cms_SC: 10161
Data source: Big Local News · About: big-local-datasette
| rowid | facility_name | facility_id | address | city | state | zip | inspection_date | deficiency_tag | scope_severity | complaint | standard | eventid | inspection_text | filedate |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 10161 | HEARTLAND HEALTH CARE CENTER - GREENVILLE WEST | 425294 | 600 SULPHER SPRINGS ROAD | GREENVILLE | SC | 29611 | 2011-01-13 | 314 | D | EE4V11 | **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]. | 2014-04-01 |