| 8416 |
THE WATERS OF ROBERTSON, LLC |
445137 |
104 WATSON ROAD |
SPRINGFIELD |
TN |
37172 |
2013-09-26 |
151 |
E |
0 |
1 |
6APT11 |
**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 . |
2017-06-01 |