cms_TN: 10
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| rowid | facility_name | facility_id | address | city | state | zip | inspection_date | deficiency_tag | scope_severity | complaint | standard | eventid | inspection_text | filedate |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 10 | ST BARNABAS AT SISKIN HOSPITAL | 445008 | 1 SISKEN PLAZA | CHATTANOOGA | TN | 37403 | 2020-02-20 | 679 | D | 0 | 1 | UNET11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policy, medical record review, review of activity calendars, observations, and interviews, the facility failed to provide activities for 4 of 25 sampled residents (Resident #131, Resident #132, Resident #230, and Resident #232) who resided on the Sub-Acute Unit. Failure to provide residents with an activity program has the potential to affect the residents' physical, mental, and psychosocial well-being. Findings Include: Review of the St. Barnabas/Siskin West Policy Activities Department updated/revised 12/2018 indicated the definition of an activity was any activity other than activities of daily living that enhanced the resident's well-being. The policy indicated the activities would be person-centered and highlight the resident's quality of life. The procedure indicated the AD would visit the resident after admission to obtain likes and dislikes. The procedure further indicated the AD would educate the resident on happenings on the unit and she would provide an activity calendar for the resident. The policy stated, .should the patient/resident decline to attend activities .they will be provided with in-room options or 1:1 (one on one) opportunities .puzzles, books, magazines, movies and music. Resident #131 was admitted to the facility on [DATE] for occupational and physical therapy following a motor vehicle accident. Review of the Baseline Care Plan dated 2/17/2020, revealed it did not address Resident #131's activity preferences. Review of Resident #131's Resident Activities Assessment Preferences for Customary Routine Activities dated 2/19/2020, revealed it was very important for the resident to do her favorite activities; and it was somewhat important for the resident to have books, newspapers, and magazines to read, to listen to music she liked, to do things with groups of people, to go outside to get fresh air when the weather was good, and to participate in religious services or practices. Review of the admission Minimum Data Set (MDS) assessment with an Assessment Reference Date (ARD) of 2/23/2020 revealed Resident #131 was cognitively intact. Observations of Resident #131 conducted through-out the day on 2/18/2020, 2/19/2020, and 2/20/2020, in the resident's room, revealed Resident #131 had not been approached to attend activities and had not been observed in activities, either at her bedside, or in a group setting. Review of the Activity Calendar posted on the hallway by the nurses station on the 2nd floor Subacute Unit on Wednesday 2/19/20 at 8:49 AM, indicated good morning rounds were to be done at 9:00 AM; tai ji (Tai Chi) at 10:30 AM; at 2:00 PM Oliver visits; bingo was at 2:15 PM; and chili tasting was at 2:45 PM. During interview with Resident #131 on 2/19/2020 at 3:49 PM, at her bedside, Resident #131 was asked if she participated in the activities provided by the facility. The resident stated No, I didn't realize they had activities. Resident #131 was asked if anyone had come around and asked if she wanted to attend the activities, or to bring her a magazine or newspaper, and the resident stated, No. The resident was asked, if she were asked to participate in activities would she, and the resident stated, It would depend on the activities. The resident was asked if she would have attended this afternoon's bingo and chili tasting, and Resident #131 stated, I would have liked that. Resident #132 was admitted to the facility on [DATE] for occupational and physical therapy following a right total knee arthroplasty. Review of Resident #132's Baseline Care Plan dated 2/13/2020, showed it did not address the resident's activity preferences. Review of the admission MDS with an ARD of 2/19/2020 revealed Resident #132 was cognitively intact. Review of the Resident Activities Assessment, Preferences for Customary Routine Activities dated 2/19/2020, revealed it was very important to Resident #132 to listen to music he liked; and somewhat important to have books, newspapers, and magazines to read, keep up with the news, to do things with groups of people, to do his favorite activities, and to go outside to get fresh air when the weather was good. Observations conducted through-out the day on 2/18/2020, 2/19/2020, and 2/20/2020, in the resident's room, revealed Resident #132 had not been approached to attend activities and had not been observed in activities, either at his bedside, or in a group setting. During interview with Resident #132 on 2/19/2020 at 2:04 PM, the resident was asked if he had participated in any of the activities since he had been in the facility. Resident #132 stated, No. Resident #132 was asked if he was aware there were activities offered at the facility, and the resident stated, No, no one has told me anything about any activities. Resident #132 was questioned if the staff were to ask, would he participate in activities, and the resident stated, I probably would. Resident #230 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Record review of the Social History/Admission assessment dated [DATE], revealed Resident #230 had a mini mental score of 15, which indicated Resident #230 had intact cognition. Record review of Resident #230's initial Resident Activities Assessment Preferences for Customary Routine Activities dated 2/17/2020, indicated it was very important to the resident to have animals around, keep up with the news, and participate in religious services. Observation on 2/18/2020 at 9:39 AM, revealed Resident #230 was in his room. There was an activity calendar posted in the resident's room. Interview with Resident #230 on 2/18/2020 at 9:39 AM, revealed no one had informed him of any activities going on that day. Resident #230 stated Lord I did not even know that the activity calendar was posted in the room. He stated he had not read the calendar and did not think anyone had ever come to him to discuss activities. Resident #230 stated he would be interested in going to activities according to the time of day. He stated he liked working in the yard. Observation on 2/18/2020 at 2:18 PM, revealed Resident #230 was sitting up in a chair in his room. There was not an activity person in his room or on the