{"rowid": 3752, "facility_name": "HEALTH CENTER AT STANDIFER PLACE, THE", "facility_id": 445111, "address": "2626 WALKER RD", "city": "CHATTANOOGA", "state": "TN", "zip": 37421, "inspection_date": "2017-02-15", "deficiency_tag": 151, "scope_severity": "D", "complaint": 1, "standard": 0, "eventid": "C72111", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on review of review of facility policy, medical record review, review of a facility investigation, and interview, the facility failed to ensure resident rights were honored without interference for 1 resident (#6) of 3 residents review for resident rights of 8 sampled residents. Review of the facility policy Patients' Rights, undated, revealed .Privacy-Knock on doors before entering, do not enter while you are knocking, wait for response . Medical record review revealed Resident #6 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Review of the Admission Minimal (MDS) data set [DATE] revealed Resident #6's Brief Interview Mental Status (BIMS) score was 15 (cognitively intact). Review of a facility investigation dated 2/6/17 at 11:20 AM revealed Resident #6 reported Licensed Practical Nurse (LPN) #5 violated his personal rights by entering his room after he told the LPN to wait. Interview with Registered Nurse (RN) #5 on 2/14/17 at 2:25 PM, in the conference room, revealed LPN #5 came to her (RN #5) office on 2/6/17 and reported .she (LPN #5) had just walked in on the resident and his girlfriend having sex .asked (LPN #5) if she had knocked before entering .she said she had and the resident replied hold on a minute .asked (LPN #5) if she had waited before she (LPN #5) entered the room and she replied no . Further interview revealed RN #5 informed LPN #5 the resident . did have the right to privacy . Interview with Resident #6 on 2/14/17 at 2:45 PM, in his room, revealed .I do not know what her (LPN #5) deal was .I told her to hold on a minute .I knew I had rights . Interview with the Risk Manager on 2/15/17 at 11:45 AM, in the conference room, confirmed Resident #6's rights were violated and the facility failed to follow facility policy.", "filedate": "2020-02-01"}
{"rowid": 4245, "facility_name": "THE WATERS OF UNION CITY , LLC", "facility_id": 445138, "address": "1105 SUNSWEPT DR", "city": "UNION CITY", "state": "TN", "zip": 38261, "inspection_date": "2016-09-29", "deficiency_tag": 151, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "1KSC11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on policy review, medical record review, and interview, the facility failed to honor resident's rights to have personal items in their room for 4 of 59 (Resident # 64, 7, 41, and 33) residents. The findings included: 1. The facility's Your Resident Rights and Protections under State and Federal Law policy documented, .Personal Property .You have the right to keep and use your personal belongings and property . 2. Medical record review revealed Resident #64 was admitted to the facility on [DATE] and readmitted on [DATE] with [DIAGNOSES REDACTED]. The admission Minimum Data Set (MDS) dated of 8/29/16 documented Resident #64 had a Brief Interview of Mental Status (BIMS) score of 14 and was cognitively intact. The care plan dated 9/13/16, revealed there were no documentation of safety concerns. Interview with Resident #64 on 9/20/16 at 8:33 AM, in Resident #64's room, Resident #64 stated, .(named Director of Nursing (DON)) came in and pulled all of my deodorant, hair spray, and lotion from my drawer yesterday and took them to his office .I didn't like that .(named DON) said they don't want them in here . 3. Medical record review revealed Resident #7 was admitted to the facility on [DATE] and readmitted on [DATE] with [DIAGNOSES REDACTED]. The quarterly MDS dated [DATE] documented Resident #7 had a BIMS score of 15 which indicated she was cognitively intact. Observations at facility all 12 days revealed Resident #7's door was closed at all times unless staff was in the room. Interview with Resident #7 on 9/20/16 at 1:32 PM, in Resident #7's room, Resident #7 stated, .those two women (named Human Resources Clerk and RN #5) came in last night and confiscated my 3 shower gels, 2 1/2 bottles of cologne, hair spray, all of my cosmetics, eye brow pencil, rouge .stated I could keep my lip stick if I keep it where they, nobody can see it .eye glass cleaner, 2 pairs of scissors, crochet hooks .so I couldn't crochet last night, which is what I like to do at night .mouthwash, toothbrush, and tooth paste. I couldn't brush my teeth last night or this morning . face cream, and denture tablets .said they (staff) would be mounting boxes that will be mounted on the wall in the bathroom .We were all really upset . 4. Medical record review revealed Resident #41 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. The quarterly MDS dated [DATE] documented Resident #41 had a BIMS score of 9, which indicated moderate cognitive impairment. Observations in Resident #41's room on 9/20/16 at 1:33 PM, revealed an open tool box in Resident #41's bathtub that contained hairspray, baby powder, packets of topical antibiotic ointment, and an aerosol can of fabric freshener. Interview with Resident #41 on 9/20/16 at 1:36 PM, in Resident #41's room, Resident #41 stated, .upset with things put away .I can't get to them . 5. Medical record review revealed Resident #33 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. The quarterly MDS dated [DATE] documented Resident #33 had a BIMS score of 12, which indicated moderate cognitive impairment. Interview with Resident #33 on 9/20/16 at 1:50 PM, in Resident #33's room, Resident #33 stated, .upset because they (staff) took everything . 6. Interview with the Administrator and the DON on 9/20/16 at 2:36 PM, in the Conference room, the Administrator was asked if personal items had been removed from resident rooms. The Administrator stated, .we met as a team .purchased personal care boxes .the residents won't be without their personal items more than 8-10 hours . There was no documentation that there was an approved facility policy for the staff's action regarding the removal of the residents personal property.", "filedate": "2019-10-01"}
{"rowid": 8416, "facility_name": "THE WATERS OF ROBERTSON, LLC", "facility_id": 445137, "address": "104 WATSON ROAD", "city": "SPRINGFIELD", "state": "TN", "zip": 37172, "inspection_date": "2013-09-26", "deficiency_tag": 151, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "6APT11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on policy review, review of the facility's smoking schedule, medical record review and interview, it was determined the facility failed to honor resident rights to smoke for 3 of 5 (Random Resident (RR) #2, 3 and 4) interviewable random residents that smoke. This finding was related to a substantiated allegation in a complaint investigation initiated on 9/10/13. The findings included: 1. Review of the facility's Smoking Policy documented, .Every resident who desires to smoke is permitted to do so if the center's interdisciplinary team has determined that the practice would be safe for the resident . 2. Review of the facility's SMOKING SCHEDULE DATED 7/25/13 documented, .9:00 A (AM), 10:30 A, 1:30 P (PM), 4:00 P, 7:00 P, 9:00 P . with the persons or department responsibility listed for each smoke time. 3. Medical record review for RR #2 documented an admission date of [DATE] with [DIAGNOSES REDACTED]. Review of the nurses CLINICAL HEALTH STATUS dated 9/6/13 documented RR #2's short term and long term memory was marked as .OK (okay) .Additional notes . She was oriented to room and surroundings; instructed to call for assistance as needed . During an interview in RR #2's room on 9/10/13 at 7:35 PM, RR #2 confirmed that she does smoke but she is unable to walk and is dependent on staff to get her out of the bed. RR #2 stated, .smoke time was 7 PM, I turned my light on for them to come to get me up so I could go smoke. I can't walk, I broke my hip . RR #2 was asked how her light got turned off. RR #2 stated, I cut my light on at 6:45 PM (for the 7:00 PM smoke time) and no one came. My light was turned off right before you came in. They finally came in here and got me off the bed into the wheelchair (wc) but I missed the smoke break . During an interview in the conference room on 9/10/13 at 3:00 PM, the Administrator confirmed that residents were allowed to smoke. The Administrator stated, It's their right . During an interview in the conference room on 9/10/13 at 4:30 PM, the Social Worker was asked who is responsible for coordinating the smoke breaks for the residents. The Social Worker stated, Smoke breaks are coordinated by the Director of Nursing and the Administrator. We know ahead of time who is in charge of taking the residents out to smoke . During an interview in the 600 hall on 9/11/13 at 8:05 AM, Certified Nursing Assistant (CNA) #1 was asked if RR #2 could get up by herself. CNA #1 stated, No, she has to have help. She has a [MEDICAL CONDITION] . During an interview in the east hall on 9/11/13 at 8:30 AM, CNA #2 was asked who is responsible for getting residents up so they can go out for smoke break. CNA #2 stated, It's ours, its the CNAs . 4. Medical record review for RR #3 documented an admission date of [DATE] with [DIAGNOSES REDACTED]. Review of the Minimum Data Set (MDS) Brief Interview for Mental Status (BIMS) dated 6/20/13 documented a score of 15 out of 15 indicating RR #3 is cognitively intact. Upon further review of the MDS, it was also documented that it is very important . for RR #3 to go outside to get fresh air when the weather is good . Review of the care plan dated 11/29/10 documented, .Smokes independently with supervision . Assist to and from Designated Smoking Area . During an interview in the 300 hall on 9/10/13 at 7:20 PM, RR #3 was asked if she receives help to get out of the bed when help is needed. RR #3 stated, .a couple of months ago went to bed before 9:00 (PM) smoke break and they wouldn't get me back up, so I just stay up in the wc from the time I get up until after smoke break. If I have to pee they come and change me. They have to use a standing lift to get me up . 5. Medical record review for RR #4 documented an admission date of [DATE] with [DIAGNOSES REDACTED]. Review of the MDS Brief Interview for Mental Status dated 5/24/13 documented a score of 15 out of 15 indicating RR #4 is cognitively intact. Upon further review of the MDS, it was also documented that it is very important . for RR #4 to do her favorite activities. During an interview in RR #4's room on 9/10/13 at 7:20 PM, RR #4 confirmed that she smokes. RR #4 was asked if she receives assistance to go outside during smoking times. RR #4 stated, .They (staff) take me out to smoke, but you can only go at certain times. If you don't get up when it is time to go, you miss your time .", "filedate": "2017-06-01"}
{"rowid": 12001, "facility_name": "GRACE HEALTHCARE OF CORDOVA", "facility_id": 445218, "address": "955 GERMANTOWN PKWY", "city": "CORDOVA", "state": "TN", "zip": 38018, "inspection_date": "2011-07-07", "deficiency_tag": 151, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "ZND511", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, review of the meals service time for the 100 hall, observation and interview, it was determined the facility failed to honor a residents' right to rise and dress at her designated time in the morning for 1 of 29 (Resident #25) sampled residents observed. The findings included: Medical record review for Resident #25 documented an admission date of [DATE] with [DIAGNOSES REDACTED]. Review of the physician's orders [REDACTED].@ (at) 4:00 - (to) 5:00 AM DAILY. Review of a list of Resident Requests on Resident #25's chart documented, (Resident) is asking that we meet her following requests: Personal care completed and up in chair after breakfast everyday. Review of the meal service time for the 100 hall documented, .BREAKFAST .100 HALL - 7:30 A (AM). Observations in Resident #25's room (room [ROOM NUMBER]) on 7/5/11 at 9:45 AM and 7/7/11 at 10:45 AM, revealed Resident #25 was still in bed. During an interview in Resident #25's room on 7/5/11 at 9:45 AM, Resident #25 was asked what was the latest time she would like to get up after breakfast. Resident #25 stated, . 9:00 (AM). During an interview in the conference room on 7/7/11 at 8:00 PM, Resident #25's attending physician was asked what time Resident #25 should be gotten up in the morning. Resident #25's attending physician stated, .Should do what the resident wants.", "filedate": "2015-10-01"}
{"rowid": 12097, "facility_name": "MEADOWBROOK NURSING CENTER", "facility_id": 445443, "address": "1245 E COLLEGE ST", "city": "PULASKI", "state": "TN", "zip": 38478, "inspection_date": "2011-03-24", "deficiency_tag": 151, "scope_severity": "F", "complaint": 0, "standard": 1, "eventid": "OSFO11", "inspection_text": "Based on the group interview, it was determined the facility failed to ensure each resident had the right to exercise their choice of time when getting up in the morning when 3 of 8 Random Residents (RR) #3, 4 and 5) attending the group interview voiced that the facility staff got them up for breakfast. The facility had a census of 63 residents. Sixty two of the 63 residents residing in the facility received a breakfast tray. The findings included: During the group interview in the therapy room on 3/21/11 at 3:00 PM, the group was asked if the facility had rules about what time residents had to get up in the morning. Three alert and oriented residents made the following statements: a. RR #3 stated, yes there was a getting up time. b. RR #4 supported RR #3's statement by saying they had to get up for breakfast. c. RR #5 stated, .we have to get up. the night shift helps (getting resident up in the morning).", "filedate": "2015-10-01"}
{"rowid": 12734, "facility_name": "LAURELBROOK SANITARIUM", "facility_id": 4.4e+201, "address": "114 CAMPUS DRIVE", "city": "DAYTON", "state": "TN", "zip": 37321, "inspection_date": "2012-08-03", "deficiency_tag": 151, "scope_severity": "D", "complaint": 1, "standard": 0, "eventid": "9S9K11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, review of facility records, review of local Election Commission records, observation, and interview, the facility failed to provide State and County candidate information to ensure informed voting choices for one resident (#1) of five residents reviewed. The findings included: Resident #1 was admitted to the facility on [DATE], with [DIAGNOSES REDACTED]. Medical record review of an Admission Minimum Data Set (MDS) assessment dated [DATE], revealed a Brief Interview for Mental Status (BIMS) assessment, with a score of fifteen out of fifteen. A score of fifteen revealed the Resident's cognition was intact. Medical record review of an Activity Progress Note dated July 12, 2012, at 4:08 p.m., revealed the Resident had heard an announcement about Election Commission and voting (Absentee Voting, scheduled to occur at the facility on July 12, 2012, at 9:30 a.m.). Continued review revealed, \"...(Resident) said (Resident did not know who to vote for. I (Activity Coordinator) told (Resident) I had a list but (Resident) had to give me some time to finish something that I was doing at that moment. A few minutes later I brought the...list of information about the event. (Resident) was still upset because (Resident) never got enough information about the elections...\" Medical record review of an Activity Progress Note dated July 13, 2012, at 2:36 p.m., revealed the Activity Department provided a local newspaper which contained information about local candidates. Review of a facility document dated June 4, 2012, revealed information to register Resident #1 was submitted to the Election Commission by the Activity Coordinator. Review of an Election Commission notice to vote, (no date), addressed to the facility, informed the facility the Absentee Voting Deputies would be at the facility on Thursday, July 12, 2012, at 9:30 a.m., \"...to vote your registered Residents...\" Observation and interview of the Resident, in the Sun Room, on July 31, 2012, at 4:30 p.m., revealed the Resident was sitting in a wheelchair, using a personal laptop computer. \"I am very angry because of the lack of information on the (State and County) political candidates...I was unable to vote when they came (Absentee Voting Deputies) because I didn't (did not) have enough information and details about the candidates...\" Interview with the Activity Coordinator on August 1, 2012, at 4:30 p.m., in the Sun Room, revealed Resident Voting Program had been assigned to the Activity Coordinator sometime during the last of May 2012, (unable to recall a specific date). Continued interview confirmed, \"...I did not understand the voting process in Tennessee; but I understood the process in Rhode Island. To be honest, I didn't (did not) know what to do.\" Continue interview confirmed the Activity Coordinator did not seek help due to the lack of understanding; and the facility failed to provide Resident #1 with enough information to make an informed voting decision on July 12, 2012. C/O", "filedate": "2015-08-01"}
{"rowid": 14312, "facility_name": "TRI STATE HEALTH AND REHABILITATION CENTER", "facility_id": 445263, "address": "600 SHAWANEE RD", "city": "HARROGATE", "state": "TN", "zip": 37752, "inspection_date": "2010-03-31", "deficiency_tag": 151, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "J54J11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation, and interview the facility failed to honor the rights of one resident (#12) of twenty-three residents reviewed. The finding's included: Resident # 12 was admitted to the facility on [DATE], with [DIAGNOSES REDACTED]. Medical record review of the Minimum Data Set (MDS) dated [DATE], revealed the resident was independent in decision making and had no short or long term memory problems. Observation and interview on March 29, 2010, at 11:45 a.m., and March 30, 2010, at 8:15 a.m., in the resident's room revealed the resident awake and resting in bed with bilateral half side rails in the down position. Continued observation and interview with resident on these dates revealed, the resident wished to have the side rails up for increased safety but had been told by Licensed Practical Nurse (LPN) #1 that side rails in the up position were illegal. Interview on March 30, 2010, at 8:20 a.m., in the resident's room, with LPN #2 confirmed it was the resident right to have side rails in the up position. Interview on March 30, 2010, at 8:32 a.m., with LPN #1 on the 200 hall revealed, LPN #1 told the resident that, side rails could be up when Certified Nursing Assistants (CNA's) were in the room but side rails were to be down when staff were not in the room. Continued interview with LPN #1 revealed, the facility's Risk Manager had informed LPN #1 of the above. Interview on March 30, 2010, at 8:45 a.m., with the facility's Risk Manager, in the Risk Manager's office revealed, the Risk Manager had told LPN #1 that the resident was to have side rails when CNA's were in the room to assist in turning; but was not to have the side rails in place in the up position when staff was not in room. Continued interview confirmed, that it was the resident right to have side rails in the up position.", "filedate": "2014-01-01"}
{"rowid": 6184, "facility_name": "THE STRATFORD HOUSE", "facility_id": 445205, "address": "8249 STANDIFER GAP ROAD", "city": "CHATTANOOGA", "state": "TN", "zip": 37421, "inspection_date": "2015-09-04", "deficiency_tag": 152, "scope_severity": "D", "complaint": 1, "standard": 0, "eventid": "SRXG11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and interview, the facility failed to inform the resident's designated Power of Attorney and obtain consent for administration of a vaccine for one resident (#9) of 15 residents reviewed. The findings included: Medical record review revealed Resident #9 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Medical record review of the Power of Attorney dated and signed by the resident on 5/20/13, revealed the resident appointed his daughter as his .attorney in fact the full power and authority to authorize medical treatment for [REDACTED]. Medical record review of the Informed Consent for Pneumococcal Vaccine dated 4/7/15, revealed the resident signed the consent himself with no documentation the POA was informed. Medical record review of the Minimum (MDS) data set [DATE] revealed the resident had severe cognitive impairment and required assistance with all activities of daily living. Interview with the Registered Nurse, who obtained the resident's consent and administered the vaccine, on 8/6/15 at 11:45 AM, in the conference room, confirmed the POA was not contacted prior to administering the pneumonia vaccine.", "filedate": "2018-09-01"}
{"rowid": 13890, "facility_name": "TRENTON CENTER", "facility_id": 445308, "address": "2036 HIGHWAY 45 BYPASS", "city": "TRENTON", "state": "TN", "zip": 38382, "inspection_date": "2011-04-28", "deficiency_tag": 152, "scope_severity": "D", "complaint": 1, "standard": 0, "eventid": "M8B211", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Complaint #TN 705 Based on medical record review, it was determined the facility failed to ensure the resident's rights were exercised by the legally appointed individual for 1 of 5 (Resident #1) sampled residents. The findings included: Medical record review for Resident #1 documented an admission date of [DATE] with [DIAGNOSES REDACTED]. Review of Resident #1's Power of Attorney (POA) dated 9/1/09 documented the resident had appointed an individual to make decisions for any type of medical treatment. Review of the physician's orders [REDACTED].#1 was receiving hospice care.", "filedate": "2014-08-01"}
{"rowid": 4844, "facility_name": "LIFE CARE CENTER OF HIXSON", "facility_id": 445380, "address": "5798 HIXSON HOME PLACE", "city": "HIXSON", "state": "TN", "zip": 37343, "inspection_date": "2016-06-30", "deficiency_tag": 153, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "UFS611", "inspection_text": "Based on record review and interview, the facility failed to provide requested release of information of a resident's medical records timely in accordance with facility policy for 1 resident (#25) of 2 residents reviewed for requests of information, of 41 residents reviewed. Findings include: Medical record review revealed Resident #25's POA (Power of Attorney) filled out an Authorization for Release of Information signed and dated on 1/15/16. Continued review revealed the Authorization for Release of Information was also signed and dated by facility nursing staff as Signature of Witness on 1/15/16. Record review indicated the facility office logged the request for information on 1/20/16 and dated given to POA on 1/21/16, which was 4 business days after the request was made on 1/15/16. Review of the facility policy titled Health Information Management Policy & Procedure Manual, Chapter 6, page 46, confirmted If a current resident or their legal representative requests copies, notify the (legal department) by telephone, and then comply with providing the records within two working days. Interview with Licensed Nurse #3 on 6/29/16 at 5:20 PM confirmed requests for release of information are faxed to the facility corporate office and the medical records should be released to the family or power of attorney within 2 business days as specified in the facility policy.", "filedate": "2019-07-01"}
{"rowid": 8391, "facility_name": "LIFE CARE CENTER OF GRAY", "facility_id": 445479, "address": "791 OLD GRAY STATION ROAD", "city": "GRAY", "state": "TN", "zip": 37615, "inspection_date": "2014-07-09", "deficiency_tag": 153, "scope_severity": "D", "complaint": 1, "standard": 0, "eventid": "145111", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of a Authorizaton of Release of Information, review of facility policy, review of a postal ship date, and interview, the facility failed to ensure a resident received copy of a medical record timely after submission of a written request for one resident (#1) of sixteen residents reviewed. The findings included: Resident #1 was admitted to the facility on [DATE], with [DIAGNOSES REDACTED]. Record review of an Authorization of Release of Information dated December 20, 2013, revealed the resident had submitted in writing a request for a copy of the entire medical record. Review of facility policy, Release of Information, revealed .Requested copies should be provided within two working days (excluding weekends and/or holidays) unless state law mandates a shorter period . Review of a postal ship date for the requested medical record revealed a ship date of January 24, 2014, and a delivery date of January 28, 2014 (thirty-nine days after the request date). Interview with the Medical Records Clerk on July 1, 2014, at 11:14 a.m., in the facility conference room confirmed the facility had failed to follow it's own policy after the written request for medical records. C/O #", "filedate": "2017-07-01"}
{"rowid": 8942, "facility_name": "LIFE CARE CENTER OF CROSSVILLE", "facility_id": 445167, "address": "80 JUSTICE ST", "city": "CROSSVILLE", "state": "TN", "zip": 38555, "inspection_date": "2014-03-24", "deficiency_tag": 153, "scope_severity": "D", "complaint": 1, "standard": 0, "eventid": "SQ5811", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policy, medical record review, review of facility investigation, review of a Concern and Comment form, review of an authorization for release of information, review of shipping labels, and interview, the facility failed to provide requested medical records in a timely manner for one resident (#9) of three residents reviewed. The findings included: Review of an undated facility policy titled, Chapter 6: Confidentiality, Release of Information, and HIPPA (Health Insurance Portability and Accountability Act) revealed, .Handling a Request for Copies of Medical Records. The request should be put in writing on an Authorization for Release of Information form and signed by the resident or personal representative .should specifically state which records are to be copied .To comply with federal regulations, the copies must be made within two business days .Note: The maximum turnaround time to respond to a valid request for a discharged or expired resident's information is 30 days from the date of the request unless otherwise required by state law . Medical record review revealed the resident (#9) was admitted to the facility on [DATE], with [DIAGNOSES REDACTED]. Medical record review revealed the resident's responsible party was a relative. Review of a Concern & Comment Form dated [DATE], revealed, .describe in detail your Concern, Comment .Request for records. Were you able to report his concern .Yes. If yes, please provide the staff member's name (Administrator) . Review of a Facility Investigation and Response form dated [DATE], revealed, .explained process and advised (resident's reponsible party) to request through HIM (Health Information Management) at (responsible party's) .convenience .since the patient was discharged release of records needed to go through corporate and could take up to 30 days . Review of an Authorization for Release of Information dated [DATE], revealed the resident's responsible party requested a copy of the resident's medical record. Review of a shipping label provided by the Director of Health Information on February 11, 2014, revealed the medical records were shipped to the facility's corporate headquarters on [DATE]. Continued review revealed the requested medical records were shipped from corporate headquarters to the resident's responsible party on [DATE]. Interview with the Director of Health Information on February 11, 2014, at 3:15 p.m., in a conference room, revealed according to corporate policy the facility had thirty days to provide copies of medical records for residents discharged from the facility. Continued interview revealed the medical records were sent to corporate headquarters for review and confirmed the facility failed to provide requested medical records for Resident #9 in a timely manner. C/O: #", "filedate": "2017-03-01"}
{"rowid": 8982, "facility_name": "MABRY HEALTH CARE", "facility_id": 445272, "address": "1340 N GRUNDY QUARLES HWY P O BOX 7", "city": "GAINESBORO", "state": "TN", "zip": 38562, "inspection_date": "2013-10-10", "deficiency_tag": 153, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "F4M111", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and interview, the facility failed to allow the legal representative to purchase a copy of medical records for one resident (#98) of thirty-one residents reviewed. The findings included: Resident #98 was admitted to the facility on [DATE], with [DIAGNOSES REDACTED]. Review of medical records revealed resident #98 was transferred to a hospital on [DATE], at 7:10 a.m., after the resident was found unresponsive. The resident was discharged from the facility on [DATE], after the family removed all personal belongings from the resident's room. Medical record review of a nurse's note dated [DATE], revealed, .Family here and wanted copy of medical records . Interview with the Power of Attorney (POA) on [DATE], at 8:35 a.m., by telephone, revealed the facility refused to allow the POA to purchase a copy of the medical records. Interview with an attorney representing a family member of eesident #98 revealed, My client's (parent) is deceased and my client has asked for the medical records and the facility refused. I have also sent three letters to the facility with requests for copies of the medical records and the facility has not acknowledged my letters. Interview with the Administrator by telephone on [DATE], at 5:05 p.m., confirmed, I am not going to give my records to anyone unless they go through my attorney. complaint #", "filedate": "2017-03-01"}
{"rowid": 13590, "facility_name": "ST BARNABAS NURSING HOME", "facility_id": 445008, "address": "950 SISKIN DRIVE", "city": "CHATTANOOGA", "state": "TN", "zip": 37403, "inspection_date": "2011-07-28", "deficiency_tag": 153, "scope_severity": "D", "complaint": 1, "standard": 0, "eventid": "UMD211", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and interview, the facility failed to allow access to the medical record for one resident #3 of 8 residents reviewed. The findings included: Resident #3 was admitted to the facility on [DATE], from the hospital, with [DIAGNOSES REDACTED]. Review of the Minimum Data Set (MDS) dated [DATE], revealed the resident had difficulty with long and short term memory and the resident's decision making skills were not able to be scored. Continued review of the MDS revealed the resident was non-ambulatory and required assistance for all activities of daily living. Interview with the Durable Power of Attorney (DOPA) on July 27, 2011, at 4:15 p.m., by phone revealed the facility would not allow the DOPA for health care, to review the medical records for Resident #3. Continued interview with the DOPA revealed there had been a difference of opinion about the resident's care which was provided by the resident's physician. Interview with the Director of Nursing (DON) on July 26, 2011, at 3:30 p.m., in the conference room confirmed the DOPA, who is a Physician, had asked to review the medical record. When the DON heard the DOPA wanted to review the chart, there was hesitation about allowing the DOPA (Physician) to review the chart alone. This was later accomplished after receiving a phone call from the POA's attorney. The DOPA was allowed to review the resident's medical record with a staff present but failed to meet the within 24 hour request time frame. C/O #", "filedate": "2014-11-01"}
{"rowid": 13969, "facility_name": "JEFFERSON CITY HEALTH AND REHAB CENTER", "facility_id": 445246, "address": "283 W BROADWAY BLVD", "city": "JEFFERSON CITY", "state": "TN", "zip": 37760, "inspection_date": "2009-08-19", "deficiency_tag": 153, "scope_severity": "D", "complaint": 1, "standard": 0, "eventid": "7WTY11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and interview, the facility failed to provide copy of a resident medical records in a timely manner after requested for one resident (#1) of five residents reviewed. The findings included: Resident #1 was admitted to the facility on [DATE], with [DIAGNOSES REDACTED]. Medical record review of the Tracking HIPPA Privacy Request and Response log revealed the resident's spouse (Power of Attorney) had requested a copy of the medical records on August 4, 2009.Continued review revealed no documentation the request had been processed. Telephone interview with the Director of Nursing on August 19, 2009, at 1:45 p.m., confirmed the request had not been completed as requested on August 4, 2009. c/o tn 518", "filedate": "2014-07-01"}
