cms_SC: 6584
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 6584 | FLORENCE REHAB & NURSING CENTER | 425163 | 133 WEST CLARKE ROAD | FLORENCE | SC | 29501 | 2014-06-19 | 309 | E | 0 | 1 | T4HW11 | **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 provide necessary care and treatment for one of one resident reviewed receiving [MEDICAL TREATMENT] services. The facility failed to monitor the [MEDICAL TREATMENT], failed to monitor fluid intake, and failed to communicate amended diet and fluid intake orders to the [MEDICAL TREATMENT] clinic for Resident #122. Also, there was no evidence of communication of laboratory results from the [MEDICAL TREATMENT] clinic to the facility for Resident #122. Additionally, the facility failed to accurately monitor/document the intake and output as ordered by the physician for two of five sampled residents reviewed for hydration/intake and output (Residents #122 and #82). Cross refer to F 315 as it relates to the care of a resident with a Foley catheter The findings included: The facility admitted Resident #122 with [DIAGNOSES REDACTED]. Record review on 6-17-14 at approximately 3:15 PM revealed that the resident was hospitalized from 6-7-14 to 6-9-14 for Volume Overload and 6-12-14 to 6-14-14 for [MEDICAL CONDITION]. Record review on 6-16-14 at 4 PM revealed that Resident #122 was admitted with a physician's orders [REDACTED]. Intake & Output. A dietary assessment was completed on 6-6-14. Nutritional Interventions Recommended and physician's orders [REDACTED]. Record review on 6-17-14 at 3:25 PM revealed a Fluid Restriction form in front of the chart to delineate the breakdown of fluid to be administered by nursing and dietary. Nursing was to give 60 cc of fluids with the medication pass four times daily. Dietary was to give 360 cc with each meal. Total = 1080 + 240=1320 cc which left 180 cc for the remainder of the day. No intake and output record was noted in the resident's room, closet, or bathroom for Certified Nursing Assistant (CNA) use to record total intake. During an interview on 6-17-14 at 3:30 PM, Licensed Practical Nurses (LPNs) #3 and #5 were asked how the staff was handling the fluid restriction for Resident #122. LPN #5 referred the surveyor to a fluid breakdown sheet in the Medication Administration Record (MAR). When asked how CNAs knew about the fluid restriction and what the resident could/could not have on their shift, LPN #5 referred to an instruction sheet (CNA Care Plan) on the inside of the resident's closet door. When reviewed with the surveyor, the nurse confirmed no instructions were noted on the form for a fluid restriction. LPN #3 stated, The resident should have a 'no water pitcher' sign over the bed. That sign was also not present as verified by LPNs #3 and #5. LPN #3 stated, I have 3 places to put the information for a fluid restriction: a sign over the bed, inside the closet, and in the ADL (Activities of Daily Living-CNA Care Plan) book. I don't know how I missed it. Review of the medical record and [MEDICAL TREATMENT] Communication forms (dated 6-4-14, 6-11-14, 6-16-14) on 6-17-14 at 3:45 PM revealed no evidence of notification to the clinic about the discontinuance of the renal restriction or of starting a Ready Care supplement. No results of laboratory tests done at the [MEDICAL TREATMENT] clinic were noted on the communication sheets and no reports from [MEDICAL TREATMENT] could be located. During an interview on 6-18-14 at 9:40 AM, LPN #3 stated, [MEDICAL TREATMENT] doesn't usually send labs. They may send a report at the end of the month. S/he verified there were no lab reports from [MEDICAL TREATMENT] in the record. When asked if the dietary supplement had been calculated into the daily fluid restriction or if this was in addition to the 1500 cc restriction, LPN #6 did not know, but stated s/he had not been adding the 120 cc given on evening shift into the recorded fluid intake. LPN #3 reviewed the form in the front of the chart and on the MAR and confirmed that the additional fluid had not been calculated into daily fluid restriction. Review of the Intake & Output Monitoring Log and interview with LPNs #3 and #5 revealed that it did not reflect an accurate fluid intake as it did not include meal intake, the amount of fluid given with medication, and the amount of the liquid supplement that had been ordered on 6-6-14. When asked if the [MEDICAL TREATMENT] clinic had been notified of the change in the diet order and the addition of the supplement, LPN #3 stated s/he had not told them, but that the dietitian had made the changes, so s/he might have contacted the clinic. During an interview at 4:45 PM on 6-17-14, the Registered