cms_TN
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| Link | rowid | facility_name | facility_id ▼ | address | city | state | zip | inspection_date | deficiency_tag | scope_severity | complaint | standard | eventid | inspection_text | filedate |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | 1 | NHC HEALTHCARE, OAKWOOD | 445002 | 244 OAKWOOD DR | LEWISBURG | TN | 37091 | 2019-05-31 | 609 | D | 1 | 1 | 4KQP11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on policy review, medical record review, observation, and interview, the facility failed to report an allegation of abuse for 1 of 3 (Resident #53) sampled residents reviewed for abuse. The findings include: The facility's Patient Protection .for Allegations/Incidents of Abuse . policy revised 12/11/17 documented, .The patient has the right to be free from abuse .5. Identification Policy .Any patient event that is reported to any partner by patient .will be considered an allegation of .abuse .if it meets any of the following criteria .patient or family complaint of physical or verbal harm, pain or mental anguish resulting from the actions of others .6. Reporting Policy .It is the policy of this facility that abuse allegations .are reported per Federal and State Law . Medical record review revealed Resident #53 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Review of the quarterly Minimum Data Set ((MDS) dated [DATE] revealed a Brief Interview of Mental Status (BIMS) of 13, which indicated the resident was cognitively intact for decision making, required extensive assistance with activities of daily living, and had functional limitations in range of motion with impairment in both of her lower extremities. Review of the facility investigation of Resident #53's allegation of abuse revealed no documentation the abuse allegation was reported to the State. Interview with the Administrator on 5/29/19 at 5:09 PM in the Conference Room, the Administrator was asked when he was made aware of the allegation of abuse by Resident #53. The Administrator confirmed he was made aware of the allegation on 5/16/19, the day the allegation was made. The Administrator was asked if the allegation was reported to the State and the Administrator stated, .No. Interview with Resident #53 on 5/30/19 at 7:55 AM, in Resident #53's room, Resident #53 was asked if she had ever been abused or mistreated in the facility. Resident #53 stated, Well, uh… | 2020-09-01 |
| 2 | 2 | NHC HEALTHCARE, OAKWOOD | 445002 | 244 OAKWOOD DR | LEWISBURG | TN | 37091 | 2019-05-31 | 641 | E | 0 | 1 | 4KQP11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and interview the facility failed to accurately assess residents for the use of unnecessary medications and pressure ulcers for 7 of 17 (Resident #4, #24, #27, #30, #45, #51, and #254) sampled residents reviewed. The findings include: 1. Medical record review revealed Resident #4 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Review of the annual Minimum Data Set ((MDS) dated [DATE] revealed a Brief Interview for Mental Status (BIMS) score of 13, which indicated no cognitive impairment, and the resident received anticoagulant medications daily during the 7-day look-back period. Review of the (MONTH) 2019 Medication Administration Record [REDACTED]. Interview with the MDS Coordinator on 5/30/19 at 12:48 PM in the Conference Room, the MDS Coordinator confirmed the MDS was inaccurate related to anticoagulant use. 2. Medical record review revealed Resident #24 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Review of the quarterly MDS dated [DATE] revealed a BIMS of 14, indicating no cognitive impairment, and received anticoagulant medications 5 of the 7 days of the look-back period. Review of the (MONTH) 2019 MAR indicated [REDACTED] Interview with the MDS Coordinator on 5/30/19 at 12:50 PM in the Conference Room, the MDS Coordinator confirmed the MDS was inaccurate related to anticoagulant use. 3. Medical record review revealed Resident #27 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Review of the admission MDS dated [DATE] revealed a BIMS of 15, which indicated no cognitive impairment, and received antianxiety medications, antidepressant medications, anticoagulant medications, and diuretic medications 5 of the 7 days of the look-back period. Review of the (MONTH) 2019 MAR indicated [REDACTED]. Interview with the MDS Coordinator on 5/30/19 at 9:59 AM in the Conference Room, the MDS Coordinator was asked if the admission MDS dated [DATE] was coded correctly… | 2020-09-01 |
| 3 | 3 | NHC HEALTHCARE, OAKWOOD | 445002 | 244 OAKWOOD DR | LEWISBURG | TN | 37091 | 2019-05-31 | 689 | D | 0 | 1 | 4KQP11 | Based on observation and interview, the facility failed to ensure the environment was free from accident hazards when 1 of 2 (Sling Lift) resident transfer lifts was not functioning properly. The findings include: Observations in Resident #36's room on 5/31/19 at 10:35 AM revealed Certified Nursing Assistant (CNA) #1 and #2 used a sling lift to transfer Resident #36 from his bed to his wheelchair. The lift malfunctioned momentarily and left Resident #36 suspended over his bed in the sling. The lift began working again, and the CNAs were able to lower Resident #36 into his wheelchair. Interview with CNA #2 outside Resident #36's room on 5/30/19 at 10:42 AM, CNA #2 was asked if there had been problems with the sling lift. CNA #2 stated, Here lately, yes. We have told maintenance. CNA #2 was asked how long the lift had been malfunctioning. CNA #2 stated, I'm not sure, maybe a week. Interview with CNA #3 on the West Hall on 5/30/19 at 10:43 AM, CNA #3 was asked if she had any problems with the sling lift. CNA #3 stated, Once in awhile it will get stuck .It's been reported to maintenance. We were just talking about it Monday. CNA #3 was asked what she was told by the maintenance staff. CNA #3 stated, He said he would look at it and try to oil it up or something. Interview with CNA #4 at the nurses station on 5/30/19 at 10:46 AM, CNA #4 was asked if she had any problems with the sling lift. CNA #4 stated, A little bit. CNA #4 was asked how long that had been going on. CNA #4 stated, It's been recent .I've noticed it usually happens more on bigger patients that it struggles with . Interview with the Director of Maintenance on 5/30/19 at 12:22 PM in the Conference Room, the Director of Maintenance was asked if he worked on the patient lifts. The Director of Maintenance stated, Not much .I just check the batteries. The Director of Maintenance was asked if he had been notified of a problem with the sling lift. The Director of Maintenance confirmed he had been notified. The Director of Maintenance was asked when he was firs… | 2020-09-01 |
| 4 | 4 | NHC HEALTHCARE, OAKWOOD | 445002 | 244 OAKWOOD DR | LEWISBURG | TN | 37091 | 2017-08-16 | 371 | D | 0 | 1 | RSCD11 | Based on observation and interview the facility failed to ensure food was properly stored in 1 of 1 (Nurses Station) nourishment refrigerators. The findings included: Observations in the medication room nourishment refrigerator on 8/15/17 at 3:20 PM, revealed 3 cans of strawberry yogurt with expiration date of 8/4/17 and 3 cans of Glucerna Therapeutic Nutrition Classic Butter Pecan with expiration date of 5/1/17. Interview with Licensed Practical Nurse (LPN) #1 on 8/15/17 at 3:20 PM, in the medication room, LPN #1 was asked should expired food be kept in the refrigerator. LPN #1 stated, No it should not. Interview with LPN #2 on 8/16/17 at 1:04 PM, at the nurses' station, LPN #2 was asked what is the process for ensuring expired foods are removed from the refrigerator in the medication room. LPN #2 stated, It is dietary's responsibility for checking and removing expired food from the refrigerator .we stand at the door and allow them to go in and check everything and if something is expired then they remove it and replace it. Interview with the Dietary Manager (DM) on 8/16/17 at 1:08 PM, in the dining room, the DM was asked what the process is for removing expired food from the refrigerator in the medication room. The DM stated, Every night they go and rotate the oldest to the front and new to the back and check the dates and that is suppose to be done nightly. The DM was asked should you expect to find expired food in the refrigerator. The Dietary Manager stated, No. Interview with the Director of Nursing (DON) on 8/16/17 at 1:11 PM, at the nurses' station, the DON was asked what is the process for ensuring the nourishment refrigerator in the medication room is free of expired food. The DON stated, Dietary comes out and checks the refrigerator .we open the door and stand there while they check it but I expect my nurses to check for expiration dates prior to administering medications or food to a resident. | 2020-09-01 |
| 5 | 5 | NHC HEALTHCARE, OAKWOOD | 445002 | 244 OAKWOOD DR | LEWISBURG | TN | 37091 | 2018-08-22 | 641 | D | 0 | 1 | X6JV11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and interview, the facility failed to ensure assessments were completed to accurately reflect the resident's status for hospice and cognition for 2 of 12 (Resident #32 and 41) sampled residents reviewed. 1. Medical record review revealed Resident #32 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. A physician's orders [REDACTED]. The significant change Minimal Data Set ((MDS) dated [DATE] failed to document that hospice services had been provided during the assessment period. Interview with the MDS Coordinator on 8/22/18 at 2:26 PM, in the MDS office, the MDS Coordinator was asked if the MDS dated [DATE] should have been marked to reflect the resident was receiving hospice services. The MDS coordinator stated, Yes. 2. Medical record review revealed Resident # 41 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. The admission MDS dated [DATE] did not have a Brief Interview for Mental Status (BIMS) which is a score that indicates the resident's cognitive function. The MDS was not completed (blank) in the cognitive assessment area. Interview with the MDS Coordinator on 8/21/18 at 2:23 PM, in the MDS office, the MDS Coordinator was asked if the BIMS score and cognitive function section of the MDS was completed. The MDS Coordinator stated, No. | 2020-09-01 |
