| 10184 |
ROSECREST REHABILITATION AND HEALTHCARE CENTER |
425376 |
200 FORTRESS DRIVE |
INMAN |
SC |
29349 |
2010-09-08 |
281 |
G |
|
|
9VMS11 |
**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. |
2014-04-01 |