cms_SC: 66
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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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 66 | FAITH HEALTHCARE CENTER | 425009 | 617 WEST MARION STREET | FLORENCE | SC | 29501 | 2017-06-14 | 279 | J | 0 | 1 | J20Y11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and staff interview the facility failed to develop a comprehensive person-centered care plan for each 2 of 18 residents whose care plans were reviewed in Stage 2. This involved Resident #6 for nutrition/swallowing precautions which resulted in an Immediate Jeopardy when the resident became choked during a meal after asking for and not receiving assistance from staff with positioning. In addition, Resident #77 had no care plan to address the use of anti-psychotic medications. Findings include: 1. Record review for Resident #6 of physician progress notes [REDACTED].diabetes with peripheral circulatory disorders, type 1 .coronary [MEDICAL CONDITION] (hardening/narrowing of arteries) of unspecified type of vessel .[MEDICAL CONDITION] (lacking control) bladder, CKD ([MEDICAL CONDITION]) stage IV (4), [MEDICAL CONDITION] . Record review of the Therapy Screening Form dated 01/19/17 revealed, Indicate all areas reflecting a change in condition or an area with a deficit that may warrant therapy: Difficulty with mobility, bed mobility .difficulty turning to assist with ADL's (Activities of Daily Living). Record review of the Functional limitations Assessment by OT (Occupational Therapy) dated 01/25/17 revealed, Pt evaluation this date and is presently at 90% impairment to do self feeding, ADLS and bed/chair positioning requiring increased assist from care givers. Record review of Speech Therapy (ST) Plan of Care dated 01/30/17 revealed, .During routine screen, ST noted increased coughing during PO (by mouth) consumption .Therapy necessary for increased upper airway protection. Without therapy patient at risk for aspiration . Record review of Minimum Data Set ((MDS) dated [DATE] revealed, Section G-Functional Status-Bed mobility: total dependence, one person physical assist .Section K Swallowing/Nutritional Status- Swallowing disorder-Z. None of the above. Record review of ST daily treatment note dated 03/13/17 revealed, Swallowing functional limitation, current status has been documented based on clinical judgment;pt able to follow safe swallow strategies with min cues to increase upper airway protection. Education provided to the resident on the importance of sitting upright in 90 degree position for all oral intake . Record review of ST -Therapist Progress & Discharge Summary dated 04/07/17 revealed, .The patient will perform pharyngeal elevation/excursion (specific phases of swallowing) exercise given 30% visual and verbal instruction/cues to increase pharyngeal squeeze to decrease aspiration risk exhibiting mild impairment (25-50% impairment;risk of aspiration on liquids; mild oral residue and may need meats ground or chopped; cueing and intermittent supervision for carry-over. Record review of OT (Occupational Therapy) daily treatment record dated 03/30/17 revealed, OT supervisory visit completed .OT saw patient in her room initially for using ADL (Activities of Daily Living) training. OT pulled her up in edge then set up her lunch tray. Patient stayed up to complete her meal with 20% spillage .the resident transition from supine (lying face up) to sit EOB (edge of bed) with max (maximum) A (assist). resident was then taken to rehab gym .to work on arm strength to assist with bed/chair mobility/positioning . Record review of Nursing Policies and Procedures for Aspiration Precaution Guidelines dated 07/01/16 revealed, Follow protocols/guidelines developed by speech and/or occupational therapists. Remember mealtime strategies should always be individualized. Every precaution should be communicated to all staff. These may include: Position the resident at a 90 degree angle or as upright as possible while eating or taking oral medications; .Avoid positioning the resident in a flat position . Record review of Aspiration Precautions Sheet for Resident #6, with no date revealed, 1. upright in chair for all meals . Record review of Kardex (CNA communication/task sheet) with no date for Resident #6 revealed, Eating- Independent/Set-up, Activity/Mobility- out of bed/wheelchair/mechanical lift ., no further indication of positioning. On 04/10/17 at 12:57 PM Resident #6 was observed sitting very low in her bed, with the head of the bed raised causing her to to have her chin to her chest. Her tray of food was on the table and she was feeding herself. On 04/11/17 at 12:37 PM during an observation, she is slouched in her bed, not at a 90 degree angle and tilted on her right side, and is feeding herself. A CNA (Certified Nurses Assistant) Staff #34 is currently in the room feeding another resident. The same CNA brought her food. Her call light is out of reach hanging on the other side of her bed. On 04/11/17 at 12:37 PM During an interview with the Resident #6, when asked if she still works with therapy, she stated that she does, when asked if she remembers what they tell her when she eats, she stated, yes, they tell me I am supposed to be sitting straight up so the food goes down into my stomach, not like this. On 04/11/17 12:45 PM Resident #6 began yelling at CNA Staff #34, asking several times to put her head up, and CNA Staff #34 continued saying that the bed was all the way up. Resident #6 asked two more times, and CNA Staff #34 stated that her head is fine. CNA Staff #34 came to the edge of the bed and adjusted her tray, but did not put her head up or help her adjust in the bed. The resident remained in the same position, slouched and turned to the right side of the bed. On 04/11/17 at 12:47 