{"rowid": 10123, "facility_name": "UNIHEALTH POST-ACUTE CARE - COLUMBIA", "facility_id": 425013, "address": "2451 FOREST DRIVE", "city": "COLUMBIA", "state": "SC", "zip": 29204, "inspection_date": "2010-12-07", "deficiency_tag": 463, "scope_severity": "J", "complaint": null, "standard": null, "eventid": "R87Z11", "inspection_text": "On the days of the complaint and extended survey based on observations, interviews and record reviews the facility failed to ensure that all components of the nurse call system were operational. The nurse call panel at the Unit 700 nursing station was not operational during the first day of the survey. The findings included: An observation on 12/06/2010 at approximately 7:30 PM revealed call lights lit over resident rooms 701, 712 and 715 with Certified Nurse Aide (CNA) #1 attempting, without success, to turn off the call lights after providing care. The call light to room 712 was blinking on and off with no sounds. The call light to room 715 was lit with no sounds. In an interview with the surveyor, at the time of the observation, CNA #1 confirmed that the call lights to rooms 701, 712 and 715 were not working appropriately. CNA #1 stated that he went to room 715 to turn off the call light for room 701. The 700 Unit comprised of four halls not in full view of the nurse's station and rooms 718 and 719, located in a corner, not readily visible to the staff from the halls. When asked how long problems existed on the unit with the call lights CNA #1 stated that the call lights had not been working since last week when he informed a nurse. When asked how the staff determined a resident needed assistance CNA #1 stated that they looked to see if a light was on over the resident's door to determine if the resident needed assistance. An observation by the surveyor on 12/06/2010 at approximately 8 PM revealed the lights were on over the doors to rooms 710, 712 and 715; the call light panel was not functioning at the nurse's station. There was no staff member at the nurse's station. A nurse observed near room 701 called for a CNA to go to room 717 due to the call light being on over the door, in the hallway. Observation of the call light panel at the nurse's station revealed the light for room 717 was not lit. In an interview with the surveyor on 12/06/2010 at approximately 8:25 PM Licensed Practical Nurse (LPN) #1 revealed she was aware of the problems with the call lights a few weeks ago and so was the Maintenance Manager. LPN #1 stated the call lights for rooms 701 and 715 would just \"come on\". In an interview with the surveyor on 12/06/2010 at 8:30 PM the Director of Nursing (DON) and LPN#1 revealed the call light system used by the facility was both audible and visual. When a resident pushed the call light button in the room a sound was heard and the light came on over the resident's doorway and at the panel at the nurse's station. In an interview with the surveyor on 12/06/2010 at approximately 8:45 PM the Administrator confirmed she was aware the call lights were not working and that the Maintenance Manager received a report regarding call lights not functioning properly on 11/25/2010. The Administrator showed the surveyor a maintenance log dated 11/25/2010 that documented the concern that the call light system on Unit 700 was not working. In an interview with the surveyor on 12/06/2010 at approximately 9:05 PM the Maintenance Manager stated that some work was performed on the call lights 2 months ago. He stated he was not aware of the recent concerns but showed the survey a log dated 11/25/2010 that addressed concerns that the call light was not working on Unit 700. The Maintenance Manager stated that because the concerns were documented in the log did not mean anyone knew about the problems. Cross Refer to F-490, as it relates to the facilities administrator being aware of the call lights no working prior to the survey. No interventions were in place to prevent further concerns with the call lights. On 12/06/2010 at approximately 9:15 PM, Immediate Jeopardy was identified related to F463 at a scope and severity level of J. An acceptable plan of correction was submitted at 2:03 PM on 12/07/2010; at 2:30 PM, the Immediate Jeopardy was removed. However, the citations remained at a lower scope and severity level of D.", "filedate": "2014-04-01"}
{"rowid": 10124, "facility_name": "UNIHEALTH POST-ACUTE CARE - COLUMBIA", "facility_id": 425013, "address": "2451 FOREST DRIVE", "city": "COLUMBIA", "state": "SC", "zip": 29204, "inspection_date": "2010-12-07", "deficiency_tag": 490, "scope_severity": "J", "complaint": null, "standard": null, "eventid": "R87Z11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the complaint and extended survey based on observations, interviews and record reviews the facility failed to administer in a manner that enables 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 nurse call panel at the Unit 700 nursing station was not operational during the first day of the survey and the facility administrative staff was aware of problems with the call lights. The findings included: An observation on 12/06/2010 at approximately 7:30 PM revealed call lights lit over resident rooms 701, 712 and 715 with Certified Nurse Aide (CNA) #1 attempting, without success, to turn off the call lights after providing care. The call light for room [ROOM NUMBER] was blinking on and off with no sounds. The call light for room [ROOM NUMBER] was lit with no sounds. In an interview with the surveyor, at the time of the observation, CNA #1 confirmed that the call lights for rooms 701, 712 and 715 were not working appropriately. CNA #1 stated that he went to room [ROOM NUMBER] to turn off the call light for room [ROOM NUMBER]. The 700 Unit comprised of four halls not in full view of the nurse's station and rooms [ROOM NUMBERS], located in a corner, not readily visible to the staff from the halls. When asked how long problems with the call lights had existed on the unit CNA #1 stated that the call lights had not been working since last week when he informed a nurse. When asked how the staff determined a resident needed assistance CNA #1 stated that they looked to see if a light was on over the resident's door to determine if the resident needed assistance. An observation by the surveyor on 12/06/2010 at approximately 8 PM revealed the lights were on over the doors to rooms 710, 712 and 715; the call light panel was not functioning at the nurse's station. There was no staff member at the nurse's station. A nurse observed near room [ROOM NUMBER] called for a CNA to go to room [ROOM NUMBER] due to the call light being on over the door, in the hallway. Observation of the call light panel at the nurse's station revealed the light for room [ROOM NUMBER] was not lit. In an interview with the surveyor on 12/06/2010 at approximately 8:45 PM the Administrator confirmed she was aware the call lights were not working and that the Maintenance Manager received a report regarding call lights not functioning properly on 11/25/2010. The Administrator showed the surveyor a maintenance log dated 11/25/2010 that documented the concern that the call light system on Unit 700 was not working. In an interview with the surveyor on 12/06/2010 at approximately 9:05 PM the Maintenance Manager stated that some work was performed on the call lights 2 months ago. He stated he was not aware of the recent concerns but showed the survey a log dated 11/25/2010 that addressed concerns that the call light was not working on Unit 700. The Maintenance Manager stated that because the concerns were documented in the log did not mean anyone knew about the problems. Cross Refer to F-463, as it relates to a nonfunctioning nurse call panel at the Unit 700 nursing station during the first day of the survey On 12/06/2010 at approximately 9:15 PM, Immediate Jeopardy was identified related to F463 at a scope and severity level of J. An acceptable plan of correction was submitted at 2:03 PM on 12/07/2010; at 2:30 PM, the Immediate Jeopardy was removed. However, the citations remained at a lower scope and severity level of D.", "filedate": "2014-04-01"}
{"rowid": 10125, "facility_name": "UNIHEALTH POST-ACUTE CARE - COLUMBIA", "facility_id": 425013, "address": "2451 FOREST DRIVE", "city": "COLUMBIA", "state": "SC", "zip": 29204, "inspection_date": "2010-12-07", "deficiency_tag": 280, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "R87Z11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the complaint and extended survey based on record review the facility failed to assure a resident's care plan was reviewed and revised to reflect the current status of one of one resident reviewed with socially inappropriate behaviors. Resident #1 alleged that a new Certified Nurse Aide (CNA) hit him in the eye. Resident #1's care plan was not updated to reflect the allegation and no new interventions were initiated to attempt to address the behaviors. The findings included: The facility admitted Resident #1 on 11/14/2007 and readmitted him on 11/14/2008 with [DIAGNOSES REDACTED]. During record review for Resident #1 on 12/06/2010 the Nurse's Notes dated 11/11/2010 stated, \"Resident called nurse to room and states, 'look what the new CNA did to me'. Nurse asked what did CNA do resident states 'CNA punched me in the face'. SA (screening assessment) done noted bluish injury to (R) (right) eye...\" Review of the resident's care plan dated 08/17/2010 identified Socially inappropriate/disruptive behavior and Resistance to care, restlessness, crawling on the floor, history of combative behavior...w (with) potential for self-inflicted injury as problems. The care plan had not been updated following the 11/11/2010 incident related to the allegation that the CNA punched him in the face. No new interventions were initiated to address the resident's behavior or the alleged response of a staff member to the continuing behaviors. The care plan included a statement under the problem area dated 11/12/2010 \"continue problem x 3 months\".", "filedate": "2014-04-01"}
{"rowid": 10126, "facility_name": "FELLOWSHIP HEALTH & REHAB OF ANDERSON, LLC", "facility_id": 425016, "address": "208 JAMES STREET", "city": "ANDERSON", "state": "SC", "zip": 29625, "inspection_date": "2011-01-26", "deficiency_tag": 281, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "ZGHV11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the complaint inspection based on limited record review, observations and interviews, the facility failed to assure that licensed staff appropriately handled narcotics. Two licensed practical nurses (LPN) failed to appropriately count narcotics at the change of shift. Liquid [MEDICATION NAME] was left unattended on a resident's bedside table for an unknown period of time. That resident (Resident #2) was sent to the emergency room with a change in condition. The findings included: The facility readmitted Resident #2 on 3/10/2010 with [DIAGNOSES REDACTED]. Record review revealed the resident was receiving [MEDICATION NAME] 7.5/500 milligrams 1-2 tablets every 6 hours for pain. The resident was also receiving [MEDICATION NAME] for anxiety nightly. Residents #2 and #3 sampled as a result of a facility reported incident dated 1/9/2011 related to an allegation against Licensed Practical Nurses (LPN) #2 and #3. The initial 24 hours report stated, \"medication left at bedside on Saturday 1/8/2011. A thorough investigation was implemented immediately. The incident was reported to the administration at 2:08 PM.\" Review of the 5 Day Follow Up dated 1/13/2011 revealed the alleged perpetrator as LPN #1. The Director of Nurses was notified on 1/8/2011 at 2:08 PM. The report indicated that the resident (#2) was last observed at 12:30 PM and was noted to be alert with increased congestion and thick green mucous. The Details of the Incident were \"nurse in attending to resident and found liquid [MEDICATION NAME] at bedside. Due to change in resident's respiratory status earlier in the day and the potential ingestion of medication the resident was sent to the emergency room . The hospital was notified of the potential ingestion as a precaution. The intervention in place prior to the incident was \"narcotics are counted and reconciled at shift change.\" Immediate corrective action taken was that LPN #1 was \"suspended immediately and will not return to employment and license will be reported to LLR per protocol. 100% audit of narcotics in 4 of 4 medication carts was conducted. 100% of licensed staff was re-inserviced regarding securing and accounting for narcotics. Hazardous material re-inservice was done with 100% of staff.\" The Summary of Incident was \"Nurse violated standard of practice related to securing medication.\" Review of the Timeline related to the incident provided by the facility revealed the resident was found lethargic and unintelligible at 1 PM per the nurse's notes. At 1:21 PM, the ambulance was called. At 1:27 PM the ambulance arrived at the facility (per the ambulance record). Per the nurses notes the resident left at 1:30 PM. According to the ambulance record the resident did not leave the facility until 1:58 PM and arrived at the hospital at 2:03 PM. LPN #1 notified the Director of Nursing (DON) at 2:08 PM of the [MEDICATION NAME] and incorrect narcotic count. LPN #1 also reported to the DON that Resident #2 was sent to the emergency room in respiratory distress. LPN #1 reported that 13.5 milliliters of liquid [MEDICATION NAME] were unaccounted for. The DON arrived at the facility at 2:30 PM. Drug tests were performed on all staff with potential contact with Resident #2 including LPN #1 and 2 and on two Certified Nursing Assistants. LPN #1 and #2's drug tests were negative. CNAs #1and #2 drug tests were positive; they were suspended. Review of the nurse's notes dated 1/8/2010 at 5:30 AM stated, \"Resident coughing up thick green tinged sputum. Breathing trt (treatment) given. Congestion noted in upper lobes bilaterally. Will continue to monitor.\" On 1/8/2010 at 6:30 AM it was documented that \"Breathing trt helped resident loosen mucous and has productive cough with green sputum.\" At 1PM, \"Resident lethargic, unintelligible sounds noted, resp(iratory) distress noted. Spitting up green mucous. Talked with RP (responsible party) and she would like res(ident) sent to ER. (Doctor) notified and order received to send to ER for eval and treatment.\" At 1:30 PM the resident was sent to the ER via ambulance. Further review revealed no documentation of the resident's status between 6:30 AM and 1 PM, however review of the Medication Administration Record [MEDICATION ADMINISTRATION RECORD DETAILS REDACTED]. Review of the Narcotic Count sheets on 01/26/2011, for Resident #3 (roommate of Resident #2) revealed [MEDICATION NAME] 20 mg/ml, 30 ml (milliliter) bottle. Line 48 indicated that LPN #1 signed out the [MEDICATION NAME] on 1/8/2011 at 2 PM. It was documented that 23.5 ml should have been left in the bottle. Review of the facility obtained statement for LPN #1 revealed that she and LPN #2 \"counted narcotics this am (1/8/2011). I saw three bottles of [MEDICATION NAME] and glanced at them for content. I did not read labels with names. At 1:30 PM, I went to get Resident #3's [MEDICATION NAME] and could not find the bottle on the cart. I checked each drawer, narcotic box, and refrigerator and (the nurse) checked her cart. I(t) occurred to me that some nurses administer [MEDICATION NAME] with the dropper so. I immediately check res(ident) room and found bottle on bedside table of roommate (Resident #2). I had been in room several times this AM and did not see bottle (or notice bottle). Bottle of [MEDICATION NAME] had 10 ml when I found it. When we counted meds this AM, I looked at the meds and LPN #2 looked at the sheets.\" During an interview on 1/26/2011 at 12 PM, LPN #1 stated that during the narcotic count at shift change it was routine practice not to count the liquid medications because they were \"always off.\" LPN #1 stated that she was giving [MEDICATION NAME] to another resident around 11:30 AM or 12 PM and noticed only three bottles of [MEDICATION NAME] were in the cart. She stated that she searched for the missing [MEDICATION NAME] in other drawers, medication room, refrigerator and the other med carts. She stated that it \"occurred to her that nurses would use the medication dropper.\" She stated that she then went into Residents #2 and #3's room and found the [MEDICATION NAME] on Resident #2's bedside table. She stated that she immediately counted the medication and noticed it was off. She stated that the CNAs then reported to her that Resident #2 was unarousable. LPN #1 performed a sternal rub and notified the family and then the doctor. She stated that she assumed the resident consumed the medication. LPN #1 then stated that it was between 12 and 12:30 PM that she noticed the missing [MEDICATION NAME] and about 15-20 minutes later noticed Resident #2 was unarousable. LPN #1 stated that she did not obtain any vital signs and had administered the resident's breathing treatment. LPN #1 stated that she notified the family and then the doctor because that was the normal protocol. LPN #1 stated that she instructed the CNAs to \"clean the resident up\" before she was sent out. LPN #1 stated that during the narcotic counts at shift change, one nurse would look at the medication and one nurse would look at the sheets. She stated that both nurses did not visualize the medications. LPN #1 stated that it \"was not an absolute necessity\" for both nurses to reconcile the narcotics. LPN #1 stated that no other nurse had access to her cart that day. LPN #1 also stated that there was only one set of keys per cart. LPN #1 verified her facility obtained statement was correct as well as the statement reported to the surveyor. LPN #1 could not account for the discrepancies in the statement nor in the times of the events accounted. Review of LPN #2's facility obtained statement dated 1/8/2011 revealed that LPN #2 \"counted off with first shift nurse. I stated amounts left in [MEDICATION NAME] bottles and she stated ok. I was looking at each narcotic sheet and did not visualize the narcotics as we were counting. I gave (Resident #3) her meds then her [MEDICATION NAME] set the [MEDICATION NAME] on (Resident) nightstand, started her breathing treatment. When (sic) to (Resident #2) to check on her, she asked for pain medicine. I went back to med cart to get (Resident's #2's) two [MEDICATION NAME] and breathing treatment. At the end of my shift I counted off with first shift nurse called amounts left in [MEDICATION NAME] bottles and she stated ok for each.\" During an interview on 1/26/2011 at 4:35 PM, LPN #2 stated that she was positive she replaced Resident #3's [MEDICATION NAME] back into the medication cart after she administered the [MEDICATION NAME] to her at 6 AM. LPN #2 stated that during the Narcotic count at shift change she was calling off the medications from the narcotic sheets and LPN #1 was counting the medications. LPN #2 stated that she visualized all 4 [MEDICATION NAME] bottles but didn't measure the contents. LPN #2 stated that LPN #1 didn't pick up any [MEDICATION NAME] bottles but both visualized all 4 bottles were present at shift change. LPN #2 stated that she normally reads the narcotic sheets and counts the medications. She stated that the other nurse picks up the liquid medications and would hold them up so both could visualize the amounts. LPN #2 stated that she \"always counted liquid narcotics.\" LPN #2 verified the accuracy of her facility obtained statement and stated that both the statement given to the facility and the statement given to the surveyor were the same and accurate. LPN #2 again stated that she visualized the [MEDICATION NAME] bottles at shift change. LPN #2 could not account for the discrepancy in the statements. During an interview on 1/25/2011 CNA #1 stated that she was assigned to Residents #2 and #3 on 1/8/2011. She stated that she did not see the [MEDICATION NAME] bottle in the residents' room. CNA #1 stated that she was informed that [MEDICATION NAME] was missing by the DON and was drug tested . CNA #1 stated that her drug test was positive. CNA #1 stated that she had not been back to work since 1/8/2011 and stated that she had not been contacted by the facility since her suspension. During an interview on 1/25/2011, CNA #2 stated that she was working on 1/8/2011 but was not assigned to either Resident #2 or #3. CNA #2 stated that she was not aware of the missing [MEDICATION NAME] nor was she questioned regarding the incident. CNA #2 stated that she was drug tested and the test was positive. During an interview on 1/24/2011 at 12 PM, the DON stated that LPN #1 and #2 were suspended pending the conclusion of the investigation. The Director of Nursing (DON) stated that the facility was \"still in the investigation process.\" During a follow up interview with the DON and the Administrator, the Administrator stated that the hospital was notified of the potential ingestion of [MEDICATION NAME]. The emergency room (ER) doctor stated that a Toxicology Screen was not performed because the resident was already prescribed narcotics. The ER doctor did state that [MEDICATION NAME] was given and the resident did \"perk up a bit.\" The DON stated that both LPN #1 and #2 admitted to counting the narcotics incorrectly, the DON stated that both nurses should have visualized the narcotic as well as the narcotic sheet. The DON stated that LPN #1 reported that only 3 [MEDICATION NAME] bottles were in the cart at shift change even though 4 were recorded as present. The DON stated that she did not know what happened to the missing 13.5 ml of [MEDICATION NAME]. A Narcotic Count of liquid [MEDICATION NAME] was conducted on 1/24/2011 with the DON and the surveyor. Some of the [MEDICATION NAME] bottles were noted to have more than the recorded amount. The Narcotic sheets would record a number then a + sign to indicate the excess. The DON stated that the pharmacy was aware. The Pharmacy stated that the amount in the bottles was correct, however the curvature of the [MEDICATION NAME] bottles made it appear that there was more in the bottles. Review of the Controlled Medication Policy stated, \"...there must be complete accountability of all controlled substances being stored at the facility. The nurse going off duty and the nurse coming on duty must count all controlled substances at the end of each shift.\"", "filedate": "2014-04-01"}
{"rowid": 10127, "facility_name": "FELLOWSHIP HEALTH & REHAB OF ANDERSON, LLC", "facility_id": 425016, "address": "208 JAMES STREET", "city": "ANDERSON", "state": "SC", "zip": 29625, "inspection_date": "2011-01-26", "deficiency_tag": 431, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "ZGHV11", "inspection_text": "On the days of the complaint inspection based on interviews, review of the facility's investigation and review of the facility's policy on Drug Storage, the facility failed to assure narcotics were securely and safely stored. A bottle of Roxanol was found at a resident's bedside with 13.5 milliliters (ml) missing. The findings included: Review of the 24 Hour Report dated 1/9/2011 revealed neglect was alleged against Licensed Practical Nurse (LPN) #2. The description of the incident was \"medication left at bedside on Saturday 1/8/2011. An investigation was implemented immediately. The incident was reported to the administration at 2:08 PM. Review of the 5 Day Follow Up dated 1/13/2011 revealed the alleged perpetrator as LPN #1. The Director of Nursing (DON) was notified on 1/8/2011 at 2:08 PM. The report indicated that Resident #2 was last observed at 12:30 PM and was noted to be alert with increased congestion and thick green mucous. The Details of the Incident were \"nurse in attending to resident and found liquid Morphine at bedside. Due to change in resident's respiratory status earlier in the day and the potential ingestion of medication the resident was sent to the emergency room . The hospital was notified of the potential ingestion as a precaution. The intervention in place prior to the incident were 'narcotics are counted and reconciled at shift change.' Immediate corrective action that was taken was LPN #1 was \"suspended immediately and will not return to employment and license will be reported to LLR per protocol. 100% audit of narcotics in 4 of 4 medication carts was conducted. 100% of licensed staff was re-inserviced regarding securing and accounting for narcotics. Hazardous material re-inservice was done with 100% of staff.\" The Summary of Incident was \"Nurse violated standard of practice related to securing medication.\" Review of the Timeline related to the incident provided by the facility revealed the resident was found lethargic and unintelligible at 1 PM per the nurse's notes. At 1:21 PM, the ambulance was called. At 1:27 PM the ambulance arrived at the facility (per the ambulance record). Per the nurse's notes the resident left at 1:30 PM. According to the ambulance record the resident did not leave the facility until 1:58 PM and arrived at the hospital at 2:03 PM. LPN #1 notified the Director of Nursing (DON) at 2:08 PM of the Morphine and incorrect narcotic count. LPN #1 also reported to the DON that Resident #2 was sent to the emergency room in respiratory distress. LPN #1 reported that 13.5 milliliters of liquid Morphine were unaccounted for. The DON arrived at the facility at 2:30 PM. Drug tests were performed on all staff with potential contact with Resident #2 including LPN #1 and 2 and on two Certified Nursing Assistants. LPN #1 and #2's drug tests were negative. CNAs #1 and #2 tested positive for drugs and were suspended. Review of the Narcotic Count sheets for Resident #3 revealed Roxanol 20 mg/ml, 30 ml bottle. Line 48 indicated that LPN #1 signed out the Roxanol on 1/8/2011 at 2 PM. It was documented that 23.5 ml should have been left in the bottle. Review of the facility obtained statement for LPN #1 revealed that she and LPN #2 \"counted narcotics this am (1/8/2011). I saw three bottles of Roxanol and glanced at them for content. I did not read labels with names. At 1:30 PM, I went to get Resident #3's Roxanol and could not find the bottle on the cart. I checked each drawer, narcotic box, refrigerator and (the nurse) checked her cart. It occurred to me that some nurses administer Roxanol with the dropper so I immediately check resident room and found bottle on bedside table of roommate (Resident #2). I had been in room several times this AM and did not see bottle (or notice bottle). Bottle of Roxanol had 10 ml when I found it. When we counted meds this am, I looked at the meds and LPN #2 looked at the sheets. During an interview on 1/26/2011 at 12 PM, LPN #1 stated that during the Narcotic Count at shift change it was routine practice not to count the liquid medications because they were \"always off.\" LPN #1 stated that she was giving Roxanol to another resident around 11:30 AM or 12 PM and noticed only three bottles of Roxanol were in the cart. She stated that she searched for the missing Roxanol in other drawers, medication room, refrigerator and the other med carts. She/he stated that it \"occurred to her that nurses would use the medication dropper.\" She stated that she then went into Residents #2 and #3's room and found the Roxanol on Resident #2's bedside table. She stated that she immediately counted the medication and noticed it was off. She stated that the CNAs then reported to her that Resident #2 was unarousable. LPN #1 performed a sternal rub and notified the family and then the doctor. She stated that she assumed the resident consumed the medication. LPN #1 then stated that it was between 12 and 12:30 PM that she noticed the missing Roxanol and about 15-20 minutes later noticed Resident #2 was unarousable. LPN #1 stated that she did not obtain any vital signs and had administered the resident's breathing treatment. LPN #1 stated that she notified the family and then the doctor because that was the normal protocol. LPN #1 stated that she instructed the CNAs to \"clean the resident up\" before she was sent out. LPN #1 stated that during the narcotic counts at shift change, one nurse would look at the medication and one nurse would look at the sheets. She stated that both nurses did not visualize the medications. LPN #1 stated that it \"was not an absolute necessity\" for both nurses to reconcile the narcotics. LPN #1 stated that no other nurse had access to her cart that day. LPN #1 also stated that there was only one set of keys per cart. LPN #1 verified her facility obtained statement was correct as well as the statement reported to the surveyor. LPN #1 could not account for the discrepancies in the statement nor in the times of the events accounted. Review of LPN #2's facility obtained statement dated 1/8/2011 revealed that LPN #2 \"counted off with first shift nurse. I stated amounts left in Roxanol bottles and she stated ok. I was looking at each narcotic sheet and did not visualize the narcotics as we were counting. I gave (Resident #3) her meds then her Roxanol, set the Roxanol on nightstand, started her breathing treatment. Went to (Resident #2) to check on her, she asked for pain medicine. I went back to med cart to get (Resident #2's) Lortab and breathing treatment. At the end of my shift I counted off with first shift nurse called amounts left in Roxanol bottles and she stated ok for each.\" During an interview on 1/26/2011 at 4:35 PM, LPN #2 stated that she was positive she replaced Resident #3's Roxanol back into the medication cart after she administered the Roxanol to her at 6 AM. LPN #2 stated that during the narcotic count at shift change she was calling off the medications from the narcotic sheets and LPN #1 was counting the medications. LPN #2 stated that she visualized all 4 Roxanol bottles but didn't measure the contents. LPN #2 stated that LPN #1 didn't pick up any Roxanol bottles but both visualized all 4 bottles were present at shift change. LPN #2 stated that she normally reads the narcotic sheets and counts the medications. She stated that the other nurse picks up the liquid medications and would hold them up so both could visualize the amounts. LPN #2 stated that she \"always counted liquid narcotics.\" LPN #2 verified the accuracy of her facility obtained statement and stated that both the statement given to the facility and the statement given to the surveyor were the same and accurate. LPN #2 again stated that she visualized the Roxanol bottles at shift change. LPN #2 could not account for the discrepancy in the statements. During an interview on 1/24/2011 at 12 PM, the DON stated that both LPN #1 and #2 admitted to counting the narcotics incorrectly, the DON stated that both nurses should have visualized the narcotic as well as the narcotic sheet. The DON stated that LPN #1 reported only 3 Roxanol bottles were in the cart at shift change even though 4 were recorded as present. The DON stated that she did not know what happened to the missing 13.5 ml of Roxanol. A Narcotic Count of liquid Morphine was conducted on 1/24/2011 with the DON and the surveyor. Some of the Roxanol bottles were noted to have more than the recorded amount. The Narcotic sheets would record a number then a + sign to indicate the excess. The DON stated that the pharmacy was aware. The Pharmacy stated that the amount in the bottles was correct, however the curvature of the Roxanol bottles made it appear that there was more in the bottles. Review of the Controlled Medication Policy revealed, \"there must be complete accountability of all controlled substances being stored at the facility. The nurse going off duty and the nurse coming on duty must count all controlled substances at the end of each shift. Review of the \"Medication Storage in the Facility\" policy revealed, \"medications and biologicals are stored safely, securely and properly....\" \"The medication supply is accessible only to licensed nursing personnel, pharmacy personnel or staff members lawfully authorized to administer medications.\" Cross refers to F-281 as it relates to two nurses inappropriately accounting for narcotics.", "filedate": "2014-04-01"}
{"rowid": 10128, "facility_name": "MAJESTY HEALTH & REHAB OF EASLEY, LLC", "facility_id": 425018, "address": "200 ANNE DRIVE", "city": "EASLEY", "state": "SC", "zip": 29640, "inspection_date": "2010-08-25", "deficiency_tag": 250, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "8F5E11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on record review and interviews, the facility failed to provide medically related social services to attain or maintain the highest practicable physical, mental, and psychosocial well-being of 1 of 14 residents reviewed for social services. Resident #16 failed to receive medically related social services for discharge planning and lost personal items. The findings included: The facility admitted Resident #16 on 06/07/10 with the following [DIAGNOSES REDACTED]. He/she was coded on the Minimum Data Set (MDS) as having no short or long term memory problems and as having modified independence with cognitive skills for daily decision making with new situations only. The resident was noted in the Resident Assessment Profile as being a short term rehabilitation resident, planning to return to home. The social service note dated 6/7/10 (admitted ) stated that the resident was living in an apartment alone at Pickens County disability prior to hospitalization and that\" the goal is to d/c (discharge) home on 31st day. \" Social service notes stated, \"will visit on reg. 1:1 basis to observe moods and adjustment to placement.\" The social service notes contained 5 more entries -6/14/10, 6/21/10, 6/24/10, 7/6/10, and 8/3/10. None of the entries addressed discharge planning or assessment for the resident's plan to return home. There was no indication in the documentation that the social services director had talked with the resident regarding the plans to return home and no documentation that he/she had helped the resident with planning for the discharge to home. The information in the social services notes addressed areas,such as; the resident's mood, appetite, weight, and activities. There was no mention of the arrangements to prepare for a move back home, although the 31st day had passed on July 1, 2010. There was no documentation as to why the resident's discharge date had been extended. In review of the resident's current Care Plan dated 6/24/10, there was no mention of the resident's upcoming discharge under social services or nursing sections of the plan. In an interview with the Social Services Director (SSD) on 8/25/10 at 9:00 AM he/she was unsure of the agencies involved with the resident and stated there was a man and a nurse who visited him/ her (the resident) , but was unsure of who they were, the agency they represented, or the role they played in the resident's discharge plan. The SSD did indicate he/she thought the delayed discharge was related to the resident's inability to bear weight. The SSD was unable to provide any additional evidence of social services involvement related to discharge planning with the resident and stated that his/her careplan for the resident was included on the overall careplan in the patient's record. In an interview with Resident #16 on 8/25/10 at 10:15 AM, the resident appeared upset about his/her missing purse and Playstation. He/she thought the items went missing in late July, but was unsure of the exact date. Resident #16 continued to complain about the missing items during the interview and stated he/she had notified the facility and his/her sister about this concern. When questioned about the plan to return to his/her apartment, he/she stated that he/she knew he/she needed a \"rail put up in the bathroom\" before he/she could return to the apartment, but did not know how it would be paid for. Resident #16 also informed this surveyor that he/she had been employed in the local Disability Board's Day Program(workshop) and was unsure if he/she could ever return to this work. The resident expressed he/she wanted to return to the apartment provided by the Disability Board and was upset that his/her purse was missing because his/her only keys for the apartment were in that purse. In an interview with Licensed Practical Nurse(LPN) #1 on 8/25/10 at 11:05 AM , he/she stated he/she overheard the resident complaining about the loss of his/her Playstation , but could not recall the date this occurred. He/she stated he/she told the Social Services Director and he/she was to talk with the resident's sister regarding the lost Playstation . LPN #1 did not recall hearing the resident complain about a lost purse. In an interview with the Social Services Director on 8/25/10 at 11:10 AM related to the lost items, he/she presented a Grievance/Complaint which documented the resident's complaint that a black purse and Playstation was missing and that a search was conducted of the resident's room and staff were questioned with no results.. There was no date or signature on the copy presented. There was no documentation in the social service notes related to the resident's lost items and concerns the resident expressed about the missing keys in relation to his/her return to the apartment.", "filedate": "2014-04-01"}
{"rowid": 10129, "facility_name": "MAJESTY HEALTH & REHAB OF EASLEY, LLC", "facility_id": 425018, "address": "200 ANNE DRIVE", "city": "EASLEY", "state": "SC", "zip": 29640, "inspection_date": "2010-08-25", "deficiency_tag": 514, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "8F5E11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on record reviews, observations, and interviews the facility failed to maintain accurately documented records for 3 of 18 records reviewed for accuracy of records. Resident #7 had inaccurate documentation related to the application of a sling, Resident #13 had inaccurate documentation related to the application of ted hose, and Resident #16 had inaccurate documentation of a Grievance/Complaint Report. The findings included: The facility admitted Resident #16 on 06/07/10 with the following [DIAGNOSES REDACTED]. He/she was coded on the Minimum Data Set (MDS) as having no short or long term memory problems and as having modified independence with cognitive skills for daily decision making with new situations only. In an interview with Resident #16 on 8/25/10 at 10:15 AM, the resident appeared upset about his/her missing purse and Playstation. He/she thought the items went missing in late July, but was unsure of the exact date. He/she continued to complain about the missing items during the interview and stated he/she had notified the facility and his/her sister about this concern. In an interview with Licensed Practical Nurse(LPN) #1 on 8/25/10 at 11:05 AM , he/she stated he/she overheard the resident complaining about the loss of his/her Playstation , but could not recall the date this occurred. He/she stated he/she told the Social Services Director (SSD) and the SSD was to talk with the resident's sister regarding the lost Playstation . LPN #1 did not recall hearing the resident complain about a lost purse In an interview with the Social Services Director on 8/25/10 at 11:10 AM related to the lost items, he/she presented a Grievance/Complaint which documented the resident's complaint that a black purse and Playstation was missing and that a search was conducted of the resident's room and staff were questioned with no results.. There was no date or signature on the copy presented. The Social Services Director informed that the form should had been dated 8/16/10 and offered to date the form for the surveyor. This Surveyor requested a copy of the original document as received with no date. When the copy was provided at 12 noon, the copy was dated 8/16/10 and signed by the Social Services Director. Resident #7 was originally admitted on [DATE] and readmitted on [DATE] with [DIAGNOSES REDACTED]. There were multiple observations on all days of the survey of the resident without a sling, however, the Treatment Record documented the resident had worn the sling on all 3 days of the survey. Record Review on 8/23/10 at 3:48 PM revealed cumulative physician's orders [REDACTED].D. (Medical Doctor). O.K. to remove orthopedic device to left arm for ADL (Activities of Daily Living) Care\". The following observations were made in which Resident #7 was not wearing the ordered sling. - On 8/23/10 at 1:52 PM. Resident sitting in the doorway of the therapy office. at 2:59 PM. Resident sitting in wheelchair in her room. at 6:22 PM. Resident sitting in wheelchair in her room eating dinner. - On 8/24/10 at 8:55 AM. Resident lying in bed. at 10:00 AM. Resident lying in bed. at 12:32 PM. Resident eating lunch in her room. -On 8/25/10 at 9:12 AM. Resident sitting in wheelchair in room. During an interview on 8/24/10 at 10:00 AM, Resident #7 was asked about the sling and why it wasn't being worn. The resident stated that at her/his last appointment, the orthopedic doctor told her/him that she/he could take it off. She/He stated that if the doctor wanted her to wear it, she/he would. When asked if staff encourage her/him to wear the sling, the resident stated that staff members haven't instructed her/him to wear it. Review of the consult section of the chart on 8/24/10 revealed no orthopedic notes. Review of the Nurses Notes on 8/25/10 revealed no mention of the use of a sling for 8/23/10 through 8/25/10. During an interview on 8/25/10 at 10:30 AM, Licensed Practical Nurse #3 was asked about Resident #7's last orthopedic visit. The nurse checked the appointment calendar and stated the last orthopedic visit for Resident #7 was in July. When asked about any orthopedic progress notes, the nurse stated the physician only sent a note if there were any changes and verified there were no orthopedic notes in the chart. LPN #4 joined the interview and both nurses were told that Resident #7 had been observed on all days of the survey without her/his sling having been worn. The cumulative physician's orders [REDACTED]. Upon review of the Treatment Record for Resident #7 for August 2010, documentation for the dates of the survey were brought to the nurses attention. For August 23rd and 24th, the Orthopedic Device Sling To Left Arm had been initialed as having been worn for the 11-7, 7-3, and 3-11 shifts. For August 25th, the Orthopedic Device Sling To Left Arm had been initialed as having been worn for the 11-7 and 7-3 shifts. LPN #4 verified she/he was the nurse that documented on the Treatment Record regarding the use of the sling. When asked about the discrepancy between the surveyor observations and documentation on the Treatment Record, LPN #4 stated that she/he had been asking Physical Therapy (PT) if Resident #7 had been wearing her/his sling. LPN #4 stated she/he thought that PT had supplied the sling for the resident. The surveyor and LPN #4 then went to see Resident #7, who was not wearing the ordered sling. Resident #13 was admitted on [DATE] with [DIAGNOSES REDACTED]. There were multiple observations on 8/24/10 of the resident without her/his ordered TED Hose, however, the Treatment Record documented the resident had worn the TED Hose that day. Record review on 8/24/10 at 9:05 AM revealed cumulative physician's orders [REDACTED].M. OFF IN P.M. R/T (Related To) [MEDICAL CONDITION]\". Review of the Care Plan on 8/24/10 at 11:24 AM revealed \"TED hose as ordered\" as an approach for resident being \"At risk for complications r/t (related to) [MEDICAL CONDITION]\". Review of the 8/9/10 \"Easley Living Center\" progress note (signed by the Nurse Practitioner) on 8/24/10 at 9:30 AM revealed \"Her/His [MEDICATION NAME] was recently increased to 40 mg (milligrams) because she/he was having [MEDICAL CONDITION]\". Review of the 8/6/10 \"Easley Living Center\" progress note signed by the Physician revealed \"She does complain of some increased [MEDICAL CONDITION] in her left lower extremity, however. Nursing staff reports no major issues with this patient including any skin breakdown...Extremities: She does have 1+ [MEDICAL CONDITION] in that left lower extremity primarily in the dorsum of her left foot. Trace lower extremity [MEDICAL CONDITION] on the right...Regarding the lower extremity [MEDICAL CONDITION], we will increase her [MEDICATION NAME] up to 40 mg a day\". Review of the August 2010 Treatment Record on 8/24/10 at 10:20 AM revealed an entry for \"Ted Hose: On in A.M. Off in P.M. R/T [MEDICAL CONDITION], 7-3 On, 3-11 Off\" that had been initialed for the 7-3 shift for August 24th. Observations on 8/24/10 at 10:25 AM, 11:48 AM, 12:27 PM, 1:52 PM, 4:00 PM, and 4:38 PM revealed Resident #13 sitting in her/his wheelchair wearing socks, but no TED hose. During an interview on 8/25/10 at approximately 10:20 AM, Licensed Practical Nurse (LPN) # 3 was told that there were observations made of Resident #13 without her/his TED hose on. LPN #3 reviewed and verified the cumulative Physician\"s Orders for August 2010 and the resident's Care Plan which indicated the resident was to wear the Ted Hose. She/He also verified the Physician's progress notes that indicated the resident had [MEDICAL CONDITION]. LPN #4 joined the interview and was told that the resident had been observed without the ordered TED Hose. LPN #4 verified that she/he was the nurse that documented on the Treatment Record regarding the application of the TED Hose. The surveyor, LPN #3 and LPN #4 reviewed the Treatment Record documentation for August 2010 in which the TED hose had been initialed as having been worn on 8/24/10 and 8/25/10 for the 7-3 shift. When asked about the discrepancy between the Treatment Record documentation and the observations of the resident without her/his TED Hose, the nurse stated that she/he reminded the Certified Nursing Assistants (CNAs) to apply the TED Hose. When asked to go to check and see if the resident was currently wearing the TED Hose, LPN #4 stated that she/he was new and didn't know the residents well, and if the resident was not in her/his room then LPN #3 would have to point the resident out to her/him. Upon entry to the room, Resident #13 was lying on her/his bed. The nurse stated the resident would not be wearing TED Hose in bed, and staff usually kept the TED Hose on her/his wheelchair. There were no TED Hose on the wheelchair, and, while checking the bedside table and closet, the nurse stated the TED Hose was probably in the laundry being washed. When asked if the resident only had one pair of TED Hose, the nurse answered \"yes\".", "filedate": "2014-04-01"}
{"rowid": 10130, "facility_name": "MAJESTY HEALTH & REHAB OF EASLEY, LLC", "facility_id": 425018, "address": "200 ANNE DRIVE", "city": "EASLEY", "state": "SC", "zip": 29640, "inspection_date": "2010-08-25", "deficiency_tag": 164, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "8F5E11", "inspection_text": "**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 policies entitled \"Competency Catheter Care- Female\" (undated) and \"Competency Catheter Care-Male\" ([DATE]), the facility failed to provide adequate personal privacy for 2 of 2 sampled residents observed for catheter care. Appropriate clothing/draping was not provided for Residents #6 and #8 to prevent unnecessary exposure of body parts during catheter care. Also, based on random observation and interviews, the facility failed to provide privacy/confidentiality during medical/financial communication with Resident #13 in a common area of the facility. The findings included: The facility admitted Resident #6 on [DATE] with [DIAGNOSES REDACTED]. Prior to beginning catheter care on [DATE] at 2:40 PM, Licensed Practical Nurse (LPN) #1 and Certified Nursing Assistant (CNA) #1 closed the corridor door and pulled the privacy curtain around the resident's bed. Observation revealed the resident lying in bed with a house dress pulled up to the epigastric area. A towel was positioned across the abdomen and perineal area. The resident's legs were bare to her/his ankles except for the disposable brief which was pulled down to the knees. Prior to the treatment, the CNA removed the towel drape and placed it below the resident's feet on the bed, exposing the resident from the epigastric area to the ankles. Resident #6 remained thusly exposed throughout the catheter care, perineal care, positioning on her/his left side, and cleansing of the buttocks and anal areas. The resident was then instructed to \"lie back\" which she/he did without assistance. Both staff then left the bedside with the resident exposed to wash their hands. They returned to the bedside and assisted the resident to replace the brief and pull down and snap the housedress in readiness to get out of bed. Resident #8 was admitted on [DATE] with [DIAGNOSES REDACTED]. Resident #8 had not been draped appropriately during catheter care. During observation of catheter care on [DATE] at 3:32 PM, Licensed Practical Nurse (LPN) #1 removed the towel covering Resident #8's perineum leaving him exposed while she/he raised the bed to a workable height. Certified Nursing Assistant (CNA) #3 then performed catheter care. After removing her/his gloves and discarding them in the trash bag, CNA #3 left the bedside to wash her/his hands leaving the resident's perineum exposed. LPN #1 followed and observed while CNA #3 washed her/his hands. Upon returning to the bedside, CNA #3 said \"I am going to place the towel back over you\" and redraped the resident. During an interview on [DATE] at 9:18 AM, LPN #1 and CNA #3 verified Resident #8 had been left exposed while the bed was being raised and during handwashing. LPN #1 stated that she/he thought privacy had been afforded since the privacy curtain had been closed. Review of the policy provided by the facility entitled \"Competency, Catheter Care- Male\" on [DATE] at 3:42 PM revealed that once catheter care was completed, the procedure would be to \"...Remove gloves. Reposition residents clothing and cover. Wash hands\". Resident #13 was admitted on [DATE] with [DIAGNOSES REDACTED]. Resident #13 had been asked by a staff member to sign paper work allowing the facility to collect funds for room and board in a common area. During a random observation on [DATE] from 4:35 PM to approximately 4:45 PM, Resident #13 was observed in the dining room of Unit 1 sitting across from a staff member. The staff member was attempting to get her/him to sign a paper. The resident loudly exclaimed, \"I'm not going to sign any papers!\" Resident #13 was visibly agitated and upset and stated that she/he did not want to talk to him/her and that she/he had not spoken to a (man/woman) since her/his (spouse) had died . The staff member reminded the resident that they had talked yesterday and went on to compliment the resident on the clothing she/he was wearing. The resident exclaimed, \"Don't touch me!\" The staff member continued to ask her/him to sign the paper work with the resident tearfully yelling out \"No!\" Another surveyor working in the chart room behind the Unit 1 Nurses Station overheard the incident. A Certified Nursing Assistant (CNA) identified the staff member as someone who worked in the therapy department. During an interview on [DATE] at 5:45 PM, the Occupational Therapist (OT) and Director of Rehabilitative Services were present. The OT stated that he/she had been asked by Social Services to have the resident sign paperwork to allow the facility to collect funds from her/his account for room and board. He/She stated that therapy had a good working relationship with the resident before, but that today the resident was not in a good mood. The OT stated that the resident would not sign the paper so, \"We thought it best to stop\". During an interview on [DATE] at 3:35 PM, the Social Services Director (SSD) and the Director of Nursing (DON) were present. The SSD stated that Resident #13 had exhausted her/his Medicare benefits and the facility needed funds in order for the resident to stay there. She/He stated that the resident's son needed a letter signed by the resident in order to have the bank release her/his funds. She/He stated that the resident had refused to sign the paper work for her/him, so therapy was asked to get the paper work signed since the resident was more comfortable with the therapy staff. The SSD stated that Resident #13 had \"Sundowners in the afternoon\" and that she/he discussed the funds matter with the resident this morning. They did not have the resident sign any papers. Instead, she/he stated they had the resident call the bank herself/himself in order to get the funds released. The SSD and DON were informed of concerns that the OT attempted to get Resident #13 to sign paper work related to her/his financial affairs in the dining room and did not provide privacy. The SSD verified that she/he had brought the resident to her/his office that morning to discuss the resident's financial matters and stated this was the usual practice.", "filedate": "2014-04-01"}
