cms_SC: 10287
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 10287 | BRIAN CENTER NURSING CARE - ST ANDREWS | 425129 | 3514 SIDNEY ROAD | COLUMBIA | SC | 29210 | 2010-12-08 | 520 | E | R42P11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on observation, record review, and interview, the facility failed to fully identify quality concerns related to restraints. Resident # 2 with a known restraint, had no quarterly assessment to determine if the restraint was the least restrictive device and whether or not the restraint continued to be necessary. The facility conducted weekly restraint quality assurance reviews and failed to fully identify missing documentation related to the restraint. The findings included: The facility admitted Resident # 20 with a primary [DIAGNOSES REDACTED]. During the initial tour of the facility on 12/6/10 the resident was identified as wearing a hand mitt restraint, "at the families request." The resident was observed with an oven mitt with a splint applied over the mitt on the right hand. On 12/8/10, record review revealed an order was written on 2/2/10 for: "Oven mitt to right hand(with) left hand Spica. Remove for ADL's (Activities of Daily Living) + (and) check skin integrity Q (every) shift d/t (due to) restlessness, Dementia, playing in feces and self scratching." Further review revealed a Quarterly Restraint Review dated 1/8/10 (before the restraint order) which stated: ' Continue current restraint order. ...Look for alternative to mitt that is less restrictive." The quarterly physical restraint review was completed thirteen times, each time recommending the continued use of the restraint. On 12/8/10 from 10AM to approximately 11:15AM, interviews were conducted with the Director of Rehabilitation who stated she was responsible for restraint documentation and the Physical therapist. It was questioned what follow up was done to obtain an alternative which was less restrictive and or whether the resident still required the use the use of the restraint. In reviewing the nurses notes, there was no documentation of the resident scratching or attempting to play in feces when the restraint was released for ADL's. The last note documenting the behavior was 2/2/10 which was stated by the daughter on the day the order was written. The restorative notes did not document any behaviors when the restraint was released for range of motion. There was no documentation that an attempt was made to allow the resident to be either restraint free or attempt made to use a lesser device. The Director of Rehabilitation stated an additional form was used to assess if a resident was a candidate for restraint reduction but verified there was no form in the resident's chart. A search for additional information was also conducted in the thinned record and in the therapy department. On 5/16/10, nursing documented a 2 cm (centimeter) round light purple bruise to the residents right wrist "where glove applied." Safety committee notes for 5/16/10 noted the bruise and stated "glove to be placed loosely"- therapy screening. On 5/17/10 occupational therapy documented a follow up from 5/17/10 concern of a "pressure area "over the right anterior wrist.. The screen stated the therapist had reviewed with the daughter/caregiver to leave strap through loop but not to pull through D ring and tighten over wrist with Velcro. On 7/2/10 the therapist documented reviewed with pts. (patients) splint on, straps correctly placed through d- ring only. no redness, swelling noted. (previous pressure area over wrist). Neither documentation addressed the need for the restraint, whether it was the least restrictive device, resident behaviors or whether the resident had been tried restraint free. At approximately 11AM, the concerns were shared with the Administrator. At 11:15AM, the Director of Rehabilitation provided a form titled report of quality improvement action team. The form was dated 12/6/10 and identified three residents who had not been "tried at a lower rest. (restraint) level for at least 1 year." The possible solution was for trial lower restraint levels this month to see if downgrades are possible with a goal date of 1/1/11. When the Director was asked how she had identified the concern, she stated she had been looking at the chart. When asked if she had also discovered there had been no quarterly assessments documented per policy, she stated "no." At approximately 11:30AM, during an interview with the Administrator, she stated a quality assurance review for restraints was completed every week on Monday. The Administrator verified the weekly quality assurance had not fully identified concerns related to the restraint. | 2014-01-01 |