{"rowid": 1955, "facility_name": "LIFE CARE CENTER OF BRUCETON-HOLLOW ROCK", "facility_id": 445326, "address": "105 ROWLAND", "city": "BRUCETON", "state": "TN", "zip": 38317, "inspection_date": "2017-06-21", "deficiency_tag": 154, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "ZIWL11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on policy review, medical record review, and interview, the facility failed to inform a resident of the risks and benefits of receiving an antianxiety medication and obtain consent prior to administration for 1 of 5 (Resident #80) sampled residents reviewed for unnecessary medication use. The findings included: The facility's Policies for Medication Administration documented, .Patient consents will be obtained prior to the administration of any new and/or changed psychopharmacologic medications . Medical record review revealed Resident #80 had admission physician orders [REDACTED]. There was no Psychoactive Medication Informed Consent form in the medical record indicating Resident #80 had been informed of the risks and benefits of taking [MEDICATION NAME] prior to administration and no signed consent form for receiving the anti-anxiety medication. Review of the PRN (As needed) Administration Record for (MONTH) (YEAR) indicated the [MEDICATION NAME] was administered 10 times. Review of the physician orders [REDACTED]. Review of the PRN Administration Record for (MONTH) (YEAR) indicated the [MEDICATION NAME] was administered 3 times without Resident #80 providing consent and being informed of the risks and benefits. Review of the physician's orders [REDACTED]. Interview with the Social Services Assistant #1 and the Social Services Director in the Social Services office on 6/20/17 at 3:05 PM, revealed the nurses obtain the resident's medication consent forms on admission. When asked when the consent form should be obtained, they stated, Would hope as soon as possible. The Social Services Assistant #1 stated it should be done shortly after the medication was in place. Interview with the Assistant Director of Nursing (ADON) #1 on 6/20/17 at 3:20 PM in the ADON office, ADON #1 confirmed the medication consent form should have been obtained on admission. She stated they reviewed all consents in the building, one hall per week. ADON #1 confirmed Resident #80 did not have a consent form for the [MEDICATION NAME]. Interview with Licensed Practical Nurse (LPN) #1 on 6/21/17 at 7:48 AM in the hallway, LPN #1 confirmed the medication consent should be completed on admission by the nurse.", "filedate": "2020-09-01"}
{"rowid": 4137, "facility_name": "MT PLEASANT HEALTHCARE AND REHABILITATION", "facility_id": 445374, "address": "904 HIDDEN ACRES DR", "city": "MOUNT PLEASANT", "state": "TN", "zip": 38474, "inspection_date": "2016-11-03", "deficiency_tag": 154, "scope_severity": "J", "complaint": 1, "standard": 0, "eventid": "J51L11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on medical record review and interview, the facility failed to inform the responsible party/Power of Attorney of a change in the treatment when a 60 cubic centimeter syringe was used to force feed food and liquid for 1 resident (#1) of 6 residents who were totally dependent on staff for eating. This failure placed all residents at risk for aspiration and requiring total dependence on staff for eating in Immediate Jeopardy (a situation in which the provider's noncompliance with one or more requirements of participation has caused, or is likely to cause, serious injury, harm, impairment or death of a resident). The Administrator, Director of Nursing and the Quality Assurance Nurse were informed of the Immediate Jeopardy on [DATE] at 3:00 PM in the Administrator's office. The findings included: Medical record review revealed Resident #1 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Medical record review of the Physician telephone Orders revealed an order on [DATE] for a pureed (blenderized food) diet. Continued medical record review revealed no physician orders from admission to discharge, to syringe feed Resident #1. Medical record review of the Speech Therapy Evaluation and Plan of Treatment dated [DATE] revealed Resident #1's diet was changed to pureed due to pocketing (food getting stuck in mouth), increased feeding time and lethargy. Further review revealed Resident #1 had used general swallowing techniques/precautions and upright posture during meals 70% (percent) of the time by [DATE], was tolerating the pureed diet while fed by staff, caregiver/staff were educated on safe swallowing strategies including bite/sip, small bites, and positioning. The swallowing treatment training included small bites/sips (,[DATE] to ,[DATE] teaspoon) and facilitation of body positioning to increase safety with intake. Medical record review of the Progress Notes revealed the following: [DATE] at 11:30 PM .No further emesis noted, had earlier after lunch x (times) 1. Afebrile . [DATE] at 2:15 PM .Moderately large emesis noted during activity in dining room. Afebrile . [DATE] at .1:30 PM Res (resident) consumed 100% of meal with asst (assist) with no dysphagia (difficulty swallowing). Res vomited very large amt (amount) of liquid et (and) pureed food. Res entered Cheyne-Stokes (abnormal pattern of breathing characterized by progressively deeper and sometimes faster breathing, followed by a gradual decrease that results in a temporary stop in breathing) respirations et was unresponsive. Nurse at this x (time) went to supply closet to obtain suction equipment .at 1:34 PM Re-entered room. Noted absence of pulse, B/P (blood pressure) et respirations. Skin pale/gray et cool to touch. RN (Registered Nurse) #1 Supervisor notified .at 1:40 PM Pronounced deceased . Interviews with Licensed Practical Nurse (LPN) #5 on [DATE] at 2:55 PM and at 4:25 PM on the long hall and the conference room, on [DATE] at 11:10 AM in the conference room, on [DATE] at 4:10 PM in the conference room, and on [DATE] at 8:30 AM on the long hall revealed Resident #1 had been pocketing food and had ,[DATE] vomiting episodes after eating. Further interview revealed the LPN had .fed (Resident #1) Magic Cup (nutritional supplement) and fluids ,[DATE] times by syringe .a couple of months before hospice started .I gave Magic Cup and water by syringe the morning of [DATE] . and (Resident #1) .wanted water and could no longer suck on a straw .I didn't want him dehydrated . When asked why the LPN used the syringe, the LPN stated .I was trying to help the man out . When asked what happened to the syringe the LPN stated .I told Certified Nurse Aide (CNA) #4 to throw it away because there was no doctor's order for it . When asked when you saw CNA #4 spoon feeding the resident lunch and you told CNA #4 the syringe was available for use you knew there was a possibility the CNA would use it, would you consider that force feeding, the LPN stated I guess I would. Continued interview, when asked if the LPN had informed Hospice, her supervisors, the physician, the resident or responsible party/Power of Attorney of the use of the syringe prior to Resident #1's death, the LPN stated No. Further interview revealed, when asked since the resident did not want artificial feeding and you used a syringe to force food and fluid into his mouth, do you think you violated his right to make the decision in the change of the method of being fed, the LPN stated .it was against his wishes .I took away his autonomy . Interviews with CNA #4 on [DATE] at 9:25 AM and [DATE] at 10:15 AM and 12:35 PM, in the conference room and the nursing station revealed CNA #4 had been spoon feeding Resident #1 lunch on [DATE] when LPN #5 entered the resident's room and informed the CNA .syringe in drawer and she told me to try to use it. I got syringe out, liquefied the pureed food with the fluid on the tray and put a little in his mouth, he swallowed .he ate all the food, 100% and when I was done feeding he started vomiting . When asked when she was spoon feeding the resident lunch how had the resident been accepting the by mouth food, the CNA stated .he wasn't taking it like before . When asked why she used the syringe, CNA #4 stated .(LPN #5) told her the LPN had been using the syringe throughout the day with magic cup and juice and he did fine . When asked what happened to the syringe, CNA #4 stated .(CNA #1) told her that (LPN #5) told (CNA #1) to tell (CNA #4) to get the syringe out of there, I threw it in the trash in the resident's room, and then I removed it and took it to the hopper room trash . Telephone interviews with the Hospice Patient Care Coordinator on [DATE] at 8:45 AM and 10:00 AM, and on [DATE] at 10:30 AM, when asked regarding the resident's POST status and having a syringe used to force food into the mouth how that would affect resident's rights stated .syringe is force feeding . Interviews with the Speech Therapist on [DATE] at 11:10 AM and on [DATE] at 8:40 AM, in the therapist office and the conference room revealed Resident #1's pureed diet was primarily due to pocketing, increased time feeding and lethargy. Further interview revealed .he was definitely an aspiration risk when I changed the diet to pureed (on [DATE]) due to lethargy and there are no circumstances you should use a syringe .such a high risk for everything to go wrong and my biggest fear was for aspiration . Interviews with the Director of Nursing (DON) on [DATE] at 3:40 PM, [DATE] at 10:50 AM and 4:40 PM, [DATE] at 12:53 PM, and [DATE] at 8:35 AM and 1:45 PM. Further interview revealed the DON was not aware a syringe was being used to feed a resident prior to the event. The DON stated she had been notified by RN #1 of Resident #1's death on [DATE] and of being fed lunch with a syringe, vomiting and then the death after the resident was pronounced and had left the building.", "filedate": "2019-11-01"}
{"rowid": 12729, "facility_name": "LAURELBROOK SANITARIUM", "facility_id": 4.4e+201, "address": "114 CAMPUS DRIVE", "city": "DAYTON", "state": "TN", "zip": 37321, "inspection_date": "2012-05-15", "deficiency_tag": 154, "scope_severity": "D", "complaint": 1, "standard": 1, "eventid": "G6LS11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and interview, the facility failed to inform one resident (#1) of a laboratory test performed of twenty-seven residents reviewed. The findings included: Resident #1 was admitted to the facility on [DATE], with [DIAGNOSES REDACTED]. Medical record review of the Minimum Data Set (MDS) dated [DATE], revealed the resident scored fifteen of fifteen on the Brief Interview for Mental Status (BIMS) indicating intact cognitive skills and no memory impairment. Interview with the Nursing Home Administrator (NHA) on May 7, 2012, at 1:50 p.m., in the NHA office, revealed a urine drug screen was completed on the resident on May 3, 2012, without the resident's knowledge or consent. Interview with the Director of Nursing (DON) on May 9, 2012, at 9:10 a.m., in the front lobby, confirmed the facility completed a urine drug screen on the resident without the resident's knowledge or consent. C/O # #", "filedate": "2015-08-01"}
{"rowid": 918, "facility_name": "NHC HEALTHCARE, HENDERSONVILLE", "facility_id": 445191, "address": "370 OLD SHACKLE ISLAND RD", "city": "HENDERSONVILLE", "state": "TN", "zip": 37075, "inspection_date": "2017-06-28", "deficiency_tag": 155, "scope_severity": "D", "complaint": 1, "standard": 1, "eventid": "QJYC11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on patient rights review, medical record review, and interview, the facility failed to allow 1 Resident (#59) of 32 residents reviewed the right to refuse dental services. The findings included: Review of the Patient Rights handbook provided to each resident in the facility revealed, .You have the right to accept or refuse any medication or treatment .You are entitled to explore various options available to you and to choose the treatment option you prefer . Resident #59 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Medical record review of a physician's orders [REDACTED].>Telephone interview with Resident #59's family conservator on 6/28/17 at 12:53 PM revealed she had revoked her consent for dental care in (YEAR). Continued interview revealed she had verbalized this to the Social Worker (SW) who stated she would call the dental office and tell them to take the resident off the list to be seen at the facility. Continued interview revealed the family conservator learned the resident received dental services on 1/5/17 after receiving a bill from the dental clinic. She called the facility and spoke with the SW and was told she would call the dental clinic again and make sure the resident was no longer on the list for cleanings or any further dental care. Medical record review revealed a Dental Progress Note dated 1/5/17 indicating that a dental exam, cleaning, and x-rays had been completed by the dental clinic for Resident #59. Interview with the SW on 6/28/17 at 2:05 PM in the classroom confirmed the family conservator had requested no dental services to be performed for the resident. Continued interview revealed the resident was placed on the exam list by the dental clinic in error, and the resident did receive dental services on 1/5/17. The SW stated, I just overlooked her being on the list when he showed it to me. The SW confirmed the facility failed to honor the resident's right to refuse dental services.", "filedate": "2020-09-01"}
{"rowid": 3307, "facility_name": "NEWPORT HEALTH AND REHABILITATION CENTER", "facility_id": 445504, "address": "135 GENERATION DRIVE", "city": "NEWPORT", "state": "TN", "zip": 37821, "inspection_date": "2017-05-24", "deficiency_tag": 155, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "8GYB11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policy, review of medical records, and interview, the facility failed to ensure advance directives for appropriate care and treatment were identified in the resident's record for 1 (#142) of 27 residents reviewed. The findings included: Review of the facility policy, Advance Directives, revision date 2/2017, .the resident has a right to accept or refuse medical or surgical treatment and to formulate an advance directive .specific instructions on the types of treatment .or withheld .maintained in the resident's clinical record . Medical record review revealed Resident #142 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Medical record review of the Admission Record, dated 2/9/17, revealed, Do Not Resuscitate - DNR (Do Not Resuscitate). Medical record Review of the POS [REDACTED]. Medical record Review of the POS [REDACTED]. Continued review revealed treatment requested included antibiotics, intravenous fluids, and feeding tube. Medical record review of an APN-BC (Advanced Practice Nurse-Board Certified) Progress Note dated 4/18/17 revealed comfort care - the patient is a DNR with no intubation and wants comfort measures only. Interview with the Director of Nursing (DON) on 5/23/17 at 5:00 PM, in the conference room, confirmed the facility was responsible for a valid POST/POLST. Further interview confirmed the resident's record contained 2 opposing POSTS/POLST regarding resuscitation. Interview continued and confirmed the medical record contained no physician order for [REDACTED]. Interview with the Administrator on 5/23/17 at 6:50 PM, in the conference room, confirmed the facility failed to ensure Resident #142's advance directives were clearly documented in the resident's medical record.", "filedate": "2020-09-01"}
{"rowid": 3717, "facility_name": "SIGNATURE HEALTHCARE OF FENTRESS COUNTY", "facility_id": 445362, "address": "208 DUNCAN ST N", "city": "JAMESTOWN", "state": "TN", "zip": 38556, "inspection_date": "2017-03-28", "deficiency_tag": 155, "scope_severity": "J", "complaint": 1, "standard": 0, "eventid": "Q88111", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on review of facility policy, medical record review, review of facility investigation, and interview, the facility failed to administer Cardiopulmonary Resuscitation (CPR) in accordance with the resident's advanced directives for 1 resident (Resident #6) of 6 resident deaths sampled, of 13 residents reviewed for advanced directives. The facility's failure to honor Resident #6's Advance Directives status resulted in Resident #6 not receiving CPR on [DATE] and dying, placing Resident #6 in Immediate Jeopardy (a situation where the providers noncompliance with one or more requirements of participation, has caused, or is likely to cause, serious injury, harm, impairment or death). The Administrator, Director of Nursing (DON), and Corporate Nurse were informed of the Immediate Jeopardy on [DATE] at 3:25 PM, in the conference room. The IJ was effective [DATE] - [DATE]. The facility's corrective action plan which removed the IJ was received and corrective actions were validated onsite by the surveyor on [DATE] - [DATE]. The IJ was cited as past noncompliance for F-155, the facility is not required to submit a plan of correction. The findings included: Review of the facility policy, Cardiopulmonary Resuscitation, (CPR), undated, revealed .Upon identifying a resident with a change of condition which presents as an unresponsive condition .check the medical record for advance directive status .if resident record indicates CPR is to be instituted, then initiate Basic Life Support (maintenance of airway, breathing, circulation) if a pulse and/or respirations are undetectable .if a resident is found unresponsive and without respirations, a licensed staff member who is certified in CPR .shall promptly initiate CPR for residents .who have requested CPR in their advance directives . Medical record review revealed Resident #6 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Medical record review of Admission Consent Forms and the Tennessee Physicians Orders for Scope of Treatment (POST or advanced directives form) executed on [DATE], revealed Resident #6, a [AGE] year old resident, was to receive CPR, Intubation (insertion of a breathing tube), advanced airway interventions, mechanical ventilation as indicated, transfer to a hospital or intensive care unit if indicated, and full treatment in an intensive care unit if indicated, in the event of a respiratory or [MEDICAL CONDITION]. Medical record review of the Admission Minimum Data Set ((MDS) dated [DATE], revealed Resident #6 had a Brief Interview of Mental Status (BIMS) score of 15 (cognitively intact), was independent in decision making, dependent upon supplemental oxygen to breathe, and the resident required moderate assistance of one person for activities of daily living (ADLs). Medical record review of a Nursing Progress Notes Report dated [DATE] at 6:00 AM, revealed Resident #6 was found seated on her bedside by Licensed Practical Nurse (LPN) #1, and the resident reported to the LPN she had problems breathing. Continued review revealed LPN #1 administered ordered breathing treatments ([MEDICATION NAME], a medication to open airways in the lungs) and oral medications ([MEDICATION NAME], narcotic for pain relief) to the resident. Review of the facility investigation dated [DATE] revealed after LPN #1 administered medications to Resident #6, she informed her supervisor, Registered Nurse (RN) #1 of the resident's status. Continued review revealed at 6:37 AM, Resident #6 activated the call light and RN #1 and LPN #1 responded to the resident's call. Medical record review of the Nursing Progress Notes Report dated [DATE], revealed RN #1 and LPN #1 found Resident #6 again seated on the side of the bed, and the resident informed them she remained short of breath and requested to be transferred to the hospital for intubation. Continued review of the Nursing Progress Note Report revealed the resident's vital signs were heart rate at 88 beats per minute (within normal limits, WNL) Oxygen (O2) Saturation (a measure of blood oxygen levels) 95% (WNL) and Respiratory Rate 36 breaths per minute (abnormally elevated). Further review revealed Resident #6 asked for assistance back into bed and RN #1 placed the resident in her bed, with head of the bed elevated 90 degrees. Continued review revealed no documentation either nurse attempted to arrange transport for Resident #6 to the hospital as requested. Continued review of the Nursing Progress Notes Report revealed . elder did not look right .pulled .the .elder .chart and looked up to see the next of kin .and attempted to call the ex-husband work number x4 (4 times) .next call was made to .son in law .went to voice mail . Continued review revealed at around 7:00 AM (23 minutes after the resident exhibited respiratory distress and requested to be transported to the hospital), RN #1 re-entered the resident's room and discovered Resident #6 slumped over, without a pulse or respirations, and gray in color. Continued review of the Nursing Progress Notes Report revealed .I (RN #1) entered the room and there were no breath sounds .elder gray in color .no palpable pulse was felt .Despite elder being full code .I did not perform CPR on elder . Continued review of the Nursing Progress Notes revealed RN #1 declared Resident #6 deceased at 7:06 AM (6 minutes after she was discovered in cardiac and respiratory arrest) and no attempts to resuscitate the resident were documented. Review of RN #1's investigative interview summary (the findings of the investigative interview conducted by the facility's attorney) dated [DATE], revealed .Entered resident's room to give drink .assisted resident with same .replaced resident O2 mask back on face .(LPN #1) giving meds .Resident SATS (blood oxygen saturation) were 95% good .Later 2 CNAs (Certifiied Nurse Aide) approached, saying resident would like to go to hospital .I assessed resident .resident stated she wanted to be intubated .I found not needed and that resident was very tired .covered resident with blanket .put at 90 degrees . relayed I would notify her family and doctor .skin color dusky color .cool to touch .room was very cool .with .(LPN #1) .started looking up family contact info (information) .called ex-husband and son in law both went to VM (voice mail) with no ability to leave message .tried calling son in law again .no connect .then walked back to resident room to get more family names from resident .found resident slumped over with her head down to the end of bed .this was approximately 30 minutes after I had left resident .yelled for stethoscope .two other nurses nearby .one went to call resident's daughter .assessed resident .no pulse or respirations .skin dusky, eyes 1/2 open, lips and nails blue tinge .Nurse (LPN #1) said resident is full code .I responded resident has clearly passed, nothing to do .Spoke with Doctor, told him resident expired and I would not initiate code, would pronounce her at 7:06 AM .Doctor adamant about doing compressions, I refused, relayed he could speak to administration about it .I then told my administrator and DON (Director of Nursing) what happened, wanted them to know from me . Interview with CNA #1 on [DATE] at 6:55 PM, in the conference room, revealed she was present on the unit when Resident #6 was declared deceased by RN #1, and confirmed no CPR was attempted on the resident. Further interview revealed CNA #1 overheard RN #1 advise the resident's physician .I will not do chest compressions on a dead person . Interview with Physician #3 on [DATE] at 10:57 AM, by telephone, revealed the physician reported he was called sometime between 7:00 and 7:15 AM on [DATE], and was informed by RN #1 Resident #6 had expired and no CPR was attempted. Continued interview revealed the Physician questioned RN #1 if CPR was in progress or had been attempted on Resident #6, prior to her being declared deceased . Continued interview revealed Physician #3 informed RN #1 the resident was a full code and CPR was to have been attempted. Physician #3 reported RN #1 questioned him initially and asked him you want me do compressions on a dead person? Continued interview revealed Physician #3 stated RN #1 failed to honor the resident's wishes and he did not order CPR to begin after his conversation with RN #1, as he was given the impression by the nurse Resident #6 had been pulseless for an extended period of time when the telephone call to him was made. Interview with LPN #1 on [DATE] at 11:36 AM, in the conference room, revealed on [DATE] at 7:00 AM, when Resident #6 was discovered in cardiac and respiratory arrest, LPN #1 entered the resident's room behind RN #1, and LPN #1 informed RN #1 the resident was a full code and the resident's desire was to have CPR. Continued interview revealed RN #1 stated to the LPN .we're not doing nothing to this poor woman, she's gone, she has been through enough . Continued interview revealed LPN #1 reported Respiratory Therapist (RT) #4, LPN #3 and LPN #15 had also been prohibited from performing CPR on Resident #6 by RN #1. LPN #1 reported RN #1 stood between the staff and the resident's body, with her arms outstretched laterally, as if to block them from approaching Resident #6, as she told the staff no CPR would be performed. Interview with LPN #3 on [DATE] at 12:47 PM, in the conference room, confirmed RN #1 refused to perform CPR on Resident #6. Interview with the DON on [DATE] at 2:45 PM, in the conference room, revealed the facility investigation concluded RN #1 was fully aware of Resident #6's Advance Directives status at the time she elected not to perform CPR on Resident #6. The DON confirmed the nurse failed to perform CPR in accordance with the resident's advance directives and failed to follow facility policy. Interview with Respiratory Therapist (RT) #4 on [DATE] at 1:40 PM, in the conference room, revealed on [DATE] around 7:00 AM, she entered Resident #6's room and observed her slumped sideways in the bed with her head tilted backwards, mouth open, not breathing, and ashen in color. Continued interview revealed RT #4 informed RN #1 the resident was a full code. Continued interview revealed RN #1 stated to her, .absolutely not, we are not doing a code, she has been down too long . Further interview revealed RN #1 repeatedly prohibited attempts by other staff members to perform CPR. Telephone Interview with LPN #15 on [DATE] at 2:24 PM, revealed she was present on the unit as an oncoming day shift nurse on [DATE] and witnessed the incident. Continued interview revealed when Resident #6 was discovered without a pulse or respirations at 7:00 AM, she responded to the room to assist in resuscitation efforts and she informed RN #1 the resident was a full code. Continued interview revealed RN #1 refused to permit CPR to be performed and ordered her from the resident's room. Further interview revealed RN #1 told LPN #15 to go to the nursing station and call Physician #3 and advise him the resident was deceased . Further interview revealed LPN #15 called Physician #3 sometime after 7:06 AM, and as she spoke to the Physician, RN #1 took the phone from her hands and took over the phone call at that point. Further interview revealed as LPN #15 and LPN #3 moved the crash cart toward the resident's room, RN #1 waved her hands, pointed at the two LPNs and mouthed NO. The facility's corrective action plan included the following: On [DATE] the facility did the following: [NAME] Held an ad hoc Quality Assurance (QA) meeting during the daily stand up meeting and reviewed the incident. Incident was reported to the State Agency. Follow up QA meeting was scheduled for [DATE]. Responsible party was the Administrator. B. The regional nurse consultant reviewed with the DON and the Administrator the education to be provided to all staff on [DATE] to include Abuse, Resident Rights, Advance Directives, Where to Locate the Advance Directives in the Medical Record, Cardiopulmonary Resuscitation (CPR), Following Physician Orders, Change in Condition and Following Care Plans. Responsible party was the Director of Nursing (DON). C. Once the Administrator and DON were educated, they were assigned to educate the Nursing Administration team Assistant Director of Nursing (DON), Unit Managers, Minimum Data Set (MDS) Nurses, and Staff Development Coordinator), who in turn were assigned to educate all the staff on Abuse, Neglect, Resident Rights, Advance Directives, Where to Locate Advance Directives in the Medical Record, CPR, Following Physician Orders, Change in Condition, and Following Care Plans. Responsible party was the DON). D. Began written competency testing of all staff educated on Abuse, Neglect, Resident Rights, Advance Directives, Where to Locate Advance Directives, CPR, Following Physician Orders, Change in Condition and following Care Plans. Responsible party was the Director of Nursing (DON). E. All staff educated, were required to submit written post-tests with scores of 100% before being permitted to work. All staff who failed to score 100% on the post-tests were immediately re-educated and re-tested until all staff scored 100% on the post tests. Responsible party was the Director of Nursing (DON). F. Initiated the first Mock Code Drill conducted by the DON, ADON, Unit Manager (UM) and the Staff Development Coordinator (SDC) to ensure staff understanding and compliance with the facility code blue policy (policy related to emergency resuscitation) and procedures. No irregularities noted. Mock codes were then planned to be completed for every shift (7 A-7P, 7P-7A) for 72 hours through [DATE], then twice weekly on rotating shifts for 4 weeks starting on [DATE] through [DATE] (scheduled to occur on ,[DATE], ,[DATE], ,[DATE], ,[DATE], ,[DATE], ,[DATE], and on [DATE] on both shifts) to ensure staff understanding and compliance with the facility code blue policy. The first two Mock Codes were conducted by members of the Nursing Administration Team under observation of the DON, then Mock codes were conducted by nursing staff members under observation of members of the Nursing Administration team. Findings were to be reported to the QA committee weekly for 4 weeks to determine compliance and any further need of continued education or revision of the plan. Responsible party was the Director of Nursing (DON). [NAME] Began ongoing monitoring of staff compliance with abuse, advanced directives, resident rights, CPR, location of advanced directives and Do Not Resuscitate (DNR) forms in the medical record, following physician orders, change in condition reporting and following Care Plans. Responsible party was the Administrator. On [DATE] the facility did the following: [NAME] Resident #6's chart and care plan were reviewed by the Regional Nurse Consultant and Director of Clinical Operations. Registered Nurse (RN) #1 was to have been terminated concluding the investigation but resigned prior to termination. Licensed Practical Nurses (LPN) LPN #1 LPN #3, LPN #15 and Respiratory Therapist (RT) #4 received disciplinary action related to not following facility policy. Responsible party was the DON. B. Began audits of the medical records for all residents in the facility, by the Regional Nurse Consultant and Director of Clinical Operations, to ensure advance directives were in the medical record, were addressed on the care plan, and had current Physician orders related to each resident's code status. Responsible party was the DON. C. All residents were assessed for any possible resident rights violations. Those residents with Brief Interview of Mental Status (BIMS scores, a measure of cognitive function), greater or equal to 8 (cognitively intact) were interviewed by the DON, ADON, UM, Social Services Director (SSD), Social Services Assistant (SSA) for quality of life or resident rights violations. No issues were identified. Responsible party was the DON. D. All residents with BIMS scores less or equal to 7 (cognitively impaired) had skin assessments completed on [DATE] for any concerns by ADONs and UMs for any possible abuse or neglect issues. All residents with a BIMS greater or equal to 8 were interviewed for possible abuse or neglect violations. No issues were identified. Responsible party was the DON. E. Held a Resident