistance for transfers and total body lift staff assistance times two. There were two additional undated Rehab Pre/Admission Worksheets documenting that Resident #8 required total assistance with stand lift for all transfers with two staff and maximal/total assistance for transfers with Hoyer lift for bed to chair and bed to toilet. Physical Therapy and Occupation Therapy daily notes for 10/21/11 noted Resident #8 required maximal assistance for activities of daily living and transfers. During an interview with the acting Director of Nursing (DON) on 2/7/12 at 4:30 PM the surveyor requested the facility's policy and inservice training documentation for the staff who were assigned to transfer the residents requiring either a stand-up or Hoyer lift. The inservice documentation sheets provided by the DON completed on 9/1/11, 4/1/11, and 3/2/11 did not contain the signatures of the individuals listed on the incident reports from 8/25/11, 10/21/11 and 12/31/11. The facility's policy and procedure for lifts provided by the DON included directions: at least two people are present during transferring . An interview was conducted on 07/08/12 at 1:45 PM with Physical Therapy Assistant (PTA) #1 regarding when Resident #8 was changed from a stand-up lift to a Hoyer lift. After record review PTA #1 stated that she could not determine since two of the Rehab Admission Worksheets had not been dated. The PTA did identify that Resident #8 was assessed for use of a Hoyer lift on 10/25/11. When asked who was responsible for training the staff regarding the proper use of the stand-up and Hoyer lift, PTA stated therapy staff does the training only when nursing staff asks the therapy department for the training. The surveyor interviewed Certified Nurses Assistant (CNA) #3 (listed on the incident report dated 10/21/11) about who she had received her training from regarding the use of the stand-up lift. CNA #3 stated she was instructed by former DON approximately one year previously. When asked who instructed CNA #3 on how to use the Hoyer lift, she stated she learned from other CNA's on the floor. The facility failed to provide evidence of initial and ongoing training related to use of resident care equipment. Record review revealed a care plan that the resident was at risk for fall/injury which contained two added hand written interventions. The interventions were not dated and intervention #14 stated use appropriate lift according to therapy recommendations. The care plan was not specific as to which lift was to be used and there were no changes in interventions following the 3 falls. The care plan was not updated following the most recent fall incident dated 12/31/11. The facility admitted Resident # 1 on 2/08 and readmitted her on 3/18/10 with [DIAGNOSES REDACTED]. During record review on 2/7/12 skin sheets were noted with multiple documentation's of bruising to the resident's arms, legs, and toes. Incident reports were requested for the periods of documentation; however, only two reports were provided by the facility. A report dated 8/13/11 documented a fall in the day room with a skin tear to right hand. The report documented as steps taken to prevent recurrence : Morse Fall Scale Complete, Res.(resident) may need around the clock sitter. The Post Fall Assessment showed at the time of the fall no alarms were being used for this resident. The report noted the resident was on Lexapro 20 mg (milligrams), Trazadone 50 mg, and Lorazepam 0.5 mg. The Falls Prevention Follow-up had 2 areas checked: care plan updated to reflect fall , additional interventions added to care plan, and continue POC (plan of care). Report to Risk Committee. No other recommendations were made by the committee. Morse Fall Scale Assessments were also noted in the medical record dating back to 3/18/11. The resident scored as a high risk for falls. Sensor alarm i.e.: bed alarm and/or chair alarm initialed with low bed also initialed on the 3/18/11 assessment. Other Morse Fall Scale assessments dated 6/6/11, 6/19/11, 8/13/11, 9/18/11, and 12/18/11 also scored the resident as high risk for falls. Each of the sheets had lines drawn to include all the interventions listed for low risk and high risk, but never any new interventions. Review of the Resident's Care Plan for risk of falls documented falls on 6/6/11, 7/13/11, and 8/13/11. Interventions # 8, #9, #10, and #11 had been added to the care plan but there were no dates as to when the intervention had been added. A chair alarm when up in chair was added as an additional intervention. ( #10). An interview with the Unit Manager (RN #1) revealed that the resident had a bed alarm and a chair alarm. Review of the Physicians Orders only revealed and order for a bed alarm. The nurse stated an order would have been obtained in order to apply a chair alarm. Actual visual inspection at 11 AM on 2/8/11 of the resident seated in her wheel chair by the nurse and surveyor revealed no chair alarm in place. The sitter staying with the resident stated, She has never had a chair alarm. She has a bed alarm. During the two days of the survey, the resident was always noted up in her wheel chair. Interviews revealled the sitter only stays during the day leaving the facility responsible for the resident's supervision and safety. The sitter was not oberved during the supper meal. The incident on 8/13/11 occurred at 5:30 PM and the sitter was not present.",2016-06-01
