cms_SC: 69
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 69 | FAITH HEALTHCARE CENTER | 425009 | 617 WEST MARION STREET | FLORENCE | SC | 29501 | 2017-06-14 | 282 | D | 0 | 1 | J20Y11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observation and interview, the facility failed to implement the care plan for 3 (Resident #110, # 22 and #66) of 18 residents whose care plans were reviewed in Stage 2. This involved lack of a therapy evaluation, for Resident #110, pressure ulcer care for Resident #66 and positioning while eating for Resident #22. Findings include: 1. Record review of the admission nurses note for Resident #110 dated 3/22/17 at 6:00 PM, revealed, .Body assessment completed . Bilat (bilateral) lower extremities contracted .resident requires total assistance and care with all needs . Record review of Care Plan for Resident #110 dated 03/22/17 revealed, Resident is limited in range of motion R/T (related to) contractures of the upper and lower extremities .Goal Resident's joint contractures will be free from injury and skin breakdown Perform a contracture assessment .Staff to perform PROM (passive range of motion) during ADLs (activities of daily living)/care as tolerated . Record review of Minimal Data Set (MDS) for Resident #110 dated 03/28/17 revealed, Section G Functional Status indicates that the resident is dependent in all areas of care. On the following dates and times during observations, the Resident # 110 was found in her bed, with bilateral contractions to her legs, positioned on her back, no splints, and towel rolls in her hand: 04/11/17 at 8:40 AM, 10:17 AM, 11:03 AM, 12:27 AM, 1:32 AM, 2:29 AM, and 3:06 AM, 4:54 AM, and 5:17 AM. 04/12/17 at 7:42 AM and 8:44 AM. On 04/12/17 she was up in her chair at 10:39 AM, 1:19 AM, and 2:40 PM, tilted to her left side with no support, splints, or other interventions for contractures. On 04/12/17 at 11:39 am during an interview with Occupational Therapists Staff #127, when asked if residents get screened when they are admitted , to decide whether they need therapy, she confirmed that they are. When asked if there is a reason why someone would not be screened, she confirmed that sometimes, only a screen is appropriate and therapy will not pick them, up but they should be screened right away. When asked who decides when a resident may need a therapy evaluation, she stated, It is a multi-tier decision. I have had nurses, therapists, or other coworkers ask for screenings. When asked if someone contracted, what interventions are normally recommended, or how would the process begin, she stated, Anyone that comes to this facility should be evaluated based on how they will be, here. You go through the same process with everyone. For contractures, you would do passive range of motion and try to find the most appropriate splint, then decide how long they should wear it, then DC (discontinue) the resident from therapy and they go to restorative (nursing). Then it is a nursing decision. When asked who provides the therapy recommendations if a splint is required or passive range of motion, she confirmed that nursing will provide those interventions after the therapy evaluation. When asked if there would be any situation where a resident with contractures would not receive some type of intervention, she stated, pain may be an issue, its situational . On 04/12/17 at 11:46 AM during an interview with Physical Therapy Assistant Staff # 123, when asked if Resident #110 has been evaluated by therapy, he stated, We don't have a full-time OT (occupational therapist), so she is awaiting an eval (evaluation) on Thursday (04/13/17). When asked where this information is documented, he confirmed it should be in her chart . On 04/12/17 at 2:48 PM during an interview with Licensed Practical Nurse #66, when asked if there was anyone that she is taking care of today that receives range of motion from nursing, she stated, No, restorative does that. They (CNA's) may walk them and things like that. The CNA's aren't told to do it (ROM), they do get them up and do ADL's (activities of daily living). Record review of Restorative Nursing Policies and Procedures dated 12/01/14 revealed, Subject: Joint Mobility/Range of Motion (ROM) Program and Splinting - Initiating the Program Policy: Patients/residents will be assessed for joint mobility limitation upon admission, re-admission, quarterly, annually, and with significant changes .A restorative program will be implemented through the care plan to increase, maintain, or prevent deterioration of joint mobility and to maximize physical function when referral to therapy is not indicated .Orthotic, assistive, or prosthetic devices will be provided if indicated .Procedures: 2. The problems, goals, target dates and approaches are documented on the patients/residents care plan .Candidates: Appropriate candidates for the Nursing Restorative ROM (Range of motion) Program may include, but are not limited to, patients/residents with the following conditions: contractures, decreased AROM (active range of motion), Decreased PROM (passive range of motion) . On 04/12/17 at 3:08 PM, during an interview with Restorative Aide Staff #99, when asked if Resident #110 was on restorative services such as range of motion, she confirmed that therapy have not given recommendations for her for any restorative services. 