{"rowid": 10131, "facility_name": "MAJESTY HEALTH & REHAB OF EASLEY, LLC", "facility_id": 425018, "address": "200 ANNE DRIVE", "city": "EASLEY", "state": "SC", "zip": 29640, "inspection_date": "2010-08-25", "deficiency_tag": 241, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "8F5E11", "inspection_text": "**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 promote care in a manner that maintained or enhanced dignity and respect. Staff failed to respect Resident #13's wishes to refuse to sign paperwork and terminate a conversation in a common area which resulted in increased agitation. The findings included: Resident #13 was admitted on [DATE] with [DIAGNOSES REDACTED]. During a random observation on [DATE] from 4:35 PM to approximately 4:45 PM, Resident #13 was observed in the dining room of Unit 1 sitting across from a staff member. The staff member was attempting to get her/him to sign a paper. The resident loudly exclaimed, \"I'm not going to sign any papers!\" Resident #13 was visibly agitated and upset and stated that she/he did not want to talk to him/her and that she/he had not spoken to a (man/woman) since her/his (spouse) had died . The staff member reminded the resident that they had talked yesterday and went on to compliment the resident on the clothing she/he was wearing. The resident exclaimed, \"Don't touch me!\" The staff member continued to ask her/him to sign the paperwork with the resident tearfully yelling out \"No!\" After the staff member left, Certified Nursing Assistant (CNA) #2 came and sat down next to the resident to talk to her/him. Another surveyor working in the chart room behind the Unit 1 Nurses Station overheard the incident. A CNA identified the staff member as someone who worked in the therapy department. During an interview on [DATE] at 5:45 PM the Occupational Therapist (OT) and Director of Rehabilitative Services were present. The OT stated that he/she had been asked by Social Services to have the resident sign paperwork to allow the facility to collect funds from her/his account for room and board. He/She stated that therapy had a good working relationship with the resident before, but that today she/he was not in a good mood. The OT stated that the resident would not sign the paper so, \"We thought it best to stop\". During an interview on [DATE] at 3:35 PM, the Social Services Director (SSD) and the Director of Nursing (DON) were present. The SSD stated that Resident #13 had exhausted her Medicare benefits and the facility needed funds in order for the resident to stay there. She/He stated that the resident's son needed a letter signed by the resident in order to have the bank release her/his funds. She/He stated that the resident had refused to sign the paper work for her/him, so therapy was asked to get the paper work signed since the resident was more comfortable with the therapy staff. The SSD stated that Resident #13 had \"Sundowners in the afternoon\" and that she/he discussed the funds matter with the resident this morning. They did not have the resident sign any papers. Instead, she/he stated they had the resident call the bank herself/himself in order to get the funds released. The SSD and DON were informed of concerns about the OT's continued attempts to get Resident #13 to sign the paper work after the resident clearly indicated she/he was not going to sign them and became increasingly agitated and upset. During an interview on [DATE] at 4:02 PM, the surveyor asked CNA #2 what she/he knew about the incident since she/he had been observed going in and out of the dining room the day before while the therapist was speaking with Resident #13. CNA #2 stated she/he had heard Resident #13 fussing with the therapist about signing papers. The CNA stated that the resident had been thinking that people are trying to steal her/his money. The CNA stated the resident's demeanor is usually pretty quiet during the day, but in the afternoon the resident gets upset and cries when approached. When asked about how long this had lasted yesterday afternoon, CNA #2 stated that the resident had been agitated for about ,[DATE] minutes before she/he calmed down. Cross Refer to F164 as it relates to failure of the facility to address personal issues with", "filedate": "2014-04-01"}
{"rowid": 10132, "facility_name": "MAJESTY HEALTH & REHAB OF EASLEY, LLC", "facility_id": 425018, "address": "200 ANNE DRIVE", "city": "EASLEY", "state": "SC", "zip": 29640, "inspection_date": "2010-08-25", "deficiency_tag": 157, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "8F5E11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on record review and interviews, the facility failed to notify the responsible party (RP) of changes. For one of five residents reviewed for falls, Resident #3 had a family member who was not notified of a fall with injury. The findings included: Resident #3 was admitted on [DATE] with [DIAGNOSES REDACTED]. Observation on 8/23/10 at 1:45 PM revealed Resident #3 sitting on her/his bed. She/He had a dark swollen area on her/his forehead along with yellow/black discolorations under her/his eyes. Record Review on 8/24/10 at 11:52 AM revealed Nurse's Notes dated \"8/11/10 5P(M) Resident asleep in high back chair + rolled onto floor. Has aprox(imately) 9 cm (centimeter) bruise to forehead. BP (Blood Pressure) 158/84, P(ulse)- 76, R(espirations)- 20, T(emperature)- 97.8. ROM (Range of Motion) (without) difficulty. Assisted to chair. Neuro (checks) WNL (within normal limits). No distress noted\". \"8/11/10 6 P(M) (Family member) called + notified of fall + injury.\" \"8/11/10 6:15 P(M) Dr.__ notified on voice mail of fall + injury.\" Review of the Incident/Accident Report on 8/24/10 revealed the following: \"Date of Incident/Accident: 8-11-10, Time of Incident/Accident: 5 PM, ...Name of Physician Notified: Dr. __, Date: 8/11/10, Time of Notification: 6:15 PM, Name and Relationship of Family Member/Resident Representative Notified: (Family Member), Date: 8/11/10, Time of Notification: 6 PM\". During a phone interview on 8/25/10 at 9:00 AM, Resident #3's family member stated that she/he would be the person who would be notified if the resident's condition changed. The family member went on to state that she/he came in to visit her/his family member one afternoon and found bruises on Resident #3's face. She/He had asked the staff what had happened, but they didn't know. She/He stated that there was a big fuss made because nothing had been documented about it, but that she/he was told that Resident #3 had fallen the night before. The family member stated she/he later received a call from the nurse who had been taking care of Resident #3 at the time of the incident, and was told that Resident #3 went to sleep in a chair without arms and had fallen out of the chair. She/He was unable to recall the date she/he had visited and found her/his family member with the injury. During an interview on 8/25/10 at 10:10 AM, Licensed Practical Nurse (LPN) # 3 stated she/he was aware of the incident and that the Assistant Director of Nursing (ADON) had been called to talk to the family member and had handled the situation. During an interview on 8/25/10 at 10:48 AM, the ADON stated she/he had spoken with the family member regarding the incident and verified that the family member had not been notified of the fall with injury. The ADON could not recall the date she/he had spoken with the family member about the incident. The ADON stated that she/he had called the nurse who had been on duty the evening of the incident and the nurse had stated she/he had been so busy that she/he didn't notify the family.", "filedate": "2014-04-01"}
{"rowid": 10133, "facility_name": "MAJESTY HEALTH & REHAB OF EASLEY, LLC", "facility_id": 425018, "address": "200 ANNE DRIVE", "city": "EASLEY", "state": "SC", "zip": 29640, "inspection_date": "2010-08-25", "deficiency_tag": 309, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "8F5E11", "inspection_text": "**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 care and services as ordered by the Physician for 2 of 18 sampled residents reviewed. The facility failed to ensure that Resident #13, on anticoagulant therapy, did not receive [MEDICATION NAME] after the Physician ordered the medication held due to an elevated PT/INR ([MEDICATION NAME]/International Normalization Ratio). In addition, Resident #13 did not have Ted Hose applied as ordered. Resident #7 did not have a sling applied as ordered by the physician. The findings included: Resident #13 was admitted on [DATE] with [DIAGNOSES REDACTED]. Record review on 8/24/10 at 9:36 AM revealed a laboratory (lab) report dated 5/17/10. The PT was 37.2 H(igh). The reference range was listed as 9.4-10.8 sec(onds). The INR was 3.9 H(igh). The reference range was listed as .9-1.2 with the suggested therapeutic INR range for venous [MEDICAL CONDITION] and [MEDICAL CONDITION] listed as 2.0-3.0. A handwritten note to the right of the page stated \"Dr. __: Hold [MEDICATION NAME]. Redraw PT/INR Thursday 5/20/10 and call to Dr. __during business hrs (hours) Thursday\". Review of the Physician's Telephone Orders on 8/24/10 at 12:42 revealed an order to \"Hold [MEDICATION NAME], Check PT/INR Thursday 5/20/10, Call results to Dr. __ during business hours Thursday\". The Physician's Telephone Order had been dated 5/17/10 and the time next to \"Signature of Nurse Receiving Order\" was 6:45 PM. Review of the Medication Administration Record [MEDICATION ADMINISTRATION RECORD DETAILS REDACTED]\"[MEDICATION NAME] 5 mg (milligrams) (1) PO (By Mouth) (at) HS (Bedtime) 9P(M)\". The [MEDICATION NAME] had been initialed as having been given on 5/15/10, 5/16/10, and 5/17/10. The [MEDICATION NAME] had been held from 5/18/10 through 5/22/10 and had been discontinued on 5/23/10 according to the MAR indicated [REDACTED] During an interview on 8/24/10 at 3:45 PM, the Director of Nursing (DON) reviewed and verified the 5/17/10 PT/INR results, the Physician's Telephone Order dated 5/17/10 at 6:45 PM, and the MAR indicated [REDACTED]. Review of the laboratory reports and additional physician orders [REDACTED]. At that time the physician ordered Vitamin K to be given and a follow-up PT/INR to be drawn on 5/22/10, continue to \"hold [MEDICATION NAME], d/c (discontinue [MEDICATION NAME])\". The lab work on 5/22/10 was INR 3.19. Record review on 8/24/10 at 9:05 AM revealed cumulative physician's orders [REDACTED].M. OFF IN P.M. R/T (Related To) [MEDICAL CONDITION]\". Review of the Care Plan on 8/24/10 at 11:24 AM revealed \"TED hose as ordered\" as an approach for resident being \"At risk for complications r/t (related to) [MEDICAL CONDITION]\". Review of the 8/9/10 \"Easley Living Center\" progress note (signed by the Nurse Practitioner) on 8/24/10 at 9:30 AM revealed \"Her/His [MEDICATION NAME] was recently increased to 40 mg (milligrams) because she/he was having [MEDICAL CONDITION]\". Review of the 8/6/10 \"Easley Living Center\" progress note signed by the Physician revealed \"She does complain of some increased [MEDICAL CONDITION] in her left lower extremity, however. Nursing staff reports no major issues with this patient including any skin breakdown...Extremities: She does have 1+ [MEDICAL CONDITION] in that left lower extremity primarily in the dorsum of her left foot. Trace lower extremity [MEDICAL CONDITION] on the right...Regarding the lower extremity [MEDICAL CONDITION], we will increase her [MEDICATION NAME] up to 40 mg a day\". Observations on 8/24/10 at 10:25 AM, 11:48 AM, 12:27 PM, 1:52 PM, 4:00 PM, and 4:38 PM revealed Resident #13 sitting in her/his wheelchair wearing socks, but no TED hose. During an interview on 8/25/10 at approximately 10:20 AM, Licensed Practical Nurse (LPN) # 3 was told that there were observations made of Resident #13 without her/his TED hose on. LPN #3 reviewed and verified the cumulative Physician\"s Orders for August 2010 and the resident's Care Plan which indicated the resident was to wear the Ted Hose. She/He also verified the Physician's progress notes that indicated the resident had [MEDICAL CONDITION]. LPN #4 joined the interview and was told that the resident had been observed without the ordered TED Hose. LPN #4 verified that she/he was the nurse that documented on the Treatment Record regarding the application of the TED Hose. The surveyor, LPN #3, and LPN #4 then reviewed the Treatment Record documentation for August 2010 in which the TED Hose had been initialed as having been worn on 8/24/10 and 8/25/10 for the 7-3 shift. When asked about the discrepancy between the Treatment Record documentation and the observations of the resident without her/his TED Hose, the nurse stated that she/he reminded the Certified Nursing Assistants (CNAs) to apply the TED Hose. When asked to go to check and see if the resident was currently wearing the TED Hose, LPN #4 stated that she/he was new and didn't know the residents well. She/He went on to say that if the resident was not in her/his room, then LPN #3 would have to point the resident out to her/him. Upon entry to the room, Resident #13 was lying on her/his bed. The nurse stated the resident would not be wearing TED Hose in bed, and staff usually kept the TED Hose on her/his wheelchair. There were no TED Hose on the wheelchair, and, while checking the bedside table and closet, the nurse stated the TED Hose was probably in the laundry being washed. When asked if the resident only had one pair of TED Hose, the nurse answered \"yes\". Resident #7 was originally admitted on [DATE] and readmitted on [DATE] with [DIAGNOSES REDACTED]. Resident #7 had not worn a sling as ordered for all the days of the survey. Record Review on 8/23/10 at 3:48 PM revealed cumulative physician's orders [REDACTED].D. (Medical Doctor). O.K. to remove orthopedic device to left arm for ADL (Activities of Daily Living) Care\". Review of the Care Plan on 8/23/10 at 4:33 PM revealed \"Orthopedic device as ordered 7/13/10\" as an approach to impaired mobility. The following observations were made in which Resident #7 was not wearing the ordered sling. - On 8/23/10 at 1:52 PM. Resident sitting in the doorway of the therapy office. at 2:59 PM. Resident sitting in wheelchair in her room. at 6:22 PM. Resident sitting in wheelchair in her room eating dinner. - On 8/24/10 at 8:55 AM. Resident lying in bed. at 10:00 AM. Resident lying in bed participating in interview with surveyor. at 12:32 PM. Resident eating lunch in her room. -On 8/25/10 at 9:12 AM. Resident sitting in wheelchair in room. During an interview on 8/24/10 at 10:00 AM, Resident #7 was asked about the sling and why it wasn't being worn. The resident stated that at her/his last appointment, the orthopedic doctor told her/him that she/he could take it off. She/He stated that if the doctor wanted her to wear it, she/he would. When asked if staff encourage her/him to wear the sling, the resident stated that staff members haven't instructed her/him to wear it. Review of the consult section of the chart on 8/24/10 revealed no orthopedic notes. During an interview on 8/25/10 at 10:30 AM, Licensed Practical Nurse (LPN) #3 was asked about Resident #7's last orthopedic visit. The nurse checked the appointment calendar and stated the last orthopedic visit for Resident #7 was in July. When asked about any orthopedic progress notes, the nurse stated the physician only sent a note if there were any changes and verified there were no orthopedic notes in the chart. LPN #4 joined the interview and both nurses were told that Resident #7 had been observed on all days of the survey without her/his sling having been worn. The cumulative physician's orders [REDACTED]. Upon review of the Treatment Record for Resident #7 for August 2010, documentation for the dates of the survey were brought to the nurses attention. For August 23rd and 24th, the Orthopedic Device Sling To Left Arm had been initialed as having been worn for the 11-7, 7-3, and 3-11 shifts. For August 25th, the Orthopedic Device Sling To Left Arm had been initialed as having been worn for the 11-7 and 7-3 shifts. LPN #4 verified she/he was the nurse that documented on the Treatment Record regarding the use of the sling. When asked about the discrepancy between the surveyor observations and documentation on the Treatment Record, LPN #4 stated that she/he had been asking Physical Therapy (PT) if Resident #7 had been wearing her/his sling. LPN #4 stated she/he thought that PT had supplied the sling for the resident. The surveyor and LPN #4 then went to see Resident #7, who was not wearing the ordered sling.", "filedate": "2014-04-01"}
{"rowid": 10134, "facility_name": "BROOKVIEW HEALTHCARE CENTER", "facility_id": 425062, "address": "510 THOMPSON STREET", "city": "GAFFNEY", "state": "SC", "zip": 29340, "inspection_date": "2010-12-20", "deficiency_tag": 224, "scope_severity": "G", "complaint": null, "standard": null, "eventid": "5SHE11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the day of the complaint inspection based on observations, record reviews, interviews and review of the facility's Abuse and Neglect policy, the facility failed to assure 3 of 5 sampled residents were free from neglect. Resident #1 and #3's dressings were not changed per the physician's orders [REDACTED]. Resident #2's wound was observed to have a yellow center with dried blood. The findings included: Resident #1 sampled as a result of an incident reported by the facility on 11/24/2010 that indicated the facility substantiated neglect against Licensed Practical Nurse (LPN) #1 for failure to change Resident #1's dressings as ordered. The facility admitted Resident #1 on 5/5/2006 with [DIAGNOSES REDACTED]. Further review of the medical record revealed the Annual Minimum Data Set ((MDS) dated [DATE] coded Resident #1 as having a short-term and long-term memory problem with severely impaired cognitive skills for daily decision-making. The Annual MDS coded Resident #1 as totally dependent for hygiene, bathing and toileting. Resident #1 was coded as needing extensive assistance with transfers, dressing and eating. No behaviors were coded as occurring during the assessment period. Review of the facility's Five-Day Follow-Up Report dated 11/24/2010 indicated the facility substantiated neglect against LPN #1 for failure to change Resident #1's dressings as ordered. The interventions that were in place prior to the incident were \"abuse and neglect addressed 10/1/2010 by staff development coordinator.\" The interventions taken by the facility to prevent future abuse were \"facility continues to stress no tolerance for abuse or neglect. Reeducation of staff on abuse/neglect.\" LPN #1's facility obtained statement dated 11/23/2010 indicated that she worked 7 AM to 7 PM the weekend of 11/20/2010 and 11/21/2010. LPN #1 documented that she \"had done all of my treatments. I done (sic) some extra tx (treatment) on the opposite hall, and stayed over on Sunday night to make sure I had all of my tx done. I remember gathering the notes I wrote and the tx cart and going down the hall. I do recall doing the skin prep and the applying of the [MEDICATION NAME] to the resident's right foot and toes. I unintentionally must have looked over the inner ankle. I could have been thinking about the regular dressing I normally do on 7 p-7 a. I do understand that's no excuse.\" LPN #3's facility obtained statement dated 11/22/2010 stated, \"On 11-22-10, I removed a foam drsg (dressing) and a bordered guaze from Res. (resident) coccyx and Rt (right) inner ankle. Both drsgs were dated 11-19-10.\" Review of the care plan revealed \"Altered Skin Integrity\" as a problem area. Interventions and approaches included \"Tx (treatments)/dressings as ordered, Routine body audits, observe skin with care.\" Review of the Nurses' Progress Notes dated 11/19/2010 indicated a \"tx to right foot continued, odor to right foot.\" On 11/20/2010 at 1:10 AM, \"tx cont(inued) to R foot. Strong odor noted. Black areas noted on R foot.\" The next nurse's note dated 11/23/2010 documented [MEDICATION NAME] sprinkles were ordered for the wound bed. Review of the Weekly Skin Evaluations revealed the resident's skin was assessed on 11/13/2010 with Right Foot and Sacrum receiving treatments. On 11/20/2010, the resident was assessed as having \"right foot dark toes and underneath. Draining with odor...treatment continued.\" On 11/27/2010 the right foot with toes were \"black with odor.\" Review of the physician's orders [REDACTED].\" The coccyx wound was to be cleaned with normal saline and \"apply santyl and cover with foam dressing everyday and as needed.\" Review of the MAR from November 2010 revealed on 11/20/2010 and 11/21/2010, LPN #1 initialed the MAR indicated [REDACTED]. The facility admitted Resident #2 on 11/17/2010 with [DIAGNOSES REDACTED]. Observation of Resident #2 on 12/20/2010 revealed the resident laying in bed. The resident had a [MEDICATION NAME] dressing on her lower right leg dated 12/06/2010. The wound bed was observed to be yellow with dried blood observed under the [MEDICATION NAME]. Review of the Medication Administration Record [MEDICATION ADMINISTRATION RECORD DETAILS REDACTED]. Further review of the medical record revealed no documentation related to the wound. The Unit Manager confirmed the presence of the yellow wound bed and dried blood. She assessed the wound after the surveyor brought the wound to the facility's attention and then provided appropriate treatment for [REDACTED]. The facility admitted Resident #3 on 03/05/2010 with [DIAGNOSES REDACTED]. Observation of Resident #3 on 12/20/2010 revealed the resident lying in bed. The Resident had a Medi-honey strip on the lateral aspect of her lower leg. The Medi-honey was not covered with a [MEDICATION NAME] pad nor was the strip dated. The resident had a dressing on her left foot dated 12/17/2010. Review of the MAR indicated [REDACTED]. Another order for Medi-Honey to the top of the left foot and to cover with a [MEDICATION NAME] pad and to change daily. The treatments were last initialed as done on 12/17/2010. The Unit Manager confirmed that the dressings had not been changed since 12/17/2010. She assessed the wounds and performed the prescribed treatments. During a telephone interview on 12/20/2010, LPN #2 stated that she worked weekends from 7 PM to 7 AM. She stated that she was working the weekend of 12/18 and 12/19/2010. LPN #2 confirmed that she was assigned to Resident's #2 and #3. She stated that she did not change the dressing on Resident #3's foot on either 12/18 or 12/19. She stated that she \"just didn't do it.\" LPN #2 stated that she was aware of the orders to change the dressings daily. LPN #2 also stated that if she noticed the dressings were not changed per the physician's orders [REDACTED]. She stated that she would not notify the unit manager or the Director of Nurses. LPN #2 stated she was aware that Resident #2 had a dressing on her right leg but did not notice that it was dated 12/06/2010. LPN #2 stated that she was unaware of any dressing changes for Resident #2's right leg. Three other LPN's were asked if they checked orders daily. All answered \"yes.\" All 3 LPN's stated that during their daily assessments of the residents they check the dressings. All 3 stated that if the dressing was not changed per the physician's orders [REDACTED]. Three CNA's were interviewed; all three stated that they would notify the nurse immediately if a dressing was not in place or if there were any skin concerns. During an interview on 12/20/2010, the Director of Nurses (DON) stated that LPN #1 failed to change Resident #1's dressing as ordered. The DON stated that the LPN signed the treatment record. LPN #3 on 11/22/2010 reported to the unit manager that the dressings had not been changed. LPN #1 was suspended and an investigation was completed. Upon completion of the investigation it was determined that LPN #1 neglected Resident #1 and she was immediately terminated. Resident #1's dressings were immediately changed and her wounds assessed. The DON stated that all residents with dressings were assessed on 11/22/2010 with no other abnormal findings. The DON stated that weekly wound rounds were conducted with the DON as the lead and the unit managers. She stated that wound team evaluated the wounds including measurements and assured the treatments were appropriate. She stated that the floor nurses were responsible for changing the dressings on a daily basis. If there were any changes in the wounds, then the physician would be notified as well as a member of the wound team (a unit manager of the DON). The DON also confirmed the dressings on Resident #3's left leg and foot had not been changed since 12/17/2010. The DON confirmed the physician's orders [REDACTED]. The DON also confirmed that the dressing on Resident #2's right leg was dated 12/06/2010. She confirmed that the wound bed was yellow with dried blood. She stated that the dressing should have been changed on 12/11/2010 and 12/18/2010. The DON stated that anytime an allegation of abuse or neglect is made an inservice would be conducted that was mandatory for all staff. An inservice was conducted on Abuse and Neglect on 11/23/2010 regarding the allegation on 11/22/2010. Review of the inservice conducted on 11/23/2010 revealed that 13 nurses signed the attendance log and 20 CNA's signed the log. Review of the facility's employment record indicated that 41 nurses were employed and 72 CNA's were employed. The DON confirmed that not all licensed staff members attended the inservice. Review of the facility's policy on \"Abuse and Neglect\" revealed that \"it is the policy of this facility that all residents have the right to be free from abuse that includes but is not limited to verbal, physical, sexual and mental abuse... Abuse also includes those practices and omissions, neglect and misappropriation of resident property that left unchecked, lead to abuse. Neglect means failure to provide goods and services necessary to avoid physical harm, mental anguish or mental illness.\"", "filedate": "2014-04-01"}
{"rowid": 10135, "facility_name": "BROOKVIEW HEALTHCARE CENTER", "facility_id": 425062, "address": "510 THOMPSON STREET", "city": "GAFFNEY", "state": "SC", "zip": 29340, "inspection_date": "2010-12-20", "deficiency_tag": 315, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "5SHE12", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the day of the follow up inspection based on observations, interviews and review of the facility policy on Peri (perineal)-care, Certified Nursing Assistant #1 failed to provide for the dignity of Resident #6 and failed to appropriately provide peri-care for Resident #6. One of two residents observed for peri-care. The findings include: The facility admitted Resident #6 on 12/18/2008 with [DIAGNOSES REDACTED]. During peri-care observation on 2/7/2011, CNA #1 was observed in Resident #6's room removing the resident's pants. The blinds were left open. The curtains were observed to be open as well. The resident's roommate was in bed awake. A grabber was observed in the bed lying along side the resident's left leg. The CNA exposed the resident and wiped the resident's groin and then wiped once down the middle. CNA #2 then closed the blinds and pulled the curtain. CNA #1 then retrieved a clean brief from the resident's closet using the soiled gloves. CNA #1 rolled the resident over onto the metal grabber and placed the clean brief under the resident. CNA #1 still using soiled gloves fastened the brief and dressed the resident. During an interview on 2/7/2011, CNA #1 stated that she did not close the blinds or pull the curtain to provide for the resident's dignity. She also stated that she \"forgot\" to clean the resident's bottom. CNA #1 confirmed that she did not change her gloves prior to placing a new brief on the resident. CNA #1 stated that she did not recall the last time she was checked off on peri-care competency. Review of the facility's plan of correction revealed that CNA#1 was checked off on competency on peri-care on 1/6/2011. No concerns were noted at that time. Review of the facility's policy on Peri-Care revealed the following:...\"3. Provides for privacy. 17. Asks resident to lower legs and assume side lying position. Assists as necessary.\"", "filedate": "2014-04-01"}
{"rowid": 10136, "facility_name": "BROOKVIEW HEALTHCARE CENTER", "facility_id": 425062, "address": "510 THOMPSON STREET", "city": "GAFFNEY", "state": "SC", "zip": 29340, "inspection_date": "2010-12-20", "deficiency_tag": 314, "scope_severity": "G", "complaint": null, "standard": null, "eventid": "5SHE11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the day of the complaint inspection based on observations, interviews and record reviews, the facility failed to provide the necessary care and services to 3 of 5 sampled resident's wounds. Resident #1 and #3 did not have their dressings changed as ordered. Resident #2 had a dressing on her right lower leg dated 12/6/2010; the dressing was observation on 12/20/2010. The findings included: The facility admitted Resident #1 on 5/5/2006 with [DIAGNOSES REDACTED]. Resident #1 sampled as a result of an incident reported by the facility on 11/24/2010 that indicated the facility substantiated neglect against Licensed Practical Nurse (LPN) #1 for failure to change Resident #1's dressings as ordered. Review of the facility's Five-Day Follow-Up Report dated 11/24/2010 indicated the facility substantiated neglect against LPN #1 for failure to change Resident #1's dressings as ordered. On 11/22/2010 LPN #3 removed dressings from Resident #1's coccyx and right inner ankle dated 11/19/2010; daily dressing changes were ordered. LPN #1's facility obtained statement dated 11/23/2010 indicated that she worked 7 AM to 7 PM the weekend of 11/20/2010 and 11/21/2010. LPN #1 documented that she \"had done all of my treatments. I done (sic) some extra tx on the opposite hall, and stayed over on Sunday night to make sure I had all of my tx done. I remember gathering the notes I wrote and the tx cart and going down the hall. I do recall doing the skin prep and the applying of the [MEDICATION NAME] to the resident's right foot and toes. I unintentionally must have looked over the inner ankle. I could have been thinking about the regular dressing I normally do on 7 p-7 a. I do understand that's no excuse.\" LPN #3's facility obtained statement dated 11/22/2010 stated, \"On 11-22-10, I removed a foam drsg (dressing) and a bordered guaze from Res. (resident) coccyx and Rt (right) inner ankle. Both drsgs were dated 11-19-10.\" Review of the physician's orders [REDACTED].\" The coccyx wound was to be cleaned with normal saline and \"apply santyl and cover with foam dressing everyday and as needed.\" Review of the MAR from November 2010 revealed on 11/20/2010 and 11/21/2010, LPN #1 initialed the MAR indicated [REDACTED]. The facility admitted Resident #2 on 11/17/2010 with [DIAGNOSES REDACTED]. Observation of Resident #2 on 12/20/2010 revealed the resident laying in bed. The resident had a [MEDICATION NAME] dressing on her lower right leg dated 12/6/2010. The wound bed was observed to be yellow with dried blood observed under the [MEDICATION NAME]. Review of the Medication Administration Record [MEDICATION ADMINISTRATION RECORD DETAILS REDACTED]. Further review of the medical record revealed no documentation related to the wound. The Unit Manager confirmed the presence of the yellow wound bed and dried blood. She assessed the wound after the surveyor brought the wound to the facility's attention and then provided an appropriate treatment for [REDACTED]. The facility admitted Resident #3 on 3/5/2010 with [DIAGNOSES REDACTED]. Observation of Resident #3 on 12/20/2010 revealed the resident lying in bed. The Resident had a Medi-honey strip on the lateral aspect of her/his lower leg. The Medi-honey was not covered with a [MEDICATION NAME] pad nor was the strip dated. The resident had a dressing on her left foot dated 12/17/2010. Review of the MAR indicated [REDACTED]. Another order for Medi-Honey to the top of the left foot and to cover with a [MEDICATION NAME] pad and to change daily. The treatments were last initialed as done on 12/17/2010. The Unit Manager confirmed that the dressings had not been changed since 12/17/2010. She assessed the wounds and performed the ordered treatments. During a telephone interview on 12/20/2010, LPN #2 stated that she worked weekends from 7 PM to 7 AM. She stated that she was working the weekend of 12/18/2010 and 12/19/2010. LPN #2 confirmed that she was assigned to Resident's #2 and #3. She stated that she did not change the dressing on Resident #3's foot on either 12/18 or 12/19. She stated that she \"just didn't do it.\" LPN #2 stated that she was aware of the orders to change the dressings daily. LPN #2 also stated that if she noticed the dressings were not changed per the physician's orders [REDACTED]. She stated that she would not notify the unit manager or the Director of Nurses. LPN #2 stated she was aware that Resident #2 had a dressing on her right leg but did not notice that it was dated 12/06/2010. LPN #2 stated that she was unaware of any dressing changes for Resident #2's right leg. During an interview on 12/20/2010, the Director of Nurses stated that LPN #1 failed to change Resident #1's dressing as ordered. The DON stated that the LPN signed the treatment record. The nurse on 11/22/2010 reported to the unit manager that the dressings had not been changed. She stated that the floor nurses were responsible for changing the dressings on a daily basis. If there were any changes in the wounds, then the physician would be notified as well as a member of the wound team (a unit manager of the DON). The DON also confirmed the dressings on Resident #3's left leg and foot had not been changed since 12/17/2010. The DON confirmed the physician's orders [REDACTED]. The DON also confirmed that the dressing on Resident #2's right leg was dated 12/06/2010. She confirmed that the wound bed was yellow with dried blood. She stated that the dressing should have been changed on 12/11/2010 and 12/18/2010.", "filedate": "2014-04-01"}
{"rowid": 10137, "facility_name": "BAYVIEW MANOR", "facility_id": 425067, "address": "11 TODD DRIVE", "city": "BEAUFORT", "state": "SC", "zip": 29901, "inspection_date": "2010-12-15", "deficiency_tag": 502, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "OVIO11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the complaint inspection, based on limited record review, and interview the facility failed to provide laboratory services to meet the needs of its residents in a timely manner for 1 of 3 residents reviewed for laboratory services. Resident #1 with documented [MEDICAL CONDITION] of the external genitalia; waist and legs had a physician's orders [REDACTED]. The CMP and BMP were not drawn. The findings included: Resident #1 admitted to the facility on [DATE] and readmitted [DATE] with [DIAGNOSES REDACTED]. Review of the current medical record revealed nurses' notes dated 10/06/2010 at 11:00 AM which stated, \"...increased [MEDICAL CONDITION] notified Dr. ... N.O. (new order) 40 mg (milligrams) [MEDICATION NAME] IM (intramuscularly) now then 80 mg [MEDICATION NAME] PO (by mouth) BID (twice a day) x 1 week then resume 80 mg [MEDICATION NAME] PO QD (daily), CMP BMP on 10-13-10...\" In a telephone interview with the Director of Nurses on 12/15/2010 at approximately 10:00 AM she stated that the CMP and BMP were not drawn, that she thinks the nurse who took the order failed to transfer it to a lab requisition.", "filedate": "2014-04-01"}
{"rowid": 10138, "facility_name": "BAYVIEW MANOR", "facility_id": 425067, "address": "11 TODD DRIVE", "city": "BEAUFORT", "state": "SC", "zip": 29901, "inspection_date": "2010-12-15", "deficiency_tag": 157, "scope_severity": "G", "complaint": null, "standard": null, "eventid": "OVIO11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the complaint inspection based on limited record review and interview the facility failed to consult the resident's physician regarding persistent pain and swelling following an injury to Resident #2 left arm/hand/wrist. The resident fell on [DATE], the facility notified the physician and an order was obtained for an x-ray of the hand/wrist. Review of the x-ray report revealed that only the hand was x-rayed and reported as negative for fracture. On 11/25/2010 a call was placed to the physician to notify him of the x-ray results, the physician did not return the call. The resident continued to complain of pain in the left arm/wrist and swelling/bruising was noted; on 11/28/2010 the physician was notified and the resident was sent to the hospital for evaluation. Resident #2 was admitted to the hospital on [DATE] with a [DIAGNOSES REDACTED]. The findings included: Resident #2 admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Review of the current medical record revealed Nurses' Notes with the following documentation: \"11/24/2010 3:02 PM Nurse called to Res. (resident) room. Res slided (sic) to floor by CNA. CNA was transferring Res. from w/c (wheelchair) to bed. CNA notes was slipping and gently placed res on floor with pillow under Res head.... Res assessed... 3:30 PM Redness and swelling noted to (R) (right) arm and wrist. Old Ecchymotic area noted on Extremity. Arm put on free floating pillows to decrease swelling and order obtained for mobile x-ray of (R) arm... 3:45 PM Mobile x-ray obtained x-ray... 2210 Mobile x-ray obtained r/t (related to) fall resulting to injury to (L) (left) arm waiting for results. (L) arm elevated on billow (sic). c/o (complaining of) pain medicated as ordered... 11/25/2010 3 P (M) Resident has swelling (L) forearm and bruising x-ray neg (negative) Fx (fracture) or dislocation mild [MEDICAL CONDITION] No return call. resident continues to c/o pain (L) forearm recs (receives) [MEDICATION NAME] for pain... 11/26/2010 7 P to 7 A (M) Arm bruised/swollen as well as hand R/T previous fall... 11/27/2010 3 p continues to c/o pain (L) arm. (L) arm elevated on pillow bruising to (L) forearm noted... 7 P - 7 A (L) arm/hand elevated on a pillow. Bruise and slight swelling remains the same due to last fall...Receives scheduled pain medication. 11/28/2010 11 A Resident continues to c/o pain (L) arm bruising and swelling to (L) arm. (L) arm elevated on pillow. Notified Dr. ... N.O. (new order) transport to ER (emergency room ) for evaluation... 12/03/2010 6 pm Resident readmitted with Dx (diagnosis) of Fx (fracture) to (L) wrist and UTI (urinary tract infection)...\" In an interview with the Director of Nurses on 12/13/2010 at approximately 4:10 PM she was unable to provide information as to why the physician was not notified about the persistent pain and swelling of the resident's left arm/wrist. She stated that the resident was treated for [REDACTED].", "filedate": "2014-04-01"}
{"rowid": 10139, "facility_name": "BAYVIEW MANOR", "facility_id": 425067, "address": "11 TODD DRIVE", "city": "BEAUFORT", "state": "SC", "zip": 29901, "inspection_date": "2010-12-15", "deficiency_tag": 309, "scope_severity": "G", "complaint": null, "standard": null, "eventid": "OVIO11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the complaint inspection, based on observation, interview and record review, the facility failed to provide care and services to maintain the highest practicable physical well being for 1 of 3 residents reviewed for a change in condition. Resident #2 injured her left arm/hand/wrist on 11/24/2010, and was not treated for [REDACTED]. The findings included: Resident #2 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Review of the current medical record revealed Nurses' Notes with the following documentation: \"11/24/2010 3:02 PM Nurse called to Res. (resident) room. Res slided (sic) to floor by CNA. CNA was transferring Res. from w/c (wheelchair) to bed. CNA notes was slipping and gently placed res on floor with pillow under Res head.... Res assessed... 3:30 PM Redness and swelling noted to (R) (right) arm and wrist. Old Ecchymotic area noted on Extremity. Arm put on free floating pillows to decrease swelling and order obtained for mobile x-ray of (R) arm... 3:45 PM Mobile x-ray obtained x-ray... 2210 Mobile x-ray obtained r/t (related to) fall resulting to injury to (L) (left) arm waiting for results. (L) arm elevated on billow (sic). c/o (complaining of) pain medicated as ordered... 11/25/2010 3 P (M) Resident has swelling (L) forearm and bruising x-ray neg (negative) Fx (fracture) or dislocation mild [MEDICAL CONDITION] No return call. resident continues to c/o pain (L) forearm recs (receives) [MEDICATION NAME] for pain... 11/26/2010 7 P to 7 A (M) Arm bruised/swollen as well as hand R/T previous fall... 11/27/2010 3 p continues to c/o pain (L) arm. (L) arm elevated on pillow bruising to (L) forearm noted... 7 P - 7 A (L) arm/hand elevated on a pillow. Bruise and slight swelling remains the same due to last fall...Receives scheduled pain medication. 11/28/2010 11 A Resident continues to c/o pain (L) arm bruising and swelling to (L) arm. (L) arm elevated on pillow. Notified Dr. ... N.O. (new order) transport to ER (emergency room ) for evaluation... 12/03/2010 6 pm Resident readmitted with Dx (diagnosis) of Fx (fracture) to (L) wrist and UTI (urinary tract infection)...\" Review of the physician's orders [REDACTED]. Review of the Mobliex Radiology Report dated11/24/2010 at 5:01 pm stated, \"...Examination: Exam: Hand 2 views, Left - Results: ...No fracture or dislocation is seen. [MEDICAL CONDITION] is present...Conclusion: Moderate [MEDICAL CONDITION] of the left hand, but no fracture or dislocation seen...\" Review of the Beaufort Memorial Hospital Discharge Summary dated 12/03/2010 stated, \"...Reason for admission: ...The patient presented with left upper extremity cellulites and fracture... Hospital course: The patient was admitted and placed on IV [MEDICATION NAME] for cellulites...\" Review of the x-ray report revealed that only the hand was x-rayed and reported as negative for fracture. On 11/25/2010 a call was placed to the physician to notify him of the x-ray results, the physician did not return the call. The resident continued to complain of pain in the left arm/wrist and swelling/bruising was noted; on 11/28/2010 the physician was notified and the resident was sent to the hospital for evaluation. Resident #2 was admitted to the hospital on [DATE] with a [DIAGNOSES REDACTED]. In an interview with the Director of Nurses on 12/13/2010 at approximately 4:10 PM she was unable to provide information as to why only the hand was x-rayed on 11/24/2010. She could not explain why the physician had not seen Resident #2 following the injury or why the physician was not notified about the persistent pain and swelling of the left arm/wrist.", "filedate": "2014-04-01"}
{"rowid": 10140, "facility_name": "MAGNOLIA MANOR - SPARTANBURG", "facility_id": 425091, "address": "375 SERPENTINE DRIVE", "city": "SPARTANBURG", "state": "SC", "zip": 29305, "inspection_date": "2011-01-14", "deficiency_tag": 250, "scope_severity": "E", "complaint": null, "standard": null, "eventid": "JSXU11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the compliant inspection based on record review and interviews the facility failed to assure medically related social services were provided for one of five sampled residents. Resident #1 did not have his hearing aides replaced after the facility misplaced them. The social worker also had Resident #1 sign legal documents even though the resident was deemed incapacitated by two physicians. The findings included: The facility admitted Resident #1 on 4/16/2010 and readmitted him on 7/23/2010 with [DIAGNOSES REDACTED]. Review of the Minimum Data Set (MDS) with an Assessment Review Date of 8/22/2010 indicated the resident had short-term memory problems and modified independence in decision making. No behaviors were documented as occurring within the assessment period. Review of the monthly summary dated 12/18/2010 revealed the resident had short-term memory problems. He was also noted to have disorganized thinking with moderately impaired abilities for decision making. The resident was noted to be verbally abusive and had delusions. Review of the resident's care plan revealed \"Cognitive Impairment as evidenced by short-term memory loss and confusion at times.\" Review of the medical record revealed two Decisional Capacity forms. The first was signed by the Vascular Surgeon on 5/19/2010 and by the Attending Physician on 5/27/2010. The second form was signed by the Vascular Surgeon on 7/23/2010 and by the Attending Physician on 8/6/2010. Review of the record revealed that Resident #1's first hearing aide was lost in May and the second one was lost in early June 2010. A Certified Letter was sent to the Resident's first responsible party and to the resident's son on August 10, 2010. The letter included the \"Medicare Determination Notice, Community Long Term Care and a form regarding Resident #1's hearing aide replacement. On August 10, 2010 the Social Worker documented that she spoke with the resident's son and he stated, \"He was not signing anything.\" Review of the Advance Notice Beneficiary Form, dated August 9, 2010 revealed the resident signed the form on August 12, 2010. Review of the Medicare Non Coverage Letter dated 8/9/2010 revealed the resident signed the form on 8/12/2010. Review of the form regarding the resident's hearing aide replacement revealed the resident signed the form on 8/12/2010. During an interview on 1/12/2011 at 4:15 PM, the Social Worker confirmed that Resident #1 was incapacitated and was unable to sign legal documents. She confirmed that the resident signed the Medicare Non-coverage Letter, the Advanced Notice to Beneficiary form and the hearing aide form. The Social Worker stated that she sent the forms to the son to sign. She stated that the son refused to sign and that he stated the Resident could sign for himself. The Social Worker stated that she informed the son that the resident was unable to sign legal papers because he was declared incapacitated by two physicians. The Social Worker stated that Resident #1 did not have a legal Power of Attorney and could not get one at the time because of his lack of capacity. The Social Worker stated that she informed the son he had to go through the probate court to obtain guardianship. The Social Worker stated that on August 12, 2010 the Social Worker and the Resident's son were in the resident's room. The son stated to the social worker that the resident could sign all the paperwork. The social worker then allowed the resident to sign the paperwork. She stated that she knew the resident was not supposed to sign but stated that she needed a signature on the paperwork. The court appointed Guardian Ad Litem on 11/12/2010 signed the legal form for the hearing aides again. As of 1/12/2011 the resident did not have hearing aides.", "filedate": "2014-04-01"}
{"rowid": 10141, "facility_name": "SUNNY ACRES", "facility_id": 425093, "address": "1727 BUCK SWAMP ROAD", "city": "FORK", "state": "SC", "zip": 29543, "inspection_date": "2010-12-01", "deficiency_tag": 225, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "07P711", "inspection_text": "On the day of the inspection, based on review of facility concern forms and interview, the facility failed to ensure that all allegations of misappropriation of resident property were reported to the State survey and certification agency for 2 of 2 allegations reviewed (Resident A). The findings included: Review of the concerns filed with facility administration since the last recertification survey revealed two allegations of misappropriation from Resident A. On 8/12/10, the resident reported $12.00 missing. Facility staff searched for the money but it was not found. The facility reimbursed the resident. On 9/1/10, Resident A reported $50.00 missing, two twenty dollar bills and other money totaling fifty dollars. A search revealed some one dollar bills in the resident's coat, but she stated this was not part of the $50.00 she had put in her purse. The facility reimbursed the resident by depositing the money in her fund account. The Administrator and Director of Nurses were asked at 4 PM on 12/1/10 if these allegations had been reported to the State survey and certification agency. After researching their files, no evidence was discovered to show the allegations of misappropriation of resident property were reported.", "filedate": "2014-04-01"}
{"rowid": 10142, "facility_name": "GLORIFIED HEALTH AND REHAB OF GREENVILLE, LLC", "facility_id": 425102, "address": "8 NORTH TEXAS AVENUE", "city": "GREENVILLE", "state": "SC", "zip": 29611, "inspection_date": "2010-07-07", "deficiency_tag": 309, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "KOJZ11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on record review and interviews, the facility failed to provide care and services as ordered by the physician. One of fourteen residents reviewed for care and services, Resident # 8, did not receive a follow-up with the oncologist to get biopsy results as ordered. The findings included: The facility admitted Resident # 8 on 6/14/10 with [DIAGNOSES REDACTED]. Record review on 7/6/10 at 2:30 PM of the accumulative physician's orders [REDACTED]. ___ (1) wk (week) for biopsy results\". Review of the Physician Discharge Summary dated 6/14/10 on 7/6/10 at 2:37 PM revealed under \"Hospital Course\", that Resident # 8 was admitted with AMS (Altered Mental Status) s/p (status [REDACTED]. [MEDICATION NAME] on 6/10 with ROSE (Rapid On-Site cytopathologic Examinations) revealing malignancy...Heme/Onc (Hematology/Oncology) was consulted and recommended breast mass biopsy. This was performed on 6/14 by general surgery and final pathology/results pending. (Resident #8) is scheduled to follow up with Dr. ___ in 1 week for these results and to initiate plan of care... (She/He)does need quick follow up for biopsy results with Heme/Onc as this looks like [MEDICAL CONDITION] from preliminary results. (She/He) may be a possible Hospice candidate given her PMH (Primary Medical History) of dementia and other co-morbid conditions\". Review of the Physician's Progress Notes, Nurses Notes, and Laboratory results on 7/6/10 revealed no mention of the breast mass biopsy results or an office visit. During an interview on 7/7/10 at 9:15 AM, RN (Registered Nurse) #1 reviewed the June 2010 accumulative physician's orders [REDACTED]. During an interview on 7/7/10 at 11:20 AM, Unit Clerk #1 was asked if they used an appointment calendar to keep track of residents' appointments. She/He stated that Resident #8's appointment was not on her calendar. When asked about how Resident #8 would have been transported to the appointment, she/he stated that EMS (Emergency Medical Systems) would transport Resident #8 to her/his appointment. She/He could not provide documentation that an ambulance was requested and stated that sometimes the ambulance service doesn't leave documentation. During an interview on 7/7/10 at 11:25 AM, RN #1 stated that Unit Clerk #1 had called the physician's office and that Resident #8 was in the system, but did not have an appointment. When asked about the process of how appointments are made for residents when they return from the hospital, RN #1 stated that the nurse takes off the orders and leaves a posting for the secretary to make an appointment for the resident. RN #1 stated that sometimes the secretary reads the notes from the hospital and goes ahead and makes the appointment. On 7/7/10 at 11:45 AM, when asked how the facility prevents appointments from being missed, RN #1 stated that the night nurse checks to make sure all orders are carried out. On 7/7/10 at 11:56 AM, RN #1 verified the breast mass biopsy results were not in the chart.", "filedate": "2014-04-01"}
{"rowid": 10143, "facility_name": "BRIAN CENTER NURSING CARE - ST ANDREWS", "facility_id": 425129, "address": "3514 SIDNEY ROAD", "city": "COLUMBIA", "state": "SC", "zip": 29210, "inspection_date": "2010-12-08", "deficiency_tag": 365, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "R42P11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on record review and observations, the facility failed to provide food prepared in a form designed to meet individual needs for 1 of 3 sampled residents with an order for [REDACTED]. The findings included: The facility admitted Resident #14 on 4/28/08 with [DIAGNOSES REDACTED]. Review of the medical record on 12/07/10 revealed a current physician's orders [REDACTED].\" Review of the physician's telephone orders dated 11/19/10 indicated, \"D/C prev. diet. Mech (mechanical) soft, gr (ground) meats...for better tolerance.\" Review of the Nurses Notes dated 11/19/10 at 1:00 PM indicated, \"Difficulty chewing pork chop at lunch - given gr mts (meats) (with) better tolerance.\" Review of the Dietary Progress Notes dated 11/23/10 revealed, \"The resident's diet consistency was downgraded to mech soft (11/19/10)...\" Observation on 12/07/10 at approximately 12:30 PM revealed Resident #14 sitting at a table in the dining room in the process of eating lunch. Observation of the resident's plate revealed fish which was cut into pieces. Observation of the diet card on the lunch tray indicated, \"Diet regular Texture regular.\" Observation on 12/07/10 at approximately 5:45 PM revealed Resident #14 resting in bed, and staff was observed to deliver the dinner tray to Resident #14's room. Observation revealed the dinner plate contained sliced roast beef with gravy, and observation of the tray card again revealed \"Diet regular Texture regular.\" The surveyor asked Licensed Practical Nurse (LPN) #3 to review the current orders related to diet, and LPN #3 confirmed that the order was for ground meat. LPN #3 observed the dinner plate at that time and confirmed that Resident #14's meat was not ground. LPN #3 informed staff to hold the dinner plate and stated that another meal with ground meat would be obtained for Resident #14. On 12/08/10 at approximately 10:30 AM, LPN #3 was asked about the process of communicating diet orders to the dietary department. LPN #3 stated that staff complete a Diet Order Form upon receiving a dietary order. LPN #3 stated that the top copy of the Diet Order Form is filed on the medical record, the yellow copy of the form is sent to the Dietary Department, and the pink copy of the order form is sent to the pharmacy. LPN #3 stated that review of the medical record revealed staff failed to complete a Diet Order Form upon receipt of the diet change on 11/19/10; and therefore, the Dietary Department did not receive the diet change.", "filedate": "2014-04-01"}