Council Meeting (a group of residents who reside in the facility and meet regularly, discuss resident concerns, and discuss resident concerns with Administration) and the SSD and Activities Director reviewed the Resident Rights Statement and Policies for Prohibition of Abuse, Neglect and Misappropriation of Property and provided a copy to each resident. Responsible party was the DON. F. All deaths in the facility for the past 30 days were reviewed by the Regional Nurse to ensure advanced directives were honored with no irregularities noted. The DON reviewed all resident deaths in the facility for the prior 12 months with no irregularities noted. Results were discussed in the QA meeting. Responsible party was the Administrator. [NAME] Held first formal QA meeting to address the incident. DON, ADON, UM, Nursing Supervisors or Medical Records staff were to review all new admissions/readmits and residents with DNR related changes, 24 hour shift reports, and incidents accidents daily for 2 weeks, then Monday through Friday ongoing, starting during morning clinical meeting, to ensure sustained compliance with physician notification, physician orders, interim care plan, advance directives, and resident rights. Corporate administrative oversight of the QA meeting was completed by the Regional Vice President or member of the regional staff weekly for 4 weeks beginning [DATE], then monthly for one quarter. The facility allegation of compliance (A[NAME]) was reviewed by the committee. Responsible party was the Administrator. H. Continued staff education and post testing on Abuse and Neglect, Advanced Directives, Where to find Advanced Directives in the chart, CPR, Resident Rights, following Physician orders, Notification of Change in Condition, and Following Care plans. Responsible party was the DON. I. Grievance logs were reviewed by the Director of Clinical Operation with no irregularities noted. [NAME] Continued Mock Code drills as outlined. Responsbile party was the DON. K. Corrective actions were reviewed by the Administrator, DON, Medical Director and Regional Consultants. Responsible party was the Administrator. On [DATE] the facility did the following: [NAME] The DON, ADON, UM, Administrator and Department Heads continued advance directive/abuse post-tests with 10 random Nursing staff members daily on rotating shifts for 2 weeks through [DATE]. Then 5 random nursing staff members on rotating shifts daily for 2 weeks through [DATE], then 5 random Nursing staff members weekly for 3 weeks through [DATE], with all staff required to score 100% on the post tests. Staff members who failed to achieve 100% scores on the tests were immediately re-educated and required to re-test until 100% scores were achieved. Responsible party was the DON. B. Continued education of all staff members on the facility Abuse and Neglect Policy, Resident Rights, CPR, Advance Directives and Where to find them in the medical record, Notification of Change in Condition, Physician Orders, and Care plans. Responsible party was the DON. C. Continued Mock Code drills on every shift through [DATE] as outlined. Responsible party was the DON. On [DATE] the facility did the following: [NAME] Completed review of all residents medical records by the Director of Clinical Operations and the Regional Nurse to ensure advance directives were in the medical records, addressed on the care plans, and had a current Physician Order regarding code status. No irregularities noted. Responsible party was the Director of Clinical Operations. B. Completed a 100% audit of licensed clinical staff CPR certifications by the Regional Vice President and Regional Nurse Consultant. C. Completed 100% audit of all licensed staff to verify valid Tennessee professional licensure completed by the Regional Vice President. No irregularities were noted. D. Completed 100% audit to ensure staff were not listed on the abuse registry by the Regional Vice President with no irregularities noted. E. Mailed certified letters to all employees who had not completed mandatory training and education and advised completion of training was required prior to any return to work at the facility. The letters included all employees on vacation or paid leave, part time or prn (as needed status). Responsible party was the DON. F. The Administrator began reviews of completed audits for new admissions, readmissions and residents with DNR to ensure sustained compliance with all advanced directives. [NAME] DON, ADON, UM or Weekend Manager on duty began interviews with 5 residents with BIMS scores equal or greater than 8 and 5 family members of residents with BIMS scores less than 8 daily for 2 weeks ([DATE] to [DATE]) for any possible resident rights violations; then 3 residents and 3 family members daily for 2 weeks ([DATE] to [DATE]), then 2 residents and 2 family members daily for 4 weeks ([DATE] to [DATE]), then 1 resident and 1 family member daily for 4 weeks ([DATE] to [DATE]). Results of the interviews and assessments forwarded to the QA committee. Responsible party was the DON. H. All deaths in the facility were reviewed by the DON, ADON, UM or Administrator to ensure code status was implemented correctly as per the resident's wishes and documented on the advance directives daily for 2 weeks through [DATE]; then weekly for 4 weeks from [DATE] to [DATE], then continuing as part of the daily stand up meetings attended by the Administrator, DON, ADONs, UM, MDS Coordinator, Treatment Nurses, Chaplain, SDC, Quality of Life Department Head, SSD, Dietary Manager and Formulary Nurse (the nurse in charge of the central supply office) to ensure sustained compliance. Responsible party was the DON. I. Began Administrative oversight of the facility by a member of Senior Regional Team twice weekly for 2 weeks, beginning [DATE] to [DATE]; then weekly for 4 weeks beginning [DATE] through [DATE], then monthly for one quarter. Responsible party was the Director of Clinical Operations. [NAME] Continued Mock Code drills as outlined above. Responsible party was the DON. K. The DON and SDC began tracking all licensed staff members for CPR certification monthly for 3 months; then every 6 months to ensure all licensed nurses maintained CPR certifications. Findings documented and forwarded to the QA committee monthly to determine any need for education or revision of the process. Responsible party was the DON. L. Established plans for daily contact between the facility and nurses from the regional team or corporate office for 2 weeks, then 2 times weekly for 4 weeks. Nurses from the regional team or home office reviewed compliance with the Plan of Correction and Policy and Procedures, compliance of any code blue to occur, and review of compliance with all new/readmissions. Responsible party was the DON. On [DATE] the facility did the following: [NAME] Completed the twice daily mock code drills as outlined above with no irregularities noted. Initiated the plan for transition to twice weekly Mock Code drills to occur on rotating shifts for another 4 weeks. Responsible party was the DON. B. Continued staff education and competency testing on Abuse and Neglect, Resident Rights, Advance Directives and Where to find them in the Chart, CPR, Notification of Change in Condition, Physician Orders, and Care Plans. Responsible party was the DON. C. Held a follow up QA meeting to review findings from initial audits, scheduled weekly QA meetings for 4 weeks, then monthly, for recommendations and further follow up regarding the Corrective Action Plan. At that time, based upon evaluation, the QA committee would determine at what frequency any ongoing audits would be continued. Responsible party was the Administrator. On [DATE] the facility did the following: [NAME] Completed education and competency testing of all staff, with the exception of those on Family Medical Leave (FMLA) or PRN status who had not worked, with 100% scores attained on all post-tests for facility Abuse and Neglect Policy, Resident Rights, CPR and Advance Directives, Where to Locate Advance Directives in the Medical Records, Physician Orders, Notification of Change in Condition, and Care Plans. Employees on FMLA or PRN status were not permitted to work until all education and competency testing completed. Responsible party was the DON. B. Continued all random audits, staff and resident interviews, and competency testing as outlined above. Responsible party was the DON. C. Continued daily stand up meeting reviews as outlined above, which included reports to Administration on the progress of the facility corrective action plans and changes in resident condition. Responsible party was the DON.", "filedate": "2020-03-01"}
{"rowid": 3784, "facility_name": "STARR REGIONAL HEALTH & REHABILITATION", "facility_id": 445277, "address": "886 HWY 411 NORTH", "city": "ETOWAH", "state": "TN", "zip": 37331, "inspection_date": "2017-02-22", "deficiency_tag": 155, "scope_severity": "D", "complaint": 1, "standard": 0, "eventid": "IXF411", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on facility policy review, medical record review, review of facility investigation, and interview, the facility failed to honor resident rights to refuse administration of a medication for 1 resident (#1) of 10 residents reviewed. The findings included: Review of the facility's policy titled Refusal of Treatment dated (MONTH) 2013, revealed .Our facility shall honor a resident's request not to receive medical treatment as prescribed by his or her physician .The resident is not forced to accept any medical treatment and may refuse specific treatment even though it is prescribed by a physician . Medical record review revealed Resident #1 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Medical record review of the quarterly Minimum Data Set ((MDS) dated [DATE] revealed Resident #1 scored 15 out of 15 on the Brief Interview for Mental Status (BIMS), indicating the resident was cognitively intact. Medical record review of the physician's orders [REDACTED]. Medical record review of a nursing progress note dated 11/6/16, written by Licensed Practical Nurse (LPN) #2, revealed .new order for [MEDICATION NAME] 5 mg IM was received and given . Further review of the progress notes revealed LPN #2 documented [MEDICATION NAME] 5 mg IM was administered at 9:50 PM. Review of the note, documented by LPN #2, revealed the resident's response to the medication was .Still mad .refusal of meds . Review of a facility investigation witness statement dated 11/7/16, completed by the Occupational Therapist (OT), revealed the resident reported to the OT .after dinner he (Resident #1) was in dining room and the security guard told him he will be getting a shot because of his behaviors .(Resident #1) reported he was getting upset and said 'I'll take my pills but you are not giving me a shot.' (Resident #1) reported the nurse stated 'you're going to take that shot no matter what . Review of the facility's investigation revealed an interview was conducted by the Director of Nursing (DON) with Resident #1 on 11/7/16; .(Resident #1) stated he received a shot after refusing it from the nurse (LPN #2) .(Resident #1) stated nurse (LPN #2) came in and told him he was going to get a shot and he said he refused the shot . Continued review revealed Resident #1 stated the security guard and two Certified Nurse Aides (CNAs) were in the dining room when the nurse gave him the shot and he was trying to scoot out of the chair to get away from the shot. Review of the facility's investigation witness statement dated 11/7/16, completed by LPN #2, revealed .(LPN #2) called the physician and got an order for [REDACTED].#2) went and got two CNAs and the security guard and lifted the resident up in a semi-standing position so I could give him the shot .(resident) said he wasn't taking a shot .we just turned him up on to the right side so I could get the shot in the left hip . Review of the facility's investigation witness statement dated 11/8/16, completed by a Security Guard, revealed .after I returned from my rounds I was requested to assist with the shot .I went to the dining room where (Resident #1) was sitting .About 5-10 minutes later 3 nurses entered and told (resident) the doctor had ordered a shot .(the resident) became very upset and said he would take some pills but he wouldn't take a shot .the nurse was able to administer the shot in his left hip . Review of the facility's investigation witness statement dated 11/9/16, completed by CNA #4, revealed .(CNA #10) came to me and said (LPN #2) was ready to give (Resident #1) the shot .(LPN #2) told (Resident #1) she had a shot for him to calm him down .He stated he did not want the shot .(Resident #1) tried sliding out of the chair to get away from the shot .(LPN #2) stated to turn him up and she gave him the shot . Review of the facility's investigation written statement dated 11/9/16, completed by CNA #9, revealed .(Resident #1) was sitting in the dining room calmly when (LPN #2) came in .(Resident #1) immediately began swinging at the nurse and telling her he wasn't taking any shot but he would take a pill .(Resident #1) was tilted enough to administer the injection in his left hip . Medical record review revealed no documentation of distress by the resident and no changes in behavior or mood were noted. Review of a psychotherapy note on 11/10/16 revealed the resident was managing his chronic ongoing symptoms well and there was no change in his mental health. Interview with CNA #4 on 2/16/17 at 11:30 AM, in the Board Room, revealed CNA #10 asked CNA #4 to come help the nurse give the resident a shot and .(Resident #1) stated he didn't want the shot because he doesn't know what is in it . CNA #4 stated the security guard and CNA #9 assisted with positioning the resident for the shot administration. Interview with Resident #1 on 2/16/17 at 2:25 PM, in his room, revealed he .after getting out of bed I went to the nurses station and me and (LPN #2) had a few more words .(LPN #2) came in and told me she was giving me a shot to calm down and I told her I ain't taking no dern thing . Resident #1 stated LPN #2 administered the medication after he refused. Interview with CNA #9 on 2/21/17 at 7:15 AM, in the Board Room, revealed on the evening of 11/6/16, .(CNA #9) went into the dining room. (Resident #1) was watching TV and when (LPN #2) came in (Resident #1) said .you are not giving me a (expletive) shot .I'll take a pill . Interview with the Administrator and the DON on 2/22/17, at 11:15 AM, in the Board Room, confirmed LPN #2 did not follow the facility's policy related to refusal of treatment and administered the injection of [MEDICATION NAME] after the resident refused.", "filedate": "2020-02-01"}
{"rowid": 4138, "facility_name": "MT PLEASANT HEALTHCARE AND REHABILITATION", "facility_id": 445374, "address": "904 HIDDEN ACRES DR", "city": "MOUNT PLEASANT", "state": "TN", "zip": 38474, "inspection_date": "2016-11-03", "deficiency_tag": 155, "scope_severity": "J", "complaint": 1, "standard": 0, "eventid": "J51L11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on medical record review and interview, the facility failed to honor the Advanced Directives for a resident with swallowing and aspiration risks for 1 resident (#1) of 6 residents who were totally dependent on staff for eating. This failure placed all residents at risk for aspiration and requiring total dependence on staff for eating in Immediate Jeopardy (a situation in which the provider's noncompliance with one or more requirements of participation has caused, or is likely to cause, serious injury, harm, impairment or death of a resident). The Administrator, Director of Nursing and the Quality Assurance Nurse were informed of the Immediate Jeopardy on [DATE] at 3:00 PM in the Administrator's office. The findings included: Medical record review revealed Resident #1 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Medical record review of Resident #1's Physician order [REDACTED].Do Not Attempt Resuscitation, Comfort Measures-Relieve pain and suffering .Use oxygen, suction, and manual treatment of [REDACTED]. was signed by the resident's Power of Attorney and the Medical Director on [DATE]. Medical review of the Speech Therapy (ST) Evaluation and Plan of treatment dated [DATE] revealed Resident #1 had .Clinical S/S (signs and symptoms) of Dysphagia (difficulty swallowing): effortful mastication (chewing process) . The ST Recertification and Update of Treatment Plan dated [DATE] to [DATE] revealed the diet was changed to pureed (blenderized food) due to pocketing (food getting stuck in mouth), increased feeding time and lethargy. The treatment plan further revealed Resident #1 had used general swallowing techniques/precautions and upright posture during meals 70% (percent) of the time by the [DATE] discharge, was tolerating pureed diet while fed by staff, caregiver/staff educated on safe swallowing strategies including bite/sip, small bites, positioning. The swallowing treatment training included small bites/sips (,[DATE] to ,[DATE] teaspoon) and facilitation of body positioning too increase safety with intake. Medical record review of the Progress Notes revealed the following: [DATE] at 11:30 PM .No further emesis noted, had earlier after lunch x (times) 1. Afebrile . [DATE] at 2:15 PM .Moderately large emesis noted during activity in dining room. Afebrile . [DATE] at .1:30 PM Res (resident) consumed 100% of meal with asst (assist) with no dysphagia. Res vomited very large amt (amount) of liquid et (and) pureed food. Res entered Cheyne-Stokes (abnormal pattern of breathing characterized by progressively deeper and sometimes faster breathing, followed by a gradual decrease that results in a temporary stop in breathing) respirations et was unresponsive. Nurse at this x (time) went to supply closet to obtain suction equipment .at 1:34 PM Re-entered room. Noted absence of pulse, B/P (blood pressure) et respirations. Skin pale/gray et cool to touch. RN (Registered Nurse) #1 Supervisor notified .at 1:40 PM Pronounced deceased . Interviews with Licensed Practical Nurse (LPN) #5 on [DATE] at 2:55 PM and at 4:25 PM on the long hall and the conference room, on [DATE] at 11:10 AM in the conference room, on [DATE] at 4:10 PM in the conference room, and on [DATE] at 8:30 AM, on the long hall revealed Resident #) had been pocketing food, and had ,[DATE] vomiting episodes after eating. Further interview revealed the LPN had .fed (Resident #1) Magic Cup (nutritional supplement) and fluids ,[DATE] times by syringe .a couple of months before hospice started .I gave Magic Cup and water by syringe the morning of [DATE] . and (Resident #1) .wanted water and could no longer suck on a straw .I didn't want him dehydrated . When asked why the LPN used the syringe, the LPN stated .I was trying to help the man out . When questioned of the resident's advanced directive of no artificial feeding why was a syringe okay to use, the LPN stated .because not able to suck through straw and when you held a cup to the lips the resident could blow into it so I tried a syringe, he knew to swallow once in mouth . When asked what happened to the syringe, the LPN stated .I told Certified Nurse Aide (CNA) #4 to throw it away because there was no doctor's order for it . When asked when you saw CNA #4 spoon feeding the resident lunch and you told CNA #4 the syringe was available for use you knew there was a possibility the CNA would use it, would you consider that force feeding, the LPN stated I guess I would. When asked since the resident did not want artificial feeding and you used a syringe to force food and fluid into his mouth, do you think you violated his rights, the LPN stated .it was against his wishes .I took away his autonomy . Interviews with CNA #4 on [DATE] at 9:25 AM and on [DATE] at 10:15 AM and 12:35 PM, in the conference room and the nursing station revealed CNA #4 had been spoon feeding Resident #1 lunch on [DATE] when LPN #5 entered the resident's room and informed the CNA .syringe in drawer and she told me to try use it. I got syringe out, liquefied the pureed food with the fluid on the tray and put a little in his mouth, he swallowed .he ate all the food, 100% and when I was done feeding he started vomiting . When asked when she was spoon feeding the resident lunch how had the resident been accepting the by mouth food, the CNA stated .he wasn't taking it like before . When asked why she used the syringe, CNA #4 stated .(LPN #5) told her the LPN had been using the syringe throughout the day with magic cup and juice and he did fine . When asked what happened to the syringe, CNA #4 stated .(CNA #1) told her that (LPN #5) told (CNA #1) to tell (CNA #4) to get the syringe out of there, I threw it in the trash in the resident's room then I removed it and took it to the hopper room trash . Telephone interviews with the Hospice Patient Care Coordinator on [DATE] at 8:45 AM and 10:00 AM, and on [DATE] at 10:30 AM, when asked regarding the resident's POST status and having a syringe used to force food into the mouth how that would affect resident's rights stated .syringe is force feeding . Refer to F154 [NAME]", "filedate": "2019-11-01"}
{"rowid": 4621, "facility_name": "MAJESTIC GARDENS AT MEMPHIS REHAB & SNC", "facility_id": 445150, "address": "131 N TUCKER", "city": "MEMPHIS", "state": "TN", "zip": 38104, "inspection_date": "2016-06-09", "deficiency_tag": 155, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "RCPZ11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on the facility's list of staff certified in Cardiopulmonary Resuscitation (CPR) and interview, the facility failed to ensure CPR staff were available for 4 of 14 ([DATE] 11 PM-7 AM, [DATE] 11 PM-7 AM, [DATE] 7 PM-7 AM, and [DATE] 11 PM-7 AM) days. The findings included: The facility's Daily Assignment Sheet dated [DATE] revealed there was no CPR certified staff on the 11 PM - 7 AM shift. The facility's Daily Assignment Sheet dated [DATE] revealed there was no CPR certified staff on the 11 PM - 7 AM shift. The facility's Daily Assignment Sheet dated [DATE] revealed there was no CPR certified staff on the 7 PM - 7 AM shift. The facility's Daily Assignment Sheet dated [DATE] revealed there was no CPR certified staff on the 11 PM - 7 AM shift. In an interview with the Director of Nursing (DON) on [DATE] at 10:38 AM, in the conference room, the DON was asked if the facility should be staffed at all times with personnel that is certified in CPR. The DON stated, Yes.", "filedate": "2019-08-01"}
{"rowid": 4652, "facility_name": "WHITEHAVEN COMMUNITY LIVING CENTER", "facility_id": 445233, "address": "1076 CHAMBLISS ROAD", "city": "MEMPHIS", "state": "TN", "zip": 38116, "inspection_date": "2016-06-28", "deficiency_tag": 155, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "N42U11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of the facility's list of staff certified in Cardiopulmonary Resuscitation (CPR), record review and interview, the facility failed to ensure CPR certified staff were available for all shifts for 7 of 30 shifts from [DATE] through [DATE]. The findings included: Review of the list of the facility staff certified in CPR and the working schedule revealed there was no one certified in CPR scheduled to cover the following shifts: a. [DATE] - 7 AM to 7 PM and 11 PM to 7 AM b. [DATE] - 7 AM to 7 PM and 11 PM to 7 AM c. [DATE] -11 PM to 7 AM d. [DATE] - 7 PM to 7 AM e. [DATE] - 7 PM to 11 PM. Interview with the Regional Director of Operations (RDO) on [DATE] at 7:15 PM, in the conference room, the RDO confirmed that not all shifts had staff that were certified in CPR.", "filedate": "2019-08-01"}
{"rowid": 5528, "facility_name": "CLARKSVILLE MANOR NURSING CENTER", "facility_id": 445455, "address": "900 PROFESSIONAL PARK DRIVE", "city": "CLARKSVILLE", "state": "TN", "zip": 37040, "inspection_date": "2015-11-05", "deficiency_tag": 155, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "4Z6811", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on policy review, medical record review, and interview, the facility failed to ensure staff honored advance directives as evidenced by Cardiopulmonary Resuscitation (CPR) being performed on a resident with a Do Not Resuscitate (DNR) status for 1 of 33 (Resident #228) residents included in the stage 2 review. The findings included: The facility's advance directive policy documented, .Adult patients are informed and written information provided regarding the right to accept or refuse medical or surgical treatment and, at the individual's option, formulates an advance directive . The patient's right of self-determination of withholding resuscitative services will be respected . Should the patient show signs of cardiopulmonary arrest, the clinician will follow the CPR order . Medical record review revealed Resident #228 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. of Right Lower Extremity, Malignant Neoplasm of Bladder, Anxiety, [MEDICAL CONDITIONS], [DIAGNOSES REDACTED] Fibrillation, Gout, [MEDICAL CONDITION], Urinary Incontinence, History of [MEDICAL CONDITION], Cerebral Infarction Without Residual Deficits, Hypertension, and [DIAGNOSES REDACTED]. A Tennessee Physician order [REDACTED]. documented, .CARDIOPULMONARY RESUSCITATION (CPR): Patient has no pulse and is not breathing . (checkmark) Do Not Attempt Resuscitation (DNR/no CPR) (Allow Natural Death) . The Basis for These Orders Is . (checkmark) Patient's preferences . The electronic Medication Administration Record [REDACTED].Advance Directives . Do Not Resuscitate . A hospital History and Physical form dated [DATE] documented, .CODE STATUS . DNR . A nurse's note dated [DATE] at 4:15 AM documented, .Called to resident's room r/t (related to) unresponsiveness. CPR performed. A nurse's note dated [DATE] at 4:25 AM documented, Resident observed to be unresponsive by staff at 0200 am this morning. At this current time the computer systems were down and the staff were unable to access information on resident. CPR was immediately started. O2 (oxygen) was placed on resident and Automatric defibrillator placed. EMS (Emergency Medical Service) was called and arrived at 210 am. The code was called off at 0225 am by EMS. They had contacted a doctor at (named hospital) and received the order. RN (Registered Nurse) pronounced had expired at 0225am. Interview with the Administrator on [DATE] at 2:00 PM, in the conference room, the Administrator was asked whether there was a back up plan for computer failure at the facility. The Administrator stated, We have a disaster recovery computer. They just didn't have time to get it out and print it out last night. The Administartor was asked if a copy of the POST forms are kept anywhere other than in the computer system. The Administrator stated, Yes. They are in a book at the nurses' stations. His (Resident #228) wasn't in there. It just hadn't been updated yet. The Administrator was asked whether an updated copy of Resident #228's POST form should have been available. The Administrator stated, Well, sometimes it's just hard to chase the doctors down and get them to sign it, and get it in there as soon as possible. Interview with the Director of Nursing (DON) on [DATE] at 8:43 AM, in the conference room, the DON was asked whether Resident #228 should have received CPR. The DON stated, No. Vision (computer system) was down. Our backup binders that should have been at the nurses' stations were locked up in another office. They were not readily available.", "filedate": "2019-02-01"}
{"rowid": 5879, "facility_name": "FOUR OAKS HEALTH CARE CENTER", "facility_id": 445458, "address": "1101 PERSIMMON RIDGE RD", "city": "JONESBOROUGH", "state": "TN", "zip": 37659, "inspection_date": "2015-10-14", "deficiency_tag": 155, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "IC5J11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on resident rights, medical record review, and interview, the facility failed to allow a resident (#35) to refuse treatment for [REDACTED]. The findings included: Review of Resident Rights-Integrity Healthcare of Jonesboro-LLC, revealed .B.Notice of rights and services .4. The Resident has the right to refuse treatment . Medical record review revealed Resident #35 was admitted to the facility on [DATE] and readmitted on [DATE], with [DIAGNOSES REDACTED]. Medical record review of the Quarterly Minimum (MDS) data set [DATE] revealed the resident's Brief Interview for Mental Status score was 15 indicating the residnet was cognitively intact. Interview with Resident #35 on 10/12/15 at 11:32 AM, in the resident's room revealed approximately 1 month ago (September) at 4:00 AM, staff woke her up and held her down to obtain a blood sample. Continued interview revealed the staff member was a nurse, CNA (Certified Nursing Assistant) and the outsource laboratory technician. The resident stated had refused to have the blood drawn. Continued interview with the resident revealed this had made the resident mad. The resident stated she normally has blood drawn from the right arm, and the staff had taken the blood sample from the left, causing bruises. Medical record review of a facility investigation dated 9/2/15 revealed the resident had 2 bruises, 1 on the left forearm and 1 on the left hand as a result of the attempt and the actual blood sample had been drawn. Interview with Resident #35 on 10/13/15 at 1:50 PM and again on 10/14/15 at 9:00 AM, revealed the resident remembered the staff holding her against her will to obtain the blood specimen. During each interview the resident stated had made her mad that staff did not listen to her and how they (staff) had caused the bruises to her left arm and hand. Interview with the Assistant Director of Nursing (ADON) on 10/14/2015 at 6:50 AM, in the Director of Nursing's office confirmed the resident had been held down to obtain the blood specimen which was against the resident's rights.", "filedate": "2018-11-01"}
{"rowid": 6410, "facility_name": "FAYETTEVILLE HEALTH AND REHABILITATION CENTER", "facility_id": 445320, "address": "4081 THORNTON TAYLOR PARKWAY", "city": "FAYETTEVILLE", "state": "TN", "zip": 37334, "inspection_date": "2015-04-15", "deficiency_tag": 155, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "WJ8M11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on policy review, review of the facility's list of staff certified in Cardiopulmonary Resuscitation (CPR), record review and interview, the facility failed to ensure CPR certified staff were available for 4 of 14 (Monday, Tuesday, Wednesday and Sunday for 6 PM to 6 AM) shifts per week. The findings included: The facility's Emergency Procedure - Cardiopulmonary Resuscitation policy documented, Policy Statement . Personnel have completed training on the initiation of Cardiopulmonary Resuscitation / Basic Life Support (BLS) in victims of sudden [MEDICAL CONDITION] . Policy Interpretation and Implementation . If an individual (resident, visitor, or staff member) is found unresponsive and not breathing normally, a licensed staff member who is certified in CPR/BLS shall initiate CPR . Preparartion for cardiopulmonary Resuscitation . Obtain and/or maintain . certification in Basic Life Support / Cardiopulmonary Resuscitation . Select and identify a CPR Team for each shift in the case of an actual [MEDICAL CONDITION] . Review of the list of the facility staff certified in CPR and the schedule revealed there was no one certified in CPR scheduled to cover the 6 PM to 6 AM shift for Monday, Tuesday, Wednesday and Sunday. Review of the facility pharmacy orders dated [DATE] revealed 20 residents currently in the facility had a code status for CPR. Interview with the Administrator and the Director of Nursing (DON) on [DATE] at 10:34 AM, confirmed that there is no staff scheduled in the facility that is CPR certified on Monday, Tuesday, Wednesday and Sunday from 6 PM to 6 AM. The Administrator and the DON confirmed the facility policy does require staff members to be certified in CPR/BLS.", "filedate": "2018-08-01"}
{"rowid": 7897, "facility_name": "THE WATERS OF UNION CITY , LLC", "facility_id": 445138, "address": "1105 SUNSWEPT DR", "city": "UNION CITY", "state": "TN", "zip": 38261, "inspection_date": "2014-09-24", "deficiency_tag": 155, "scope_severity": "J", "complaint": 1, "standard": 0, "eventid": "EQWV11", "inspection_text": "Deficiency Text Not Available", "filedate": "2017-09-01"}