| 6 | 6 | NHC HEALTHCARE, OAKWOOD | 445002 | 244 OAKWOOD DR | LEWISBURG | TN | 37091 | 2018-08-22 | 728 | E | 0 | 1 | X6JV11 | Based on review of the RULES OF TENNESSEE DEPARTMENT OF HEALTH BOARD FOR LICENSING HEALTH CARE FACILITIES DIVISION OF HEALTH CARE FACILITIES CHAPTER 1200-08-06 STANDARD FOR NURSING HOMES 1200- 6-.15, CNA (Certified Nursing Assistant) INSTRUCTOR job description, the Nurse Aide Training Program (NAT) sign in sheets, the Tennessee State tested Nurse Aide Exam results, the (NHC) OAKWOOD Time Schedule as Worked schedules, the Partner Time Collection Report, and interview, the facility failed to ensure 13 of 22 (Nursing Assistant (NA) #1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, and 13) NAs enrolled in the facility's Nurse Aide Training Program (NAT) were supervised by the NAT instructor when they worked in the facility. The findings included: 1. The RULES OF TENNESSEE DEPARTMENT OF HEALTH BOARD FOR LICENSING HEALTH CARE FACILITIES DIVISION OF HEALTH CARE FACILITIES CHAPTER 1200-08-06 STANDARD FOR NURSING HOMES 1200- 6-.15 documented, .The provision of direct individual care to residents by a trainee is limited to appropriately supervised clinical experiences .a program instructor must be present or readily available on-site during all clinical training hours . 2. The facility's .CNA INSTRUCTOR job description documented, .The CNA instructor is to direct and sustain the CNA Training program in the Center in order to maintain adequate CNA staffing .Arrange and provide a clinical experience for the student that insures they are prepared for the skill test . 3. Review of the NAT program sign in sheets for the facility's NAT program held in (MONTH) and (MONTH) (YEAR) revealed a total of 22 students were enrolled in the program, which included NA #1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, and 13. 4. Review of the Tennessee State tested Nurse Aide Exam (Certified Nursing Assistant Examination) results revealed NA #1, 2, 3, 4, 5, 6, and 7 failed the examination. NA #8, 9, 10, 11, 12, and 13 have not taken the Tennessee State tested Nurse Aide Exam (Certified Nursing Assistant Examination). 5. Review of the NHC (National Healthcare Co… | 2020-09-01 |
| 4900 | 4900 | NHC HEALTHCARE, OAKWOOD | 445002 | 244 OAKWOOD DR | LEWISBURG | TN | 37091 | 2016-05-25 | 278 | D | 0 | 1 | 4W6411 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and interview, the facility failed to accurately assess resident behaviors for 1 of 11 (Resident #4) sampled residents of the 23 residents included in the stage 2 review. The findings included: Medical record review revealed Resident #4 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Review of the quarterly Minimum Data Set (MDS) with an Assessment Reference date of 3/25/16 revealed Resident #4 was severely cognitively impaired and exhibited no behaviors during the 7 day review period. Review of the Task Administration Record Report for the month of (MONTH) (YEAR) revealed Resident #4 exhibited severe verbal and physical aggression on 3/23/16. This behavior was not reflected on the quarterly MDS 3/25/16. Interview with the MDS Coordinator on 5/25/16 at 11:10 AM, in her office, the MDS Coordinator was asked if the behaviors exhibited on 3/23/16 should have been reflected on the quarterly MDS dated [DATE]. The MDS Coordinator stated, Yes, it probably should have . | 2019-06-01 |
| 4901 | 4901 | NHC HEALTHCARE, OAKWOOD | 445002 | 244 OAKWOOD DR | LEWISBURG | TN | 37091 | 2016-05-25 | 371 | E | 0 | 1 | 4W6411 | Based on policy review, observation and interview, the facility failed to ensure food was prepared and served under sanitary conditions as evidenced by a dirty ice machine, a mixer with dried substance on the base of the mixer, a dirty deep fat fryer, and the double ovens were dirty with dried food particle buildup. The facility had a census of 53 with 51 of those residents receiving a meal tray from the kitchen. The findings included: 1. The facility's Safety & Sanitation Best Practice Guidelines .CLEANING PR[NAME]EDURES .MIXER policy documented, .Frequency .cleaning instructions .After each use . 2. The facility's Safety & Sanitation Best Practice Guidelines .CLEANING PR[NAME]EDURES .DEEP FRYER policy documented, .cleaning instructions. After each use . 3. The facility's Safety & Sanitation Best Practice Guidelines .CLEANING PR[NAME]EDURES .OVENS policy documented, .Frequency: Daily, weekly, or as needed . 1. Wipe up spills as they occur .Scrape burned-on particles from hearth . 4. Observations in the kitchen on 5/24/16 at 10:12 AM, 11:20 AM, and on 5/25/16 at 8:55 AM, revealed the following: a. A small hole in the ice machine draining brown liquid. b. Brown dried substance on the mixer base. c. Black buildup on the metal part inside of the deep fat fryer. d. Black build up and dried food particles on the bottoms of the double ovens. Interview with the Dietary Manager (DM) on 5/24/16 at 10:14 AM, in the kitchen, the DM was shown the brown water that was coming out of the small hole in the ice machine and was asked should there be brown water dripping in the ice machine. The DM stated, No, it shouldn't . The DM was shown the hand held mixer and was asked should the mixer have a brown dried substance on it. The DM stated, .looks like someone didn't clean it well . The DM was then shown the deep fat fryer and was asked what was the black substance on the metal inside of the deep fryer. The DM stated, .it's build up .needs to be cleaned . | 2019-06-01 |
| 5950 | 5950 | NHC HEALTHCARE, OAKWOOD | 445002 | 244 OAKWOOD DR | LEWISBURG | TN | 37091 | 2015-10-07 | 157 | D | 1 | 0 | SQJ611 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Complaint # TN 985 Based on policy review, medical record review and interview, the facility failed to notify the physician and responsible party of a change in condition of 1 of 3 (Resident #1) sampled residents. The findings included: Review of the facility's policy and procedure regarding change in patient status documented, .The charge nurse on duty is notified immediately of any change in a patient's condition. The charge nurse will then assess the patient's condition and notify the physician or physician extender and the patient's family/legal representative . Medical record review revealed Resident #1 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. The resident was do not resuscitate status and provide comfort measures. A nurse's note dated 3/18/15 documented, .11:00 AM . Pt (patient) having 35- (to) 60 secs (seconds) apnea. Pulse Ox (oximetry) 86% (percent) RA (room air). O2 (oxygen) applied at 2.5 L (liters) / NC (nasal cannula) per concentrator . B/P (Blood Pressure) 60/42, P (pulse) 85 . The facility was unable to provide documentation that the resident's responsible party or the attending physician had been notified of a change in the resident's condition. Telephone interview with the resident's responsible party (RP) (wife) on 10/7/15 at 11:30 AM, in the conference room, the resident's RP was asked if she was notified of the change in the resident's. The resident's RP stated, I called that morning before 7 o'clock and was told he had been restless the night before. I called again at 2 PM and was told he was on oxygen and his B/P was 84/52. They never called and notified me of the change in his condition. When I got here shortly after 3 o'clock I said to the nurse he's dying isn't he. The nurse said Yes, I wish they had called me so that me and my daughter could have been with him all day. His sister would have wanted to be here with him as well. Interview with the Director of Nursing (DON) on 10/7/15 at 11:56 AM… | 2018-10-01 |
| 5951 | 5951 | NHC HEALTHCARE, OAKWOOD | 445002 | 244 OAKWOOD DR | LEWISBURG | TN | 37091 | 2015-10-07 | 309 | D | 1 | 0 | SQJ611 | Based on policy review, medical record review and interview, the facility failed to monitor and document vital signs (V/S) every shift for 72 hours for 1 of 3 (Resident #1) sampled residents. The findings included: The facility's documentation guidelines policy documented, .Alert Charting: The process of every shift monitoring and documentation following an initial event, a change in condition, or institution of a new treatment or medication . Events/conditions for which Alert Charting should be initiated include, but are not limited to . Admissions, readmissions . Review of the vital signs records revealed the following: a. 3/16/15 - V/S were checked on admission at 8:20 PM and 8:40 PM. b. 3/17/15 - V/S were checked on the 2 PM to (-) 10 PM shift and on the 10 PM - 6 AM shift. There was no documentation of the resident's V/S being checked on the 6 AM -2 PM shift. The facility failed to monitor the resident's V/S on every shift as per policy. Nurses' notes documented the the following: a. 3/16/15 - an admission note was documented at 8:20 PM (2 PM - 10 PM shift) and on the 10 PM 6 AM shift. b. 3/17/15 - there was no documentation of a nurse's note on the 6 AM - 2 PM shift or on the 2 PM - 10 PM shift. The facility failed document on the resident every shift as per policy. Interview with the Director of Nursing (DON) on 10/7/15 at 11:56 AM, in the conference room, the DON was asked how often are newly admitted residents charted on and how often are vital signs checked on new admissions. The DON stated, On new admissions alert charting is done for 3 days on each shift as well as the vital signs are checked on every shift. If there are any problems past 3 days then they are kept on alert charting. | 2018-10-01 |