{"rowid": 10144, "facility_name": "LAKE CITY SCRANTON HEALTHCARE CENTER", "facility_id": 425149, "address": "1940 BOYD ROAD", "city": "SCRANTON", "state": "SC", "zip": 29591, "inspection_date": "2011-03-02", "deficiency_tag": 514, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "HLEE11", "inspection_text": "**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 accurate, complete, and organized clinical information about each resident that was readily accessible for resident care for 3 of 15 records reviewed for clinical records. For Resident #5 the documentation of allergies [REDACTED]. For Resident # 11 the MDS and Care Plan were not readily accessible and for Resident #7 the Care Plan was not readily accessible. The findings included: The facility admitted Resident #5 on 12/30/10 with the following [DIAGNOSES REDACTED]. The record review on 2/28/11 at 1:45 PM revealed that there were no current Physician order [REDACTED]. The only orders found on the resident's record were dated 12/2010. In an interview with Licensed Practical Nurse(LPN) #1 at that time, she was unable to state where the orders might be or to locate the current orders. The Admissions Director and Facility Consultant #1 attempted to locate the orders for January and February 2011, but were unable to locate the orders. The Medication Administration Record [MEDICATION ADMINISTRATION RECORD DETAILS REDACTED]. While in the process of reviewing the record the MDS and Care Plan were also not found for this resident. LPN #1 was interviewed and did not know where the documentation could be found. The Admissions Director, Director of Nurses, and Consultant #1 all pursued locating the information within the facility. After 3 hours the MDS was not located and a copy had to be printed for the surveyor. At that time the Care Plan was located and provided. The record review on 2/28/11 also revealed a sticker on the front of the chart which stated \"allergies [REDACTED]. A review of the Medication Administration Record [MEDICATION ADMINISTRATION RECORD DETAILS REDACTED]\"No Known allergies [REDACTED]. The facility admitted Resident #7 on 3/13/07 with the following [DIAGNOSES REDACTED]. Record review on 3/1/11 at 9:10 AM revealed that the Care Plan could not be located and when LPN #1 was questioned she stated she thought the Care Plan was located with the MDS in the file cabinet. The Care Plans were in a separate area and the Admissions Director had to locate the Care Plan for the surveyor and provided it about 2 hours later. The facility admitted Resident # 11 on 12/17/10 with the following [DIAGNOSES REDACTED]. During the record review on 3/1/11 at 8:35 AM the MDS was not in the file and the Care Plan was not available. The Admissions Director had to assist the surveyor in locating the MDS and Care Plan for this resident and it was an hour before it could be located for review.", "filedate": "2014-04-01"}
{"rowid": 10145, "facility_name": "LAKE CITY SCRANTON HEALTHCARE CENTER", "facility_id": 425149, "address": "1940 BOYD ROAD", "city": "SCRANTON", "state": "SC", "zip": 29591, "inspection_date": "2011-03-02", "deficiency_tag": 250, "scope_severity": "E", "complaint": null, "standard": null, "eventid": "HLEE11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on record reviews and interview, the facility failed to provide documented evidence that sufficient medically-related social services were provided to meet the needs of 3 of 12 sampled residents reviewed for social services. Resident # 6 experienced a significant personal loss and expressed suicidal thoughts, which were addressed by the physician in 2/2011. The last documented social service intervention was November 2010. Resident # 8 had a planned discharge which was to occur on 3/1/11. The resident left unexpectedly on 2/28/11. There was no evidence of the anticipated discharge plans/interventions documented by social services. Resident # 24's social service noted did not include an accurate description of the resident's behaviors, the room change with subsequent change in social work providers, or behavior interventions. The findings included: The facility admitted Resident #6 on 3/24/10 with [DIAGNOSES REDACTED]. A review of the medical record revealed a Physician's progress note dated 2/24/11 that the resident had lost her husband of [AGE] years recently. A follow-up note dated 2/25/11 documented the resident was seen and that grief and tearfulness was normal as a reaction to loss of her husband. A nursing note dated 2/24/11 documented indicated that the resident had stated \"I just want to die\" during the morning medication pass. Medicine for increased anxiety was given and the resident seemed to be calmer after the nurse talked to her for a while. The Responsible party was notified and she was going to visit. Follow-up monitoring dated 2/27 revealed no signs or symptoms of depression. Documentation by the Facility psychiatrist dated 3/1/11 revealed that the resident was seen. Group therapy and receiving activity out of the facility was discussed. The resident felt very positive about the opportunity to get out and about the opportunity to socialize with new people. The psychiatrist also addressed the vaguely suicidal comments and concluded there was no suicidal ideation and certainly no intent. A review of the Social Service notes revealed no entries since November 2010. In an interview with Social Worker (SW) #2 on 3/1/11 at 1:55 PM, she stated she had made a referral to Senior Renewal for outpatient counseling and that group therapy had been done. She also stated she did room rounds every morning to check on her residents, but these interventions were not documented in her notes on this resident. The Social Service notes did not mention the resident's spouse dying. An entry by Social Worker #2 dated 3/1/11 documented that she had spoken to nursing about the statement \"I just want to die. It was not reported to her due to the fact that the resident was calmer after receiving the medicine for anxiety. A 3/2/11 note documented that the resident was out of the facility from 9:30-1:30 at Senior Renewal. The facility admitted Resident #8 on 12/22/10 with [DIAGNOSES REDACTED]. Resident #8 was admitted for short term rehabilitation. During the Initial Tour it was mentioned the resident was due to be discharged on [DATE] but left on 2/28/11. Review of the Social Worker notes revealed her last note was dated 12/22/10 with no further documentation related to discharge planning. In an interview with SW (Social Worker) #2 on 3/1/11 at 1:55 PM, she stated that the resident went home with his sister-in-law instead of living by himself. Home Health was contacted to do an evaluation. The prescriptions were given to his sister-in-law, but the Social Worker had not documented the discharge planning interventions in the Social Services notes . A final nursing note dated 2/28/11 documented the \"res(ident) d/c (discharged at 2:15 P with all meds (medications) and order for referral to home health. MD notified of d/c. All meds explained. BA (body audit) complete. No new areas noted.\" The facility admitted Resident #24 on 1/28/10 with [DIAGNOSES REDACTED]. During initial tour of the facility on 2/28/11, the ADON (Assistant Director of Nursing) stated that the resident was diagnosed with [REDACTED]. Record review revealed a Social Services note dated 10/21/10 which stated that the resident has been referred to Senior Renewal Program to address behaviors and will be able to attend \"when the foot heals from sprain.\" Further notations in the Social Services notes for 11/3/10 states \"Annual Assessment....... Referral has been made to \"Senior Renewal\", which is an out patient counseling service provided by.....She is eligible for this service but had to be able to make transfers from W/C ( wheel chair) to toilet appropriately before she can attend the program.\" Another note from Social Services dated 11/15/10 stated \"Resident returned to facility on 11/13/10, returned medicare....\" Additional notes were written on 11/16 related to a medication change; 11/22 related to diet changes and behavior; 11/23/10 related to a room change. The additional November documentation did not address follow up participation of the Senior Renewal program. There was no social service progress notes from 11/23 to 2/4/11 which addressed the resident's participation eligibility in the program. An interview with Social Worker #1 on 3/1/11 at 4:15 PM revealed that the resident had been referred to the above mentioned program. The consent from the family was not obtained in a timely manner. The resident then had been admitted to the hospital and returned to the facility under Medicare and could not attend the program while on Medicare. She further stated that they once again are waiting for the family to sign the consent forms. This surveyor then obtained the medical record for Resident #24 from the nurses station on 3/1/11 at 5:00 PM and noted that there was an additional notation in the Social Services notes dated 2/25/11 which had not been there prior to the 4:15 PM interview with Social Worker #1. An interview was done at 5:15 PM with Social Worker #1, the Administrator and several Corporate Consultants. Social Worker #1 confirmed that she had just written the note and asked if she should have put todays date for the note. The note addressed sending the family a consent form and waiting for a response. Resident #25 was admitted by the facility on 10/08/09 with the following [DIAGNOSES REDACTED]. On 3/1/11 at 4:45 PM Resident #25 stopped a fell ow surveyor in the hall and reported that Resident #24 exhibited behaviors in the dining room and used profanity. In an interview with Resident #25 on 3/2/11 at 9:05 AM she further explained that Resident #24 \"scares me to death\" when she \"takes over\" in the dining room and it takes \"four to handle (her) sometimes... she (Resident #24) tries to fight and I have to leave.\" She stated that Resident #24 has \"never hurt me\". During an interview with Social Worker #1 on 3/2/11 at 11:30 AM, she stated that the facility had tried some behavior modification programs with Resident # 24 but they were not effective. When questioned about the resident's behaviors, she stated that the ADON (Assistant Director of Nursing) had very good communication skills with the resident and could deal with her behaviors. She further stated that Social Worker #2 was working with this resident up until her room change on 11/23/10. Social Worker #1 shared that the resident had been seen by the Psychiatrist on 2/8, 2/15, 2/17 and 2/22/11. An accurate description of the resident's behaviors, the room change with subsequent change in social work providers, nor any of the above mentioned interventions were noted by Social Worker #1 or #2 in the documentation. She stated that it should have been documented in the notes what was being done for the resident.", "filedate": "2014-04-01"}
{"rowid": 10146, "facility_name": "LANCASTER CONVALESCENT CENTER", "facility_id": 425155, "address": "2044 PAGELAND HWY", "city": "LANCASTER", "state": "SC", "zip": 29721, "inspection_date": "2010-12-01", "deficiency_tag": 225, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "DFSK11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the day of the survey based on record review, interview, review of the facility's grievance log and review of the facility's policy on Abuse and Neglect, the facility failed to report an injury of unknown origin. On 10/14/2010 a large, dark purple bruise was noted on Resident #5's back and left side of his chest; he was unable to state how the injury happened. There was no documentation to indicate the facility reported the incident as an injury of unknown origin. (1 of 5 sampled residents reviewed) The findings included: The facility admitted Resident #5 on 2/07/2009 with [DIAGNOSES REDACTED]. Review of the Quarterly MDS (Minimum Data Set) dated 7/12/2010 indicated the resident had no memory problems with moderately impaired cognitive skills for daily decision-making. Review of the Nurses' Note dated 10/14/10 at 1:30 PM stated, \"large dark purple bruise note L (left) side of chest and back. Res (resident) stated, I don't know it happened...\" Review of the \"Incident/Accident Report\" form signed 10/18/2010 revealed a date of 10/15/2010 as the date a large, dark purple bruise was noted on the left side of the chest and back of Resident #5. The incident report included the statement, \"I don't know what happened.\" There was no documentation that a referral was made to the State Survey Agency. An interview on 12/01/2010 at approximately 10:38 PM with the Administrator and Director of Nursing (DON) confirmed the findings. The Administrator stated they did not feel the bruises were significant enough to make a report. The Administrator further stated it was the facility practice to determine the cause of the bruise instead of reporting.", "filedate": "2014-04-01"}
{"rowid": 10147, "facility_name": "OAKBROOK HEALTH AND REHABILITATION CENTER", "facility_id": 425156, "address": "920 TRAVELERS BOULEVARD", "city": "SUMMERVILLE", "state": "SC", "zip": 29485, "inspection_date": "2011-01-26", "deficiency_tag": 279, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "M3RJ11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the day of the survey, based on record review, the facility failed to ensure that comprehensive care plans were developed to describe the safety services to be furnished to residents for 2 of 3 residents reviewed who had repeated falls (Residents #1 and #2). The findings included: Resident #1, with [DIAGNOSES REDACTED]. Review of the resident assessments of 11/2/10 and 11/26/10 showed the resident needed total care from the staff with his activities of daily living. The resident did not ambulate. The resident was discharged home with his daughter on 12/20/10 as planned. Review of the medical record revealed the resident fell on [DATE] at 11:30 AM. He was found on the day room floor, sitting in front of the wheelchair. It appeared that he slipped out of the chair. A non slip product was added to the wheelchair seat to prevent further similar occurrences. At 12 noon on 10/30/10, staff coming from the day room heard a noise and they found the resident lying on his right side on the floor. No injuries were assessed. A tab safety alarm was added to his safety precautions. Documentation in the nurses' notes revealed the resident made multiple attempts to get up unassisted on two days. The nurse's note on 11/2/10 at 11:35 AM noted frequent attempts by the resident to get out of his chair. The tab alarm was in place. The 11/20/10 nurse's note at 3:20 PM stated the resident made multiple attempts to get out of his chair and so was assisted back to bed with no further attempts to get up unassisted. The resident's last fall, on 12/12/10 at 6:40 AM, occurred in the day room. Review of the facility's documentation revealed the resident was up early that morning and placed in the day room. The nurse heard a loud noise coming from the day room and found the resident face down on the floor with the wheelchair tipped over, bleeding from a laceration above his right eye. The resident received emergency treatment and returned to the facility. Review of the Certified Nursing Assistant (CNA) Cardex, which was undated, completed in pencil, and not part of the resident's permanent medical record showed the resident needed: padded L shaped calf support; Roho (anti-thrust) cushion with Dycem (non-slip material) underneath; tab alarm to the wheelchair; and a bed sensor alarm. On 12/13/10 the following note was added: \"Don't leave unattended while up and OOB (out of bed).\" The CNA Cardex showed the resident transferred with assist of two or mechanical lift. Review of the physical therapy note of 11/1/10 showed \"(change) transfer status from Hoyer (mechanical) to (A) X 2 (assist with two people).\" Review of the Cardex computerized printout, also not a permanent part of the medical record, showed the resident's tab alarm on the 11/3/10, 11/10/10, and 11/17/10 weekly printout. On 12/1/10, the form listed the resident's tab alarm and included an anti-thrust cushion, calf pad, and sensor alarm to the bed. The 12/8/10 printout showed the tab alarm, the calf pad, a gel cushion with Dycem, and the sensor alarm. Review of the resident's care plan dated 11/3/10 showed a problem of \"At risk for falls related to: Dependency on staff for transfers\" and \"Hx (history) of fall.\" The facility's planned approaches to assist the resident with this problem were: \"1. Give needed assist with transfers. \"2. Encourage resident to call for assistance as needed. \"3. Monitor for changes needed in transfer techniques and update therapy for recommendations. \"4. Review any falls for patterns. \"5. Safety devices as indicated.\" The care plan did not specify which safety measures were needed or how the resident was to transfer. An update to the care plan on 12/12/10, after the resident's fall, did show the tab alarm to the wheelchair, cushion change, and to keep the resident in sight of staff by nurses' station. Resident #2 with [DIAGNOSES REDACTED]. The resident was also noted to be able to turn off her safety alarm. A nurse's note on 10/10/10 stated the bed alarm was moved out of the resident's reach because of this. The resident's last fall was on 1/10/11 at 7:10 AM. She yelled for help from the bathroom. Staff found her sitting on the floor. The resident's alarm was not on at the time. Review of the CNA Cardex showed interventions of hipsters as tolerated, chair alarm, sensor alarm to the bed, anti-roll back brakes, and gel cushion with Dycem. The plan of care for the resident dated 1/11/11 showed she was at risk for falls due to poor safety awareness and dementia. Approaches listed were: 1. Monitor attempts to stand or ambulate without assistance 2. Review falls for needed changes in care plan No #3 listed 4. Inform therapy of falls for assessment 5. Safe, well lit, clutter free environment 6. Call light and belongings in reach 7. Encourage non-skid footwear 8. Monitor gait and assist with transfer and ambulation 9. Monitor medications for side effects related to unsteady gait 10. Encourage participation in ADLs (activities of daily living) 11. Anti-roll back brakes 12. Cushion armrest to wheelchair 13. Alarm to bed as indicated.", "filedate": "2014-04-01"}
{"rowid": 10148, "facility_name": "OAKBROOK HEALTH AND REHABILITATION CENTER", "facility_id": 425156, "address": "920 TRAVELERS BOULEVARD", "city": "SUMMERVILLE", "state": "SC", "zip": 29485, "inspection_date": "2011-01-26", "deficiency_tag": 323, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "M3RJ11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the day of the survey, based on record review, interviews, and review of the facility's investigative materials related to a fall with serious injury, the facility failed to ensure residents received adequate supervision and assistance devices for 1 of 3 residents reviewed for falls (Resident #1). The findings included: Resident #1, with [DIAGNOSES REDACTED]. Review of the resident assessments of 11/2/10 and 11/26/10 showed the resident needed total care from the staff with his activities of daily living. The resident did not ambulate. The resident was discharged home with his daughter on 12/20/10 as planned. Review of the resident's interim care plan dated 10/26/10 showed the resident at risk for falls related to weakness, poor endurance, and a new environment. Review of the medical record revealed the resident fell on [DATE] at 11:30 AM. He was found on the day room floor, sitting in front of the wheelchair. It appeared that he slipped out of the chair. A non slip product was added to the wheelchair seat to prevent further similar occurrences per the nurse's note. At 12 noon on 10/30/10, staff coming from the day room heard a noise and the staff found the resident lying on his right side on the floor. No injuries were assessed. The post fall assessment by physical therapy recommended a tab safety alarm on the wheelchair. A nurse's note on 11/2/10 stated \"... Tab alarm in place.\" Sporadic nurses' notes after that date stated the alarm was in place. The care plan dated 11/3/10 showed a problem of \"At risk for falls related to: Dependency on staff for transfers\" and \"Hx (history) of fall.\" The facility's planned approaches to assist the resident with this problem were: \"1. Give needed assist with transfers. \"2. Encourage resident to call for assistance as needed. \"3. Monitor for changes needed in transfer techniques and update therapy for recommendations. \"4. Review any falls for patterns. \"5. Safety devices as indicated.\" Documentation in the nurses' notes revealed the resident made multiple attempts to get up unassisted on two days. The nurse's note on 11/2/10 at 11:35 AM noted frequent attempts by the resident to get out of his chair. The tab alarm was in place. The 11/20/10 nurse's note at 3:20 PM stated the resident made multiple attempts to get out of his chair and was assisted back to bed with no further attempts to get up unassisted. The resident's last fall, on 12/12/10 at 6:40 AM, occurred in the day room. Review of the facility's documentation revealed the resident was up early that morning and placed in the day room. The nurse heard a loud noise coming from the day room and found the resident face down on the floor with the wheelchair tipped over. The resident was bleeding from a laceration above his right eye. He received emergency treatment and returned to the facility. The care plan was updated on 12/12/10 to show the fall, the tab alarm, wheelchair cushion, and to keep the resident in a supervised location when up in the wheelchair. Review of the Physical Therapy notes showed a post fall assessment on 12/13/10 recommending all alarms be on and active. Another recommendation was that the resident be supervised when in the wheelchair. The 12/15/10 note said the resident had improved in strength and ability to assist in his activities of daily living and this may have made him feel he could try to get up unassisted. The facility's investigation, and an interview with the 11-7 Certified Nursing Assistant (CNA) who got the resident up that morning, revealed the tab alarm was not in place on the morning of 12/12/10. Although the tab alarm was not ordered by the physician or part of the resident's care plan, the facility assessed that it was needed for the resident's safety. Review of the medical record showed occasional nurse's notes stating the resident's alarm was in place. There was no other documentation, by nurses or CNAs, to show the alarms were used on a consistent basis.", "filedate": "2014-04-01"}
{"rowid": 10149, "facility_name": "CAROLINAS HOSP SYS TRANS CARE", "facility_id": 425177, "address": "121 EAST CEDAR STREET", "city": "FLORENCE", "state": "SC", "zip": 29501, "inspection_date": "2011-01-19", "deficiency_tag": 279, "scope_severity": "E", "complaint": null, "standard": null, "eventid": "988C11", "inspection_text": "**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 develop a Comprehensive Plan of Care which reflected the residents' current status of 3 of 7 sampled residents reviewed for Comprehensive Plan of Care. Resident #4 and Resident #6 did not have an Initial Plan of Care to address [MEDICAL TREATMENT]. Resident #1 did not have an Initial Plan of Care to address a Foley Catheter. The findings included: The facility admitted Resident #1 on 01-08-11 with [DIAGNOSES REDACTED]. Record review on 01-18-11 at 5:15 PM of the Daily Physician order [REDACTED]. Additional record review on 01-19-11 at 3:30 PM of the Initial Plan of Care dated 01-08-11 revealed an Initial Plan of Care for a Foley Catheter had not been developed. During an interview on 01-19-11 at 5:17 PM with Registered Nurse (RN) #1, she, after record review, verified an Initial Plan of Care for a Foley Catheter had not been developed. The facility admitted Resident #06 on 12-29-10 with [DIAGNOSES REDACTED]. Record review on 01-19-11 at 4:00 PM of the Daily Physician order [REDACTED].d.)\". Additional record review on 01-19-11 at approximately 4:00 PM of the Initial Plan of Care dated 12-29-10 and updated on 01-11-11 revealed a Plan of Care for [MEDICAL TREATMENT] had not been developed. During an interview on 01-19-11 at 6:00 PM with RN #1, she, after record review, verified a Plan of Care for [MEDICAL TREATMENT] hd not been developed. The facility admitted Resident #4 on 12/24/10 with [DIAGNOSES REDACTED]. Review of the medical record on 1/18/11 revealed Resident #4 received [MEDICAL TREATMENT] treatment three times weekly. Further record review revealed the care plan for Resident #4 did not include [MEDICAL TREATMENT] treatment as a problem area and did not include any treatment objectives or medical care areas related to [MEDICAL TREATMENT] treatment that reflect the standards of current professional practice. This information was shared with the Minimum Data Set (MDS) Coordinator on 1/19/11 at approximately 4:30 PM at which time the MDS Coordinator confirmed the care plan did not address [MEDICAL TREATMENT] treatment for [REDACTED].", "filedate": "2014-04-01"}
{"rowid": 10150, "facility_name": "CAROLINAS HOSP SYS TRANS CARE", "facility_id": 425177, "address": "121 EAST CEDAR STREET", "city": "FLORENCE", "state": "SC", "zip": 29501, "inspection_date": "2011-01-19", "deficiency_tag": 280, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "988C11", "inspection_text": "**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 a plan of care to ensure care needs were met for 2 of 7 resident care plans reviewed. The care plans for Resident #3 and Resident #4 were not revised and updated after both residents were placed on contact precautions. The findings included: The facility admitted Resident #4 on 12/24/10 with [DIAGNOSES REDACTED]. Review of the medical record on 1/18/11 revealed a physician's orders [REDACTED].\" Further record review revealed a positive culture screen for [MEDICATION NAME] Resistant [MEDICATION NAME] reported on 1/08/11. Review of the care plan indicated the care plan was last updated on 1/06/11. The care plan was not reviewed and revised to include Contact Precautions as a problem area after the positive culture and physician's orders [REDACTED]. This information was shared with the Minimum Data Set (MDS) Coordinator on 1/19/11 at approximately 4:30 PM at which time the MDS Coordinator confirmed the care plan was not revised to include Contact Precautions following the 1/08/11 culture screen. The facility admitted Resident #3 on 12/31/10 with [DIAGNOSES REDACTED]. Record review on 1/18/11 revealed that the resident had been placed on Contact Isolation on 1/3/11 and that a care plan for infection/isolation had not been developed. An interview with Licensed Practical Nurse #2 on 1/18/11 at 6:05 PM revealed that if the [DIAGNOSES REDACTED]. An interview with the Care Plan Coordinator on 1/19/11 at 6:30 PM confirmed that a care plan had not been developed to reflect that Resident #3 had been placed on Contact Precautions.", "filedate": "2014-04-01"}
{"rowid": 10151, "facility_name": "CAROLINAS HOSP SYS TRANS CARE", "facility_id": 425177, "address": "121 EAST CEDAR STREET", "city": "FLORENCE", "state": "SC", "zip": 29501, "inspection_date": "2011-01-19", "deficiency_tag": 502, "scope_severity": "E", "complaint": null, "standard": null, "eventid": "988C11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on observation and interviews, the facility failed to follow a procedure to ensure that expired laboratory testing supplies were not stored with other laboratory testing supplies available for resident testing in 1 of 1 nursing station. The findings included: On [DATE] at 4:10 PM, observation of a cabinet located behind the nursing station revealed 59 - 6.0 ml BD pink top Vacutainer which expired ,[DATE]. During the observation, Licensed Practical Nurse(LPN) #3 verified that the Vacutainer had expired. During an interview with LPN #1 on [DATE] at 4:55 PM, she stated that nurses were responsible for maintaining in- date Vacutainer and that the cabinet was checked weekly. LPN #1 could not provide documentation which confirmed the weekly checks. During the interview, LPN #1 also confirmed that staff does draw blood samples for testing.", "filedate": "2014-04-01"}
{"rowid": 10152, "facility_name": "CAROLINAS HOSP SYS TRANS CARE", "facility_id": 425177, "address": "121 EAST CEDAR STREET", "city": "FLORENCE", "state": "SC", "zip": 29501, "inspection_date": "2012-02-08", "deficiency_tag": 371, "scope_severity": "F", "complaint": null, "standard": null, "eventid": "4V0311", "inspection_text": "**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 discard 28 cartons of milk which were expired in the resident's refrigerator in the day room. There was an additional observation of the resident's refrigerator not functioning for six (6) hours on the last day of the survey. In addition, the facility failed to discard nine (9) cans of nutritional supplements that had expired in a cabinet in the nurses station. The findings included: On 2/6/12 at approximately 5:30 PM during observation of the residents refrigerator, three Tru Moo one percent low fat chocolate milk and seven Pet skim milk were found with the expiration date of February 3, 2012. Nine (9) Pet whole milk and nine (9) Pet skim milk were found with the expiration date of February 5, 2012. On 2/7/12 at approximately 9:30 AM, the surveyor observed that the expired milk remained in the residents refrigerator in the day area. Review of the refrigerator cleaning schedule states: \"All items are dated and labeled properly, free of all expired items, and temperatures grafted daily. Further review of the schedule revealed the Month of February 2012 was checked off daily. On 2/7/12 at approximately 10:20 AM, Food Service Director verified that the milk was expired. Through interview the Food Service Director stated, \" Dietary Aides do the in and outs in the resident's refrigerator. The in and out policy is to put old to front and new to the back.\" On 2/8/12 at approximately 9:25 AM, the surveyor observed the Speech Language Pathologist Director opening the residents refrigerator to get milk for a resident and the interior light did not come on. Following the observation the surveyor checked the temperature of the refrigerator which read 46 degrees Farenheit and freezer which read 38 degrees Farenheit. Noting the temperature of the freezer, the surveyor checked the ice cream cup which was soft and runny. On 2/8/12 at approximately 2:15 PM, there was an observation of two Certified Nursing Assistants getting ice cream cups for residents, following the observation the surveyor checked the temperatures of the the freezer which read 42 degrees Farenheit and the refrigerator which read 49 degrees Farenheit. On 2/8/12 at approximate 2:30 PM, review of the Daily Temperature log did not indicate the actual temperature taken in the Month of February. On 2/8/12 at approximately 3:30 PM, the Director of Nursing and Administrator verified that the residents refrigerator was not functioning. Through interview the Administrator stated \"we will get maintenance to look at the refrigerator.\" On 2/7/12 at 7:50 AM, during inspection of the storage cabinets in the nursing station, 7- 237 milliliters cans of [MEDICATION NAME] 1.2 High Protein Nutrition with an expiration of 2/1/12 were found. In addition, 2 cans [MEDICATION NAME] Specialized Nutrition containing 237 milliliters each were found with an expiration date of 2/1/12. During an interview on 2/7/12 at 8:07 AM, the Director of Nursing (DON) confirmed the presence of the expired nutritional supplements. The DON stated that Dietary Services was responsible for checking the expiration dates, usually once a week. She further stated that the nurses do not check expiration dates. At 10:24 AM on 2/7/12, the Director of Dietary Services stated that Dietary Services does not stock the nutritional supplements or check expiration dates of the supplements. He further stated that he thought that the Purchasing Department was responsible for stocking and checking expiration dates of the nutritional supplements and stated he would have the Director of Purchasing from the main hospital contact the surveyor. At the time of the exit, the Director of Purchasing had not contacted the surveyor.", "filedate": "2014-04-01"}
{"rowid": 10153, "facility_name": "CAROLINAS HOSP SYS TRANS CARE", "facility_id": 425177, "address": "121 EAST CEDAR STREET", "city": "FLORENCE", "state": "SC", "zip": 29501, "inspection_date": "2012-02-08", "deficiency_tag": 463, "scope_severity": "E", "complaint": null, "standard": null, "eventid": "4V0311", "inspection_text": "On the days of the survey, based on observation and interview, the facility failed to ensure the safety of residents by not having resident call systems equipped in two of four common area restrooms which were accessible to residents. The findings included: During a general observation of the environment on 2/6/12 and throughout the days of the survey, observations were made of two restrooms that were unlocked and with no call system in place for residents use. The restrooms were located on the opening of the hallway across from the Physical Therapy and Activity area. Residents who were able to ambulate and propel themselves independently resided at the facility. During an interview on 2/8/12 at approximately 3:35 PM, the Administrator verified the restrooms were accessible to the residents and that there were no call systems in place.", "filedate": "2014-04-01"}
{"rowid": 10154, "facility_name": "CAROLINAS HOSP SYS TRANS CARE", "facility_id": 425177, "address": "121 EAST CEDAR STREET", "city": "FLORENCE", "state": "SC", "zip": 29501, "inspection_date": "2012-02-08", "deficiency_tag": 323, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "4V0311", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on observation, the facility failed to ensure that the resident environment remains as free of accident hazards as is possible. Observation of Room 910 revealed hazardous objects stored on opening shelving in the resident's room. The findings included: The facility admitted Resident #7 on 2/03/12 with [DIAGNOSES REDACTED]. During a tour of resident rooms on 2/07/12 at approximately 10:30 AM, Resident #7 was observed in his/her wheelchair in the hallway. After Resident #7 entered his/her room, the surveyor entered the room and talked briefly with the resident. While in the room, observation of the open shelves on the wall near the resident's bathroom revealed two clear boxes containing multiple bronze/gold-colored small objects. Observation of the end of one of the boxes revealed the word \"Ammunition\" among the wording on the box. At that point, the resident informed the surveyor that the boxes were his ammunition and that they were a birthday gift. After informing the Director of Nursing (DON) and Administrator of these findings, the surveyor accompanied the DON to the resident's room, and the DON observed the boxes of ammunition. After talking with the resident, the DON informed the resident that the ammunition would need to be removed from the room for safety reasons. After removing the boxes of ammunition from the room, it was determined that the two boxes contained a total of 100 bullets. The DON and Administrator confirmed that the ammunition was given to the resident as a gift while the resident was in the hospital for surgery. Further investigation was necessary to assure that the resident was not in possession of a firearm. Review of the medical record revealed no Inventory of Personal Items list was completed upon admission to the facility. In addition, the hazardous objects stored on the open shelving were not observed/identified until brought to the staff's attention by the surveyor.", "filedate": "2014-04-01"}
{"rowid": 10155, "facility_name": "CAROLINAS HOSP SYS TRANS CARE", "facility_id": 425177, "address": "121 EAST CEDAR STREET", "city": "FLORENCE", "state": "SC", "zip": 29501, "inspection_date": "2012-02-08", "deficiency_tag": 309, "scope_severity": "E", "complaint": null, "standard": null, "eventid": "4V0311", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the Recertification Survey, based on record review, review of the policy entitled [MEDICAL TREATMENT] and interview, the facility failed to consistently document checking for thrill and bruit of the arteriovenous (AV) graft for Resident #1 used for his [MEDICAL TREATMENT]. The findings included: The facility admitted Resident #1 on 12/26/11 with [DIAGNOSES REDACTED]. Record review of the nurses notes on 2/8/12 revealed the nurses had not consistently documented checking for thrill and bruit of the resident's AV graft. The record review revealed that the thrill and bruit had not been documented for a total of 22 days since the resident's admission to the facility. On 20 days there was documentation of a positive thrill and bruit and there was one day for which no documentation could be found. After sharing this information with the Director of Nursing, the facility did not dispute the findings or provide any additional documentation that the thrill and bruit had been checked. On 2/8/12 review of the facility's policy entitled [MEDICAL TREATMENT] in the section designated as \"Post-[MEDICAL TREATMENT] Nursing Responsibilities\" revealed...\"Assess and document status of access site every four hours and prn (as needed).\" At that time the Director of Nursing verified that the policy did not specifically address checking for thrill and bruit of an AV graft for residents receiving [MEDICAL TREATMENT].", "filedate": "2014-04-01"}
{"rowid": 10156, "facility_name": "CAROLINAS HOSP SYS TRANS CARE", "facility_id": 425177, "address": "121 EAST CEDAR STREET", "city": "FLORENCE", "state": "SC", "zip": 29501, "inspection_date": "2012-02-08", "deficiency_tag": 314, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "4V0311", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the Recertification Survey, based on observation, interviews and review of the facility's policy entitled Dressing Changes, the facility failed to provide necessary treatment and services to promote healing and prevent infection for Resident # 1, 1 of 1 residents reviewed for wound care. The findings included: The facility admitted Resident #1 on 12/26/11 with [DIAGNOSES REDACTED]. On 2/8/12 at 9:49 AM, Licensed Practical Nurse (LPN) #2 was observed performing wound care to 5 wounds for Resident #1. After explaining the procedure to the resident, setting up her supplies and clean field, the LPN cut and removed the soiled dressing from the left knee wound. She removed her gloves, washed her hands and donned clean gloves. She then obtained a non-adherent dressing from a shelf on the wall and opened it. She sprayed the periwound with wound cleanser and rubbed around the periwound several times. She then sprayed the wound bed with wound cleanser and dabbed the bed several times right to left then back from left to right. She applied the clean dressing and applied tape. The LPN then removed the dressing from a posterior lower leg wound and discarded the soiled dressing. She removed her gloves, washed her hands and donned clean gloves. She then removed the soiled outer dressing from the anterior foot and heel of the left foot and discarded them. LPN # 2 sprayed wound cleanser on the periwound and cleaned the medial, lateral and distal periwound areas with several wipes without turning the gauze. Wound cleanser was then sprayed on the wound bed, and the LPN dabbed the wound bed with gauze 3 times, went beyond the wound margin into the periwound area then back into the wound bed. A clean gauze was moistened with Normal Saline and applied to the wound bed and a dry gauze was placed over the moist gauze. She removed her gloves washed her hands and donned clean gloves. The soiled inner dressing from the left heel was removed and discarded. LPN # 2 removed her gloves, washed her hands and donned gloves. The LPN sprayed the periwound with wound cleanser and wiped the medial periwound twice, sprayed wound cleanser onto the same area of the gauze and wiped the lateral periwound 3 times. She sprayed the wound bed with the cleanser and wiped 5 times with the same gauze without turning it, left to right and top to bottom, then place a normal saline moist gauze in the wound bed, covered it with the clean dressing and wrapped the foot with Kerlix gauze. She removed her gloves, washed her hands, and donned clean gloves. The LPN then sprayed the posterior lower leg periwound with wound cleanser, wiped the medial periwound and around to the proximal wound twice then 3 times on the lateral periwound and around to the distal area. With a clean gauze she cleaned the periwound a second time wiping the lateral area twice and around the bottom and then back and forth on the medial periwound. She sprayed the wound bed with cleanser and with a clean gauze wiped back and forth 4 times. A normal saline moist gauze was placed in the wound bed, covered with a dry gauze and secured it with tape. The LPN did not change gloves at this time but opened the resident's brief, removed the soiled dressing from the penis and discarded it. She then removed her gloves, washed her hands and donned clean gloves. She obtained an additional package of gauze from the shelf on the wall and opened it. She moistened a gauze with normal saline and wiped the periwound and shaft of the penis 10 times then wiped the periwound 2 more times. The wound bed was cleaned with a normal saline moist gauze with 2 wipes. LPN # 2 then turned the gauze and wiped 6 more times in the wound bed. The LPN then applied Saf Gel to a clean gauze, applied it to the wound bed, placed a dry gauze over that and wrapped with a second dry gauze and secured with tape. The LPN did not change gloves after cleaning any of the wounds before applying the clean dressings. Review of the facility's policy, Dressing Changes, revealed, in the section labeled \"Procedure\", ...5. Don Clean gloves. 6. Place water proof pad under affected area. 7. Clean wound thoroughly. Pat dry with guaze sponge. 8. Remove gloves and don a clean pair. 9. Apply topical medication ointment as ordered to wound bed and/or periwound area. 10. Apply dressing per physician order [REDACTED]. During an interview at 2:29 PM on 2/8/12, the LPN stated she had \"tried to be extra careful\" since she was being observed. She stated she thought \"some gentle scrubbing would be required\" to clean the wound bed. She further stated that she did not think she needed to change gloves between cleaning the wound and applying the clean dressing. The LPN stated that it had not been intentional to go out side the wound bed and into the periwound area when she had cleaned the wound bed. In addition, she confirmed that she had left the posterior lower extremity wound open while she did the dressing changes to the top of the left foot and the left heel. During an interview on 2/8/12 at 3:03 PM, the the Director of Nursing confirmed that the LPN should have changed her gloves after cleaning the wound prior to applying the clean dressing. She also confirmed it was inappropriate to go over the same area of the wound bed with the same gauze and verified the standard of practice is to clean a wound bed in a circular motion from the center outward in one continuous motion. In addition, the DON also confirmed the posterior wound should not have been left open while the dressings were being changed to the foot.", "filedate": "2014-04-01"}
{"rowid": 10157, "facility_name": "CAROLINAS HOSP SYS TRANS CARE", "facility_id": 425177, "address": "121 EAST CEDAR STREET", "city": "FLORENCE", "state": "SC", "zip": 29501, "inspection_date": "2012-02-08", "deficiency_tag": 332, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "4V0311", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the Recertification Survey, based on observations, interviews and record reviews, the facility failed to maintain a medication error rate less that 5 per cent. The facility had 2 errors out of 40 opportunities for error resulting in an error rate of 5.0 per cent. The findings included: Error #1: On 2/6/12 at 4:49 PM, Registered Nurse (RN) #1 was observed during the Medication Pass. RN #1 removed 2 [MEDICATION NAME] ([MEDICATION NAME]) 40 milligram (mg) tablets in single dose packs from the Pyxis machine and the dose of the tablets was confirmed by the surveyor. She verified that the dose to be administered was 40 mg. in the Medication Administration Record (MAR) and in the electronic record in the Pyxis. This was confirmed by the surveyor at that time. She continued to Resident #2's room and opened both single dose unit packs and placed the tablets into the souffle cup. She informed the resident that she was giving him 40 mg. of [MEDICATION NAME] and handed him the souffle cup. The surveyor stopped RN #1 at that time from administering the medication. Review of the Discharge Medication Reconciliation Orders Form from the hospital, signed by the physician, revealed the order was for [MEDICATION NAME] 40 mg. 1 tablet by mouth every AM and every PM. During an interview at that time, RN #1 confirmed that she had two 40 mg tablets in the souffle cup for administration and that it was double the amount ordered to be administered. During an interview on 2/7/12 at 8:15 AM, the Director of Nursing confirmed the order was written for [MEDICATION NAME] 40 mg. 1 tablet every AM and every PM. She stated she would have expected the nurse to check the dose of the medication when it was removed from the Pyxis drawer, check it against the MAR and again in the resident's room. Error #2: During observation of the medication pass on 2/7/12 at 9:04 AM, Licensed Practical Nurse (LPN) # 1 withdrew 0.11 milliliters (ml) of [MEDICATION NAME] 20,000 units per 1 ml. into a syringe and administered it into Resident A's right upper arm. Review of the Daily Physician order [REDACTED].\" At 9:55 AM, the LPN confirmed that she gave the incorrect dose of [MEDICATION NAME]. She stated she \"was having difficulty seeing the markings\" on the syringe but required cues from the surveyor to calculate the appropriate amount that needed to be administered. During an interview on 2/7/12, the Director of Nursing stated that if the nurse was having difficulty reading the markings on the syringe, she would have expected the nurse to have one of the other nurses check behind her to ensure the correct dose was administered.", "filedate": "2014-04-01"}
{"rowid": 10158, "facility_name": "CAROLINAS HOSP SYS TRANS CARE", "facility_id": 425177, "address": "121 EAST CEDAR STREET", "city": "FLORENCE", "state": "SC", "zip": 29501, "inspection_date": "2013-03-07", "deficiency_tag": 371, "scope_severity": "F", "complaint": null, "standard": null, "eventid": "375T11", "inspection_text": "On the days of the survey, based on random observations and interview, the facility failed to store, prepare, distribute, and serve food under sanitary conditions. Multiple concerns were identified related to cleanliness, food storage, and the lack of appropriate hair restraints. The findings included: During initial tour of the kitchen area on 3/5/13 at 9:30 AM with the Manager of Dining and Kitchen, the following items were observed: the main oven had dark brown dried substances inside the ovens; cabinets, carts, and ovens had a grease-like film on the outside; carts had debre' inside the carts; multiple pans were stored wet on the dry rack; a small cooler by the tray line had multiple racks of food that were unlabeled or undated; the reach in cooler had multiple pans of food unlabeled and undated; the walk-in cooler had 4 pans of jello undated; 1 container of food labeled with date 2/27/13 was outdated; salad items in containers that were uncovered and undated on a cart in the walk-in cooler; trash and debre' noted under racks near the walls of the walk-in cooler and freezer. It was also noted the kitchen floor had a heavy grease build-up; there was no trash can with a pedal by the handwashing sink; a large uncovered trash barrel near the tray line and a deep fryer with very dark oil and crumbs floating on top of the oil. The Manager verified the deep fryer could not have been cleaned on Sunday as per the cleaning schedule. There were bags of grapes stored in the walk-in cooler not sealed. One kitchen employee had hair not completely covered by a hairnet, and two male employees had beards not covered. The Manager confirmed each of the items noted above.", "filedate": "2014-04-01"}
{"rowid": 10159, "facility_name": "CAROLINAS HOSP SYS TRANS CARE", "facility_id": 425177, "address": "121 EAST CEDAR STREET", "city": "FLORENCE", "state": "SC", "zip": 29501, "inspection_date": "2013-03-07", "deficiency_tag": 520, "scope_severity": "F", "complaint": null, "standard": null, "eventid": "375T11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on record review and interview, the facility's Quality Assessment and Assurance Program failed to develop and implement appropriate steps to correct identified quality deficiencies concerning ongoing issues related to the dietary department. The findings included: On 3/6/13 at approximately 1:30 PM Registered Nurse (RN) #1, who was identified as the Quality Assessment and Assurance Program (QAA) contact by the Administrator, was asked by the surveyor if there were any ongoing QAA that identified issues related to the kitchen. His/her response was \"Yes\" and stated he/she would get the information. On 3/6/13 at 4 PM the Manager of Dining and Kitchen Services gave the surveyor a 2012 Quality Improvement Plan for Food & Nutrition Services 4th Quarter Report. The report identified: Indicator, Goal, Results, and Outcome / Plan. On 3/7/13 at 9:41 AM the Administrator gave the surveyor Carolinas Hospital System Food & Nutrition 2012 4th Quarter for \"Monitor: Patients will receive meals that are accurate and served at the correct temperature\", \"Food & Nutrition will maintain a clean and safe environment at all\", and \"Patients receiving [MEDICATION NAME] nutrition will meet ASPEN Guidelines for appropriateness\". The Goal and Results for both 2012 Quality Improvement Plan for Food & Nutrition Services 4th Quarter Report and Carolinas Hospital System Food & Nutrition 2012 4th Quarter were written in percentages and had a completion date of \"Ongoing monitor, \"Ongoing weekly monitor\", or \"Ongoing monthly monitor\". On 3/7/13 at 9:35 AM RN #1 provided the facility policy on QAA. The QAA for the Transitional Care Unit (TCU) states \"The Transitional Care Unit Participates with the Quality Improvement Program of Carolinas Hospital System (CHS). TCU adheres to the policies of CHS in regard to Program Improvement and Quality Assurance and Assessment. RN #1 delivered the Plan for Organizational Improvement for Department Generating Policy \"Quality Improvement\" and stated that it was the hospitals QAA policy. The CHS Quality Improvement (QI) policy section XII defines the procedural steps for the QAA process as \"Plan, Design, Measure, Assess, Improve\". The facility was unable to produce a QAA in progress, for ongoing kitchen deficiencies, that fulfilled their policy requirements. Neither the The Goal and Results for both 2012 Quality Improvement Plan for Food & Nutrition Services 4th Quarter Report nor Carolinas Hospital System Food & Nutrition 2012 4th Quarter identified the deficiencies and their root cause, developed nor described a plan of action, defined how they would monitor that plan of action, included a goal date for review for monitoring the effectiveness of the plan of action, or define how revisions would be implemented when the plan of action was found ineffective.", "filedate": "2014-04-01"}
{"rowid": 10160, "facility_name": "HEARTLAND HEALTH CARE CENTER - GREENVILLE WEST", "facility_id": 425294, "address": "600 SULPHER SPRINGS ROAD", "city": "GREENVILLE", "state": "SC", "zip": 29611, "inspection_date": "2011-01-13", "deficiency_tag": 281, "scope_severity": "E", "complaint": null, "standard": null, "eventid": "EE4V11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the day of the complaint inspection based on record review, interviews and review of the facility's policy on \"Venous Access Devices,\" the facility failed to assure the nursing staff provided the appropriate interventions for Resident #1's peripherally inserted central catheter (PICC) line (one of two residents sampled with a PICC line.) The facility also failed to assure a newly admitted resident had a written plan of care to meet the needs of that resident. Resident #1's interim care plan did not include his PICC line, his leg wounds or his extensive activities of daily living (ADL) requirements. The findings included: The facility admitted Resident #1 on 2/28/2010 and discharged on [DATE] with [DIAGNOSES REDACTED]. Review of the Medicare 5 Day Minimum Data Set (MDS) with an Assessment Reference Date of 3/7/2010 revealed the resident had no short term or long-term memory problems and was independent in decision-making. The MDS documented the resident as having repetitive verbal complaints and was verbally abusive 1-3 days within the assessment period. The MDS also coded the resident as needing extensive assistance with transfers, toileting and bathing. The resident was coded as totally dependent for ambulation on and off the units and was totally dependent for toileting. The resident was coded as frequently incontinent of bowel and bladder. The resident was also coded as have a Stage III ulcer. Review of the Interim Care Plan revealed no problem areas related to his PICC his wound or his need for extensive assistance related to his activities of daily living. Review of the Medication Administration Record [MEDICATION ADMINISTRATION RECORD DETAILS REDACTED]. There was no documentation that the PICC line was flushed every 12 hours. However the resident was receiving antibiotics once daily through the PICC line. Review of the facility's policy on \"Venous Access Devices\" revealed PICC lines should be flushed a minimum of every 12 hours. The dressing should be changed every 7 days if an occlusive dressing was used, the dressing should be changed every 48 hours if gauze was used. During an interview on 11/9/2010, Resident #1's spouse stated that she saw the dressing change to the PICC line once. She stated that she observed blood under the dressing but was unsure how long the blood had been there. Two staff Registered Nurses were interviewed, both stated that PICC lines were to be flushed with normal saline twice a day and the dressings were to be changed once a week. During an interview on 1/13/2011, the Administrator confirmed the interim care plan did not include the resident's PICC line, the lower extremity ulcer or the need for extensive assistance with ADL's. The Administrator stated that the interim care plan should have included the above. The Administrator also confirmed that there was no documentation related to the PICC line flushes. The Administrator stated that the PICC line dressing should be changed every 7 days. He confirmed that the resident's PICC line dressing was not changed timely. The Administrator confirmed the policy was not followed related to the resident's PICC line.", "filedate": "2014-04-01"}
