cms_SC: 70
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 70 | FAITH HEALTHCARE CENTER | 425009 | 617 WEST MARION STREET | FLORENCE | SC | 29501 | 2017-06-14 | 314 | E | 0 | 1 | J20Y11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and interviews, the facility failed to ensure that interventions to support healing and prevention of pressure ulcers were being implemented for 3 (Resident #60, #66 and #110) of 4 resident reviewed for pressure ulcers in Stage 2. Findings are: 1. Record review for Resident #60 of physicians progress note dated 12/14/17 revealed,72 yo (year old) F (female), who was admitted to secondary to gradual functional decline over several weeks. Prior to admission, pt (patient)resided at an Intermediate Care Facility (ICF)) for 15yrs (years) and steadily became incapable of caring for herself and was incontinent of bowel and bladder per prior documentation at . She had also begun to pocket her food. The pt (patient) is wheelchair-bound at baseline. Record review of Minimum Data Set ((MDS) dated [DATE] revealed, Section G Functional Status- resident is dependent with one person assist for all areas including bed mobility, transfer, personal hygiene .Skin Conditions: Number for untraceable pressure ulcers: 1, Dimensions of Unhealed Stage 3 or 4 Pressure Ulcers or Eschar: Pressure ulcer length: 4.5 cm, width: 2.1, depth: 3.1. Record review of Care Plan date 01/01/17 revealed, Problem: Pressure Ulcer .Goal: Residents skin will remain intact .Approach: Assess resident for presence of risk factors. Treat, reduce, eliminate risk factors to extent possible .turn and reposition every ___(frequency) (section left blank) . On the back of the care plan were wound measurements, on 03/30/17 the documentation revealed, .Left buttock stage 3 CCTX (Continue current treatment) 0.2cmx 0.2cm x 0.2 cm. Record review of Care Plan dated 01/05/17 revealed, Problem: Pressure Ulcer Resident is at risk for skin breakdown R/T incontinence and impaired mobility .Goal: Residents skin will remain intact .Approach: Assess resident for presence of risk factors. Treat, reduce, eliminate risk factors to extent possible . Observations on 04/11/17 during the following times, the resident was observed positioned on her right side in her bed: 8:25 AM, 8:45 AM, 10:18 AM, 11:02 AM, 12:26 PM, 1:33 PM, 2:30 PM, 3:01 PM, 4:53 PM, and 5:17 PM. On 04/12/17 during the following times, the resident was observed positioned on her right side in her bed: 8:44 AM, 9:18 AM, 10:45 AM, 1:20 PM, and 2:43 PM. On 04/12/17 at 1:22 PM, during an interview with Unit Manager Staff #45, when asked when Resident #60's pressure ulcer was first identified, she stated, It was acquired in-house on 10/4/16. On 04/12/17 at 1:36 PM during an interview with Licensed Practical Nurse #54 while doing wound care for Resident #60 during observation of wound care, when asked if Resident #60 has an air mattress, she confirmed that she does. When asked how often nurses do skin checks, she stated, Once a week, and the CNA's (Certified Nurses Assistant) check their skin once a day. When asked how often the resident goes to the wound clinic, she confirmed that she used to go once a week, but now she goes once every three weeks because the wound is healing. When asked if Resident #60 is ever is disagreeable about getting out of bed, or being moved, she stated, Every once in a while, but not often. On 04/12/17 at 3:53 PM, during an interview with Licensed Practical Nurse Staff # 54, when asked if there is a reason resident #60 is not getting turned, she stated, I was just in the room and helped the CNA (Certified Nurse's Assistant) turn her, and she has an air mattress anyway. When asked if that was the first time that she assisted today with turning R #60, she would not answer the question. When asked why she is not getting out of bed, she stated, I don't know that she isn't getting out of the bed. She has a high-back chair she can get up into. She used to get up everyday, before we (morning shift) came in. She was also going to therapy. She started getting these areas on her butt and started breaking down a lot., When asked if she has pain, she confirmed that she does not appear to be in pain, but she does have Tylenol ordered if she did. 2. Record review of the care plan for Resident #110 dated 3/22/17 revealed, Problem: Pressure Ulcer Resident at risk of pressure ulcer due to friction and shear .Goal: Intact skin without evidence of redness, irritation, maceration, or open areas through next review .Approach: Minimum or 2 people plus draw sheet to lift resident while in bed .Skin assessment and inspection every shift with close attention to heels . On the care plan the following notes were added: 04/08/2017 Open area to right buttock with DWC (wound cleanser). Apply hydrogel and dry dressing BID (twice a day) until healed .4/11/2017 per Nurses note R (right) buttocks measurements are 0.4 cm , width 0.5 cm . Record review of Minimum Data Set (MDS) for Resident #110 dated 03/28/17, revealed, Section G Functional Status indicated that resident is dependent with one person assist with all function, including bed mobility. Section M Skin Conditions revealed that R #110 is at risk for pressure ulcers. On 04/10/17 at 4:00 PM, during a family interview with Resident #110's father, when asked if had any concerns with the care that his daughter receives in the facility, he stated, I do have a concern that she has a gray area on her buttocks now. In the last place that she was, they were turning her often, and she did not have any skin problems, but now she does. I don't feel like they are turning her enough. On 04/11/17 during observations at the following times, the resident was positioned on her back: 8:40 AM, 10:17 AM, 11:03 AM, 12:27 PM, 1:32 PM, 2:29 PM, 3:06 PM, 4:54 PM, and 5:17 PM. On 04/13/17 at 8:10 AM during an interview with Certified Nurse's Assistant (CNA) Staff #116, when asked how she knows if a resident needs specific positioning, she stated, I would look in the Kardex. When asked if there is a place for documenting turning, she confirmed that there is not. When asked how often R #110 was repositioned, she confirmed it was every two hours. When asked if she has any other interventions, she stated, Yes, she has heel protectors. Record review of Resident #110's Kardex with no date, revealed, no indication of positioning. On 04/12/17, in the afternoon during an interview with Corporate Nurse Staff #134, when asked if the facility uses air mattresses, she stated, Only for stage four's (pressure ulcers), we just don't have another option. When asked how turning schedules are relayed to CNA's, she stated, That is a standard of care that we teach . Record review of Performance Improvement Projects (PIPs) dated 2/10/17 revealed, Issues Identified: Facility is over stated average for wounds, wound documentation is not accurate and staging is not correct. Accurate information was not coded correctly on MDS (Minimum Data Set) which lead to QM (Quality Measures) % increasing .Wounds were not being staged correctly and wound sheets were not filled out correctly which lead to inaccurate coding and wound worsening due to improper treatment. Wound measuring not accurate, turn schedule not being performed in timely manner, no assisted devices to heels and other areas of concern .Action #2 Facility wide turn schedule to be implemented. Labs to be obtained and tests to be ordered for other types of wounds, staff education provided on 2/20/17 .Action #4 DON(Director of Nursing)/ADON(Assistant Director of Nursing)/Wound nurse and Unit Managers to monitor for turn schedule, skin sheets, and frequent incontinent care provided to residents . On 04/13/17 at 7:44 AM during an interview with the Administrator Staff #43, when asked if she if familiar with the residents in the facility, she stated, I am not familiar with a lot of them. When asked if the facility has a positioning protocol, she stated, We are working on that. We were going to do a turning and repositioning thing and they got clocks and received the clocks on 3/21 and need to implement the program. When asked if there are alerts for the staff now for positioning, she stated, If the CNA's (Certified Nurse's Assistants) have someone, they turn them. When asked if it is a standard practice that the facility staff turns residents every two hours, she confirmed that it is. When asked if there is a place to document positioning and turning, she stated, am not sure. I know that there are some things that need to get addressed here, I need to get order and time to do it.' 3. Resident #66 was admitted to the facility on [DATE]. Her record revealed she had a current pressure ulcer to her right heel. Review of the residents most recent Minimum (MDS) data set [DATE] revealed she required the extensive assistance of 2 staff for bed mobility. The MDS also reflected documentation of a current pressure ulcer to her right heel and was noted to have a pressure reduction mattress for her bed and was receiving pressure ulcer care. Review of her current pressure ulcer care plan dated 10/24/2016 revealed Resident #66 was at risk for pressure ulcers due to impaired mobility. The current interventions included that staff were to avoid shearing, conduct skin assessment per facility protocol, encourage and assist the resident 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 off the bed to promote healing of her pressure ulcer to her right heel. Observations were made of Resident #66 on 4/11/2017 7:40 AM and 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 orders. Observation 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 not floated per current orders. These concerns were shared with the Administrative staff on 4/12/17 at 11 AM. The facility failed to implement the floating of Resident #60's heels to assist in the promotion of healing of her current pressure ulcer to her right heel. | 2020-09-01 |