| 6152 | 6152 | NHC HEALTHCARE, OAKWOOD | 445002 | 244 OAKWOOD DR | LEWISBURG | TN | 37091 | 2015-04-28 | 247 | D | 0 | 1 | VDPT11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on policy review, medical record review and interview, the facility failed to give advance notification of a new roommate for 1 of 27 (Resident #7) who were interviewed about a room or roommate change. The findings included: The facility's residents' rights policy documented, .ROOM ASSIGNMENT . At all times you will be notified of a change in your room or in your roommate . Medical record review revealed Resident #54 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. The 14 day Minimum Data Set (MDS) assessment dated of 2/17/15 documented, no cognitive impairment. The facility was unable to provide documentation that Resident #54 had been informed of any new roommates. Interview with Resident #54 on 4/26/15 at 2:17 PM, in Resident #54's room, Resident #54 was asked, if she had been moved to a different room or had a roommate change in the last nine months. Resident #54 stated, Yes, have had several since (MONTH) (2015). Resident #54 was asked, were you given notice before room or roommate changes. Resident #54 stated, No, they (staff) didn't tell me until they brought them in here and introduced me to them. Didn't tell me until they (new roommates) were here. Resident #54 was asked, How many is several. Resident #54 stated, Four since (MONTH) (2015). Interview with the Social Worker (SW) on 4/27/15 at 1:15 PM, in the Social Services office, the SW was asked, when are the residents notified that they are changing rooms or getting a new roommate. The SW stated, As soon as we know it. The SW was asked, where is it documented that the resident has been informed that the resident will be getting a new roommate. The SW looking at the chart and stated, There is no documentation of notifying her(Resident #54) here in my notes. I am the one that normally does that, but on weekends it could have been the nurse. Interview with the Director of Nursing (DON) on 4/27/15 at 1:50 PM, at the nurses station, the DON was asked, when do the … | 2018-09-01 |
| 6153 | 6153 | NHC HEALTHCARE, OAKWOOD | 445002 | 244 OAKWOOD DR | LEWISBURG | TN | 37091 | 2015-04-28 | 253 | D | 0 | 1 | VDPT11 | Based on observation and interview, the facility failed to maintain a sanitary and comfortable environment that was free from lingering pervasive odors on 1 of 2 (West hall) halls. The findings included: Observations on the west hall on 4/26/15 at 10:48 AM, revealed a strong pervasive odor between rooms 25, 26, 27 and 28. Observations on the west hall 4/26/15 at 10:51 AM, revealed a strong pervasive odor in the bathroom of room 34, and a yellow liquid on the floor between the sink and the commode. Observations on the west wing on 4/26/15 at 11:22 AM, revealed a strong pervasive odor in room 27. Interview with housekeeping staff member (HSM) #1 on 4/28/15 at 1:30 PM, on the west hall beside room 27, HSM #1 was asked what was done in the facility to control odors. HSM #1 stated, The area is cleaned with bleach or peroxide repeatedly until odors are eliminated. HSM #1 was asked if it was acceptable for the facility to have odors. HSM #1 stated, No, it is not. | 2018-09-01 |
| 6154 | 6154 | NHC HEALTHCARE, OAKWOOD | 445002 | 244 OAKWOOD DR | LEWISBURG | TN | 37091 | 2015-04-28 | 309 | D | 0 | 1 | VDPT11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of the contract review, policy review, medical record review, observation and interview, the facility failed to follow the [MEDICAL TREATMENT] contract, failed to maintain intake and output (I&O) measurements and failed to follow the physician's orders [REDACTED].#5) sampled resident receiving [MEDICAL TREATMENT] included in the stage 2 review. The findings included: The facility's SNF (skilled nursing facility) OUTPATIENT [MEDICAL TREATMENT] SERVICES AGREEMENT contract documented, .Obligations of Nursing Facility and/or Owner . [MEDICAL CONDITION] (end stage [MEDICAL CONDITION]) Residents Information. The Nursing Facility shall ensure that all appropriate medical and administrative information accompanies all [MEDICAL CONDITION] Residents at the time of referral to the [MEDICAL CONDITION] [MEDICAL TREATMENT] Unit . Mutual Obligations . Collaboration of Care. Both parties shall ensure that there is documented evidence of collaboration of care and communication between the Nursing Facility and [MEDICAL CONDITION] [MEDICAL TREATMENT] Unit . The facility failed to follow the outlined contract. The facility's D[NAME]UMENTATION GUIDELINES policy documented, .Intake and Output Records are used when requested by a physician or at the discretion of the charge nurse . Intake/Output records include . Total fluid intake in ml's (milliliters) . Total fluid output in ml's or number of times voided, as appropriate . Date . and shift . Initials of person recording . Correct addition of total fluids for 24 hours . Medical record review revealed Resident #5 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. The Minimum (MDS) data set [DATE] documented that Resident #5 had some cognitive difficulty in new situations only, required extensive staff assistance with activities of daily living, was non-ambulatory, and was receiving [MEDICAL TREATMENT] services. The care plan for Resident #5 dated 2/18/15 documented, .[MEDICAL TREATMEN… | 2018-09-01 |
| 6155 | 6155 | NHC HEALTHCARE, OAKWOOD | 445002 | 244 OAKWOOD DR | LEWISBURG | TN | 37091 | 2015-04-28 | 323 | D | 0 | 1 | VDPT11 | Based on observation and interview, the facility failed to ensure the laundry area was free of accident hazards as evidenced by unsecured chemicals in 1 of 1 laundry room. The findings included: Observations in the laundry room on 4/26/15 at 11:29 AM and 4/26/15 at 5:47 PM, revealed the door was unlocked, and the following chemicals were unattended and accessible to residents: a. 2 buckets of 5 gallon-sized Supreme Lemon scented laundry detergent. b. 1 bottle of 22 fluid (fl) ounces (oz) resolve pre-treat spray. c. 3 spray bottles of 32 oz liquid furniture polish d. 1 gallon of supreme super foam extraction cleaner. e. 1 bottle of 6.5 oz fresh scent metered air fresher. f. 1 gallon of grout renew. g. 1 gallon of Bleach, 2 bottles of glass cleaner. h. 6 pound container of bleach wipes. Interview with the Director of Environmental Services (DES) on 4/27/15 at 8:06 AM, by the laundry door, the DES was asked if the door should be unlocked when the room was unattended. The DES stated, (The laundry room door) should always be locked if there is no one in here. | 2018-09-01 |
| 6156 | 6156 | NHC HEALTHCARE, OAKWOOD | 445002 | 244 OAKWOOD DR | LEWISBURG | TN | 37091 | 2015-04-28 | 333 | D | 0 | 1 | VDPT11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, review of an incident report and interview, the facility failed to obtain a physician's clarification order for psychoactive medications for 1 of 5 (Residents #37) sampled residents of the 27 residents included in the stage 2 review. The findings included: Medical record review revealed Resident #37 was admitted to the facility on [DATE] and readmitted on [DATE] with [DIAGNOSES REDACTED]. The annual Minimum Data Set ((MDS) dated [DATE] documented Resident #37 was severely cognitive impairment, feelings of depression or hopelessness, and the use of antipsychotic, antianxiety and antidepressant medications. The physician's orders [REDACTED].[MEDICATION NAME] 2mg (milligrams) TABLET (1/2) HALF (1/2) TAB (tablet) DAILY BY MOUTH . The psychiatric progress notes dated 2/27/15 documented, .1. [MEDICATION NAME] 2mg - 1/2 tab (1 mg) po (by mouth) q (every) daily 2. Add [MEDICATION NAME] 2mg po q daily . The medication and treatment administration record report for (MONTH) 1, (YEAR) through (MONTH) 21, (YEAR), revealed Resident #37 continued to receive [MEDICATION NAME] 2mg TABLET (1/2) daily. The incident report dated 4/27/15 documented, .Description of what happened: recommendation to increase [MEDICATION NAME] to 2 mg daily 2/27/15 and md (medical doctor) agreed. Order not processed and filed in chart. Found 4/28/15 and processed. Witness 1 comments: med (medication) order corrected and correct dose given this am . Interview with Licensed Practical Nurse (LPN) #1 on 4/28/15 at 9:39 AM, in the west hall, LPN #1 was asked what dose of [MEDICATION NAME] Resident #37 received. LPN #1 stated, 1 mg at 10 AM. LPN #1 was asked how are the psychiatric orders written. LPN #1 stated, I'm not sure. Our unit manager talks to psych (psychiatric providers). Interview with Unit Manager #1 on 4/28/15 at 9:45 AM, in the west hall, Unit Manager #1 was asked how are the psychiatric orders written. Unit Manager #1 stated, Fax doctor the r… | 2018-09-01 |
| 6157 | 6157 | NHC HEALTHCARE, OAKWOOD | 445002 | 244 OAKWOOD DR | LEWISBURG | TN | 37091 | 2015-04-28 | 514 | D | 0 | 1 | VDPT11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and interview, the facility failed to ensure a medical record had accurate documentation of weight for 1 of 27 (Resident #7) sampled resident of the 27 included in the stage 2 review. The findings included: Medical record review revealed Resident #7 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. The nutritional assessment for Resident #7 dated 12/19/14 documented a weight of .127.0 however admission weight was 113.0 Hospital wt (weight) of 118.0. UBW (usual body weight) 120 per pt. BMI (body mass index) 20.5 using wt of 127 . The admission Minimum Data Set (MDS) for Resident #7 with an Assessment Reference Date (ARD) of 12/20/14 documented weight of 127. Resident #7's weight records documented the following weights; 12/14/14 - 113.0 standing, 12/17/14 - 127.0 wheelchair, 12/31/14 - 119.0 standing, 1/2/15 - 120.8 standing, 1/22/15 - 117.0 wheelchair, 1/27/15 - 119.0 wheelchair and 2/5/15 - 118.2 standing. Interview with the Registered Dietician (RD) on 4/27/15 at 3:09 PM, in the dining room, the RD was asked about Resident #7's weight loss. The RD stated, I don't think that weight is correct (referring to the 12/27/14 weight). Interview with the Assistant Director of Nursing (ADON) on 4/27/15 at 5:26 PM, the ADON was asked if the weight of 127 on 12/19/15 was correct since the admission weight was 113 and the hospital discharge weight was 118. The ADON stated, No, I doubt she gained 15 or so pounds in 3 days and then lost down that quick. If she did I need on that diet. | 2018-09-01 |
