cms_TN: 87
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 87 | NASHVILLE COMMUNITY CARE & REHABILITATION AT BORDE | 445033 | 1414 COUNTY HOSPITAL RD | NASHVILLE | TN | 37218 | 2018-07-25 | 604 | D | 0 | 1 | 565T11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on facility policy review, medical record review, observation and interview, the facility failed failed to obtain a physician's order, failed to assess, failed to obtain a consent, failed to monitor and failed to re-evaluate the need for restraints for 1 of 23 (Resident #117) residents reviewed; failed to obtain a medical diagnosis, failed to monitor, and failed to re-evaluate the need for a restraint for 1 of 23 (Resident #111) residents reviewed. Findings include: Review of facility policy Use of Restraints undated, revealed, .Restraints only may be used .after consideration, evaluation, and the use of all other viable alternatives. All residents have the right to be free from restraint .PHYSICAL RESTRAINTS: are defined as any manual method, or physical .device, .or equipment attached or adjacent to the resident's body that an individual cannot remove easily and which restricts the resident's freedom of movement or normal access to his/her body . Medical record review revealed Resident #117 was admitted to the facility on [DATE] and readmitted on [DATE] with [DIAGNOSES REDACTED]. Medical record review of a Quarterly Minimum Data Set ((MDS) dated [DATE] revealed Resident #117 had a Brief Interview for Mental Status (BIMS) of 3 indicating severe cognitive impairment. He was totally dependent for bed mobility and transfers with assistance of 2 or more people required. He was totally dependent for dressing, eating, toileting, personal hygiene and bathing with assistance of 1 person. The resident did not stand or ambulate and was unsteady with surface to surface transfers. He had bilateral impairments to upper and lower extremities. He used a wheelchair for mobility with assistance from 1 person. The resident did not use any physical restraints. Observation of Resident #117 on 7/23/18 10:48 AM in the B3 day room revealed he was seated in a wheelchair tilted back 30 degrees with his feet unable to reach the floor. There was a Velcro release belt to his upper chest and a regular seat belt latched across his lap. Both belts were secured by a metal clasp attached to the wheelchair. Resident #117 was asked if he could release the chest belt and stated, No ma'am. Observation of Resident #117 on 7/23/18 at 12:20 PM in the B3 day room revealed he was seated in a wheelchair tilted back 30 degrees with his feet unable to reach the floor. The Velcro release belt was intact to his upper chest and the seatbelt was latched across his lap. Continued observation revealed the resident was moving his right arm up from his lap above his head and was moving his head forward and backward repeatedly causing the wheelchair to bounce slightly. Medical record review of Resident #117's electronic medical record revealed no physician's orders for a restraint or positioning device. Medical record review of recapitulation Physician's Orders for (MONTH) (YEAR) revealed no orders for a restraint or positioning device. Medical record review revealed no restraint assessment, no restraint consent, no monitoring of a restraint and no re-evaluation of the restraint. There was no documentation that a lesser alternative to a restraint had been attempted prior to the use of the tilted wheelchair and belts. Interview with Licensed Practical Nurse (LPN) #2 and Unit Manager on B3 on 7/25/18 at 10:45 AM in his office was provided Resident #117's chart and asked where the documentation was regarding the resident's restraints and stated, They're not restraints, they use them for positioning. Those belts are for positioning and they don't prevent him from doing anything he can do without the belt. Continued interview with LPN #2 when asked why use the belts at all and stated, They are for positioning. We were told by MDS and care plan committee they weren't restraints due to his [DIAGNOSES REDACTED]. upright in the wheelchair he will flop over. (Demonstrated leaning forward over his knees). He has [DIAGNOSES REDACTED] in his legs sometimes and they go straight out, so he has the lap belt or he would slide right out of the chair. When asked where the assessment for the restraints, and documentation of their release every 2 hours, medical diagnosis, consent, and documentation of the least restrictive restraints previously used on the resident he stated, There is not any documentation for any of that, because we didn't do it, we used the chair with those belts for positioning. Interview with the MDS Coordinator on 7/25/18 at 11:58 AM in LPN #2's office with LPN #2 present stated, We were using the chair with the belts for positioning to prevent falls. When asked if the resident had had a fall LPN #2 stated,He has not. Continued interview revealed the MDS Coordinator stated, If he can't stand up then its not a restraint. Assistant Director of Nursing (ADON) #2 entered the office at 12:05 PM and all 3 staff were asked if other residents with a [DIAGNOSES REDACTED].? The staff stated they were not sure. The staff was asked if the resident could voluntarily move his head backward and forward was the chest belt preventing him from moving voluntarily and ADON #2 and LPN #2 both said Yes. The staff was asked if the resident was receiving his highest practicable well being by being