{"rowid": 10161, "facility_name": "HEARTLAND HEALTH CARE CENTER - GREENVILLE WEST", "facility_id": 425294, "address": "600 SULPHER SPRINGS ROAD", "city": "GREENVILLE", "state": "SC", "zip": 29611, "inspection_date": "2011-01-13", "deficiency_tag": 314, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "EE4V11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the day of the inspection based on observations, interviews, record review and review of the facility's policy on \"Treatment Changes,\" the facility failed to provide the necessary care and services to 2 of 5 sampled residents. Resident #1 did not have the dressing changed per the physician's orders [REDACTED]. Resident #4 also did not receive appropriate wound care to her bilateral lower extremities. The findings included: The facility admitted Resident #1 on 2/28/2010 and discharged on [DATE] with [DIAGNOSES REDACTED]. Review of the Medicare 5 Day Minimum Data Set (MDS) with an Assessment Reference Date of 3/7/2010 revealed the resident had no short term or long-term memory problems and was independent in decision making. The MDS documented the resident as having repetitive verbal complaints and was verbally abusive 1-3 days within the assessment period. The MDS also coded the resident as needing extensive assistance with transfers, toileting and bathing. The resident was coded as totally dependent for ambulation on and off the units and was totally dependent for toileting. The resident was coded as frequently incontinent of bowel and bladder. The resident was also coded as have a Stage III ulcer. Review of the Physician order [REDACTED]. To the right leg, clean with wound cleanser, apply Mesalt to wound and then wrap leg with ace bandage, change every day and as needed. Review of the Medication Administration Record [MEDICATION ADMINISTRATION RECORD DETAILS REDACTED]. Review of the wound care notes revealed a \"Skin Alteration\" record for the Right leg first dated 2/28/2010. The wound was noted to be 10 cm by 10 cm by 3 cm deep, with a moderate amount of serous drainage and [MEDICAL CONDITION]. No odor was noted. The next note was dated 3/8/2010, the wound was noted to be 2.3 cm by 2.3 cm by 0.1 cm deep, a scant amount of slough was noted, a scant amount of serous drainage was documented and no foul odor. Review of the Physician's Progress Notes revealed an entry dated 3/5/2010 that documented the resident had a \"small open wound on the pretibial region of his right lower leg. It measures approximately 0.5 to 0.2 cm. The wound bed is pale pink. It is moist and stippled with nonviable slough. There was no odor.\" Review of the nurses notes dated 3/5/2010 at 10:45 AM revealed the following entry: \"writer in to change dressing to bilat (eral) lower legs. Res (ident) had visitors and explained to writer that the figure eight wrappings were too tight. Stated that he has a family member that was a nurse practitioner that wrapped his legs last pm...Requested that wraps be left in place because the family nurse practitioner would be back to re-wrap his legs tomorrow. Writer paged attending for building to discuss concerns...Discussed need for some pressure to lower extremities...bilateral lower extremities weeping clear fluid, writer cleansed wound to right lower ext with wound cleanser wound bed noted to be 40% slough and 60 % pink. No complaints of pain or discomfort...pulses checked in lower ext, present and strong bilaterally.\" During an interview on 11/9/2010, Resident #1's spouse stated that family member's changed Resident #1's dressings frequently because of his weeping legs. The spouse stated that there was a foul odor when she changed the dressings. During an interview on 1/13/2011 the Administrator confirmed the dressing was not changed on 3/6/2010. The facility admitted Resident #4 on 12/31/2010 with [DIAGNOSES REDACTED]. Observation of wound care on 1/13/2011 revealed the following: Registered Nurse #1 removed the left leg dressing and then the right leg dressing without cleaning the scissors or cleansing his hands in between the removal of the dressings. No dressings were noted under the Kerlix gauze wraps. The left leg was noted to have deep crevices and nodules from the knee down to the ankle. The foot was also noted to have deep crevices. A non draining, dark red/black pressure ulcer was noted to the left heel. The left big toe bony prominence was noted to be red with an approximately 1 cm scabbed area in the center. RN #1 was observed to use saline wipes and wipe up and down the leg and foot repeatedly with the same wipe. RN #1, without cleansing his hands, proceeded to clean the right leg the same way (repeatedly wiping with the same cloth). RN #1 used skin prep to the heel area. Then he proceeded to put [MEDICATION NAME] onto his gloved hands and rub it into both legs. RN #1 sanitized his hands and donned new gloves; he then put [MEDICATION NAME] cream onto his fingertips and rubbed the medicine onto the resident's legs, using the same finger for multiple areas and on both legs without cleansing his hands. RN #1 was asked what the treatment to the bony prominence of the left toe was; he stated, \"skin prep.\" However RN #1 failed to apply any treatment to the bony prominence. RN #1 cleansed his hands and applied new gloves. He wrapped the right leg with Kerlix and used soiled scissors to cut the excess. Without sanitizing his hands, he then placed a [MEDICATION NAME] pad on the left heel and wrapped the left leg with Kerlix; RN #1 used the soiled scissors again to cut the excess gauze. During an interview on 1/13/2011 at 4:25 PM, RN #1 confirmed that he did not apply any treatment to the bony prominence of the left big toe. He confirmed that he performed the dressing change on both legs at the same time. RN #1 confirmed he repeatedly wiped the wounds with the same cloth. He stated that he knew he should have kept the wounds separate and stated that he should have done \"one swipe one cloth.\" He confirmed that he did not use an applicator for the medications and confirmed that he used the same finger on multiple areas on both legs. RN #1 also confirmed he did not clean the scissors in between the clean and dirty parts of the dressing change. Review of the facility's policy on \"Treatment Change\" revealed \"dressing removed, gloves removed, hands washed, clean field established...treatment performed with out contaminating dressing supplies...cleanse wound per order, remove gloves and wash hands, apply dressing as ordered, remove gloves and perform hand hygiene.\" Review of the Skin Worksheets revealed the resident had only one performed since her admission on 12/31/2010. The Worksheet was not dated, however the administrator and staff nurses stated that the audits were completed on the resident's shower days and the Worksheet was from Monday, January 10, 2011. The Worksheet indicated the abnormal area to the left big toe. Further review of the medical record (including wound notes, physician orders, progress notes, PUSH tool, skin alteration records, Medication Administration Records and nurses notes) revealed no documentation of the wound or any treatment to the bony prominence. The resident's Braden Scale was assessed as \"Low Risk.\" The Pressure Ulcer Healing Chart dated 12/31/2010 and 01/06/2011 documented the wound to the left heel. Wound Nurse notes dated 12/31/2010 and 01/06/2011 described the wound to the left heel as a \"blister area...measures 2.5 cm (centimeters) x 2.5 cm. order for skin prep to (L) heel 2 x/day (twice per day)\". There was no documentation regarding the left big toe bony prominence. The resident's was also noted to always wear her shoes, even to sleep. During an interview on 1/13/2011, RN #1 confirmed no treatment had been done to the left bony prominence of the big toe. The Administrator confirmed the undated Skin Worksheet identifying the abnormal area on the left big toe. The Administrator also confirmed there was no documentation or treatment ordered related to the area. The Administrator stated that the nurses should have documented the area in the medical record and obtained an order for [REDACTED].", "filedate": "2014-04-01"}
{"rowid": 10162, "facility_name": "UNIHEALTH POST-ACUTE CARE - NORTH AUGUSTA", "facility_id": 425296, "address": "1200 TALISMAN DRIVE", "city": "NORTH AUGUSTA", "state": "SC", "zip": 29841, "inspection_date": "2010-12-15", "deficiency_tag": 281, "scope_severity": "K", "complaint": null, "standard": null, "eventid": "Inf", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the Recertification and Complaint survey, based on observations, interviews, record reviews, and review of facility policies for Change of Condition and Laboratory Services, it was determined on 12/14/10 at 10:30AM that Immediate Jeopardy and Substandard Quality of Care existed for CFR 483.20 F-281 at a scope and severity of \"K\", starting 9/12/10. The facility Nursing staff repeatedly failed to identify a delay in the receipt of laboratory tests and subsequently failed to contact the attending physicians in a timely manner to obtain further medical direction for the assessment, monitoring and treatment of [REDACTED]. Residents # 1, 4, 5, 6, 7, 14, 15, 21,and 29 were 9 of 22 sampled residents reviewed for professional standards related to physician notification of laboratory results who were found to be affected by the deficient practice. The findings included: The facility admitted Resident #1 on 6-2-10 with [DIAGNOSES REDACTED]. Record review on 12-14-10 at approximately 5 PM revealed that on 9-12-10, Respiratory Therapy noted moderate yellow sputum and a Physician's Interim Order for \"Sputum Culture today\" was obtained. Further review revealed no laboratory results in the medical record. Review of the Respiratory Therapy notes revealed that the sputum specimen was obtained on 9-15-10. During an interview on 12-14-10 at 6 PM, Registered Nurse (RN) #3 reviewed the medical record and Lab Book and could find no record of the sputum culture having been completed. During an interview on 12-15-10 at 9:20 AM, RN #3 stated that the physician's orders [REDACTED]. She reviewed the Respiratory Therapy Notes with the surveyor and confirmed that the sputum specimen had been obtained on 9-15-10. The lab report was obtained from the computer and RN #3 verified that the lab had received the specimen on 9-16-10 and reported it on 9-20-10. The RN reviewed the Lab Book and confirmed that the lab was entered to be done on 9-13-10 and there was no follow-up to ensure that the results were received and called to the physician in a timely manner. She also reviewed the medical record and could locate no evidence that the physician was ever notified of the results which showed \"pseudomonas aeruginosa 2+\" and the gram stain with \"many\" positive rods and \"many\" white blood cells. Further review revealed that a weekly PT ([MEDICATION NAME])/INR (International Normalization Ratio) was done and the report available to the facility on [DATE] via computer. The lab report noted that the resident was currently \"on 2 mg [MEDICATION NAME]\" and was faxed to the physician on 11-3-10 (2 days later). The PT was 12.9 seconds with a reference range of 10.0 to 13.0. The INR ratio was 1.0 L(ow) with a reference range of 2.0-3.0. The physician wrote an order on the lab report on 11-4-10 to \"Please ^ (increase) to 3 mg\". This order was transcribed onto a Physician's Interim Order form on 11-5-10. During an interview on 12-15-10 at 8:50 AM, Licensed Practical Nurse #4 reviewed the medical record and confirmed that the [MEDICATION NAME] was not increased until 11-5-10 based on the 11-1-10 PT/INR results. There was no documentation that the nursing staff identified the delay in contacting the physician and initiated corrective action. Resident # 14 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Review of the medical record on 12/13/10 revealed the resident had a Urine Culture and Sensitivity obtained on 9/16/10. The resident was started empirically on Bactrim on 9/17/10. Per the lab result, a report of the lab was available on 9/18/10 which indicated the resident had an E-Coli infection which was not sensitive to the Bactrim as ordered. Review of the nurses notes revealed on 9/20/10 the resident expressed to the nursing staff that she thought the Bactrim was \"not strong enough to cure UTI\" (urinary tract infection). On 9/21/10 the resident complained of burning all over and asked to go to the emergency room . The resident returned from the emergency with a new order for Keflex for 10 days and a [DIAGNOSES REDACTED]. There was no documentation that the facility tried to access the lab result after 48 hours, or attempted to access the result once the resident complained of not feeling better. On 12/14/10 during an interview with the ADON (Assistant Director of Nursing) who was also the Unit Manager she stated that just because the lab result was available in the computer did not mean the facility could access the information. She then called the lab to learn that if the report indicated the result was available it would indeed be available in the computer for the facility staff to access. There was no explanation provided by the Assistant Director of Nursing as to why there was a delay in the receipt of the lab result or fax to the physician. The resident was not included on the audit log on the nursing unit for monitoring for the return of the result or physician notification. Resident # 15 was admitted on [DATE]. A PT/INR ([MEDICATION NAME] time/International normalized ratio) was obtained on 11/29/10. The lab report indicated that the result was available on 11/29/10. The report was faxed to the facility on [DATE] and the physician notified on 12/1/10 who ordered for the [MEDICATION NAME] to be held one day on 12/1/10. The result of the [MEDICATION NAME] was 27.0 (high) and INR 3.4 (high) Resident # 15 had a urine culture obtained on 11/19/10. The lab report indicated the result was available on on 11/21/10. A physician order [REDACTED]. There was no indication that the nursing staff followed the facility protocol for lab services or questioned the delay in treatment for [REDACTED]. Resident #6 was admitted on [DATE] with a [DIAGNOSES REDACTED]. During record review of laboratory reports it was found that a sputum culture was done on 6/10/10 with a report date of 6/12/10. The results were not faxed to the Physician until 6/15/10 at which time the resident was [MEDICATION NAME] mg PO BID for 5 days for a Pseudomonas infection. A Pro-Time of 10/18/10 with a report date of 10/18/10 was not sent to the Physician until 10/21/10 . The result of the lab test was a [MEDICATION NAME] time 18.6 (high) and 1.8 (low). A Pro-time was drawn on 11/1/10 with a report date of 11/1/10 . The result of the test was 21.3 (high) and 2.3. The physician was faxed the results on 11/3/10. There was no documentation found that nursing identified the delay in treatment. The facility admitted Resident # 7 on 11-23-10 with [DIAGNOSES REDACTED]. On 12-13-10 at approximately 11:30 AM, review of the Medical Record revealed that the resident was on an anticoagulant therapy. Review of the physicians orders revealed the following order dated 12-6-10: \"^ (increase) [MEDICATION NAME] to 7 mg (milligrams) Q (every) day. INR on Friday 12/10/10\". Further review revealed that no labs had been drawn for Resident # 7 on Friday 12-10-10. Licensed Practical Nurse (LPN # 2) confirmed that the lab had not been written in the log book, nor drawn on 12-10-10. A new lab order was written on 12/13/10 after it was brought to the attention of the staff by the surveyor. The results revealed a low INR of 1.1 ratio. The results were faxed to the physician at 8:10 PM on 12-13-10, and new orders were put in place to begin on 12-14-10. The delay of treatment was 4 days. The facility admitted Resident #4 on 7/26/10. The resident was being maintained on bedrest with [DIAGNOSES REDACTED]. Record review on 12/13/10 revealed the resident to be on [MEDICATION NAME] Therapy requiring PT/INR's ([MEDICATION NAME] Time/ International Normalization Ratio) to be drawn routinely. Further record review revealed the labs were drawn timely; however, copies of the lab results did not return timely to the facility nor were they found to have been acted upon timely. Resident #4 had anticoagulant monitoring labs drawn on 8/24/10 which were not called to the Doctor until 8/26/10 when an order was received to increase the [MEDICATION NAME] dose. A PT/INR done and reported on 9/2710 was not received by the facility until 10/21. There was no order change required for this lab. On 10/11 a PT/INR was drawn and reported. and faxed to the physician on 10/13. On 10/25/10 a PT/INR was drawn and results available on 10/25/10. There were three fax dates noted on the report. (10/29/10, 11/1/10, and 11/2/10). On 11/210 the physician faxed an order to the facility to increase the [MEDICATION NAME] dose to 4 milligrams. This was not transcribed to a telephone order nor started until 11/5/10. During an interview with RN #1 (Registered Nurse), the nurse showed this surveyor an audit form that was being used to track labs. However, check marks were only placed if report was faxed, placed in folder, or phone call made to Physician. Some sheets only had the dates reports were received and dates reports were placed in the chart. No follow-up was done by the nurses if a report had been delayed to ascertain the result or the reason why the lab was delayed. The lab test for the 10/25/10 PT/INR for Resident #4 was not been listed on the audit sheet as confirmed by RN #1. The facility admitted Resident #5 on 8/26/09 and readmitted the resident on 11/17/10 with [DIAGNOSES REDACTED]. Record review on 12/13/10 revealed a lab report for a Complete Blood Count (CBC) and a Basic Metabolic Profile (BMP) drawn on 2/08/10. Iron studies were not ordered until 2/14/10 based on the result of the lab of 2/8/10. CBC and BMP were done and reported to the facility on [DATE] with multiple abnormal values noted. The lab report documented an unsuccessful attempt to fax the report to the physician. There was no evidence of subsequent follow up. On 12/14/10, Registered Nurse # 1 was unable to provide an explanation. Review of the medical record revealed Resident #21 was admitted to the facility on [DATE] and readmitted on [DATE]. [DIAGNOSES REDACTED]. Review of the Nurses' Progress Notes dated 11/29/2010 indicated Resident #21 \"complained of congestion, called (the Attending Physician) new order for sputum C&S (culture and sensitivity). At 3:40 PM, the \"sputum culture was obtained from resp(iratory) therapist.\" On 12/4/2010 at 4 AM, Resident #21 complained of nausea and vomiting and a headache. His temperature was 100.4 degrees, pulse of 112 and blood pressure of 145/95 (significantly higher than the 100's systolic as his baseline). On 12/5/2010, Resident #21 refused care. On 12/6/2010 Resident #21 continued to complain of nausea and vomiting, headache and neck ache. On 12/7/2010 at 12:00 AM, Resident #21's temperature was 102.7 and he stated that he did not feel well. His temperature was rechecked at 3:20 AM, and it was recorded as 103 degrees. The physician was notified and an order was obtained to send him to the emergency room . Resident #21 returned from the emergency roiagnom on [DATE] at 9:15 AM, with orders for intravenous antibiotics (IV) for \"[MEDICAL CONDITION].\" On 12/8/2010, Resident #21's antibiotics were changed from IV [MEDICATION NAME] to Cipro, [MEDICATION NAME] and intramuscular (IM) [MEDICATION NAME]. On 12/9/2010 at 9:40 AM, \"new order airborne precautions move to room [ROOM NUMBER]....MRSA sputum.\" Review of the Physician's Telephone Orders revealed the following: 11/29/2010, \"Sputum C&S\"; 12/7/2010 \"Send to ER (emergency room ) for increased temperature\"; 12/7/2010 \" [MEDICATION NAME] 1 gram IV every day for 10 days\". 12/8/2010 \"DC(discontinue) [MEDICATION NAME] and [MEDICATION NAME] mg (milligrams) BID(twice a day), [MEDICATION NAME] 120 mg IM for 7 days\"; 12/9/2010 \" airborne precautions, move to room [ROOM NUMBER]\". Review of the Respiratory Therapy notes revealed on 11/27/2010, Resident #21's sputum was thin and yellow. Additional notes revealed the sputum was noted to be increasing in quantity and was noted to be thick and yellow. No respiratory distress was documented. Review of the Laboratory data revealed a sputum culture was sent to the lab on 11/30/2010. The lab reported the final results to the facility on [DATE]. The facility notified the the Attending Physician on 12/8/2010, two days after receipt of the report. On 12/8/2010 the antibiotic treatment was altered for Resident #21 because [MEDICAL CONDITION] was not sensitive to the current treatment. There was no documentation noted that the nursing staff followed up to assure the timely receipt of the culture, which resulted in the resident not being place on appropriate transmission based precautions in a timely manner. The resident resided in a room with three other residents at high risk for infection related to cormorbidities. The facility admitted Resident #29 on 1/2/2010 with [DIAGNOSES REDACTED]. Record review revealed a physician's orders [REDACTED]. The results of the culture were made available to the facility on [DATE]. The physician was not notified of the positive culture until 11/15/2010. Further review revealed a PT/INR dated 10/11/2010 was available the same day and the physician was not notified until 10/13/2010. An additional PT/INR was available to the facility on [DATE], with physician notification occurring on the 28th . A PT/INR was dated 11/1/2010 and the results were available to the facility on [DATE] but the physician was not notified until 11/3/2010. During an interview the Nurse Manager from Station II, confirmed the delay in obtaining the culture results from 11/30/2010 for Resident #21 and confirmed the delay in notification for the culture and PT/INR results for Resident #29. She stated that normally cultures take 2-3 days to report. She stated that it was the nurses' responsibility to call and check on the results if they were delayed. The nurse stated that the lab normally faxed over the results when they were available. Lab results were also available through the computer. The Nurse Manager stated that the fax machine was located in the business office or the Admissions office, both of which were locked after 5 PM and on weekends. She/he stated that if a lab was faxed on the weekend, the nurses would not receive the results until the following Monday. If the lab was faxed after 5 PM, the nurses would receive the results the next day. The Nurse Manager confirmed that there had been a two day delay in notifying the physician of [MEDICAL CONDITION] positive culture. She stated that the nurses should have faxed the results to the physician immediately upon receipt of the lab. The Nurse Manager also confirmed that Resident #21 was not placed on isolation precautions for [MEDICAL CONDITION] pneumonia until 12/9/2010, 3 days after the report was made available to the facility. During an interview,a representative from the contract Lab stated that sputum cultures take 1-2 days to report. She/he stated that all cultures were sent to --- Hospital. She stated that if there was a delay in obtaining the results that a lab tech would call the hospital to check on the results. She stated that no documentation of the phone calls were kept. The Lab tech stated that the facility had access to the lab results on the computer and the results were available to the facility on the date reported. She also stated that a fax was automatically generated and sent to the facility upon report of the lab. She stated that there was no confirmation receipt kept for specific lab reports. During an interview, the Director of Nursing confirmed the delay in obtaining the culture report and confirmed the delays in reporting the result to the physician for both Resident #21 and #29. She/he also stated that Resident #21 should have been placed on isolation precautions immediately upon receipt of the lab results on 12/6/2010 and should not have waited 3 days. The facility provided policy entitled Change of Condition Care Guard Program stated on page 2 of 3...: \"With the patient/resident's medical record in front of you and the documented assessment on the Change of Condition Nurses Notes form verbally report patient/resident's status to the physician and provide detailed description of the observed signs and symptoms, and any laboratory and or radiology test results that have been obtained.\" The facility provided policy entitled Laboratory Services: Procedure for processing page 2 of 2 (1/99) stated...\"The nurse will screen the reports for abnormal results and document the follow up as needed.\" The facility Administrator and two Corporate Nurse Consultants were present on 12/14/10 at 10:30AM when advised by the Team Leader that Immediate Jeopardy and Substandard Quality of Care had been identified by the survey team as existing in the facility on 9/12/10 after conferring with the State Agency. The Immediate Jeopardy was not removed upon exit from the facility and remains ongoing.", "filedate": "2014-04-01"}
{"rowid": 10163, "facility_name": "UNIHEALTH POST-ACUTE CARE - NORTH AUGUSTA", "facility_id": 425296, "address": "1200 TALISMAN DRIVE", "city": "NORTH AUGUSTA", "state": "SC", "zip": 29841, "inspection_date": "2010-12-15", "deficiency_tag": 505, "scope_severity": "K", "complaint": null, "standard": null, "eventid": "Inf", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the Recertification and Complaint survey, based on observations, interviews, record reviews, and review of facility policies, it was determined on 12/14/10 at 10:30AM that Immediate Jeopardy and Substandard Quality of Care existed for CFR 483.75 F-505 which was identified at a scope and severity of \"K\" which began on 9/12/10. The facility failed to assure laboratory test results were returned to the facility in a timely manner and promptly provided to the physician to use for assessment, diagnoses, treatment and initiation of appropriate infection control practice. The systematic failure to provide lab services and notify the physician promptly placed residents at risk for serious harm. The immediate jeopardy was not removed upon exit from the facility. Residents #'s 1,4,5,6,14,15,21 and 29 who were 8 of 22 sampled residents reviewed for Physician notification of lab services were identified with concerns related to physician notification resulting in a delay of treatment. The findings included: The facility admitted Resident #1 on 6-2-10 with [DIAGNOSES REDACTED]. Record review on 12-14-10 at approximately 5 PM revealed that on 9-12-10, Respiratory Therapy noted moderate yellow sputum and a Physician's Interim Order for \"Sputum Culture today\" was obtained. Further review revealed no laboratory results in the medical record. Review of the Respiratory Therapy notes revealed that the sputum specimen was obtained on 9-15-10. During an interview on 12-14-10 at 6 PM, Registered Nurse (RN) #3 reviewed the medical record and Lab Book and could find no record of the sputum culture having been completed. During an interview on 12-15-10 at 9:20 AM, RN #3 stated that the physician's orders [REDACTED]. She reviewed the Respiratory Therapy Notes with the surveyor and confirmed that the sputum specimen had been obtained on 9-15-10. The lab report was obtained from the computer and RN #3 verified that the lab had received the specimen on 9-16-10 and reported it on 9-20-10. The RN reviewed the Lab Book and confirmed that the lab was entered to be done on 9-13-10 and there was no follow-up to ensure that the results were received and called to the physician in a timely manner. She also reviewed the medical record and could locate no evidence that the physician was ever notified of the results which showed \"pseudomonas aeruginosa 2+\" and the gram stain with \"many\" positive rods and \"many\" white blood cells. Further review revealed that a weekly PT ([MEDICATION NAME])/INR (International Normalization Ratio) was done and the report available to the facility on [DATE] via computer. The lab report noted that the resident was currently \"on 2 mg [MEDICATION NAME]\" and was faxed to the physician on 11-3-10 (2 days later). The PT was 12.9 seconds with a reference range of 10.0 to 13.0. The INR ratio was 1.0 L(ow) with a reference range of 2.0-3.0. The physician wrote an order on the lab report on 11-4-10 to \"Please ^ (increase) to 3 mg\". This order was transcribed onto a Physician's Interim Order form on 11-5-10. During an interview on 12-15-10 at 8:50 AM, Licensed Practical Nurse #4 reviewed the medical record and confirmed that the [MEDICATION NAME] was not increased until 11-5-10 based on the 11-1-10 PT/INR results. Resident # 14 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Review of the medical record on 12/13/10 revealed the resident had a Urine Culture and Sensitivity obtained on 9/16/10. The resident was started empirically on Bactrim on 9/17/10. Per the lab result, a report of the lab was available on 9/18/10 which indicated the resident had an E-Coli infection which was not sensitive to the Bactrim as ordered. Nurses notes documented on 9/20/10 that the resident expressed to the nursing staff that she thought the Bactrim was \"not strong enough to cure UTI\" (urinary tract infection). On 9/21/10 the resident complained of burning all over and asked to go to the emergency room . The resident returned from the emergency room with a new order for Keflex for 10 days and a [DIAGNOSES REDACTED]. The lab report filed in the medical record indicated the result was possibly faxed to the facility on [DATE] and clearly faxed on 9/22/10 and faxed to the physician on 9/22/10. There was no documentation that the facility tried to access the lab result after 48 hours, or attempted to access the result once the resident complained of not feeling better. On 12/14/10 during an interview with the ADON (Assistant Director of Nursing) who was also the Unit Manager she stated that just because the lab result was available in the computer did not mean the facility could access the information. She then called the lab and learn that if the report indicated the result was available it would indeed be available in the computer for the facility staff to access. There was no explanation provided by the Assistant Director of Nursing as to why there was a delay in the receipt of the lab result or fax to the physician. The resident was not included on the audit log on the nursing unit for monitoring for the return of the result or physician notification. Resident # 15 was admitted on [DATE]. A PT/INR ([MEDICATION NAME] time/International Normalization Ratio) was obtained on 11/29/10. The lab report indicated that the result was available on 11/29/10. The report was faxed to the facility on [DATE] and the physician notified on 12/1/10 who then ordered for the [MEDICATION NAME] to be held one day on 12/1/10. The result of the [MEDICATION NAME] was 27.0 (high) and INR 3.4 (high) Resident # 15 had a urine culture obtained on 11/19/10. The lab report indicated the result was available on on 11/21/10. A physician order [REDACTED]. Further interview with the Director of Nursing (DON) revealed that there had been intermittent problems with accessing lab results on the facility computers. A back up plan was for the lab results to be faxed to the facility. However, the fax was located in the business office which closed at 5:30PM and was not open on weekends. Additionally, the DON stated she had trained new hires on how to access labs but now was aware that the weekend supervisor (who worked a 16 hour shift) and potentially other staff hired prior to her arrival did not know to access the labs. Therefore, any lab result received on the weekend was not currently accessible to the nursing staff. Resident #6 was admitted on [DATE] with a [DIAGNOSES REDACTED]. During record review of laboratory reports it was found that a sputum culture was done on 6/10/10 with a report date of 6/12/10. The results were not faxed to the Physician until 6/15/10 at which time the resident was [MEDICATION NAME] mg PO BID for 5 days for a Pseudomonas infection. A Pro-Time of 10/18/10 with a report date of 10/18/10 was not sent to the Physician until 10/21/10 . The result of the lab test was a [MEDICATION NAME] time 18.6 (high) and 1.8 (low). A Pro-time was drawn on 11/1/10 with a report date of 11/1/10 . The result of the test was 21.3 (high) and 2.3. The physician was faxed the results on 11/3/10. There was no documentation found that nursing identified the delay in treatment. The facility admitted Resident #4 on 7/26/10 with [DIAGNOSES REDACTED]. Record review on 12/13/10 revealed the resident to be on [MEDICATION NAME] Therapy requiring PT/INR's ([MEDICATION NAME] Time/ International Nationalizing Ratio) to be drawn routinely. Further record review revealed the labs to be drawn timely; however, copies of the lab results did not appear to return timely to the facility or to be acted upon timely. Resident #4 had labs drawn: 8/24/10 not called to Doctor until 8/26/10 with an order for [REDACTED]. During an interview with RN #1 (Registered Nurse), the nurse showed an audit form that was being used to track labs. However, check marks were only placed if report faxed, placed in folder, or phone call made to Physician. Some sheets only had dates report received and date report placed in the chart. No follow-up was done by the nurses if a report had been delayed to find out why report delayed or to ask what results were. The lab test for 10/25/10 PT/INR for Resident #4 had not been listed on the audit sheet. This was confirmed by RN #1. Therefore, no one questioned why the result was not faxed until 10/29 and not faxed to doctor until 11/2. The Physician ordered an increase of 1 mg (milligram) to the current [MEDICATION NAME] order on 11/2/10. The facility admitted Resident #5 on 8/26/09 and readmitted on [DATE] with [DIAGNOSES REDACTED]. Record review on 12/13/20 revealed a lab report for a Complete Blood Count (CBC) and a Basic Metabolic Profile (BMP) drawn on 2/08/10. The report was reviewed on 2/14/10 and iron studies ordered. A lab report done on 8/30/10 and sent to facility on 8/30/10 for CBC and BMP had irregularities noted. Note on bottom of report faxed to doctor- fax unsuccessful. There was no documentation of any follow up to refax or call to the doctor. Review of the medical record revealed Resident #21 was admitted to the facility on [DATE] and readmitted on [DATE]. [DIAGNOSES REDACTED]. Review of the Nurses' Progress Notes dated 11/29/2010 indicated Resident #21 \"complained of congestion, called (the Attending Physician) new order for sputum C&S (culture and sensitivity). At 3:40 PM, the \"sputum culture was obtained from resp(iratory) therapist.\" On 12/4/2010 at 4 AM, Resident #21 complained of nausea and vomiting and a headache. His temperature was 100.4 degrees, pulse of 112 and blood pressure of 145/95 (significantly higher than the 100's systolic as his baseline). On 12/5/2010, Resident #21 refused care. On 12/6/2010 Resident #21 continued to complain of nausea and vomiting, headache and neck ache. On 12/7/2010 at 12:00 AM, Resident #21's temperature was 102.7 and he stated that he did not feel well. His temperature was rechecked at 3:20 AM, and it was recorded as 103 degrees. The physician was notified and an order was obtained to send him to the emergency room . Resident #21 returned from the emergency roiagnom on [DATE] at 9:15 AM, with orders for intravenous antibiotics (IV) for \"[MEDICAL CONDITION].\" On 12/8/2010, Resident #21's antibiotics were changed from IV [MEDICATION NAME] to Cipro, [MEDICATION NAME] and intramuscular (IM) [MEDICATION NAME]. On 12/9/2010 at 9:40 AM, \"new order airborne precautions move to room [ROOM NUMBER]....MRSA sputum.\" Review of the Physician's Telephone Orders revealed the following: 11/29/2010, \"Sputum C&S\"; 12/7/2010 \"Send to ER (emergency room ) for increased temperature\"; 12/7/2010 \" [MEDICATION NAME] 1 gram IV every day for 10 days\". 12/8/2010 \"DC(discontinue) [MEDICATION NAME] and [MEDICATION NAME] mg (milligrams) BID(twice a day), [MEDICATION NAME] 120 mg IM for 7 days\"; 12/9/2010 \" airborne precautions, move to room [ROOM NUMBER]\". Review of the Respiratory Therapy notes revealed on 11/27/2010, Resident #21's sputum was thin and yellow. Additional notes revealed the sputum was noted to be increasing in quantity and was noted to be thick and yellow. No respiratory distress was documented. Review of the Laboratory data revealed a sputum culture was sent to the lab on 11/30/2010. The lab reported the final results to the facility on [DATE]. The facility notified the the Attending Physician on 12/8/2010, two days after receipt of the report. On 12/8/2010 the antibiotic treatment was altered for Resident #21 because [MEDICAL CONDITION] was not sensitive to the current treatment. There was no documentation noted that the nursing staff followed up to assure the timely receipt of the culture, which resulted in the resident not being place on appropriate transmission based precautions in a timely manner. The resident resided in a room with three other residents at high risk for infection related to cormorbidities. The facility admitted Resident #29 on 1/2/2010 with [DIAGNOSES REDACTED]. Record review revealed a physician's orders [REDACTED]. The results of the culture were made available to the facility on [DATE]. The physician was not notified of the positive culture until 11/15/2010. Further review revealed a PT/INR dated 10/11/2010 was available the same day and the physician was not notified until 10/13/2010. An additional PT/INR was available to the facility on [DATE], with physician notification occurring on the 28th . A PT/INR was dated 11/1/2010 and the results were available to the facility on [DATE] but the physician was not notified until 11/3/2010. During an interview the Nurse Manager from Station II, confirmed the delay in obtaining the culture results from 11/30/2010 for Resident #21 and confirmed the delay in notification for the culture and PT/INR results for Resident #29. She stated that normally cultures take 2-3 days to report. She stated that it was the nurses' responsibility to call and check on the results if they were delayed. The nurse stated that the lab normally faxed over the results when they were available. Lab results were also available through the computer. The Nurse Manager stated that the fax machine was located in the business office or the Admissions office, both of which were locked after 5 PM and on weekends. She/he stated that if a lab was faxed on the weekend, the nurses would not receive the results until the following Monday. If the lab was faxed after 5 PM, the nurses would receive the results the next day. The Nurse Manager confirmed that there had been a two day delay in notifying the physician of [MEDICAL CONDITION] positive culture. She stated that the nurses should have faxed the results to the physician immediately upon receipt of the lab. The Nurse Manager also confirmed that Resident #21 was not placed on isolation precautions for [MEDICAL CONDITION] pneumonia until 12/9/2010, 3 days after the report was made available to the facility. During an interview,a representative from the contract Lab stated that sputum cultures take 1-2 days to report. She/he stated that all cultures were sent to --- Hospital. She stated that if there was a delay in obtaining the results that a lab tech would call the hospital to check on the results. She stated that no documentation of the phone calls were kept. The Lab tech stated that the facility had access to the lab results on the computer and the results were available to the facility on the date reported. She also stated that a fax was automatically generated and sent to the facility upon report of the lab. She stated that there was no confirmation receipt kept for specific lab reports. During an interview, the Director of Nursing confirmed the delay in obtaining the culture report and confirmed the delays in reporting the result to the physician for both Resident #21 and #29. She/he also stated that Resident #21 should have been placed on isolation precautions immediately upon receipt of the lab results on 12/6/2010 and should not have waited 3 days. The facility's policy on Changes in Condition was reviewed. The policy documented that the nurses were to \"verbally report resident's status to the physician and provide detailed description of the observed signs and symptoms and any laboratory and or radiology test results. Communication...must occur in a timely manner...\" The facility Administrator and two Corporate Nurse Consultants were present on 12/14/10 at 10:30AM when advised by the Team Leader that Immediate Jeopardy and Substandard Quality of Care had been identified by the survey team after conferring with the State Agency. The Immediate Jeopardy was not removed upon exit from the facility and remains ongoing. First Follow-Up Visit During an unannounced onsite visit on 12/30/2010 at 10:30 AM, it was determined based on interviews, observations, review of records, and review of facility policies, that the Allegation of Compliance submitted by the facility on 12/22/2010 had been implemented by the facility and was in practice as of 12/22/2010, removing the immediacy of the deficient practice. The citation at F-505 remained at a lowered scope and severity of \" E\". The facility will be in compliance at F-505 when an acceptable Plan of Correction is submitted and a follow up visit is conducted to determine that the facility has implemented their Plan of Correction as stated.", "filedate": "2014-04-01"}
{"rowid": 10164, "facility_name": "UNIHEALTH POST-ACUTE CARE - NORTH AUGUSTA", "facility_id": 425296, "address": "1200 TALISMAN DRIVE", "city": "NORTH AUGUSTA", "state": "SC", "zip": 29841, "inspection_date": "2010-12-15", "deficiency_tag": 153, "scope_severity": "G", "complaint": null, "standard": null, "eventid": "Inf", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the Recertification, Complaint survey,and Extended Survey, based on record reviews, review of facility documents, and interviews, the facility failed to ensure that the resident's legal representative was provided with the opportunity to purchase copies of the medical record for 2 of 7 resident representative requests reviewed (Residents #23 and #39) and failed to provide copies of requested records in two working days for 3 of 7 resident representative requests approved to received them (Residents C, D, E). The findings included: During the Entrance Conference, the facility was asked to provide a list of requests made since [DATE] for copies of resident medical records. A list of nineteen names was provided. The facility was then asked to provide dated request forms and evidence the copies were provided as requested. Documents for eighteen residents were provided which included Authorization For Use & Disclosure Of Information, PHI (protected health information) Request Cover Sheet, written requests, Power of Attorney documentation, Certificates of Appointment, Fiduciary Letters, letters of denial, e-mail correspondence with the facility medical records person, \"Goin Postal\" receipts for certified letters, Medical Record Billing Invoices, and Certified Mail receipts. None of the resident information packets contained copies of all the above listed forms, usually two or three forms were provided for each resident. All of the resident representatives who requested copies of the medical record were identified by the facility as the resident's Responsible Party and were the individuals notified concerning changes in the resident's condition or treatment (protected health information). The denials all stated in part: \"... As you may be aware, the Health Insurance Portability and accountability Act and the privacy regulations promulgated thereunder (collectively, \"HIPAA\") has imposed strict requirements on health care providers regarding the release of protected health information (\"PHI\") Under HIPAA, a provider may release PHI of an individual to a personal representative authorized under state law to act on behalf of the individual. See 45 CFR 164.502(g). Further, HIPAA requires that the provider verify the identity of the personal representative and that person's authority to access PHI as a personal representative. 164.514(h)(1)(i). Such a personal representative may be a durable power of attorney for health care or guardian of the person if the individual is living or the permanent administrator or executor of the estate if the individual is deceased . The center will not be able to release these records until it receives verification of the applicable representation. ...\" Resident #23 arrived at the facility on [DATE]. His [DIAGNOSES REDACTED]. Review of the resident assessments of [DATE] and [DATE] showed no memory, decision making, or communication problems. On admission, the resident's brother was listed as the Responsible Party but this was changed to his son on an unknown date. The resident's son did start receiving the resident's Statement of Account by [DATE]. Resident #23's son began requesting copies of the medical record on [DATE]. The resident was transferred to the hospital on [DATE] and expired later that day. His son continued to make multiple requests for copies of the medical record and enlisted the aide of The Regional Ombudsman. His requests were repeatedly denied by the corporation legal staff. The Power of Attorney document provided by the son was deemed unacceptable. The probate court's certification of the son as the resident's personal representative was also deemed insufficient. Resident #23's son was directed to produce a fiduciary letter. During an interview with the Administrator on [DATE] at 8:35 AM, a representative from the corporate legal department was called and confirmed that copies of the resident's medical record had not been provided because the son failed to produce fiduciary letters. Resident #39 entered the facility on [DATE]. Her [DIAGNOSES REDACTED]. The resident's daughter was listed as her Responsible Party. Review of the resident assessment of [DATE] revealed the facility was unable to assess the resident's memory and decision making ability due to her medical status. Communication was impaired. Resident #39 was found unresponsive on [DATE]. Cardiopulmonary resuscitation was initiated and the resident was sent to the hospital where she expired. The daughter was notified of all the events leading to discharge. On [DATE], the resident's daughter requested copies of her mother's medical record and was denied that same day. The corporate representative stated during the interview on [DATE] that it was because she did not have the resident's Healthcare Power of Attorney. Information provided by the facility revealed the following information concerning lack of timeliness in addressing requests for copies of the medical record made by resident representatives: The resident representative for Resident C requested copies of the medical record on [DATE] and was initially denied on [DATE] but documents provided by the facility showed this decision was reversed at a later date. The second request, made on [DATE], showed corporate approval on [DATE] and a posting bill dated [DATE]. Resident D's representative made a request for copies on [DATE] and did not receive approval for the copies until [DATE]. Resident E's representative requested copies of the record on [DATE] but did not receive approval for the copies until [DATE].", "filedate": "2014-04-01"}
{"rowid": 10165, "facility_name": "UNIHEALTH POST-ACUTE CARE - NORTH AUGUSTA", "facility_id": 425296, "address": "1200 TALISMAN DRIVE", "city": "NORTH AUGUSTA", "state": "SC", "zip": 29841, "inspection_date": "2010-12-15", "deficiency_tag": 225, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "Inf", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey and complaint investigations, based on review of the facility's investigation into allegations of abuse and/or neglect, the facility failed to thoroughly investigate 2 of the 5 allegations reviewed (Residents #24 and #26). The findings included: Resident #24 with [DIAGNOSES REDACTED].#4. A day shift CNA reported that same day that the resident was found on several mornings with soaked and/or stained linens. The facility obtained statements from the resident's roommate, the accused CNA, and one other CNA assigned to provide care to the resident on one of the \"several\" 11-7 shifts. The facility failed to investigate to determine the exact dates of the alleged verbal abuse and the exact dates of the alleged neglect of the resident. Their investigation failed to show evidence that other staff members were interviewed concerning the allegations in an effort to identify other potential perpetrators or witnesses to the alleged abuse and neglect. Resident #26 was admitted with [DIAGNOSES REDACTED]. Review of the facility's \"Initial 24-Hour Report\" dated 12/02/10 and the \"Five-Day Follow-Up Report\" dated 12/08/10 revealed the alleged perpetrator CNA (Certified Nursing Aide) #13 was not interviewed related to allegation of abuse. Further review of the completed investigative report submitted by the facility revealed that no one at the facility attempted to interview CNA #13. Review of the facility policy on Abuse and Neglect in the \"INVESTIGATING\" under page 1 of 3 #1 *\"Investigation documentation will include, but not be limited to, the following: \"Date and time of the alleged occurrence. Patient/resident's full name and room number. Names of the accused and any witnesses. Names of the healthcare center/agency staff who investigated the allegations. Any physical evidence and description of emotional state of patient/resident (s). Details of the alleged incident and injury. Signed statements from pertinent parties.\" On page 2 of 3 under \"INVESTIGATING\" the second paragraph indicated \"Interviews will be conducted of all pertinent parties, utilizing open-ended questions. Written signed statements from any involved parties will be obtained and notarized, if indicated. Statements will be gathered from the suspect, person making accusations, patient/resident involved, reliable patient/residents who may have witnessed the incident, and any other persons who may have some information.\" During an interview with this surveyor on 12/13/10 at 10:30 AM, the DON (Director of Nursing) stated she had the responsibility of investigating allegations of staff to resident abuse and neglect. The DON further confirmed she made no effort to obtain a written statement from CNA #13. The DON stated that no one had attempted to get a witness statement from the alleged perpetrator. The DON confirmed CNA #13 and alleged suspect was a \"pertinent party\" involved and stated she did not follow the abuse policy related to investigation in obtaining a statement from the CNA.", "filedate": "2014-04-01"}