| 7880 | 7880 | NHC HEALTHCARE, OAKWOOD | 445002 | 244 OAKWOOD DR | LEWISBURG | TN | 37091 | 2013-10-01 | 246 | D | 0 | 1 | 5LIL11 | Based on observation and interview, it was determined the facility failed to accommodate the needs and choices of 2 of 13 (Residents #93 and 96) sampled residents of the 28 residents included in the stage 2 review. The findings included: 1. Observations in Residents #93's room on 10/1/13 at 8:03 AM, revealed Resident #93's door was open. During an interview in Resident #93's room on 10/1/13 at 8:03 AM, Resident #93 stated, They (staff) leave the door open and it lets cold in from the hall. They just forget (to close the door). 2. Observations in Residents #96's room on 10/1/13 at 8:03 AM, revealed Resident #96's door was open. During an interview in Resident #96's room on 10/1/13, Resident #96 stated, I ask them (staff) every time they come in to shut the door and leave it cracked so it doesn't get stuffy. We can tell them 500 times and they still forget to close it (the door). 3. During an interview at the nurses station on 10/1/13 at 8:50 AM, the Director of Nursing (DON) was asked what she expected the nurses to do when a resident asked that their door be kept closed. The DON stated, .Communicate to all the staff . Keep the door closed . | 2017-09-01 |
| 7881 | 7881 | NHC HEALTHCARE, OAKWOOD | 445002 | 244 OAKWOOD DR | LEWISBURG | TN | 37091 | 2013-10-01 | 253 | D | 0 | 1 | 5LIL11 | Based on observation and interview, it was determined the facility failed to keep the facility free from odors on 1 of 2 (west hall) halls. The findings included: Observations on the west hall on 9/29/13 at 8:10 AM and 10:38 AM, on 9/30/13 at 4:25 PM and 4:50 PM and on 10/1/13 at 7:15 AM and 7:34 AM, revealed the presence of a urine odor in the hallway. During an interview in the west hall on 10/1/13 at 9:20 AM, the Administrator was asked about the odor in the west hall. The Administrator stated, .do know it is a smell .There is a scent . | 2017-09-01 |
| 7882 | 7882 | NHC HEALTHCARE, OAKWOOD | 445002 | 244 OAKWOOD DR | LEWISBURG | TN | 37091 | 2013-10-01 | 280 | D | 0 | 1 | 5LIL11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation and interview, it was determined the facility failed to revise the care plan to reflect the current status of residents related to dental and a nutritional supplement for 2 of 13 (Residents #54 and 56) sampled residents of the 28 residents included in the stage 2 review. The findings included: 1. Medical record review for Resident #54 documented an admission date of [DATE] with [DIAGNOSES REDACTED]. The quarterly Minimum Data Set ((MDS) dated [DATE] documented it requires one person physical assistance to brush the resident's teeth to maintain oral care. Review of the care plan dated 9/13/13 documented, .Oral care daily and as needed . has his own teeth . During an interview at the nurses station on 10/1/13 at 8:50 AM, the Certified Nursing Assistant (CNA) #1 was asked about oral care to brush the resident's teeth. CNA #1 stated, There are two ways to brush his teeth . if he pats his cheeks means that his teeth are hurting . use a toothett with mouth wash . if the resident smiles . use the toothbrush with toothpaste . The care plan did not include the interventions as noted above for oral care for Resident #54. 2. Medical record review for Resident #56 documented an admission date of [DATE] with [DIAGNOSES REDACTED]. Review of the dietary progress notes documented, .5/16/13 . 2 oz (ounces) Medpass TID (three times a day) added for additional nutrition option . 6/4/13 . 2 oz Medpass TID discontinued at this time . Review of the care plan dated 8/22/13 documented, .PROBLEM . PATIENT AT NUTRITIONAL RISK . APPROACHES . 2 OZ MEDPASS TID FOR ADDITIONAL NUTRITION . During an interview in the conference room on 10/1/13 at 9:15 AM, the Registered Dietician (RD) was asked about weight loss for this resident. The RD stated this resident was started on Medpass, but she did not like the Medpass so it was discontinued. The RD was asked about the intervention of Medpass on the care plan. The RD stated, .must have … | 2017-09-01 |
| 7883 | 7883 | NHC HEALTHCARE, OAKWOOD | 445002 | 244 OAKWOOD DR | LEWISBURG | TN | 37091 | 2013-10-01 | 333 | D | 0 | 1 | 5LIL11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of the MED-PASS COMMON INSULINS provided by the American Consultant Pharmacists, policy review, medical record review, observation and interview, it was determined the facility failed to ensure 1 of 2 (Nurse #1) nurses administered medications free of a significant medication error. Nurse #1 failed to administer insulin within the proper time frame related to food intake for Resident #1. The findings included: Review of the facility's Insulin Administration policy documented, .PURPOSE: To ensure that designated partners administer insulin using proper technique into the subcutaneous tissue . OBJECTIVE: To administer insulin to patient and assure appropriate monitoring of diabetic patients . Procedure . [MEDICATION NAME] or Humalog . will be given within a time range of no greater than 15 minutes before a meal thru no later than 30 minutes post consumption of the meal . Review of the MED-PASS COMMON INSULINS: Pharmocokinetics, Compatibility, and Properties provided by the American Society of Consultant Pharmacists for typical dosing administration related to meals documented, .[MEDICATION NAME] . ONSET (In Hours, Unless Noted) .15 min . TYPICAL ADMINISTRATION / COMMENTS . 5- (to) 10 minutes before meals . Medical record review for Resident #1 documented an admission date of [DATE] with [DIAGNOSES REDACTED]. Review of the physician's orders [REDACTED].[MEDICATION NAME] 100 UNIT / ML (milliliters) VIAL . SEVEN UNITS SUBQ (subcutaneously) IF FINGERSTICK GREATER THAN 150 . Observations in Resident #1's room on 9/30/13 at 4:05 PM, Nurse #1 administered 7 units of [MEDICATION NAME]to Resident #1. Resident #1 was not given a snack. Resident #1 did not receive her meal tray until 4:50 PM, 45 minutes after the insulin had been administered. The administration of the insulin more than 15 minutes before Resident #1 received her meal tray, resulted in a significant medication error. During an interview in the Director of Nursing's (DON) of… | 2017-09-01 |
| 7884 | 7884 | NHC HEALTHCARE, OAKWOOD | 445002 | 244 OAKWOOD DR | LEWISBURG | TN | 37091 | 2013-10-01 | 441 | D | 0 | 1 | 5LIL11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on policy review, observation and interview, it was determined 2 of 2 (Nurses #1 and 2) nurses failed to ensure practices to prevent the potential spread of infection were maintained during medication administration. The findings included: 1. Review of the facility's HANDWASHING policy documented, .PROCEDURE . Wash hands before and after contact with each patient, after toileting, smoking or eating, and before and after removal of gloves . 2. Observations in front of room [ROOM NUMBER]A on 9/30/13 at 3:55 PM, Nurse #1 applied gloves, cleansed the accucheck machine and then removed her gloves. Nurse #1 did not perform hand hygiene. Nurse #1 then entered room [ROOM NUMBER]A, applied gloves and administered insulin to a resident. Nurse #1 then removed her gloves and washed her hands. 3. Observations in room [ROOM NUMBER]A on 9/30/13 at 8:10 AM, Nurse #2 applied gloves, cleansed the bedside table and applied barriers on the table. Nurse #2 returned to the medication cart, opened the cart and obtained a bin from the cart and cleansed with a sanicloth. Nurse #2 removed gloves and continued to prepare medications at the cart, without performing hand hygiene. Nurse #2 entered room [ROOM NUMBER]A, applied gloves and prepared water in cups and removed his gloves. Nurse #2 applied new gloves, without performing hand hygiene and administered medications through a percutaneous gastrostomy tube to a resident. Nurse #2 then removed his gloves and washed his hands. Observations in front of room [ROOM NUMBER]A on 10/1/13 at 10:25 AM, Nurse #2 applied gloves, prepared insulin and removed his gloves. Nurse #2 applied new gloves, without performing hand hygiene before preparing the medications. Nurse #2 removed his gloves and applied new gloves, without performing hand hygiene before administering oral medications to a resident. Nurse #2 administered an inhaler to a resident, then wheeled a resident into room [ROOM NUMBER]A, and administered insulin to a r… | 2017-09-01 |
| 9886 | 9886 | NHC HEALTHCARE, OAKWOOD | 445002 | 244 OAKWOOD DR | LEWISBURG | TN | 37091 | 2011-10-21 | 221 | D | 0 | 1 | GOV611 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on policy review, medical record review, observation, and interview, it was determined the facility failed to ensure restraint assessments were completed or a physician's orders [REDACTED].#49) sampled residents reviewed of 7 residents with potential restraint use. The findings included: Review of the facility's Restraints Physical or Chemical policy documented, .They (restraints) may be used only with a physician's orders [REDACTED]. Physical restraints are defined by federal regulations as any manual or physical or mechanical device, material or equipment attached or adjacent to the residents body that the individual cannot remove easily which restricts freedom of movement or normal access to one's body .Included are facility practices that meet the definition of restraints such as bed rails which are used to keep a resident from voluntarily getting out of bed rather than being used for the purpose of enhancing mobility while in bed . Medical record review for Resident #49 documented an admission date of [DATE] with [DIAGNOSES REDACTED]. Review of the physician's orders [REDACTED].okay for pt (patient) to ambulation (ambulate) independently c (with) RW (rolling walker) to/from bathroom in room from P.T. (physical therapist) standpoint . Review of the comprehensive care plan dated 8/17/11 documented, .SR (side rail) as needed WIB (when in bed) to enable bed mobility . There was no documentation of a physician's orders [REDACTED]. Observations in Resident #49's room on 10/19/11 at 3:00 PM, revealed Resident #49 seated in a regular chair with a rolling walker in front of her. Observations in Resident #49's room on 10/20/11 at 8:45 AM and 6:05 PM, revealed Resident #49 lying in bed with a 3/4 side rail up on both sides of the bed. During an interview in Resident #49's room on 10/17/11 at 4:40 PM, Resident #49 stated she could sit on the side of the bed and stand if the side rails are not up. During an interview in Resident #49's room on 1… | 2016-09-01 |
