| 1852 |
PRUITTHEALTH-AIKEN |
425145 |
830 LAURENS STREET NORTH |
AIKEN |
SC |
29801 |
2018-08-30 |
656 |
E |
0 |
1 |
H9EX11 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record reviews, and interviews, the facility failed to develop and/or implement the care plans for 2 of 3 sampled residents reviewed for activities, 2 of 5 sampled residents reviewed for pressure ulcers, and 4 of 4 sampled residents reviewed for range of motion (R0M). For Resident #18, a Care Plan was not developed to address contractures, the activity Care Plan goal was not measurable, and the Care Plan was not followed related to activities and positioning. For Resident #115, Care Plan goals and interventions did not reflect the staff assessment for activities on the Minimum Data Set assessment and Care Plan interventions were not followed for contractures. The Care Plan was not followed for Resident #120 related to provision of ROM and turning and positioning every 2 hours. Resident #19's Care Plan related to splint application and provision of ROM was not followed. The findings included: The facility admitted Resident #18 with [DIAGNOSES REDACTED]. Initial observation on 8/27/18 at 11:34 AM and throughout the survey revealed left upper extremity contractures with a soft elbow splint but no device or handroll in place for the hand/wrist. Review of the 6-12-18 Quarterly Minimum Data Set (MDS) Assessment on 8/29/18 at 10:57 PM revealed that the resident had functional impairment of one upper and both lower extremities. No ROM or Restorative services were noted as provided. No behaviors were noted. Review of the Care Plan on 8/30/18 at 8:02 AM revealed no reference to contractures or planned interventions to maintain or improve ROM. During an interview on 8-30-18, Registered Nurse #1 verified that the Care Plan did not address the resident's contractures. Continued review of the 10-19-17 Annual and 6-12-18 Quarterly Minimum Data Set Assessments on 8/29/18 at 10:57 PM revealed that the resident required extensive assistance with bed mobility and was at risk for pressure ulcer development. Review of the Care Plan on 8/30/18 at 8:02 AM revealed that interventions to prevent pressure ulcers included to Reposition patient every 2 hours as tolerated. Observations during the first 2 days of the survey revealed the resident was never out of the bed or the room. Multiple observations (on 8/27/18 at 11:34 AM, 1:32 PM, 3:03 PM, 3:58 PM, and 5:05 PM; on 08/28/18 at 8:20 AM, 10 AM, 11:17 AM, and 12:31 PM; on 8/29/18 at 7:55 AM, 9:07 AM, 10:43 AM, 12:35 PM, 2:14 PM, 3:50 PM, and 4:54 PM) revealed that Resident #18 was on his/her back and was not turned and positioned at least every 2 hours per the Care Plan. No turning and positioning pillows or wedges were present in the resident's bed to indicate attempts made. During an interview on 8/29/18 at 6:01 PM, the Consultant Administrator reviewed SMART charting and verified that there was no documentation relating to turning and positioning for Resident #18. Further review of the 10-19-17 Annual Minimum Data Set (MDS) Assessment on 8/29/18 at 10:57 PM revealed the resident had a Brief Interview for Mental Status (BIMS) score of 15, indicating s/he was cognitively intact. Section F of the MDS noted that listening to music and being around animals were activities the resident classified as somewhat important. S/he considered keeping up with the news, going outside, and participation in religious practices to be very important. Review of the Care Plan on 8/30/18 at 8:02 AM revealed that the resident wanted to maintain interests as when s/he was at home. Interests included watching TV, listening to music (gospel, easy listening, rhythm and blues), attending church, going outside, hunting, fishing, gardening, and sports. The care plan goal of Will have his (her) interests met daily through next review was not specific and measurable. Interventions included: Assist with TV and music as needed and going outside as weather permits; Inform/invite to activities of interest; Assist to and from and in activities; Visit as needed; Provide magazines about hunting, fishing, sports and gardening. During an interview at 4:08 PM on 8/29/18, when questioned about activity attendance, Resident #18 stated,I don't get out of bed. When asked if it was his/her choice to not get up and out of the room, s/he stated,No, that is not by my choice. On 8-28-18 at 3:03 PM, the resident stated s/he would like