{"rowid": 10166, "facility_name": "UNIHEALTH POST-ACUTE CARE - NORTH AUGUSTA", "facility_id": 425296, "address": "1200 TALISMAN DRIVE", "city": "NORTH AUGUSTA", "state": "SC", "zip": 29841, "inspection_date": "2010-12-15", "deficiency_tag": 498, "scope_severity": "F", "complaint": null, "standard": null, "eventid": "Inf", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on observations, interviews, review of staff development records, review of the facility policy entitled \"NURSING: PERINEAL CARE\" (revised 4/07),the facility provided policy for Handwashing and review of the South Carolina Nurse Aide Candidate Handbook (January 2010), the facility failed to ensure that nurse aides were able to demonstrate competency related to implementation of infection control precautions in the provision of incontinent care. Nurse Aides failed to provide appropriate care and services to prevent infections for 13 of 20 residents (Residents #1, #5, #14, #15, #16, #17, #18, #19, #20, #30, #31, #32, #34) during 14 observations for incontinent care. Deficient practice and substandard quality of care was identified (CFR F- 315) during provision of incontinent care by nine of eleven Certified Nursing Assistants (CNAs) on two of three shifts and on three of three nursing units. The findings included: The facility admitted Resident #20 on 11-27-09 with Chronic [MEDICAL CONDITION] and multiple cormorbidities. During observation of incontinent care on 12-13-10 at 5:10 AM, after Certified Nursing Assistants (CNAs) #9 and #10 washed their hands and applied gloves, CNA #10 uncovered the resident from waist to feet and detached his incontinent brief. CNA #9 was unable to locate supplies at the bedside to provide incontinent care. She removed her gloves and left the room to obtain disposable wipes. CNA #9 reentered the room, applied gloves without washing her hands, and proceeded to provide care to the resident who had been incontinent of urine and feces. CNA #9 used one disposable wipe to cleanse both upper inner thighs and groin areas, then the penis, without changing the position of the cloth. When cleansing the penis, the CNA wiped down the shaft, toward the urethra, then cleansed the glans penis. The resident was positioned onto his right side and the CNA proceeded to cleanse the perianal area and buttocks of fecal material, using a single wipe repeatedly over the same areas without moving the position of the cloth. The testicles were never cleansed. The facility admitted Resident #30 on 11-19-10 with [DIAGNOSES REDACTED]. During observation of incontinent care on 12-13-10 at 5:15 AM, after Certified Nursing Assistants (CNAs) #9 and #10 washed their hands and applied gloves, CNA #9 was again unable to locate supplies at the bedside to provide incontinent care. She removed her gloves and left the room to obtain disposable wipes. CNA #9 reentered the room, again applied gloves without washing her hands, and proceeded to assist CNA #10 to provide care to the resident who had been incontinent of urine and feces. CNA #10 used one disposable wipe to cleanse both sides of the groin and pubic areas. With a second wipe, the CNA cleansed down the penile shaft repeatedly toward the urethra, without changing the position of the cloth. CNA #10 then pulled the foreskin back and cleansed the glans penis with another cloth, but again wiped repeatedly over the same areas. The resident was positioned onto his right side and the CNA proceeded to cleanse the buttocks of a large amount of fecal material, using a single wipe repeatedly over the same areas without moving the position of the cloth. The buttocks and perianal areas were cleansed using at least 6 disposable wipes, each of which were used repeatedly over the same areas from four to nine times. During an interview on 12-15-10 at 8:05 AM, when CNAs #9 and #10 were asked what could have been done better during the incontinent care provided to Residents #20 and #30, CNA #10 stated \"handwashing\". She further stated, \"You should use one wipe and throw it away\" and \"wipe front to back.\" The facility admitted Resident #1 on 6-2-10 with [DIAGNOSES REDACTED]. On 12-13-10 at 9:35 AM, the surveyor knocked and entered the room after obtaining permission to do so. CNA #8 was positioning the resident onto her right side to provide incontinent care. The CNA used disposable wipes to cleanse the buttocks and reddened perianal area of fecal material, wiping back to front repeatedly, toward the vaginal/urethral area, using the same position of the cloths. After repositioning the resident onto her back, the CNA noted fecal material present and cleansed the right outer labia, front to back, repeatedly with the same cloth. She took another cloth and cleansed the left outer labia, then the right, going over the same area twice, then the inner labia, without changing the position of the cloth. CNA #8 positioned the resident onto her left side and cleansed the right buttock and perianal areas from back to front using the same area of the cloth. The CNA repositioned the resident onto her back, obtained another wipe, and cleansed the left and right outer labia, then the inner labia using the same position on the cloth. Review of staff development records provided by the Clinical Competency Coordinator (CCC) on 12-15-10 revealed that CNAs #8 and #10 had been hired on 12-1-10. CNA #8 had documented orientation training on peri-care on 12-10-10. CNA #10 had documented orientation training on 12-6-10 on peri-care. The Orientation Checklist for CNA #10 was signed off by CNA #9. Review of CNA #9's personnel file provided by Human Resources on 12-15-10 at 9:55 AM revealed that her Skills Competency Checklist was blank. On 12-15-10 at 12:05 PM, the CCC stated she had no records of orientation for CNA #9. The CCC did provide a list of ongoing training for CNA #9 which did include attendance at an inservice on handwashing in 3-10. Resident #31 was observed for incontinent care by CNA #12 on 12/13/10 at approximately 5 AM. The CNA washed her hands and gloved before starting the procedure. She cleansed the resident, applied A&D ointment, applied a new brief, adjusted the resident's booties, positioned the resident, and pulled up the bed linens with the same gloves. While still wearing the gloves used to cleanse the resident, CNA #12 used the bed cranks to adjust the knees and head of the bed, then she restarted the feeding pump. After she finished these tasks, CNA #12 removed her gloves and washed her hands. Resident #32 was observed during incontinent care on 12/13/10 at approximately 5:30 AM. CNA #12 provided the care after washing her hands and applying gloves. The CNA removed the wet brief, cleansed the resident, applied a new brief, then positioned the resident and adjusted the bed linens while wearing the same soiled gloves. The facility was asked to produce training records for CNA #12. A one page document was provided on 12/15/10 titled Course Completion with a Date Range 1/1/2010 - 12/15/2010. There was no evidence showing CNA #12 completed training related to appropriate incontinent care or appropriate infection control resident care measures. The facility admitted Resident # 34 on 2-5-10. On 12/13/10, CNA # 7 was observed providing incontinent care for Resident # 7. CNA # 7 knocked, entered the room, provided privacy, explained the procedure to the resident, washed her hands and gloved. She then positioned the resident on her back and unfastened her brief. Using the wipes located on the over the bed table, CNA # 7 cleaned the front perineal area, discarding the wipes as used, and turned the resident on to her right side and began cleaning the back. Feces was present, and multiple wipes were used and discarded as needed. Using a tube of A & D Ointment which was on the over the bed table, CNA # 7 then put a liberal amount on her soiled gloved hands and spread it over a large area of the buttocks. The CNA stated that the resident's skin was irritated. No training records were available for review for CNA # 7 as stated by the CCC during an interview conducted on 12/14/10 at approximately 5:05PM. Resident # 16 was last admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Certified Nursing Assistant # 4 had begun care prior to the surveyor entering the room. The resident had been incontinent of both bowel and bladder. The CNA was observed wetting a bath towel in the sink, which she then used to clean feces from the resident who was positioned on his right side. The towel was rolled in a large ball and rubbed up and down the resident's buttocks and lower back. The CNA was observed to remove her soiled gloves and without washing her hands, walk to the utility room to obtain more wipes and then to the clean linen room to obtain clean linens. CNA # 4 returned to the resident's room and applied gloves without washing her hands. Using wipes she again began cleaning feces in an upward, downward motion. Without changing gloves, she then put a clean sheet, lift sheet and soaker pad on the resident's bed. After repositioning the resident and adjusting the linens, the CNA then pulled the brief up between the resident's legs. The CNA was asked by this surveyor to re-open the brief. Large amounts of loose feces were observed in the inner groin folds which had not been cleaned by the CNA. The CNA cleaned the inner groin folds and resident testicle area but did not clean the penis. Wearing the soiled gloves, a clean brief was obtained from the closet and applied. Before removing her gloves and washing her hands, the CNA applied the resident's gown, removed the soiled linen from the bed, tucked in the clean linen on the right side of the bed, and placed wipes in the bedside table. Resident # 15 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. The CNA asked the resident, \"You not need no diaper change?\" The resident replied: \"Yeah, I'm wet.\" It was determined that the resident's suprapubic Foley had leaked and he required assistance. CNA# 4 was observed to use one wipe and cleanse multiple times down the left side of the groin and repeat the same action on the right side of the groin. Without having the resident turn fully on his side, the CNA reached under and using one wipe, repeatedly cleansed the buttock area which could not be visualized. The resident was noted to be red in the inner groin folds. No attempt to clean the resident's testicles or penis was observed. Continuing to wear the same gloves, the CNA raised the head of the bed, covered the resident, emptied the bedside drainage bag, and wiped spilled urine from the floor with a paper towel before removing her gloves and washing her hands. A review of the training record provided by the facility on 12/15/10 for CNA # 4 revealed an undated skills competency list where all skills were marked as satisfactory at the same time/date and one handwashing video which did not require a return demonstration dated 3/28/10. A review of the training record provided by the facility on 12/15/10 for CNA # 4 revealed an undated skills competency list where all skills were marked as satisfactory at the same time/date and one handwashing video which did not require a return demonstration dated 3/28/10. Resident # 17 was last admitted to the facility on [DATE]. An observation of Certified Nursing Assistant # 5 performing incontinent/perineal care for the resident was conducted on 12/13/10 at 5AM. The CNA was observed to tidy the roommate's area before beginning care for Resident # 17. CNA # 5 was observed to apply gloves without first washing her hands after caring for the resident in the A bed. The CNA unfastened the resident's brief and assisted her to turn over. The buttock area was cleaned using separate wipes. There was slight fecal staining of the wipes noted. The soiled brief was removed and a new brief placed under the resident. Without changing gloves and using single wipes, the CNA cleansed down the right side of the labia, and twice down the left side. No attempt was observed to clean the inner labia. The brief was fastened, clothing adjusted, and call light placed before removing the soiled gloves. The CNA then gathered the trash, returned the wipes to the drawer, raised the head of the bed, opened the curtain, opened the door to the soiled utility room and discarded the trash. There were no paper towels in the utility room so the CNA was observed to use hand sanitizer hung in the hallway to clean her hands. Resident # 18 was admitted to the facility on [DATE]. An observation of perineal/incontinent care was observed on 12/13/10 at approximately 5:10AM. CNA # 5 applied gloves, obtained wipes from the bedside stand, and unfastened the resident's brief. The resident was noted to be incontinent of urine and stool. The CNA wiped down the right and left side of the groin using separate wipes. She then opened the bedside stand to obtain more wipes and found none. The resident's brief was fastened, the resident covered, curtain opened before the soiled gloves were removed. At 5:22AM the CNA returned to the room, applied gloves and opened the resident's brief. Using separate wipes, the CNA cleaned the right and left side of the labia, and made one swipe down the center without opening the labia. The resident was turned on her side and after cleaning the feces from the perineal area, the CNA was observed to raise the resident's leg and using a clean wipe, wiped twice near the front labia. After adjusting the resident's clothing, the soiled gloves were removed, the resident covered, curtain opened, table moved, wipes returned to storage before the CNA washed her hands. A review of the training record for CNA # 5 provided by the facility on 12/15/10 revealed no skills check list and no print out of hourly in-services. The CNA was hired by the facility on 10/13/10. Resident # 5 was last admitted to the facility on [DATE]. On 12/14/10 at 11:45AM, an observation of perineal/incontinence care was conducted when the resident was found to have been incontinent of urine when pressure ulcer care was to be done. With the wound care nurse present, CNA # 3 was observed to use one wipe and wipe once across/under the abdominal fold, multiple times in the right, left groin folds and down the center of the labia. A clean brief was placed on the resident without cleaning the buttock area. Following the procedure, the CNA was interviewed. When asked if she had been trained in incontinence/perineal care, she stated yes, in 2005. She denied having received further training since that time, stating she had only worked at the facility for about a month. When asked if the facility had evaluated her competency/skill, she stated\"no\". When asked about her orientation to the facility, she stated she had walked with a CNA and \"watched\". When asked if she could identify any concerns related to the care she had provided, she stated she may not have cleaned her well and may not have wiped the right way. On 12/14/10, in an interview conducted with the wound care nurse who was present during the incontinent/perineal care, she was asked if she had any concerns related to her observation. She confirmed that the incontinence care was not appropriate and that she should have stopped the CNA and corrected her. A copy of the training record for CNA # 3 was requested but was not provided as the CNA had been recently hired and her orientation check sheet \"had not been returned.\" There was no documentation that the CNA's competency had been tested upon hire to the facility or her skills evaluated. The facility admitted Resident #5 on 8/26/09 and readmitted on [DATE]. During 5:00 AM rounds , CNA #11 (Certified Nursing Assistant), was observed to do perineal care on Resident #5. The CNA took a disposable wipe and cleansed back and forth across the pubic area, down the right groin area, down the left groin area, and then down the center of the vagina area. The CNA used the same cloth without changing sides to clean the above areas. Once the resident was turned to the side, the CNA took another disposable wipe and cleaned back and forth over right and left buttocks, and front to back over the creases and anal area. The same cloth was used without changing sides over all these areas. A second observation of perineal/incontinence care was conducted when the resident was found to have been incontinent of urine when pressure ulcer care was to be done. With the wound care nurse present, CNA # 3 was observed to use one wipe and wipe once across/under the abdominal fold, multiple times in the right, left groin folds and down the center of the labia. A clean brief was placed on the resident without cleaning the buttock area. Following the procedure, the CNA was interviewed. When asked if she had been trained in incontinence/perineal care, she stated, \"Yes, in 2005\". She denied having received further training since that time, stating she had only worked at the facility for about a month. When asked if the facility had evaluated her competency/skill, she stated, \"No\". When asked about her orientation to the facility, she stated she had walked with a CNA and \"watched\". When asked if she could identify any concerns related to the care she had provided, she stated she may not have cleaned her (the resident) well and may not have wiped the right way. On 12/14/10, in an interview conducted with the wound care nurse who was present during the incontinent/perineal care, she was asked if she had any concerns related to her observation. She confirmed that the incontinence care was not appropriate and that she should have stopped the CNA and corrected her. A copy of the training record for CNA # 3 was requested but was not provided as the CNA had been recently hired and her orientation check sheet \"had not been returned.\" There was no documentation that the CNA's competency had been tested upon hire to the facility or her skills evaluated. The facility admitted Resident # 14 on 12/08/08. During 5:00 AM rounds, CNA #11 (Certified Nursing Assistant), was observed to provide perineal care on Resident #14. The CNA took a disposable wipe and cleansed back and forth across the pubic area, down the right groin area, down the left groin area, and then down the center of the vagina area. The CNA used the same cloth without changing sides to clean the above areas. Once the resident was turned to side, the CNA took another disposable wipe and cleaned back and forth over right and left buttocks, and front to back over the creases and anal area. The same cloth was used without changing sides over all these areas. The facility admitted Resident # 19 on 12/02/08. During 5:00 AM rounds with CNA #11 (Certified Nursing Assistant), CNA # 11 was observed to do perineal care on Resident #19. . The CNA took a disposable wipe and swiped back and forth across the pubic area, down the right groin area, down the left groin area, and then down the center of the vagina area. The CNA used the same cloth without changing sides to clean the above areas. Once the resident was turned to side, the CNA took another disposable wipe and cleaned back and forth over right and left buttocks, and front to back over the creases and anal area. The same cloth was used without changing sides over all these areas. After removing gloves the CNA did not wash hands before leaving the room to take soiled linen to the soiled utility room. On 12/15/10 all inservices and skills check off list were requested for CNA # 11 (Certified Nursing Assistant). Records reviewed documented an inservice on Handwashing 3/24/10 and a skills check-off including peri-care (not dated as to completion date). No other inservice documentation was provided. Review of the facility policy entitled \"NURSING: PERINEAL CARE\" (revised 4/07) revealed the following: \"GENERAL INFORMATION: ...3. Cleanse perineal area from front to back....PROCEDURE: 1. Wash hands. 2. Assemble necessary equipment... 10. For females: -Separate labia then clean downward from front to back with one stroke. -Repeat using a clean part of the washcloth/wipe for each stroke. More than one...may need to be used... -Clean rectal area from the vagina to the anus with one stroke. -Repeat until area is clean using a clean part of the washcloth/wipe with each stroke... 11. For males: -If uncircumcised retract foreskin. -Grasp penis. -Clean the tip using a circular motion. Start at the urethra and work outward. Repeat as needed, using a clean part of the washcloth/wipe each time... -Return the foreskin to its natural position. -Clean the shaft of the penis and top of the scrotal sack. Use firm downward [MEDICAL CONDITION] -...Cleanse rectal area and bottom of scrotal sack. Clean from front to back with one stroke... 19. Wash hands thoroughly.\" Review of the South Carolina Nurse Aide Candidate Handbook (January 2010) revealed the following under \"SKILLS LISTING\": ...\"Washes Hands is listed first as a reminder of the importance of performing this skill before all other skills.\" Directions for providing peri-care to females included: \"...8. Washes genital area, moving from front to back, while using a clean area of the washcloth for each stroke...11. After washing genital area, turns to side...\" The facility provided policy titled Handwashing Techniques (8/)*) stated: \"Hands should be washed before and after patient/resident contact and as necessary during patient/resident care.\" The purpose of the policy was to: \"Thoroughly cleanse hands before and after resident/patient contact and or contact with the patient/resident environment to reduce microbial count and prevent the spread of infection. Cross Refer 42 CFR 483.25(d)(2) Related to facility failure to provide appropriate treatment and services to prevent urinary tract infections. On the days of the survey, based on observations, interviews, review of the facility policy entitled \"NURSING: PERINEAL CARE\" (revised 4/07), and review of the South Carolina Nurse Aide Candidate Handbook (January 2010), substandard quality of care was identified based on facility failure to provide appropriate care and services to prevent infections for 14 of 20 residents (Residents #1, #4, #5, #14, #15, #16, #17, #18, #19, #20, #30, #31, #32, #34) who were observed for incontinent care. Deficient practice was identified during provision of incontinent care by nine of eleven Certified Nursing Assistants (CNAs) on two of three shifts and on three of three nursing units.", "filedate": "2014-04-01"}
{"rowid": 10167, "facility_name": "UNIHEALTH POST-ACUTE CARE - NORTH AUGUSTA", "facility_id": 425296, "address": "1200 TALISMAN DRIVE", "city": "NORTH AUGUSTA", "state": "SC", "zip": 29841, "inspection_date": "2010-12-15", "deficiency_tag": 441, "scope_severity": "F", "complaint": null, "standard": null, "eventid": "Inf", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on observation, record review, interview and review of the facility policy and procedure related to Infection Control, the facility failed to establish and maintain an effective Infection Control Program. The facility failed to maintain accurate records of infections to determine tracking and trending by resident and organism. (Resident # 30) The facility failed to initiate transmission based precautions in a timely manner for Resident # 21 with a known drug resistant respiratory infection who was located in a multi-bed room; Resident personal equipment was not labelled for individual use; Oxygen equipment was not maintained in a sanitary manner for Resident # 32; and 1 of 3 housekeeping staff was not knowledgeable in housekeeping procedures required to clean resident room who were on isolation. The facility failed to ensure staff used appropriate handwashing during resident care. The facility failed to handle soiled linen in a way which prevented the spread of infection as observed during resident care and observation of the laundry process. The findings included: During Initial Tour of the facility on 12-13-10 at approximately 5:05 AM, this surveyor observed Certified Nursing Assistant (CNA) # 7 coming out of room # 117 with a bag of soiled linen. CNA # 7 went into the soiled utility room, placed the linen in a linen barrel, left the room, and went into the clean linen room. She then proceeded to obtain clean linen and returned to room # 117 to make up the bed. CNA # 7 did not wash her hands after disposing of the soiled linen and before she handled the clean linen. At approximately 6:00 AM, CNA # 7 entered room # 113 in response to a call light, and assisted a resident into the bathroom. On the counter beside the sink in the room were two used urinals with no resident identification. CNA # 7 put each urinal into separate bags and set them in the bathroom, The room was occupied by 2 male residents, but the CNA did not label the urinals as to whom they belonged. During an interview with the CCC (Clinical Competency Coordinator) on 12-14-10 at approximately 5:05 PM, she confirmed that CNA # 7 should have washed hands after depositing soiled linen in the soiled linen room, and that urinals should be labeled with the resident's name and should always be bagged and left in the bathroom instead of at the sink. Resident #32 received incontinent care from CNA #12 on the morning of 12/13/10, at approximately 5:30 AM. The resident's oxygen nasal cannula and the face mask for a positive pressure delivery system were observed on the floor by the bed. After providing the incontinent care and positioning the resident, CNA #12, while wearing the same gloves, picked up the face mask and placed it into a plastic bag that was on top of the dresser next to the pressure machine. As CNA #12 picked up the nasal cannula, the resident asked for it to be applied. The CNA gave the cannula to the resident who proceeded to apply the cannula, beginning by inserting the nasal prongs into her nose. Neither appliance was observed to have been cleansed or sanitized. When interviewed about the facility Infection Control Logs, the CCC who was designated as the person responsible for the facility infection control program, she stated that the nurses were responsible to complete an infection report on each lab which indicated an infection. The report was to be submitted into her for evaluation and entry into the Infection Control log via computer. She commented that the reports were often incomplete, without the organism type listed, with missing data related to symptom onset, antibiotic used or interventions which had been put into place. She further stated that the reports were not given to her in a timely fashion. The CCC stated that sometimes she was not informed about isolation precautions until after they were implemented. She further stated that she had been out sick the first part of December and when she returned she found that a number of labs had been missed by the nurses on each unit. She made a list of the missing labs and gave it to the Director of Nursing. The CCC also stated that she provided the training for isolation, use personal protective equipment, hand washing and that she was responsible for new hires orientation. Review of the nine Certified Nursing Assistants (CNA) which were identified as giving incorrect incontinent care during the survey, revealed that not all of the cited nursing assistants had attended the inservice for Handwashing dated 3/23/10 and the Infection Control inservice dated 4-7-10. An incomplete list of training for Infection Control Inservice was provided during the survey. Review of the Infection Control Logs revealed the logs were incomplete, with only 22 of 282 infection reports identified by organism. The October 2010 monthly summary report was also not included in the information given to the survey team. The CCC stated that she did not monitor trends until the end of each month. When asked how she would know if a virus or outbreak of infections was occurring, she stated that she depended on the nurses to relay that information to her. Review of the personnel file for the Clinical Competency Coordinator on 12-15-10 at approximately 8:45 AM revealed that there were no job descriptions in the file listing duties, responsibilities related to infection control or staff development. During observations of the laundry process on 12/13/10 at approximately 10:55 AM, a laundry aid was observed sorting soiled laundry prior to loading the washers. The laundry aid was wearing an ill -fitting protective gown and as the laundry was sorted, soiled items touched the aides uniform multiple times. This was verified during an interview with the laundry aide immediately following the observation. The facility admitted Resident #30 on 11-19-10 with [DIAGNOSES REDACTED]. Record review on 12-14-10 at approximately 11:30 AM revealed that the resident was discharged from the hospital with orders for \"TOBI ([MEDICATION NAME]) 300 mg (milligrams) inhaled with respiratory therapy daily\" for respiratory infection. Review of Physician's Orders revealed that the TOBI was discontinued on 12-8-10. Further review of the medical record revealed 11-24-10 Physician's Orders for \"Sputum C(ulture) + S(ensitivity). UA (Urinalysis) C+S. [MEDICATION NAME] 500 mg via G(astrostomy)/T(ube) QD (daily) X 7 days (for) fever.\" Review of the record revealed that the UA was negative, but no laboratory results were on file for the sputum culture. At 12:45 PM on 12-14-10, Registered Nurse (RN) #3 reviewed the medical record and physician's communication book and found no culture results. The Lab Book contained no information related to receipt of the culture. The computerized laboratory reports were checked and it was found that the resident had 1+ [MEDICAL CONDITION][MEDICATION NAME] in the sputum. There was no evidence in the record and the RN was unable to determine when or if the physician was notified of the results. Review of the infection control surveillance logs on 12-15-10 at 8:15 AM with the Infection Control Preventionist (ICP) revealed no reference to the respiratory infection that the resident was admitted with or the results of cultures done because of the resident's elevated temperature. The ICP stated that the nurses on the units were responsible for completing computerized infection reports with the data and that she simply compiled the information. She stated it was not her responsibility to follow up in the charts to assure that culture reports were received in a timely manner or that residents were placed on appropriate medication/antibiotics or transmission-based precautions. Review of the medical record revealed Resident #21 was admitted to the facility on [DATE] and readmitted on [DATE]. [DIAGNOSES REDACTED]. Review of the Nurses' Progress Notes dated 11/29/2010 indicated Resident #21 \"complained of congestion, called (the Attending Physician) new order for sputum C&S (culture and sensitivity). At 3:40 PM, the \"sputum culture was obtained from resp(iratory) therapist.\" On 12/4/2010 at 4 AM, Resident #21 complained of nausea and vomiting and a headache. His temperature was 100.4 degrees, pulse of 112 and blood pressure of 145/95 (significantly higher than the 100's systolic as his baseline). On 12/5/2010, Resident #21 refused care. On 12/6/2010 Resident #21 continued to complain of nausea and vomiting, headache and neck ache. On 12/7/2010 at 12:00 AM, Resident #21's temperature was 102.7 and he stated that he did not feel well. His temperature was rechecked at 3:20 AM, and it was recorded as 103 degrees. the Attending Physician was notified and an order was obtained to send him to the emergency room . Resident #21 returned from the emergency roiagnom on [DATE] at 9:15 AM, with orders for Intravenous antibiotics for \"bronchitis.\" On 12/8/2010, Resident #21's antibiotics were changed from IV [MEDICATION NAME] to Cipro, [MEDICATION NAME] and Intramuscular [MEDICATION NAME]. On 12/9/2010 at 9:40 AM, \"new order airborne precautions move to room [ROOM NUMBER]....MRSA sputum.\" Review of the Physician's Telephone orders revealed the following orders: \"11/29/2010, Sputum C&S. 12/7/2010, Send to ER for increased temperature. 12/7/2010, [MEDICATION NAME] 1 gram IV every day for 10 days. 12/8/2010, DC [MEDICATION NAME] and [MEDICATION NAME] mg BID, [MEDICATION NAME] 120 mg IM for 7 days. 12/9/2010, airborne precautions, move to room [ROOM NUMBER]. Review of the Respiratory Therapy notes revealed on 11/27/2010, Resident #21's sputum was thin and yellow. Additional notes documented the sputum was noted to be increasing in quantity and was noted to be thick and yellow. No respiratory distress was documented. Review of the Laboratory data revealed a sputum culture was sent to the lab on 11/30/2010. The lab reported the final results to the facility on [DATE]. The facility waited two days before faxing the results to the Attending Physician on 12/8/2010. On 12/8/2010 the antibiotic treatment had to be altered for Resident #21 to be given an antibiotic that would treat the MRSA infection. Review of the Infection Control Log revealed an Infection report generated on 12/7/2010 that indicated Resident #21 had an Upper Respiratory Tract Infection. Another report was generated on 12/9/2010 that indicated airborne precautions. Neither report documented he had MRSA pneumonia. During an interview, the Nurse Manager from Station II, she confirmed the delay in obtaining the culture results from 11/30/2010, and confirmed the 2 day delay in notifying the physician of the positive culture. She/he stated that the nurses should have faxed the results to the physician immediately upon receipt of the lab. The Nurse Manager also confirmed that Resident #21 was not placed on isolation precautions for the MRSA pneumonia until 12/9/2010, 3 days after the report was made available to the facility. During an interview, the Infection Control Nurse stated that she was not aware of any resident on isolation precautions. She stated that she was unaware that Resident #21 had MRSA pneumonia and had been placed on isolation. She stated that the isolation should have been initiated immediately upon receipt of the positive culture. The Infection Control Nurse stated that the floor nurses were responsible for generating the infection reports. She stated that she reviews the reports every 2-3 days and prints them off for the Infection notebook. She stated that she would not have reprinted any infection reports related to Resident #21's pneumonia. She stated that she/he would not have known he had MRSA and was on isolation unless the nurses informed her. During an interview, the Respiratory Therapy Supervisor stated that if there was a change in sputum characteristics, the nurse and the doctor would be notified and a sputum culture obtained if ordered. She stated that no precautions would be taken until the results of the culture indicated a need for isolation precautions. During an interview, the Director of Nursing stated that Resident #21 should have been placed on isolation precautions immediately upon receipt of the lab results on 12/6/2010 and should not have waited 3 days. Interview with the facility Medical Director conducted on 12/14/10 at approximately 2 PM revealed that he would have expected a resident with a known drug resistant respiratory infection to be placed on transmission based precautions immediately upon receipt of the laboratory results or as soon as possible. Review of the facility's policy on Infection Control revealed \"The Infection Control Practitioner does surveillance of all infections by: review of culture reports, antibiotic orders and other pertinent lab data...\" \"MRSA Procedure: It is the policy of this healthcare center to place patients/residents in a private room, where available, and on droplet or contact precautions who are displaying symptoms of active infections with MRSA under the following conditions: if the patient is infected with MRSA in the respiratory tract and has a productive cough...\"", "filedate": "2014-04-01"}
{"rowid": 10168, "facility_name": "BROAD CREEK CARE CENTER", "facility_id": 425351, "address": "801 LEMON GRASS COURT", "city": "HILTON HEAD ISLAND", "state": "SC", "zip": 29928, "inspection_date": "2010-12-13", "deficiency_tag": 281, "scope_severity": "K", "complaint": null, "standard": null, "eventid": "GN4K11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the Recertification and Extended Survey, based on chart reviews, interviews, review of The South Carolina State Board of Nursing Advisory Option # 9 B, and review of the facility policies, the facility failed to provide care and services that met professional standards of practice for one of one sampled resident reviewed with a PICC (Peripheral Inserted Central Catheter) line (Resident # 11). The facility nurses failed to clarify with the Physician a discontinued order related to flushing a PICC line. In addition, LPNs (Licensed Practical Nurses) documented that they administered medications through the PICC line with no documentation of advanced training and there was no RN (Registered Nurse) on site when the LPN administered the medications via the PICC line. The facility nurses failed to document consistently that they were flushing the PICC line and failed to note medications used for the flush were taken from a container of expired [MEDICATION NAME] Lock Flushes with a large number of expired [MEDICATION NAME] syringes. In addition the facility nurses failed to recognize signs and symptoms of infection of a surgical wound in a timely manner for Resident # 11, which delayed treatment. The findings included: The facility originally admitted Resident # 11 on [DATE] and after a brief hospital stay readmitted Resident #11 on [DATE] with diagnoses, which included Aftercare for Reverse Total Shoulder Arthroplasty, Hypertension, [MEDICAL CONDITION] and [MEDICATION NAME] Degeneration. On [DATE], review of the progress notes revealed that on [DATE] at 3:15 PM LPN # 3 documented that the surgical wound had intact staples, and a small amount of serous yellow tinged drainage. On [DATE] at 3:56 PM, LPN # 3 documented that the wound had increased serous yellow tinged drainage and increased pain. On [DATE] at 2:42 PM. LPN # 3 documented that the wound continued to drain a moderate amount of serous yellow drainage that was blood tinged. There was no documentation of the Physician being notified. At 2:35 PM on [DATE] LPN # 3 documented a moderate amount of blood tinged yellow drainage was observed on the dressing when removed. On [DATE] an order for [REDACTED].\" Interview on [DATE] with the DON (Director of Nurses) at approximately 12:00 PM, revealed that the nursing staff should document Physician notification in the progress notes. She confirmed that the nursing staff failed to recognize signs and symptoms of the surgical wound being infected even though the nurse had documented possible signs and symptoms on [DATE] and that there was a delay in treatment. On [DATE] the resident was transferred to the hospital at 5:00 AM for Incision and Drainage of the right shoulder surgical wound. Further review of the record revealed that Resident # 11 returned to the facility on [DATE] with a PICC line in the \"left upper arm.\" Review of the Physician orders [REDACTED]. The first dose was to be given at 8:00 PM on [DATE], the evening she was readmitted to the facility. The final dose was to be given [DATE]. In addition the Physician ordered to flush the PICC line with 5 ccs (cubic centimeters) normal saline before and after each use, followed by 3 ccs of [MEDICATION NAME]. On [DATE], observation of the facility's Medication Room revealed a brown cardboard box located on the top shelf of an open cart to the right of the doorway as you entered the room. The box contained ,[DATE] millimeter (ml) [MEDICATION NAME] Lock Flushes. Review of the flushes revealed that 75 of the 79 had expired. The 4 unexpired flushes were located at the bottom of the box. The expiration dates were: ,[DATE] ml. [MEDICATION NAME] Lock Flush syringes expired [DATE]; ,[DATE] ml. [MEDICATION NAME] Lock Flush expired [DATE], ,[DATE] ml. [MEDICATION NAME] Lock Flush syringes expired [DATE]. Interview on [DATE] at 4:00 PM was held with RN #1. The RN confirmed that the [MEDICATION NAME] used to flush Resident #11's PICC line was taken from the box to the right of the medication room door. The box identified by RN #1 contained the [MEDICATION NAME] syringes that were noted by the surveyor and LPN #1 to have 75 of 79 syringes expired. Review of the MAR (Medication Administration Sheets) for November and [DATE], revealed that the IV flush was discontinued on [DATE] on the MAR without an order to discontinue the IV flush. Review of the resident progress notes (interdisciplinary notes used by all disciplines at the facility) revealed documentation that the PICC line had been flushed on [DATE], [DATE], [DATE], [DATE], [DATE], [DATE], [DATE] and [DATE] however there was no documentation as to what medication had been used to flush the IV or PICC line. On [DATE] during an interview with the DON she stated that there was no formal system in place to review that orders were entered into the computer system correctly. She stated that the facility pharmacy had discontinued the IV flush in error. The DON confirmed that the staff had documented on the MAR that the IV flushes had been done. Interview with RN # 1 on [DATE] at 4:00 PM, revealed that she had been flushing the PICC line with 5 cs of normal saline before and after administration of the IV antibiotic and following with 3 ccs of [MEDICATION NAME]. When questioned where this would be documented, she initially stated on the MAR. The surveyor shared with her that the IV flush had been discontinued on the MAR beginning [DATE]. She stated that maybe she had documented this in the progress notes. Asked why she had not questioned the IV flush not being on the MAR and calling the Physician, she confirmed that she had not called the MD that she had continued the IV flush of the PICC line because it was a standard of practice. When RN #1 was questioned if the nurses should have been documenting that the IV flushes were done and what medication was to be used per standards of practice, she stated yes. Further review of the MARs for November and [DATE], revealed that on [DATE], [DATE], [DATE] and [DATE] LPNs had initialed in the EMAR (Electronic Medication Administration Record) that they had administered the IV [MEDICATION NAME] via the PICC line. Review of the South Carolina Board of Nursing document related cardiovascular system Licensed Practical Nurse with Specialized Education and Training revealed that any LPN that administered medication via a PICC line must complete an intravenous therapy course relative to the administration of fluids and medications via peripheral and central venous devices. This document also stated: see Advisory Opinion # 9 B on the role of LPNs in IV (intravenous) therapy. Review of the South Carolina Department of Labor, Licensing and Regulation State Board of Nursing Advisory Opinion # 9 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: 1. The agency has established policy and procedures that are approved by the nursing administrator and applicable medical director. Procedures include: a.criteria for the qualification and selection of the LPN; b. description of the additional education and training necessary for assuming additional rates.c. specific standing orders for the administration, monitoring and discontinuation of peripheral and central venous lines.d. specific standing orders to deal with potential complications or emergency situations and provision for supervision by the RN.2. The selected LPN shall document completion of special education and training to include:a. Cardiopulmonary resuscitationb. Intravenous therapy course relative to the administration of fluids via peripheral and central venous access devices/line that includes both didactic and supervised clinical training with return demonstration. The facility policy reviewed on [DATE] titled Care and maintenance of the Central Line Protocol, listed under Standards of Practice - Central line care is performed by a Registered Nurse and under Documentation - Document the [MEDICATION NAME] Flush/Saline Flush on the Medication Administration Record. Documentation includes: site assessment, resident subjective complaints, and any interventions completed and resident response. On [DATE] at approximately 4:00 PM, in an interview with LPN # 3, she stated that she had administered medication via the PICC line and flushed the line. She stated that she had additional training. Interview with the facility DON revealed that the facility did not have any documentation of the advanced training for any of the LPNs and stated that the facility policy stated that only RNs administer medications via a PICC line. She stated that she had not been aware that any LPNs were administering meds via the PICC line, however confirmed that she was aware that the facility did not always have RN coverage. Review of the facility monthly time schedule revealed that there was no RN coverage on [DATE] and [DATE], which was confirmed by the facility administrator. Review of the facility protocol for the Care and maintenance of the Central Line Protocol, revealed that only a Registered Nurse was to perform care to a central line. In addition, the policy stated that flushes should be documented on the MAR. Interview with the facility Medical Director (and the attending Physician for Resident #11) on [DATE] at approximately 9:30 AM, revealed that he was unaware that LPNs were administering medication/flushing PICC lines and had no knowledge of the expired medication used as an IV flush. Immediate Jeopardy was cited at F281 with a scope and severity of \"K\" related to failure of nursing staff to clarify orders to flush a PICC line when the original order was discontinued without a physician's orders [REDACTED]. documenting on the MAR when administering medication. On [DATE] at 5:25 PM the survey team met with the Administrator and Director of Nursing to inform them of the determination of Immediate Jeopardy with a start date of [DATE] related to the system failure identified with using expired [MEDICATION NAME] to flush a PICC line; the failure to follow the facility policy for the care and maintenance of a central line and the failure to follow the South Carolina Board of Nursing policy related to the extended role of practice of the LPN. The Immediate Jeopardy was not removed at the time the survey team exited from the facility [DATE] and is ongoing.", "filedate": "2014-04-01"}
{"rowid": 10169, "facility_name": "BROAD CREEK CARE CENTER", "facility_id": 425351, "address": "801 LEMON GRASS COURT", "city": "HILTON HEAD ISLAND", "state": "SC", "zip": 29928, "inspection_date": "2010-12-13", "deficiency_tag": 425, "scope_severity": "J", "complaint": null, "standard": null, "eventid": "GN4K12", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the Recertification and Extended Survey, the facility failed to ensure that expired medications were not stored with medications readily available for resident use resulting in expired Heparin Lock Flush available for use. Seventy Five of 79-3 millimeter Heparin Lock Flushes, were observed in the medication room with expiration dates prior to the survey, an additional 30 were found 12/13/2010 in the bio-hazard container with an expiration date of 8/1/2010 and 2 used Heparin 3 millimeter syringes were found in the sharps container on 12/13/2010 with expiration dates of 8/1/2010 and 11/1/2010. One of one resident sampled with a Peripherally Inserted Central Catheter (PICC), Resident #11, had a IV flush daily with a Heparin Lock Flush ordered. The findings included: Resident #11 was originally admitted on [DATE] and was readmitted after a hospital stay on 11/16/2010 with [DIAGNOSES REDACTED]. Resident #11 was admitted back to the facility on [DATE] with a PICC line and was ordered by the physician to \"Flush PICC with 5cc Normal Saline before and after each use, followed by 3cc Heparin Once a Day at 8PM, start date 11/16/2010\". On 12/8/2010, during observation of the facility's medication room, expired supplies were noted to be in the same area as the supplies used for resident care. The medication room contained 14-3 ml. Heparin Lock Flush syringes expired 8/1/2010; 60-3 ml. Heparin Lock Flush expired 11/1/2010 and 1-3 ml. Heparin Lock Flush syringes expired 10/20/2010. The Heparin Lock Flushes were observed to be in an open brown cardboard box, sitting on a cart to the right as you entered the medication room. At 10:45 AM on 12/8/2010, expired items (Heparin Lock Flushes) in the medication room were verified by LPN #1 who then removed them from the medication room. LPN #1 stated all nurses were responsible for ensuring any expired meds were removed from the medication room, but there was no system in place to determine when it should be checked or how often it was to be done. During an interview with the Pharmacist on 12/8/2010 at 3:55 PM, he stated that it was the responsibility of the facility's Pharmacy Consultant to ensure that all expired medications and supplies were removed from the facility. The Pharmacist also stated that the pharmacy had not sent Heparin Flushes to the facility in over a year. During the interview with the facility's Pharmacist the surveyors requested the invoices for Heparin delivered to the facility. The Pharmacist stated that he was unable to locate any. When asked how he tracked the lot numbers of the Heparin, he stated that they did not charge for it so they did not track the lot numbers. When asked by the surveyors whose responsibility it was to monitor the facility's medications he stated that the Pharmacy contracted with a consultant who was responsible for that. During an interview with Registered Nurse #1 on 12/8/2010 at 4:00 PM, she stated that the Heparin Flushes she used currently were located on a cart to the right of the door as you walked into the medication room. The container identified by RN #1 was the one noted to hold the expired Heparin Lock Flushes. During an interview with the Nursing Home Administrator on 12/8/2010 at 4:15 PM, the Administrator stated that the Pharmacy Consultant was responsible for monitoring the medication room and medication carts for expired medications. She also stated that the consultant had been to the facility for review on 11/17/2010, and that she had no idea where the expired Heparin in the facility came from. The NHA verified that the Pharmacy had not sent Heparin to the facility in over a year at 5:25 PM on 12/8/2010. On 12/13/2010, an additional box of 30-3 ml. Heparin Lock Flush expired 11/1/2010 was observed in the bio-hazard box by a surveyor and 1 used-3 ml. Heparin Lock Flush syringe expired 8/1/2010 and 1 used 3-ml Heparin Flush syringe expired 11/1/2010 was retrieved by that surveyor from the sharps container located on the medication cart. In an interview with the Interim Director of Nursing (DON) on 12/13/2010, The DON stated that the bio-hazard material had been picked up on 12/1/2010 and provided documentation of that pick-up. She also stated that the medication cart sharps container was emptied approximately every 3 weeks because the facility did not use many sharps. On 12/13/2010 during an interview with the Pharmacy Consultant, the Consultant confirmed she was responsible for ensuring expired medications were removed from the medication room. She stated she was in the facility monthly for medication review and checked the medication room and carts at that time. She stated she was unaware the Heparin was in the building. On 12/13/2010 at 4:15 PM, during an interview with the facility's Pharmacist, he stated that he did not have lot numbers of Heparin Flushes received prior to September 16, 2010. When asked how he would recall medications from facility's when the Federal Drug Administration recalled medications by lot number, he stated that he would recall the medication by name, not lot number. When asked if his process would include medication lot numbers not included in the recall he stated that it would. Immediate Jeopardy was cited at F425 with a scope and severity of \"J\" related to expired Heparin Lock Flushes (75 of 79) stored in an area readily available for resident use. The Immediate Jeopardy existed when a resident (Resident #11) was admitted and was using the IV flushes daily per physician order [REDACTED]. In addition 2 used syringes of the IV Heparin Lock Flush were found in a sharps container and noted to have dates that were expired. On 12/8/2010 at 5:25 PM the survey team met with the Administrator and Director of Nursing to inform them of the determination of Immediate Jeopardy with a start date of 11/16/2010 related to the system failure identified with using expired Heparin to flush a PICC line; the failure to follow the facility policy for the care and maintenance of a central line and the failure to follow the South Carolina Board of Nursing policy related to the extended role of practice of the LPN. The Immediate Jeopardy was not removed at the time the survey team exited from the facility 12/13/2010 and is ongoing. First Follow-Up Visit During an unannounced onsite visit on 12/29/2010 at 11:30 AM, it was determined based on interviews, observations, review of records, and review of facility policies, that the Allegation of Compliance submitted by the facility on 12/13/2010 with an addendum submitted on 12/23/2010 had been implemented by the facility and was in practice as of 12/18/2010, removing the immediacy of the deficient practice. The citation at F-425 remained at a lowered scope and severity of \" D\". The facility will be in compliance at F-425 when an acceptable Plan of Correction is submitted and a follow up visit is conducted, to determine that the facility has implemented their Plan of Correction as stated.", "filedate": "2014-04-01"}
{"rowid": 10170, "facility_name": "BROAD CREEK CARE CENTER", "facility_id": 425351, "address": "801 LEMON GRASS COURT", "city": "HILTON HEAD ISLAND", "state": "SC", "zip": 29928, "inspection_date": "2010-12-13", "deficiency_tag": 490, "scope_severity": "K", "complaint": null, "standard": null, "eventid": "GN4K11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the Recertification and Extended Surveys based on observations, interviews and full and/or limited record reviews, the facility's administrator failed to assure that the facility established and maintained services in the building that met Professional Standards of Practice. The administrator failed to develop a system to ensure that outside resources were utilized effectively and that systems were in place within the facility to ensure well being of the residents. The findings included: Cross refers to the following citations: 483.20 (k)(3) Professional Standards F281, with a scope and severity of \"K\" due to facility failure to clarify orders for Peripherally Inserted Central Catheter (PICC Line) Flushes, Licensed Practical Nurses (LPNs) administering Intravenous (IV) medications via PICC Line and [MEDICATION NAME] Flushes without evidence of advance practice certification. 483.30 (b) Nursing Services F354 with a scope and severity level of \"F\" due to failure to ensure an (RN) Registered Nurse was working 8 consecutive hours every day and the facility employs a full time Director of Nurses not to be shared with another facility. 483.60 Pharmacy Services F425 with a scope and severity level of \"J\" due to the facility's failure to ensure that expired medications were not stored with medications available for resident use. 483.75 (l) Clinical Records F514 with a scope and severity of \"J\" due to inaccurately documenting Medication Administration Records (MARs). Interview with the Nursing Home Administrator was held on 12/8/2010 and again on 12/13/2010. The Nursing Home Administrator confirmed the Director of Nursing was shared with the Senior Community Assisted Living Facility. Time sheets were provided to the surveyors and did reveal there were dates without 8 consecutive hours of RN coverage. The NHA also confirmed that there was not a security feature on the electronic records and if the nurse did not completely log off before leaving the facility, her/his name would be listed as giving medications on the MAR (Medication Administration Record) as opposed to the nurse that was on duty. In addition, the Administrator confirmed that she did not have evidence that an employed LPN did have advanced training required to access and administer medications to a resident with a Peripherally Inserted Central Catheter. Immediate Jeopardy was cited at F490 with a scope and severity of \"K\" related to the facility administrator's failure to assure that the facility establish and maintain services in the building that meet Professional Standards of Practice. The administrator failed to develop a system to ensure that the Pharmacy was providing the necessary contracted services, that outside resources were utilized effectively and that systems were in place within the facility to ensure well being of the residents. On 12/8/2010 at 5:25 PM the survey team met with the Administrator and Director of Nursing to inform them of the determination of Immediate Jeopardy with a start date of 11/16/2010 related to the system failure identified with using expired [MEDICATION NAME] to flush a PICC line; the failure to follow the facility policy for the care and maintenance of a central line and the failure to follow the South Carolina Board of Nursing policy related to the extended role of practice of the LPN. The Immediate Jeopardy was not removed at the time the survey team exited from the facility 12/13/2010 and is ongoing.", "filedate": "2014-04-01"}