restrained by tilting him back, and having a chest and lap belt if he could only move his right arm a little bit and his head? The ADON and the LPN agreed the chest belt did prevent Resident #117 from moving freely. Further interview revealed when asked if a wheelchair with a chest and lap belt was the best and least restrictive alternative for Resident #117, LPN #2 stated, It's definitely not the best chair for him. I referred him to therapy a year ago for a different chair and positioning but nothing changed. The ADON stated, The chair is not appropriate. LPN #2 stated, He is supposed to be up in the chair 3 times a week for 3 hours max (maximum) because his skin is so fragile. ADON#2, the MDS Coordinator and LPN #2 confirmed there was no physician's order or any documentation in the resident's medical record indicating the tilted wheelchair, chest belt and lap belt were to be used for positioning for Resident #117. Interview with the Occupational Therapist (OT) on 7/25/18 at 12:55 PM in the Physical Therapy Department confirmed Resident #117 was last seen by therapy on 3/29/17 per request of the nursing staff. Continued interview revealed the resident was evaluated for contracture management only. The OT was asked if they re-evaluate resident equipment like specialized wheelchairs every so often after the resident has used it for a while and stated No, we're not allowed to. We have to wait for a referral from nursing. If they need to be re-evaluated, nursing sends the request on an orange request form with the specific things they are concerned about. Continued interview revealed the OT was asked when they recommend a specific wheelchair with chest and lap belt restraints, did the physician have to approve it first, and the OT stated, We write the order for what we think is best for the resident and the physician comes behind us and signs off on it. When the OT was asked if that order was supposed to be on the active order sheet if the resident is still using it he stated, Yes, it should be in the chart. Further interview revealed when the OT was asked if he could check the electronic record to determine when and how long Resident #117 had the wheelchair and restraints, the OT looked in the computer and stated, No, I can't tell how long he's had it. When (named corporation) took over the facility in (YEAR) we didn't have access to the previous electronic records. Continued interview revealed the OT was asked if there were other residents in the facility with a [DIAGNOSES REDACTED]. Interview with the Director of Nursing (DON) on 7/25/18 at 3:50 PM in her office confirmed the facility failed to obtain a physician's [DIAGNOSES REDACTED].#117; failed to assess the resident for the use of restraints and/or positioning; failed to obtain a consent for restraints; failed to document the release of the restraints; failed to evaluate the ongoing use of restraints, and failed to document the least restrictive alternative for restraints for the resident. Continued interview with the DON confirmed there was no documentation in Resident #117's medical record regarding the use of a chest belt or lap belt for positioning purposes. Findings include: Medical record review revealed Resident #111 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Medical record review of the Quarterly MDS dated [DATE] revealed the Cognitive Skills for Daily Decision Making score 3 indicating severe impairment. Medical record review of the Quarterly MDS dated [DATE], Quarterly MDS dated [DATE] and Annual MDS dated [DATE] revealed .Section P. - Used in chair or out of bed Trunk restraint 1(Used less than daily) . Medical record review of the physician orders dated 1/6/16 revealed .Seat belt with alarm when up in wheelchair. Check Placement of seat belt with alarm every 30 minutes and release every 2 hours for toileting and repositioning. DX (diagnosis): Safety ; Frequency 0600 (6 AM),0800 (8 AM),1600 (4 PM). Medical record review of the Medication Administration Record [REDACTED].Seat belt with alarm when up in wheelchair. Check Placement of seat belt with alarm every 30 minutes and release every 2 hours for toileting and repositioning. DX (diagnosis): Safety ; Frequency 0600 (6 AM),0800 (8 AM) ,1600 (4 PM). Observation of Resident #111 on 7/23/18 at 12:20 PM in R1 dining room revealed the seat belt attached to the wheelchair and buckled around his waist. Interview with LPN #4 on 7/25/18 at 8:31 AM in the hallway near the residents room revealed the seat belt was used to prevent the resident from sliding out of his wheelchair onto the floor. Further interview confirmed LPN #4 failed to adjust his seat belt as ordered. Interview with the Nurse Practitioner on 7/25/18 at 8:40 AM at the R1 nurse station revealed if Resident #111 was in his wheelchair during the day he must have seat belt for safety. Further interview revealed the reason for the seat belt is for safety. It gives him freedom but keeps him safe. Interview with LPN #3 on 7/25/18 at 1:23 PM at the nurse station Further interview confirmed no documentaion was found for the placement and release of the safety belt. Interview with the Director of Nursing on 7/25/18 at 2:15 PM in her office revealed confirmed that there is no medical [DIAGNOSES REDACTED]. Further interview revealed there was no place for the CNA's to document on the MAR. Telephone interview with the Medical Director on 7/25/18 at 2:53 PM revealed he did not confirm the medical [DIAGNOSES REDACTED]. | 2020-09-01 |