8287,MARTHA FRANKS BAPTIST RETIREMENT CENTER,425334,ONE MARTHA FRANKS DRIVE,LAURENS,SC,29360,2012-02-08,371,F,0,1,6G5L11,"On the days of the survey, based on observations and interview, the facility failed to store, prepare, distribute and serve food under sanitary conditions. The facility freezer contained unlabeled/undated food. Kitchen equipment was observed soiled with dried food splatters or contained food debris, food items were not labelled nor dated, stored foods were improperly wrapped, The findings included: On 2/7/2012 at 9:20 AM, during tour of the facility's kitchen with the Dietary Manager, the Tilt Grill and the Deep Fryer contained a large amount of food debris and the oil was a dark color. A table top stand mixer had dried food splatters. The can opener attached to a counter had a black substance around the base where it was attached to the counter and in the area where the opening tip rested on the counter. The walk-in freezer had a large bag of breaded chicken strips which were taken out of the original box and had not been dated or labeled. The freezer also contained a frozen chicken which had been wrapped in aluminum foil and was partially exposed with no date. The Dietary Manager stated that the Tilt Grill and Deep Fryer were to be cleaned on the day of the tour. She removed the partially wrapped chicken from the freezer. As she removed the chicken, she stated they know they are not supposed to do that. On 2/8/2012 at 9:10 AM, during an additional tour with the Dietary Manager, the Deep Fryer was observed to contain a large amount of food debris and dark colored oil. The Tilt Grill had been cleaned. The mixer also continued to have dried splatters. The Dietary Manager stated that the Deep Fryer had been cleaned on 2/7/12 but had been used after the cleaning A cleaning schedule was requested but not provided prior to exiting the facility.",2016-06-01
8288,MARTHA FRANKS BAPTIST RETIREMENT CENTER,425334,ONE MARTHA FRANKS DRIVE,LAURENS,SC,29360,2012-02-08,425,D,0,1,6G5L11,"On the days of the survey, based on observations, interview, and the Drug Facts and Comparisons book (updated monthly), the facility failed to follow a procedure to ensure that expired medications were removed from medication storage in 2 of 3 medication rooms. The findings included: On 2/8/12 at 10:24 AM, observation of the 300 Unit medication room revealed one 1 milliliter (ml) vial (10 tests) Tuberculin Purified Protein Derivative, Diluted/Aplisol, opened with a puncture date of 1/2/12. The Drug Facts and Comparisons book, page 2001, states (in reference to Tuberculin Purified Protein Derivative): Discard vials in use for more than 30 days because of possible oxidation and degradation that may affect potency. During an interview on 2/8/12 at 10:38 AM, Licensed Practical Nurse (LPN) #1 revealed that the House Supervisor (LPN or Registered Nurse) spot checks the medication room periodically for expired medications, but there is no schedule. On 2/8/12 at 11:06 AM, observation of the 100 Unit medication room revealed one punch card of 30 tablets of Cetirizine HCl (hydrochloride) 10 mg (milligram), expired 1/31/12. During an interview on 2/8/12 at 11:33 AM, LPN #2 revealed that night shift nurses were responsible to check expiration dates on weekends and also periodically. She added that Pharmacy also comes once every couple of months and checks for expired medications.",2016-06-01