to get up some more, but they leave me up too long and I have pain. S/he stated s/he had not gone to church or outside for a long time. The resident could not remember when s/he had last attended. S/he stated s/he just stays in bed because I don't want to be no trouble. During an interview on 8/28/18 at 3:21 PM, the Activity Director and Assistant stated, The resident does not get up. They stated that nursing used to get more people up. It all depends on the CNA (Certified Nursing Assistant). He (She) used to get up more. Staff does not get him (her) up. The Activity Director copied, reviewed and verified the Care Plan as written. Review of 6/18, 7/18, and 8/18 participation records with the Activity Director revealed that 1:1 activities were provided in the room. There was no participation in group or out of room activities. The documented records did not reflect his/her individual interests as stated on the Care Plan. The facility admitted Resident #115 with [DIAGNOSES REDACTED]. Review of the 7-24-18 Quarterly MDS Assessment on 8/29/18 at 11:46 AM revealed that the resident had functional impairment of bilateral upper and lower extremities. No ROM or Restorative services were noted as provided. During an interview on 8/30/18 at 3:41 PM, the Occupational Therapist (OT) and Rehab Director stated they treated Resident #115 in 1/18. S/he was discharged with orders to wear soft elbow splints and palmar supports or rolled washcloths in the hands. They stated they saw the resident today and (s)he did not have elbow splints on but had washcloths in his (her) hands. They stated the resident needed splints to maintain current ROM so (s)he doesn't get worse. They noted that Physical Therapy also saw the resident in (MONTH) and that soft splints were to be used for the knees. These were also not observed to be in place and were still recommended. Review of the Care Plan on 8/29/18 at 12:08 PM revealed that interventions to address contractures included provision of ROM and devices as ordered. Initial observation on 08/27/18 at 11:30 AM through 8/29/18 during the survey revealed contractures of all extremities with only a left handroll in place. There were no other positioning devices or pillows to prevent further decline in contractures. Positioning was observed and confirmed with Licensed Practical Nurse #7 on 8/27/18 at 4:53 PM. Review of the medical record revealed no evidence of provision of ROM or splint application as per the Care Plan to prevent further decline in ROM. During an interview on 8/29/18 at 6:01 PM, the Consultant Administrator stated that Resident #18 was not on a restorative program. S/he reviewed the SMART charting and confirmed that it did not reflect provision of ROM. Continued review of the 5-8-18 Annual MDS Assessment on 8/29/18 at 11:46 AM revealed the resident was totally dependent for all activities of daily living. The staff assessment for activities noted the following as important to the resident: books, newspapers, and magazines, listening to music, keeping up with the news, spending time outdoors and participating in religious activities. Further review of the Care Plan on 8/29/18 at 12:08 PM revealed that it did not reflect the staff assessment on the MDS. The resident was noted at risk for social isolation related to medical condition. He (she) is passive. The goal was for Activity staff to visit 1:1 2x weekly through next review. Interventions included: Reinforce attendance at activities events with verbal praise; Activity staff/Social Services to visit as needed; Post activity schedule in patient's room; Provide 1:1 visits, in room activities and supplies for patient for sensory stimulation. Observations throughout the survey revealed the resident never out of the bed or the room and no activities were observed other than a radio playing. The resident was unresponsive to verbal stimuli. During an interview on 8/28/18 at 3:32 PM, the Activity Director and Assistant stated, The resident does not get up. They stated that nursing used to get more people up. It all depends on the CN[NAME] When he (she) was on Unit 3 and 4, he (she) used to get up. Staff does not get him (her) up now. The activity staff noted that the resident had no family visits and that they had never seen anyone. They stated they really knew nothing about the resident except that s/he had worked for the railroad and at a nuclear plant. The Activity Director copied, reviewed and verified