{"rowid": 9001, "facility_name": "LIFE CARE CENTER OF EAST RIDGE", "facility_id": 445296, "address": "1500 FINCHER AVENUE", "city": "EAST RIDGE", "state": "TN", "zip": 37412, "inspection_date": "2014-03-24", "deficiency_tag": 155, "scope_severity": "D", "complaint": 1, "standard": 0, "eventid": "WKUE11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, facility documentation review, and interview, the facility failed to ensure the resident's right to refuse treatment was honored for one resident (#1) of five residents reviewed. The findings included: Resident #1 was admitted to the facility on [DATE], with [DIAGNOSES REDACTED]. Review of the Admission Minimum Data Set, dated dated dated [DATE], revealed the resident scored fourteen of fifteen on the Brief Interview for Mental Status assessment indicating the resident was cognitively intact and able to make decisions. Review of the facility's investigative documentation dated February 10, 2014, revealed two staff members reported being present in the resident's room and had observed the nurse administering medications insist the resident take medication, after the resident declined. Continued review revealed the resident requested not to take the medication, stating it made the resident sick. Continued review revealed the nurse continued to coax the resident into taking the medication, which eventually the resident did, against the resident's wishes. Review of the facility's admission criteria, Section 11: Resident's Rights, .5. The Resident has the right to give consent and to refuse treatment . Interview with resident #1 on March 6, 2014, at 8:45 a.m., in the resident's room, confirmed a few weeks past, the resident took medication against their wishes. Continued interview confirmed the resident believed the nurse used poor judgment, in insisting the resident take the medication. Continued interview revealed the resident stated was not feeling well at the time and believed some of the medication was causing the problem. Interview on March 6, 2014, at 11:05 a.m., via telephone, with the Licensed Physical Therapy Assistant (LPTA) who was present when the nurse attempted to give resident #1 medication, confirmed the nurse had insisted the resident take the medication, even though the resident had declined. Interview on March 6, 2014, at 11:30 a.m., in the conference room, with the Occupational Therapist who was present with the LPTA in the resident's room when the nurse attempted to give resident #1 medication, confirmed the nurse administered the medication against the resident's wishes. Telephone interview on March 6, 2014, at 12:05 p.m., with the nurse who administered the medications, confirmed knowledge the resident had not been taking the medication but believed it was because of swallowing difficulties. Continued interview confirmed the resident frequently complained of nausea. Continued interview confirmed, I don't feel like I forced .(the resident) to take it. In retrospect, I should have reported it to the physician, and had it changed to something else. Interview with the Director of Nurses on March 6, 2014, at 12:10 p.m., in the conference room, confirmed the nurse violated the resident's rights. C/O", "filedate": "2017-03-01"}
{"rowid": 9464, "facility_name": "MILAN HEALTH CARE CENTER", "facility_id": 445349, "address": "8060 STINSON ROAD", "city": "MILAN", "state": "TN", "zip": 38358, "inspection_date": "2015-08-21", "deficiency_tag": 155, "scope_severity": "F", "complaint": 0, "standard": 1, "eventid": "NSR011", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of the facility's list of staff certified in Cardiopulmonary Resuscitation (CPR), record review and interview, the facility failed to ensure CPR certified staff were available on the 11 PM to 7 AM shifts for 12 of 30 days in [DATE] of 31 days in [DATE] and 12 of 31 days in [DATE]. The findings included: Review of the CPR Certified Staff by Shift list provided to the surveyor had one nurse listed under the 3rd Shift. Review of the list of the facility staff certified in CPR and the schedule revealed there was no one certified in CPR scheduled to cover the 11 PM to 7 AM shift for [DATE], 7, 8, 9, 10, 11 and 12, 2015, for [DATE], 5, 9, 12, 17, 18, 23, 24, 29 and 30, 2015 and for [DATE], 5, 6, 10, 11, 16, 17, 22, 23, 28 and 29, 2015. Interview with the Assistant Director of Nursing (ADON) on [DATE] at 12:35 PM, in the dining room, the ADON was asked how many nurses work 11 PM to 7 AM. The ADON stated, The only nurses who work 11 to 7 are (named Licensed Practical Nurse (LPN) #2) (she) works split shifts, two 3 PM to 11 PM shifts, then works two 11 PM to 7 AM shifts. We only have one nurse on 11 to 7. Interview with the Director of Nursing (DON) on [DATE] at 2:34 PM, in the conference room, the DON was asked whether any CPR certified person was present when named LPN #1 was off. The DON stated, We don't right now, we just found that out yesterday. We are now working on that real hard and going to have a certified nurse here when (named LPN #1) is not.", "filedate": "2016-12-01"}
{"rowid": 9896, "facility_name": "ASBURY PLACE AT MARYVILLE", "facility_id": 445017, "address": "2648 SEVIERVILLE RD", "city": "MARYVILLE", "state": "TN", "zip": 37804, "inspection_date": "2013-09-20", "deficiency_tag": 155, "scope_severity": "D", "complaint": 1, "standard": 0, "eventid": "Y2MX11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of the facility's Resident's Rights, medical record review, review of a facility investigation, and interview, the facility failed to permit a resident to refuse treatment for one resident (#1) of eight sampled residents. The findings included: Review of the facility's Resident's Rights provided by the Director of Nursing (DON) on September 13, 2013, revealed, .Each resident has at least the following rights .To refuse treatment. The resident must be informed of the consequences of that decision. The refusal and its reason must be reported to the physician and documented in the resident's file . Medical record review revealed Resident #1 was readmitted to the facility on [DATE], and [DIAGNOSES REDACTED]. Medical record review of a Minimum Data Set, dated dated dated [DATE], revealed the resident's cognition was intact and the resident required total assistance with bed mobility, transfers, dressing, and hygiene. Medical record review of a physician's orders [REDACTED].DC PO (discontinue oral) [MEDICATION NAME] - refuses to take. [MEDICATION NAME] 9.75 mg IM (milligrams intramuscular) for acute [MEDICAL CONDITION] repeat in 2 hrs prn (hours as needed) .Maximum 30 mg daily . Medical record review of a nurse's note dated February 14, 2013, at 4:00 p.m., revealed, .c/o (complained of) chest pain. Called (Medical Doctor - M.D. #1) and adv (advised) of complaints. (M.D. #1) .stated to give PRN dose of [MEDICATION NAME] IM. Adv (advised) had been refusing meds (medications) daily .' IM injection given in L (left) thigh. Medical record review of the next nurse's note dated February 14, 2013, at 6:30 p.m., revealed no documentation regarding refusal of the medication, informing the patient of the consequences of the decision to refuse, and/or notification of the physician of the patient's refusal prior to the injection. Continued review revealed, Follow-up from injection. Calm . Review of a witness statement (Director of Nursing's) in the facility's investigation dated February 15, 2013, revealed, I spoke with (resident) per telephone about .(7:00 p.m.) .informed me (resident) was upset about something that happened yesterday .(M.D. #1) .had the nurse give .injection of [MEDICATION NAME] last night and that (resident) did not want the medication .was given to (resident) by the nurse (Licensed Practical Nurse - LPN #1) and (Registered Nurse - RN#1) made the nurse give it . Telephone interview with LPN #1 on September 17, 2013, at 10:00 a.m., revealed LPN #1 administered the injection on February 14, 2013, and LPN #1 stated, .I called (M.D. #1) .(M.D. #1) said to give injection of [MEDICATION NAME] .(RN #1) and I went in there. (Resident) refused. (RN #1) told me to put it in the top of (resident's) leg .I let .somebody talk me into doing something I knew was wrong. Interview with the DON on September 17, 2013, at 3:00 p.m., in the facility's family room, revealed she learned of the patient's refusal of the injection from the patient on February 15, 2013. She stated, .violated patient's rights. C/O: #", "filedate": "2016-09-01"}
{"rowid": 9955, "facility_name": "PRINCETON TRANS CARE AT NORTH", "facility_id": 445356, "address": "400 NORTH STATE OF FRANKLIN ROAD", "city": "JOHNSON CITY", "state": "TN", "zip": 37601, "inspection_date": "2013-03-20", "deficiency_tag": 155, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "5KH511", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and interview the facility failed to complete a Physician order [REDACTED].#3, #5, #7) of eleven residents reviewed. The findings included: Resident # 3 was admitted on [DATE], with [DIAGNOSES REDACTED]. Review of the physician's orders [REDACTED]. Review of the medical record revealed the POST Form had not been completed. Interview with Registered Nurse (RN #1) on March 18, 2013, at 3:30 p.m., at the nursing station, confirmed the POST had not been completed. Resident # 7 was admitted on [DATE], with [DIAGNOSES REDACTED]. Review of the physician's orders [REDACTED]. Review of the medical record revealed the POST had not been completed. Interview with RN #1 on March 19, 2013, at 1:00 p.m., at the nursing station, confirmed the POST had not been completed. Resident # 5 was admitted on [DATE], with [DIAGNOSES REDACTED]. Review of the physician's orders [REDACTED]. Review of the medical record revealed the POST had not been completed. Interview with the Director of Nursing at the nursing station on March 19, 2013, at 11:30 a.m., verified the POST had not been executed for resident #5. Interview continued and revealed the facility did not have a policy and procedure in place to ensure residents who transferred from a hospital without a POST had one executed.", "filedate": "2016-09-01"}
{"rowid": 10137, "facility_name": "WESTMORELAND HEALTH AND REHABILITATION CENTER", "facility_id": 445114, "address": "5837 LYONS VIEW PIKE", "city": "KNOXVILLE", "state": "TN", "zip": 37919, "inspection_date": "2013-08-06", "deficiency_tag": 155, "scope_severity": "D", "complaint": 1, "standard": 0, "eventid": "MCPM11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and interview, the facility failed to assist three residents (#1, #3, #5) in securing an advance directive for end of life decisions of five residents reviewed. The findings included: Resident #1 was admitted to the facility on [DATE], with [DIAGNOSES REDACTED]. Medical record review revealed a Physician order [REDACTED]. The POST document was executed on March 22, 2013, by a hospital Physician, five days prior to admission to the facility. The Physician's signature was not accompanied by the patient's and/or a surrogate's signature as required. Interview with the Director of Nursing on August 1, 2013, at 2:30 p.m., in the education room, confirmed the facility had failed to assist the resident during their thirty-eight day length of stay to secure a valid advanced directive. Resident #3 was admitted to the facility on [DATE], with [DIAGNOSES REDACTED]. Medical record review revealed a POST document placed in the front of the resident's medical record. Review of the POS [REDACTED]. The POST documented this as the patient's preference as discussed with the patient. The document was not signed by the patient/resident. The document was signed only by the resident's niece. The document did not contain the mandatory Physician and patient signatures for the DNR to be in effect. Interview with resident #3 on August 1, 2013, at 9:50 a.m., in their room, revealed an alert and oriented resident able to share pertinent details of their medical history, family dynamics, and goal to return home. Interview with the director of Nursing on August 5, 2013, at 3:30 p.m., in the education room, confirmed the facility had not assisted the resident in securing a valid advanced directive. Resident #5 was readmitted to the facility on [DATE], with [DIAGNOSES REDACTED]. Interview with resident #5 on August 5, 2013, at 8:20 a.m., in their room, revealed an alert resident able to share details about breakfast, but not willing to talk about the past, specifically about previous roommates at the facility. Medical record review revealed a POST document placed in the front of the resident's medical record. Review of the POS [REDACTED]. The POST documented this as the patient's preference and as discussed with the patient. The document was signed by the patient/resident and a facility employee. The POST document did not reflect the Physician had discussed this with the resident and did not contain the mandatory physician signature for the DNR to be in effect. Review of the resident's Care Plan revealed a Registered Nurse documented the resident's Advanced Directives had been reviewed on July 1, 2013. Interview with the Director of Nursing on August 5, 2013, at 3:30 p.m., in the education room, confirmed the facility had not assisted the resident in securing a valid advanced directive. C/O #", "filedate": "2016-07-01"}
{"rowid": 10790, "facility_name": "BLEDSOE COUNTY NURSING HOME", "facility_id": 4.4e+233, "address": "107 WHEELERTOWN AVENUE", "city": "PIKEVILLE", "state": "TN", "zip": 37367, "inspection_date": "2012-09-26", "deficiency_tag": 155, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "L8M811", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and interview, the facility failed to respect the resident's right to refuse treatment for one resident (#38) of twenty-four residents reviewed. The findings included: Resident #38 was admitted to the facility on [DATE], with [DIAGNOSES REDACTED]. Review of the Quarterly Minimum Data Set, dated dated dated [DATE], revealed the resident had no cognitive impairment and was totally dependent on staff for toileting and bathing. Medical record review of the Care Plan dated September 25, 2009, and updated quarterly revealed, .Resident is extensive to total dependent for all ADL's (Activities of Daily Living) .Verbally prompt resident to perform self-care and make choices as much as possible . Medical record review of the Licensed Nurses Notes dated July 10, 2012, revealed, .Was informed by CNAs that resident had refused to weighed (sp) for the month .After speaking (with) social services and care plan coordinator this charge nurse and another charge nurse informed resident that (resident) couldn't refuse to be weighed . Interview with the Director of Nursing (DON) on September 25, 2012, at 1:30 p.m., in the Chapel, confirmed the facility told the resident the resident could not refuse to be weighed and the facility had failed to respect the resident's right to refuse.", "filedate": "2016-05-01"}
{"rowid": 11753, "facility_name": "NHC HEALTHCARE, SMITHVILLE", "facility_id": 445116, "address": "825 FISHER AVE P O BOX 549", "city": "SMITHVILLE", "state": "TN", "zip": 37166, "inspection_date": "2011-12-06", "deficiency_tag": 155, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "SU4211", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation, and interview, the facility failed to honor a resident's right to refuse treatment for one resident (#5) of twenty-eight residents reviewed. The findings included: Resident #5 was admitted to the facility on [DATE], with [DIAGNOSES REDACTED]. Medical record view of the Minimum Data Set (MDS) dated [DATE], revealed the resident scored 14 out of 15 on the Brief Interview for Mental Status (BIMS-no cognitive impairment) and required extensive assistance with eating. Medical record review of a physician's orders [REDACTED]. Medical record review of a nurses' note dated November 29, 2011, revealed .patient complains X2 (times two) days of not receiving snacks patient reminded of diet order. Medical record review of a nurses' note dated December 1, 2011, revealed .pt (patient) argumented (argumentative) about diet et (and) MD (Medical Doctor) order of 1800 calorie diet. Pt still continues to request snacks after dinner. Medical record review of a dietary progress note dated December 1, 2011, revealed Resident continuing to voice complaints about current diet order of 1800 cal or less diet/ Observation and interview with the resident on December 4, 2011, at 12:25 p.m., and 3:01 p.m., and December 5, 2011, at 9:55 a.m., and 11:25 a.m., in the resident's room, revealed the resident's physician ordered a reduced calorie diet because the resident was fat and had a fatty liver. Further interview revealed the resident understood the ordered diet but did not want to be on the ordered diet. Further interview revealed the resident had told the physician, the director of nursing (DON), and the dietician the resident did not want to be on the ordered diet, but the facility refused the resident's requests for any foods or snacks not within the ordered diet. Interview with Registered Nurse (RN) #3 on December 5, 2011, at 9:06 a.m., outside the resident's room, confirmed staff were not providing any snacks the resident requested. Interview with the Registered Dietician (RD) on December 5, 2011, at 10:20 a.m., in the 300 hall chart room, confirmed the RD was aware the resident did not want the ordered diet but the facility was following the physician's orders [REDACTED]. Interviews with the RD on December 5, 2011, at 10:20 a.m., in the 300 hall chart room, and the DON on December 5, 2011, at 10:31 a.m., in the DON office, confirmed the resident's right to refuse a physician's orders [REDACTED].", "filedate": "2015-11-01"}
{"rowid": 12691, "facility_name": "WEST HILLS HEALTH AND REHAB", "facility_id": 445501, "address": "6801 MIDDLEBROOK PIKE", "city": "KNOXVILLE", "state": "TN", "zip": 37919, "inspection_date": "2012-05-18", "deficiency_tag": 155, "scope_severity": "J", "complaint": 1, "standard": 0, "eventid": "LG2N11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, facility policy review, and interviews, the facility failed to follow advance directives to provide emergency resuscitation for one resident (#1) of twenty residents reviewed. The facility's failure resulted in Cardio-Pulmonary Resuscitation (CPR) not being initiated for at least five minutes after the resident was found without respirations, CPR being unsuccessful, and the resident was pronounced (officially diagnosed and declared) dead at 8:05 p.m. on [DATE]. The facility's failure resulted in an Immediate Jeopardy. The Administrator, the Corporate Nurse, and the Director of Nursing were informed of the Immediate Jeopardy in the Administrator's office, on [DATE], at 11:00 a.m. The findings included: Medical record review revealed Resident #1 was initially admitted to the facility on [DATE]. Review of a history and physical dated [DATE] revealed the resident had [DIAGNOSES REDACTED]. Further review of this history and physical revealed Resident #1 was a \"full code\" (has advance directives for resuscitation measures, if found without breath or pulse, which may include providing respirations, chest compressions, electrical shock, and medications). Review of Departmental Notes (computerized multi-disciplinary notes), dated [DATE], revealed the resident fell out of the bed, at approximately 11:50 p.m., and was transferred to the hospital. Further record review revealed the resident was readmitted to the facility on [DATE], following hospitalization for surgical repair of a left [MEDICAL CONDITION]. Review of the resident's Re-admission orders [REDACTED]. Review of physician's orders [REDACTED]. Review of the resident's Care Plan, dated [DATE], revealed, \"Advance Directive...Full Code...Resuscitate\". Review of facility Departmental Notes dated [DATE], at 7:35 p.m. revealed, \"...resident did not have signs of respirations or was a pulse palpated...\" Further review of the Departmental Notes revealed, \"7:40 p.m. Code was called and CPR was intiated...7:50 p.m. EMS (Emergency Medical Services) arrived...8:05 p.m. EMS called (discontinued resuscitation efforts) the code, and resident was pronounced at the facility.\" Review of undated policy titled, \"Code Arrest - Procedure and Protocol\", revealed, \"General Guidelines...First person on the scene will begin CPR and call for help. Continue until otherwise directed by physician or relieved.\" Interview with Certified Nursing Assistant (CNA) #1, on [DATE], at 1:40 p.m., in the Director of Nurses (DON) office, revealed CNA #1 walked by the first floor dining room at approximately 7:30 p.m. and observed Resident #1 sitting alone in a geri chair. Further interview revealed CNA #1 observed Resident #1's \"color looked bad\" and the resident was unresponsive when spoken to. CNA #1 stated...went to get a nurse and found Licensed Practical Nurse (LPN) #2 passing medication in the hallway. CNA #1 stated LPN #2 went to the resident, and sent CNA #1 to find another nurse (LPN #1). CNA #1 stated she was unable to find LPN #1, and returned to the dining room where LPN #2 was with the resident. CNA #1 stated the resident was still in the geri chair and no resuscitation was started. CNA #1 stated LPN #2 told...to take the resident to the resident's room. CNA #1 stated...took the resident to...room on the 200 hall, while LPN #2 went to find LPN #1. CNA #1 stated...did not know if the resident was breathing or not, but stated, \"it was the first time I found someone like that...I covered...face up with a blanket...\" CNA #1 stated the resident still remained in the geri chair and no resuscitation was started. CNA #1 stated she went out into the hall when LPN #1 and LPN #2 arrived. CNA #1 stated...waited in the hall for approximately 5 minutes (does not know exact time) when one of the nurses (does not remember which) came out of the resident's room and went to find Registered Nurse (RN) #1. CNA #1 stated the LPN returned with RN #1, there was no crash cart or resuscitation equipment taken into the room. CNA #1 stated ...then returned to the second floor and then clocked out at 7:42 p.m. Interview with RN #1, on [DATE], at 2:07 p.m., in the DON's office revealed RN #1 was working in the treatment nurse's office on the evening of [DATE]. RN#1 stated LPN #2 came to office at approximately 7:30 p.m. (does not know exact time). RN#1 stated LPN #2, \"told me that I needed to pronounce (Resident #1)...was not breathing\". RN #1 stated...went to the resident's room and found the resident in a geri-chair with LPN #1 in the room. RN #1 stated there were no efforts being made to resuscitate the resident. RN #1 stated the resident did not have any respirations or pulse, and the resident's pupils were fixed (unmoving and un-reactive to light). RN #1 stated, \"I was under the assumption she was a DNR (advance directive to not attempt resuscitation)\". RN #1 stated...went to the nurse's station and called the resident's family, does not know the time this occurred. RN #1 stated...told the son the resident had expired. RN #1 stated LPN #1 interrupted the phone conversation, and RN #1 handed the telephone to LPN #1, and looked at the resident's medical record with LPN #2. RN #1 stated the medical record stated the resident was a full code. RN #1 stated the DON was called, and staff took the crash cart (wheeled cart with resuscitation equipment) to the resident's room, and began Cardio-Pulmonary Resuscitation (CPR). RN #1 stated residents that are full code status are to have CPR immediately when found in Cardio-Pulmonary arrest (no pulse or respirations). RN #1 stated CPR was continued by EMS until the resident was pronounced dead by EMS (time unknown by RN #1). Interview with LPN #2, on [DATE], at 11:25 a.m., in the DON's office revealed LPN #2 was working on the first floor on [DATE]. LPN #2 stated...was at the end of 400 hall when CNA #1 called Resident #1's name. LPN #2 stated...recognized something was wrong by the sound of CNA #1's voice. LPN #2 stated...did not know what time this occurred. LPN #2 stated \"I secured my medicine cart and started walking that way\". LPN #2 stated CNA #1 called out that LPN #2 needed to \"come in here\". LPN #2 stated the resident was sitting in geri-chair in dining room. LPN #2 stated, \"...was not breathing. I thought...had passed away...eyes were fixed...skin was cool to touch...\" LPN #2 stated...told CNA #1 to take the resident to...room and remove the room-mate. LPN #2 stated...went to find LPN #1, who was on the 300 hall. LPN #2 stated, \"I told...was not looking good\". LPN #2 stated they assessed Resident #1 in the resident's room and found no breath or pulse. LPN #2 stated no resuscitation efforts were made. LPN #2 stated...left LPN #1 with the resident and went to find RN #1. LPN #2 stated...notified RN #1 and they headed back to the resident's room. LPN #2 stated \"I found out...was a full code...(from LPN #1 at the nurse's station)...and RN #1 took the crash cart to the resident's room and began CPR and attached the Automatic External Defibrillator (AED, a device that delivers a stimulating shock to the patient's heart).\" Interview with LPN #1, on [DATE], at 12:49 p.m., in the DON's office revealed LPN #1 was the nurse assigned to Resident #1 on [DATE]. LPN #1 stated...was passing medications on the 300 hall, at approximately 7:35 p.m. (does not know exact time), when LPN #2 stated, \"come check...something is wrong...\". LPN #1 stated they went to the resident's room, where the resident was in a geri-chair. LPN #1 stated, \"...color was grey, not good ...did not appear that...was breathing...\" LPN #1 also stated, \"my assessment was that...had no pulse or respirations...had expired\". LPN #1 stated LPN #2 went to get RN #1 to \"assess\" the resident. LPN #1 stated, \"I thought...was a DNR\". LPN #1 stated...went to check the chart, at the nurse's station, and found the resident was a \"full code\". LPN #1 stated RN#1 and LPN #2 had just arrived at the nurses station, and...told RN #1 that the resident was a full code. LPN #1 stated RN #1 and LPN #2 took the crash cart to the resident's room to begin CPR. LPN #1 stated...stayed at the nurse's station. Interview with the DON, on [DATE], at 5:00 p.m., in the DON's office, confirmed residents with advance directives for a full code, are to have CPR intiated immediately when found without breath or pulse. In summary, the facility failed to immediately provide CPR for Resident #1, when the resident was found without breath or pulse on [DATE]. The facility failed to honor the resident's advance directive for a full code, and CPR was not initiated for at least five minutes. The CPR was unsuccessful and the resident expired at 8:05 p.m., on [DATE]. The Immediate Jeopardy was effective from [DATE] to [DATE]. An Acceptable Allegation of Compliance, which removed the immediacy of the jeopardy, was received and corrective actions were validated by the surveyor through review of documents, staff interviews, and observations conducted onsite on [DATE]. The surveyor verified the allegation of compliance by: 1. Reviewing the Inservices on resuscitation policy and procedures titled \"Code Arrest\" provided to staff from [DATE] to [DATE]. 2. Verified that 100% of the current medical records had been audited and reorganized to place the advance directives document (POST form) immediately inside the front cover of the record. 3. Conducted interviews with all nurses present in the facility to verify 100% had been inserviced and were oriented to the Code Arrest policy and procedure. All nurses knew where to find the resident's advance directives. 4. Interviewed the DON and the Staff Development Coordinator to verify the content of the Inservices and that 100% of staff had been inserviced on the Code Arrest policy and procedure. 5. Interviewed 100% of Certified Nursing Assistants (CNA) working and verified all had been inserviced and knew how to respond to a resident found without breath or pulse. 6. Interviewed the Medical Records Supervisor and confirmed 100% of records had been audited and the advance directives/POST form was correct and on the front of the record. Also confirmed the Medical Records Supervisor will continue to audit the records for three months to confirm compliance. 7. Interview with the Social Worker verified each resident's advance directives will be audited at least quarterly to ensure the document is accurate. Non-compliance continues at a \"D\" level for monitoring of corrective actions. The facility is required to submit a plan of correction.", "filedate": "2015-08-01"}
{"rowid": 13154, "facility_name": "BLEDSOE COUNTY NURSING HOME", "facility_id": 4.4e+233, "address": "107 WHEELERTOWN AVENUE", "city": "PIKEVILLE", "state": "TN", "zip": 37367, "inspection_date": "2011-03-24", "deficiency_tag": 155, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "TG1H11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and interview, the facility failed to obtain advanced directive information for one resident (#8) of fifteen residents reviewed. The findings included: Resident #8 was admitted to the facility on [DATE], and readmitted on [DATE], with [DIAGNOSES REDACTED]. Medical record review of the Minimum Data Set (MDS) dated [DATE], revealed the resident was a DNR (Do Not Resuscitate) status. Medical record review of the MDS dated [DATE], revealed the resident's Brief Interview for Mental Status (cognitive status) was one out of fifteen (fifteen being highest cognitive status). Medical record review of the Social Services notes from admission to the present revealed no documentation of addressing advanced directive information with a responsible party. Medical record review of the Patient Care Plan review dated [DATE], [DATE], [DATE], and [DATE], revealed the resident's \"...Code status: DNR...or NO CPR...\" Interview, with the Social Worker on [DATE], at 9:50 a.m. and 3:15 p.m., in the Social Worker's office, confirmed the social worker failed to obtain the Physician order [REDACTED]. Further interview confirmed the social worker failed to periodically check the advanced directive status of the resident. Further interview revealed the responsible party was contacted and confirmed the DNR status was appropriate.", "filedate": "2015-05-01"}
{"rowid": 1447, "facility_name": "AHC CUMBERLAND", "facility_id": 445262, "address": "4343 ASHLAND CITY HIGHWAY", "city": "NASHVILLE", "state": "TN", "zip": 37218, "inspection_date": "2017-03-09", "deficiency_tag": 156, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "955Y11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview the facility failed to provide appropriate Advanced Beneficiary Notices (ABN) for 3 of 3 (#14, 29, and 40) sampled residents reviewed for liability and appeal notices. The findings included: 1. The facility was unable to provide an advanced beneficiary notice for Resident #14, 29 and 40. Interview with the Administrator on 3/8/17 at 11:30 AM, in the Administrator's office, the Administrator was asked about the ABNs that were requested for Resident #14, 29, and 40. The Administrator stated .what happened the Business office coordinator started on [DATE]th (2016) and she wasn't aware she was supposed to be doing the ABN's. She was told later . The Administrator was asked if he expected the ABN's to be completed. The Administrator stated, Yes, absolutely .", "filedate": "2020-09-01"}
{"rowid": 1585, "facility_name": "CAMDEN HEALTHCARE & REHAB CENTER", "facility_id": 445274, "address": "197 HOSPITAL DRIVE", "city": "CAMDEN", "state": "TN", "zip": 38320, "inspection_date": "2017-09-27", "deficiency_tag": 156, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "EUZQ11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on policy review, medical record review and interview, the facility failed to provide appropriate liability and appeal notices for 2 of 3 (Resident #10 and 11) sampled residents reviewed for liability and appeal notices. The findings included: 1. The facility's Resident Beneficiary Notice(s) policy documented, .Skilled Nursing Facility (SNF) .required to provide a NOMNC (Notice of Medicare Non-Coverage) to beneficiaries when their Medicare covered service(s) are ending . 2. Medical record review revealed Resident #10 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Resident #10's NOMNC documented, .The Effective Date Coverage of Your Current: Skilled Nursing Services Will End .May 11, (YEAR) . There was no documentation that Resident #10 or the family acknowledged that they had been notified prior to the end of the coverage date of 5/11/17. 3. Medical record review revealed Resident #11 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Resident #11's NOMNC documented, .The Effective Date Coverage of Your Current: Skilled Nursing Services Will End .May 14, (YEAR) . There was no documentation that Resident #11 or the family acknowledged that they had been notified prior to the end of the coverage date of 5/14/17. 4. Interview with the Minimum Data Set (MDS) Coordinator on 9/26/17 at 10:05 AM, in the conference room, the MDS Coordinator was asked if certified letters had been sent related to Resident #10 and 11's Medicare covered services ending. The MDS Coordinator confirmed that no one had signed the notifications and no certified letters had been sent.", "filedate": "2020-09-01"}