8289,MARTHA FRANKS BAPTIST RETIREMENT CENTER,425334,ONE MARTHA FRANKS DRIVE,LAURENS,SC,29360,2012-02-08,514,D,0,1,6G5L11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on record reviews and interviews, the facility failed to maintain clinical records on each resident in accordance with accepted professional standards and practices that were accurately documented for Resident #4, 1 of 10 residents reviewed for allergies. Resident #4 had allergies listed on admission records and the History and Physical which were not on the Physician order [REDACTED]. The findings included: The facility admitted Resident #4 on 4/19/2011 with [DIAGNOSES REDACTED]. The resident was found to be alert and orientated and scored a 14 on his BIMS.(Brief Interview for Mental Staus). On 2/7/2012 at 2:10 PM, during review of Resident #4's medical chart, allergy documentation was reviewed. A discharge form from a hospital dated 4/2/2011 stated that the resident was allergic to Latex and [MEDICATION NAME]. A facility History and Physical (H&P) dated 4/22/2011 and signed by the attending physician indicated allergies to Latex and [MEDICATION NAME]. Another H&P from a different hospital documented the resident's allergies as [MEDICATION NAME], Latex and Shellfish. A Patient Transfer form dated 12/24/2011 also listed the resident's allergies as [MEDICATION NAME], Latex and Shellfish. An Admission/Readmission Clinical Care assessment dated [DATE] indicated the allergies were Latex, Natural Rubber, [MEDICATION NAME] and Shellfish. An assessment dated [DATE] had the allergies documented as [MEDICATION NAME] and [MEDICATION NAME] and on 4/19/11 as Latex, [MEDICATION NAME] and [MEDICATION NAME]. The POF for 12/11, 1/12/and 2/12 contained documentation of Latex and Natural Rubber as the resident's allergies. The MAR's also contained the same allergy documentation. The MAR's and POFs revealed that the resident received [MEDICATION NAME] 20 milligrams once a day. On 2/7/2012 at 4:35 PM, vinyl gloves were observed being used by the staff and in the resident's room. On 2/8/2012 at 8?20 AM, during an interview with Registered Nurse (RN) #2, she reviewed and verified the allergy discrepancies for Resident #4. At 9:05 AM, RN #2 stated that she had interviewed the resident and that he stated he was not allergic to any of the listed items. He also stated his only allergy was to Scallops. RN #2, contacted the physician for a clarification order for the allergies and provided a copy to the surveyor. At 10:15 AM, In an interview with the resident, he verified that the nurse had spoken with him about his allergies and that he had told her his only allergy was scallops.",2016-06-01
8290,C M TUCKER NURSING CARE CENTER / RODDEY,425360,2200 HARDEN STREET,COLUMBIA,SC,29203,2013-06-04,241,D,1,0,QGG311,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the day of the complaint inspection, based on observation and interview, the facility failed to promote care for residents in a manner that maintains each resident's dignity. Resident #2 was observed receiving care in a manner that did not maintain the resident's dignity. The findings included: Resident #2 was observed during initial tour of the facility at approximately 2:30 PM. Resident #2 was standing in the doorway of the bathroom facing the open door to his/her room. Resident #2's pants were down and Certified Nurse Aide #1 was providing perineal care to the resident. Registered Nurse (RN) #1 confirmed the observation. RN #1 talked with the Unit Manager and stated that Resident #2 was completely exposed and that the door should have been closed. Review of Resident #2's medical record revealed the Quarterly Minimum (MDS) data set [DATE] coded the resident as requiring extensive assistance with one person physical assistance with toileting. Review of Resident #2's care plan revealed resident had a self care deficit and needed extensive assistance with toileting was identified as a problem area. Review of the facility's Policy and Procedure for Perineal Care revealed procedures included to provide privacy by closing the door, blinds, window and privacy curtain prior to starting the procedure to reduce apprehension and encourage cooperation and preserve dignity.",2016-06-01
8291,EMERITUS AT GREENVILLE,425373,1306 PELHAM RD,GREENVILLE,SC,29615,2012-09-12,156,C,0,1,FVQN11,"On the days of the survey, based on record review and interview, the facility failed to provide Skilled Nursing Facility Advanced Beneficiary Notice (SNFABN) Denial letters for 3 of 3 residents reviewed for Medicare beneficiary liability notices. The findings included: While Reviewing the Liability Notices and Beneficiary Appeal Rights on 9/12/12 at approximately 11 AM, the surveyor observed one form that was given to the three residents which was the CMS(Centers for Medicare/Medicaid) form which indicated the first day of Medicare non coverage for the residents. The residents reviewed did not exhaust their 100 days of medicare services. Issuing the Notice to Medicare Provider Non-coverage form CMS- to a resident only gives notice of his or her rights to a review of service termination. The facility did not provide the residents the SNFABN or a Denial letter to address liability for payment. During an interview with the Executive Director on 9/12/12 at 11:15 AM, he confirmed the surveyor findings and stated he was not aware of a SNFABN or Denial Letter.",2016-06-01