the Care Plan as written. Review of 6/18, 7/18, and 8/18 participation records with the Activity Director revealed that 1:1 activities were only provided in the room [ROOM NUMBER]-6 times per month. There were only 2 times during the 3 month period that the resident was noted to be out of the room, sitting in the TV room which did not reflect participation in any type of activity. The 1:1 documentation only noted reading to the resident (not the subject), current events x 2, and listening to music (not the type). There was no other sensory stimulation noted. During an interview on 8/29/18 at 5:07 PM, when asked if Residents #18 and #115 got out of bed, Licensed Practical Nurse #7 stated, Depends on the CNA and nurse that has them. The facility admitted Resident #120 with [DIAGNOSES REDACTED]. Review of the 12-12-17 Annual and 7-31-18 Quarterly Minimum Data Set Assessments on 8/29/18 at 3:09 PM revealed that the resident was totally dependent for bed mobility and was at risk for pressure ulcer development. Review of the Care Plan on 8/29/18 at 3:48 PM revealed that interventions to prevent skin breakdown included to Reposition patient every 2 hours as tolerated. Multiple observations (on 8/27/18 at 11:30 AM, 1:22 PM, 3:03 PM, 3:55 PM, and 4:50 PM; on 08/28/18 at 8:20 AM, 10 AM, 11:17 AM, and 12:31 PM; on 8/29/18 at 7:58 AM, 9:10 AM, 10:47 AM, 12:41 PM, 2:17 PM, 3:57 PM, and 4:58 PM) revealed that Resident #18 was on his/her back and not turned and positioned at least every 2 hours. No turning and positioning pillows or wedges were present in the resident's bed to indicate attempts made. During an interview on 8/29/18 at 6:01 PM, the Consultant Administrator reviewed SMART charting and verified that there was no documentation relating to turning and positioning for Resident #18. Continued review of the MDS Assessments on 8/29/18 at 3:09 PM revealed that the 12-12-17 Annual assessment noted ROM impaired in one upper and 2 lower extremities and the 7-31-18 Quarterly assessment noted impairment in both upper and lower extremities. No ROM, restorative services, or therapy was coded. During an interview on 8/30/18 at 4:01 PM, the OT and Rehab Director stated that Resident #120 had been discharged from therapy with a left palmar splint to maintain ROM. The therapists stated they had looked at the resident that day and s/he had not had a decline on the left side. OT stated that the resident needed to keep it elevated for [MEDICAL CONDITION] and that the resident does want the splint. During an interview on 8/29/18 at 5:13 PM with the 3 MDS Coordinators, Licensed Practical Nurse #4 verified the coding for the MDS assessments. When asked what had been implemented to prevent any further decline, they researched and found that OT completed an evaluation only on 4/12/18 with no new recommendations made. Review of the Care Plan on 8/29/18 at 3:48 PM revealed that interventions to address contractures included provision of ROM with ADL (activities of daily living) care and devices as ordered. Initial observation on 08/27/18 at 11:30 AM and throughout the survey revealed contractures of both upper extremities with no splints or handrolls in place. During an interview on 8/29/18 at 6:01 PM, the Consultant Administrator stated that Resident #18 was not on a restorative program. S/he reviewed the SMART charting and confirmed that it did not reflect provision of ROM. The facility admitted Resident #19 with [DIAGNOSES REDACTED]. Review of the 6-12-18 Quarterly MDS Assessment on 8/30/18 at 2:27 PM revealed that the resident had functional impairment of one upper and one lower extremity. No ROM or Restorative services were noted as provided. Review of Occupational Therapy (OT) notes on 8/30/18 at 2:53 PM revealed that the resident was discharged with a hand splint on 1/18/18. Review of the Care Plan on 8/30/18 at 2:57 PM revealed that interventions to address contractures included provision of ROM and devices as ordered. Initial observation on 8/27/18 at 11:34 AM and throughout the survey revealed contractures of the right upper extremity with no splint or handroll in place. Continued review of the medical record revealed no evidence of splint application or provision of ROM. During an interview on 8/29/18 at 6:01 PM, the Consultant Administrator stated that Resident #18 was not on a restorative program. S/he reviewed the SMART charting and confirmed that it did not reflect provision of ROM. |
2020-09-01 |