unit, even though pet therapy was listed on the activity calendar in his room and on the big activity calendar in the hallway by the nurse's station. Interview with Resident #230 on 2/18/2020 at 2:18 PM, in his room, revealed someone had been in earlier and asked if he wanted a magazine, and that was all. Observation of Resident #230 on 2/19/2020 at 9:00 AM, revealed he was sitting up in a chair in his room and was getting ready to go to therapy at 9:45 AM. Resident #230 stated no one had been by and invited him to any activities that day, but he had a calendar that might tell what was going on. Observation on 2/19/2020 at 3:32 PM, in the dining/activity room on the 2nd floor Subacute Unit, revealed no chili tasting activity was taking place, which was listed as an activity on the calendar for 2:45 PM. Observation on 2/19/2020 at 3:35 PM, in the dining/activity room on the 3rd floor, showed a chili tasting event was occurring. Resident #230 was not in attendance. Review of the Activity Calendar posted on the hallway by the nurse's station on the 2nd floor Subacute Unit indicated on Thursday (MONTH) 20, 2020 showed there would be seven activities that day. The calendar indicated that at 8:30 AM the news would be done; 9:00 AM would be good morning rounds; 10:00 AM would be coffee activity; 11:00 AM papers were to be delivered; 11:30 AM would be bible story time; and at 2:30 PM Wheel of Fortune would be played. Interview with Registered Nurse (RN) #6 on 2/20/2020 at 12:23 PM, revealed she had not discussed any activities with Resident #230. During interview with Resident #230 on 2/20/2020 at 12:35 PM, he was in his room and his wife was at the bedside. Resident #230 stated he did not go to the chili tasting yesterday and no one had been by for morning coffee that morning. Resident #230 state he needed to get out more and socialize. Resident #230 further stated he liked chili. Resident #232 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Record review of Resident #232's Social History/Admission assessment dated [DATE], revealed the resident had a mini mental score of 15, which indicated intact cognition. Record review of Resident #232's initial Resident Activities Assessment Preferences for Customary Routine Activities dated 2/13/2020 revealed it was very important to the resident to keep up with the news and to go to religious services. Observation and interview on 2/18/2020 at 1:04 PM, revealed Resident #232 was sitting in his room watching television. During interview, Resident #232 stated he was not aware of any activities that the facility provided. Resident #232 stated he did not think anyone had ever discussed activities with him. He stated he might go to an activity, but it depended on what time it was. He stated he liked music. Resident #232 stated he had not gone to the sing a long that was posted on the calendar for the past Saturday, and he had not been invited to go. Interview with Licensed Practical Nurse (LPN) #5 on 2/20/2020 at 11:30 AM, in the dining/activity room on the 2nd floor Subacute Unit, revealed some residents would say they were bored and they had cabin fever. LPN #5 stated she would tell the residents they were welcome to come out in the hallway and visit. LPN #5 stated she would tell the resident about the books and puzzles available on the unit and there were puzzles and activities upstairs on the 3rd floor. LPN #5 stated she would give the residents the activity calendar and told them how to get to it on the 3rd floor. Interview with the Director of Nursing (DON) on 2/20/2020 at 2:24 PM, in her office, revealed very rarely did a subacute person go to activities because they were mainly interested in getting well and going home. The DON stated the subacute stays were only two weeks and then they go home. The DON stated there was an activity calendar in each room and a big calendar in the hallway that the subacute residents passed by when going to therapy. The DON stated she was not sure if the subacute had to have documentation activities were done. The DON stated the residents in the subacute unit wanted to just go home and she felt it did not pose any risk to the residents if they did not go to activities. Interview with the AD on 2/20/2020 at 10:30 AM, in her office on the 3rd floor, revealed she had been the Activity Director for 4 years. The AD stated she used to have 3 Activity Assistants, but now it was only her. She used to have more volunteers and now she has fewer. The AD stated the nurses did the initial activity assessment, she would check over the assessment, then she would go talk to the residents and gave the residents an activity calendar, and she would go over it with the resident. She offered the residents cards, magazines, puzzles, Sudoku, and CD players. She told the residents where the books and puzzles could be located. The AD stated most of the rehab residents were more self-directed and could do their own interests. Most of the rehab residents wanted to do their rehabilitation, go home, and were not much interested in activities. The AD stated the facility has 50's singing once a month and church services on Sundays and Tuesdays. If the resident filled out that religious services or music was important to them, then she tried to get them to the services. The AD stated she did not work on the weekends and could not say if Resident #230 or Resident #232 had attended any religious services on the weekends. She did not keep track of who attended the weekend activities. Pet therapy had been cancelled because of the weather. Resident #230 and Resident #232 had not participated in the chili tasting activity yesterday and had not attended any facility activity. The AD had tried to come down to the 2nd floor yesterday to do an activity, but had only been there a few minutes and the 3rd floor paged her, and she had to go back up there to do their activity. She stated the residents on the 3rd floor liked to get her attention and looked to her for activities. The AD stated she tried to get to the 2nd floor to at least pass out books and magazines. During interview with the Administrator on 2/20/2020 at 1:30 PM, in the conference room, the Administrator was asked what her expectations were related to activities for the Sub-Acute Unit residents. The Administrator stated I expect the sub-acute residents to be asked if they want to participate in activities whenever there are activities going on, or if they want to do a bedside activity. The Administrator added the Activity Director told her she hasn't had the chance to get to the subacute residents this week. | 2020-09-01 |