Dietitian stated s/he did not communicate with the [MEDICAL TREATMENT] clinic about the addition of Ready Care or about discontinuing the renal restriction. The RD reviewed the fluid allotment form and stated that s/he had not made adjustments to the dietary or nursing fluid intake to accommodate the additional 240 cc per day. During an interview on 6-16-14 at 12:16 PM, LPN #5 stated that the resident had taken a snack of a peanut butter and jelly (PB&J) sandwich, oatmeal pie, 4 ounce can of ginger ale, and applesauce with him/her to [MEDICAL TREATMENT]. On 6-17-14 at 8:55 AM, Resident #122 was served and consumed 180 cc milk and 180 cc cranberry juice with his/her breakfast. The diet card noted the resident was to receive 240 cc of milk and 120 cc of juice each meal. ( A speech therapy student verified the amount of fluids on the tray.) A copy of the diet card was provided on 6-18-14 at 5 PM by the Certified Dietary Manager (CDM) who stated that the diet card for all meals was the same. On 6-18-14, during observation of the lunch meal, 2 sizes of glasses were used- one was 120 cc and the second appeared to be approximately 180 cc. When questioned about the fluid content, LPN #3 stated s/he thought the larger of the two held 180 cc. The CDM stated they held 240 cc. After measuring to the fill level, the CDM stated they held 180 cc and had to be filled to the top rim to hold 240 cc. On 6-18-14 at 11:45 AM, Resident #122 left the facility for [MEDICAL TREATMENT] with a snack of a 240 cc can of Glucerna, a 4 ounce can of ginger ale, applesauce, and a PB&J sandwich which was verified by the transporter and CNA #4. The CDM stated, He (she) does not need the soda. However, LPN #5 was observed to remove the Glucerna from the bag. On 6-19-14 at 8:40 AM, Resident #122 received 240 cc milk and 120 cc juice for breakfast. Observation on 6-16-14 at 4 PM revealed a dressed [MEDICAL TREATMENT] access (shunt) site on the bruised right forearm of Resident # 122. Record review on 6-17-14 at 4 PM revealed Admission physician's orders [REDACTED]. No documentation could be found of routine monitoring of the [MEDICAL TREATMENT] site for thrill and bruit. On 6-18-14 at 9:58 AM, LPN #3 reviewed the medical record and stated, It should be documented on the TAR. S/he verified it was not. The facility admitted #82 with [DIAGNOSES REDACTED]. Record review on 6-18-14 at 5:35 PM revealed physician's orders [REDACTED]. There was also an order [REDACTED]. Review of the resident's Intake and Output Monitoring logs on 6-19-14 at 8:30 AM revealed they were incomplete and/or did not reflect that physician's orders [REDACTED]. During May of 2014, 10 of 31 days were incomplete or did not reflect the intake of 270 cc per shift or 300 cc every 6 hours as required. During an interview on 6-19-14 at 10:53 AM, the Director of Nurses (DON) and Registered Nurse Consultant verified that the intake records did not reflect the physician's orders [REDACTED]. The facility admitted Resident #89 with [DIAGNOSES REDACTED]. Record review on 6/18/14 revealed a current physician's orders [REDACTED]. Review of the current care plan revealed an approach to monitor intake and output every shift with a start date of 3/14/14. Review of the Intake and Output Monitoring Log for March 2014, April 2014 and May 2014 revealed multiple times intake and output was not monitored/recorded as follows: March 2014 March 1, 2014-11p-7a intake; 7a-3p intake/output March 2, 2014-7a-3p intake/output March 9, 2014- 3p-11p intake/output March 10, 2014-11p-7a-intake/output March 11, 2014-11p-7a-output March 15, 2014-11p-7a-ouput; 3p-11p intake/output March 16,2014 11p-7a-intake/output March 21, 2014-3p-11p-ouput March 22, 2014-7a-3p-intake/output March 23, 2014-7a-3p-intake/output March 24, 2014 11p-7a-ouput March 25, 2014-3p-11p-intake/output March 27, 2014-3p-11p-intake/output March 31, 2014-7a-3p-intake/output and 3p-11p-intake/output April 6, 2014-7a-3p-intake/output April 10, 2014-11p-7a-output April 11, 2014-11p-7a-intake/output and 7a-3p-output April 12, 2014-11p-7a-intake/output April 26, 2014-3p-11p-intake/output April 27, 2014-11p-7a-intake/output and 3p-11p-intake-output April 28,2014-11p-7a-intake/output May 4,2014-11p-7a-intake/output May 10, 2014-3p-11p-intake/output May 11, 2014-intake/output not documented for all three shifts May 12, 2014-11p-7a-intake/output May 13,2014-11p-7a-intake/output May 16, 2014-11p-7a-intake/output May 21, 2014-11p-7a-output May 24, 2014 11p-7a-output May 25, 2014-7a-3p-intake/output On 6/19/14, the Nurse Consultant reviewed the Intake and Output Logs and confirmed the lack of evidence that the physician's orders [REDACTED]. | 2017-12-01 |