| 9887 | 9887 | NHC HEALTHCARE, OAKWOOD | 445002 | 244 OAKWOOD DR | LEWISBURG | TN | 37091 | 2011-10-21 | 272 | D | 0 | 1 | GOV611 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation, and interview, it was determined the facility failed to ensure that 1 of 19 (Resident #49) sampled residents reviewed of 35 residents included in the Stage 2 review were assessed for the use of a physical restraint. The findings included: Medical record review for Resident #49 documented an admission date of [DATE] with [DIAGNOSES REDACTED]. Review of the admission 5 day Minimum Data Set ((MDS) dated [DATE] and the 60 day MDS dated [DATE] documented no use of restraints. There was no documentation of a pre-restraint assessment in the medical record. Observations in Resident #49's room on 10/20/11 at 8:45 AM and 6:05 PM, revealed Resident #49 lying in bed with a 3/4 side rail up on both sides of the bed. During an interview in Resident #49's room on 10/17/11 at 4:40 PM, Resident #49 stated she could sit on the side of the bed and stand if the side rails are not up. During an interview in Resident #49's room on 10/20/11 at 8:47 AM, Certified Nursing Assistant (CNA) #2 was asked how much help Resident #49 needed to get in and out of her bed. CNA #2 stated, Not much, she can sit on the side of the bed and stand with just stand by assist. I don't really help her much at all. During an interview at the nurses' station on 10/20/11 at 9:03 AM, Nurse #3 was asked if Resident #49 could transfer out of bed. Nurse #3 stated, Yes, she can. Nurse #3 was asked if Resident #49 could transfer out of bed when both side rails are up. Nurse #3 stated, She could slide around the end, but probably thinks she can't. During an interview in the therapy room on 10/20/11 at 9:07 AM, Physical Therapy Assistant (PTA) #1 was asked if Resident #49 can transfer and ambulate independently. PTA #1 stated, Yes, (named Resident #49) was released yesterday to go to the bathroom on her own. | 2016-09-01 |
| 9888 | 9888 | NHC HEALTHCARE, OAKWOOD | 445002 | 244 OAKWOOD DR | LEWISBURG | TN | 37091 | 2011-10-21 | 278 | D | 0 | 1 | GOV611 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation, and interview, it was determined the facility failed to accurately assess residents for incontinence and dressing for 1 of 19 (Resident #76) sampled residents reviewed of 35 residents included in the Stage 2 review. The findings included: Medical record review for Resident #76 documented an admission date of [DATE] with [DIAGNOSES REDACTED]. Review of the admission Minimum Data Set (MDS) assessment dated [DATE] documented Resident #76 requires limited assistance (resident highly involved in activity; staff provide guided maneuvering of limbs or other non-weight-bearing-bearing assistance) for Activities of Daily Living (ADL) self-performance, and one person physical assist for ADL support provided. Review of the quarterly MDS assessment dated [DATE] documented Resident #76 requires extensive assist (resident involved in activity; staff provide weight-bearing support) for ADL self-performance, and one person physical assist for ADL support provided. Review of the admission MDS assessment dated [DATE] documented Resident #76 is always continent of urine and bowel. Review of the quarterly MDS assessment dated [DATE] documented Resident #76 is frequently incontinent of urine and bowel. During an interview in the MDS office on 10/20/11 at 12:20 PM, the MDS Coordinator was asked about the decline in ADL status (dressing). The MDS Coordinator stated, This is an error, she (Resident #76) should have been extensive not limited, I will have to do a correction . During an interview in the MDS office on 10/20/11 at 12:25 PM, the MDS Coordinator was asked about the decline in urinary status. The MDS Coordinator stated, I do not see where she has been incontinent, looks like that was an error . I will have to do a correction . | 2016-09-01 |
| 9889 | 9889 | NHC HEALTHCARE, OAKWOOD | 445002 | 244 OAKWOOD DR | LEWISBURG | TN | 37091 | 2011-10-21 | 279 | D | 0 | 1 | GOV611 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation and interview, it was determined the facility failed to develop a care plan to reflect the use of a Foley catheter for 1 of 19 (Resident #39) sampled residents of the 35 residents included in the Stage 2 review. The findings included: Medical record review for Resident #39 documented an admission date of [DATE] with a readmission date of [DATE] with [DIAGNOSES REDACTED]. Review of a physician's orders [REDACTED]. Review of the Minimum Data Set (MDS) with an Assessment Reference Date (ARD) of 9/13/11 documented under Section H-A, indicating presence of indwelling catheter. Review of the interim care plan dated 10/17/11 did not address the Foley catheter. Observations in Resident #39's room on 10/17/11 at 10:32 AM, revealed Resident #39 sitting up in bed, alert with ? siderails (SR) elevated times (x) one with a Foley catheter patent to BSB and yellow, cloudy urine. Observations in Resident #39's room on 10/18/11 10:30 AM, revealed Resident #39 sitting up in bed, with 3/4 SR elevated x one and a Foley catheter patent to BSB. Observations in Resident #39's room on 10/19/11 at 2:30 PM, revealed Resident #39 sitting up in bed with a Foley catheter patent to BSB with yellowish, cloudy urine. During an interview in the Director of Nursing's(DON) office on 10/20/11 at 11:30 AM, the DON verified that the care plan did not address the presence of the Foley catheter. | 2016-09-01 |
| 9890 | 9890 | NHC HEALTHCARE, OAKWOOD | 445002 | 244 OAKWOOD DR | LEWISBURG | TN | 37091 | 2011-10-21 | 282 | D | 0 | 1 | GOV611 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation, and interview, it was determined the facility failed to follow the care plan interventions for an alarm for 1 of 17 (Resident #42) sampled residents reviewed of 35 residents included in the Stage 2 review. The findings included: Medical record review for Resident #42 documented an admission date of [DATE] with [DIAGNOSES REDACTED]. Review of the quarterly Minimum Data Set ((MDS) dated [DATE] documented the resident had 1 fall with no injury since the prior assessment. Review of the care plan dated 8/24/11 documented, .Risk for falls r/t (related to) .Hx (history) of falls (most recent 9-15-11) . Wandering behavior . pushing w/c's (wheelchairs) . APPROACHES . door alarm on BR (bathroom) door to alert staff pt (patient) is up in bathroom . Review of post falls nursing assessments dated 7/14/11 and 9/15/11 documented Resident #42 had two falls with no apparent injuries. Observations in Resident #42's room on 10/17/11 at 11:05 AM, revealed Resident #42 dressed and lying in bed. Resident #42 did not answer questions. Resident #42 got up from the bed, ambulated to the bathroom and no alarm sounded when the BR door was opened. Observations in Resident 42's room on 10/19/11 at 2:45 PM, revealed an alarm to the bathroom door in the off position. During an interview in Resident #42's room on 10/19/11 at 2:55 PM, Nurse #1 confirmed the alarm to the BR door was off and stated, I don't know why it was off, I guess someone turned it off. | 2016-09-01 |
| 9891 | 9891 | NHC HEALTHCARE, OAKWOOD | 445002 | 244 OAKWOOD DR | LEWISBURG | TN | 37091 | 2011-10-21 | 315 | D | 0 | 1 | GOV611 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of Sorensen and Luckman's Basic Nursing A Psychophysiologic Approach reference book, policy review, medical record review, observation, and interview, it was determined the facility failed to ensure there was a justifiable medical reason for the presence of a Foley catheter and failed to provide appropriate Foley catheter care and treatments for 1 of 3 (Resident #39) sampled residents reviewed of 13 residents with a catheter and 1 of 1 catheter/pericare observed. The findings included: Review of reference book of Sorensen and Luckmann's Basic Nursing A Psychophysiologic Approach, Third Edition page 1187, documented, .the bag (Foley catheter bag) and tubing must never touch the floor . These actions increase the chances for bacteria in the drainage bag to ascend the tubing and possibly to enter the bladder. Bacteria in the drainage bag can lead to UTI (urinary tract infection) and subsequent increased mucus production . Review of the facility's INCONTINENT CARE policy documented, .10. Wash peri-area front to back, pat dry . Medical record review for Resident #39 documented an admission date of [DATE] with a readmission date of [DATE] with [DIAGNOSES REDACTED]. Review of a physician's orders [REDACTED]. Observations in Resident #39's room on 10/19/11 at 2:30 PM, revealed Resident #39 sitting up in bed with a Foley catheter patent to BSB, the urine was cloudy, yellowish in color, and the catheter tubing was touching the floor. Observations in Resident #39 's room on 10/20/11 at 10:35 AM, revealed Certified Nursing Assistant (CNA) #1 gathered supplies, removed her gloves and washed her hands, applied gloves, sprayed a washcloth with soap, washed down the right side of the perineum and then washed down the left side without changing the area of the washcloth,. CNA #1 then cleansed the catheter tubing from the insertion site outward, and then cleansed down the middle using a different area of the washcloth and then patted the area d… | 2016-09-01 |
