| 8235 |
KINGSTREE NURSING FACILITY |
425117 |
401 NELSON BOULEVARD |
KINGSTREE |
SC |
29556 |
2013-06-07 |
309 |
E |
1 |
0 |
8GKN11 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the recertification and complaint surveys, based on record review and interviews, the facility failed to provide evidence of consistent and coordinated care and services to one of two sampled residents reviewed for provision of Hospice services. Hospice and the facility failed to adequately communicate to develop a fully integrated plan of care so as to consistently provide needed services for Resident # 20. Although Hospice provided services in the home prior to Resident #20's skilled nursing facility admission, the initial assessment and interdisciplinary care plan failed to reflect known behaviors, thus limiting the extent to which a comprehensive care plan could be developed to address these behaviors and maintain the safety of the resident to the extent possible. There was no evidence of a collaborative care plan meeting until 7-3-12, almost two months after the resident was admitted to the skilled facility. The findings included: Record review on 5-3-13 revealed that the facility admitted Resident #20 on 5-7-12 with [DIAGNOSES REDACTED]. Review of Hospice information revealed that the initial referral/coverage date was 12-13-11, approximately five months prior to the nursing home admission. The primary coverage [DIAGNOSES REDACTED]. The most recent Hospice care plan included provision of aide services four times per week and nursing services twice weekly. Renew of the biweekly care plans revealed that Hospice had been kept updated by the facility on the resident's condition. However, there was no evidence of Hospice communication with the facility regarding pre-admission concerns/problems dealt with in the home environment. Review of March, 2012 Hospice certification documentation faxed to the State Agency on 6-6-13 revealed information that was not reflected in the Admission Assessment or Care Plan or in subsequent interdisciplinary Plans of Care: Functional Limitations noted moderate assistance required for feeding, toileting, ambulation, and transfers. Maximum assistance was noted as required for dressing and bathing. S/he (Resident #20) is not answering questions appropriately (n) or is s/he finishing sentences, is showing s/sx. (signs & symptoms) of hallucinations . between 4 and 7 PM, patient gets agitated, combative, restless, and uses profanity. Mental status notes included Anger .Forgetful, Disoriented (place and time), Agitated .seeing things that are not there . Physician Narrative included: .weak and very unsteady gait .violent and psychotic behaviors have escalated . attempts and does strike hospice aides . incontinent of B&B (bowel and bladder) and paints with her/his feces. Information obtained via fax from the facility administrator on 6-6-13 revealed that Hospice provided the same caregivers (nurses and Certified Nursing Assistants) in the skilled facility as they had in the home prior to admission. There was no evidence that these caregivers communicated with the facility to accurately assess and establish a fully-integrated, coordinated plan of care for both providers. Review of the 5-16-12 Admission Minimum Data Set (MDS) revealed that the resident had a Brief Interview for Mental Status (BIMS) score of 3, indicating the resident's cognitive function was severely impaired. The MDS noted her/him as requiring supervision only for bed mobility, transfer, ambulation, and eating. dressing, toileting, hygiene, and bathing required extensive assistance. Balance was steady. There was no limitation in range of motion. Behaviors initially included inattention, disorganized thinking, and wandering. Incidence of falls was noted as unknown prior to admission. Review of the 5-7-12 Resident Admission Care Plan revealed a non-specific problem of Behavior (with the word 'potential' handwritten) Dx (Diagnosis): Dementia and a problem of Wandering. There was no entry to indicate that the resident was receiving Hospice services at the time of admission, nor was there any evidence of Hospice input or review of the initial care plan. Review of Social Service Progress Notes revealed no mention of provision of Hospice services or Hospice participation in the Care Plan Review. Examination of the 5-22-12 (interdisciplinary) Plan of Care (last reviewed/updated 8-13-12) and Care Plan Review Form revealed that meetings were held on 5-22-12, 7-3-12, and 8-13-12 with Hospice representative's only reviewing/participating in the plan on 7-3-12. The 5-22-12 Plan of Care included approaches that failed to agree with the amount of assistance required in activities of daily living as stated by Hospice. Although Potential for behavior problems related to dementia and anxiety was listed as a problem, the 5-22-12 Plan of Care failed to address specific behaviors that might only have been identified through collaboration between Hospice and facility staff. Actual incidents of displayed anger, agitation, combativeness, restlessness, socially inappropriate behavior, and verbal and physical behavior directed toward others demonstrated prior to admission to the skilled facility were not addressed, indicating lack of appropriate collaboration. Hospice staff also identified hallucinations and escalation of behaviors at certain times of the day but this was not reflected in the interdisciplinary Plan of Care. |
2016-06-01 |