cms_TN: 2657
Data source: Big Local News · About: big-local-datasette
| rowid | facility_name | facility_id | address | city | state | zip | inspection_date | deficiency_tag | scope_severity | complaint | standard | eventid | inspection_text | filedate |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 2657 | MT JULIET HEALTH CARE CENTER | 445439 | 2650 NORTH MT JULIET ROAD | MOUNT JULIET | TN | 37122 | 2017-06-07 | 157 | D | 1 | 0 | W48711 | **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. | 2020-09-01 |