{"rowid": 2736, "facility_name": "MISSION CONVALESCENT HOME", "facility_id": 445447, "address": "118 GLASS ST", "city": "JACKSON", "state": "TN", "zip": 38301, "inspection_date": "2017-11-21", "deficiency_tag": 156, "scope_severity": "C", "complaint": 0, "standard": 1, "eventid": "CXGX11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on policy review, medical record review, and interview, the facility failed to provide appropriate liability and appeal notices for 3 of 3 (Resident #16, 28, and 44) sampled residents reviewed for liability and appeal notices. The findings included: 1. The facility's Form Instructions for the Notice of Medicare Non-Coverage . policy documented, .A Medicare provider .must deliver a completed copy of the Notice of Medicare Non-Coverage (NOMNC) to beneficiaries/enrollees receiving skilled nursing .services .The NOMNC must be delivered at least two calendar days before Medicare covered services end or the second to last day of service of care is not being provided daily .The provider must ensure that the beneficiary or representative signs and dates the NOMNC to demonstrate that the beneficiary or representative received the notice and understands that the termination decision can be disputed . 2. Medical record review revealed Resident #16 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. The Skilled Nursing Facility Advance Beneficiary Notice (SNFABN) documented, .The effective date coverage of your current Medicare Part A Service will end: 7-19-17 . There was no signature of the resident or resident representative indicating advance notice was provided. The Discharge Summary documented a discharge date of [DATE]. 3. Medical record review revealed Resident #28 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. The NOTICE OF MEDICARE NON-COVERAGE form documented, .THE EFFECTIVE DATE COVERAGE OF YOUR CURRENT .Skilled Rehab (Rehabilitation) .SERVICES WILL END: 9-15-17 . There was no signature of the resident or resident representative indicating advance notice was provided. Resident #28 was still residing at the facility, 4. Medical record review revealed Resident #44 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. The Skilled Nursing Facility Advance Beneficiary Notice (SNFABN) documented, .The effective date coverage of your current Medicare Part A Service will end: 6-11-17 . There was no signature of the resident or resident representative indicating advance notice was provided. The Discharge Summary documented a discharge date of [DATE]. Interview with the Minimum Data Set (MDS) Coordinator on 11/21/17 at 11:11 AM, in the Activities Room, the MDS Coordinator was asked whether anyone signed for notification of end of medicare services for Resident #16, 28, or 44. The MDS Coordinator stated, I just mail those out to the RP (Responsible Party), and I ask them to bring it back in to me. Most of the time they don't. The MDS Coordinator was asked whether he documented when he mailed the notices. The MDS Coordinator stated, No . The MDS Coordinator was asked if he sent the notices by certified mail. The MDS Coordinator stated, No . The facility was unable to provide evidence that advanced notice was provided for Resident #16, #28, and #44 before the ending of Medicare-covered services.", "filedate": "2020-09-01"}
{"rowid": 2920, "facility_name": "HENDERSON HEALTH AND REHABILITATION CENTER", "facility_id": 445471, "address": "412 JUANITA DRIVE", "city": "HENDERSON", "state": "TN", "zip": 38340, "inspection_date": "2017-06-22", "deficiency_tag": 156, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "PPF211", "inspection_text": "Based on Advance Beneficiary Notice of Noncoverage (ABN) form review and interview, the facility failed to provide the appropriate liability and appeal notice for 1 of 3 (Resident #16) sampled residents reviewed for liability and appeal notices. The finding included: The ABN form for Resident #16 documented, The Effective Date Coverage of Your Current Skilled Rehab (rehabilitation) Services Will End: (MONTH) 10, (YEAR) .have been notified that coverage of my services will end on the effective date indicated on this notice .Signature of Patient or Representative .verbal by phone .Date .5/10/17 . Interview with the Administrator on 6/22/17 at 10:53 AM, in the Administrator's office, the Administrator was asked for a policy regarding ABN's. The Administrator stated, We do not have a policy .it's a 3 day notification . Interview with the Assistant Social Services Director on 6/22/17 at 11:00 AM, in the Administrator's office, the Assistant Social Services Director stated, .had attempted to call (Resident #16's) grandson 3 days prior to services ending, with no answer .I did not document the attempt to notify .", "filedate": "2020-09-01"}
{"rowid": 3640, "facility_name": "PALMYRA HEALTH AND REHABILITATION", "facility_id": 445184, "address": "2727 PALMYRA RD", "city": "PALMYRA", "state": "TN", "zip": 37142, "inspection_date": "2017-05-25", "deficiency_tag": 156, "scope_severity": "C", "complaint": 0, "standard": 1, "eventid": "K3HH11", "inspection_text": "Based on medical record review and interview, the facility failed to provide appropriate liability and appeal notices for 3 of 3 (Resident #8,17 and 28) sampled residents reviewed for liability and appeal notices. The findings included: Medical record review revealed Resident #8 had a therapy end date of 5/7/17 with a documented telephone notification on 5/4/17. The facility was unable to provide documentation that the liability notice had been mailed to Resident #8's responsible party (RP). Medical record review revealed Resident #17 had a therapy end date of 2/10/17 with a documented telephone notification on 2/5/17. The facility was unable to provide documentation that the liability notice had been mailed to Resident #17's responsible party. Medical record review revealed Resident #28 had a therapy end date of 3/13/17 with a documented telephone notification on 3/7/17. The facility was unable to provide documentation that the liability notice had been mailed to Resident #28's responsible party. Interview with the Business Office Manager on 5/23/17 at 4:26 PM, in the conference room, the Business Office Manager stated, I failed to tell you that we did not send letters to those family members. The Business Office Manager was asked if she could provide any proof that the letters were sent. The Business Office Manager stated, No ma'am they were never sent. Interview with the Administrator on 5/23/27 at 4:45 PM, in the conference room, the Administrator stated, .no letters were mailed out . Interview with the Social Services Director on 5/23/17 at 5:48 PM, in the Administrator's office, the Social Services Director was asked if Resident #28 was his own patient representative because his notification letter stated he refused to sign. The Social Services Director stated, No his ex-wife is his RP. The Social Services Director was asked if Resident #28's RP should have been the person receiving the liability appeal letter. The Social Services Director stated, Yes.", "filedate": "2020-04-01"}
{"rowid": 3673, "facility_name": "GREEN HILLS CENTER FOR REHABILITATION AND HEALING", "facility_id": 445267, "address": "3939 HILLSBORO CIRCLE", "city": "NASHVILLE", "state": "TN", "zip": 37215, "inspection_date": "2016-11-09", "deficiency_tag": 156, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "65VV11", "inspection_text": "Based on policy review, medical record review and interview the facility failed to provide the appropriate liability and appeal notice to 2 of 3 (Resident # 144 and 149) sampled residents reviewed for liability and appeal notices. The findings included: 1. The facility's Medicare Letters of Non-Coverage policy documented, Medicare letters of non-coverage are used to notify the resident of Medicare non-coverage at the time of admission, or of termination of benefits prior to discontinuation of either covered Medicare Part A stay or Medicare Part B Therapies .Notice Requirements .All remaining notices are delivered to the resident or responsible party a minimum of two (2) days prior to the last covered day .If unable to personally deliver the CMS required forms to the Resident or Responsible Party, Social Services (or Rehab Program Manger) must telephone the Responsible Party to notify them of the last covered day and the expedited review process .The call must be documented on all notices .Information must include name of caller, person contacted, date and time of call and telephone number All notices must be mailed to the Responsible Party the same day of the call. Please include two copies, one for their records and one to sign and return .If unable to reach the Responsible Party by telephone, the notices must be sent via certified mail, return receipt requested .Copies of all signed notices are maintained in the resident's financial file . 2. The .Notice of Medicare Non-Coverage form for Resident #144 documented, .The Effective Date Coverage of Your Current Skilled Nursing Services Will End: 6/20/16 . A handwritten note on the bottom of the notice documented, 6/17/16 - Tried to contact (named Resident #144's responsible party), daughter .Call was unanswered . 3. The .Notice of Medicare Non-Coverage form for Resident #149 documented, .The Effective Date Coverage of Your Current Skilled Nursing Services Will End: Nov. 8, (YEAR) . A handwritten note on the bottom of the notice documented, .11/7/16 .Contacted (named Resident #149's responsible party) .did not answer .left message . Interview with the Business Office Director (BOD), on 11/8/16 at 2:50 PM, in the BOD's office, the BOD was asked if they had proof, such as a letter or certified notice stating the residents or families were notified of the Notice of Medicare Non-Coverage. The BOD stated, So is that what we are supposed to do .is the documentation that we left a message not enough? The BOD was asked how they could be certain the person received the message. The BOD confirmed that they could not. The BOD was asked again if she had proof the residents or their families were notified of the date of Non-Coverage. The BOD stated, I'm sorry, I wish we did .", "filedate": "2020-04-01"}
{"rowid": 3930, "facility_name": "COUNTRYSIDE HEALTHCARE AND REHABILITATION", "facility_id": 445280, "address": "3051 BUFFALO ROAD", "city": "LAWRENCEBURG", "state": "TN", "zip": 38464, "inspection_date": "2017-02-08", "deficiency_tag": 156, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "2N4U11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on policy review, medical record review and interview, the facility failed to provide appropriate liability and appeal notices for 2 of 3 (Resident #25 and 97) sampled residents reviewed for liability and appeal notices. The findings included: 1. The facility's SNF (Skilled Nursing Facility) - Beneficiary Notice Requirements documented, .Situation .Part A Stay will end because: Provider determines that beneficiary no longer requires daily, skilled services .Beneficiary will not be receiving therapy or other part B services, resident will remain in facility (custodial) .Part A Stay will end because: Provider determines that beneficiary no longer requires daily skilled services, resident will be discharged home .Expedited Determination Notice(s) .CMS (Centers for Medicare/Medicaid) & (and) Part A & B .Part A Stay ends because: Resident has exhausted 100 days of SNF Part A coverage. (Technical Denial) .SNF NEMB (Notice of Exclusions from Medicare Benefits) or other type of notice (Voluntary) . 2. Medical record review revealed Resident #25 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. The A/R (Accounts Receivable) Type History for Resident #25 documented .Date of Change .10/03/2016 .A/R Type .MRA (Medicare) .Date of Change .10/19/2016 .A/R Type .MDN (Medicaid) . Interview with the Social Worker (SW) on 2/8/17 at 11:00 AM, in room [ROOM NUMBER], the SW was asked whether there was documentation that Resident #25 received advanced notice for the ending of covered Medicare services. The SW stated, His wife has a mental illness, so there was no way to have her sign. The SW was asked whether the resident was capable to sign. The SW stated, No. The SW was asked who was Resident #25's Responsible Party. The SW stated, .He did not sign a cut letter, no. 3. Medical record review revealed Resident #97 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Resident #97's Notice of Medicare Non-Coverage documented, .The Effective Date Coverage of Your Current: SKILLED NURSING Services Will End: 1/6/17 .Signature of Patient or Representative .1/6/17 . Interview with the Business Office Manager (BOM) on 2/8/17 at 11:30 AM, in room [ROOM NUMBER], the BOM was asked how much advanced notice the facility should give when Medicare-covered services ended. The BOM stated, .3 days . No documentation was provided that Resident #97 or the family had been notified prior to the end of coverage date of 1/6/17. The facility was unable to provide evidence that advanced notice was provided for Resident #25 and Resident #97 before the ending of Medicare-covered services.", "filedate": "2020-01-01"}
{"rowid": 4175, "facility_name": "LEWIS COUNTY NURSING AND REHABILITATION CENTER", "facility_id": 445430, "address": "119 KITTRELL ST, PO BOX 129", "city": "HOHENWALD", "state": "TN", "zip": 38462, "inspection_date": "2017-01-19", "deficiency_tag": 156, "scope_severity": "C", "complaint": 0, "standard": 1, "eventid": "ZHG411", "inspection_text": "Based on record review and interview, the facility failed to provide the appropriate liability and appeal for 1 of 4 (Resident #74) sampled residents reviewed for liability and appeal notices. The findings included: Review of the advanced beneficiary notices on 1/20/17 at 6:40 PM, in the Admissions Office, the facility was unable to provide an advanced beneficiary notice for Resident #74. Interview with the Social Services Director (SSD), on 1/18/17 at 6:48 PM, in the Admissions Office, the SSD stated, .I couldn't find the letter (advanced beneficiary letter) for (Named resident) .I think she went long term care .I dropped the ball on it .she had additional days left .", "filedate": "2019-11-01"}
{"rowid": 4653, "facility_name": "WHITEHAVEN COMMUNITY LIVING CENTER", "facility_id": 445233, "address": "1076 CHAMBLISS ROAD", "city": "MEMPHIS", "state": "TN", "zip": 38116, "inspection_date": "2016-06-28", "deficiency_tag": 156, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "N42U11", "inspection_text": "Based on review of a Survey and Certification Letter, record review and interview, the facility failed to provide the appropriate liability and appeal notice to 1 of 2 (Residents #64) sampled residents reviewed for liability and appeal notices. The findings included: The Survey and Certification Letter Ref (reference): S&C (Survey and Certification) - 09-20 dated 1/9/09 documented, .Notice Delivery to Representatives . Providers are required to develop procedures to use when the beneficiary is incapable . and the provider cannot obtain the signature of the beneficiary's representative through direct personal contact . provider should telephone the representative . Confirm telephone contact by written notice mailed on that same date . The .Notice of Medicare Non-Coverage form for Resident #64 documented, .The Effective Date Coverage of Your Current OT (Occupational Therapy) Services Will End: 5/17/16 . Interview with the Business Office Manager (BOM) on 6/16/16 at 4:45 PM in the conference room, the BOM confirmed that she did not have documentation that the responsible party was notified in writing of the end of coverage.", "filedate": "2019-08-01"}
{"rowid": 4902, "facility_name": "NHC-MAURY REGIONAL TRANSITIONAL CARE CENTER", "facility_id": 445030, "address": "5010 TROTWOOD AVE", "city": "COLUMBIA", "state": "TN", "zip": 38401, "inspection_date": "2016-06-09", "deficiency_tag": 156, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "C1XT11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of Notice of Medicare Non-Coverage forms, resident council meeting minutes, medical record review and interview, the facility failed to provide the appropriate liability and appeal notice to 2 of 3 (Residents #26 and 121) sampled residents reviewed for liability and appeal notices, and the facility failed to inform residents of ombudsman information during resident council meetings. The findings included: 1. The Notice of Medicare Non-Coverage form for Resident #26 documented, .The Effective Date Coverage of Your Current Skilled Rehab Therapy Services Will End: 3/9/2016 . The facility was unable to provide any documentation that contact was confirmed by written notice as required. 2. The Notice of Medicare Non-Coverage form for Resident #31 documented, .The Effective Date Coverage of Your Current Skilled Rehab Therapy Services Will End: 05/16/16 . The facility was unable to provide any documentation that contact was confirmed by written notice as required. 3. In an interview with the Social Worker (SW) on 6/9/16 at 11:10 AM, in the conference room, the SW was shown Resident #26 and 121's liability and appeal notices and the SW confirmed they had not been signed. The SW was asked how would she show that the residents had been informed. The SW stated, .I wouldn't . 4. Review of the monthly resident council meeting minutes dated (MONTH) through May, (YEAR) did not reflect any discussion of ombudsman information, where the information was posted or who the ombudsman was. 5. Medical record review revealed Resident #121 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. A quarterly MDS dated [DATE] revealed a BIMS score of 14 which indicated no cognitive impairment. In an interview with Resident #121 on 6/9/16 at 9:18 AM, in Resident #121's room, she was asked are you familiar with where the ombudsman information is posted. Resident #121 stated, No ma'am. Resident #121 was asked are you familiar with the ombudsman? Resident #121 stated, No ma'am.", "filedate": "2019-06-01"}
{"rowid": 4914, "facility_name": "NHC HEALTHCARE, SOMERVILLE", "facility_id": 445119, "address": "308 LAKE DRIVE, PO BOX 550", "city": "SOMERVILLE", "state": "TN", "zip": 38068, "inspection_date": "2016-04-20", "deficiency_tag": 156, "scope_severity": "C", "complaint": 0, "standard": 1, "eventid": "750M11", "inspection_text": "Based on review of a Survey and Certification Letter, record review and interview, the facility failed to provide the appropriate liability and appeal notice to 3 of 3 (Residents #15, 59 and 87) sampled residents reviewed for liability and appeal notices. The findings included: 1. The Survey and Certification Letter Ref (reference): S&C (Survey and Certification) - 09-20 dated 1/9/09 documented, .Notice Delivery to Representatives . Providers are required to develop procedures to use when the beneficiary is incapable . and the provider cannot obtain the signature of the beneficiary's representative through direct personal contact . provider should telephone the representative . Confirm telephone contact by written notice mailed on that same date . 2. The Notice of Medicare Non-Coverage form for Resident #15 documented, .The Effective Date Coverage of Your Current (Skilled Nursing & (and) Therapy) Services Will End: 1/19/16 . Telephone contact was made with the resident's responsible party on 1/14/16. The facility was unable to provide any documentation that the telephone contact was confirmed by written notice as required. 3. The Notice of Medicare Non-Coverage form for Resident #59 documented, .The Effective Date Coverage of Your Current (Skilled Nursing & Therapy) Services Will End: 11/6/2015 . Telephone contact was made with the resident's responsible party on 11/2/15. The facility was unable to provide any documentation that the telephone contact was confirmed by written notice as required. 4. The Notice of Medicare Non-Coverage form for Resident #87 documented, .The Effective Date Coverage of Your Current (Skilled Nursing & Therapy) Services Will End: 3/09/2016 . Telephone contact was made with the resident's responsible party on 3/4/16. The facility was unable to provide any documentation that the telephone contact was confirmed by written notice as required. 5. Interview with the Social Worker (SW) on 4/20/16 at 11:00 AM, in the Social Worker's office, the SW was asked if the date on the top of the page was the date she notified the legal representative of the end of their services for Resident #15, 59 and 87. The SW stated, Yes, I called them. The SW was then asked did she have any documentation that the Notice of Medicare Non-Coverage letters were mailed on the date of notice. The SW stated, No, I thought as long as I documented I talked to them then that was all I had to do.", "filedate": "2019-06-01"}
{"rowid": 5281, "facility_name": "LAUDERDALE COMMUNITY LIVING CENTER", "facility_id": 445354, "address": "215 LACKEY LANE", "city": "RIPLEY", "state": "TN", "zip": 38063, "inspection_date": "2017-05-05", "deficiency_tag": 156, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "QMFO11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on Advance Beneficiary Notice of Noncoverage (ABN) form review and interview the facility failed to provide the appropriate liability and appeal notice for 2 of 3 (Residents #2 and #6) sampled residents reviewed for liability and appeal notices. The findings included: 1. The facility did not have a policy regarding Advanced Beneficiary Notices (ABN) but provided a typed statement that documented, Lauderdale Community Living Center uses the guidelines set forth by Centers for Medicare & Medicaid Services for the completion of Advanced Beneficiary Notices. The facility supplied the survey team with a copy of Medicare Advance Beneficiary Notices from the .Centers for Medicare & (and) Medicaid Services which documented, .The ABN allows the beneficiary to make an informed decision about whether to get the item or service that may not be covered and accept financial responsibility if Medicare does not pay. If the beneficiary does not get written notice when it is required, he or she may not be held financially liable if Medicare denies payment, and you may be financially liable if Medicare does not pay . 2. The ABN form for Resident #2 did not document a date that skilled services would end. The form was signed by the resident's representative on [DATE]. 3. The ABN form for Resident #6 did not document a date that skilled services would end. The form was signed by the resident's representative on [DATE]. 4. Interview with the Minimum Data Set (MDS) Coordinator on [DATE] at 9:05 AM, in the Conference Room, the MDS Coordinator was shown the ABN forms for Residents #2 and #6 and was asked what day their coverage expired and if that date should be on the form that the resident or resident's representative signed. The MDS Coordinator stated, Absolutely .learned that yesterday .there was a form I didn't have .I know they have three days to appeal .I did learn that yesterday . The MDS Coordinator was unable to identify the date the coverage expired for Resident #2 and 6.", "filedate": "2019-04-01"}
{"rowid": 5474, "facility_name": "CLAIBORNE AND HUGHES HLTH CNTR", "facility_id": 445157, "address": "200 STRAHL STREET", "city": "FRANKLIN", "state": "TN", "zip": 37064, "inspection_date": "2015-08-27", "deficiency_tag": 156, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "66JE11", "inspection_text": "Based on record review and interview, the facility failed to provide a Notice of Medicare Non - Coverage for 1 of 3 (Resident #89) sampled resident and failed to provide completed information of a Notice of Medicate Non - Coverage for 2 of 3 (Residents #99 and #113) sampled residents reviewed for Notice of Medicare Non-Coverage. The findings included: 1. Resident #89 received Medicare A services from 5/11/15 to 6/5/15. The facility could not provide a Notice of Medicare Non-Coverage, a form that provides the information that the resident has the right to request a review of the Medicare A services the resident received from the Quality Improvement Organization (QIO). Interview with Administrative staff E on 8/27/15 at 12:17 PM, revealed the facility lacked evidence of a Notice of Medicare Non-Coverage for this resident. 2. Resident #99's Notice of Medicare Non - Coverage revealed the resident's Skilled Services would end on 5/19/15. The notice lacked the QIO's address and phone number. Interview with Administrative Staff E on 8/27/15 at 12:17 PM, confirmed the notice did not include the phone number or address of the QIO. 3. Resident #113's Notice of Medicare Non - Coverage revealed the resident's Skilled Services would end on 6/4/15. The notice lacked the QIO's address and phone number. Interview with Administrative Staff E on 827/15 at 12:17 PM, confirmed the notice did not include the phone number or address of the QIO. The facility failed to provide a Notice of Medicare Non-Coverage or a complete Notice of Medicare Non-Coverage.", "filedate": "2019-02-01"}
{"rowid": 5529, "facility_name": "CLARKSVILLE MANOR NURSING CENTER", "facility_id": 445455, "address": "900 PROFESSIONAL PARK DRIVE", "city": "CLARKSVILLE", "state": "TN", "zip": 37040, "inspection_date": "2015-11-05", "deficiency_tag": 156, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "4Z6811", "inspection_text": "Based on policy review, record review and interview, the facility failed to provide the appropriate liability and appeal notice to 3 of 3 (Residents #31, 41 and 51) sampled residents reviewed for liability and appeal notices. The findings included: 1. The facility's OTHER CMS (Centers for Medicare and Medicaid Services) REQUIREMENTS . policy documented, .Determination of Coverage (Cut Letters) . The patient and/or patient's responsible party must be notified in writing regarding the discharge from Part A and Part B services. The Determination of Coverage on Extended Stay (Cut Letters) and the Expedited Review, Generic Notice (CMS Form ) must be issued 3 days prior to patient discharge. The patient/family signature and date on this form should be a minimum of 3 business days prior to the discharge of services . 2. The Notice of Medicare Non-Coverage form for Resident #31 documented, .The Effective Date Coverage of Your Current Skilled Care Services Will End: 8-19-15 . The resident's responsible party signed and dated the form on 8/17/15. 3. The Notice of Medicare Non-Coverage form for Resident #41 documented, .The Effective Date Coverage of Your Current Skilled Care Services Will End: 6/25/15 . Telephone contact was made with the resident's responsible party on 6/17/15. The facility was unable to provide any documentation that the telephone contact was confirmed by written notice. 4. The Notice of Medicare Non-Coverage form for Resident #51 documented, .The Effective Date Coverage of Your Current Skilled Care Services Will End: 9/18/2015 . The patient signed the form on 9/17/15. The facility was not able to provide any documentation that any earlier notice was given. 5. Interview with the Social Services' Director (SSD) on 11/3/15 at 5:45 PM, in the SSD's office, the SSD was asked how much notice should be provided to residents before the end of coverage. The SSD stated, At least the 3 days, and most of the time we normally do even more. The SSD was asked whether a written notice was provided for Resident #41. The SSD stated, We normally would. I don't know that I kept anything. This one I'm not sure . The SSD was asked about Resident #31 only receiving 1 day's notice. The SSD stated, I wasn't here then. I think I was on vacation.", "filedate": "2019-02-01"}
{"rowid": 5678, "facility_name": "LAURELWOOD HEALTHCARE CENTER", "facility_id": 445413, "address": "200 BIRCH ST", "city": "JACKSON", "state": "TN", "zip": 38301, "inspection_date": "2015-08-12", "deficiency_tag": 156, "scope_severity": "B", "complaint": 0, "standard": 1, "eventid": "Z3X911", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to provide the appropriate liability and appeal notice to 2 of 3 (Residents #46 and 64) sampled residents. The findings included: 1. Review of the Notice of Medicare Non-Coverage for Resident #46 documented, .The Effective Date Coverage of Your Physical, Speech, and Occupational Therapy Services Will End: 06.08.15 and on 06.09.15 . The form was signed but not dated by the Patient / Representative. Interview with the Social Worker on 3/12/15 at 2:30 PM, in room [ROOM NUMBER], confirmed that the Notice of Medicare Non-Coverage for Resident #46 was not dated by the Patient/Representative. 2. Review of the Notice of Medicare Non-Coverage for Resident #64 documented, .The Effective Date Coverage of Your Physical, Speech, and Occupational Therapy Services Will End: 07.7.15 . The Patient/Representative signed and dated the form on 7/14/15. Interview with the Social Worker on 3/12/15 at 2:35 PM, in room [ROOM NUMBER], confirmed that the Notice of Medicare Non-Coverage for Resident #64 was not signed and dated by the Patient / Representative prior to the effective date of non-coverage.", "filedate": "2019-01-01"}
{"rowid": 5820, "facility_name": "WAVERLY HEALTH CARE & REHABILITATION CENTER", "facility_id": 445251, "address": "895 POWERS BLVD", "city": "WAVERLY", "state": "TN", "zip": 37185, "inspection_date": "2015-08-06", "deficiency_tag": 156, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "9MOG11", "inspection_text": "Based on record review and interview, the facility failed to provide a Notice of Medicare Non - Coverage for 2 of 3 (Residents #26 and #12) residents of the sample reviewed for liability notices. The findings included: 1. Resident #26 received skilled services from 4/7/15 to 4/21/15. Interview with Administrative Staff J on 7/30/15 at 11:58 A.M. revealed the facility could not find the Notice of Medicare Non-Coverage for this resident. The facility lacked documentation that they provided the Notice of Medicare Non-Coverage for this resident. 2. Resident #12 received skilled services from 2/24/15 to 5/26/15. Interview with Administrative Staff J on 7/30/15 at 11:58 A.M. revealed the facility could not find the Notice of Medicare Non-Coverage for this resident. The facility lacked documentation that they provided the Notice of Medicare Non-Coverage for this resident.", "filedate": "2018-11-01"}
{"rowid": 5967, "facility_name": "MAJESTIC GARDENS AT MEMPHIS REHAB & SNC", "facility_id": 445150, "address": "131 N TUCKER", "city": "MEMPHIS", "state": "TN", "zip": 38104, "inspection_date": "2015-05-08", "deficiency_tag": 156, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "2SUG11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to provide the appropriate liability and appeal notice to 2 of 3 (Residents #143 and 169) sampled residents. The findings included: 1. Medical record review revealed Resident #143 was admitted to the facility on [DATE] for skilled services. The Discharge Orders dated 1/12/15 documented, .Discharge patient to the care of family/friends when all arrangements are complete . The facility was unable to provide in writing where the resident or the representative was given an Advanced Beneficiary Notice or Liability Notice (ABN) prior to discharge as required by law. 2. Medical record review revealed Resident #169 was admitted to the facility on [DATE] for skilled services. The Discharge Orders dated 1/30/15 documented, .Discharge patient to the care of family/friends when all arrangements are complete . The facility was unable to provide in writing where the resident or the representative was given an Advanced Beneficiary Notice or Liability Notice (ABN) prior to discharge as required by law. 3. Interview with the Social Worker (SW) on 5/7/15 at 3:15 PM, in the family room, the SW stated, Can not find where a notice was sent to them (Resident #143 and #169), only been doing this position for 2 weeks. I can not find where the previous Social Worker has any of them. I am keeping them in a book now. I have looked and can only find ones on the residents who exhausted their days (which would not even require an ABN).", "filedate": "2018-10-01"}