| 9892 | 9892 | NHC HEALTHCARE, OAKWOOD | 445002 | 244 OAKWOOD DR | LEWISBURG | TN | 37091 | 2011-10-21 | 323 | D | 0 | 1 | GOV611 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation, and interview, it was determined the facility failed to follow the care plan interventions for an alarm for 1 of 3 (Resident #42) sampled residents reviewed of 4 residents with falls. The findings included: Medical record review for Resident #42 documented an admission date of [DATE] with [DIAGNOSES REDACTED]. Review of the quarterly Minimum Data Set ((MDS) dated [DATE] documented the resident had 1 fall with no injury since the prior assessment. Review of the care plan dated 8/24/11 documented, .Risk for falls r/t (related to) .Hx (history) of falls (most recent 9-15-11) . Wandering behavior . pushing w/c's (wheelchairs) . APPROACHES . door alarm on BR (bathroom) door to alert staff pt (patient) is up in bathroom . Review of post falls nursing assessments dated 9/15/11 and 7/14/11 documented Resident #42 had two falls with no apparent injuries. Observations in Resident #42's room on 10/17/11 at 11:05 AM, revealed Resident #42 lying in bed and did not answer questions. Resident #42 got up from the bed, ambulated to the bathroom and no alarm sounded when the BR door was opened. Observations in Resident 42's room on 10/19/11 at 2:45 PM, revealed an alarm to the bathroom door in the off position. During an interview in Resident #42's room on 10/19/11 at 2:55 PM, Nurse #1 confirmed the alarm to the BR door was off and stated, I don't know why it was off, I guess someone turned it off. | 2016-09-01 |
| 9893 | 9893 | NHC HEALTHCARE, OAKWOOD | 445002 | 244 OAKWOOD DR | LEWISBURG | TN | 37091 | 2011-10-21 | 329 | D | 0 | 1 | GOV611 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on policy review, medical record review, and interview, it was determined the facility failed to ensure 1 of 10 (Resident #65) sampled residents reviewed of 35 residents included in the Stage 2 review were free from unnecessary medication use. The findings included: Review of the facility's CONSULTANT PHARMACIST REPORTS . MEDICATION REGIMEN REVIEW documented, .E .The consultant pharmacist's evaluation includes, but is not limited to reviewing and/or evaluating the following: 1) A written diagnosis, indication, or documented objective findings to support each medication order . Medical record review for Resident #65 documented an admission date of [DATE] with [DIAGNOSES REDACTED]. Review of a physician's orders [REDACTED].[MEDICATION NAME] 600 MG (milligram) TABLET ONE (1) PO (by mouth) BID (twice a day) . There was no documented [DIAGNOSES REDACTED]. During an interview in the conference room on 10/20/11 at 10:30 AM, the Director of Nursing (DON) was asked about the [DIAGNOSES REDACTED]. The DON stated .no, I didn't find a diagnosis (for the use of [MEDICATION NAME]) . | 2016-09-01 |
| 9894 | 9894 | NHC HEALTHCARE, OAKWOOD | 445002 | 244 OAKWOOD DR | LEWISBURG | TN | 37091 | 2011-10-21 | 428 | D | 0 | 1 | GOV611 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on policy review, medical record review, and interview, it was determined the pharmacist failed to identify and report that 1 of 10 (Resident #65) sampled residents reviewed of 35 residents included in the Stage 2 review had a [DIAGNOSES REDACTED]. The findings included: Review of the facility's CONSULTANT PHARMACIST REPORTS . MEDICATION REGIMEN REVIEW documented, .E .The consultant pharmacist's evaluation includes, but is not limited to reviewing and/or evaluating the following: 1) A written diagnosis, indication, or documented objective findings to support each medication order . Medical record review for Resident #65 documented an admission date of [DATE] with [DIAGNOSES REDACTED]. Review of a physician's orders [REDACTED].MUCINEX 600 MG (milligram) TABLET ONE (1) PO (by mouth) BID (twice a day) . There was no documented [DIAGNOSES REDACTED]. During an interview in the conference room on 10/20/11 at 10:30 AM, the Director of Nursing (DON) was asked about the [DIAGNOSES REDACTED]. The DON stated .no, I didn't find a diagnosis (for the use of Mucinex) . | 2016-09-01 |
| 9895 | 9895 | NHC HEALTHCARE, OAKWOOD | 445002 | 244 OAKWOOD DR | LEWISBURG | TN | 37091 | 2011-10-21 | 431 | D | 0 | 1 | GOV611 | Based on policy review, observation, and interview, it was determined the facility failed to ensure medications were not stored past their expiration date and that internal and externals were not stored together in 2 of 3 (West hall medication cart and North hall medication cart) medication storage areas. The findings included: 1. Review of the facility's Medication Storage policy documented, .9. Drugs shall not be kept on hand after the expiration date . Observations of the West hall medication cart on 10/20/11 at 2:20 PM, revealed Hydrocodone 5/500 milligrams was stored past the expiration date of 05/11. During an interview at the Nurse's station on 10/20/11 at 2:20 PM, Nurse #2 verified the Hydrocodone was stored past the expiration date. 2. Review of the facility's Medication Storage policy documented, .1. Test reagents (Clinitest, Keto-Stix, etc. (etcetera)) germicides, disinfectants and other household substances shall be stored separate from drugs and in a storage area appropriately marked POISON .2. All internal and external medications and preparations intended for human use shall be stored separately. Suppositories, injectables, eye or ear drops and inhalers are considered internals . Observations of the North hall medication cart on 10/20/11 at 2:25 PM, revealed the following medications/chemicals stored together: a. Staphene Disinfectant Spray and Deodorizer. b. Reliv Dietary Supplement. c. Innergizer Sports Drink. d. Chlorhexidine 0.12 percent Rinse. e. Men-Phor Anti-Itch Lotion. | 2016-09-01 |
| 12738 | 12738 | NHC HEALTHCARE, OAKWOOD | 445002 | 244 OAKWOOD DR | LEWISBURG | TN | 37091 | 2012-03-20 | 368 | E | 1 | 0 | VB9W11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Intakes: TN 626 Based on policy review, medical record review, individual interview and staff member interview, it was determined the facility failed to offer bedtime (HS) snacks for 3 of 5 (Residents #2, 3, and 4) sampled residents reviewed. The findings included: 1. Review of the facility's "HYDRATION / SNACK CART PROGRAM" policy documented, "...Each center MUST have a system to ensure that all patients are offered H.S. snacks per federal guidelines..." 2. Medical record review for Resident #2 documented an admission date of [DATE] with [DIAGNOSES REDACTED]. Review of Resident #2's "House Med. (medication) Pass, Meal % (percent) BM (bowel movement) Tracking Sheet" for March 2012 revealed no documentation the resident had been offered an HS snack. 3. Medical record review for Resident #3 documented an admission date of [DATE] with [DIAGNOSES REDACTED]. Review of Resident #3's "House Med Pass, Meal % BM Tracking Sheet" for March 2012 revealed no documentation the resident had been offered an HS snack. During an interview in Resident #3's room on 3/19/12 at 4:55 PM, Resident #3 was asked if she was offered a bedtime snack. Resident #3 stated, "I get a cookie sometimes. The nurse don't always ask if I want a snack..." 4. Medical record review for Resident #4 documented an admission date of [DATE] with [DIAGNOSES REDACTED]. Review of Resident #4's "House Med Pass, Meal % BM Tracking Sheet" for March 2012 revealed no documentation the resident had been offered an HS snack. During an interview in Resident #4's room on 3/19/12 at 4:50 PM, Resident #4 was asked if she was offered a bedtime snack. Resident #4 stated, "...Sometimes, but they don't always ask me. Depends on who is working." 5. During an interview at the nurses' station on 3/19/12 at 2:45 PM, Nurse #1 was asked if all residents were offered a bedtime snack. Nurse #1 stated, "...only the diabetics get an HS snack, unless the physician specifically orders a snack for a resident..." | 2015-07-01 |
| 7 | 7 | NHC HEALTHCARE, DICKSON | 445004 | 812 CHARLOTTE ST | DICKSON | TN | 37055 | 2019-08-01 | 686 | D | 0 | 1 | 4FC811 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation, and interview, the facility failed to provide timely assessments and treatments for pressure ulcers for 1 of 4 (Resident #87) sampled residents reviewed for pressure ulcers. The findings include: Medical record review revealed Resident #87 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. The care plan dated 6/4/19 documented, .has alteration in skin r/t (related to) dark and reddened areas to (R) (right) foot . The Admission assessment dated [DATE] documented, .bilat (bilateral) red heels and outer rt (right) heel dark purple area (possible SDTI) (suspected deep tissue injury) . Review of the wound assessments revealed no assessments were completed for Resident #87's sDTI from admission until 7/9/19. Review of the Treatment Administration Records dated (MONTH) and (MONTH) 2019 revealed there was no documentation of wound care treatment for [REDACTED]. Medical record review revealed the pressure ulcer to the right heel remained an unstageable pressure ulcer and had not worsened. Observations in Resident #87's room on 7/18/18 at 2:05 PM, revealed Resident #87, she had a unstageable pressure injury to the right lateral heel. Interview with the Director of Nursing (DON) on 7/31/19 at 2:38 PM, in the Education Room, the DON was asked if Resident #87 was admitted with any pressure ulcers. The DON stated, .she had a suspected deep tissue injury .outer right heel . The DON was asked if weekly skin assessments and treatments should have been done. The DON stated, Yes. The DON was asked when the wound assessments and treatments began. The DON stated, .we started (MONTH) 2nd . The facility was unable to provide documentation that wound assessments and treatments were provided for Resident #87's pressure ulcer that was identified on 6/4/19, until 7/2/19. | 2020-09-01 |