{"rowid": 10171, "facility_name": "BROAD CREEK CARE CENTER", "facility_id": 425351, "address": "801 LEMON GRASS COURT", "city": "HILTON HEAD ISLAND", "state": "SC", "zip": 29928, "inspection_date": "2010-12-13", "deficiency_tag": 514, "scope_severity": "J", "complaint": null, "standard": null, "eventid": "GN4K11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the Recertification and Extended Survey, based on full and/or limited 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. The Medication Administration Record [MEDICATION ADMINISTRATION RECORD DETAILS REDACTED]. The findings included: Resident #11 was originally admitted on [DATE] and was readmitted after a hospital stay on [DATE] with [DIAGNOSES REDACTED]. Resident #11 was admitted back to the facility on [DATE] with a PICC line and was ordered by the physician to \"Flush PICC with 5cc Normal Saline before and after each use, followed by 3cc [MEDICATION NAME] Once a Day at 8PM, start date [DATE]\". On [DATE], review of Resident #11's Medication Record (MAR) revealed 4 dates, [DATE], [DATE], [DATE] and [DATE], which indicated that Licensed Practical Nurses (LPNs) had administered IV antibiotics and IV flushes via a Peripherally Inserted Central Catheter (PICC) Line. During an interview with one of the LPN's that signed off the MAR indicated [REDACTED]'s antibiotic and both saline and [MEDICATION NAME] flushes through the resident's PICC line and that she had advanced training and certification to allow her to administer medications via a PICC Line. On [DATE], during an interview with the facility's Administrator, the Administrator stated that there was a \"glitch\" in the e-mar (electronic) record keeping system that inserted the wrong nurse's initials onto the MAR. She stated that if the nurse did not log out completely when the shift ended there was no security system that would log them out after a certain time had passed with no activity on the part of the staff member. The Administrator did state the nurses were just not taking the time to log out completely and that when medications were given it would be documented as the wrong nurse having administered the medication. She did state that at times it was not the LPN listed on Resident #11's MAR giving the injection. The Administrator stated she was informed LPN #3 had a certificate in advanced training but did not have any evidence of that training. The Administrator did confirm during the interview that this could impact the documentation on all of the resident's MAR's as it relates to their accuracy. Immediate Jeopardy was cited at F514 with a scope and severity of \"J\" related to the facility administrator's failure to ensure the facility maintain clinical records on each resident in accordance with accepted professional standards and practices that were accurately documented. The electronic system in place for Medication Administration documentation did not ensure accuracy if not logged out properly by staff. Nursing staff were not taking the final step to log off the system and information documented related to medication administration was faulty. On [DATE] at 5:25 PM the survey team met with the Administrator and Director of Nursing to inform them of the determination of Immediate Jeopardy with a start date of [DATE] related to the system failure identified with using expired [MEDICATION NAME] to flush a PICC line; the failure to follow the facility policy for the care and maintenance of a central line and the failure to follow the South Carolina Board of Nursing policy related to the extended role of practice of the LPN. The Immediate Jeopardy was not removed at the time the survey team exited from the facility [DATE] and is ongoing.", "filedate": "2014-04-01"}
{"rowid": 10172, "facility_name": "BROAD CREEK CARE CENTER", "facility_id": 425351, "address": "801 LEMON GRASS COURT", "city": "HILTON HEAD ISLAND", "state": "SC", "zip": 29928, "inspection_date": "2010-12-13", "deficiency_tag": 272, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "GN4K11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the Recertification and Extended Survey, based on record review, interview and review of the facility's policies entitled Smoking, the facility failed to assess for safety in a timely manner Resident #3. Resident #3 was 1 of 1 sampled resident observed while smoking. The findings included: The facility admitted Resident #3 on 9/28/2009 and readmitted her on 11/14/2009 with [DIAGNOSES REDACTED]. On 12/7/2010 at 3:00 PM, during the review of Resident #3's medical chart, the smoking assessments were reviewed. The chart contained a smoking assessment dated [DATE]. The surveyor could locate no other assessments related to smoking. When the surveyors asked Licensed Practical Nurse (LPN) #3 if staff accompanied residents outside to smoke, she stated no. When asked if the residents kept their smoking materials with them, LPN #3 stated that the smoking materials were locked in the Medication Room and that the residents asked for them when they went outside to smoke and returned them to the nurses when they came back inside. At 3:55 PM on 12/7/2010, during an interview with the Director Of Nursing (DON), she verified that there had been no smoking assessment completed on Resident #3 since 10/6/2009. Review of the resident's medical chart revealed that on 8/4/2010 her cognitive status was assessed as 0100 and on 11/2/2010 as 0110 indicating a change in cognitive status. The DON also stated that the facility policy does not require assessments unless the resident has a change in condition. Review on the facility's policy entitled \"Smoking\" revealed no information related to smoking assessments.", "filedate": "2014-04-01"}
{"rowid": 10173, "facility_name": "BROAD CREEK CARE CENTER", "facility_id": 425351, "address": "801 LEMON GRASS COURT", "city": "HILTON HEAD ISLAND", "state": "SC", "zip": 29928, "inspection_date": "2010-12-13", "deficiency_tag": 441, "scope_severity": "F", "complaint": null, "standard": null, "eventid": "GN4K11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the Recertification and Extended survey, based on record reviews, interviews, review of the facility's Infection Control Logs and the facility's policy and procedure entitled Infection Control Program, the facility failed to establish and 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. The facility also failed to ensure that expired [MEDICATION NAME] Lock Flushes (3 millimeter (ml), 100 unit (u)/ml (75 of 79), Intravenous (IV) supplies (3 start kits), 1 Biopatch Antimicrobial Dressing, and Vacutainer's (3) were not stored in an area away from resident use items. The findings included: On 12/7/2010, review of the facility's Infection Control Logs revealed that the facility logged resident's who were prescribed antibiotics (Abt.). On 12/8/2010 at 12:45 PM, during an interview, the Director of Nursing (DON) was asked if the facility logged Gastrointestinal illness (vomiting and diarrhea) and Multi Drug Resistant Organisms (MDROs). The DON stated that the facility only logged residents on Abt. (antibiotic) therapy. When asked if the facility tracked and trended to recognize outbreaks and potential educational needs, the DON stated no. Review of the facility's policy and procedures entitled Infection Control Program revealed \"I. GOALS: The goals of the Infection Control Program are to: A. Decrease the risk of infection to residents and personal. B. Monitor for occurrence of infection and implement appropriate control measures. C. Identify and correct problems relating to infection control practices. D. Insure compliance with state and federal regulations relating to infection control. II. Scope of the Infection Control Program. The Infection Control Program is comprehensive in that it address detection, prevention and control of infections among residents...\" On 12/8/2010, during observation of the facility's medication room, expired supplies were noted in the same area as the supplies used for resident care. The medication room contained 1 Biopatch Antimicrobial Dressing with an expiration date of 9/2010, 2-10 ml. Vacutainer's with an expiration date of 11/2010, 1-10 ml. Vacutainer expired 06/2009, 2- IV start kits expired 9/20/2010, 1-IV start kit expired 6/2009, 14-3 ml. [MEDICATION NAME] Lock Flush syringes expired 8/1/2010, 60-3 ml. [MEDICATION NAME] Lock Flush expired 11/1/10 and 1-3 ml. [MEDICATION NAME] Lock Flush syringes expired 10/20/2010. The [MEDICATION NAME] Lock Flushes were observed to be in a brown cardboard box, sitting on a cart to the right as you entered the medication room. The Vacationers were in a caddy sitting on the same cart. During an interview with the Pharmacist on 12/8/2010 at 3:55 PM, she stated that it was the responsibility of the Pharmacy Consultant to ensure that all expired medications and supplies were removed from the facility. She also stated that the pharmacy had not sent [MEDICATION NAME] Flushes to the facility in over a year. In an interview with the Nursing Home Administrator, she stated that the Pharmacy Consultant was responsible for monitoring the medication room and the medication carts.", "filedate": "2014-04-01"}
{"rowid": 10174, "facility_name": "BROAD CREEK CARE CENTER", "facility_id": 425351, "address": "801 LEMON GRASS COURT", "city": "HILTON HEAD ISLAND", "state": "SC", "zip": 29928, "inspection_date": "2010-12-13", "deficiency_tag": 500, "scope_severity": "C", "complaint": null, "standard": null, "eventid": "GN4K11", "inspection_text": "On the days of the Recertification and Extended Survey, based on record reviews and interviews, the facility failed to provide a contract for emergency dental services for the residents. The findings included: On 12/9/2010, review of the facility's required contracts, the facility failed to provide a contract for emergency dental services. In an interview with the Nursing Home Administrator, the Administrator stated that the facility did not have a dental contract. No signed dated contract for dental services was provided prior to the survey team exiting the facility on 12/13/2010.", "filedate": "2014-04-01"}
{"rowid": 10175, "facility_name": "BROAD CREEK CARE CENTER", "facility_id": 425351, "address": "801 LEMON GRASS COURT", "city": "HILTON HEAD ISLAND", "state": "SC", "zip": 29928, "inspection_date": "2010-12-13", "deficiency_tag": 156, "scope_severity": "C", "complaint": null, "standard": null, "eventid": "GN4K11", "inspection_text": "On the days of the Recertification and Extended Survey, based on observations and interview, the facility failed to post how to apply for Medicaid and how to apply for refunds from Medicare. In addition, the facility failed to post how to contact the Department of Environmental Control (DHEC). The findings included: On 12/7/2010 and 12/8/2010, observations revealed that the facility failed to post how to apply for Medicaid and how to apply for a refund from Medicare. In addition there was no posting related to how to contact DHEC. Interview with the facility Administrator on 12/8/2010 at approximately 5:00 PM, revealed that she was unaware that the facility did not have the information posted. She confirmed that the information was not posted. The Administrator stated that the information must have been taken down during renovations of the facility and not re-posted.", "filedate": "2014-04-01"}
{"rowid": 10176, "facility_name": "BROAD CREEK CARE CENTER", "facility_id": 425351, "address": "801 LEMON GRASS COURT", "city": "HILTON HEAD ISLAND", "state": "SC", "zip": 29928, "inspection_date": "2010-12-13", "deficiency_tag": 157, "scope_severity": "G", "complaint": null, "standard": null, "eventid": "GN4K11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the Recertification and Extended Survey, based on record review and interview, the facility failed to notify the attending Physician of the signs and symptoms of an infected surgical wound for one of one resident reviewed with an infected surgical wound. (Resident # 11) The findings included: The facility admitted Resident # 11 on 11/1/2010 with diagnoses, which included aftercare for Reverse Total Shoulder Arthroplasty, Hypertension, [MEDICAL CONDITION] and [MEDICATION NAME] Degeneration. Resident #11 was re-admitted [DATE] after a hospital stay. On 12/8/2010, review of the progress notes (nurses notes) revealed that on 11/4/2010 at 3:15 PM LPN # 3 documented that the surgical wound had intact staples, and a small amount of serous yellow tinged drainage. On 11/5/2010 at 3:56 PM, LPN # 3 documented that the wound had increased serous yellow tinged drainage and increased pain. On 11/6/2010 at 2:42 PM. LPN # 3 documented that the wound continued to drain a moderate amount of serous yellow drainage that was blood tinged. There was no documentation of the Physician being notified. At 2:35 PM on 11/8/2010 LPN # 3 documented a moderate amount of blood tinged yellow drainage was observed on the dressing when removed. On 11/8/2010 an order for [REDACTED].\" Interview with the DON (Director of Nurses) at approximately 12:00 PM, revealed that the nursing staff should document Physician notification in the progress notes. She confirmed that the nursing staff failed to recognize signs and symptoms of the surgical wound being infected even though the nurse had documented possible signs and symptoms on 11/5/2010 and that the resident's MD (in addition to the resident' attending physician this was also the facility's Medical Director) had not been notified of the change of condition of the wound until 11/8/2010 which resulted in a delay in treatment. On 11/12/2010 the resident was transferred to the hospital at 5:00 AM for Incision and Drainage of the right shoulder surgical wound. Cross refers this tag to F-281 as it relates to the facility's nursing staffs failure to provide care and services that met professional standards of practice.", "filedate": "2014-04-01"}
{"rowid": 10177, "facility_name": "BROAD CREEK CARE CENTER", "facility_id": 425351, "address": "801 LEMON GRASS COURT", "city": "HILTON HEAD ISLAND", "state": "SC", "zip": 29928, "inspection_date": "2010-12-13", "deficiency_tag": 159, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "GN4K12", "inspection_text": "On the days of the Recertification and Extended Survey, based on review of the facility's petty cash fund and interview, the facility failed to adhere to acceptable accounting practices for three of three resident's funds that were reviewed. The findings included: On 12/8/2010, interview with the facility's Business office person # 1, revealed that the facility accepted monies of \"less than $50.00 dollars\" and kept this in petty cash. Review of the accounting for the funds revealed that Resident # 1's account did not accurately reflect the amount of money that the resident had in petty cash. Review of Resident # 5 accounting of funds, revealed that a receipt from Walgreen ' s for $1.06 however there was no request/authorization for the funds to be spent from the resident/responsible party.Review of Resident A's accounting of funds revealed a receipt for Walgreen ' s for $17.00 dollars and no request/authorization for the funds to be spent from the resident/responsible party.Business office person # 1 confirmed this.", "filedate": "2014-04-01"}
{"rowid": 10178, "facility_name": "BROAD CREEK CARE CENTER", "facility_id": 425351, "address": "801 LEMON GRASS COURT", "city": "HILTON HEAD ISLAND", "state": "SC", "zip": 29928, "inspection_date": "2010-12-13", "deficiency_tag": 315, "scope_severity": "E", "complaint": null, "standard": null, "eventid": "GN4K11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the Recertification and Extended Survey, based on record reviews, observation and review of the facility procedure for suprapubic catheter care, the facility failed to provide appropriate catheter care for two of two residents reviewed for catheter care. During Residents' # 2 and # 4 suprapubic catheter care, the facility staff failed to provide treatment in a manner that would prevent possible infection and failed to follow Physician orders [REDACTED]. The findings included: The facility readmitted Resident # 2 on 2/8/2008 with diagnoses, which included Urinary Tract Infection, [MEDICAL CONDITION] and [MEDICAL CONDITION]. On 12/8/2010 at approximately 3:00 PM, LPN (Licensed Practical Nurse) # 2 was observed to perform suprapubic catheter care on resident # 2. The nurse failed to wash her hands prior to donning gloves and was observed to use her gloved hand to turn on the faucet and run water into a basin. She placed the basin on the resident's overbed table, returned to the bathroom and using her right gloved hand dispensed soap onto a hand towel touching the trigger of the wall soap dispenser. LPN # 2 draped the resident with a towel. There was no dressing around the insertion site and the left side of the insertion site was observed to have a small amount of red tinged drainage. Using the hand towel, LPN # 2 cleaned around the catheter insertion site with a back and forth motion without changing position of the hand towel. Next LPN # 2 cleansed down the catheter tubing. LPN # 2 placed the hand towel back into the hand basin filled with water and was observed to use the same towel and again used a back and forth motion around the insertion site without changing position of the hand towel and then wiped down the catheter tubing. Bright red tinged drainage was observed on the right side of the catheter site. LPN # 2 returned the hand towel to the basin and picked up the towel she had used to drape the resident and using the side that had been touching the resident's body dried around the insertion site and down the tubing. Review of the resident # 2's medical record revealed a Physician order [REDACTED].\" During an interview with LPN # 2 after the treatment on 12/8/2010, the LPN confirmed that she had not followed appropriate infection control practices. When questioned if she had read the physician orders [REDACTED]. She confirmed that she had cleansed the catheter with soap and not normal saline. When questioned why she had not placed a dressing on the site related to the drainage, she initially stated that she had not seen any, however did state that she was aware of the drainage at the end of the treatment but she contributed this to the site having just been cleansed. The facility admitted Resident # 4 on 12/29/2004 with diagnoses, which included [MEDICAL CONDITION], Hypertension and Convulsions. On 12/8/2010, at approximately 4:00 PM, CNA (Certified Nursing Assistant) # 1 was observed performing suprapubic catheter care on Resident # 4. CNA # 1 was observed to use [MEDICATION NAME] Foaming Cleanser to cleanse during the treatment. There was no dressing around the insertion site. No dressing was applied after the treatment. After completion of the cleansing, CNA # 1 was observed to disconnect the catheter collection bag. Next CNA # 1 emptied the collected urine into the toilet and then placed the collection bag into the sink to \"wash it off.\" CNA # 1 then dried the collection bag and reconnected it to the catheter tubing. Review of Resident # 4's clinical record revealed a physician's orders [REDACTED]. Review of the facility procedure for providing suprapubic catheter care revealed under the section titled Preparation : \"1. Check physician's orders [REDACTED]. ...4. Perform hand hygiene. \" Interview with the DON (Director of Nurses) on 12/8/2010 confirmed that the LPN # 2 and CNA# 1 had not followed appropriate infection control practices and had not followed the MD orders related to the cleansing of the suprapubic catheter.", "filedate": "2014-04-01"}
{"rowid": 10179, "facility_name": "BROAD CREEK CARE CENTER", "facility_id": 425351, "address": "801 LEMON GRASS COURT", "city": "HILTON HEAD ISLAND", "state": "SC", "zip": 29928, "inspection_date": "2010-12-13", "deficiency_tag": 354, "scope_severity": "F", "complaint": null, "standard": null, "eventid": "GN4K12", "inspection_text": "On the days of the Recertification and Extended Survey, based on observation and interviews, the facility failed to have a RN (Registered Nurse) on duty for eight consecutive hours daily. In addition, the facility failed to employ a full time DON (Director of Nurses). The findings included: Review of the facility staffing revealed that on the following days that the facility failed to have a RN on duty for eight consecutive hours daily:10/23/ 1/6/ 1/13/ 1/20/ 2/4/2010 Interview with the facility administrator and the DON on 12/8/10 confirmed that the facility did not have the correct RN coverage on the above dates. In addition, the Administrator stated the DON did not work full time for the skilled area; that she also had duties for the Assisted Living area.", "filedate": "2014-04-01"}
{"rowid": 10180, "facility_name": "NHC HEALTHCARE - MAULDIN", "facility_id": 425359, "address": "850 E. BUTLER RD.", "city": "GREENVILLE", "state": "SC", "zip": 29607, "inspection_date": "2010-12-21", "deficiency_tag": 332, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "7CTK11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on observations, record reviews, interviews, the Drug Facts and Comparisons book (updated monthly) and the Drug Information Handbook for Nursing, 8 th Edition, 2007, the facility failed to ensure that it was free of a medication error rate of 5 percent or greater. The medication error rate was 6.5 percent. There were 3 errors out of 46 opportunities for error. The findings included: Error #1: On 12/20/10 at 4:29 PM, during observation of medication pass, Licensed Practical Nurse (LPN) #3 was observed to instill one drop of [MEDICATION NAME] Ophthalmic Suspension into each eye of Resident A without shaking the bottle before instillation. The Drug Facts and Comparisons book, page 1725, states (under \"General Considerations in Topical Ophthalmic Drug Therapy\"): \"Resuspend suspensions (notably, many ocular steroids) by shaking to provide an accurate dosage of drug.\" During an interview on 12/20/10 at 4:48 PM, LPN #3 confirmed she did not shake the [MEDICATION NAME] Ophthalmic Suspension before instillation into the resident's eyes and further stated that she knew that [MEDICATION NAME] should be shaken. Error #2: On 12/20/10 at 4:53 PM, during observation of medication pass, LPN #4 was observed to prepare and administer 1 [MEDICATION NAME] 150 milligram (mg) tablet and one other medication to Resident #23. Review of the current physician's orders [REDACTED]. [MEDICATION NAME] 150 MG TABLET TAKE 1 THREE TIMES DAILY - REC. (record) PULSE PER POLICY-\" LPN #4 was not observed to take the resident's pulse prior to administering the medication. Review of the facility's policy revealed that antiarrhythmic drugs (which included [MEDICATION NAME]) required a daily pulse. During an interview on 12/20/10 at 6:23 PM, LPN # 4 confirmed she had not taken the resident pulse and that there was no place on the Medication Administration Record [MEDICATION ADMINISTRATION RECORD DETAILS REDACTED]. During an interview with the pharmacy consultant, who was present during part of the interview with LPN #4, it was revealed that there was a notebook at the nurses station which contained vital signs, including pulse, which are recorded by the 7 AM to 3 PM medication nurses. Review of the notebook revealed that the morning pulse (12/20/10) for Resident #23 was 57 beats per minute. LPN #4 was not aware of the notebook and the information related to the resident's pulse. The Drug Facts and Comparisons book (updated monthly), page 429, states (under patient information) related to antiarrhythmic agents: \"Be aware of signs of overdosage or toxicity such as [MEDICAL CONDITION], excessive drowsiness, decreased heart rate or abnormal heartbeat.\". In addition, the Drug Information Handbook for Nursing, 8 th Edition 2007, page 1039, states, under Nursing Actions, Physical Assessments for [MEDICATION NAME]: \"Monitor therapeutic response and adverse reactions at beginning of therapy, when titrating dosage, and on a regular basis with long-term therapy. Monitor cardiac status (BP, pulse) closely.\". Error #3: On 12/21/10 at 8:28 AM, during observation of medication pass, Registered Nurse (RN) #1 prepared 1 [MEDICATION NAME] Coated (EC) Aspirin 81 mg tablet and 7 other medications for administration to Resident B. RN #1 was observed to crush the [MEDICATION NAME] Coated Aspirin Tablet and 4 other medications and mix them with applesauce for administration to the resident. Review of the current physician's orders [REDACTED].", "filedate": "2014-04-01"}
{"rowid": 10181, "facility_name": "HEARTLAND OF WEST ASHLEY REHAB AND NURSING CENTER", "facility_id": 425362, "address": "1137 SAM RITTENBURG BLVD", "city": "CHARLESTON", "state": "SC", "zip": 29407, "inspection_date": "2010-08-11", "deficiency_tag": 441, "scope_severity": "F", "complaint": null, "standard": null, "eventid": "58Y911", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey based on interviews, the facility staff failed to demonstrate appropriate knowledge related to infection control issues. The findings included: On 8/11/10 at approximately 9:30 AM during an interview with LPN # 1 when questioned what he/she would tell visitor's prior to entering a resident's room who had an order for [REDACTED]. On 8/11/10 at approximately 9:45 AM interview with Housekeeper # 1, who was responsible for cleaning a room with a \"Stop See the Nurse Prior to Entering.\" sign was questioned what the sign meant. Housekeeper # 1 was unable to tell the surveyor why the sign was posted. When questioned if he/she would utilize any special cleaning procedures for a resident who was on contact isolation for Clostridium Difficile, he/she failed to identify to use any chemical to clean the room. On 8/11/10 at approximately 10:15 AM RN # 4 was questioned what he/she would tell a visitor prior to entering a resident's room who was on contact precautions. He/She stated that he/she was unsure what to tell a visitor. On 8/11/10 at approximately 11:00 AM, Housekeeper # 2 was questioned if he/she would use any special procedure to clean a resident's room who was on contact isolation for Clostridium Difficile, and he/she stated no. When questioned if he/she had been trained on cleaning procedures for rooms that had resident's with infection control precautions, he/she said no.", "filedate": "2014-04-01"}
{"rowid": 10182, "facility_name": "HEARTLAND OF WEST ASHLEY REHAB AND NURSING CENTER", "facility_id": 425362, "address": "1137 SAM RITTENBURG BLVD", "city": "CHARLESTON", "state": "SC", "zip": 29407, "inspection_date": "2010-08-11", "deficiency_tag": 425, "scope_severity": "F", "complaint": null, "standard": null, "eventid": "58Y911", "inspection_text": "**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 medications were not stored with other medications in 2 of 4 medication rooms. The finding included: On 8/9/10 at approximately 11:15AM, inspection of the 1 South Medication Room revealed one orange colored Emergency Box sealed with a red integrity seal and bearing an outside label which read Meclizine expired 7-27-10. The box was opened and revealed the following: -One vial of Lidocaine HCl (Hydrochloride) Injection 10 mg (milligram)/ml (milliliter), 50 ml. by Hospira, Lot 68-435-DK, expired 1 [DATE] (August 1, 2010). -One Extended Phenytoin Sodium 100mg capsule lot 39 expired 8-5-10 (packaged by NCS Healthcare of SC) -Two Ciprofloxacin 500mg tablets lot BEM51B LC expired 7-2-10 (packaged by NCS Healthcare of SC) -Five Meclizine HCl 25mg tablets lot 601 EH expired 7-27-10 (packaged by NCS Healthcare of SC) These findings were verified by RN (Registered Nurse) # 1 (Floor Manager) on 8/9/10 at approximately 11:25AM who stated that the Consultant Pharmacist is supposed to check for out- of-date medications during monthly visits and was unsure whether the nurse was also responsible for checking on an ongoing basis. RN # 1 a lso confirmed that this emergency box was used to supply medications to all residents on the first floor. On 8/9/10 at approximately 1:40PM, inspection of the 2 North Medication Room revealed one orange colored Emergency Box sealed with a green integrity seal. The box was opened and revealed the following: -One vial of Lidocaine HCl (Hydrochloride) Injection 10 mg/ml, 50 ml. by Hospira, Lot 68-434-DK, expired 1 [DATE] (August 1, 2010) This finding was verified by LPN (Licensed Practical Nurse) # 1 on 8/9/10 at approximately 1:50PM. LPN # 1 stated that the box had been delivered on 8/6/10 by the Pharmacy and that the green integrity seal indicated that it had not been opened since delivery. This finding was also verified by RN # 2 (Floor Manager) on 8/9/10 at approximately 2:10PM who stated that the green seal meant that it had been unopened since delivery by the pharmacy and that if it had been opened it would have been resealed with a red integrity seal. RN # 2 also confirmed that this emergency box was used to supply medications to all residents on the second floor. On 8/9/10 at approximately 4:40PM the Facility Administrator provided a copy of the most recent \"Quality Improvement: Consultant Pharmacy Summary\" which covered 7/27/2010 to 7/28/2010 and had been signed 7/28/10. This summary showed on page 2 of 3 that out-of-date medications had been checked, but did not identify any of the expired medications found during the survey. The summary also showed that the emergency supply on \"1N, 1S and 2N needs to have e-box returned to pharmacy.\"", "filedate": "2014-04-01"}
{"rowid": 10183, "facility_name": "ROSECREST REHABILITATION AND HEALTHCARE CENTER", "facility_id": 425376, "address": "200 FORTRESS DRIVE", "city": "INMAN", "state": "SC", "zip": 29349, "inspection_date": "2010-09-08", "deficiency_tag": 279, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "9VMS11", "inspection_text": "**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 develop, review and revise the resident's comprehensive plan of care for 2 of 9 resident care plans reviewed. No Care Plan for Resident #7 was developed for [MEDICATION NAME] Therapy and Resident #9 had no Care Plan related to allergies [REDACTED]. The findings included: The facility admitted Resident #9 on 1/25/2008 with [DIAGNOSES REDACTED]. On 9/7/2010 at 3:20 PM, review of the medical chart for Resident #9 revealed that the resident had multiple medication allergies [REDACTED]. ([MEDICATION NAME]), E-Mycin ([MEDICATION NAME]), [MEDICATION NAME], Keflex, Beta Blockers and TAO (Triple Antibiotic Ointment) (adverse reaction) as well as *No sleeping pills*, OpSite Dsds (dressings), Tapes and Band-Aids. The Cumulative Orders for August and September 2010 listed Sulfa (Sulfonamide Antibiotics), [MEDICATION NAME], Ambien, [MEDICATION NAME] and [MEDICATION NAME]. The facility's Nursing Home History and Physical dated 8/5/2010 listed the resident's allergies [REDACTED]. A Nursing Home Admission History and Physical dated 8/25/2010 listed her/his allergies [REDACTED]. A hand written note was included which stated Tapes, OPsite, *No sleeping Pills Per POA (Power Of Attorney). Further review indicated that there was no Care Plan in the record related to Resident #9's numerous allergies [REDACTED].#9 had no Care Plan for allergies [REDACTED]. The facility admitted Resident # 7 on 7/26/10 with [DIAGNOSES REDACTED]. Record review on 9/7/10 revealed this resident to be receiving [MEDICATION NAME] 5 mg(milligrams) every night. Lab studies were done per physician's orders [REDACTED]. Continued review revealed no care plan had been developed related to anticoagulant therapy and the [MEDICATION NAME] usage since the resident was admitted . In an interview with the DON (Director of Nursing) on 9/8/10, s/he confirmed there was no care plan related to the [MEDICATION NAME] use. S/he also stated s/he would have expected a care plan to have been developed.", "filedate": "2014-04-01"}
{"rowid": 10184, "facility_name": "ROSECREST REHABILITATION AND HEALTHCARE CENTER", "facility_id": 425376, "address": "200 FORTRESS DRIVE", "city": "INMAN", "state": "SC", "zip": 29349, "inspection_date": "2010-09-08", "deficiency_tag": 281, "scope_severity": "G", "complaint": null, "standard": null, "eventid": "9VMS11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on observations, interviews, record reviews and review of the facility's protocol for Care Of Skin Abrasions, the facility failed to provide services for the residents which met the professional standards of quality for 1 of 9 residents sampled for professional standards and random observations during medication pass. Resident #9 had documented allergies [REDACTED]. The findings included: The facility admitted Resident #9 on 1/25/2008 with [DIAGNOSES REDACTED]. Review of the resident's medical chart on 9/7/2010 at 3:20 PM revealed that the resident had multiple allergy inconsistencies documented. The allergy sticker on the inside of the chart listed [MEDICATION NAME], Sulfa, [MEDICATION NAME], Amox. ([MEDICATION NAME]), E-Mycin ([MEDICATION NAME]), [MEDICATION NAME], Keflex, Beta Blockers and TAO (Triple Antibiotic Ointment) (adverse reaction) as well as *No sleeping pills*, OpSite Dsds (dressings), Tapes and Band-Aids. The Cumulative Orders for August and September 2010 listed Sulfa (Sulfonamide Antibiotics), [MEDICATION NAME], Ambien, [MEDICATION NAME] and [MEDICATION NAME]. The facility's Nursing Home History and Physical dated 8/5/2010 listed the resident's allergies [REDACTED]. A Nursing Home Admission History and Physical dated 8/25/2010 listed her/his allergies [REDACTED]. A hand written note was included which stated Tapes, OpSite, *No sleeping Pills Per POA (Power Of Attorney). Review of the Nurses' Notes dated 8/2/2010 at 0630 (6:30 AM), indicated that the resident had rubbed a scab off of the right side of her/his face. The nurse cleaned the area and applied \"TAO (Triple Antibiotic Ointment) and a band-aid\". At 5:00 PM, the Nurses' Notes revealed that the area on the right side of the resident's face was \"red & (and) irritated. Res. (resident) states is painful to touch. On MD (physician) book for eval. (evaluation).\" No other entries related to the resident's face were noted until 8/10/2010 at 4:40 PM which indicated that the physician had seen the resident and written new orders related to the \"area on side of face.\" Review of the Treatment Administration Record (TAR) for Resident #9 for the month of August 2010 contained no documentation of the TAO being administered prior to the new order on 8/11/2010. On 9/7/2010 at 6:00 PM, during an interview with Licensed Practical Nurse (LPN) #4, she/he stated that a Telephone Order (TO) for the TAO should have been written and the TAO should have been documented on the TAR. Review of the TO dated 8/2/2010 stated per protocol apply TAO ointment to R (right) cheek abrasion and cover with dressing until healed. A TO dated 8/10/2010 indicated that the TAO had been discontinued on 8/10/2010. Review of the facility's protocol for Care Of Skin Abrasions revealed \"...Preparation: 1. Verify that there is a physician's order for this procedure. (Note: This may be generated from a facility protocol) 2. Review the resident's care plan, current orders and [DIAGNOSES REDACTED]. 3. Check the Treatment Record....\" Review of a Physician's Progress Note dated as dictated on 8/10/2010 contained documentation indicating ...\"Allergic Reaction\"...and to stop the topical antibiotics. On 9/8/2010 at 8:30 AM, during an interview with the Director Of Nursing (DON) and the Assistant Director Of Nursing (ADON), both verified the allergy information. The DON and ADON also verified the Nurses' Notes stating that the resident had received the TAO and that it was not documented as to how long and how often the resident received the treatment. On 9/8/2010 at 11:50 AM, during an interview with Resident #9, the resident's daughter, the Nurse Practitioner (NP) and the ADON present, the resident and her/his daughter stated that the resident had received the TAO for 3 days that they were sure of stating maybe 4 days. The NP stated that she/he was reviewing the resident's allergies [REDACTED]. During a random observation of the Medication Pass on 9/7/10 at 3:30PM, Licensed Practical Nurse # 6 was observed to leave a bottle of [MEDICATION NAME] on top of the medication cart when s/he entered the room to administer medications. The medication cart was not able to be seen from the resident's bedside. After entering the resident's room, the nurse was observed to leave the medication filled syringe on the bedside table as s/he left the room the wash his/her hands. After checking the resident's blood sugar and determining the need to call the physician for further direction, the nurse returned to the medication cart where s/he left both the bottle of insulin and the medication filled syringe on top of the cart unattended as s/he returned to the bathroom to wash his/her hands. On 9/8/10 at approximately 7:40AM, during observation of medication pass, Licensed Practical Nurse # 7 was observed to enter a resident's room and leave a medication cup containing nine medications and a bottle of [MEDICATION NAME] Nasal Spray on the bedside table when s/he left the room to wash his/her hands. The medications were not visible to the nurse as s/he washed his/her hands. On 9/8/10 at 10:30AM, the findings were shared with the Director of Nursing, who verified it was not facility policy to leave medications unattended.", "filedate": "2014-04-01"}
{"rowid": 10185, "facility_name": "ROSECREST REHABILITATION AND HEALTHCARE CENTER", "facility_id": 425376, "address": "200 FORTRESS DRIVE", "city": "INMAN", "state": "SC", "zip": 29349, "inspection_date": "2010-09-08", "deficiency_tag": 371, "scope_severity": "F", "complaint": null, "standard": null, "eventid": "9VMS11", "inspection_text": "**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 ensure food was stored, prepared, and distributed under sanitary conditions. Four of 4 ovens were observed to have dried, baked on spills on the interior walls, racks and floors of the ovens which extended to the exterior surfaces of the oven doors. The resident refrigerators on 2 of 3 units contained 16 [MEDICATION NAME] Extra nutritional supplements which had expired. The findings included: On 9/7/2010, during initial tour of the facility's kitchen, 4 ovens were observed to have a build up of food spills which were baked onto the oven doors and interiors. On 9/8/2010 at 8:40 AM, during an additional tour of the kitchen the ovens remained unchanged. On 8:45 AM, Dietary Staff worker #1 verified the ovens with the build up. At 9:20 AM, the Dietary Manager stated that the ovens were on a cleaning schedule but there was not a check of to ensure the staff had completed the task. A cleaning check off was initiated and provided on 9/8/10. During initial observation of the resident refrigerator on the Orchard View unit, 13- 8 ounce (oz) (237 milliliter (ml) containers on [MEDICATION NAME] Extra for Wounds with an expiration date of 20 July 2010 were noted. The location of the supplements and expiration date was verified by the Director Of Nursing. At 10:35 AM, Licensed Practical Nurse (LPN) #1 stated that the unit had 1 resident receiving the [MEDICATION NAME]. The resident refrigerator on the Overlook Point Unit contained 3-8 ounce (oz) (237 milliliter (ml) containers on [MEDICATION NAME] Extra for Wounds with an expiration date of 20 July 2010. The location of the supplements and expiration date was verified by Certified Nursing Assistant (CNA) #3.", "filedate": "2014-04-01"}
{"rowid": 10186, "facility_name": "ROSECREST REHABILITATION AND HEALTHCARE CENTER", "facility_id": 425376, "address": "200 FORTRESS DRIVE", "city": "INMAN", "state": "SC", "zip": 29349, "inspection_date": "2010-09-08", "deficiency_tag": 492, "scope_severity": "E", "complaint": null, "standard": null, "eventid": "9VMS11", "inspection_text": "On the days of the survey, based on review of personnel files, the facility failed to verify 2 of 3 LPN's (Licensed Practical Nurses) license were in good standing with the State Board of Nursing prior to hiring. The facility also failed to verify the criminal back ground for 1 of 3 LPNs prior to the hire date.The findings included:On 9/7/10 review of LPN #7's personnel file revealed that LPN # 7 started work on 6/16/10, however the facility failed to verify that his/her license was in good standing with the State Board of Nursing until 6/30/10. Review of LPN #8's personnel file revealed that LPN #8 started work on 7/7/10, the facility failed to verify that his/her license was in good standing with the State Board of Nursing until 7/20/10. The facility also failed to complete a criminal background check for LPN #8 until 7/20/10. LPN #9's hire date was 7/7/10 and the facility completed the license verification on 7/20/10. An interview with the Minimum Date Set (MDS) Nurse and the Staffing Coordinator on 9/7/10 at 3:00 PM confirmed that the license/criminal background check was not verified prior to hiring the nurses. On 9/8/10 at 9:00 AM, the NHA stated the he/she was not aware of the license and criminal background verifications not being done prior to hire until it was discovered by the surveyor. He/she also stated that a plan to resolve the issue had been started.", "filedate": "2014-04-01"}
{"rowid": 10187, "facility_name": "ROSECREST REHABILITATION AND HEALTHCARE CENTER", "facility_id": 425376, "address": "200 FORTRESS DRIVE", "city": "INMAN", "state": "SC", "zip": 29349, "inspection_date": "2010-09-08", "deficiency_tag": 496, "scope_severity": "E", "complaint": null, "standard": null, "eventid": "9VMS11", "inspection_text": "On the days of the survey, based on employee personnel record reviews and interviews, the facility failed to verify certification checks and/or criminal background checks prior to beginning work for 3 of 2 Certified Nursing Assistant's reviewed for certification verification and criminal background checks.The findings included:On 9/7/10 review of employee personnel records revealed that the facility failed to verify certification for 2 of 2 CNAs (Certified Nursing Assistants) prior to beginning work. On 9/7/10, review of the CNA personnel records revealed:CNA # 1 began work on 6/9/10 with verification completed 8/11/10.CNA # 2 began work on 6/16/10 with her/his criminal background check completed on 6/17/10 and verification completed 7/31/10. An interview with the Minimum Date Set (MDS) Nurse and the Staffing Coordinator on 9/7/10 at 3:00 PM confirmed that the license/criminal background check was not verified prior to hiring the CNA's. On 9/8/10 at 9:00 AM, the NHA stated the he/she was not aware of the license and criminal background verifications not being done prior to hire until it was discovered by the surveyor. He/she also stated that a plan to resolve the issue had been started.", "filedate": "2014-04-01"}
{"rowid": 10188, "facility_name": "ROSECREST REHABILITATION AND HEALTHCARE CENTER", "facility_id": 425376, "address": "200 FORTRESS DRIVE", "city": "INMAN", "state": "SC", "zip": 29349, "inspection_date": "2010-09-08", "deficiency_tag": 160, "scope_severity": "B", "complaint": null, "standard": null, "eventid": "9VMS11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on review of resident funds for conveyance upon death, the facility failed to convey one fund within 30 days of death, and failed to have proper authorization to convey 2 other resident funds. The findings included: An interview with the Business Office Manager on [DATE] related to conveyance of funds upon death revealed 3 of 4 accounts reviewed were refunded improperly. Account of Resident A, who expired on [DATE], was refunded by check written on [DATE]. The manager explained that corporate had recently found several accounts that had not been refunded, and she made out the check this day. Resident B had expired on [DATE] and a check had been made out to Colonial Trust on [DATE]. No legal authorization had been obtained to make the check out to this entity. Resident C expired on [DATE], and a check was made out on [DATE] to a son who had not been appointed as an administrator of the estate.", "filedate": "2014-04-01"}
{"rowid": 10189, "facility_name": "ROSECREST REHABILITATION AND HEALTHCARE CENTER", "facility_id": 425376, "address": "200 FORTRESS DRIVE", "city": "INMAN", "state": "SC", "zip": 29349, "inspection_date": "2010-09-08", "deficiency_tag": 167, "scope_severity": "C", "complaint": null, "standard": null, "eventid": "9VMS11", "inspection_text": "On the days of the survey, based on observation and interview, the facility failed to post for resident review the Certification Survey for 8/20/09. The findings included: During a random observation on 9/7/10, the facility survey book, located upstairs in the skilled unit, was reviewed and found it contained last year's Licensure Survey, a Complaint Survey, and a Certification Survey dated 2008. The Certification Survey results for 8/20/09 were not included. The Director of Nursing (DON) reviewed the book and confirmed the survey was not included. The DON reviewed the survey book posted downstairs at the entrance and confirmed that book also did not have the 2009 Certification Survey included.", "filedate": "2014-04-01"}
{"rowid": 10190, "facility_name": "ROSECREST REHABILITATION AND HEALTHCARE CENTER", "facility_id": 425376, "address": "200 FORTRESS DRIVE", "city": "INMAN", "state": "SC", "zip": 29349, "inspection_date": "2010-09-08", "deficiency_tag": 441, "scope_severity": "F", "complaint": null, "standard": null, "eventid": "9VMS11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on review of facility Infection Control Policies, Logs, and interviews, the facility failed to maintain an infection control program to help prevent the development and transmission of disease and infection related to cleaning/non cleaning of glucometers, not making documented compliance rounds of all departments, and not keeping accurate infection control logs for trending and tracking of infections. There were also expired supplies in 2 of 3 medication rooms. The findings included: Review of the monthly infection control logs on [DATE] and [DATE] revealed list of x-rays done each month and pharmacy printouts for residents on antibiotics for each month with listings of residents, tests done, organisms identified, antibiotics started. However, these listings were not in order by date. When the DON (Director of Nursing) and ADON (Assistant Director of Nursing) were interviewed regarding their infection control program, they stated the ADON filled out the log weekly or bi-weekly. They received the printouts from X-Rays and Pharmacy the next month so those were added to the logs then. The logs were not current. When asked how they did their tracking or trending for infections, they stated they had weekly meetings where infections were discussed. If they saw more infections were occurring, they would check to see which unit. No line listing of MDRO's ( Multi Drug Resistant Organisms) in the facility were being kept. The Admission's Coordinator would have to call someone in Nursing before placing a new resident. The ADON did not do compliance rounds to other departments for infection control. She stated she supposed the department heads did their own rounds. She did not receive any written reports for these. She did not do compliance rounds in nursing, but did competency checks on staff yearly. During observation of medication pass on [DATE] at 3:30PM, Licensed Practical Nurse #6 was observed to use a multi-resident glucometer to check a resident's blood sugar. The glucometer was not observed to be cleaned by the nurse either before or following its use. Random interviews related to cleaning of glucometers on [DATE] at 1:40PM and [DATE] at 4PM (two different units and two different shifts) revealed that both nurses stated they would use Alcohol to clean the glucometer. On [DATE] two boxes of Stat Let lancets with a manufacturers expiration date of ,[DATE] were observed stored in the Overlook Pointe medication room as verified by Licensed Practical Nurse #8. In the Orchard Medication Room, (2) IV 3000 Standard dressings with a manufacture's expiration date of ,[DATE] and (2) Allevyn thin dressings with a manufacturers expiration date of ,[DATE] were stored as verified by Licensed Practical Nurse # 1 at 5:45PM. Both nurses stated it was the responsibility of the third shift to check for outdated supplies.", "filedate": "2014-04-01"}
{"rowid": 10191, "facility_name": "ROSECREST REHABILITATION AND HEALTHCARE CENTER", "facility_id": 425376, "address": "200 FORTRESS DRIVE", "city": "INMAN", "state": "SC", "zip": 29349, "inspection_date": "2010-09-08", "deficiency_tag": 309, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "9VMS11", "inspection_text": "**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 follow a physician's order to monitor Resident # 14's blood pressure before administering a medication. Resident #14 was one of four sampled resident's receiving medications with physician ordered parameters for administration. The findings included: Resident # 14 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. The resident was discharged home on[DATE]. On 9/8/10, a review of the closed medical record revealed a physician's order for \"[MEDICATION NAME] 60 milligrams, hold if pulse is less than 40\" and notify the physician. A review of the July and August 2010 Medication Administration Records revealed there was no documentation that the resident's pulse was obtained/documented prior to the medication administration given daily at 6AM, 12P, 6P, or 12AM. The findings were verified and not disputed when shared with the Director of Nursing on 7/8/10 at 10:30 AM.", "filedate": "2014-04-01"}
{"rowid": 10192, "facility_name": "THE LAKES AT LITCHFIELD SNF", "facility_id": 425380, "address": "120 LAKES AT LITCHFIELD DRIVE", "city": "PAWLEYS ISLAND", "state": "SC", "zip": 29585, "inspection_date": "2011-01-24", "deficiency_tag": 225, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "T04211", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the day of the survey, based on review of the facility's investigative materials related to 2 of 2 resident falls with fractures, the facility failed to report timely and failed to thoroughly investigate a fall with fracture (Resident #1) and failed to report a fracture of unknown origin (Resident #2). The findings included: Resident #1 with [DIAGNOSES REDACTED]. Because the resident had poor safety awareness and made attempts to get out of bed, a tab alarm, when in the chair and when in the bed, was ordered at 6 AM on 12/9/10. At 6:30 AM on 12/9/10, the resident was found on the floor of his room. The alarm did not sound because the resident held it in his hand. The previous order for the tab alarm was discontinued and a pressure pad alarm was ordered for the bed and chair. The resident fell again on 12/11/10 at 9:35 AM. According to the Nurse's Note, the resident was found sitting on his buttocks in the dining room. His urinary catheter was intact. No immediate signs of injury were noted. Later that morning, at 11:30 AM, the resident complained of left leg pain and he was sent to the hospital where a fractured femur was diagnosed . The facility reported this incident to the State survey and certification agency on 12/13/10, which exceeded the 24 hour limit for initial reports. During an interview with the Administrator and Director of Nurses on 1/24/10 at 1:10 PM, they stated they thought the facility had 24 \"business hours\" to report the incident. The resident fell on a Saturday and the initial facility report was made on Monday. Review of the facility's investigative materials revealed documentation on the fall report stating: \"Aide was returning tray to kitchen when resident attempted to stand up & fell . Alarm did not sound.\" The Certified Nursing Assistant's (CNA's) statement said: \"Resident was in the dinning (sic) room talk I went to Clean up and take his plate to the kitchen he tried to get up and fell . Alarm didn't go off. When I heard that he fell and called both nurses. They came check him out and took him back to the desk.\" The facility's investigation did reveal that the wrong type of alarm was used that day, a tab alarm instead of the pressure pad alarm. Their investigation did not show why the tab alarm was used, if it had been placed properly, if it was functioning properly, or if the resident silenced it somehow. The CNA's statement was never clarified concerning did she actually see the resident fall or simply \"heard that he fell .\" There was no information about other people present in the room, either as potential witnesses or potential perpetrators to the incident. Resident #2 with [DIAGNOSES REDACTED]. On 10/14/10, at 3:45 PM, the resident was found on the floor in her room. She complained of pain at the back of her head and in her back. A hospital evaluation revealed a right Colles fracture. The facility reported the incident to the Ombudsman and Health Licensing. It did not report the injury of unknown origin from an unwitnessed fall to the State survey and certification agency.", "filedate": "2014-04-01"}