{"rowid": 6064, "facility_name": "PICKETT CARE AND REHABILITATION CENTER", "facility_id": 445390, "address": "129 HILLCREST DRIVE", "city": "BYRDSTOWN", "state": "TN", "zip": 38549, "inspection_date": "2015-07-08", "deficiency_tag": 156, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "L07311", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and interview, the facility failed to provide timely notification of non-covered skilled services for 1 resident (#70) of 3 residents reviewed. The findings included: Medical record review revealed Resident #70 was admitted [DATE], with [DIAGNOSES REDACTED]. Medical record review of admission orders [REDACTED].rehab potential: Good . Review of a Physician's progress note dated 2/26/15, revealed Resident #70 required assistance with activities of daily living, medication administration, skilled nursing, and physical therapy. Medical record review of the Physical Therapy Discharge Summary dated 3/6/15, revealed Resident #70 had reached maximum potential with skilled services. Medical record review of the Occupational Therapy Discharge Summary dated 3/6/15, revealed Resident #70 had achieved the highest practical level of functioning. Review of the Notice of Medicare Non-Coverage letter provided to the resident by the facility revealed the resident's skilled nursing services would end on 3/6/15. Continued review of the letter revealed the resident had acknowledged the letter on 3/11/15, five days after services ended. Interview with the Administrator on 7/7/15, at 4:58 PM, in the conference room, confirmed the resident had 46 skilled days available at the time skilled services were discontinued. Continued interview confirmed the notification of non-coverage had not been provided to the resident prior to the date the services would end.", "filedate": "2018-10-01"}
{"rowid": 6081, "facility_name": "SIGNATURE HEALTHCARE OF CLARKSVILLE", "facility_id": 445448, "address": "198 OLD FARMER ROAD", "city": "CLARKSVILLE", "state": "TN", "zip": 37043, "inspection_date": "2015-07-09", "deficiency_tag": 156, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "9R4511", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, 3 of 4 (Residents #25, #56 and #160) residents selected for a review of liability notice in stage 2 were not given the appropriate liability and appeal notice at the time of discharge. The findings included: 1. Resident #25 was admitted on [DATE] for rehabilitation services. [DIAGNOSES REDACTED]. Physical therapy was started on 4/1/15 and a discharge note was written on 4/29/15. The resident was discharged to home due to exhausted benefits, patient/ representative (RSP) declines treatment. Physician order [REDACTED]. Discharge summary completed on 4/30/15 note for PT, OT, and ST revealed the patient participated in PT, OT, ST services with discharge home related to refusal to pay copay. No evidence that the appropriate liability notice was issued on or after 4/28/15 when doctor's order was written for discharge. 2. Resident #56 was admitted on [DATE] for rehabilitation services. [DIAGNOSES REDACTED]. The last daily skilled nurse's note, dated 3/3/15, noted the resident was alert, oriented and able to verbalize needs. This resident was able to transfer to wheelchair and to toilet with little assistance. The resident required moderate assist with Activities of Daily Living (ADLs) and had no complaints of pain at this time. Resident #56 was able to take medications without difficulty. This resident was observed to be resting comfortably with call light within reach. There was no indication of resident's decision to be discharged [DATE]. Social Services progress note of 3/3/2015 noted the resident requested discharge on 3/4/15. Occupational Therapy noted service dates between 2/20/15 through 3/3/15 with a discharge note stating resident was being discharged to home per physician or case manager. The discharge was resident's choice. A physician order [REDACTED]. 3. Resident #160 discharged from PT on 5/18/15 and OT on 5/19/15, and was present in the facility until 5/26/15. Interview on 7/9/15 at 2:52 P.M., Business staff #6 stated the facility did not give the resident a Liability and Appeal Notice after discharge from therapy. Business staff #6 stated usually they sent or gave a Liability Notice within 3 days of discharge from therapy, and agreed he/she should have given the Notice to the resident or obtained a witness signature if the resident refused. 4. Interview with Business staff #6 on 7/9/15 at 1:20 P.M., revealed Residents #25, #56 and #160 did not receive the appropriate liability and appeal notice upon discharge. Interview with the Administrator on 7/9/15 at 1:30 PM, revealed he was not aware that all skilled resident should be given the appropriate notice.", "filedate": "2018-10-01"}
{"rowid": 6214, "facility_name": "HILLCREST HEALTHCARE CENTER", "facility_id": 445316, "address": "111 E PEMBERTON STREET", "city": "ASHLAND CITY", "state": "TN", "zip": 37015, "inspection_date": "2015-06-11", "deficiency_tag": 156, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "9ZLX11", "inspection_text": "Based on record review, interview and review of the Centers for Medicare and Medicaid Services (CMS) form titled Form Instruction for the Notice of Medicare Non-Coverage (NOMNC) CMS- , the facility failed to provide a notification of discontinued Medicare services for 1 of 3 (Resident #5) residents sampled for notification of Medicare Non-Coverage notification. The findings included: Review of 3 resident's Notice of Medicare Non-Coverage revealed Resident #5 lacked a notification letter including the date of discontinued services, the appeal process and contact information to appeal the decision, and the signature of the resident (beneficiary). Interview on 6/11/15 at 2:17 PM, the Social Services Director (SSD) stated Resident #5 was discharged from Medicare skilled services on 6/10/15. The SSD did not give the resident a notice of discharge and rights of appeal information because he/she thought a notice was not required for a resident on managed care services. He/She gave the notices to other residents, but did not give this resident a notice. Licensed Nurse #6 provided the CMS form on 6/11/15 at 4:14 PM, titled Form Instruction for the Notice of Medicare Non-Coverage (NOMNC) CMS- . Licensed Nurse #6 stated the document was followed by the facility, but was not a policy. The Form Instructions for the Notice of Medicare Non-Coverage - CMS - directed: A Medicare provider or health plan . must deliver a completed copy of the Notice of Medicare Non-Coverage (NOMNC) to beneficiaries / enrollees receiving covered skilled nursing . services. The NOMNC must be delivered at least two calendar days before Medicare covered services end or the second to last day of service if care is not being provided daily . The provider must ensure that the beneficiary or representative signs and dates the NOMNC to demonstrate that the beneficiary or representative received the notice and understands that the termination decision can be disputed . The facility failed to provide a Medicare Non-Coverage notification to Resident #5.", "filedate": "2018-09-01"}
{"rowid": 6531, "facility_name": "SIGNATURE HEALTHCARE OF ERIN", "facility_id": 445377, "address": "278 ROCKY HOLLOW ROAD", "city": "ERIN", "state": "TN", "zip": 37061, "inspection_date": "2015-03-19", "deficiency_tag": 156, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "FS4W11", "inspection_text": "Based on policy review, record review and interview, the facility failed to provide the appropriate liability and appeal notice to 2 of 3 (Residents #36 and 97) sampled residents. The finding included: 1. Review of the facility's Notice of Medicare Non-Coverage (NOMC) policy documented, .NOMNCs will be delivered to all Medicare beneficiaries at least forty-eight (48) hours or two (2) days prior to anticipated termination of services . 2. Review of the Notice of Medicare Non-Coverage for Resident #36 documented, .The Effective Date Coverage of Your Current . Part A Services Will End JANUARY 23, (YEAR) . Record review revealed a telephone contact with the representative was made on 1/15/15. There is no documentation the telephone contact was confirmed by written notice on that same day. 3. Review of the Notice of Medicare Non-Coverage for Resident #97 documented, .The Effective Date Coverage of Your Current . Skilled Nursing Services Will End: 01/24/2015 . Record review, revealed a telephone contact with the representative was made on 1/13/15. There is no documentation the telephone contact was confirmed by written notice on that same day. 4. Interview with the Business Manager on 3/18/15 at 10:55 AM, in the business office, the Business Manager was asked if the date on the top of the page was the date she notified the resident or power of attorney of the end of their services for Resident #36 and 97. The Business Manager stated, Yes, I mailed them in advance. The business Manager was then asked did she have any documentation that the letters were mailed on the date of notice. The Business Manager stated, No.", "filedate": "2018-07-01"}
{"rowid": 6648, "facility_name": "GOOD SAMARITAN HEALTH AND REHAB CENTER", "facility_id": 445170, "address": "500 HICKORY HOLLOW TERRACE", "city": "ANTIOCH", "state": "TN", "zip": 37013, "inspection_date": "2015-02-11", "deficiency_tag": 156, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "XIH911", "inspection_text": "Based on review of notices of medicare non-coverage forms and interview, the facility failed to provide the appropriate liability and appeal notices to 2 of 3 (Resident #71 and 134) sampled residents. The findings included: 1. Review of the Notice of Medicare Non-Coverage form for Resident #71 documented a termination date of 9/5/14 and was signed by Resident #71's Responsible Party (RP) on 8/25/14. 2. Review of the Notice of Medicare Non-Coverage form for Resident #134 documented a termination date of 10/10/14 and was signed by Resident #134's RP on 8/26/14. 3. Interview with the admission's coordinator on 2/5/15 at 3:00 PM, outside the business office, the admission's coordinator was asked when she gets the Notice of Medicare non-Coverage form signed. The admission's coordinator stated, Sometimes I get them to sign them on admission because there are some families that don't come back for any of the care plan meetings. Sometimes I get them signed at the discharge planning meetings . it just depends on the family and the situation . that's why some of them are signed way in advance . I don't want to not ever have this signed . Interview with the admission's coordinator on 2/5/15 at 3:25 PM, in the 400 hallway, the admission's coordinator was asked if she would change the termination date on the Notice of Medicare non-Coverage if the resident's termination date changed. The admission's coordinator stated, No, I don't put the date on it until the discharge planning meeting is completed. The admission's coordinator was then asked if she had the responsible party sign the Notice of Medicare non-Coverage without having a termination date on it. The admission's coordinator stated, Yes.", "filedate": "2018-05-01"}
{"rowid": 6719, "facility_name": "CUMBERLAND HEALTH CARE AND REHABILITATION INC", "facility_id": 445262, "address": "4343 ASHLAND CITY HWY", "city": "NASHVILLE", "state": "TN", "zip": 37218, "inspection_date": "2014-10-09", "deficiency_tag": 156, "scope_severity": "C", "complaint": 0, "standard": 1, "eventid": "ZBLF11", "inspection_text": "Based on record review and interview, it was determined the facility failed to provide the appropriate liability and appeal notice to 3 of 3 (Residents #26, #66 and 115) sampled residents. The findings included: 1. Review of the Notice of Medicare Non-Coverage for Resident #26 documented, .The Effective Date Coverage of Your Current Skilled Nursing Services Will End: 05-26-2014 . Telephone contact with the representative was made on 5/22/14. There is no documentation the telephone contact was confirmed by written notice on that same date. 2. Review of the Notice of Medicare Non-Coverage for Resident #66 documented, .The Effective Date Coverage of Your Current Skilled Nursing Services Will End: 08-14-14 . There is documentation with Resident #66's signature dated 8/18/14, four days after notification of Medicare Non-Coverage days. 3. Review of the Notice of Medicare Non-Coverage for Resident #115 documented, .The Effective Date Coverage of Your Current Skilled Nursing Services Will End: 06-06-2014 . Telephone contact with the representative was made on 5/22/14. There was no documentation the telephone contact was confirmed by written notice on that same date. 4. During an interview in the hallway on 10/8/14 at 6:30 PM, the Social Worker was asked to provide documentation where the Responsible Party had been notified in writing of the resident's Notice of Medicare Non-Coverage letter. The Social Worker stated, No, I do not have proof that I gave them a copy of the letter. The Social Worker was asked to verify the dates on Resident #66 Notice of Medicare Non-Coverage letter. The Social Worker stated, Oh, I can't believe I did that . I have the dates backward.", "filedate": "2018-05-01"}
{"rowid": 6949, "facility_name": "WOODCREST AT BLAKEFORD", "facility_id": 445378, "address": "11 BURTON HILLS BLVD", "city": "NASHVILLE", "state": "TN", "zip": 37215, "inspection_date": "2014-09-10", "deficiency_tag": 156, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "O65F11", "inspection_text": "Based on record review and interview, it was determined the facility failed to provide the appropriate liability and appeal notice to 1 of 3 (Residents #131) sampled residents. The findings included: Review of the Notice of Medicare Non-Coverage for Resident #131 documented, .The Effective Date Coverage of Your Current Skilled Nursing Services Will End: Thursday July 3, 2014 . Resident and dtr (daughter) verbally informed of d/c (discharge) date of 6/28/14 . There is no signature of the resident or the representative on the form. The facility was unable to provide in writing where the resident or the representative was given this information. During an interview in the Social Worker's office on 9/10/14 at 1:39 PM, the Social Worker (SW) was asked why there was no signature on Resident #131's Notice of Medicare Non-Coverage form. The SW stated, I just documented we had discussed it in the note. The SW was asked if she sent a copy of the Notice of Medicare Non-Coverage form for Resident #131 or the Representative to sign. The SW stated, No.", "filedate": "2018-04-01"}
{"rowid": 7103, "facility_name": "THE KINGS DAUGHTERS AND SONS", "facility_id": 445221, "address": "3568 APPLING ROAD", "city": "BARTLETT", "state": "TN", "zip": 38133, "inspection_date": "2014-09-04", "deficiency_tag": 156, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "QM2L11", "inspection_text": "Based on record review and interview, it was determined the facility failed to provide the appropriate liability and appeal notice to 2 of 3 (Residents #94 and 126) sampled residents. The findings included: 1. Review of the Notice of Medicare Non-Coverage for Resident #94 documented, .The Effective Date Coverage of Your Current Skilled Nursing Services Will End: 04-03-2014 . Telephone contact with the representative was made on 3/3/14. There is no documentation the telephone contact was confirmed by written notice on that same date. 2. Review of the Notice of Medicare Non-Coverage for Resident #126 documented, .The Effective Date Coverage of Your Current Skilled Nursing Services Will End: 04-06-14 . Telephone contact with the representative was made on 4/3/14. There is no documentation the telephone contact was confirmed by written notice on that same date. 3. During an interview in the Admission's office on 9/4/14 at 2:24 PM, the Admissions Coordinator was asked if she had mailed the notices to the responsible parties. The Admission's Coordinator stated, We always just call on the phone if the family doesn't visit or the resident can't sign. I didn't know they had to be made in writing.", "filedate": "2018-03-01"}
{"rowid": 7223, "facility_name": "THE HIGHLANDS OF DYERSBURG HEALTH & REHAB", "facility_id": 445497, "address": "350 EAST TICKLE STREET", "city": "DYERSBURG", "state": "TN", "zip": 38024, "inspection_date": "2014-10-01", "deficiency_tag": 156, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "FT1O11", "inspection_text": "Based on record review and interview, it was determined the facility failed to provide the appropriate liability and appeal notice for 1 of 3 (Resident #43) sampled residents. The findings included: Review of the Notice of Medicare Non-Coverage for Resident #43 documented, .The Effective Date Coverage of Your Current Services Will End: 4-16-14 DC'd (discharged ) home . There is no signature of the resident or the representative on the form. The facility was unable to provide in writing where the resident or the representative was given this information. During an Interview in the conference room on 9/30/14 at 5:25 PM, the Minimum Data Set (MDS) Coordinator #2 was asked why there was no signature on Resident #43's Notice of Medicare Non-Coverage form. The MDS Coordinator #2 stated, I mailed out the notice to Resident #43, but that was before certified mail was used. I never got anything back from them. There is no proof other than my word.", "filedate": "2018-03-01"}
{"rowid": 7330, "facility_name": "SIGNATURE HEALTHCARE OF CLEVELAND", "facility_id": 445369, "address": "2750 EXECUTIVE PARK PLACE", "city": "CLEVELAND", "state": "TN", "zip": 37312, "inspection_date": "2014-12-03", "deficiency_tag": 156, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "F7K511", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and interview, the facility failed to issue a Notice of Medicare Provider Non Coverage for two (#131 and #87) of three residents reviewed for liability notices. The findings included: Resident #131 was admitted to the facility on [DATE], with [DIAGNOSES REDACTED]. Medical record review of the Discharge Summary dated July 16, 2014, revealed the resident was discharged home with family and home health on July 4, 2014. Resident #87 was admitted to the facility on [DATE], with [DIAGNOSES REDACTED]. Medical record review of the Discharge Summary dated August 8, 2014, revealed the resident was discharged home with family on July 15, 2014. Interview on December 3, 2014, at 1:15 p.m., with the Administrator in the Administrator's office, revealed resident #131 and resident #87 were not issued letters of Notice of Medicare Provider Non Coverage,they were missed. Continued interview confirmed the residents were discharged home and had not given the opportunity to appeal the decision, as the the letters had not been issued.", "filedate": "2018-02-01"}
{"rowid": 7696, "facility_name": "APPLINGWOOD HEALTH CARE CENTER", "facility_id": 445411, "address": "1536 APPLING CARE LANE", "city": "CORDOVA", "state": "TN", "zip": 38018, "inspection_date": "2014-05-15", "deficiency_tag": 156, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "YI7411", "inspection_text": "Based on record review and interview, it was determined the facility failed to provide 2 of 3 (Residents #28 and 128) sampled residents with the proper advanced beneficiary notices as required by law. The findings included: 1. Review of advanced beneficiary notices for Resident #28 revealed the effective date that the coverage would end was 1/10/14. Resident #28 was notifeid on 1/10/14, as documented on the dated signature of the power of attorney on the Notice of Medicare Non-Coverage form. 2. Review of advanced beneficiary notices for Resident #128 revealed the resident's end of coverage date was 12/24/13. Resident #128 signed the Notice of Medicare Non-Coverage form on 12/23/13. 3. During an interview in the administrator's office on 5/13/14 at 1:35 PM, the administrator was asked about the advanced beneficiary notices. The administrator stated, I'll be honest with you, the social worker we had before was not doing her part in some things. That's why she isn't here anymore. During an interview in the administrator's office on 5/14/14 at 4:50 PM, the administrator was asked how much notice is given before the end of coverage for services. The administrator stated, If we are exhausting their days, they are going to know roughly, (we) always do at least a 3-day notice.", "filedate": "2017-11-01"}
{"rowid": 7999, "facility_name": "RIPLEY HEALTHCARE AND REHAB CENTER", "facility_id": 445492, "address": "118 HALLIBURTON DRIVE", "city": "RIPLEY", "state": "TN", "zip": 38063, "inspection_date": "2014-03-13", "deficiency_tag": 156, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "K8WW11", "inspection_text": "Based on review of Beneficiary Notices Initiative Summary- Part A, record review and interview, it was determined the facility failed to provide the appropriate liability and appeal notice for 2 of 3 (Residents #15 and 97) sampled residents The findings included: 1. Review of the Beneficiary Notices Initiative Summary - Part A documented, .SNF (Skilled Nursing Facility) . Yes - 2 days Before Termination of Services . 2. Review of the Notice of Medicare Non-Coverage for Resident #15 documented, .The Effective Date Coverage of Your Current Occupational therapy services . Services Will End 2/26/14 . Review of the therapy discharge letters documented the Advance Beneficiary Notice (ABN) letter was mailed on 2/27/14 after Resident #15 was discharged from skilled services. 3. Review of the Notice of Medicare Non-Coverage for Resident #97 documented, .The Effective Date Coverage of Your Current OT (Occupational Therapy), PT (Physical Therapy), and ST (Speech Therapy) services . Services Will End: 2/26/14 . Review of the therapy discharge letters documented the ABN letter was mailed on 2/27/14 after Resident #97 was discharged from skilled services. 4. During an interview in the Minimum Data Set (MDS) Coordinator's office on 3/11/14 at 1:45 PM, the MDS Coordinator was asked when should the ABN letters of discontinuing services have been sent to the residents. The MDS Coordinator stated, I've been sick . should have been mailed out on the 23rd instead of the 26th .", "filedate": "2017-09-01"}
{"rowid": 8214, "facility_name": "HEALTH CENTER AT STANDIFER PLACE, THE", "facility_id": 445111, "address": "2626 WALKER RD", "city": "CHATTANOOGA", "state": "TN", "zip": 37421, "inspection_date": "2014-04-30", "deficiency_tag": 156, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "CRSS11", "inspection_text": "Based on review of facility termination of services notifications and interview, the facility failed to provide timely notification to beneficiaries of the decision to terminate covered services no later than two days before the proposed end of services for one resident (#105) and failed to notify of change in services for one resident (#169) of three residents reviewed for notification of services. The findings included: Review of the facility termination of services notification for resident #105 dated March 3, 2014, revealed, .On 3/3/14, our Utilization Review Committee reviewed (resident #105's) medical information and found the services furnished to (resident #105) no longer qualified for payment by Medicare beginning on 3/4/14 . Review of the facility termination of services notification for resident #169 dated February 1, 2014, revealed, .This letter is to notify you that on 01/31/14 (resident #169) exhausted all 100 days of (the resident's) Medicare coverage. As a result, Medicare will no longer pay for (resident #169) continued stay after this date . Interview with the Administrator of Daily Operations on April 30, 2014, at 3:45 p.m., in the conference room, confirmed the facility failed to provide notification of the decision to terminate services under Medicare prior to termination of services for resident #105 and resident #169.", "filedate": "2017-07-01"}
{"rowid": 8464, "facility_name": "PALMYRA HEALTH CARE CENTER", "facility_id": 445184, "address": "2727 PALMYRA RD", "city": "PALMYRA", "state": "TN", "zip": 37142, "inspection_date": "2013-11-25", "deficiency_tag": 156, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "1YLU11", "inspection_text": "Based on record review and interview, it was determined the facility failed to provide the appropriate liability and appeal notice for 3 of 3 (Residents #23, 40 and 41) sampled residents. The findings included: 1. Review of the NOTICE OF MEDICARE PROVIDER NON-COVERAGE form for Resident #23 documented, .THE EFFECTIVE DATE COVERAGE OF YOUR CURRENT: SERVICES WILL END: 09/06/2013 . The form is not signed or dated by the resident or representative. 2. Review of the NOTICE OF MEDICARE PROVIDER NON-COVERAGE form for Resident #40 documented, .THE EFFECTIVE DATE COVERAGE OF YOUR CURRENT: SERVICES WILL END: 05/15/2013 . The form is not signed or dated by the resident or representative. 3. Review of the NOTICE OF MEDICARE PROVIDER NON-COVERAGE form for Resident #41 documented, .THE EFFECTIVE DATE COVERAGE OF YOUR CURRENT: SERVICES WILL END: 11/05/2013 . The form is not signed or dated by the resident or representative. 4. During an interview in the conference room on 11/25/13 at 4:17 PM, the Resident Assessment Coordinator (RAC) was asked why the notices were not signed. The RAC stated, I send them out by regular mail . with a self addressed stamp envelope . The RAC was asked if she had evidence that the notices were received. The RAC stated, No.", "filedate": "2017-06-01"}
{"rowid": 9410, "facility_name": "SIGNATURE HEALTHCARE AT SAINT FRANCIS", "facility_id": 445149, "address": "6007 PARK AVE", "city": "MEMPHIS", "state": "TN", "zip": 38119, "inspection_date": "2013-08-01", "deficiency_tag": 156, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "NC2111", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, it was determined the facility failed to ensure an Advanced Beneficiary Notice (ABN) was issued to 1 of 5 (Resident #237) Medicare residents reviewed for ABN. The findings included: Record review for Resident #237 documented and admission date of [DATE]. Resident #237 was discharged on [DATE]. The facility failed to issue an ABN. During an interview in the conference room on 8/1/13 at 12:30 PM, the Administrator stated, We did not give him an ABN because we were not cutting him off. He was going home .", "filedate": "2016-12-01"}
{"rowid": 9822, "facility_name": "CENTER ON AGING AND HEALTH", "facility_id": 445424, "address": "880 SOUTH MOHAWK DRIVE", "city": "ERWIN", "state": "TN", "zip": 37650, "inspection_date": "2013-03-21", "deficiency_tag": 156, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "JVCX11", "inspection_text": "Based on observation and interview, the facility failed to notify three residents (#84, #90, & #102) in a timely manner (no later than 2 days) of appeal rights of skilled services being termination. The findings included: Review of Liability Notices and Resident Appeal Rights (Advance Beneficiary Notice (ABNs) of three residents #84, #90, & #102, revealed no documentation the residents or their legal representative were notified of appeal rights at least two days prior to termination of skilled services. Interview with the Admission Coordinator, in the Admission office, on March 20, 2013, at 3:00 p.m., confirmed the facility haad failed to insure the residents or residents' representives were notified timely of appeal rights for termination of skilled services for resident #84, #90, and #102.", "filedate": "2016-10-01"}
{"rowid": 10235, "facility_name": "WHITEHAVEN COMMUNITY LIVING", "facility_id": 445233, "address": "1076 CHAMBLISS ROAD", "city": "MEMPHIS", "state": "TN", "zip": 38116, "inspection_date": "2012-08-29", "deficiency_tag": 156, "scope_severity": "C", "complaint": 0, "standard": 1, "eventid": "RWBL11", "inspection_text": "Based on observation and interview, it was determined the facility failed to prominently display the nursing home information posting that contained how to apply for Medicare / Medicaid benefits, contact advocacy groups and the state agency, and how to file a grievance on 4 of 4 (8/26/12, 8/27/12, 8/28/12, and 8/29/12) days of the survey. The findings included: Observations in the front lobby on 8/26/12, 8/27/12, 8/28/12, and 8/29/12 revealed no information was posted related to an application for Medicare and Medicaid, names and telephone numbers of advocacy groups or the state agency, and no complaint or grievance statement information displayed for public and resident access. During an interview in the business office on 8/28/12 at 9:45 AM, the facility Administrator was asked if the required postings were posted for public viewing. The Administrator stated, .I don't know what happened to them, they were here . There is stuff up here we don't need and then there is stuff we need that is not .", "filedate": "2016-07-01"}
{"rowid": 10252, "facility_name": "GLEN OAKS HEALTH AND REHABILITATION", "facility_id": 445234, "address": "1101 GLEN OAKS ROAD", "city": "SHELBYVILLE", "state": "TN", "zip": 37160, "inspection_date": "2012-02-29", "deficiency_tag": 156, "scope_severity": "C", "complaint": 0, "standard": 1, "eventid": "6K9O11", "inspection_text": "Based on review of facility documentation and interview, it was determined the facility failed to notify the residents of their right to request a demand bill to appeal the denial for termination of Medicare services for 28 of 32 residents reviewed. The findings include: Review of the facility's Noncoverage of Medicare Denial letters identified that 32 residents were given notices that their Medicare coverage was to be terminated. Twenty-eight of the 32 residents had not reached the maximum benefit days allowed by Medicare (non-technical denial) and were terminated for not meeting the requirements for skilled services. Although, notification letters were sent within the required 48 hour time frame the letter failed to include the opportunity for residents to request a demand bill to appeal the denial. During an interview in the conference room on 2/29/12 at 4:30 PM, the Admission Director was asked if residents were given the choice to submit a demand bill. The Admission Director stated, .we were using the wrong form. No, the residents were not given notification of their right to request a demand bill to appeal the denial.", "filedate": "2016-07-01"}
{"rowid": 10977, "facility_name": "LIFE CARE CENTER OF GREENEVILLE", "facility_id": 445228, "address": "725 CRUM STREET", "city": "GREENEVILLE", "state": "TN", "zip": 37743, "inspection_date": "2012-07-27", "deficiency_tag": 156, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "YH5V11", "inspection_text": "Based on interview and review of the resident's financial record the facility failed to provide Liability and Appeal notices to two dicharged residents (#61 & #160) of thirty one residents reviewed in stage 2 of the quality indicator survey. The findings included: Interview and financial record review with the Admission Coordinator in the faciity conference room on July 26, 2012, at 9:03 a.m., confirmed the facility failed to provide resident #61 and #160 with a Liability and Appeal notice.", "filedate": "2016-03-01"}
{"rowid": 10982, "facility_name": "CHURCH HILL CARE & REHAB CTR", "facility_id": 445237, "address": "701 WEST MAIN BLVD", "city": "CHURCH HILL", "state": "TN", "zip": 37642, "inspection_date": "2012-08-02", "deficiency_tag": 156, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "PZ5711", "inspection_text": "Based on review of financial records and interview, the facility failed to provide timely Notice of Medicare Non-Coverage to one (#76) of five resident records reviewed. The findings included: Review of resident financial records revealed a Social Service note dated July 30, 2012, Medicare skilled services will end 7/31. Spoke with res. (resident's) .adult child) .and explained NOMNC (Notice of Medicare Non-Coverage) and the completion of skilled care .(adult child) verbalized understanding and will be . Interview with the Social Service Director on August 2, 2012, at 8:35 a.m., in the business office, confirmed the facility failed to give at least two full days notice and the Notice of Medicare Non-Coverage was not completed timely.", "filedate": "2016-03-01"}