8292,EMERITUS AT GREENVILLE,425373,1306 PELHAM RD,GREENVILLE,SC,29615,2012-09-12,225,D,0,1,FVQN11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of survey, based on record review, interviews and review of the facility's Event Management Report, Investigating & (and) Reporting Policy and Event Management And Reporting Policy, the facility failed to report alleged violations involving mistreatment, neglect, or abuse, including injuries of unknown source and misappropriation of resident property are reported immediately to the administrator of the facility and to other officials in accordance with State law through established procedures (including to the State survey and certification agency). Resident #10, 1 of 1 resident with an injury of unknown origin, failed to have the injury reported by the facility to the appropriate state agency. The findings included: On 9/12/12 at 11:40 AM, during the record review for Resident #10, the Nurse's Notes contained documentation which stated on 6/24/12 at 11:30 AM .Upon inspection of pt (patient) there is a large discolored area to the L (left) ribcage area, baseball size .Area of unknown origin . Review of the resident's skin form stated the area was at the L (left) [MEDICATION NAME] area underarm and was Large baseball size discoloration to L underarm . The facility's Event Report Management-SNF form which was signed by the Director of Nursing (DON) stated Cause, if known, Unknown The DON added a statement to the back of the forms that the injury had occurred as the resident was being transferred as the DON had witnessed the resident being transferred by the staff lifting the resident with their arm/elbow lined up with the discolored area/hematoma. The statement also indicated that the staff transferred Resident #10 this way and held the resident tightly due to resisting care. The DON determined that the injury was from the staff transferring the resident. On 9/12 at 12:30 PM, during an interview with the DON, the DON stated that the staff should not have written Unknown. When asked if she had completed a 24 hour report and investigation and a Five Day report which was required for injuries of unknown origin, the DON stated she had investigated and written the findings on the back of the Event Report Management-SNF form. The DON stated that they did not take written statements from the staff or report as required to the state agency. The facility's Event Management Report indicated .The Executive Director will report to the licensing agency within State specific guidelines of any of the following events: Death of a resident, Any serious injury, as determined by the attending physician, while the resident is under facility supervision .Incidents which threaten the welfare, safety, or health of any resident .Event Investigation: In the event is the result of an injury of unknown origin, the Executive Director shall complete an Event Investigation Form. Attach the Event Management Report. For investigations of allegations of abuse, neglect or exploitation, refer to the Abuse Prevention, Identification and Reporting Policy . The facility's Investigating And Reporting Policy indicated .Procedure .6. All facilities will follow their state specific regulations .",2016-06-01
8293,COVENANT TOWERS HEALTHCARE CENTER,425382,5001 LITTLE RIVER ROAD,MYRTLE BEACH,SC,29577,2013-01-23,156,C,0,1,IOUH11,"On days of the survey, based on review of residents' funds and interview, the facility failed to complete 3 of 3 mandated Liability Notices: Skilled Nursing Facility Advanced Beneficiary Notices (SNFABN) for 3 of 3 residents. The findings included: On 1/23/13 at approximately 10:30 AM, review of 3 of 3 residents' funds revealed mandated Liability Notices had not been completed. During an interview on 1/23/13 at approximately 10:30 AM with the Director of Social Services/Activities, s/he confirmed the Skilled Nursing Facility Advanced Beneficiary Notices (SNFABN) were not completed.",2016-06-01
8294,COVENANT TOWERS HEALTHCARE CENTER,425382,5001 LITTLE RIVER ROAD,MYRTLE BEACH,SC,29577,2013-01-23,425,D,0,1,IOUH11,"On days of the survey, based on observation and interview, the facility failed to follow a procedure to ensure an expired medication was removed from 1 of 2 medication carts. The findings included: During the observation of medications in medication cart for Long Hall on 1/22/13 at approximately 12:30 PM the following medication was observed: Clonazepam (Klonopin) 1 mg (milligram), Manufactured by Actavis 8-13, Lot #891J11 C had expired on 1/17/13. During an interview on 1/22/13 at approximately 12:30 PM, Licensed Practical Nurse (LPN) #1 verified the expiration date of 1/17/13 and s/he stated No one is assigned to routinely check for expired medications.",2016-06-01