| 4610 | 4610 | NHC HEALTHCARE, DICKSON | 445004 | 812 CHARLOTTE ST | DICKSON | TN | 37055 | 2016-07-07 | 247 | D | 0 | 1 | 48TR11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on policy review, medical record review, and interview, the facility failed to inform 1 of 2 (Resident #39) sampled residents of a roommate change of the 19 Residents interviewed in stage 1. The findings included: The facility's PATIENT RIGHTS policy documented, .At all times you will be notified of a change in your room or in your roommate . Medical record review revealed Resident #39 was admitted to the facility on [DATE]. Review of the admission Minimum Data Set ((MDS) dated [DATE] and the quarterly MDS dated [DATE] revealed Resident #39 had a Brief Interview for Mental Status (BIMS) score of 15 indicated she was cognitively intact. Interview with alert and oriented Resident #39 on 7/5/16 at 5:08 PM, in the resident's room, Resident #39 was asked, have you been moved to a different room or had a roommate change in the last 9 months. Resident #39 stated, Yes. Resident #39 was asked, were you given notice before a room change or a change in roommate. Resident #39 stated, .did not tell me about a roommate change . Interview with alert and oriented Resident #39 on 7/7/16 at 3:31 PM, on the 200 hall, Resident #39 stated, I got a new roommate last night. When asked if she was informed of getting a new roommate, Resident #39 stated, No There was no documentation in the medical record that Resident #39 had been notified of a change of roommate. Interview with the Social Services Director (SSD) on 7/7/16 at 5:24 PM, the SSD confirmed there was no documentation that Resident #39 had been informed of a change in her roommate. | 2019-08-01 |
| 4611 | 4611 | NHC HEALTHCARE, DICKSON | 445004 | 812 CHARLOTTE ST | DICKSON | TN | 37055 | 2016-07-07 | 309 | D | 0 | 1 | 48TR11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on policy review, medical record review, observations, and interview, the facility failed to monitor behaviors for 1 of 2 (Resident #146) sampled residents of the 2 residents reviewed with behaviors; failed to ensure communication between the facility staff and Hospice for 1 of 1 (Resident #60) sampled residents reviewed for hospice services, and failed to provide treatment to 1 of 1 (Resident #60) sampled residents with skin tears observed during a random observation. The findings included: 1. The facility's Behavior Documentation policy documented, .Behaviors are documented numerically on an every shift basis . Medical record review revealed Resident #146 was admitted to the facility on [DATE] and readmitted on [DATE] with [DIAGNOSES REDACTED]. The quarterly MDS dated [DATE] documented Resident #146 had severe cognitive deficits, hallucinates and had delusions, and exhibited physical and verbal behaviors towards others. The physician's orders [REDACTED].[MEDICATION NAME] 125 mg (milligram) .Give two (2) capsules twice daily . The Physician's Progress Note dated 6/7/16 documented, .Patient is on [MEDICATION NAME] for behavior modification . The Medication, Treatment and Task Administration Record Report dated (MONTH) (YEAR) did not document behavior monitoring after (MONTH) 6, (YEAR), 7am-7pm shift. Interview with Registered Nurse (RN) #1 on 7/7/16 at 10:03 AM, at the Unit 1 nursing station, RN #1 was asked why Resident #146 was on [MEDICATION NAME]. RN #1 stated, .in the physician's progress note, it states the [MEDICATION NAME] is prescribed for behavior modification . RN #1 was asked if Resident #146 behaviors should then be monitored every shift. RN #1 stated, I would think so, yes, yes .I can see in the nurses notes they are monitoring behaviors but it is not shift to shift . Observations in Resident #146's room on 7/5/16 at 3:54 PM, revealed Resident #146 in her rock and go wheelchair and attempted multiple times to get out of he… | 2019-08-01 |
| 5952 | 5952 | NHC HEALTHCARE, DICKSON | 445004 | 812 CHARLOTTE ST | DICKSON | TN | 37055 | 2015-06-25 | 282 | D | 0 | 1 | M5UR11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation, and interview, the facility failed to ensure care plan interventions were followed for falls for 1 of 21 (Resident #144) sampled residents reviewed of the 37 residents included in the stage 2 review. The findings included: Medical record review revealed Resident #144 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. The annual Minimum Data Set ((MDS) dated [DATE] documented Resident #144 had a Brief Interview for Mental Status (BIMS) score of 6, indicating severe cognitive impairment, and that Resident #144 required extensive staff assistance for activities of daily living. The MDS documented Resident #144 was not steady and required human assistance to stabilize when moving from a seated to a standing position, and with surface-to-surface transfers. The MDS documented no falls since the prior assessment. The care plan dated 6/5/15 documented, .PROBLEM . Safety risk . at high risk for falls . does not often recognize her limitations . APPROACHES . Keep Wheelchair out of patients (patient's) sight when she is in bed . Observations in Resident #144's room on 6/22/15 at 4:43 PM and 6/23/15 at 7:23 AM and 3:35 PM, revealed Resident #144 lying in the bed with the wheelchair at the bedside within her sight. Interview with Licensed Practical Nurse (LPN) #2 on 6/23/15 at 3:27 PM, at the unit 4 nurses' station, LPN #2 was asked to explain the care plan intervention related to keeping the wheelchair out of Resident #144's sight while she was in bed. LPN #2 stated, That is because when she sees it (wheelchair), she thinks she can get up and go by herself. But, she is not safe to go by herself. Interview with LPN #2 on 6/23/15 at 3:35 PM, in Resident #144's room, LPN #2 was asked if the wheelchair was in the resident's sight at this time while she is in bed. LPN #2 stated, Yes. Right now it is. | 2018-10-01 |
| 5953 | 5953 | NHC HEALTHCARE, DICKSON | 445004 | 812 CHARLOTTE ST | DICKSON | TN | 37055 | 2015-06-25 | 309 | D | 0 | 1 | M5UR11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on closed medical record review and interview, the facility failed to follow physician's orders for the administration of intravenous (IV) antibiotics for 1 of 37 (Resident #329) sampled residents included in the stage 2 review. The findings included: Closed medical record review revealed Resident #329 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. The Minimum (MDS) data set [DATE] documented Resident #329 had a cognitive score of 12 indicating the resident was moderately impaired. The Medication Discharge Report documented, 3/26/15 . [MEDICATION NAME] . 2 gm, (gram) Intravenous (IV), Every 24 hours, stop date 4/27 . The Medication, Treatment and Task Administration Record Report for (MONTH) (YEAR) documented the IV antibiotic [MEDICATION NAME] was administered one time on 3/27/15. The facility HISTORY & (and) PHYSICAL documented, DOS (date of services) 3/28/15 . presented (named the hospital) . with fever and chills and back pain. Evaluation accomplished in the hospital revealed that she has a bacterial endocarditis . has been transferred here for continued IV antibiotic therapy, which she will need for a total of six weeks . The Telephone Orders documented, .4/15/15 . pt (patient) went out to Cardiologist apt (appointment) and was admitted to Hospital from that apt . The hospital Discharge Summary documented, .admitted : 4/14/15 . Dischg (discharge) 4/21/15 . History and Physical . recent admission for group B [DIAGNOSES REDACTED] bacteremia was suspected endocarditis, bioprosthetic aortic valve, severe back pain secondary to a [MEDICATION NAME] 12 compression fracture . was recently discharged to (named nursing home facility) after being admitted here . diagnosed with [REDACTED]. was discharged with Peripherally Inserted Central Catheter (PICC) line complete course of [MEDICATION NAME] and [MEDICATION NAME] . was supposed to be on [MEDICATION NAME] for a total of 6 weeks . it appears that her antibiotics were inadv… | 2018-10-01 |
| 5954 | 5954 | NHC HEALTHCARE, DICKSON | 445004 | 812 CHARLOTTE ST | DICKSON | TN | 37055 | 2015-06-25 | 312 | D | 0 | 1 | M5UR11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation, and interview, the facility failed to ensure a resident, who were unable to carry out activities of daily living (ADLs), received the necessary assistance with dining for 1 of 4 (Resident #252) sampled residents reviewed for ADL care of the 37 residents included in the stage 2 review. The findings included: Medical record review revealed Resident #252 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. The significant change Minimum Data Set ((MDS) dated [DATE] documented Resident #252 was severely cognitively impaired, required extensive staff assistance for eating. The care plan dated 4/13/15 documented, .requires max (maximum) assist (assistance) with ADLs . PROBLEM . Altered Food and/or Intake as evidenced by . Hospice services . Encourage greater than 75% intake of diet, supplements, fluid . A hospice case conference summary dated 6/18/15 documented, .Re-Evaluation of patient's overall condition during the past benefit period reveals: FUNCTIONAL DECLINE NOTED IN THAT PT (patient) IS NO LONGER ABLE TO FEED HERSELF AND HAS BECOME A DEPENDENT DINER . TOTAL ASSIST ADL'S . The physician's orders [REDACTED].DIET ORDERS . PUREE . The nurses' note dated 3/24/15 documented Resident #252 was a dependent diner. Nurses' notes dated 4/15/15 and 4/29/15 documented Resident #252 required total staff assistance for ADLs. A nutritional assessment dated [DATE] documented, .Describe the patient's ability to feed themselves: Limited or Extensive Assistance . Deteriorated/Dependent ADL status . Observations on 6/22/15 at 12:35 PM, in the unit 4 dining room revealed Resident #252 sitting at a table alone in a wheelchair. There was a glass of tea with a plastic cover on the table in front of her. Resident #252 was using a spoon to scoop at the cover on the top of the tea glass. Certified Nursing Assistant (CNA) #1 placed a lipped plate containing pureed foods (chicken, potatoes, cabbage) on the table i… | 2018-10-01 |