{"rowid": 11193, "facility_name": "DONELSON PLACE CARE & REHABILITATION CENTER", "facility_id": 445148, "address": "2733 MCCAMPBELL AVENUE", "city": "NASHVILLE", "state": "TN", "zip": 37214, "inspection_date": "2012-08-16", "deficiency_tag": 156, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "LTRR11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of financial records and interview, the facility failed to provide timely Notice of Medicare Non-Coverage to one (#79) of five resident records reviewed. The findings included: Review of resident financial records revealed Resident #79 was discharged on [DATE] due to resident reaching maximum potential with rehabilitation. Continued review revealed no documentation of a Notice of Medicare Non-Coverage was provided. Interview with the Business Office Manager on August 15, 2012 at 1:50 p.m. to 2:10 p.m., in the Business Office confirmed the facility failed to give at least two full days notice and the Notice of Medicare Non-Coverage was not completed.", "filedate": "2016-02-01"}
{"rowid": 11290, "facility_name": "CONSULATE HEALTH CARE OF CHATTANOOGA", "facility_id": 445205, "address": "8249 STANDIFER GAP ROAD", "city": "CHATTANOOGA", "state": "TN", "zip": 37421, "inspection_date": "2012-10-17", "deficiency_tag": 156, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "R9ZZ11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility documentation, interview, and medical record review, the facility failed to provide two residents (#46, #95) of three residents reviewed with an appropriate liability and appeal notice, and failed to provide resident rights in writing for one resident (#11) of forty-three sampled residents. The findings included: Review of facility documentation for two residents #46, and #95, revealed no denial letter and the beneficiary had not been advised of his/her rights to have a claim submitted to Medicare or advise the standard claim appeal rights if the claim was denied by Medicare. Interview with the Office Manager on October 16, 2012, at 4:28 p.m., in the front office, confirmed the facility failed to provide the residents a liability and/or appeal notice. Resident #11 was admitted to the facility on [DATE], with [DIAGNOSES REDACTED]. Medical record review of the quarterly Minimum Data Set, dated dated dated [DATE], revealed the resident had no cognitive impairment. Interview with the resident on October 17, 2012, at 9:00 a.m., in the resident's room, revealed the resident stated had never recieved a copy of the resident's rights and wanted a copy. Review of admission documentation and interview with the Social Worker on October 17, 2012, at 10:40 a.m., in the conference room, confirmed the resident had signed and initialed all the admission paperwork except the section indicating, I hereby acknowledge that I have received copies of the following information and that it has been clearly explained to me by the facility staff. Patient Rights . Further interview confirmed the admission documentation did not indicate the resident had received a written copy of the Patient Rights.", "filedate": "2016-02-01"}
{"rowid": 11321, "facility_name": "MABRY HEALTH CARE", "facility_id": 445272, "address": "1340 N GRUNDY QUARLES HWY P O BOX 7", "city": "GAINESBORO", "state": "TN", "zip": 38562, "inspection_date": "2012-06-07", "deficiency_tag": 156, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "W4VF11", "inspection_text": "Based on review of facility documentation and interview, the facility failed to provide three residents (#32, #62, #93) of three residents reviewed with an appropriate liability and appeal notice. The findings included: Review of facility documentation for three residents #32, #62, and #93, revealed the Medicare denial letter did not include the notification of the beneficiary of his/her right to have a claim submitted to Medicare or advise of the standard claim appeal rights if the claim was denied by Medicare. Interview with the billing clerk on June 5, 2012, at 3:45 p.m., in the front office, confirmed the facility failed to provide the residents the appropriate liability and/or appeal notice. Interview with the Administrator on June 5, 2012, at 3:49 p.m., in the front office, confirmed the facility failed to provide the residents the appropriate liability and/or appeal notice.", "filedate": "2016-02-01"}
{"rowid": 11507, "facility_name": "BELCOURT TERRACE NURSING HOME", "facility_id": 445273, "address": "1710 BELCOURT AVENUE", "city": "NASHVILLE", "state": "TN", "zip": 37212, "inspection_date": "2012-10-11", "deficiency_tag": 156, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "6IO711", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and interview, it was determined the facility failed to ensure an Advanced Beneficiary Notice (ABN) was issued for 1 of 3 (Resident #50) sampled residents reviewed for ABNs. The findings included: Medical record review for Resident #50 documented an admission date of [DATE] with a discharge date from Occupational Therapy 8/6/12 and a discharge date from Physical Therapy 8/7/12. Review of the Resident Census documented Resident #50 changed to medicaid from skilled services 8/8/12. During an interview in the Social Service's office on 10/9/12 at 5:50 PM, the Social Service Director (SSD) was questioned concerning the ABN notice for Resident #50. The SSD stated, .we mail forms (ABNs) to the resident's responsible party, sometimes they sign them and send them back. She (Resident #50) is still in the building, living here, met her maximum for therapy, but I can not find where one (ABN) was sent for her (Resident #50) .", "filedate": "2016-01-01"}
{"rowid": 11721, "facility_name": "NHC HEALTHCARE, MILAN", "facility_id": 445069, "address": "8017 DOGWOOD LANE P O BOX A", "city": "MILAN", "state": "TN", "zip": 38358, "inspection_date": "2012-02-28", "deficiency_tag": 156, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "V9VF11", "inspection_text": "Based on review of Advanced Beneficiary Notices (ABN) and interview, it was determined the facility failed to ensure advanced notice of the estimated cost per day to continue services when Medicare benefits were expected to end for 3 of 3 (Resident #17 and Random Residents (RR) #4 and 5) residents reviewed for ABN. The findings included: Review of the ABN for Resident #17, RR #4 and RR #5 revealed Medicare coverage would end 2/23/12. Review of the signature page revealed no signatures of the patient or the authorized representative. During an interview in the conference room on 2/28/12 at 1:10 PM, the Social Worker (SW) was asked when the ABN notices were mailed. The SW stated, .mailed them 2/23/12. The SW was asked for any ABN letters prior to the 2/23/12 letters. The SW stated, .can't find any of last years. this is all I have.", "filedate": "2015-11-01"}
{"rowid": 12572, "facility_name": "MAURY REGIONAL HOSPITAL SNU", "facility_id": 445398, "address": "1224 TROTWOOD AVE", "city": "COLUMBIA", "state": "TN", "zip": 38401, "inspection_date": "2012-04-25", "deficiency_tag": 156, "scope_severity": "C", "complaint": 0, "standard": 1, "eventid": "YU7V11", "inspection_text": "Based on interview, it was determined the facility failed to provide residents with liablity and/or appeal notice(s) for three Medicare beneficiaries who were discharged from the facility in the past 6 months. The findings included: During an interview in the Activity/Dining room on 4/25/12 at 3:30 PM, the surveyor asked the Administrator to provide the liability and appeal notice(s) given for 3 discharged Medicare covered residents who had days of Medicare covered services left. The Administrator stated, \"...We don't do them (Liability Notices and Beneficiary Appeal Rights). At admission it is understood we are a short term facility...\" During an interview in the Social Worker's office on 4/25/12 at 5:00 PM, the Social Worker was asked if she gave Medicare covered residents the required liability and/or appeal notice(s) to a resident with Medicare Skilled coverage remaining. The Social Worker stated, \"...No...\"", "filedate": "2015-08-01"}
{"rowid": 12857, "facility_name": "LIFE CARE CENTER OF HIXSON", "facility_id": 445380, "address": "5798 HIXSON HOME PLACE", "city": "HIXSON", "state": "TN", "zip": 37343, "inspection_date": "2011-03-30", "deficiency_tag": 156, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "479Y11", "inspection_text": "Based on observation, resident/family/group interview, and a review of facility information provided to residents/families at admission, the facility failed to communicate at admission and during the residents stay at the facility, information regarding visitation hours, access to private telephone conversations, availability of a la carte dining service, and personal items allowed in resident's rooms for twelve of twelve alert, oriented residents in the group interview. The findings included: Observation on the front door of the facility on March 29, 2011, at 7:30 a.m., revealed signage stating facility visitation hours were between 8:00 a.m. and 8:00 p.m. Continued observation revealed the front door was locked preventing access from the outside. Family interview on March 29, 2011, at 10:30 a.m., in a resident's room, revealed facility visiting hours are 8:00 a.m. to 8:00 p.m.; the front and side doors remain locked until 8:00 a.m., preventing family members access to residents, and family members' entrance into the building prior to 8:00 a.m. was dependent upon who answered the buzzer (attached at the outside door entrance). Continued family interview revealed if the family member was unable to gain entrance into the facility by 7:30 a.m., the resident could not get dressed in time to eat in the dining room. Group interview on March 29, 2011, at 2:00 p.m., in the Activity Room, with twelve alert, oriented residents revealed the resident's family members were unable to enter the facility prior to 8:00 a.m. Review of facility provided documents (admissions information provided to residents and families) revealed no written information was provided to residents regarding visitation hours or the ability to gain access into the facility for off hour visitation (8 p.m.-8 a.m.). Interview with the Administrator on March 30, 2011, at 2:00 p.m., in the Conference Room, revealed family members were to be allowed entry into the building if they used the buzzer, and confirmed residents and families were not provided with information regarding access to the facility. Resident group interview on March 29, 2011, at 2:00 p.m., in the Activity Room, revealed residents in the group (who did not have a personal telephone in their room), were unaware of a phone available for private use. Resident #1 stated (in the group interview) residents had use of a cordless phone at the previous facility (from which the resident moved to the current facility), but cordless phones were not currently available at this facility for resident use. Interview with the Administrator on March 30, 2011, at 2:05 p.m., in the Conference Room, revealed there was a cordless phone for use at the nurse's station. Review of admission materials revealed no information was provided to residents at the time of admission or thereafter regarding the availability of use of a cordless phone at the nurse's station for private telephone calls. Interview with the Administrator on March 30, 2011, at 2:15 p.m., in the Conference Room, revealed the Administrator depended on the Resident Council President to share with other residents information about the facility, and confirmed residents had not been informed of their right to make private telephone calls through the use of a cordless phone at the nurse's station. Resident group interview on March 29, 2011, from 2:00 p.m. until 3:00 p.m., in the Activity Room, revealed the residents concern regarding personal items, such as picture frames, in the room. Continued group interview revealed residents were asked to take pictures out of picture frames and place the pictures on a small bulletin board in the resident's rooms. Review of admission materials revealed no written information provided to residents about what personal items were allowed and not allowed in the room. Interview with the Administrator on March 30, 2011, at 2:27 p.m., in the Conference Room, confirmed residents had not been provided written information about the specific items allowed in the resident's room. Observation of resident #17 on March 28, 2011, at 4:35 p.m., in the day room (next to the dining room) revealed the licensed nurse asked the resident to go (to the resident's room) for a fingerstick. Continued observation revealed the resident became upset about leaving the day room as (the resident) was waiting for the dining room to open for dinner service. Continued observation revealed the resident verbalized (the resident) was afraid the dining room would be closed if (the resident) did not get back to the dining room at a certain hour. Resident group interview on March 29, 2011, from 2:00 p.m. until 3:00 p.m., in the Activity Room, revealed residents were not allowed to eat breakfast in the dining room if they arrived at the dining room after 8:30 a.m. Continued group interview revealed if the residents did not eat in the dining room, they could not order food items from the a la carte menu. Interview with the Certified Dietary Manager (CDM) on March 30, 2011, at 2:45 p.m., in the Conference Room, revealed if residents arrived at the dining room late (after the breakfast had been served), the resident's tray was sent to the floor, and someone would have to bring the tray back to the dining room. Continued interview with the CDM confirmed no written information regarding dining room services and a la carte services was provided to the residents at admission, or thereafter.", "filedate": "2015-07-01"}
{"rowid": 14327, "facility_name": "CRESTVIEW HEALTH AND REHABILITATION", "facility_id": 445409, "address": "2030 25TH AVE N", "city": "NASHVILLE", "state": "TN", "zip": 37208, "inspection_date": "2012-05-15", "deficiency_tag": 156, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "LH9611", "inspection_text": "Based on record review and interview, it was determined the facility failed to provide 2 of 3 (Residents #9 and 105) residents with an advanced beneficiary notice as required by law. The findings included: Review of advanced beneficiary notices on 5/14/12 at 1:05 PM, the facility was unable to provide an advanced beneficiary notices for Residents #9 and #105. During an interview in the Assistant Director of Nursing's (ADON) office on 5/14/12 at 1:05 PM, the Social Worker stated, \"We did not start giving them (advanced beneficiary notice) until April (2012).\"", "filedate": "2014-01-01"}
{"rowid": 56, "facility_name": "NHC-MAURY REGIONAL TRANSITIONAL CARE CENTER", "facility_id": 445030, "address": "5010 TROTWOOD AVE", "city": "COLUMBIA", "state": "TN", "zip": 38401, "inspection_date": "2017-07-19", "deficiency_tag": 157, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "788Z11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and interview the facility failed to notify the Physician of a clinical complication for one resident (#168) of 3 residents reviewed for abuse. The findings included: Medical record review revealed Resident #168 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Medical record review of the Quarterly Minimum (MDS) data set [DATE] revealed a Brief Interview for Mental Status could not be conducted because the resident was rarely/never understood. Medical record review of a nurse note by Registered Nurse (RN) #1 dated 7/18/17 at 8:50 AM revealed did not find [MEDICATION NAME] (narcotic pain medication [MEDICATION NAME]) to R (right) chest as documented. will ask on coming nurse to double-check and if none found, to place another patch. Interview with RN #1on 7/19/17 at 2:25 PM via telephone revealed she worked the 7PM to 7AM shift the night of 7/17/17 and cared for Resident #168. Further interview revealed she noticed the [MEDICATION NAME] was missing around 4 AM. Continued interview revealed RN #1 reported the missing [MEDICATION NAME] to Licensed Practical Nurse (LPN) #1 at shift change and asked her to get it replaced if it wasn't found. Interview with LPN #1 on 7/19/17 at 2:55 PM via telephone revealed she worked 7/18/17 from 7 AM to 7 PM and cared for Resident #168. Further interview revealed RN #1 told her at shift change the [MEDICATION NAME] was missing. Continued interview confirmed LPN #1 intended to notify the Physician of the missing [MEDICATION NAME] but failed to do so.", "filedate": "2020-09-01"}
{"rowid": 400, "facility_name": "THE WATERS OF CLINTON, LLC", "facility_id": 445135, "address": "220 LONGMIRE RD", "city": "CLINTON", "state": "TN", "zip": 37716, "inspection_date": "2017-11-13", "deficiency_tag": 157, "scope_severity": "D", "complaint": 1, "standard": 1, "eventid": "UJ6N11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on medical record review and interview, the facility failed to notify the physician and family of a fall for 1 resident (#43) of 8 residents reviewed for falls, of 29 residents reviewed. The findings included: Medical record review revealed Resident #43 was admitted to the facility on [DATE] and readmitted on [DATE] with [DIAGNOSES REDACTED]. Medical record review of the Quarterly Minimum Data Set ((MDS) dated [DATE] revealed a Brief Interview for Mental Status (BIMS) score of 8, indicating moderately impaired cognition. Review of the significant change MDS dated [DATE] revealed the resident required extensive assist of 2 persons for bed mobility, transfers, toilet use; and extensive assist of 1 person for locomotion on the unit, dressing, and eating. Medical record review of a nursing note dated 9/15/17 at 8:45 PM revealed, .Night nurse here for shift report. Night nurse taken to resident's room for report. Night nurse verbalizes understanding to this nurse's shift report. Resident lying on floor mat. Resident's eyes closed, respirations even and unlabored. Skin warm, dry and normal color . Medical record review of a nursing note dated 9/15/17 at 9:30 PM revealed, .This nurse and staff observe resident sitting on mat. Resident offered water per this nurse. Resident refuses to drink water. Resident covered with blanket for comfort. This nurse leaves room with door open due to no residents in hallway . Medical record review of the SBAR - Change of Condition (Situation, Background, Action, Response) created on 9/16/17 at 12:14 AM with an effective date (meaning the time/date of incident) of 9:07 PM, revealed, .Resident observed sitting on floor in her room. Resident was scooting across floor . Medical record review of a nursing noted dated 9/16/17 at 7:32 AM revealed, .Post Fall: Head to toe assessment - greyish/blue colored bruise & (and) swelling across forehead - tissue soft to palpate .Quarter size blue bruise with raised area top of head. Bruise remains bridge of nose; swelling with reddish bruise lt (left) eye. Old bruising both hands & scattered bruises BUE & BLE (bilateral upper extremities and bilateral lower extremities) .Bruise rt (right) side rib area. No c/o (complaint of) pain. Rested quietly during the night in low bed - mattress beside bed . Medical record review of a nursing note dated 9/16/17 at 6:39 PM revealed, .Notified of increase in bruising and [MEDICAL CONDITION] to the nose, forehead, and eyes of this resident S/P (after) fall last night. Spoke with the hospice medical director .Medical director for hospice at this time wants to wait for the hospice nurse to evaluate the resident and speak with the family on their wishes . Medical record review of a nursing note dated 9/16/17 at 7:50 PM revealed, .Talked with D.O.N. (Director of Nursing) regarding resident previous fall. Hospice called and nurse came in .Asked to call family to see if they wanted to send resident to ER (emergency room ) or not .Talked with (family member) . Interview with Registered Nurse (RN) #1 on 11/7/17, at 8:04 AM, at the south nurses' station, revealed RN #1 was notified of Resident #43's facial bruising on 9/16/17, at approximately 6:30 PM, approximately 21 1/2 hours after the fall. The RN then notified the hospice physician and family at that time. Further interview confirmed the facility failed to notify the physician and family of the fall in a timely manner.", "filedate": "2020-09-01"}
{"rowid": 529, "facility_name": "MAJESTIC GARDENS AT MEMPHIS REHAB & SNC", "facility_id": 445150, "address": "131 N TUCKER", "city": "MEMPHIS", "state": "TN", "zip": 38104, "inspection_date": "2017-08-24", "deficiency_tag": 157, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "5LE311", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and interview, the facility failed to notify the physician of a significant change in status for 1 of 17 (Resident #24) sampled residents reviewed of the 35 residents included in the stage 2 review. The findings included: Closed medical record review revealed Resident #24 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. A physician's orders [REDACTED].HumaLOG Solution .Inject as per sliding scale .For blood glucose .300-349 = (equal) 20 (units); 350 + (plus) (=) 24 If BS (Blood Sugar) over 349 give 24 units and call physician, subcutaneously before meals . A physician's orders [REDACTED].inject as per sliding scale .300-349 = 20 units, 350-600 = 24units and call MD (Medical Doctor), subcutaneously before meals and at bedtime for DM (Diabetes Mellitus) . Review of the Medication Administration Records (MARs) for 7/8/17 through 7/15/17 revealed the following blood sugar levels greater than 349: 7/8/17 at 9:00 PM = 376 7/11/17 at 4:00 PM = 450 7/13/17 at 9:00 PM = 571 7/15/17 at 5:00 AM = 454 The facility was unable to provide any documentation that the physician or nurse practitioner was notified regarding the elevated blood sugar levels on 7/8/17, 7/11/17, 7/13/17, and 7/15/17. Interview with the Director of Nursing (DON) on 8/24/17 at 9:55 AM, in the restorative dining room, the DON was asked what the protocol was for elevated blood sugar levels. The DON stated, Follow physician's orders [REDACTED]. The DON was asked if the nurses should document that the physician was notified. The DON stated Yes .in the progress notes . The DON was unable to find any documentation that the physician had been notified for the elevated blood sugar levels. Interview with the Doctor of Nursing Practice (DNP) on 8/24/17 at 11:37 AM, in the conference room, the DNP was asked when she expected to be notified regarding elevated blood sugar levels. The DNP stated, .there are standing orders that they are supposed to call me if their blood sugar is greater than 350 . The DNP was asked if she could remember being notified by the nursing staff that Resident #24's blood sugar was greater than 350. The DNP stated, At home? No .", "filedate": "2020-09-01"}
{"rowid": 604, "facility_name": "CLAIBORNE AND HUGHES HLTH CNTR", "facility_id": 445157, "address": "200 STRAHL STREET", "city": "FRANKLIN", "state": "TN", "zip": 37064, "inspection_date": "2017-05-10", "deficiency_tag": 157, "scope_severity": "D", "complaint": 1, "standard": 0, "eventid": "DC3711", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on facility policy review, medical record review, and interview, the facility failed to notify the physician the ordered urine analysis (U/A) and culture was not obtained for 1 resident (#1) of 8 residents reviewed. The findings included: Review of facility policy, Policy for MD/RP (Medical Doctor/Responsible Party) Notifications, undated revealed .PURPOSE: To keep the physician, who is in charge of the medical care .informed of the resident's medical condition .STANDARD: Notification of the physician .should occur promptly, according to federal regulations, when there is a change in the resident's condition . Medical record review revealed Resident #1 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Medical record review of the Telephone Physician order [REDACTED].U/A + (and) culture . Medical record review of the Lab Log, with Licensed Practical Nurses (LPN's) #2 and #3 present, revealed the 3/23/17 U/A order was documented in the Lab Log to be obtained on 3/24/17. Further review revealed a written notation .Unable to Obtain . Interview with LPN's #2 and #3 on 5/9/17 at 3:00 PM at the 1 East nursing station confirmed the 3/23/17 U/A and culture order had been documented in the Lab Log and the facility was not able to obtain a specimen. When the LPN's were asked if the physician had been notified the U/A had not been obtained, the LPN's confirmed the facility failed to notify the physician until 5/8/17. Interview with the Administrator and the Director of Nursing on 5/9/17 at 4:25 PM in the Administrator's office confirmed the facility failed to notify the physician the U/A had not been obtained and seek further instructions.", "filedate": "2020-09-01"}
{"rowid": 720, "facility_name": "GOOD SAMARITAN HEALTH AND REHAB CENTER", "facility_id": 445170, "address": "500 HICKORY HOLLOW TERRACE", "city": "ANTIOCH", "state": "TN", "zip": 37013, "inspection_date": "2017-02-16", "deficiency_tag": 157, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "BNS411", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, medical record review and interview, the facility failed to obtain a discharge to hospital order for 1 resident (#4) of 30 residents reviewed and failed to obtain a physician order for [REDACTED]. The findings included: Medical record review revealed Resident #4 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Medical record review of a nursing note dated 1/16/17 revealed Resident #4 was transferred to the hospital for pain. Medical record review revealed no physician order to transfer the resident to the hospital. Further review revealed a physician order dated 1/18/17 .Return from hospital . Interview with Licensed Practical Nurse (LPN) #4 on 2/14/17 at 9:04 AM in the conference room confirmed the facility failed to obtain a physician order for [REDACTED]. Medical record review revealed Resident #14 was admitted to the facility on [DATE], and re-admitted on [DATE] with [DIAGNOSES REDACTED]. Observation on 2/13/17 at 11:00 AM and on 2/14/17 at 11:12 AM revealed a C-Pap mask stored on the bed side table in Resident #14's room. Medical record review of the physician orders revealed no order for the C-Pap setting. Interview with LPN #3 on 2/15/17 at 8:12 AM at the nursing station revealed the staff turned the machine on and off per the direction of the resident and gave him the mask to put on. Further interview confirmed the facility failed to obtain the C-Pap setting order.", "filedate": "2020-09-01"}
{"rowid": 1126, "facility_name": "PINE MEADOWS HEALTH CARE", "facility_id": 445232, "address": "700 NUCKOLLS ROAD", "city": "BOLIVAR", "state": "TN", "zip": 38008, "inspection_date": "2017-05-18", "deficiency_tag": 157, "scope_severity": "D", "complaint": 1, "standard": 1, "eventid": "7VZO11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on medical record review and interview, the facility failed to notify the physician of significant changes in a resident's status for 1 of 20 (Resident #87) sampled residents of the 32 residents included in the stage 2 review. The findings included: Closed medical record revealed Resident #87 was admitted to the facility on [DATE] and readmitted on [DATE] with [DIAGNOSES REDACTED]. The admission Minimum Data Set ((MDS) dated [DATE] documented Resident #87 was cognitively intact, required extensive assistance with activities of daily living, and had no functional limitations in range of motion. Confidential QA (Quality Assurance) document - allegation of neglect (Resident #87) (undated) documented, .She stated that around 5:45-6:00 [NAME]M. she made her round on the resident and noted he was not speaking as he had been earlier and was staring. She immediately got the night nurse to check him. They both went into the room and the resident was cold to touch. His blood pressure was 90/50 and he started responding by nodding his head when they asked him questions . Written statement by Registered Nurse (RN) #1 (undated) documented, .At approximately 545 AM, the CNA (Certified Nursing Assistant) call me to his room. She stated he was not talking to her. We checked his vitals. I noted his skin was cool so I replaced his blanket and sheet . Written statement by CNA #3 (undated) documented, .On Thursday Feb (February) 2nd (YEAR) .When I went in to check on (Resident #87) around 5:45am-6:00am he was lying like he was sleeping with his eyes open and he was cold to the touch. He would not answer me. I called for the nurse. She came right away to check on him. The nurse tried to take (Resident #87)'s O2 (oxygen) but his fingertips were very cold. The nurse told me to take his BP (blood pressure) and it was 90/50. The nurse and I kept talking to (Resident #87) to try to get a response. (Resident #87) did not talk but he nodded his head in response to the nurse and I . Interview with the Director of Nursing (DON) on 5/16/17 at 1:10 PM, in the Break Room, the DON was asked if the physician was notified when the resident became unresponsive in the night. The DON stated, .Not to my knowledge .there was not any documentation of that incident . The DON was asked if there should have been documentation describing the earlier incident with the resident. The DON stated, .oh yes, there should have been . The DON was asked if the family was notified. The DON stated, Not to my knowledge. The DON was asked if she expected her staff to notify the physician when there is a change in status. The DON stated, Yes, the nurse should have notified the doctor. Telephone interview with (Named Physician) on 5/17/17 at 11:47 AM, (Named Physician) was asked if he was familiar with Resident #87. (Named Physician) stated, .I see a lot of residents .I will look at the medical records on my computer . (Named Physician) was asked if the facility notified him of Resident #87's non-responsive episode at 6:00 AM on 2/3/17. (Named Physician) stated, .they will notify me .I don't remember if they did, I get a lot of phone calls . (Named Physician) was asked if he expected for the facility to notify him when a resident becomes non-responsive. (Named Physician) stated, .well sure .I would send them to the emergency room unless maybe they were a DNR (Do not Resuscitate) .", "filedate": "2020-09-01"}
{"rowid": 1349, "facility_name": "HARTSVILLE CONVALESCENT CENTER", "facility_id": 445256, "address": "649 MCMURRY BLVD", "city": "HARTSVILLE", "state": "TN", "zip": 37074, "inspection_date": "2017-09-12", "deficiency_tag": 157, "scope_severity": "D", "complaint": 1, "standard": 0, "eventid": "9I4J11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on medical record review, review of the facility investigation, and interview, the facility failed to notify the Responsible Party of a non-abusive allegation timely for 1 resident (#1) of 3 residents reviewed. The findings included: Medical record review revealed Resident #1 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Review of the facility investigation and a Nurse's Note dated 3/5/17 at 8:25 PM revealed Resident #2 had his pants down and was found on top of Resident #1 in bed. Further review of the facility investigation revealed Social Progress Notes dated 3/6/17 .This writer along (with) DON (Director of Nursing) called resident's daughter .this afternoon (although the event took place 3/5/17 at 8:25 PM) to let her know about the situation that happened last PM around 8:25 in her room (with) a male resident . Interview with Resident #1 on 9/11/17 at 8:48 AM and 2:00 PM in her room revealed the resident recalled Resident #2, nodded her head Yes when asked if she had affection for him and was ok with him being on top of her and doing what he did. When asked if the resident was ever afraid while he was on top of her, if he had hurt her, and if he had done anything she did not want him to do, she shook head No to each question. Interview with the Abuse Coordinator, the Social Service Director (SSD), with the DON and Administrator present, on 9/11/17 beginning at 9:30 AM in the conference room revealed the SSD informed both resident's Responsible Parties of the event. Further interview confirmed the facility failed to notify Resident #1's Responsible Party timely.", "filedate": "2020-09-01"}
