| 8277 |
RICHARD M CAMPBELL VETERANS NURSING HOME |
425301 |
4605 BELTON HIGHWAY |
ANDERSON |
SC |
29621 |
2016-02-12 |
490 |
J |
0 |
1 |
3WCN11 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record reviews, interviews and review of the facility Abuse and Reporting Manual, the facility failed to be administered in a manner that enabled it to use its resources effectively and efficiently to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident. Administration failed to ensure that abuse policies were developed and/or implemented related to identification of abuse, investigation of allegations of abuse, protection of the resident, and screening of applicants prior to hire. Administration did not identify and address staff failure to follow established abuse policies related to identification of abuse and protection of Resident #62, one of two sampled residents reviewed for abuse. Administration failed to identify staff actions as abuse and failed to protect Resident #62 when accused employees were allowed to continue to work on the unit where s/he resided. On 2-10-2016 at 8:14 PM, the Administrator and Director of Nursing were notified that Immediate Jeopardy and /or Substandard Quality of Care existed in the facility as of 12/31/2015. The findings included: Cross Refer CFR 483.13(b), 483.13(c)(l)(i) Abuse, F-223 Related to the facility failure to prevent Resident # 62 from being physically abused by two employees on 12/31/15. The employees held the resident and performed incontinent care after the resident had repeatedly refused the care. Cross Refer CFR 483.13(c) F226 Related to facility failure to develop and/or implement policies on identification of abuse, investigation of abuse allegations, resident protection during investigation of allegations. Cross Refer CFR 483.15(g)(1) Provision of Medically related Social Services, F250 The facility failed to provide medically related social services for Resident # 62. Social Services failed to follow-up with the resident related to an incident of alleged abuse leaving the resident fearful of staff reprisal. The facility did not substantiate the allegation of abuse after the facility investigation and both employees returned to work on the Unit Resident #62 resides. The CNA cared for the resident 15 times following the resident's expression of fear. The nurse cared for the resident 6 times following the expression of fear. Facility administration was aware of the resident's expression of fear and failed to act upon the expression. The facility's administration failed to recognize the resident's psychosocial/emotional state following the incident of abuse and provide support. Facility administration did not recognize the incident as abuse. Resident #62 was admitted to the facility with [DIAGNOSES REDACTED]. Review of a 24 hour facility incident report dated 1/1/2016, revealed the following information; Resident (Resident #62 was identified) stated Two men held me down and changed my brief and hurt my back. Investigation initiated, MD and RP notified. Staff involved suspended pending investigation. (Two employees were identified-a Licensed Practical Nurse (LPN) and Certified Nursing Assistant (CNA). A five day follow up report to the incident revealed the following; Resident did not want incontinence care provided most of the night. The CNA went in to provide incontinence care to the resident and he/she was combative and was continuing to refuse care and the CNA notified the nurse. The nurse came in to talk to the resident and encourage him to allow the staff to provide care because he was wet. The resident swung at the nurse and the nurse held his hands in order for the CNA to provide care because the resident was extremely wet. Once they finished the resident continued to curse and they left the residents room. The resident has been referred to the psychiatrist for evaluation. A review of the facility Abuse and Reporting Manual revealed the following: Section One-Abuse 3. Abuse is defined as the willful infliction of injury, unreasonable confinement resulting in pain or mental anguish. Section Two- Components of Abuse: b.Training - Staff will be trained in the following abuse prohibition practices: 5. Appropriate interventions to deal with aggressive resident behaviors. c. Prevention - .2. The facility will identify residents whose personal histories, aggressive behaviors, dependency for daily care, and/or communication needs render them at risk for abuse and/or abusing other residents. 5. Supervisory staff will be responsible for identifying and intervening in situations of inappropriate staff/resident behaviors. f. Protection - 1. With suspected staff to resident abuse, the resident(s) will be protected by removing them from the situation of possible abuse 5. The behaviors and physical condition of the residents will be evaluated with appropriated interventions identified to address the behaviors. A review of the facility Abuse and Reporting Manual notes under Section 2 - Components of Abuse - e. Investigation - Responsibility: Administrator and/or Director of Nursing or Designee. f. Protection - Responsibility: All Staff. During a meeting with the facility Administrator and the Director of Nurses interviewed together on 2-10-2016 at 7:45 PM, they were asked about their expectations of the staff when a resident was refusing care. I expect safety first with the resident and then notify the nurse to assess and evaluate the situation. An Allegation of Compliance (AOC) alleging compliance as of 2/12/16 was received and accepted by the State Agency (SA) on 2/12/16 and included the following: Criterion #1 The social worker met with resident # 62 on 2-9-16 to assess and discuss his voice of fear and to assure his psychosocial needs were met. The plan of care was updated on 2-9-16 to include reassurance of his safety and our concern, nursing and social services; Encourage resident to vent thoughts and feelings. The Administrator and witness met with the resident and assured him he was in a safe environment on 2-10-16 at 1030pm. The alleged employees LPN#I and CNA #1 were removed off the unit that the resident resides on February 10, 2016 and will not be allowed to care for the resident. LPN #1 and CNA #1 were provided education by and RN Supervisor on 2-11-16 on the abuse policy and catastrophic event/reactions how to respond. Catastrophic reactions/events include emotional outbursts, sometimes accompanied by physical acting-out behavior, that seems inappropriate or out of proportion to the situation. Criterion#2 Interviewed or attempted to interview all residents on unit 604 on by Social Worker and Assistant Social Worker on 2-11-16 to identify any alleged abuse or fearfulness. No additional residents were identified as abused or being fearful. Care plans will be developed to reflect resident's needs and social services will be notified to assure psychosocial needs are met. Criterion #3 The Staff Development Coordinator and RN managers will provide education for all staff on the definition of a catastrophic event, defined as emotional outbursts, sometimes accompanied by physical acting-out behavior, that seems inappropriate or out of proportion to the situation, and how to address a resident refusing care and how to respond to the resident to be initiated on 2-11-16. Staff who was not available will be in-serviced as soon as they are available prior to being able to work. Newly- hired staff will be in-serviced during the orientation process. Education on the entire Abuse policy including screening, training, prevention, protection, investigation, identification and reporting will be initiated on 2-11-16 by Staff Development Coordinator and RN Supervisors for all staff. Staff who was not available will be in-serviced as soon as they are available prior to being able to work. Newly hired staff will be in-serviced during the orientation process. Education to be provided to the Social Service Workers on 2-11-16 by the Regional Corporate Nurse Consultant regarding responsibilities when a resident makes a complaint and what to document and how to handle a resident with an alleged allegation and what to document and follow-up. Corporate Regional Vice President provided education to the Nursing Home Administrator, Director of Nursing, Staff Development Coordinator and RN Managers regarding the abuse policy and catastrophic events on 2-11-16. Based on interviews with staff, observations in the facility and review of inservice records, the allegation of compliance was implemented and verified by the survey team on 2/12/16 and the immediate jeopardy was removed. The citations remained at a lowered scope and severity level of D. |
2016-06-01 |