2. Resident # 22 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. [MEDICAL CONDITION]. Review of the most recent Minimum (MDS) data set [DATE] revealed she had no swallowing disorder and receives a therapeutic mechanically altered diet. She was noted to require the extensive assistance of two staff members to position her in bed, required eating supervision with oversight and encouragement/cueing and was a set up only with her meals. Review of her current care plan dated 3/1/2017 revealed interventions to include that staff are to assist her with eating, monitor for mastication difficulties, monitor her intake for safe swallowing and report any problems to the nurse. Review of Nurse Aide flow records for (MONTH) and (MONTH) (YEAR) revealed she requires the extensive assistance from staff to turn in bed. Her record was silent to any speech therapy orders or evaluations. Observation of resident #22 on 4/11/2017 at 5:15 PM revealed she was observed to be served her meal and the nursing assistant elevated the head of her bed but she did not pull the resident up in the bed. Resident #22 remained slouched down in the bed and was in poor position to feed herself when her meal was served. The staff prepared her meal and left her to feed herself while she was still not positioned straight up in the bed as she was still noted to be slouched down in the bed. Resident #22 was observed to feed herself but was noted to struggle getting the food on her spoon and feeding herself without spilling the food on herself. During this observation the Social Service staff #108 walked by the room and observed Resident #22 in her bed positioned poorly and she entered the room and ask the resident why are you laying so far back in the bed trying to feed yourself. She began to reposition the resident and when doing so the resident began to cough/choke on the food that she had in her mouth. The Social Service staff #108 attempted to assist the resident by offering her a drink of water but the resident continued to cough and her eyes began to water and she was not able to speak. The Social Service staff #108 called for the nurse to come the the room and the nurse assessed Resident #22 and she was then able to drink water and she ceased coughing. Nurse #51 and Social Service Staff #108 pulled the resident up in bed and repositioned her in an adequate position so she could feed herself in an upright position and the resident was then able to feed herself her meal with no further concerns. The staff failed to monitor Resident #22 for safe swallowing per her nutrition care plan during her meal on 4/11/2017 at 5:30 PM. She was found by the Social Service Staff #108 to be poorly positioned and experienced a coughing/choking episode while feeding herself in bed. 3. Resident #66 was admitted to the facility on [DATE]. She was noted to have a current [DIAGNOSES REDACTED]. Review of her most recent Minimum (MDS) data set [DATE] revealed she required the extensive assistance of 2 staff for bed mobility and eating. She was noted to have a pressure ulcer to her right heel and had pressure reduction for bed and was receiving pressure ulcer care. Review of her current pressure ulcer care plan dated 10/24/2016 revealed she was at risk for pressure ulcers due to impaired mobility. The current interventions included to avoid shearing, conduct skin assessment per facility protocol, encourage and assist with turning and to report any signs of skin breakdown. On 12/24/2016 new orders were noted for the resident to wear heel protectors at all times and to float her heels. Observations of Resident #66 on 4/11/2017 7:40 AM she was observed to be in bed with heel protectors on but her heels were noted to resting on the bed. On 4/12/2017 at 8:40 AM she was observed to be in bed with heel protectors on but her heels were not being floated per her current orders. Observation again on 4/13/2017 at 8:32 AM revealed Resident #60 was observed in the bed with heel protectors on both her feet but her feet were laying on the bed and not floated per orders. These concern were shared with the Administrative staff on 4/12/17 at 11 AM. The facility failed to implement the care plan interventions for Resident #66 in regards to promoting healing of her current pressure ulcer. | 2020-09-01 |