PM during an interview with Resident #6, when asked if she is having trouble swallowing that way, she states,yes, everything is hard sitting like this. Resident #6 begins coughing, and coughed up coleslaw that she was eating. LPN (Licensed Practical Nurse) Staff #12 and LPN Staff #38 were in hall and were asked to come straighten up the resident and check on her. They came in and pulled her up in bed and repositioned her, but not in a 90 degree angle. She remained low in the bed and tilted to the right side. On 04/11/17 at 12:57 PM, during an interview with Resident #6, when asked if they always put her head up to eat, she stated no. She stated, this is better than when I am laying down, I can't eat like that. On 04/11/17 at 1:03 PM, during an interview with the ST (Speech Therapist) Staff #125 that wrote recommendations for Resident #6, she was brought to the room to see the positioning for Resident #6. She was asked if this was the correct positioning for her to eat in, and she verified that it is not. She asked Resident #6 why she was sitting that way, and the resident stated, I asked for help, but they wont help me. ST Staff #125 asked if she knows where she should be, and the resident confirmed that she should be straight up in the bed. ST Staff #125 asked Resident #6 what CNA was working with her, and the resident stated, I don't remember her name but it is someone who works with me a lot. ST Staff #125 stated that she discharged her from her service last week, or the week before and she used to come in before meals to help get her positioned with help from a CN[NAME] She stated that she has done education many times with Resident #6, and she knows where she should be positioned. ST Staff #125 walked down the hall to find the CNA that was working with her and found CNA Staff #34. ST Staff #125 asked CNA #34 if she had helped the resident position herself, and CNA #34 confirmed that she helped her with her tray and raised the head of her bed. CNA #34 then stated that the nurses came in later to reposition her. ST Staff #125 asked CNA #34 if she understands how she should be positioned, and she confirmed that she did. On 04/11/17 1:28 PM during an interview with LPN Staff #38, when asked how Resident #6 is supposed to be positioned when eating, she responded She should be on her back, but she has an area on her bottom, so she has to be on her side. We try to get her straight up on her back, but she turns every two hours. When we do pull her up, she slides back down in the bed. When asked if Resident #6 will let staff know if she needs readjusted, she confirmed that she will. When asked if Resident #6 will get up in a chair, she stated, Yes, she will get up for therapy for a little while, and she wants right back in the bed. If she needs anything, she will let you know. On 04/11/17, in the evening, the most current and complete care plan for Resident #6 was requested from Corporate Nurse Staff # 134. It was received in the morning of 04/11/17 with no indication of a swallowing or positioning care plan. 2. Record review for Resident # 77 revealed she was admitted to the facility on [DATE] with a [DIAGNOSES REDACTED]. The [DIAGNOSES REDACTED]. The resident was noted to be receiving Risperidol 2 milligrams two times a day for [MEDICAL CONDITION]. Review of the Most recent Minimum Data Set ((MDS) dated [DATE] documented the resident was receiving an anti-psychotic medication 7 days a week. Review of the current care plan revealed the care plan was silent to the use of the anti-psychotic medication. There were no individual person centered care plan goals or interventions noted regarding the use of the anti-psychotic medication or any behaviors the resident exhibits in regards to the use of this anti-psychotic medication. Interview with the MDS nurse #99 on 4/11/2017 at 1:30 PM verified there was not a current comprehensive care plan in place to address Resident #77s [MEDICAL CONDITION] diagnosis, her use of anti-psychotic medications or current goals and interventions to direct her care in regards to the anti-psychotic medication. On 04/11/17 at 2:10 PM, Corporate Nurse Staff #134, Regulation Specialist Staff #135, and Director of Nursing Staff #136 were notified that Immediate Jeopardy (IJ) began on 04/11/17 at 12:47 PM when Resident #6 was observed lying slouched down in her bed on her right side and began choking while feeding herself lunch after repeated requests from the resident to be placed in a position so she could feed herself safely. The facility's Allegation of Compliance (A[NAME]) was received on 04/11/17 at 6:22 PM. The A[NAME] included: 1. Affected resident has been assessed by Speech Therapy and staff educated on proper positioning during meals. 2. Education provided to floor staff regarding proper positioning of residents who eat in bed by speech therapy and nursing management prior to dinner meal on 04/11/17. 3. DON (Director of Nursing) or designee to visually check on residents during meal times to ensure proper positioning in bed at each meal x 7 days. 4. Speech Therapy will screen residents noted to have any difficulties with swallowing as reported by nursing on therapy referral form. 5. Residents noted for speech therapy screen will be reviewed in Q[NAME] (Quality of Care) meeting weekly beginning immediately. 6. Speech therapy to provide DON with copy of recommendations for processing to current orders or Kardex. 7. Staff that did not attend initial education on 04/11/17 will be educated on proper positioning and aspiration precautions before working the floor. The survey team completed record review and interview to ensure the facility had implemented their A[NAME]. The Immediate Jeopardy at F279 was removed on 4/13/2017, but the citation remained at a lowered scope and severity of D. | 2020-09-01 |