{"rowid": 10193, "facility_name": "THE LAKES AT LITCHFIELD SNF", "facility_id": 425380, "address": "120 LAKES AT LITCHFIELD DRIVE", "city": "PAWLEYS ISLAND", "state": "SC", "zip": 29585, "inspection_date": "2011-01-24", "deficiency_tag": 323, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "T04211", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the day of the survey, based on limited record reviews and interviews, the facility failed to ensure that personal safety alarms were used as ordered for 1 of 1 resident who fell and sustained a fractured femur (Resident #1). The findings included: Resident #1 with [DIAGNOSES REDACTED]. Because the resident had poor safety awareness and made attempts to get out of bed, a tab alarm when in the chair and a pressure pad alarm for the bed was ordered at 6 AM on 12/9/10. At 6:30 AM on 12/9/10, the resident was found on the floor of his room. The alarm did not sound because the resident held it in his hand. The previous order for the tab alarm was discontinued and a pressure pad alarm was ordered for the bed and chair. The fall report stated the pressure pad alarm \"was applied.\" The Nurse's Notes entry on 12/9/10 at 2125 (9:25 PM) stated \"pressure pad alarm in place.\" Review of the 11-7 Nurse's Notes for 12/10-11/10 showed the resident made numerous attempts to get out of bed unassisted. The resident fell again on 12/11/10 at 9:35 AM. According to the Nurse's Note, the resident was found sitting on his buttocks in the dining room. His urinary catheter was intact. No immediate signs of injury were noted. Later that morning, at 11:30 AM, the resident complained of left leg pain and he was sent to the hospital where a fractured femur was diagnosed . Review of the facility's investigative materials related to the fall with fracture revealed the safety alarm did not sound. The investigation also revealed the resident did not have the pressure pad alarm in place, but instead the tab alarm was in place that day. Their investigation did not show if the alarm was on and functioning, or why it did not sound on 12/11/10. Review of the Treatment Record showed nurses' initials for \"Pressure pad alarm WIB/WIC (when in bed/when in chair) d/t (due to) poor safety awareness\" for 3-11 and 11-7 on 12/9 and 12/10/10, and for 7-3 on 12/11/10. The initials indicated the treatment was done. Review of the 12/11/10 Daily Alarm Check For The Skilled Unit Nurses revealed a notation made beside the resident's name saying \"need pressure pad for W/C (wheelchair).\" An interview with the Administrator and Director of Nurses on 1/24/11 at 1:10 PM confirmed that a tab alarm, and not the pressure pad alarm, was in place on 12/11/10 at the time of the resident's fall.", "filedate": "2014-04-01"}
{"rowid": 10194, "facility_name": "ELLEN SAGAR NURSING HOME", "facility_id": 425012, "address": "1817 JONESVILLE HIGHWAY", "city": "UNION", "state": "SC", "zip": 29379, "inspection_date": "2010-09-15", "deficiency_tag": 441, "scope_severity": "E", "complaint": null, "standard": null, "eventid": "A4CW11", "inspection_text": "On the days of the survey, based on observation and interview, the facility failed to sanitize residents' personal laundry. The findings included: During observation on 9/14/10 at approximately 1:36 PM, Laundry Aid #1 loaded multiple residents' personal laundry into the washer and set the cleaning solution pump on \"F1.\" The sign posted on the wall stated F1 solution was without bleach. During an interview at that time, the laundry aid stated she always used setting 1 for residents' personal clothes so they wouldn't be damaged. At 1:46 PM, during an interview, the Area Mechanic stated the water in the washer was between 115 and 120 degrees. He further stated the water used to be at 180 degrees but, after changing chemicals, they had been told the water temperature didn't need to be that high. At approximately 3:08 PM on 9/14/10, the Director of Environmental Services confirmed that the F1 setting did not include bleach and stated the (solution) pump should have been set on the F2 setting which added bleach after five minutes. Review of the detergent container did not reveal that the detergent contained any sanitizer. The Director of Environmental Services did not provide any additional information that the detergent had any bateriocidal properties.", "filedate": "2014-03-01"}
{"rowid": 10195, "facility_name": "ELLEN SAGAR NURSING HOME", "facility_id": 425012, "address": "1817 JONESVILLE HIGHWAY", "city": "UNION", "state": "SC", "zip": 29379, "inspection_date": "2010-09-15", "deficiency_tag": 333, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "A4CW11", "inspection_text": "**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 that one of 20 residents reviewed for medication assessment was free of significant medication errors. Potassium was not administered as ordered to Resident #6 for a period of 5 days. The findings included: The facility admitted Resident #6 with [DIAGNOSES REDACTED]. Prognosis was \"nil\" at the time of admission. Record review on 9-14-10 at 1:55 PM revealed 7-19-10 physician's orders [REDACTED]. Review of the 7-19-10 Basic Metabolic Profile revealed the following results: Sodium = 130 LOW (reference 135-145 mmol/L); Potassium = 4.9 (reference 3.6-5.0 mmol/L); Chloride = 95 LOW (reference 101-111 mmol/L); Blood Urea Nitrogen = 52 HIGH (reference 6-20 mg/dl); Creatinine = 1.8 HIGH (reference 0.5-1.2 mg/dl). Review of the 7-10 Documentation Record (Medication Administration Record/MAR) revealed that the medication was held as ordered and that the [MEDICATION NAME] was resumed on 7-27-10. The Potassium (20 milliEquivalents daily) was not initialed on the MAR indicated [REDACTED]. During an interview on 9-15-10 at 9:40 AM, the Director of Nurses verified that the medication had not been initialed as given for the five day period as noted. She stated she had been unaware of the omissions, no medication error report had been completed, and the physician had not been notified. She reviewed the record and verified that no recent Potassium level had been drawn.", "filedate": "2014-03-01"}
{"rowid": 10196, "facility_name": "ELLEN SAGAR NURSING HOME", "facility_id": 425012, "address": "1817 JONESVILLE HIGHWAY", "city": "UNION", "state": "SC", "zip": 29379, "inspection_date": "2010-09-15", "deficiency_tag": 315, "scope_severity": "E", "complaint": null, "standard": null, "eventid": "A4CW11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on observation, record review, interview, and review of the policy provided by the facility entitled \"Skills Checklist for Suprapubic Catheter Care\", the facility failed to ensure appropriate treatment and services for residents with catheters. The Certified Nursing Assistant (CNA) failed to properly anchor the suprapubic catheter tubing during catheter care for Resident #2, one of three residents observed with catheter care. Also, the facility failed to assess oral intake and urinary output as indicated by residents' medical condition for one of two sampled residents reviewed with an indwelling Foley catheter and Care Plan for intake and output monitoring. Resident #6, with a history of fluid imbalance and [MEDICAL CONDITION], had incomplete intake and output documentation. The findings included: The facility admitted Resident #2 on 10/22/09 with [DIAGNOSES REDACTED]. Observation of catheter care on 9/14/10 at 12:23 PM revealed CNA(Certified Nursing Assistant) #2 cleaning, rinsing, and drying the catheter tubing. She held the tubing between her index finger and thumb, approximately 4 inches from the insertion site, and anchored it to the resident's thigh while wiping down the tubing. The CNA cleansed from the insertion site distally toward where she held the catheter, causing undo tension on the catheter tubing. During an interview on 9/15/10 at 11:25 AM, CNA #2 verified she had anchored the catheter tubing at the resident's thigh instead of at the insertion site while performing catheter care. She stated she thought she was supposed to anchor the tubing to the thigh. Review of the policy entitled \"Skills Checklist for Suprapubic Catheter Care\" on 9/15/10 revealed \"...6. Apply soap to one wet cloth, 7. Hold tubing (Without pulling) in other hand, 8. Wash around one side of tubing with soapy cloth-, 9. Using a different, clean part of cloth- wash around the other side of the Tubing, 10. Hold the tubing closest to the body to anchor it and prevent it from being pulled, 11. Using a different, clean part of cloth- wrap cloth around tubing (while holding with other hand) and wash tubing at least 4 inches away from body...14. Rinse one side of the insertion site ___/other side of tubing ___/the tube at least 4 inches___(while anchoring the tubing)___...16. Dry with clean cloth- one side of insertion site ___/other side of insertion site __/ around tubing and out 4 inches ___/ while anchoring tubing___.\" The facility admitted Resident #6 with [DIAGNOSES REDACTED]. Prognosis was \"nil\" at the time of admission. Record review on 9-14-10 at 1:55 PM revealed significant weight loss noted on both the 11-16-09 Admission and 7-22-10 Quarterly Minimum Data Set Assessments. Weight records revealed an admission weight of 242 pounds and a 7-10 weight of 129.3 pounds. Further review revealed stabilization after the most recent assessment. The resident was admitted with and continued to have an indwelling Foley catheter. During an interview on 9-15-10 at 9:40 AM, the Director of Nurses (DON) attributed the majority of the weight loss to a dramatic decrease in [MEDICAL CONDITION] after admission (related to the [DIAGNOSES REDACTED]. Review of the current Care Plan revealed approaches including monitoring for [MEDICAL CONDITION] and recording intake and output every shift. Review of Intake and Output (I&O) Records revealed that urinary output was inconsistently monitored. For the month of 7-10, 31 of 31 days had omissions of recorded output. For 8-10, 30 of 31 days were incomplete. 13 of 13 days were incomplete in 9-10, through the dates of the survey. There was no output recorded for 7-31-10 7AM-3PM shift through 8-1-10 11PM-7AM shift (6 consecutive shifts), from 8-28-10 7AM-3PM shift through 8-31-10 7AM-3PM shift (10 consecutive shifts), and from 8-31-10 11PM-7AM shift through 9-3-10 7AM-3PM shift (8 consecutive shifts). Review of the diet card on 9-14-10 at 12:05 PM indicated that the resident was on a 1500 ml (milliliter) fluid restriction. As the tray was delivered, Certified Nursing Assistant (CNA) #4 stated she would \"go get the coffee\" as per the resident's request. During an interview at this time, CNA #4 reviewed the diet card and stated that she thought the resident was on a fluid restriction. The CNA verified that the diet card noted and that the resident received only 5 ounces of soup and 1/2 cup of iced tea as fluids for that meal. CNA #4 also verified that the resident had a water-filled pitcher at the bedside. A water pitcher had also been observed at the residents bedside on 9-13-10 at 9:35 PM and on 9-14-10 at 10:15 AM. At 12:30 PM on 9-14-10, Licensed Practical Nurse (LPN) #2 verified that a resident on fluid restriction should not have a water pitcher at the bedside and that intake and output should be monitored. I&O records were reviewed and 23 of 31 days in 7-10, 27 of 31 days in 8-10, and 11 of 13 days in 9-10, through the dates of the survey, were recorded with intakes of greater than 1500 ml. No current physician's orders [REDACTED]. During an interview on 9-15-10 at 9:35 AM, LPN #5 verified that Resident #6 should have had her intake and output monitored every shift. She stated that nurses wrote this information on the daily assignment sheet. CNAs were to record the intake and output at the end of their shifts. The Ward Secretary was responsible to \"get the I&O and record it\" on the Intake and Output Records. During the interview on 9-15-10 at 9:40 AM, the DON confirmed that Resident #6 had not been on a fluid restriction \"for quite some time...She was on a restriction when first admitted due to [MEDICAL CONDITION] (skin) all over her body...\" The DON stated that the diet card had been corrected. She verified the Care Plan to monitor the intake and output and confirmed that the reports were incomplete.", "filedate": "2014-03-01"}
{"rowid": 10197, "facility_name": "ELLEN SAGAR NURSING HOME", "facility_id": 425012, "address": "1817 JONESVILLE HIGHWAY", "city": "UNION", "state": "SC", "zip": 29379, "inspection_date": "2010-09-15", "deficiency_tag": 332, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "A4CW11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on observations, record reviews, interviews and the Drug Facts and Comparisons book (updated monthly), the facility failed to ensure that it was free of medication error rates of five percent or greater. The medication error rate was 6.5 %. There were 3 errors out of 46 opportunities for error. The findings included: Error #1: On 9/13/10 at 8:36 PM, during observation of medication pass, Registered Nurse (RN) #5 was observed to administer two Klor-Con 10 (Potassium Chloride Extended Release) tablets and 7 other medications to Resident #10. During an interview on 9/13/10 at 8:48 PM, RN #5 revealed that supper trays arrived on the unit at about 6 PM and that Resident #10 had eaten in his room (approximately 2 and one-half hours before the potassium was administered). The Drug Facts and Comparisons book, page 49 (Potassium Replacement Products), states (under \"Patient Information\"): \"May cause GI (gastro-intestinal) upset; take after meals or with food and with a full glass of water.\" Error #2: On 9/13/10 at 9 PM, during observation of medication pass, RN #2 was observed to administer one drop of [MEDICATION NAME] Ophthalmic Solution and one drop of [MEDICATION NAME] Ophthalmic Solution to the right eye of Resident A with one minute and 56 seconds between the two drops. RN #2 then administered one drop of the same two eye drops to the resident's left eye with 2 minutes and 4 seconds between the 2 drops. The Drug Facts and Comparisons book, page 1725, states (under \"General Considerations in Topical Ophthalmic Drug Therapy\"): \"Because of rapid lacrimal drainage and limited eye capacity, if multiple drop therapy is indicated, the best interval between drops is 5 minutes. This ensures that the first drop is not flushed away by the second or that the second drop is not diluted by the first.\". Error #3: On 9/14/10 at 7:47 AM, during observation of medication pass, RN #1 was observed to instill one drop of [MEDICATION NAME] Ophthalmic Suspension into each eye of Resident B without shaking the bottle before instillation. The Drug Facts and Comparisons book, page 1725, states (under \"General Considerations in Topical Ophthalmic Drug Therapy\"): \"Resuspend suspensions (notably, many ocular steroids) by shaking to provide an accurate dosage of drug.\". During an interview on 9/14/10 at 9:53 AM, RN #1 confirmed she did not shake the [MEDICATION NAME] Ophthalmic Suspension before instillation into the resident's eyes. Observation of the [MEDICATION NAME] Ophthalmic Suspension bottle revealed that there was no auxiliary \"Shake Well\" label attached to the bottle. During an interview on 9/14/10 at 10:43 AM, the facility's Consultant Pharmacist stated that she doesn't supply medications to the facility but agreed that there should be a \"Shake Well\" auxiliary label attached to the [MEDICATION NAME] bottle.", "filedate": "2014-03-01"}
{"rowid": 10198, "facility_name": "ELLEN SAGAR NURSING HOME", "facility_id": 425012, "address": "1817 JONESVILLE HIGHWAY", "city": "UNION", "state": "SC", "zip": 29379, "inspection_date": "2010-09-15", "deficiency_tag": 225, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "A4CW11", "inspection_text": "**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 policy provided by the facility entitled \"Alleged Violations of Mistreatment, Neglect and Abuse Including Injuries of Unknown Origin and Misappropriation of Property\" dated 2/09, the facility failed to complete a thorough investigation for one of one reportable incidents reviewed for misappropriation of funds. The findings included: One of three reportable incidents reviewed on 9/15/10 revealed that a resident reported $44.00 missing from his room on 9/7/10. According to the DHEC (Department of Health and Environmental Control) Five-Day Follow-Up Report dated 9/13/10, \"He had noticed this the week prior to the report\". Under \"Witnesses and other Staff on duty at time of/or prior to Reportable Incident:\", there was nothing written. According to the report, the missing money had been reported by the facility to the Union County Sheriff's Office on 9/8/10. The \"Summary Report of Facility Investigation:\" stated \"(Resident) keeps various items in the basket where he reported the money had been stored. (Numerous pieces of mail, straws, playing cards, and various other items). He has been reminded again to lock up any large amounts of money.\" Attached to the Five-Day Follow-Up Report was a letter dated May 4, 2010 from the Administrator addressed to residents and their families reminding them that the facility could store valuables and that residents are encouraged to not keep any items of personal or monetary value in their room. The letter went on to state that \"The facility will take every precaution to protect belongings but cannot be accountable for valuables left in resident rooms\". There were no resident or staff statements attached or evidence of a thorough investigation being completed. During an interview on 9/15/10 at approximately 12:30 PM, the Social Services Director (SSD) stated the resident had a history of [REDACTED]. After reviewing the Five-Day Follow-Up Report, she verified there were no resident or staff statements included. When asked if she had asked any of the staff about the missing money, she said \"We felt like, they know to report. We thought it would be ineffective to ask each one.\" She went on to state that they had thought it best if the Sheriff's Department handled it. The SSD stated staff receive inservices on misappropriation. She then stated they did ask staff present at the time of the report if anyone knew about missing money, however, they did not get any statements and did not check to see which staff may have been on duty at the time of the alleged incident. The SSD had questions about where to draw the line as far as who to interview during an investigation. Review of the policy entitled \"Alleged Violations of Mistreatment, Neglect and Abuse Including Injuries of Unknown Origin and Misappropriation of Property\" on 9/15/10 revealed \"Investigation procedures for allegations of misappropriation of resident property are as follows: ...The individual assigned to conduct the investigation will conduct a thorough investigation of the allegation. Areas/items that may be included as appropriate in the investigation include: a. An interview with the person reporting the missing items, b. A search of the resident's room for the missing items, c. an interview with the resident, as medically appropriate, e. An interview with the alleged individual accused of taking the residents' property, if known, f. Interviews with staff members, g. Interviews with the resident's roommate, family members, and visitors as appropriate...\".", "filedate": "2014-03-01"}
{"rowid": 10199, "facility_name": "ELLEN SAGAR NURSING HOME", "facility_id": 425012, "address": "1817 JONESVILLE HIGHWAY", "city": "UNION", "state": "SC", "zip": 29379, "inspection_date": "2010-09-15", "deficiency_tag": 323, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "A4CW11", "inspection_text": "**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 the resident environment remained free of accident hazards as was possible and that each resident received assistance devices to prevent accidents. Random observations were made of unattended paint thinner accessible to cognitively impaired, mobile residents and of bottles of Hydrogen Peroxide (H2O2) stored unsecured in Resident #3's bathroom. The facility also failed to provide interventions as required to minimize injury for one (1 )of 6 sampled residents reviewed for falls. Resident # 6 who was assessed at high risk for falls did not have a low bed and mats provided as per the plan of care. The findings included: On 9/14/10 at 10:50 AM a random observation was made by two surveyors on Unit 1 Maple Lane in the patient shower area of an unattended 1 gallon container of Paint Thinner on the window sill and 2 paint cans without covers containing paint thinner, soaked brushes, and rags soaked in paint thinner. There was a strong odor of the chemical in the shower area and in the Maple Lane Hall. The label on the Paint Thinner read, \"DANGER: COMBUSTIBLE LIQUID, FLAMMABLE--HARMFUL OR FATAL IF SWALLOWED\". The Material Safety Data Sheet (MSDS) provided by the Administrator on 9/14/10 read : \"RISK STATEMENTS-Irritating to eyes, respiratory system, and skin. Harmful by inhalation, may cause lung damage if swallowed. Harmful in contact with skin. Vapors may cause drowsiness and dizziness\". SAFETY STATEMENTS on the MSDS read: \"Avoid contact with skin and eyes, Keep container tightly closed. Do not breathe gas, fumes, vapor, or spray, Keep away from sources of ignition. Take precautionary measures against static discharges.\" HANDLING AND STORAGE SECTIONS of the MSDS stated, \"STORAGE : Vapors may ignite explosively and spread long distances. Prevent vapor build up. Keep cool and keep in the dark. Do not store above 49 C/120 F(Fahrenheit). Keep container lightly closed and upright when not in use to prevent leakage.\" \"HANDLING: Use only with adequate ventilation. Avoid breathing of vapor of spray mist. Avoid contact with skin and eyes. Wear OSHA standard goggle or face shield. Wear gloves, apron, and footwear impervious to this material. Wash clothing before reuse. Avoid free fall of liquid. Empty container very hazardous!\" Residents in nearby rooms #17 and #15 were using oxygen at the time of the random observation and a fan was blowing in the hall by the shower room with the observed Paint Thinner. In an interview on 9/14/10 at 11:00 AM with the Administrator and Environmental Services Manager they recognized the paint thinner as a hazardous chemical and removed if from the premises promptly. The Administrator stated they had contracted painters to repaint the facility halls and the Paint Thinner was left by the painters who were currently using the product. He stated that he had informed them prior to the start of the painting of the halls to remove unattended hazardous chemicals while painting the facility. He did not have a formal, written contract with the paint company, or evidence of this instruction. Following completion of tracheal suctioning and care on 9-14-10, Registered Nurse (RN) #1 removed the two-tiered wired basket cart containing all tracheostomy suctioning and care supplies from Resident #3's room. She stated that it was routinely stored in the resident's bathroom. The cart contained two 16 ounce bottles of Hydrogen Peroxide which were labeled, \"Harmful if swallowed. Keep out of the reach of children.\" On 9-15-10 at 10:45 AM, Licensed Practical Nurse (LPN) #4, while preparing to perform tracheostomy care for Resident #3, stated that she had obtained the cart containing the H2O2 and other supplies from the unlocked resident bathroom. The facility admitted Resident #6 with [DIAGNOSES REDACTED]. Record review on 9-14-10 at 1:55 PM revealed that resident was assessed at high risk for falls on the most recent Fall Risk Assessment completed on 7-20-10. The 7-22-10 Care Plan noted that the resident was to have a \"Low bed with mats\". The 7-22-10 Quarterly Minimum Data Set Assessment noted the resident with both short- and long-term memory problems and varying mental function. On 9-13-10 at 9:35 PM, the resident was observed in a low bed, but without mats in place. The resident was observed in a regular height bed without mats on 9-14-10 at 9 AM, 10:15 AM, 12:05 PM, 1:30 PM, and 3:50 PM. During an interview on 9-14-10 at 4 PM, Certified Nursing Assistant (CNA) #1 stated that she did not know how long the resident had not had the low bed/mats. She was aware that the resident was supposed to have them \"because it's on the Basic Care Sheet (CNA Care Plan).\" During an interview on 9-14-10 at 3:50 PM, RN #2 checked the Documentation Record and verified that it indicated that the resident was to have a low bed with mats. The form noted \"FYI\" next to the intervention which RN #2 stated meant that the nurse was to check to assure the item was in place. She went to the resident's room and verified that the resident was in a regular height bed without mats. The nurse was unable to lower the bed and was unable to locate mats in the room for the resident.", "filedate": "2014-03-01"}
{"rowid": 10200, "facility_name": "ELLEN SAGAR NURSING HOME", "facility_id": 425012, "address": "1817 JONESVILLE HIGHWAY", "city": "UNION", "state": "SC", "zip": 29379, "inspection_date": "2010-09-15", "deficiency_tag": 309, "scope_severity": "E", "complaint": null, "standard": null, "eventid": "A4CW11", "inspection_text": "**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 follow physician's orders for application of Knee High TED (antiembolism stockings) Hose for Resident # 11, 1 of 4 residents reviewed with orders for TED Hose. The facility also failed to include provision of Services from a Chaplain and Social Services in the care plan and no documentation of visits from these disciplines were found in the record for Resident #18, 1 of 2 resident's reviewed receiving Hospice Services . The findings included: The facility admitted Resident #11 on 4/26/04 with [DIAGNOSES REDACTED]. Record Review on 9/14/10 at approximately 6:15 PM revealed a Physician's Order for \"Knee high TED hose on in the morning before getting out of bed & (and) remove at bedtime ([MEDICAL CONDITION])\" with a start date of 9/16/08. Observation of the resident at 6:25 PM on 9/14/10 revealed the resident was not wearing TED Hose. During an interview on 9/15/10 at 1:15 PM, the resident stated she had never had any stockings and that she did have swelling in her feet \"sometimes.\" Review of the resident's Minimal Data Set revealed the resident was coded as not having any short or long term memory problems. The resident was named on the list provided by the facility of Interviewable Residents and she was a member of the Resident Council. Record Review on 9/15/10 at approximately 1:30 PM revealed that the TED Hose had been signed off daily for August and September, including being signed off for being applied the morning of 9/15/10. During an interview on 9/15/10 at approximately 2:15 PM, Registered Nurse (RN) #4 stated she had just received a new pair of TED Hose for the resident the previous week. Upon observation of the resident, RN #4 confirmed the resident was not wearing TED Hose. RN #4 was unable to locate any TED Hose in the resident's drawers. When informed of the resident's statement that she had never had any stockings, RN #4 stated: \"She's usually pretty with it.\" During an interview on 9/15/10 at approximately 2:45 PM, Physical Therapy Assistant #1 stated Resident #11 was being seen 3 times per week by Physical Therapy and the treatment included leg exercises. She further stated that she had not observed the resident wearing TED Hose for at least the last month. The facility admitted Resident #18 on 7/6/10 with [DIAGNOSES REDACTED]. She was placed on Hospice Services on 7/30/10 for [DIAGNOSES REDACTED]. Review of Resident #18's record on 9/15/10, revealed no documentation of Chaplain or Social Service visits since the resident was admitted to Hospice. Review of the resident's facility and Hospice care plans revealed no care plan for Chaplain or Social Services. During an interview with RN #4 at approximately 12:00 PM, she stated she knew of no other place there would be any documentation from the Hospice staff other than in the chart. At approximately 12:30 PM on 9/15/10, the Director of Nursing stated she had spoken to the Hospice provider in the past regarding keeping information in the residents' charts in the facility and not just in the Hospice office. She stated the Director of Social Services might know if there was any documentation located anywhere else. During an interview on 9/15/10 at 1:22 PM, the Social Services Director stated she did not know of any documentation other than what was located in the chart and confirmed there was no documentation in the record of Chaplain or Social Service visits. Review of the Hospice Contract revealed the Hospice Provider was responsible for providing medical social services and counseling services (including bereavement,...and spiritual counseling.) It further stated that \"Hospice shall furnish Nursing Facility with a copy of the Hospice Plan of Care\" and any modifications to the plan of care.", "filedate": "2014-03-01"}
{"rowid": 10201, "facility_name": "ELLEN SAGAR NURSING HOME", "facility_id": 425012, "address": "1817 JONESVILLE HIGHWAY", "city": "UNION", "state": "SC", "zip": 29379, "inspection_date": "2010-09-15", "deficiency_tag": 322, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "A4CW11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on observation, interviews, and review of the facility's policies entitled \"Gastrostomy Tube Check List\" and \"Procedure for Cleaning 60 cc (cubic centimeters) Syringes Used for Resident Feeding\", the facility failed to utilize universal precautions and clean technique when flushing the Gastrostomy (G-) Tube and when cleaning and storing the piston syringes and gravity set for 2 of 3 residents observed for Gastrostomy Tube flushes. The findings included: The facility admitted Resident #5 on 7/17/09 with [DIAGNOSES REDACTED]. On 9/14/10 at approximately 12:33 PM, Licensed Practical Nurse (LPN) #6 was observed by two surveyors providing a Gastrostomy Tube flush before and after medication administration without washing her hands prior to initiating the procedure. LPN #6 opened the Medication cart, retrieved a bottle of liquid Tylenol from the drawer and poured 20 milliliters (ml) of Tylenol into a medication cup. LPN #6 proceeded to the resident's room, knocked, entered the room and filled the 2 empty medicine cups with 30 ml of water from the sink and placed all 3 medicine cups on the over-bed table. She then closed the door, opened a plastic bag and placed it on the foot of the bed and donned a pair of non-sterile gloves. LPN #6 proceeded to check for and replace residual, checked for placement of the [DEVICE], and administered the 30 ml flush, the medication and ended with another 30 ml flush. Upon completion of the procedure, the piston syringe was rinsed and placed wet, back into the bag. Review of the \"Gastrostomy Tube Check List\" provided by the facility on 9-14-10 revealed \"2. Placement check: Check placement before flushes,...Gather supplies..., Explain procedure to Resident, Provide Privacy, Wash Hands, (apply) Non-sterile gloves, ...\" The facility admitted Resident #3 on 4-8-01 with [DIAGNOSES REDACTED]. Prior to observation of a Gastrostomy (G-) feeding and flush on 9-14-10 beginning at 9:55 AM, two Certified Nursing Assistants exited the resident's room after completing AM care, including incontinent care. Registered Nurse (RN) #1 proceeded to prepare the resident for a gravity feeding. She checked placement using a 60 cc (cubic centimeter) piston syringe and then infused 30 cc of water via gravity through the barrel of the syringe. The RN then connected the gravity feeding tubing to the [DEVICE] and set the clamp so as to infuse it slowly. She then took apart the piston syringe and placed it in the sink. She removed the gloves she had used during the procedure, rinsed the syringe with water, placed the piston in the barrel of the syringe, and stored it together, wet, in its original packaging. At 10:30 AM, RN #1 disconnected the gravity feeding set and hung the capped tubing on the feeding pole. She neglected to rinse out the feeding set, allowing feeding to remain in the tubing and bottom of the bag. When asked if this was how the set was stored until the next feeding, the RN replied, \"Yes.\" The nurse completed the water flush via gravity using the barrel of the feeding syringe. After completing the procedure, RN #1 again placed the piston and barrel of the feeding syringe into the sink. She removed the gloves she had used during the procedure, rinsed the syringe with water, placed the piston in the barrel of the syringe, and stored it together, wet, in its original packaging. RN #1 verified that this was the procedure she always followed. During an interview on 9-15-10 at 10 AM, the Director of Nurses stated that the facility policy did not address handling of the piston syringe or gravity feeding set. She stated that the syringe should not have been placed in the sink and that the feeding should have been rinsed out of the gravity set and not allowed to remain until the next feeding time. On 9-15-10 at 1 PM, RN #1 verified the procedure as above noted. During an interview on 9-15-10 at 12:05 PM, the Administrator stated there was no evidence on file that RN #1 had been trained on the proper procedure for [DEVICE] feeding/flush. Review of the facility's policy entitled \"Gastrostomy Tube Checklist\" on 9-15-10 revealed no reference to cleansing or storage of the piston syringe or gravity feeding set. Review of the Infection Control Manual on 9-15-10 revealed a policy entitled \"Procedure for Cleaning 60 cc Syringes Used for Resident Feeding\" which stated: \"...3. The syringe is washed and cleaned thoroughly with dispenser soap and water and rinsed well in hot water subsequent to use. Be sure not to place the syringe in the sink. 4. The syringe is stored separate (barrel and syringe) on a clean paper towel and covered with a clean towel and allowed to air dry...7. Syringes used for tube feeding are cared for in the same manner as described above...\"", "filedate": "2014-03-01"}
{"rowid": 10202, "facility_name": "ELLEN SAGAR NURSING HOME", "facility_id": 425012, "address": "1817 JONESVILLE HIGHWAY", "city": "UNION", "state": "SC", "zip": 29379, "inspection_date": "2010-09-15", "deficiency_tag": 328, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "A4CW11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on observation, record review and interviews, the facility failed to follow the Physician's Orders for the administration of oxygen for 1 of 4 sampled residents reviewed with oxygen. Resident # 18 oxygen rate was observed above the stated physician's order. The findings included: The facility admitted Resident #18 on 7/6/10 with [DIAGNOSES REDACTED]. She was placed on Hospice Services on 7/30/10 for [DIAGNOSES REDACTED]. Review of the record on 9/15/10 at approximately 11:00 AM revealed a Physician's order for O2 (oxygen) at 2 liter per minute (lpm) via NC (nasal cannula.) Review of the Hospice Nursing Visit Note revealed the Hospice nurse had documented the oxygen at 3 lpm via NC on 9/15/10, 9/8/10 and on 8/23/10. Review of the Documentation Record (MAR) revealed facility nursing staff was signing off the O2 at 2 lpm via NC each shift including the days of the survey. Observation on 9/15/10 at approximately 11:30 revealed the oxygen was flowing at approximately 3 1/2 lpm via NC. At approximately 1:00 PM on 9/15/10, Registered Nurse (RN) # 4, verified the oxygen was flowing at 3 1/2 lpm via NC. Upon questioning, she stated \"I'd have to check the MAR (Documentation Record) but I'm pretty sure it's supposed to be at 2 (lpm).\" RN #4 also reviewed the record and confirmed the Physician's Orders and the MAR indicated and could not locate any new order to increase the flow rate. During an interview on 9/15/10 at 2:28 PM, the Hospice Nurse stated the oxygen was supposed to be at 2 lpm and had been since admission to Hospice. She stated she thought the oxygen flow rate had inadvertently been changed on 9/15/10 when the Certified Nursing Assistant had reached to turn the oxygen back on after the resident's AM care had been completed. She stated the 3 lpm documented on the Nursing Visit Note for 9/15/10 had been a documentation error only. The Hospice Nurse later changed the documentation on the 9/8/10 Nursing Visit Note from 3 lpm to 2 lpm and did not date the change.", "filedate": "2014-03-01"}
{"rowid": 10203, "facility_name": "ELLEN SAGAR NURSING HOME", "facility_id": 425012, "address": "1817 JONESVILLE HIGHWAY", "city": "UNION", "state": "SC", "zip": 29379, "inspection_date": "2010-09-15", "deficiency_tag": 468, "scope_severity": "E", "complaint": null, "standard": null, "eventid": "A4CW11", "inspection_text": "On the days of the survey, based on observation and interview, the facility failed to equip multiples areas in the corridors with handrails. The findings included: On 9/15/10 at approximately 1:55 PM, multiple areas leading into or on corridors were observed without handrails affixed to the walls. Areas included, but were not limited to: -an area approximately 3 1/2 feet at the entrance to Rocky Road Hall on the left and right sides of the hall -an area approximately 3 1/2 feet at the entrance to Rainbow Row Hall on the right side of the hall -approximately 5 feet across from the Unit I Nurses Station -a section approximately 8 feet long in a corridor behind the Unit I Nurses Station -the entire length of the corridor connecting Unit I and Unit II on both sides of the hallway -two 5 foot sections and two 3 1/2 foot sections on Unit II at the Nurses Station and several other areas leading into the 3 halls from the nurses station. During an interview on 9/14/10 at approximately 4:15 PM, the Maintenance Director verified multiple areas were without handrails and stated that the corridor between Units I and II had never had handrails as far as he knew. He also stated that the area behind the Unit I Nurses Station \"looks like there used to be one there.\"", "filedate": "2014-03-01"}
{"rowid": 10204, "facility_name": "FELLOWSHIP HEALTH & REHAB OF ANDERSON, LLC", "facility_id": 425016, "address": "208 JAMES STREET", "city": "ANDERSON", "state": "SC", "zip": 29625, "inspection_date": "2010-11-08", "deficiency_tag": 323, "scope_severity": "G", "complaint": null, "standard": null, "eventid": "CCT011", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the day of the inspection based on record review, interviews, review of the facility's policy on Falls, and review of the facility's inservices, the facility failed to assure each resident was free of accidents as was possible for 1 of 6 sampled residents. Resident #1 sustained 3 falls in 3 days without new interventions implemented. Resident #1 fell on ,[DATE], 7/30 (sustained injuries to the face and mouth) and on 8/1/2010, no interventions were implemented until 8/2/2010. The findings included: The facility admitted Resident #1 on 6/29/2010. [DIAGNOSES REDACTED]. Review of the medical record revealed the Initial Minimum Data Set ((MDS) dated [DATE] coded Resident #1 as having a short-term and long-term memory problem with moderately impaired cognitive skills for daily decision-making. The MDS coded the resident as needing extensive 1 person assistance with transfers and bed mobility and completely dependent for locomotion on and off the unit. Resident #1 was also coded as dependent for eating, dressing, hygiene, and bathing with no behaviors coded as occurring during the assessment period. The resident was coded as receiving Hospice services. Resident #1 was not coded as having any accidents within 180 days. Review of the Nurses' Progress Notes dated 7/29/2010 at 12:30 PM indicated Resident #1 \"fell forward out of wheelchair and hit his R(ight) forehead. He reports no pain and no sign of injury.\" A Nurses' Note dated 7/30/2010 at 5 PM documented that Resident #1 was \"observed on floor laying on L(eft) side of body with blood on floor (small amount) from nose and mouth. Resident helped off the floor and into bed and pressure to nose applied. Writer took out bottom and top dentures and noted a small piece of the palate of the denture was broke off and a few small cuts on top of gums...\" Further review revealed an entry dated 8/1/2010 at 6 AM, \"slid off of the bed on to floor, Resident observed sitting on floor with back against bed.\" On 8/2/2010 at 11 AM, the nurses' note indicated an order was obtained for a bed alarm and 1/2 lap tray. Review of the care plan revealed a risk for injury (falls) related to weakness, history of syncope, dementia and seizures was identified as a problem area. Interventions and approaches to this problem area were documented on the care plan and included \"observe frequently, call light within reach..., provide assistive devices for mobility, provide assistance with mobility, review circumstances of how falls occur to try to eliminate further falls, keep floor/pathway free of debris, notify MD/hospice PRN (as needed).\" The care plan was updated on 7/29/2010 with a handwritten note to \"observe res(ident) frequently when up.\" The care plan was not updated with the 7/30/2010 fall nor the 8/1/2010 fall. On 8/2/2010 the bed alarm was written on the care plan, however the lap tray was not added. The care plan did not include new or appropriate interventions to prevent Resident #1 from falling after he sustained several falls on 7/29/2010, 7/30/2010 and 8/1/2010. Review of the MD Progress Notes dated 8/2/2010 indicated that Resident #1 was assessed by the physician, however there was no documentation relevant to the falls on 7/29, 7/30 or 8/1/2010. Review of the physician's orders [REDACTED]. No other orders were written related to the falls on 7/29, 7/30 or 8/1/2010. Review of the Medication Administration Record (MAR) revealed that the bed alarm and lap tray were added on 8/2/2010 and then signed for each shift. Review of the Nursing Admission Screen dated 6/29/2010 revealed that Resident #1 scored a \"12\" on the Fall Risk Screen, indicating he was at \"high risk\" for falls. Resident #1 had another Fall Risk Screen completed on 7/7/2010 scoring a \"12\", indicating he was still at high risk for falls. The interventions listed were \"staff observes freq(uently), no hx (history) of falls.\" Review of the incident reports related to each fall revealed: On 7/29/2010 at 12:00 PM, Resident #1 was in the hallway with he \"tipped forward out of wheelchair, caught himself with his arms and his R(ight) forehead the floor. No injuries or report of pain. Hospice nurse notified.\" \"Steps taken to prevent recurrence: 1/2 lap tray for w/c (wheelchair) on 8/2/2010.\" An incident report dated 7/30/2010 at 5 PM, indicated the \"resident was observed lying on L(eft) side of body with blood on floor (small amount) from nose and mouth. Resident helped off the floor and into bed and pressure to nose applied. Writer took out bottom and top dentures and noted a small piece of the palate of the denture was broke off and a few small cuts on top of gums...\" \"Steps taken to prevent recurrence: bed alarm ordered on [DATE].\" An incident report dated 8/1/2010 at 6 AM revealed Resident #1 was \"trying to get up and slid off of the bed. Resident observed sitting on floor with back resting against bed...no injury observed.\" \"Steps taken to prevent recurrence: bed alarm ordered on [DATE].\" During an interview on 11/8/2010 at 10:00 AM, CNA (Certified Nursing Assistant) stated #1 that she routinely cared for Resident #1. CNA #1 stated that she witnessed the resident fall on 7/29/2010. She further stated that she knew he had a bed alarm and 1/2 lap tray put in place but was unsure as to when they were placed. During an interview on 11/8/2010 at 10:15 AM, LPN Supervisor (Licensed Practical Nurse) #1 stated she was present for Resident #1's fall on 7/30/2010. She stated that she assessed the resident after the fall and filled out the incident report. She stated that Resident #1's dentures were broken and he was bleeding from his gums. She stated that she did not implement an intervention to prevent further falls and stated that she thought it \"was ok to wait on the DHS.\" She stated that it was routine practice to wait for the DHS to implement a new fall prevention intervention. LPN #1 confirmed there was a delay in implementing appropriate fall prevention devices. During an interview on 11/8/2010 at 10:30 AM, LPN #2 stated that she was present for Resident #1's fall on 8/1/2010. She stated that she was aware of his previous two falls and stated that the resident did not have any fall prevention devices in place. LPN #2 stated that she found the resident on the floor in his room. She further revealed that the intervention she implemented was to \"observe frequently.\" LPN #2 confirmed that this was not a new intervention. LPN #2 confirmed that there was a delay in implementing appropriate fall prevention devices. During an interview on 11/8/2010 at 11:30 AM, RN (Registered Nurse) #1 stated that she was present for Resident #1's fall on 7/29/2010. RN #1 stated that he was in orientation at the time of the fall. She further stated that she did not know that she was supposed to implement intervention after each fall to prevent further falls from occurring. RN #1 confirmed there were no interventions put in place after the fall and confirmed that there was a delay in implementing appropriate interventions. During an interview on 11/8/2010 at 12 PM, the Medical Director stated that when a resident falls he would expect the staff to assess the resident, notify him via phone or fax, execute routine procedure (i.e. vital signs, incident reports etc.). The Medical Director then stated that Resident #1 should have had an intervention put in place after he sustained the fall on 7/30/2010 that resulted in injuries to the face. The Medical Director also stated that the intervention should have been implemented immediately and not waited. During an interview on 11/8/2010 at 8:50 AM, the DHS stated that nursing should have implemented an intervention immediately after Resident #1's falls on 7/29, 7/30 and 8/1/2010. The DHS further stated that staff was waiting on her to implement interventions and she stated that she was aware that this practice was not appropriate. The DHS also indicated that the care plan coordinator was to update the care plans with each fall and add interventions. The DHS stated that she was first made aware of the concern related to untimely interventions related to falls when she reviewed Resident #1's record at the end of September 2010. The DHS confirmed there was a delay in implementing Resident #1's fall prevention interventions. .", "filedate": "2014-03-01"}
{"rowid": 10205, "facility_name": "FELLOWSHIP HEALTH & REHAB OF ANDERSON, LLC", "facility_id": 425016, "address": "208 JAMES STREET", "city": "ANDERSON", "state": "SC", "zip": 29625, "inspection_date": "2010-11-08", "deficiency_tag": 280, "scope_severity": "G", "complaint": null, "standard": null, "eventid": "CCT011", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the day of the inspection based on record reviews and interviews, the facility failed to assure 1 of 6 resident's care plans were reviewed and revised appropriately. Resident #1's care plan was not reviewed and revised with each fall. The findings included: The facility admitted Resident #1 on 6/29/2010. [DIAGNOSES REDACTED]. Review of the Nurses' Progress Notes dated 7/29/2010 at 12:30 PM indicated Resident #1 \"fell forward out of wheelchair and hit his R(ight) forehead. He reports no pain and no sign of injury.\" A Nurses' Note dated 7/30/2010 at 5 PM documented that Resident #1 was \"observed on floor laying on L(eft) side of body with blood on floor (small amount) from nose and mouth. Resident helped off the floor and into bed and pressure to nose applied. Writer took out bottom and top dentures and noted a small piece of the palate of the denture was broke off and a few small cuts on top of gums...\" Further review revealed an entry dated 8/1/2010 at 6 AM, \"slid off of the bed on to floor, Resident observed sitting on floor with back against bed.\" On 8/2/2010 at 11 AM, the nurses' note indicated an order was obtained for a bed alarm and 1/2 lap tray. Review of the care plan revealed a risk for injury (falls) related to weakness, history of [MEDICAL CONDITION], dementia and [MEDICAL CONDITION] was identified as a problem area. Interventions and approaches to this problem area were documented on the care plan and included \"observe frequently, call light within reach..., provide assistive devices for mobility, provide assistance with mobility, review circumstances of how falls occur to try to eliminate further falls, keep floor/pathway free of debris, notify MD/hospice PRN (as needed).\" The care plan was updated on 7/29/2010 with a handwritten note to \"observe res(ident) frequently when up.\" The care plan was not updated with the 7/30/2010 fall or the 8/1/2010 fall. On 8/2/2010 the bed alarm was written on the care plan, however the lap tray was not added. The care plan did not include new or appropriate interventions to prevent Resident #1 from falling after he sustained several falls on 7/29/2010, 7/30/2010 and 8/1/2010. Review of the incident reports related to each fall revealed: On 7/29/2010 at 12:00 PM, Resident #1 was in the hallway with he \"tipped forward out of wheelchair, caught himself with his arms and his R(ight) forehead the floor. No injuries or report of pain. Hospice nurse notified.\" \"Steps taken to prevent recurrence: 1/2 lap tray for w/c (wheelchair) on 8/2/2010.\" An incident report dated 7/30/2010 at 5 PM, indicated the \"resident was observed lying on L(eft) side of body with blood on floor (small amount) from nose and mouth. Resident helped off the floor and into bed and pressure to nose applied. Writer took out bottom and top dentures and noted a small piece of the palate of the denture was broke off and a few small cuts on top of gums...\" \"Steps taken to prevent recurrence: bed alarm ordered on [DATE].\" An incident report dated 8/1/2010 at 6 AM revealed Resident #1 was \"trying to get up and slid off of the bed. Resident observed sitting on floor with back resting against bed...no injury observed.\" \"Steps taken to prevent recurrence: bed alarm ordered on [DATE].\" During an interview on 11/8/2010 at 8:50 AM, the DHS stated that nursing should have implemented an intervention immediately after Resident #1's falls on 7/29, 7/30 and 8/1/2010. The DHS further stated that staff was waiting on her to implement interventions and she stated that she was aware that this practice was not appropriate. The DHS also indicated that the care plan coordinator was to update the care plans with each fall and add new interventions. The DHS stated that the care plans were only updated on the weekdays when the care plan coordinators were working. No other staff members updated the care plans. There was not a system in place to update the care plans on the weekends or off hours.", "filedate": "2014-03-01"}
{"rowid": 10206, "facility_name": "MAJESTY HEALTH & REHAB OF EASLEY, LLC", "facility_id": 425018, "address": "200 ANNE DRIVE", "city": "EASLEY", "state": "SC", "zip": 29640, "inspection_date": "2010-11-04", "deficiency_tag": 323, "scope_severity": "G", "complaint": null, "standard": null, "eventid": "GK1G11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on limited record reviews, interviews, observations, and review of facility files, the facility failed to provide residents and staff with adequate supervision to ensure it's system for safe transfer of residents was followed by Hospice and facility staff members for 1 of 1 resident reviewed who sustained injury from an inappropriate transfer (Resident #1). Resident #1 was transferred from bed to chair on [DATE] by manual lift instead of by mechanical lift by his Hospice Certified Nursing Assistant (CNA) and two facility CNAs resulting in bruising to the left axilla and chest. The findings included: Resident #1 with [DIAGNOSES REDACTED]. The resident was hospitalized from [DATE] to [DATE] because of acute renal failure and congestive heart failure exacerbation. Several medications were discontinued on his return to the facility including the Prednisone the resident had taken for years. The resident was admitted to Hospice on [DATE]. Review of the resident assessments of [DATE] and [DATE] showed the resident had short and long term memory problems with moderately impaired decision making ability. The resident was dependent on staff for all activities of daily living. The Significant Change Assessment of [DATE] noted mechanical lift was needed for transfers. According to the Resident Assessment Protocol (RAP) notes of [DATE], the resident required mechanical lift for transfers. Review of the care plan, dated [DATE] and reviewed by the facility and the resident's Hospice nurse, showed no direction to the staff to use a mechanical lift for transfers. The care plan noted problems with fragile skin due to steroid use, risk for pathological fractures related to osteoporosis, risk for falls, risk for complications due to CVA with left side weakness, and impaired mobility. Approaches to these problems included: handle resident cautiously; handle gently during care; transfer resident with care; assist with mobility as needed; provide assistive devises for transfer as needed; and evaluate the use of assistive devices for transferring from bed to chair. review of the resident's medical record revealed [REDACTED]. Review of the Resident Care Plan used by CNAs showed a sling lift was needed for transfers. The form was completed in pencil and showed no date of completion. Observations of resident rooms for three residents on Unit #3 who required mechanical lift transfers showed each resident had a sign at the head of the bed noting how the resident needed to be transferred. Resident #1's sign stated he needed a sling lift. Review of the Nurses' Notes revealed that on [DATE], the resident's daughter notified staff of new discolored areas on her father's left arm, axillary area, and left upper chest. Although the resident had a history of [REDACTED].#1 revealed the areas she saw on the axillary area and left chest on [DATE] were new. The facility's investigation revealed the resident was given care on the morning of [DATE] by his Hospice CNA (CNA #1). After bathing and dressing the resident, CNA #1 requested help to transfer him to the recliner. CNA #1 and a facility CNA (CNA #2) manually transferred the resident to the chair. According to CNA #2's statement, a third CNA (CNA #3) was present in the room and steadied the recliner during the transfer. According to the information in the facility's investigation, the facility CNAs assisted in the inappropriate transfer. There was no evidence to show either of the facility CNAs requested that the mechanical lift be used for the resident.", "filedate": "2014-03-01"}