{"rowid": 1361, "facility_name": "HARTSVILLE CONVALESCENT CENTER", "facility_id": 445256, "address": "649 MCMURRY BLVD", "city": "HARTSVILLE", "state": "TN", "zip": 37074, "inspection_date": "2017-11-15", "deficiency_tag": 157, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "4ZDI11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and interview, the facility failed to notify the Physician of recommendations for 1 resident (#5) of 26 residents reviewed. The findings included: Resident #5 was admitted to the facility on [DATE] and readmitted on [DATE] with [DIAGNOSES REDACTED]. Medcial record review of the Quarterly Minimum Data Set ((MDS) dated [DATE] and 9/1/17 revealed Resident #5 had a Brief Interview for Mental Status score of 3, indicating severe cognitive impairment. Continued review of the MDS dated [DATE] and 9/1/17 revealed the resident had impaired vision and did not have corrective lenses. Medcal record review of the Care Plan for Resident #5 revealed the resident had visual deficits. Medical record review of a Request for an Eye Evaluation dated 6/13/17 revealed a request for an eye evaluation to be completed. Continued review of an eye exam evaluation completed on 6/30/17 revealed a recommendation for the resident to receive .artificial tear tid (three times per day) .Daily activities and quality of life affected. Refer for Cataract evaluation . Medical record review revealed no documetation the Physician had been notified of the recommendations nor had a cataract evaluation referral been made. Interview with Licensed Practical Nurse (LPN) #4 on 11/14/17 at 2:50 PM at the 2nd floor nurses station revealed if a referral was needed the Physician was notified and ordered the referral appointment. Interview with LPN #1 on 11/14/17 at 5:05 PM in the conference room revealed an eye exam evaluation went to the Director of Nursing (DON) and then to the floor nurse, who was responsible for contacting the Physician to notify of recommendations. Continued interview revealed documentation of the Physician notification would be in the Nurse's Notes. LPN #1 reviewed Nurse Progress Notes and confirmed there was no documentation of notification to the Physician of the recommendations. LPN #1 confirmed the facility failed to notify the Physician of the eye exam recommendations for a cataract referral and artificial tears for Resident #5. Interview with the DON on 11/14/17 at 5:17 PM in the conference room confirmed the facility failed to ensure the Physician was notified of the eye exam recommendations for a cataract referral or the need for artificial tears for Resident #5.", "filedate": "2020-09-01"}
{"rowid": 1593, "facility_name": "LIFE CARE CENTER OF JEFFERSON CITY", "facility_id": 445275, "address": "336 WEST OLD ANDREW JOHNSON HWY", "city": "JEFFERSON CITY", "state": "TN", "zip": 37760, "inspection_date": "2017-03-22", "deficiency_tag": 157, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "BNNZ11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policy, medical record review, review of an informal facility report, and interview, the facility failed to notify the physician and the family of a change in condition related to elopement for 1 resident (#128) of 29 residents reviewed. The findings included: Review of the facility policy Elopement Policy, revised 4/2009, revealed .Definition of Elopement: Elopement occurs when a resident leaves the premises or a safe area without authorization (i.e., an order for [REDACTED].family and physician notification .reports findings and condition of the resident . Medical record review revealed Resident #128 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Medical record review of the Minimum Data Set ((MDS) dated [DATE], revealed a Brief Interview of Mental Status (BIMS) of 4 (severe cognitive impairment), Delusions (1 to 3 days), Wandering (1 to 3 days), and Wandering Impact yes (indicating the wandering placed the resident at significant risk of getting to a potentially dangerous place). Medical record review of Licensed Practical Nurse (LPN) #1's Progress Note, dated 10/3/16 at 6:47 PM, revealed .Found by CNA walking outside dining room, looking at foliage. DON (Director of Nursing) notified. Q (every) 15 min (minute) checks initiated . Medical record review of an informal facility report, dated 10/3/16, revealed Resident #128 exited the building, visitors going on to their car called the DON, and reported the resident outside in front of the dining room. Continued review revealed Certified Nursing Assistant (CNA) #3 brought the resident back into the facility, the DON ordered 15 minutes checks .for the next few days . and instructed LPN #1 to notify the family and Family Nurse Practitioner. Further review revealed 15 minutes checks performed from 5:15 PM on 10/3/16 through 11:00 PM on 10/8/16. Medical record review of Resident #128's Physician Orders revealed no orders for Resident #128 for 10/3/16 or 10/4/16. Continued review revealed no documentation of the elopement in the Physician's progress notes, the Social Service Director (SSD) notes, or the Care Plan Meeting notes, dated 10/14/16. Medical record review revealed no nursing documentation of the physician, physician extender, or family being notified of the elopement. Interview with LPN #1 on 3/21/17 at 3:50 PM, at the 200 Hall nursing station, confirmed she received a phone call on the evening of 10/3/16 from a CNA informing her Resident #128 was found outside the dining room, on the sidewalk at the front of the building, and she had been brought back into the facility. Further interview revealed LPN #1 telephoned the DON who instructed her to do 15 minute checks. Continued interview confirmed she did not notify the physician or the resident's family, I think I put it on the Nurse Practitioner's log. Interview with the SSD on 3/21/17 at 5:35 PM, in the conference room confirmed she saw Resident #128 outside the building, walking by the dining room window, but did not document the event or notify the family. Interview with the Administrator and the DON on 3/22/17 at 6:25 PM, in the conference room, confirmed the facility failed to notify the physician and the family of Resident #128's elopement.", "filedate": "2020-09-01"}
{"rowid": 1808, "facility_name": "NORRIS HEALTH AND REHABILITATION CENTER", "facility_id": 445303, "address": "3382 ANDERSONVILLE HIGHWAY", "city": "ANDERSONVILLE", "state": "TN", "zip": 37705, "inspection_date": "2017-04-26", "deficiency_tag": 157, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "6ADV11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and interview, the facility failed to notify the physician of a medication recommendation by a consulting practitioner for one resident (#101) of 29 residents reviewed. The findings included: Resident #101 was admitted to the facility with [DIAGNOSES REDACTED]. Medical record review of the Minimum (MDS) data set [DATE], revealed the resident was cognitively intact with a Brief Interview for Mental Status score of 13 points out a possible 15 points. Medical record review of the Behavioral Medicine Progress Note dated 2/07/17, revealed Reason for Visit (Chief complaint): f/u (follow-up) medication review for recent consult to initiate trazadone (antidepressant medication also used to treat [MEDICAL CONDITION]) r/t (related to) [MEDICAL CONDITION]. Medical record review of the facility Order Summary Report dated 4/05/17 revealed no order for the resident to receive [MEDICATION NAME]. Interview with the Director of Nursing on 4/25/2107 at 4:00 PM, in the conference room, confirmed the physician had not been notified of the recommendation from the Behavioral Medicine Progress Note for [MEDICATION NAME], and no order had been written.", "filedate": "2020-09-01"}
{"rowid": 2558, "facility_name": "BRIGHT GLADE HEALTH AND REHABILITATION CENTER INC", "facility_id": 445426, "address": "5070 SANDERLIN AVENUE", "city": "MEMPHIS", "state": "TN", "zip": 38117, "inspection_date": "2017-10-26", "deficiency_tag": 157, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "O8YD11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and interview, the facility failed to notify the physician related to diagnostic test for 1 of 15 (Resident 14) residents of the 24 residents included in the Stage 2 sample review. The findings included: Medical record review revealed Resident #14 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Review of the quarterly Minimum (MDS) data set [DATE] revealed Resident #14 had severe cognitive impairment. An Ultrasound Requisition signed by the physician and dated 10/8/17 documented, .Reason for Exam .Wound, R/o (Rule out) [DIAGNOSES REDACTED] . The Claim Status Points form documented, .CANCELLED .10/05/2017 15:49 .Patient confused and/or combative . Interview with the Director of Nursing (DON) on 10/26/17 at 9:26 AM, in the DON office, the DON was asked if she would expect the physician to be notified if the resident refused an ultrasound . The DON stated, Yes. There was no documentation the Physician was notified of the ultrasound not being performed as ordered.", "filedate": "2020-09-01"}
{"rowid": 2657, "facility_name": "MT JULIET HEALTH CARE CENTER", "facility_id": 445439, "address": "2650 NORTH MT JULIET ROAD", "city": "MOUNT JULIET", "state": "TN", "zip": 37122, "inspection_date": "2017-06-07", "deficiency_tag": 157, "scope_severity": "D", "complaint": 1, "standard": 0, "eventid": "W48711", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on medical record review, review of facility investigation, and interviews, the facility failed to notify the physician and the resident representative of a change in condition in physical status for 1 resident (#1) of 3 residents reviewed for notification of change; and failed to notify the physician of a missed medication for 1 resident (#4) of 3 residents reviewed for medication administration of 13 sampled residents. The findings included: Medical record review revealed Resident #1 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Medical record review of the quarterly Minimum Data Set ((MDS) dated [DATE] revealed the resident scored 09/15 (moderately cognitive impaired) on the Brief Interview for Mental Status (BIMS). Further review revealed the resident required extensive assistance of one for transfer, dressing, and hygiene/bathing. Review of the facility's investigation dated 2/10/17, not timed, revealed on 2/10/17 at approximately 2:45 PM a Certified Nursing Assistant (CNA) found Resident #1 with her leg elevated on a chair. Continued review revealed .she was complaining about her right leg was hurt .I told the nurse .we put her to bed . Further review revealed the resident's knee was assessed by Licensed Practical Nurse (LPN) #4 and was observed as swollen and LPN #4 instructed the CNA to lay the resident down and elevate the leg on a pillow. Medical record review of a Nurse's note dated 2/10/17 at 3:46 PM revealed the resident complained of pain in her right knee. Continued review revealed there was some swelling in the right knee with no bruising or redness noted. Further review revealed .there is a small scrape on the right knee which appears to be old .no open areas noted .right knee is tender and slightly warm to the touch . denied falling or hurting herself . Medical record review of a Nurse's note dated 2/12/17 at 9:55 PM revealed the resident's right knee was swollen. Continued review revealed .pedal pulses equal and strong .knee elevated with a pillow .note placed in NP (Nurse Practitioner) box and 24 hr (hour) report book .knee is very tender to the touch .denied falling or hurting herself . Medical record review of a NP progress note dated 2/13/17 revealed .right knee that has progressively been bothering her for a couple weeks. It is large, swollen, and quite warm to touch .extremely tender to touch and rom (range of motion) is limited .right knee is approx. twice the size of left knee, very warm to touch, extreme tenderness to palpation - with patient stating she fell 2 weeks ago, and the knee cap is the source of all pain .assessment right knee bursitis probable, right knee pain . Medical record review of the x-ray ordered on [DATE] of the right knee revealed .arthroplasty (knee replacement) at the RIGHT knee .distal femoral diaphyseal fracture displaced laterally by approximately one half bone width .mild overriding of fracture fragments .mild anterior angulation. Prosthesis appears intact .Impression: distal femur fracture . Review of the facility's investigation dated 2/14/17 revealed a written statement by LPN #4. Continued review revealed .CNA stated Friday 2/10/14 the resident's right knee was swollen. She brought the resident to her room and I assessed her and the right knee .the resident showed no signs of distress or SOB (shortness of breath). The right knee was swollen and slightly warm to the touch. The resident denied pain but when I touched it she did complain of some pain .put the resident in bed and elevated the right knee .assessed the resident some more .Pedal pulses were equal and strong. Over the weekend the resident's granddaughter and daughter were in visiting and made aware of swollen knee .daughter informed me that the resident had a past right knee replacement and the knee swells from time to time. The resident denied falling or hurting herself. I asked the resident did she fall or hurt herself and the resident's daughter (named) asked the resident as well. Both times the resident responded, 'No' .over the weekend the resident denied pain. I kept the resident in bed over the weekend with her right leg elevated . Review of facility's investigation dated 2/24/17 staff were counseled related to .Failure to deliver services. Resident change in condition nurse did not follow up. Contact physician, family as appropriate . Interview with the NP on 6/5/17 at 1:00 PM, in the Social Services office, revealed when she saw the resident on 2/13/17 the knee was red, hot, and swollen and an x-ray was ordered. Telephone interview with LPN #4 on 6/6/17 at 1:05 PM revealed Resident #1 did not complain of pain or show signs/symptoms of distress. Further interview revealed LPN #4 kept the resident in the bed over the weekend with the leg elevated. Continued interview revealed, when asked by the writer if LPN #4 should have reported the incident, the LPN replied she would report the incident to the physician based on the level of care the resident required and if the resident showed any signs of distress. Continued interview revealed LPN #4 did not notify the resident's family timely. Interview with the Regional Nurse Consultant on 6/6/17 at 3:05 PM, in the Social Services office, confirmed the nurse did not immediately notify the physician or the resident's family, regarding the change of status for Resident #1. Interview with the NP on 6/7/17 at 10:15 AM, in the Social Services Office, confirmed she would have expected to be notified of the resident's change in condition. Medical record review revealed Resident #4 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Medical record review of the quarterly Minimum Data Set ((MDS) dated [DATE] revealed Resident #4 scored 08/15 (severely cognitive impaired) on the Brief Interview for Mental Status (BIMS). Further review revealed the resident required limited assistance for transfer and hygiene/bathing with extensive assistance for dressing. Medical record review of a Patient Medication Profile (physician's recapitulation of Resident #4's medications), not dated, revealed on 7/23/16 a physician's orders [REDACTED].[MEDICATION NAME] (pain medication) 25 MCG (micrograms) APPLY 1 PATCH [MEDICATION NAME] (through the skin) Q (every) 3 DAYS . Medical record review of the paper Controlled Drug Receipt/Record/Disposition Form revealed the [MEDICATION NAME] Patch was signed out on the controlled substance log and administered on 5/7/17, 5/11/17, 5/13/17, and 5/16/17. Further review revealed the medication was due on 5/10/17, but was not given until 5/11/17. Interview with the Interim Director of Nursing (DON) on 6/5/17 at 3:25 PM, in the Social Services office, confirmed the facility failed to administer Resident #4's [MEDICATION NAME] Patch when due on 5/10/17. Further interview confirmed the medication was administered on 5/11/17 (24 hours later) and the nurse should have advised the physician of the missed dose of medication.", "filedate": "2020-09-01"}
{"rowid": 2759, "facility_name": "AHC MCNAIRY COUNTY", "facility_id": 445452, "address": "835 EAST POPLAR AVENUE", "city": "SELMER", "state": "TN", "zip": 38375, "inspection_date": "2017-06-28", "deficiency_tag": 157, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "63XQ11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on policy review, medical record review and interview, the facility failed to notify the physician of a significant change in condition and that the resident refused all medications necessary to treat cardiac conditions for 1 of 22 (Resident #124) sampled residents reviewed during the stage 2 review. The findings included: Review of the Documentation of Med (Medication) Pass policy dated (MONTH) 2014 revealed, The physician should be consulted and made aware if the patient is frequently refusing any or all of their meds. Medical record review revealed Resident #124 was admitted on [DATE] with [DIAGNOSES REDACTED]. Review of the Medication Administration Record [REDACTED]. These medications included Aspirin 81 milligrams (mg), [MEDICATION NAME] 125 micrograms (mcg), [MEDICATION NAME] Sodium 100 mg, [MEDICATION NAME] 20 mg, [MEDICATION NAME] 10 mg, [MEDICATION NAME] ER(Extended Release) 50 mg, Multivitamin, and Potassium Chloride 20 milliequivalents (mEq). The Nurse's Notes dated 4/27/17 at 10:45 AM documented by Licensed Practical Nurse (LPN) #1 revealed Resident #124 spit out medications and breakfast stating that's enough. The Nurse's Notes dated 5/2/17 at 2:22 AM indicated nursing staff had difficulty administering meds (medications) this shift. Appetite poor. Increased weakness noted. There was no documentation on 4/27/17 or 5/2/17 that the physician had been notified of Resident #124 refusing to take the medications or the change in condition of a poor appetite and increased weakness. Interview with Licensed Practical Nurse (LPN) #1 on 6/27/17 at 3:55 PM in the conference room. LPN #1 stated she was familiar with Resident #124. She stated, (Resident #124) didn't take her medication that day. She would do that with food and fluids too. I would normally write it down in the doctor's book. I wouldn't call him. He comes in almost every day. We have a communication book we write things in for him. He looks at the book and then removes the paper. LPN #1 could not find any documentation from the physician acknowledging he was notified that Resident #124 did not take her medication on 4/27 and 5/2/17 or had a change in condition on 5/2/17. Interview with the Assistant Director of Nursing (ADON) on 6/27/17 at 4:25 PM, in the conference room, the ADON stated the physician should be notified that a resident refuses medications. That doctor is here every day. He has a communication book that they write things in for him. They can call him if there is something that needs to be called. He doesn't keep the papers we communicate with him on. Interview with the Director of Nurses (DON) on 6/28/17 at 8:15 AM in the conference room, the DON stated, Our policy says you don't have to report refusals unless they are frequent. Frequent to me would be almost daily.", "filedate": "2020-09-01"}
{"rowid": 2803, "facility_name": "SWEETWATER NURSING CENTER", "facility_id": 445456, "address": "978 HWY 11 SOUTH", "city": "SWEETWATER", "state": "TN", "zip": 37874, "inspection_date": "2017-08-16", "deficiency_tag": 157, "scope_severity": "D", "complaint": 1, "standard": 0, "eventid": "5ODH11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on facility policy review, medical record review, and interview the facility failed to provide notification for a change in health status for 1 resident (#1) of 3 residents reviewed for notification of change. The findings included: Review of the facility policy Changes in a Resident's Condition or Status Effective Date ,[DATE] Revised ,[DATE] revealed .Nursing Services shall be responsible for notifying the Resident and responsible party when: .there is a significant change in the Resident's physical, mental, or emotional status . Medical record review revealed Resident #1 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. The resident was discharged to the hospital on [DATE] where he subsequently expired. Review of a Minimum Data Set ((MDS) dated [DATE] for Resident #1 revealed a Brief Interview of Mental Status was unable to be completed .short term memory problem .long term memory problem .moderately impaired - decisions poor; cues/supervision required . Review of the Nurse Practitioner (NP) note dated [DATE] revealed, .nurse requested visit for decline .was walking when first admitted ; now not walking. On exam resident with respiratory distress, unresponsive .CNA's (certified nurse aides) report some coughing with intake. SLP (speech language pathologist) evaluated yesterday and unable to fully participate with exam .respiratory tachypnea (rapid breathing) . Review of a Physician's Order dated [DATE], revealed, .stat 2 view CXR (chest xray), [MEDICAL CONDITION]. [MEDICATION NAME] stat (now) q (every) 6 hrs (hours) .Respiratory therapy to evaluate .) Review of the Mobile Images (chest xray) report revealed, acute right lower lobe infiltrate . Review of the NP note dated [DATE] revealed, .visit requested by Respiratory Therapy. Resident with shortness of breath and rhonchi . Interview with the Regional Client Operations Consultant on [DATE] at 4:00 PM, in the conference room confirmed expectations were the families would be notified of a significant change in a resident's medical condition unless the resident was able to make the decision, and they did not want the family to be notified. Further interview confirmed if a resident was their own responsible party and had a significant change the expectation was the family would be notified. Interview with the Director of Nursing on [DATE] at 4:30 PM, in her office confirmed it was expected the family be notified when a resident had a significant change in condition, and the facility had failed to notify Resident #1's family of his change in health status.", "filedate": "2020-09-01"}
{"rowid": 2897, "facility_name": "ALAMO NURSING AND REHABILITATION CENTER", "facility_id": 445467, "address": "580 W MAIN STREET", "city": "ALAMO", "state": "TN", "zip": 38001, "inspection_date": "2017-07-19", "deficiency_tag": 157, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "NDN711", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and interview, the facility failed to notify the physician of a change in blood pressure (BP) reading for 1 of 2 (Resident #31) residents of 20 residents in the Stage 2 sample review. The findings included: Medical record review revealed Resident #31 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Review of the the most recent comprehensive Minimum Data Set (MDS) assessment completed on 4/17/17 revealed the resident was severely impaired in cognition with a Brief Interview for Mental Status (BIMS) score of 4 out of 15 (0 - 7 equaled severe cognitive impairment) and required either extensive assistance or was totally dependent on staff for the provision of activities of daily living (ADLs) such as transfers, dressing, eating, toilet use, etc. Review of Physician's Orders for (MONTH) (YEAR) revealed Resident #31 was prescribed [MEDICATION NAME] (antihypertensive medication), 15 mg once a day for a [DIAGNOSES REDACTED]. The medication was initiated on 5/26/15. The Physician's orders did not include parameters for holding the medication (not administering when BP was below a specified level). BP measurements were to be taken once a week. Review of Resident #31's BP readings revealed: the following low BP readings documented on the following forms: 5/19/17-82/56 (Blood pressure log) 5/26/17-81/54 (Blood pressure log) 6/9/17-73/49 (Blood pressure log) 6/12/17-78/49 (Nursing Departmental Note) 6/22/17-66/38 (Nursing Departmental Note) There was no evidence the Physician was notified of Resident #31's low BP readings. Review of Doctor's Orders and Progress Notes dated 6/22/17 revealed the Physician was aware of the low BP reading and [MEDICATION NAME] was discontinued on this date. Interview with Licensed Practical Nurse (LPN) #4 on 7/19/17 at 4:49 PM, LPN #4 stated there should be nursing documentation of the low blood pressure readings and notification to the Physician. Interview with the Director of Nursing (DON) on 7/19/17 at 6:12 PM, the DON stated the Physician should have been notified of Resident #31's low BP readings, and verified Resident #31 had been prescribed a medication for high BP. The DON stated nurses should have notified the Physician of all low BP readings with a systolic BP of less than 80 and a nurse's note should have been written in each instance to document the low BP and notification to the physician.", "filedate": "2020-09-01"}
{"rowid": 3027, "facility_name": "CORNERSTONE VILLAGE", "facility_id": 445483, "address": "2012 SHERWOOD DRIVE", "city": "JOHNSON CITY", "state": "TN", "zip": 37601, "inspection_date": "2017-05-17", "deficiency_tag": 157, "scope_severity": "G", "complaint": 1, "standard": 1, "eventid": "LW9W11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on review of facility policy, medical record review, and interview, the facility failed to notify the Physician or the Nurse Practioner (NP) of poor nutritional intake, resulting in a 10.9% weight loss in a one month period (harm) for 1 resident (#51) of 4 residents reviewed for nutrition, of 46 sampled residents. The findings included: Review of the facility policy Weight Loss Intervention (undated) revealed .Weight loss intervention will be implemented for those residents experiencing a weight loss .Weight loss intervention is implemented to prevent further weight loss and to maintain/improve the resident's nutritional status .Steps .5% weight loss in 30 days .Referral to Registered Dietician, Physician . Medical record review revealed Resident #51 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Further review revealed Resident #51 was discharged to the hospital on [DATE] with [DIAGNOSES REDACTED]. Medical record review of the Daily Charting completed by the Certified Nurse Assistants (CNAs) dated 2/18/17 to 3/24/17 revealed Resident #51 consumed 25% or less for 71 of 102 meals, and 18 meals had no documentation if the resident consumed any of the meal. Medical record review of the laboratory results dated [DATE] revealed a hemoglobin of 11.5 (normal 13.5 - 17.5) and a hematocrit of 34.2 (normal 38.0 - 50.0), indicating the resident was anemic (low iron). Medical record review of the Physician Standing Orders signed by the resident's physician on 2/22/17 revealed .Weekly weights X (times) 4 weeks on admission, if stable then monthly . Medical record review of the admission Minimum Data Set ((MDS) dated [DATE] revealed a Brief Interview for Mental Status (BIMS) score of 3, indicating Resident #51 was severely cognitively impaired, and the resident required extensive assistance for bed mobility, dressing, toileting, and personal hygiene. Continued review revealed Resident #51 was total dependence for transfer, eating, and bathing. Further review revealed Resident #51 had no problems with eating. Medical record review of Resident #51's care plan dated 2/28/17 revealed .I am at risk for altered nutritional status r/t (related to) assistance with all meals and a dx (diagnosis) of dementia .I will have a PO (by mouth) intake of at least 51-75% of most meals by next review .Weigh me and monitor my weight per facility policy .Monitor my daily food and fluid intake .Coordinate my nutritional care with RD (Registered Dietitian), MD (Medical Doctor), and other disciplines as necessary . Medical record review of the resident's weights revealed the resident weighed 164.4 pounds (lbs) on 2/21/17 (3 days after admission) and was 146.2 lbs on 3/17/17 (approximately 1 month after admission), a weight loss of 18.2 pounds, or 10.9% of the resident's body weight. Interview with Licensed Practical Nurse (LPN) #6 on 5/15/17 at 9:56 AM, at the 600 nurse's desk, confirmed he was aware of Resident #51's poor intake and did not notify the Nurse Practitioner (NP) or the physician. Interview with LPN #7 on 5/15/17 at 9:56 AM, at the 600 nurse's desk, confirmed she was aware of Resident #51's poor intake and did not notify the NP or the physician. Interview with NP #1 on 5/16/17 at 11:21 AM in the small conference room, revealed NP #1 was in the facility Monday through Friday each week. Further interview revealed new admission residents were weighed weekly for 4 weeks and then monthly. Continued interview revealed NP #1 usually received reports from the Nursing Supervisors or the Certified Dietary Manager if a resident had a poor appetite, but was not notified of Resident #51's poor appetite or weight loss until 3/24/17, when Resident #51 was discharged to the hospital. Interview via telephone with Resident #51's physician (who was also the Medical Director) on 5/16/17 at 1:30 PM, revealed the physician was first notified of Resident #51's poor nutritional intake, the resident not being weighed weekly, and weight loss on 3/23/17, the day before Resident #51 was discharged to the hospital. Further interview confirmed had the physician been notified sooner of the poor intake, she would have made recommendations to try and increase the resident's intake and reduce the amount of weight loss. Refer to F325.", "filedate": "2020-09-01"}
{"rowid": 3248, "facility_name": "PAVILION-THS, LLC", "facility_id": 445500, "address": "1406 MEDICAL CENTER DRIVE", "city": "LEBANON", "state": "TN", "zip": 37087, "inspection_date": "2017-09-07", "deficiency_tag": 157, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "OECK11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policy, medical record review, and interview, the facility failed to notify the physician of the family's request to hold a medication order for 1 resident (#65) of 27 residents reviewed. The findings included: Review of facility policy, Change in a Resident's Condition of Status, revised 4/5/16 revealed .The Nurse Supervisor/Charge Nurse will notify the resident's Attending Physician or On-Call Physician when there has been .A need to alter the resident's medical treatment significantly . Medical record review revealed Resident #65 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Medical record review of the Quarterly Minimum Data Set ((MDS) dated [DATE] revealed Resident #65 was severely cognitively impaired. Medical record review of a Physician's Telephone Orders Audit dated 7/24/17 revealed .(1) taper off [MEDICATION NAME] (antidepressant) QOD (every other day) x (times) 1 wk (week), then DC (discontinue), (2) [MEDICATION NAME] (antidepressant) 50 mg (milligrams) . Medical record review of the 7/2017 through 8/2017 Medication Review Report revealed an order dated 8/8/17 for [MEDICATION NAME] 100 mg every other day for 1 week then DC and an order dated 8/8/17 for [MEDICATION NAME] 50 mg. Interview with Licensed Practical Nurse (LPN) #2 on 9/6/17 at 4:05 PM at the 100/200 hall nursing station confirmed she wrote the Physician's Telephone Orders Audit dated 7/24/17 for Resident #65. Further interview revealed the resident's daughter requested the 7/24/17 order be held until the daughter was able to review the genetic testing results for the resident. Continued interview with LPN #2 confirmed the facility failed to notify the prescribing Physician for clarification of the medication order. Interview with Director of Nursing (DON) on 9/6/17 at 4:20 PM in her office confirmed the facility failed to notify the prescribing Physician for clarification of the medication order dated 7/24/17 for Resident #65.", "filedate": "2020-09-01"}