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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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 72 | FAITH HEALTHCARE CENTER | 425009 | 617 WEST MARION STREET | FLORENCE | SC | 29501 | 2017-06-14 | 323 | J | 0 | 1 | J20Y11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and interviews, the facility failed to keep two resident's, #6 and #22, out of 18 residents identified for dependant eating, free from choking due to improper positioning while eating. This resulted in Immediate Jeopardy (IJ) for 2 residents (Resident #6, and #22). The sample was expanded to include Resident #1 and #20 who were identifed to be on swallowing precautions by the facility during the extended survey. The facility identified that the total number of residents that required assistance with meal service was 18. In addition, the facility failed to ensure handrails in the hallways did not have rough and splintered areas making them a hazard to residents when used. Findings include: Record review for Resident #6 of physician progress notes [REDACTED].diabetes with peripheral circulatory disorders, type 1 .coronary arteriosclerosis (hardening/narrowing of arteries) of unspecified type of vessel .Neurogenic (lacking control) bladder, CKD (Chronic Kidney Disease) stage IV (4), [DIAGNOSES REDACTED] . Record review of 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 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, UB 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 pt on 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 pt (patient) in her room initially for using ADL (Activities of Daily Living) training. OT pulled pt up in edge then set up her lunch tray. Pt stayed up to complete her meal with 20% spillage .Pt transition from supine (lying face up) to sit EOB (edge of bed) with max (maximum) A (assist). Pt then taken to rehab gym .to work on arm strength to assist with bed/chair mobility/positioning . Record review of care plan for Nutritional Status for R#6 edited on 11/02/16 with long term goal target date: 4/30/17 revealed, Resident receives CCHA, NAS, Renal Mechanical Soft with ground meats diet .Resident will ave (average) nutritional needs met qd by weight remaining stable within +/- 5% each month through next review period .Monitor for needed assistance with meals and notify nurse and dietary manager .notify nursing staff immediately if resident shows any signs or symptoms of difficulty swallowing . 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 R #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. When asked if she is comfortable like that, she confirmed that she was not. 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 Certified Nurses Assistant (CNA) 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 R#6 began yelling at Certified Nurse's Assistant (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. R#6 asks 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 R#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 cant 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 R#6, she was brought to the room to see the positioning for R#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 (R)#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 R#6 what Certified Nurse's Assistant (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 R#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 Licensed Practical Nurse (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. During the extended survey process all residents were observed for proper positioning while in the bed feeding them self. During the extended survey observation was made of resident #22 on 4/11/2017 at 5:15 PM and 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. Record review revealed Resident # 22 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. 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 Resident #22's 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. During this same meal observation on 4/11/2017 at 5:15 PM Resident #49 was also observed during the supper meal service. He was observed to be served his meal and nursing assistant #93 elevated the head of his bed but she did not pull the resident up in the bed to position him properly so he could feed himself safely. Resident #49 remained slouched down in the bed and he was leaning the to left against the bed rail. The Nurse Aide Staff #93 prepared his meal and left him to feed himself while he was not positioned straight up in the bed so he could eat without risk of choking and potential aspiration. The Social Service staff #108 walked by Resident 49's room and observed him slouched down in the bed, leaning to the left and attempting to feed himself. She repositioned the resident by pulling him up and over in the bed and placing pillows beside him for positioning so he could feed him self without risk of choking. Record review for Resident #49 revealed he was not on any swallowing precautions and his care plan was silent to any special interventions regarding swallowing. Review of Resident 49's most recent MDS dates 1/17/2017 revealed he required the extensive assistance of staff for bed mobility. When the Social Service Staff #108 repositioned him so he could feed himself safely he was not able to self assist with positioning. Interview with Nurse Aide #93 on 4/11/2017 at 5:30 PM revealed she had been educated by the Speech Therapist when she arrived on shift on this date prior to the evening meal about how to properly position resident while they are eating in bed. She said she was in-serviced to elevate the head of the bed and to use pillows as need to position the resident so they were in a safe position to feed them self. She stated she had never observed Resident #22 or #49 to have any issues feeding themselves in bed and had never observed them to choke. Further interview with Nurse Aide staff #97 and #102 at this time also revealed they had been educated on how to position residents in bed to ensure they are safe to feed themselves in bed to prevent any choking hazards. They both also stated they had never known Resident #22 or #49 to have any issues with feeding themselves while in bed and had not known either of them to choke while feeding themselves in bed. Review of the sign in sheet for the education/in-service provided by the Speech Therapist on 4/11/2017 reveled Nurse Assistant #93. #97,and #102 were all present for the mandatory in-service on safe positioning of resident while eating. Review of the education that was provided to the staff during this mandatory in-service reveled they were educated on assisting residents with feeding and positioning, swallowing precautions and a review was done of swallowing guidelines for the patient and the caregiver. This in-service was to be provided to all staff on shift on 4/11/2017 and to all staff who worked on the days following prior to them providing care until all the staff who assisted residents with meals had been in-serviced. The Corporate Nurse #134 was advised of the observation of Resident #22 being poorly positioned by Nurse Aide Staff #93 on 4/11/2017 at 6 PM. At 6:10 PM she advised this surveyor that she had spoken with Nurse Aide #93 and the Nurse Aide had been suspended due to the poor positioning of Resident #22 during her meal after she had just been inserviced on how to properly position resident for safe eating while in bed. The corporate Nurse #134 verified Resident #22 had not had any previous speech evaluations and had not had any incidence of previous choking or coughing incidents while feeding herself. The staff failed to monitor Resident #22 for safe swallowing per her nutrition care plan and failed to position her in a safe manner in bed so she could eat her meal on 4/11/2017 at 5:30 PM. The staff also failed to position Resident #49 in a position while in bed to promote safety while he was feeding himself in bed. Both residents were found by the Social Service Staff #108 to be poorly positioned and Resident #22 was observed to experience a coughing/choking episode while feeding herself in bed while being poorly positioned. Two additional residents were observed during the meal service on 4/11/2017 as they were identified by the facility as being on swallowing precautions. At 5:05 PM Resident #1 who was identified by the facility as being on swallowing precautions was observed sitting in a wheelchair in the dining room feeding himself. He was observed eating a pureed diet and thick liquids and was observed to have no concerns while feeding himself. Resident #20 was also observed in the dining room in her wheelchair feeding herself and no concerns were noted as she fed herself a mechanical soft diet with chopped meats. 3. During the environmental tour observations were made of the handrails in the hallway on all 4 units that were noted to have rough and splintered areas along the edges and along the lengths of the handrails. The Maintenance Director who was present during this tour verified the splintered areas on the handrails and indicated he had repaired some of them in the past with wood putty but verified there were still many areas that still needed to be repaired. He advised this surveyor that they need to replace all of the handrails but the building is in the process of being sold and he has not been given any funds to do any repairs in the building in a very long time so he does the best he can do. He stated all he can do at this time is to put blue tape on all of the splintered areas until he is given funds to do repairs. 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 made observations, record review and interview to ensure the facility had implemented their A[NAME]. The Immediate Jeopardy and Substandard Quality of Care at F-323 was removed on 4/13/2017, but the citation remained at a lowered scope and severity of D. | 2020-09-01 |