{"rowid": 10207, "facility_name": "MAJESTY HEALTH & REHAB OF EASLEY, LLC", "facility_id": 425018, "address": "200 ANNE DRIVE", "city": "EASLEY", "state": "SC", "zip": 29640, "inspection_date": "2010-11-04", "deficiency_tag": 282, "scope_severity": "G", "complaint": null, "standard": null, "eventid": "GK1G11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on observation, record review, and interviews the facility failed to ensure that care plans were followed for Resident #1, 1 of 3 sampled residents care planned for a mechanical lift with transfers, was transferred from bed to chair on [DATE] by manual lift by his Hospice Certified Nursing Assistant (CNA) and two facility CNAs resulting in bruising to the left axilla and chest. The findings included: Resident #1 with [DIAGNOSES REDACTED]. The resident was admitted to Hospice on [DATE]. Review of the resident assessments of [DATE] and [DATE] showed the resident had short and long term memory problems with moderately impaired decision making ability. The resident was dependent on staff for all activities of daily living. The Significant Change Assessment of [DATE] noted mechanical lift was needed for transfers. According to the Resident Assessment Protocol (RAP) notes of [DATE], the resident required mechanical lift for transfers. Review of the care plan, dated [DATE] and reviewed by the facility and the resident's Hospice nurse, showed no direction to the staff to use a mechanical lift for transfers. The care plan noted problems with fragile skin due to steroid use, risk for pathological fractures related to [MEDICAL CONDITION], risk for falls, risk for complications due [MEDICAL CONDITION] left side weakness, and impaired mobility. Approaches to these problems included: handle resident cautiously; handle gently during care; transfer resident with care; assist with mobility as needed; provide assistive devises for transfer as needed; and evaluate the use of assistive devices for transferring from bed to chair. review of the resident's medical record revealed [REDACTED]. Review of the Resident Care Plan used by CNAs showed a sling lift was needed for transfers. The form was completed in pencil and showed no date of completion. Observations of resident rooms for three residents on Unit #3 who required mechanical lift transfers showed each resident had a sign at the head of the bed noting how the resident needed to be transferred. Resident #1's sign stated he needed a sling lift. Review of the Nurses' Notes revealed that on [DATE], the resident's daughter notified staff of new discolored areas on her father's left arm, axillary area, and left upper chest. Although the resident had a history of [REDACTED].#1 revealed the areas she saw on the axillary area and left chest on [DATE] were new. The facility's investigation revealed the resident was given care on the morning of [DATE] by his Hospice CNA (CNA #1). After bathing and dressing the resident, CNA #1 requested help to transfer him to the recliner. CNA #1 and a facility CNA (CNA #2) manually transferred the resident to the chair. According to CNA #2's statement, a third CNA (CNA #3) was present in the room and steadied the recliner during the transfer. Cross Refers to F323 as it relates to the failure of the facility to follow an established care plan to prevent harm and ensure the safety of Resident #1 when moving the resident in bed or transferring the resident to allow for care.", "filedate": "2014-03-01"}
{"rowid": 10208, "facility_name": "MAJESTY HEALTH & REHAB OF EASLEY, LLC", "facility_id": 425018, "address": "200 ANNE DRIVE", "city": "EASLEY", "state": "SC", "zip": 29640, "inspection_date": "2010-11-04", "deficiency_tag": 225, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "GK1G11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on limited record reviews, interviews, observations, and review of facility files, 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). Resident #1, 1 of 1 sampled resident that sustained an injury during a transfer, was transferred from bed to chair on [DATE] by manual lift instead of by mechanical lift, as care planned, by his Hospice Certified Nursing Assistant (CNA) and two facility CNAs resulting in bruising to the left axilla and chest. The findings included: Resident #1 with [DIAGNOSES REDACTED]. The resident was admitted to Hospice on [DATE]. Review of the resident assessments of [DATE] and [DATE] showed the resident had short and long term memory problems with moderately impaired decision making ability. The resident was dependent on staff for all activities of daily living. The Significant Change Assessment of [DATE] noted mechanical lift was needed for transfers. According to the Resident Assessment Protocol (RAP) notes of [DATE], the resident required mechanical lift for transfers. Review of the Resident Care Plan used by CNAs showed a sling lift was needed for transfers. The form was completed in pencil and showed no date of completion. Observations of resident rooms for three residents on Unit #3 who required mechanical lift transfers showed each resident had a sign at the head of the bed noting how the resident needed to be transferred. Resident #1's sign stated he needed a sling lift. Review of the Nurses' Notes revealed that on [DATE], the resident's daughter notified staff of new discolored areas on her father's left arm, axillary area, and left upper chest. Although the resident had a history of [REDACTED].#1 revealed the areas she saw on the axillary area and left chest on [DATE] were new. The facility's investigation revealed the resident was given care on the morning of [DATE] by his Hospice CNA (CNA #1). After bathing and dressing the resident, CNA #1 requested help to transfer him to the recliner. CNA #1 and a facility CNA (CNA #2) manually transferred the resident to the chair. According to CNA #2's statement, a third CNA (CNA #3) was present in the room and steadied the recliner during the transfer. According to the information in the facility's investigation, the facility CNAs assisted in the inappropriate transfer. There was no evidence to show either of the facility CNAs requested that the mechanical lift be used for the resident.", "filedate": "2014-03-01"}
{"rowid": 10209, "facility_name": "MOUNTAINVIEW NURSING HOME", "facility_id": 425027, "address": "340 CEDAR SPRINGS ROAD", "city": "SPARTANBURG", "state": "SC", "zip": 29302, "inspection_date": "2010-11-10", "deficiency_tag": 280, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "0LRQ11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the compliant inspection, based on observations, interviews and record reviews, the facility failed to ensure that Resident #4's care planned was review and revised regarding one-to-one supervision by the staff (1 of 4 sampled reviewed with behaviors). The findings included: The facility admitted Resident #4 on 10/23/09 with [DIAGNOSES REDACTED]. Review the of Nurse's Progress Notes dated 10/03/10 at 1250 documented at 1145 the staff was paged to the facility's canteen and that Resident #4 was in the canteen area and he threw a chair at a snack machine, hit a visiting family member of another resident and slammed a nurse's finger in a cabinet. The Nurse's Note further indicated that once the resident calmed down he requested to call law enforcement. At 1245 physician's orders [REDACTED].#4 returned to the facility from the hospital; at 1930 Resident #4 was noted running his wheelchair into people and things. The resident later calmed down and went to bed. A Nurse's Note dated 10/04/10 at 2330 indicated the staff was at the bedside with no behaviors noted. A Nurse's Note dated 10/05/10 at 0830 indicated the staff was at the bedside with no behaviors noted; at 2145 the resident became agitated and talked about hitting the vending machine on 10/03/10. Nurse's Note date 10/06/10 indicated that a staff member was at the bedside and in attendance when family and friends visited the resident. A Nurse's Note dated 10/07/10 at 1340 indicated Resident #4 was in the facility lobby with a staff member when he knocked over a table in the front lobby and tried to hit a staff member with a chair. The resident was return to the unit and given 5 mg (milligrams) of [MEDICATION NAME] IM for combativeness. An observation on 11/03/10 at 11:10 AM, 1:30 PM and 2:10 PM revealed staff seated in the room with the resident. There was nothing in the chart to indicate why a staff was seated in the room with the resident. There was no care plan to indicate why staff was present in the room with the resident at all times. An interview on 11/03/10 at 2:45 PM with the SSD (Social Service Director) revealed the care plan did not address one-to-one supervision with the resident as a result of his behaviors. The SSD further stated the resident was put on one-to-one supervision on 10/04/10. The Assistant Administrator confirmed the resident's care plan did not address one-to-one supervision.", "filedate": "2014-03-01"}
{"rowid": 10210, "facility_name": "MAGNOLIA MANOR - INMAN", "facility_id": 425032, "address": "63 BLACKSTOCK ROAD", "city": "INMAN", "state": "SC", "zip": 29349, "inspection_date": "2010-11-17", "deficiency_tag": 241, "scope_severity": "E", "complaint": null, "standard": null, "eventid": "JNTL11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on record review and observation of meal service, the facility failed to provide services that respected resident's dignity during a random observation of a meal. Resident # 5 and 2 other unidentified residents were not served their meal in a timely manner. The findings included: The facility admitted Resident # 5 on 10/30/06 with [DIAGNOSES REDACTED]. On 11/16/10, at 12:20 PM, the lunch trays were delivered to the dining room. Resident # 5 was observed along with two other residents sitting in the dining room facing the other residents. Meal trays were served and the other residents ate or were assisted with their meals. Resident # 5's meal tray was noted to be on the cart. Resident # 5 and the other two residents were not assisted to a table or served the meal until 1:00 PM. This observation was shared with the DON during sharing. The facility admitted Resident # 3 on 6/23/10 with [DIAGNOSES REDACTED]. Prior to observation of wound care on 11-16-10 at 1:35 PM, Licensed Practical Nurse (LPN) #3 and Registered Nurse (RN) #5 entered the room without knocking. During the course of the treatment from 1:35 PM until 2:55 PM, the LPN left the room two times to obtain needed supplies and reentered without knocking. The nurse entered the shared bathroom to wash her hands four times without knocking to ensure that residents from the adjoining room were not using the commode. At 2:30 PM, when the nurse entered the bathroom for the fifth time (without knocking) to wash her hands, she walked in on a resident who was using the commode. After this incident, the nurse continued to enter the bathroom door three more times without knocking while completing the wound care. The privacy curtain was not closed at the foot of the resident's bed during the entire treatment. During an interview with LPN # 3 on 11-17-10 at 12:40 PM, the nurse verified that she had failed to knock when entering the room and each time she entered the bathroom to wash her hands. On 11-17-10 at 1:05 PM, the Staff Development Coordinator (SDC) provided a document entitled \"Survey Readiness\" which stated: \"Remember Privacy: Knock on each door, close the door, pull the privacy curtain, and close the blinds.\" The SDC stated that she goes over this information with new hires and periodically as needed. During a discussion with the Director of Nursing (DON) related to privacy issues identified during treatments on 11-17-10 at 1:00 PM, the DON said she had in-serviced the staff on closing blinds, pulling curtains around the bed, and closing and knocking on doors. She stated she did not recall specifically addressing bathroom doors.", "filedate": "2014-03-01"}
{"rowid": 10211, "facility_name": "MAGNOLIA MANOR - INMAN", "facility_id": 425032, "address": "63 BLACKSTOCK ROAD", "city": "INMAN", "state": "SC", "zip": 29349, "inspection_date": "2010-11-17", "deficiency_tag": 250, "scope_severity": "E", "complaint": null, "standard": null, "eventid": "JNTL11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on record review and interview, no medically related social services were provided for Residents #21 and #26 related to behaviors. ( 2 of 6 residents reviewed for specific medically related social services.) The findings included: The facility admitted Resident # 26 on 3/23/10 with [DIAGNOSES REDACTED]. Record review on 11/16/10 revealed numerous nurse's notes documenting sexually inappropriate behaviors towards staff and residents and wandering into other resident rooms. This was also confirmed on 11/16/10 at 1:30 PM by 4 of 4 residents who attended group meeting. These residents stated they had been touched on the arms, toe, and asked \"give me some sugar.\" Nurse's note on 5/18/10 documents \" CNA (Certified Nursing Assistant) - resident touching and rubbing her leg - won't quit.\" On 5/25/10 \" MD (Medical Doctor) in today for touching staff inappropriately. CNA reported resident asked for a kiss.\" On 5/26/10 note documents \" CNA makes resident hold to side rails to keep him from reaching for her.\" Nurses notes continue: 6/12/10- touches staff inappropriately at times; 6/14/10 - started on Lexapro 10 mg (milligrams) r/t (related to) inappropriate sexual disinhibition; 6/16/10 - continues to enter resident rooms, continues to attempt to touch staff and residents- redirect as necessary; 9/1/10 CNA and PT (Physical Therapist) reported resident made inappropriate gestures and sexual comments. Resident attempted to enter other resident's rooms without permission; 9/4/10 - inappropriate sexual remarks at staff at times; 10/17/10 - staff and residents reported resident has been making inappropriate comments \"give me some sugar and I want a lick.\" staff will continue to monitor behavior. On 11/16/10 resident approached a surveyor and asked \"when can we meet\" and made an explicit sexual gesture. Only two physician progress notes [REDACTED]. Review of Social Service Notes revealed a note on 4/22/10 -Resident has been noted wandering into other peoples rooms. He is confused. Easily re-directed. Next note on 6/18/10 - Has periods of wandering t/o (through out) facility, in others rooms. Has inappropriate conduct, tries to touch staff and peers. Does not appear to remember what you tell him. Note of 9/10/10 \"Flirts with staff and visitors.\" There was no documentation of any interventions tried by social services. During an interview with Social Services on 10/17/10 at 11:00 AM, she stated \"it was put into the hot box and in the doctors book.\" When asked if she did the analysis per the care plan, she stated \"no.\" Nursing should have done that. Interview with 100 Unit Manager on 11/17/10 at 12 NOON revealed someone put in hot box charting (to observe and chart every shift for 72 hours ) 10/17/10; however, the Unit Manager stated staff did not do that. They only charted one shift and stopped. It was placed in the doctor's book (nurse did not remember when) but doctor didn't check resident. Did not check with doctor until 11/16/10 after brought to attention by surveyors. On 11/16/10 Nurse Practitioner increased Lexapro to 20 mg and ordered a Psych Consult. No analysis of key times, places, circumstances, triggers, or what de-escalates behavior per care plan had been done by any discipline listed on the care plan. The facility admitted Resident # 27 on 10/20/09 with [DIAGNOSES REDACTED]. Nurses Assistant) responded to the resident's room and intervened d/t (due to) this resident hitting another resident from another station, with a metal/aluminum grabber stick. Yelling at the resident while hitting resident in the back of the resident's head. CN removed the injured resident and checked resident, where she (CNA) found a knot on his head..\" Resident # 27 was encouraged to ask for assistance. Further review of the record revealed no additional follow-up or intervention from Social Services. On 11/16/10 at approximately 11:00 AM, revealed that the DON (Director of Nurses') was unaware of the incident. She stated that the nurse working should have filled out an occurrence report and passed reported this on the twenty-four hour report. She stated that she did not find any incident report related to this incident. The surveyor requested the twenty-four hour report sheet for that date. By the end of the survey no twenty-four hour report was provided to the team. On 11/16/10 at approximately 11:26 during an interview with Social Service Worker # 1, she stated that she was not aware of the incident, however she was not the primary social worker for the unit. When questioned about follow-up by social services, she confirmed that there were no social service notes related to the incident. She confirmed that there should have been an intervention by social services.", "filedate": "2014-03-01"}
{"rowid": 10212, "facility_name": "MAGNOLIA MANOR - INMAN", "facility_id": 425032, "address": "63 BLACKSTOCK ROAD", "city": "INMAN", "state": "SC", "zip": 29349, "inspection_date": "2010-11-17", "deficiency_tag": 281, "scope_severity": "E", "complaint": null, "standard": null, "eventid": "JNTL11", "inspection_text": "**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 nursing services that met professional standards of practice. The facility nurse failed to transcribe Resident # 7's medication order correctly and multiple nurses administering medications to the resident failed to clarify the entry on the MAR (Medication Administration Record) for [MEDICATION NAME] as needed on Monday, Wednesday and Friday, resulting in a medication errors. The findings included: The facility admitted Resident # 7 on 11/10/10 with [DIAGNOSES REDACTED]. On 11/16/10, review of the resident's medical revealed a physician's orders [REDACTED]. Review of the MAR (Medication Administration Record) revealed that the order had been transcribed incorrectly to the MAR indicated [REDACTED]. Further review of the MAR indicated [REDACTED]. On 11/16/10 at approximately 4:00 PM interview with RN (Registered Nurse) # 4 revealed that she had transcribed the order incorrectly. She stated that the computer system being used will not recognize Monday, Wednesday, Friday orders unless entered as a prn order. She stated that she had failed to mark out the PRN as needed when the MAR indicated [REDACTED].", "filedate": "2014-03-01"}
{"rowid": 10213, "facility_name": "MAGNOLIA MANOR - INMAN", "facility_id": 425032, "address": "63 BLACKSTOCK ROAD", "city": "INMAN", "state": "SC", "zip": 29349, "inspection_date": "2010-11-17", "deficiency_tag": 279, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "JNTL11", "inspection_text": "**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 develop a plan of care which addressed the non compliance of Resident # 21 with safety regulations within the facility and failed to address the resident's non compliance with fluid restrictions. (One of one sampled resident known to be noncompliant with smoking regulations and one of one sampled resident reviewed with a fluid restriction reviewed for the development of care plans) The findings included: Resident # 21 was recently readmitted with a [DIAGNOSES REDACTED]. On 11/14/10, at 6:50PM, the resident was observed to be out of bed sitting near the nurses station and in the dining room. The resident was observed to obtain glass(es) of water from a drinking cooler three times during the observation which lasted approximately one hour. No staff intervened or spoke with the resident about his fluid consumption. During an interview with the unit manager, when asked if the resident was compliant with the fluid restriction, she stated \"no.\" The unit manager further verified that the resident's plan of care did not address his non-compliance or the facility plan to address the concern. Further record review revealed the resident had been noncompliant with the facility smoking regulations which had been addressed by the facility Administrator. On August 21, 2009 and on September 10, 2010, the resident had received a letter from the facility addressing his non-compliance. Nursing notes also revealed that on 9/16/10, two cigarette lighters had been removed from the resident's room. When the Administrator was questioned if he was aware of the 9/16/10 occurrence, he did not respond. Further review of the resident's comprehensive plan of care did not reveal any concern/plan related to the residents non-compliance with the facility safety/non-smoking regulations. A copy of the smoking policy (7/06) stated; \"All residents are prohibited from keeping any type of smoking materials (lighter, matches, cigarettes, etc.) in their rooms or on their person.\"", "filedate": "2014-03-01"}
{"rowid": 10214, "facility_name": "MAGNOLIA MANOR - INMAN", "facility_id": 425032, "address": "63 BLACKSTOCK ROAD", "city": "INMAN", "state": "SC", "zip": 29349, "inspection_date": "2010-11-17", "deficiency_tag": 309, "scope_severity": "E", "complaint": null, "standard": null, "eventid": "JNTL11", "inspection_text": "**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 provide physician-ordered care and services for one of two residents reviewed with orders for Hospice services and one of one residents reviewed for provision of [MEDICAL TREATMENT]. There was no evidence of implementation of a 10-6-10 hospital transfer order for Hospice for Resident #17. Intake and output was not monitored to ensure compliance with a fluid restriction order for Resident #21. The findings included: The facility initially admitted Resident #17 on 10-5-09 and readmitted him following a hospitalization from [DATE] to 10-6-10. Record review on 11-15-10 at 12:45 PM revealed a hospital Patient Transfer Form dated 10-6-10 which was noted as faxed to the facility on the same date. Instructions on the cover page of the form included to \"Arrange hospice\". Additionally, the same Discharge Instruction was listed as a line item on an attached Order Confirmation Report. There was no evidence in the medical record that the order had been implemented. During an interview on 11-15-10 at 3:30 PM, the Director of Nurses reviewed the transfer document and confirmed the order for Hospice. She stated she \"did not see\" and had not been aware of the order until 10-26-10, the date of the resident's death. During an interview on 11-16-10 at 11:35 AM, Registered Nurse (RN) #6 also confirmed the Hospice order and stated that she had been unaware of the Hospice order until after the resident's death when she \"found the Hospice note\". The RN stated that the transfer information usually came from the hospital in a packet and that the nurse who received the resident should have written the order for the referral. She stated that, when she became aware of the order, she questioned the nursing staff and they \"said they never saw the order\". The nurse further stated that the admitting nurse \"should have made the referral\". Resident # 21 was recently readmitted with a [DIAGNOSES REDACTED]. The resident's Comprehensive Plan of Care was updated and stated: \"I & 0 record\" (record intake and output). Further record review revealed consistent missing documentation that the resident's intake and output were monitored. On 11/15/10 at 10:15AM, during an interview with the Unit Manager, she confirmed the resident's intake and output were not consistently/accurately recorded. The Unit Manager stated it was the responsibility of the nurse on each shift to enter the total fluids the resident received per shift and then it was the responsibility of the 11-7 shift to total the amounts for the day.", "filedate": "2014-03-01"}
{"rowid": 10215, "facility_name": "MAGNOLIA MANOR - INMAN", "facility_id": 425032, "address": "63 BLACKSTOCK ROAD", "city": "INMAN", "state": "SC", "zip": 29349, "inspection_date": "2010-11-17", "deficiency_tag": 314, "scope_severity": "G", "complaint": null, "standard": null, "eventid": "JNTL11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on record reviews, facility policy on care and assessment of Pressure Ulcers, and interview, the facility failed to ensure that a resident having pressure sores receives necessary treatment and services to promote healing, prevent infection and prevent new sores from developing for four of seven sampled residents reviewed for pressure ulcers. Resident # 23 was admitted [DATE] with a known pressure ulcer. treatment for [REDACTED]. Resident # 22 with a known red area to the back, receiving treatment, was not assessed weekly for changes in the area and effectiveness of treatment. Resident #1 failed to have ongoing documentation available of a pressure ulcer as it was treated to allow staff to accurately determine response to the treatment and the need for possible changes in treatment. During a pressure ulcer treatment observed on Resident #3 the licensed staff failed to implement infection control techniques to ensure healing. The findings included: The facility admitted Resident # 23 on 3/6/10 with [DIAGNOSES REDACTED]. On the weekly skin documentation form dated 3/6/10 the resident was documented by nursing to have a black area to the right heel with no further description/measurement noted. On 3/15/10 the area was documented as \"soft and black.\" There was no physician order for [REDACTED]. ... He has a large decubitus over the right heel. It is covered by skin\" . He previously had a blister and nursing staff reported that this has drained and there is some serosanguineous type drainage....Small area in the plantar surface of the right foot that is measuring approximately .5cm (centimeter) in diameter Wound bed in this area is pink, moist. This again is a very superficial area ...\" The NP at this time ordered vitamin C, Prosource and Vitamin with Minerals, treatments to both areas, continued use of Podus boots, and floating of the heels while in bed. The physician saw the resident on 3/23/10 and made no changes. A care plan for the pressure ulcer to the heel was not developed until 3/18/10 During an interview with the current Unit Manager and the Unit Manager for the unit on which the resident originally resided, revealed that neither nurse could provide evidence the wound(s) noted on admission had been measured or assessed as pressure areas. There was no documentation found that the facility was providing any treatment to the heel wound from 3/6 until 3/18/10. During the interview, the unit manager stated- \"It should have been skin prepped. Anything black we always skin prep to off with.\" On 3/22/10 a \"dark area\" to the bottom of the right foot was documented on the weekly assessment form. However, an order was written previously on 3/9/10 to apply skin prep to the ball of the right foot bid until healed (stage I decubitus) . There was no documentation per facility provided policy to include: \" location, measurement, appearance, drainage, odor, color, presence of undermining/tunneling, healing, stage if a pressure ulcer, pain and [MEDICAL CONDITION].The resident's admission care plan noted on 3/8/10 the presence of a stage I - \"ball of RH foot (?right heel) -skin prep ball of rh foot as ordered.\" Resident # 22 was admitted to the facility with Arthritis and Bullous Lung Disease. On 6/12/10 a weekly skin assessment noted the resident had a \"pink\" area to the bony prominence of the mid back and sacral area. On 6/27/10 an order was obtained for Optofoam pad, cover with [MEDICATION NAME] every three days for protection to mid back bony prominence area. On 11/15/10 at 11AM, during an interview with the Unit Manager, she stated although weekly skin assessments were completed, they were done by the weekend nurse who would be unable to see thru the Optofoam pad to visualize the area. There was no documentation that the area was measured. On 11/17/10, during an interview with the Director of Nursing, she verified that a red/pink area over a bony prominence would meet the definition of a Stage I pressure area. She stated she would have expected the area to be measured weekly and to have been included in the pressure ulcer reports submitted to her office. After checking the pressure ulcer records on file in her office, the Director of Nursing stated the resident was not and had not been included in the pressure ulcer reports. Further review of the treatment flow sheet for October 2010 revealed there were no signatures present for the application of the treatment to the back from from 10/17 to 10/29/10. On 11/15/10 at 11AM, during an interview, the Unit Manager and the nurse responsible for the application of the treatment verified there was no documentation that the dressing had been applied per the order. Resident #22 was seen by the Nurse Practitioner (NP) on 11/8/10 who commented: ...\"The family was somewhat concerned.... The buttocks area and gluteal cleft are inspected. There is some pinkness in the superior aspect of the gluteal cleft. She has a very prominent coccyx, and some pinkness over these and open areas. ...Upper back approximately T8 through T 12 is pink. She has a foam dressing on, which was removed, and there is some mild what appears to be fungal -type changes to the skin, redness and pinkness, which again blanched, while there are no open areas.....\" The resident was diagnosed by the NP with a stage I decubitus to the Sacrococcygeal area and started on Vitamin C. The treatment to the mid back was changed at that time. The Facility provided policy for Staging pressure ulcers (Revised 6/08) stated: A stage I pressure ulcer was defined as \"intact skin\" and a Stage II pressure ulcer was a \"partial loss of dermis...\" The policy also stated that wounds will be evaluated/documented to include: \" location, measurement, appearance, drainage, odor, color, presence of undermining/tunneling, healing, stage if a pressure ulcer, pain and [MEDICAL CONDITION].Treatments should be re-evaluated every 2-3 weeks. If no wound progression noted treatment change should be considered. If no change in treatment done documentation should occur as to why current treatment maintained.\" The facility admitted Resident #1 on 7/07/10 with [DIAGNOSES REDACTED]. Record review on 11/16/10 revealed the resident to be receiving treatments of Santyl ointment to right heel and wrap for a pressure ulcer. The last documentation found in the record was dated 9/03/10 showing a measurement of 4 cm ( centimeters) by 6 cm 1/2 sealed off pink brown lower area- 1/2 dark purple with surrounding skin normal. On 9/17/10 the wound measured .3 by .8 had scant amount of yellow drainage. An interview with RN #1 (Registered Nurse) revealed she did not do the daily dressings but measured all the wounds weekly. She stated, \"I have a sheet I document all the information on and give a copy to the DON (Director of Nursing). I am supposed to transfer the information to each resident's individual Wound Treatment & Progress Record weekly. I goofed. I have not always documented weekly on the individual sheets.\" The nurses doing the dressings had nothing to compare with in order to make recommendations about continuing or changing treatments. The nurses assigned to do the treatments were the staff nurses on duty each day and not the same nurse each day. There was no continuity of care in treating the wound. The facility admitted Resident #3 on 6/23/10 with a [DIAGNOSES REDACTED]. During an observation of wound treatment for [REDACTED].#3 failed to wash or sanitize her hands between removal of the soiled dressing from the Stage III wound on the top of the left foot and placement of the clean dressing. LPN #3 stated that the dressing was saturated with \"yellow, bloody drainage\". Prior to placement of the clean dressing, the nurse removed scissors from her pocket and cut a foam dressing for use on the wound without disinfecting or cleaning the scissors prior to use. The dressing was then applied to the Stage III wound. Prior to the wound treatment to the Stage II wound on the left buttock, when the resident was positioned onto her right side, the underpad was noted to be soiled with a red tinged drainage. LPN # 3 stated, \"This could be a vaginal drainage\". After removal of the soiled dressing, the resident was allowed to turn back onto her back on the underpad without a dressing to the open wound on the left buttock. When the resident was turned back for placement of the clean dressing, an area of red tinged drainage the size and shape of the wound was noted on the soiled underpad. On 11-17-10 at 1:05 PM the Staff Development Coordinator (SDC) provided a facility policy entitled, \"Dressing-Absorption Dressing, Application of\". Step #10 stated: \"Disposes of soiled dressings appropriately. Removes gloves and disposes. Washes hands.\" The policy then continued with the preparation and application of the clean dressing. An interview was conducted with LPN #3 on 11-17-10 at 12:40 PM. The nurse verified all the above observations and stated, \"I messed up with glove changing and handwashing.\" The nurse stated that she cleaned the scissors prior to placing them in her pocket and she was unaware that the scissors should be cleaned prior to each use.", "filedate": "2014-03-01"}
{"rowid": 10216, "facility_name": "MAGNOLIA MANOR - INMAN", "facility_id": 425032, "address": "63 BLACKSTOCK ROAD", "city": "INMAN", "state": "SC", "zip": 29349, "inspection_date": "2010-11-17", "deficiency_tag": 367, "scope_severity": "E", "complaint": null, "standard": null, "eventid": "JNTL11", "inspection_text": "**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 provide the diets as ordered by the physician for two of seven sampled residents reviewed for therapeutic diets. Resident #17 was provided solid foods on a mechanically-altered (pureed) diet and an order for [REDACTED]. The findings included: The facility initially admitted Resident #17 on 10-5-09 and readmitted him following hospitalization from [DATE] to 10-6-10 for Aspiration Pneumonia, Dehydration, and [MEDICAL CONDITION]. Additional/chronic [DIAGNOSES REDACTED]. Record review on 11-15-10 at 12:45 PM revealed that Resident #17 was on a \"Puree diet with nectar thick liquids for pleasure\" prior to hospitalization and received an \"egg salad sandwich c (with) ea(ch) meal\" per a physician's orders [REDACTED]. The hospital Patient Transfer Form dated 10-6-10 noted \"Instructions\" for a Discharge Diet of \"TF (tube feeding)\". The hospital Discharge Summary noted that the resident was to receive \"[MEDICATION NAME] 1.5 at 80 ml (milliliters)/hour for 18 hours, start at 3 PM, off at 9 AM.\" physician's orders [REDACTED]. There was no evidence in the record that the sandwiches had been reordered. A copy of a Diet Order & Communication form dated 10-7-10 was found in the medical record. Pureed Texture and Nectar-Like Thickened Liquids were checked to indicate the type of diet to be provided. During an interview on 11-15-10 at 4 PM, the Speech Language Pathologist (SLP) reviewed the Rehabilitation Screen form she had completed on 10-8-10. She stated that the resident had been on caseload prior to the 9-26-10 hospitalization , but had reached a plateau. He had received the sandwich with meals prior to hospitalization and was \"safe\" with it. Upon readmission, she stated that the resident was uncooperative with the screening process for oral motor assessment and noted that the resident was \"WFL (within functional limits) for puree\". She did not request an upgrade in the diet because of her inability to perform an assessment. The SLP was aware that Resident #17 had received the sandwich without an order and thought that dietary had written an order or provided it without a current order or evaluation/recommendation from the SLP. During an interview on 11-15-10 at 4:15 PM, the Certified Dietary Manager (CDM) stated that Resident #17 had been provided a pureed diet with nectar thick liquids and an egg salad sandwich three times daily from the date of his readmission on 10-6-10 to the date of his death. The CDM stated that she had received verbal notification from nursing staff upon readmission to continue the resident's diet as prior to hospitalization . She reviewed and verified receipt of the diet communication form dated 10-7-10 and that the order failed to include the sandwich. When questioned as to the reason the resident had continued to receive the sandwich after receipt of the order on 10-7-10, the CDM stated that there was \"no order to discontinue it\". During an interview on 11-16-10 at 11:05 AM, the Director of Nurses (DON) reviewed and verified the Speech Language Pathologist's documented screen. During interviews with the DON on 11-16-10 at 11:05 AM and Registered Nurse (RN) #6 on 11-16-10 at 11:35 AM, each stated that the sandwich should have been cancelled if not reordered after hospitalization . Interviews with Licensed Practical Nurse (LPN) #4 on 11-15-10 at 3:45 PM, with CNA #2 on 11-16-10 at 12 PM, with CNA #1 on 11-16-10 at 12:05 PM, and with the Unit 4 Manager on 11-16-10 at 11:35 AM revealed that Resident #17 had received egg salad sandwiches with each meal daily prior to his death and had tolerated them well with no choking episodes noted. During an interview on 11-15-10 at 5 PM, the attending physician stated that he would expect physician's orders [REDACTED]. Resident # 21 was recently readmitted with a [DIAGNOSES REDACTED]. During observation of the breakfast meal on 11/15/10, the resident was observed to receive fluids in excess of what the planned dietary plan had established. When the resident was interviewed as to what the facility had sent in his bagged lunch to eat while at [MEDICAL TREATMENT], it was stated that less fluids were sent than established in his dietary plan. During an interview with the Dietary department on 11/16/10 at 9AM, it was verified that a plan had been developed which established how much dietary would send the resident with each meal and how much nursing would provide. However, it was confirmed that the Dietary Department had not followed the established plan for breakfast nor lunch on the day of the observation.", "filedate": "2014-03-01"}
{"rowid": 10217, "facility_name": "MAGNOLIA MANOR - INMAN", "facility_id": 425032, "address": "63 BLACKSTOCK ROAD", "city": "INMAN", "state": "SC", "zip": 29349, "inspection_date": "2010-11-17", "deficiency_tag": 156, "scope_severity": "C", "complaint": null, "standard": null, "eventid": "JNTL11", "inspection_text": "On the days of the survey, based on record review and interview, the facility failed to provide Liability Notices to 3 of 3 residents reviewed for notification of Medicare Provider Non- Coverage. The facility did not utilize form or any of the 5 denial letters to inform residents or their responsible party of the items and services expected to be denied under Medicare Part A. The findings included: On 11/17/10 at 10:20 AM, a review of 3 random Medicare Non-Coverage Notices revealed that there were no Liability Notices included in the information given to the resident or responsible party. An interview with the Admission Coordinator revealed that she had not been aware until yesterday that Liability Notices were required. According to information provided by the Admission Coordinator, Resident A had used 50 days and his last covered day was 10/27/10 due to therapy being discontinued. Resident B had used 64 days and no longer required skilled services. His last covered day had been 9/2/10. Resident #8 had used 36 days and her last covered day had been 8/20/10 due to her therapy having been discontinued.", "filedate": "2014-03-01"}
{"rowid": 10218, "facility_name": "MAGNOLIA MANOR - INMAN", "facility_id": 425032, "address": "63 BLACKSTOCK ROAD", "city": "INMAN", "state": "SC", "zip": 29349, "inspection_date": "2010-11-17", "deficiency_tag": 159, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "JNTL11", "inspection_text": "On the days of the survey, based on record review and interview, the facility co-mingled personal funds with facility funds for 2 of 5 residents reviewed with Resident Trust Fund Accounts. Resident D had personal funds withdrawn from her Trust Fund Account and deposited into the facility account. Resident E had retirement checks deposited into the facility account instead of being deposited into her Trust Fund Account first. In addition, there was no evidence of notification of balances that would jeopardize Medicaid eligibility for Resident D. The findings included: Review of Resident D's Trust Fund Account record on 11/17/10 at 1:42 PM revealed a Care Cost Payment dated 9/17/10 of $3.04, a second Care Cost Payment dated 10/7/10 for $11.28, and a third Care Cost Payment dated 11/5/10 for $30.06. When asked about what these payments were for, the Business Office Manager stated that she withdrew these amounts from the resident's Trust Fund Account and deposited the monies into the facility account since the resident had reached her $1800.00 limit in which she would need to start spending down her account since she was a Medicaid recipient. According to the Business Office Manager, the monies deposited into the facility account would go towards payment of any remaining balances the resident might have. When asked if the resident owed a balance, she stated \"no\". She stated the facility account was not interest bearing. When asked if she had contacted the family of the resident to try to see if they could spend down her account she stated she had never seen the family and hadn't recently tried to get ahold of them, but she would try now. Review of the Resident Fund Management Service reports revealed that these funds had been withdrawn from the resident's Trust Fund Account and had been deposited into the facility account. During the funds interview on 11/17/10 at approximately 9:30 AM, the Business Office Manager stated that when a Medicaid resident's account reached #1800.00, she told the resident or responsible party that they needed to spend down the account. She stated she did not document this notification any where. According to the Administrator, the facility used letters to notify residents that their Trust Fund Account balances were within $200.00 of exceeding what is allowable under Medicaid. However, he was unable to provide a copy of any letters notifying Resident D or her responsible party with this information. Review of Resident E's Trust Fund Account Record on 11/17/10 at 12:25 PM revealed a Care Cost Payment of $31.00 on 6/8/10 and another Care Cost Payment of $1077.33 dated 11/5/10. When asked what these payments were for, the Business Office Manager stated they were payments for balances owed since the resident's room and board were more than her Social Security check. She provided documentation of these balances owed and revealed a Resident Statement dated 5/21/10 which listed a balance of $31.00 on 6/8/10. It also had a \"receipt copy\" included on the statement dated 5/26/10 for a check from the \"State Budget\" for $461.85. The amount of the check received from the State Budget had been handwritten onto the statement and deducted from the resident's balance on 5/26/10. According to the Business Office Manager, the \"State Budget\" check had been deposited into the facility account, and had not been deposited into the Resident's Trust Fund. When asked if the \"State Budget\" checks were made out to the resident, she said that they were. When asked why it had not been deposited into the resident's Trust Fund Account, she did not answer. Review of a letter dated October 23, 2007 from the resident to the Insurance Operations Department revealed the resident had requested her \"WestPoint Stevens\" retirement check to go to the nursing home, and that she only wished to change her check mailing address. Review of the Resident statement dated 5/21/10 revealed an entry for a check from \"West Point Stevens\" for $63.11 that had been deducted from the resident's balance on 6/1/10. According to the Resident Trust Fund Account Statement dated 6/1/10 through 11/16/10, there had not been a deduction of $63.11 from that account on 6/1/10. The Business Office Manager also provided a Resident Statement dated 10/21/10 that listed a balance of $1077.33 on 11/5/10. On the statement were 2 payments that were both dated 10/8/10, one for $461.85 and one for $63.11, both of which had been deducted from the resident's balance and were not included in the Resident Trust Account statement dated 6/1/10 through 11/16/10. This indicated these funds had not been first deposited into the Trust Fund Account for the resident before being used to pay balances owed. Further review of the Trust Fund Account record dated 6/1/10 through 11/16/10 revealed the resident had been receiving \"miscellaneous income\" of $63.11 on 8/4/10, 9/1/10, and 11/8/10. According to the statement, she also had a \"State/Cnty/City CK\" for $461.85 that had been deposited into her Trust Fund Account on 11/8/10. There was no indication of any deposits matching these amounts in October.", "filedate": "2014-03-01"}
{"rowid": 10219, "facility_name": "MAGNOLIA MANOR - INMAN", "facility_id": 425032, "address": "63 BLACKSTOCK ROAD", "city": "INMAN", "state": "SC", "zip": 29349, "inspection_date": "2010-11-17", "deficiency_tag": 160, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "JNTL11", "inspection_text": "On the days of the survey, based on record review and interview, one of five resident records reviewed for conveyance of funds revealed disbursement of funds without written authorization. The findings included: On 11/17/10 at approximately 9:30 AM, the Business Office Manager stated that Resident #19 had $30.00 in the Resident Trust Fund Account that had been sent to the funeral home at the family's request after her death. According to the Business Office Manager, the family wanted the cash money, however, she told them she could send it to the funeral home or the estate. The family requested the money sent to the funeral home. According to the Business Office Manager, there was no Power of Attorney in effect over the resident's financial matters. Review of the Admission Agreement revealed a \"Beneficiary Designation:\" section that was not filled out and did not designate a person to receive the resident's personal funds.", "filedate": "2014-03-01"}
{"rowid": 10220, "facility_name": "MAGNOLIA MANOR - INMAN", "facility_id": 425032, "address": "63 BLACKSTOCK ROAD", "city": "INMAN", "state": "SC", "zip": 29349, "inspection_date": "2010-11-17", "deficiency_tag": 167, "scope_severity": "C", "complaint": null, "standard": null, "eventid": "JNTL11", "inspection_text": "On the days of the survey, based on observations, the facility failed to post the most recent survey report within the facility. The facility failed to post the most recent complaint survey with citations from 9/16/10 and failed to post a complaint survey with citations from February 2010. The findings included: Observation on 11/15/10 at approximately 5:00 PM revealed a plastic holder mounted on the wall in the hallway near the front lobby. Observation of the contents of the holder revealed a labeled notebook containing the annual recertification survey report from September 2009. The complaint surveys with citations from 9/16/10 and February 2010 were not posted as required. On 11/17/10 at approximately 4:30 PM, the surveyor reviewed the contents of the notebook with the Administrator. The Administrator confirmed that the complaint surveys were not posted at that time.", "filedate": "2014-03-01"}
{"rowid": 10221, "facility_name": "MAGNOLIA MANOR - INMAN", "facility_id": 425032, "address": "63 BLACKSTOCK ROAD", "city": "INMAN", "state": "SC", "zip": 29349, "inspection_date": "2010-11-17", "deficiency_tag": 282, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "JNTL11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on record review and interview, the care plan was not followed related to pacemaker checks for Resident #9 and analysis of causative factors of behavior for Resident # 26. ( 1 of 2 residents reviewed with pacemakers and 1 of 1 resident reviewed for socially inappropriate behaviors.) The findings included: The facility admitted Resident #9 on 5/13/09 with [DIAGNOSES REDACTED]. Record review on 11/15/10 revealed the resident to have a pacemaker. The Physician's History and Physical listed a [DIAGNOSES REDACTED]. Dates of 5/14/09, 9/3/09, 12/17/09 and 3/4/10 were listed on the sheet as to when checks should be done. The only documentation of testing in the medical record was dated 9/03/09. No other documentation could be found. There was no physician order to do pacemaker checks. The care plan for pacemaker also documented pacemaker check as ordered q 3 months ( every 3 months). An interview with RN # 1 (Registered Nurse) and the Unit Manager revealed that the nurse did not know the resident had a pacemaker. She was unable to find any information in the record related to the checks other than the one report of 9/03/09. RN #1 placed a call to the Clinic and found that a check had been done on 9/03/10. There were no other reports sent at this time. The facility admitted Resident # 26 on 3/23/10 with [DIAGNOSES REDACTED]. Review of the resident's care plan revealed a problem which stated, \"Resident exhibits socially inappropriate behaviors IE: wandering into others room, touching peers and staff inappropriately, pulling fire alarm. Under approaches were listed: assess resident's understanding of the situation, monitor resident frequently, analyze key times, places, circumstances, triggers, and what de-escalates behavior, and Psychiatric evaluation as indicated. An interview with the Unit Manager of 100 unit and Social Services on 11/17/10 revealed that no one had done an analysis, and no psychiatric evaluation had been done. The Unit Manager was not even aware of the care plan approach, and although Social Services was listed also, she stated, \"Nursing should do that, not me.\" None of the disciplines listed for the approach had done an analysis.", "filedate": "2014-03-01"}
{"rowid": 10222, "facility_name": "MAGNOLIA MANOR - INMAN", "facility_id": 425032, "address": "63 BLACKSTOCK ROAD", "city": "INMAN", "state": "SC", "zip": 29349, "inspection_date": "2010-11-17", "deficiency_tag": 441, "scope_severity": "E", "complaint": null, "standard": null, "eventid": "JNTL11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on observation and interviews, the facility failed to provide evidence that all personal laundry was effectively cleansed/sanitized to destroy microorganisms. Also, based on observations and interviews, the facility failed to follow a procedure whereby expired topical agents, irrigation trays, and wound care supplies were removed from current stock and were available for daily use in two of four medication rooms reviewed. The findings included: During observation of the laundry on [DATE] at 10:15 AM, two home-type washers were noted (in use) not to be connected (via the chemical dispensing system) to any type of sanitizing agent. Bleach was set up to be dispensed on an automatic dispensing system to a third commercial-type washer. A sign was noted on the wall above a dryer indicating \"no bleach\" formula to be used on given wash cycles. When asked at this time, the Laundry Aide confirmed that bleach was not used for some personal laundry. She stated that the water temperature ranged from 120 to 160 degrees and was monitored by maintenance. She was unaware if any type of sanitizer was used and deferred to the Housekeeping Supervisor. During an interview on [DATE] at 2 PM, the Maintenance Supervisor provided laundry water temperature logs for review. Water temperatures ranged from 129 to 141 degrees Fahrenheit over the previous six month period. When informed that personal laundry was being washed without bleach, or water temperatures over 160 degrees, the Housekeeping Supervisor stated that he could provide no information to verify use of any other type of sanitizing agent. During an interview at 2:35 PM on [DATE], a second maintenance employee stated that he had checked the dispensing mechanism on the two home-type washers and that the commercial bleach product had not been connected. At that time, the Housekeeping Supervisor verified that he could provide no information on use of any type of sanitizing agent, other than the bleach product used on one of the three machines in use, to enable the facility to provide hygienically cleansed laundry. On [DATE] at 7:43 AM, observation of the Station 2 Medication Room revealed 2 Medline Piston Irrigation Trays with Sterile Sodium Chloride expired ,[DATE]. During an interview on [DATE] at 8:01 AM, Licensed Practical Nurse (LPN) #4 revealed that the medication nurses and the stock supply person from Central Supply checked the medication room for expired products. Central Supply comes to restock the cabinets about once a week. There is no set schedule for the medication nurses to check the medication room. On [DATE] at 8:04 AM, observation of the Station 3 Medication Room revealed the following: - two one ounce (28.35 gram) White [MEDICATION NAME] USP (United States Pharmacopoeia), expired ,[DATE] - two Piston Irrigation Trays with Sterile Sodium Chloride, expired ,[DATE] - 14 Medline Sterile Bordered Gause, 4 inch by 14 inch dressings, expired [DATE] During an interview on [DATE] at 8:32 AM, Registered Nurse (RN) #5 revealed that the medication nurses checked the medication room for expired products and that it should be checked every day. The Nurse Manager could also check the medication room.", "filedate": "2014-03-01"}