| 499 |
MUSC HEALTH CHESTER NURSING CENTER |
425061 |
1 MEDICAL PARK DRIVE |
CHESTER |
SC |
29706 |
2017-02-23 |
248 |
D |
0 |
1 |
4GPQ11 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews and record reviews, the facility failed to provide an on-going activity program for 3 of 31 sampled residents (Residents #75, #56, & #26), that supported their choices of activities, met their interests, and supported their physical, mental and psychological well-being. Findings include: 1. Resident (R) 75 was admitted on [DATE] with a [DIAGNOSES REDACTED]. Observations of R75 on 2/20/17 at 11:30 a.m., 2:40 p.m. and 2:50 p.m., revealed she was not engaged in activities. Record review of Activity Progress notes on the Point Click Care electronic medical record revealed R75 was provided group or one to one activities on only one occasion since admission. On 2/21/17, a gospel tape was played in her room, to which R75 responded I like that. During an interview with the Activities Therapist (AT) on 2/22/17 at 4:57 p.m., she reviewed the daily activity resident records contained in her activity book and stated R75 came to 3 activities during the past 6 months: 2/14/17 Valentine's Party for 10 to 15 minutes; 1/30/17 horse shoes and 1/13/17 church. Additionally, during the interview on 2/22/2017 at 4:57 p.m., the AT stated she considered placing R75 on one to one activities in her room because she was disruptive during group activities, but did not. 2. Resident (R) 56 was admitted on [DATE] with the primary [DIAGNOSES REDACTED]. During an interview with R56 on 2/21/17 at 11:02 a.m., the resident was noted to be bedridden responded to survey questions about activities, that staff did not encourage her to attend activities or provide assistance to attend them. During an interview with the AT on 2/22/17 at 5:40 p.m., she stated there are no evening activities and that the last activity of the day ends at 3:30 p.m. She stated activities are provided Monday through Saturday. Additionally, the AT stated R56 does not come to activities because she stays in her room and is on one to one activities in her room. During the interview with the AD reviewed the daily activity resident records contained in her activity book and stated R56 had been provided one to one activity on only 3 occasions during the past 6 months: 11/22/16, 2/6/17 and 2/16/17. 3. According to the Admission record dated 2/22/17 Resident (R) R26 had the following pertinent diagnosis; dementia without behavioral disturbances, anxiety and major [MEDICAL CONDITION]. Review of the 5/20/16 annual Minimum Data Set (MDS) section C Cognition identified that R26 has short and long-term memory problems and is severely impaired for decision regarding tasks of daily life. Section J1400 Prognosis identified that R26 had a condition or chronic disease that may result in a life expectancy of less than 6 months. Section F Preferences for Routine & Activities revealed that R26's was not assessed for daily preferences, activity preferences, interview with primary respondent (resident, family/significant or interview could not be completed), and staff assessment of daily activity and preferences was not completed. Review of the focus title Activities care plan last revised on 7/28/16 identified that R26 was dependent on staff for meeting emotional, intellectual, physical, and social needs related to physical limitations and cognitive deficits. The goal was that the resident would respond to 1:1 visits or activity verbally or with facial expressions. Observations 2/20/17 at 1:00 p.m. R26 was observed lying in bed in the fetal position. He had nothing in his room that would provide any stimulation. He was not observed to attend any activities. On 2/21/17 at 10:20 a.m. R26 was observed lying in bed in the fetal position, he had no radio or TV in his room. On 2/22/17 at 8:20 a.m. R26 was observed lying in bed on his left side, he was awake and alert. He had no TV or radio in the room. On 2/22/17 at 10:30 a.m. R26 remained in bed on his left side, he was alert but had a difficult time communicating as he is very hard of hearing and unable to see. He stated help me, and I love you, he was unable to elaborate any more than that. On 2/23/17 at 8:15 a.m. the resident was observed lying in bed, sleeping. On 2/23/17 at 9:00 a.m. the resident was observed sleeping. A certified nursing assistant (CNA) was setting up to give resident a bed bath. On 2/23/17 at 1:44 p.m. resident on his left side in the fetal position. His eyes were open, he responded to verbal stimuli. He had no TV or radio the room was dark. Record Review Review of the activity sheets for on 2/22/17 for 11/16 through 2/23/17 revealed that R26 was only seen by the activity staff three times in November, once in December, six times in (MONTH) and three times in February. There was no documentation regarding what the 1:1 consisted of, duration of visit or the resident participation/response to the activity. Review of the quarterly activity progress notes for R26 dated 10/17/16, 6/17/16, 4/25/16, and 2/4/16. The quarterly notes only addressed the visit being conducted during the quarterly note visit. There was no summary of the resident's participation, response, or frequency of the visits conducted during the quarter. There were no notes regarding how the activity staff incorporated the resident's activity preferences and needs. Review of the task documents in Point Click Care (PCC) for R26 on 2/20/17 at 3:10 p.m. revealed that there was no activity documentation found under the following tasks, 1:1 program, arts/crafts, barber, cards, cooking baking, games/exercise, kids visit, nail care, newspaper, self-directed activity, outings, puzzles, religious, social activity, special needs activity or TV/Movies. Staff Interviews: On 2/21/2017 at 3:00 p.m. spoke with the Activity Coordinator (AC) and the Activity Therapist (AT) they stated that they had documented in PCC and they may have some paper activity records. Neither record indicated that they had provided 1:1 visits with R26. On 2/21/2017 at 3:50 p.m. the AT stated that she had been the only one in the department and she had been struggling to get the documentation done as she has an AC whom staff pull to work the floor. She discussed that she does a quarterly activity note only and has not been documenting what activity she did for R26's 1:1 visits. She was unable to verbalize what activities she has done other than referencing her last quarterly note where she visited with him in his room. She stated she was not aware of the activities listed under tasks in PCC and was not aware that she needed to document time, activity, and R26's response to the activity. She was unable to remember what 1:1 activity was done with R26 yesterday. 2/21/17 at 4:13 p.m. the Administrator stated that it was his expectation that the activity staff find out and be aware of what the resident's activity preferences were and build a program around those interest. He would expect that they were trying to encourage them to come out for socialization. If the resident were bed bound by physician's orders [REDACTED]. He discussed that he would prefer to have activities staff see bed bound residents daily if possible but at minimum a few times a week. He discussed that activity staff could encourage other departments to visit with the resident and report to activity so they could capture those visits. He stated that he expected that any activity that was being provided or the resident participated in would be documented on the activity sheet and if receiving 1:1 visits there be detailed documentation of the activity. |
2020-09-01 |