cms_SC: 10271
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| rowid | facility_name | facility_id | address | city | state | zip | inspection_date | deficiency_tag | scope_severity | complaint | standard | eventid | inspection_text | filedate |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 10271 | HEARTLAND OF COLUMBIA REHAB AND NURSING CENTER | 425008 | 2601 FOREST DRIVE | COLUMBIA | SC | 29204 | 2010-09-14 | 281 | G | 916711 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the complaint inspection, based on observations, record review and interviews, the facility failed to provide care that met professional standards of practice for 2 of 3 sampled residents reviewed for standards of practice related to urinary tract infections and for 4 of 4 sampled residents reviewed for standards of practice related to aspiration precautions. The findings included: The facility admitted Resident #1 on 08/20/2008 with [DIAGNOSES REDACTED]. Record review on 09/13/2010 revealed the following Nurse's Note: 08/13/2010 at 6:00 PM that stated, "Speech only slightly garbled today. Hx (history) UTI (urinary tract infection) in the past. New order received for UA/CS (urinalysis/culture and sensitivity) Stat in AM.... 08/14/201 at 6:50 AM In and out cath (catheterization) to obtain urine specimen for UA and CS STAT in AM; pt (patient) tolerated procedure well... 08/15/2010 at 2:00 PM Pt with garble speech appears confused unable to coordinate hands to mouth. Placing hands in plate rather than spoon to eat with. Chest congested. BP (blood pressure) 114/63 p (pulse) 68 R (respirations) 18 unlabored. MD (medical doctor) notified ordered [MEDICATION NAME] Bid (twice a day) and chest x-ray given. Schedule CT (computerized tomography) of head at hospital... Late entry for 08/15/2010 12:30 AM MD here to see resident... 08/16/2010 11:40 AM Resident unable to coordinate hand movement. Garbled like speech. Tongue hanging out of mouth. Resident not herself call RP (responsible party). RP would like for resident to be evaluated. MD notified. Resident sent to hospital..." Record review on 09/13/2010 of the hospital admission history and physical dated 08/16/2010 at 3:33 PM revealed an admission assessment and plan that stated, "Urinary tract infection..." On 09/13/2010 a review of the laboratory studies revealed no results for the STAT UA/CS ordered by the physician for the AM of 08/14/2010. In an interview with the surveyor on 09/14/2010 the Director of Care Delivery (DCD) for 1 Front stated that she had discovered that the urinalysis had not been done when she came in to work on Monday morning, 08/16/2010; that the urine was left in the refrigerator. The nursing staff failed to assure that the lab picked up the urine on 08/14/2010. The facility admitted Resident #3 on 07/31/2009 with [DIAGNOSES REDACTED]. Record review on 09/14/2010 revealed a physician's orders [REDACTED]. Continued review of the physician's orders [REDACTED]. Review of the Lexington Medical Center urinalysis results dated 08/05/2010 had a note that stated, "wait for C and S". The culture and sensitivity results were available on 08/07/2010 but not obtained by the facility until 08/09/2010, treatment was started 2 days after the test results were available. In an interview with the surveyor on 09/14/2010 the DCD for 1 Front stated that she discovered that the hospice nurse carried the urine to the wrong lab and as soon as this was discovered the resident was treated. The DCD stated that the urinalysis results were usually received within 24 hours of the collection date and the culture/sensitivity results was received within 48 hours of the collection date. The nursing staff failed to followup on a urinalysis done on 08/05/2010 until 08/09/2010, four days after the urine was sent to the lab. As stated in paragraph one, the facility admitted Resident #1 on 08/20/2008 with [DIAGNOSES REDACTED]. Observation on 09/13/2010 at approximately 3:00 PM of Resident #1's room revealed a white Styrofoam cup dated 09/11/2010 filled with water. In an interview with the surveyor on 09/13/2010 at 3:30 PM Licensed Practical Nurse #1 confirmed the date on the cup and the liquid. LPN #1 stated that a Speech Therapist had been working with Resident #1 and she was to have thickened liquids only. "The cup must have been left by the weekend staff." Record review on 09/13/2010 revealed a hospital transfer summary dated 08/23/2010 with discharge [DIAGNOSES REDACTED]. The physician ordered on [DATE] Speech-Language Pathology 5 days per week daily with precaution listed as aspiration; a pureed diet with nectar thick liquids was prescribed. Review of Resident #1's care plan revised 08/31/2010 listed as a focus area "Alteration in nutritional status r/t (related to) therapeutic mechanically altered diet with thicken liquids. On 09/14/2010 at 8:15 AM Resident #1 was observed in the dining room independently eating a pureed breakfast and drinking thicken water. The facility admitted Resident #2 on 03/10/2008 with [DIAGNOSES REDACTED]. Record review on 09/14/2010 revealed physician's orders [REDACTED]. Review of Resident #2's care plan revised 09/13/2010 listed as a focus area "History of weight loss r/t receives daily diuretic and has dx (diagnosis) of dysphagia..." On 09/14/2010 at 8:20 AM Resident #2 was observed in the dining room independently drinking thicken juice at breakfast. Additional review revealed the facility admitted Resident #3 on 07/31/2009 with [DIAGNOSES REDACTED]. Record review on 09/14/2010 revealed a telephone order dated 08/26/2010 for a pureed diet with nectar-like thick liquids. Review of Resident #3's care plan revised 08/26/2010 listed as a focus area "Nutrition: potential for weight loss related to dementia is also a diabetic; therapeutic mech (mechanically) alt (altered) diet with nectar thicken liquids..." On 09/13/2010 at approximately 3:15 PM Resident #3's granddaughter stated that her grandmother was unable to drink unassisted. The facility admitted Resident #4 on 05/19/2009 with [DIAGNOSES REDACTED]. Record review on 09/14/2010 revealed a physician's orders [REDACTED]. Review of Resident #4 care plan initiated 08/12/2010 listed as a focus area "Feeding tube use with potential for complications also received ordered liquids and PO (by mouth) diet..." On 09/14/2010 at 10:00 AM Resident #4 stated that he needed help with drinking and eating. Aspiration precautions were not care planned as a focus area for Residents #1, #2, #3 and #4 and observations on 09/13/2010 and 09/14/2010 revealed no system to identify residents who were at risk for aspiration. Review of the Certified Nurse Aide (CNA) Kardex failed to list Resident #1 as at risk for aspiration; Residents #2, #3 and #4 were noted on the CNA Kardex as at risk for aspiration. The PIW (patient intervention worksheet) used by the CNAs did not include aspiration precautions for Residents #1, #2, #3 and #4. In a face-to-face interview with the surveyor on 09/14/2010 at 1:00 PM Speech Therapist #1 stated that any resident receiving nectar thick liquids should be on aspiration precautions, that she taught the CNA individually about aspiration precautions when she worked with the residents. When asked if she taught every shift she stated, "No." The Speech Therapist stated she was concerned about posting information at the bedside due to it being personal information about the resident. In face-to-face interviews with the surveyor on 09/14/2010 CNAs #1, #2 and #3 stated they would position the resident upright and give them small bites. The CNAs could not recall an inservice related to aspiration precautions. In reviewing the CNA Kardex monitor with the surveyor CNA #3 was not sure if the CNA Kardex addressed aspiration precautions, until she saw aspiration precautions on the monitor. | 2014-01-01 |