| 5955 | 5955 | NHC HEALTHCARE, DICKSON | 445004 | 812 CHARLOTTE ST | DICKSON | TN | 37055 | 2015-06-25 | 323 | D | 0 | 1 | M5UR11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on policy review, medical record review, observation, and interview, the facility failed to implement falls interventions for 1 of 3 (Resident #144) sampled residents of 5 residents reviewed with falls. The findings included: The facility's FALLS policy documented, .PURPOSE . To reduce patient risk of falling . Post falls nursing assessment to be completed when patient incident occurs. Intervention to prevent further falls to be put in place at the time of the incident . Interventions will be added to the multidisciplinary (multidisciplinary) note and Care Plan Coordinator notified of intervention. Staff will be notified of intervention . Medical record review revealed Resident #144 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. The annual Minimum Data Set ((MDS) dated [DATE] documented Resident #144 had a Brief Interview for Mental Status (BIMS) score of 6, indicating severe cognitive impairment, and that Resident #144 required extensive staff assistance for activities of daily living. The MDS documented the resident was not steady and required human assistance to stabilize when moving from a seated to a standing position, and with surface-to-surface transfers. The MDS documented no falls since the prior assessment. The care plan dated 6/5/15 documented, .PROBLEM . Safety risk . at high risk for falls . does not often recognize her limitations . APPROACHES . Keep Wheelchair out of patients (patient's) sight when she is in bed . A Post Falls Nursing assessment dated [DATE] documented, .6/19/2015 9:20 PM . PT (patient) WAS FOUND SITTING IN THE FLOOR NEXT TO HER BED. PT STATED THAT SHE WAS GETTING UP TO USE THE BATHROOM AND SLIPPED. PT WAS PLACED BACK INTO HER WC (wheelchair) . fell from bed to go bathroom . Observations on 6/22/15 at 4:43 PM, and 6/23/15 at 7:23 AM and 3:35 PM, in Resident #144's room revealed Resident #144 lying in the bed with the wheelchair at bedside within her sight. Interview with Licensed Practi… | 2018-10-01 |
| 5956 | 5956 | NHC HEALTHCARE, DICKSON | 445004 | 812 CHARLOTTE ST | DICKSON | TN | 37055 | 2015-06-25 | 463 | D | 0 | 1 | M5UR11 | Based on observation and interview, the facility failed to ensure all call systems were functioning properly in 1 of 4 (100 hall shower room) common shower areas. The findings included: Observations during the initial tour of the 100 hall on 6/22/15 at 9:35 AM, revealed the emergency call light in the 100 hall shower room would not sound an alarm and there was no light above the door. Interview with Registered Nurse (RN) #1 on 6/23/15 at 7:53 AM, in the 100 Hall, RN #1 was asked if the shower room was used by residents. RN #1 stated Yes. RN #1 was asked if the call light was functioning. RN #1 stated, No, it is not. | 2018-10-01 |
| 7755 | 7755 | NHC HEALTHCARE, DICKSON | 445004 | 812 CHARLOTTE ST | DICKSON | TN | 37055 | 2014-02-05 | 278 | D | 0 | 1 | KG8011 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and interview, it was determined the facility failed to accurately assess hospice care for 1 of 18 (Resident #201) sampled residents of the 37 residents included in the stage 2 review. The findings included: Medical record review for Resident #201 documented an admission date of [DATE] with [DIAGNOSES REDACTED]. Review of the Resident #201's Minimum Data Set (MDS) documented the following: a. Annual MDS dated [DATE] - receiving hospice care. b. Quarterly MDS dated [DATE] - not receiving hospice care. c. Quarterly MDS dated [DATE] - receiving hospice care. Review of the January recertification orders dated 1/18/14 documented, .06/08/2012 Hospice Services . Review of the care plan dated 11/12/13 documented, .receiving Hospice services for End stage late effects [MEDICAL CONDITION]. During an interview in the education room on 2/5/14 at 3:05 PM, Nurse #1 was asked about the 8/3/13 quarterly MDS which documented Resident #201 was not receiving hospice. Nurse #1 stated, .was an error . I did check the life expectancy of less than 6 months on it (MDS) . | 2017-10-01 |
| 7756 | 7756 | NHC HEALTHCARE, DICKSON | 445004 | 812 CHARLOTTE ST | DICKSON | TN | 37055 | 2014-02-05 | 280 | D | 0 | 1 | KG8011 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and interviews, it was determined the facility failed to revise the comprehensive care plan to address behaviors for 1 of 20 (Resident # 203) sampled residents of the 37 residents included in the stage 2 Review. The findings included: Medical record review for Resident #203 documented an admission date of [DATE], with [DIAGNOSES REDACTED]. Review of the Minimum Data Set ((MDS) dated [DATE], documented that Resident #203 exhibited hallucinations, delusions, other behavioral symptoms not directed toward others and rejection of care on 1 to 3 days during the 30 days after admission. Review of physician orders [REDACTED].(Increase) [MEDICATION NAME] to 25mg (milligrams) po (by mouth) BID (twice per day) . Review of a physician's progress notes documented the following: a. 12/24/14 - .Patient is being seen this day for agitation and restlessness. She has had some delusional thought as well as thinking that her family has abandoned her here. She has been very disruptive to her peers as well . IMPRESSION . Dementia with delusions and behavioral problems . b. 12/26/13 - .The patient is being seen today per family request reported that she has had increased sedation. Apparently the patient had a bad day on Monday with excessive crying and tearfulness . The care plan dated 12/13/13 had not been updated to address the behavioral problems of crying, agitation and restlessness. During an interview at the nurse's station on 1/4/14 at 5:00 PM, Nurse #4 was asked what type of behaviors were displayed by Resident #203. Nurse #4 stated, She's crying out a lot and fights staff. Nurse #4 was asked what type of behavioral management the staff uses. Nurse #4 stated, Diversional activities and calls daughter. | 2017-10-01 |
| 7757 | 7757 | NHC HEALTHCARE, DICKSON | 445004 | 812 CHARLOTTE ST | DICKSON | TN | 37055 | 2014-02-05 | 282 | D | 0 | 1 | KG8011 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on policy review, medical record review, observation and interview, it was determined the facility failed to follow the care plan intervention of a bed alarm for 1 of 20 (Resident #233) sampled residents reviewed of the 37 residents included in the stage 2 review. The findings included: Review of the facility's Post Falls Intervention policy documented, .Bed Alarm . Medical record review for Resident #233 documented an admission date of [DATE] with [DIAGNOSES REDACTED]. Review of a High-Risk Patient Selection Form dated 12/1/13 documented the resident was at risk for falls. Review of the care plan dated 12/6/13 and updated 1/10/14 documented, .PROBLEM PRIORITY . Falls, at risk for as evidenced by . is assisted with ambulation . APPROACHES . Bed alarms placed . Observations in Resident #233's room on 2/4/14 at 2:33 PM and 3:00 PM and on 2/5/14 at 7:25 AM and 8:50 AM, revealed Resident #233 lying in bed, with no bed alarm in place as care planned. During an interview in Resident #233's room on 2/5/14 at 8:50 AM, Nurse #2 was asked to locate Resident #233's bed alarm. After checking the bed, Nurse #2 stated, I will, embarrassingly, tell you it's not there . | 2017-10-01 |
| 7758 | 7758 | NHC HEALTHCARE, DICKSON | 445004 | 812 CHARLOTTE ST | DICKSON | TN | 37055 | 2014-02-05 | 314 | D | 0 | 1 | KG8011 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on policy review, medical record review, observation and interview, it was determined the facility failed to provide appropriate care and treatment for [REDACTED].#330) sampled residents of the 8 residents with pressure ulcers. The findings included: Review of the facility's PRESSURE ULCER PREVENTION policy documented, .PATIENT CARE PLAN; STRATEGIES FOR INTERVENTION . Orders are implemented promptly and the physician is kept informed of wound progress and/or the lack there of . Review of the facility's SKIN INTEGRITY PREVENTION AND MANAGEMENT policy documented, ASSESSMENT GUIDELINES . Current treatment and a patient's response to treatment and progress toward healing . Medical record review for Resident #330 documented an admission date of [DATE] and a readmission date of [DATE] with [DIAGNOSES REDACTED]. Review of the interim care plan dated 1/13/14 and updated 1/28/14 documented, .Alteration in skin integrity . potential (marked) . Stage: Coccyx . Wound/skin/surgical wound care as ordered (marked) . 1/28 ordered wound care . Review of the Admission Nursing assessment dated [DATE] documented Resident #330 with redness to the coccyx. Review of the weekly wound assessment dated [DATE] documented Resident #330 with a stage 1 pressure ulcer to the coccyx. Review of the weekly wound assessment progress note dated 1/14/14 documented, .Wound assessment complete. Stage I to coccyx . Red, non- blanchable area . Cleansed buttocks, pat dry, apply [MEDICATION NAME] BID (twice a day) et (and) PRN (as needed). Keep pt (patient) turned side to side . Will cont (continue) to monitor et tx (treatment) as indicated . Review of the Discontinued Medication Order documented, .CLEAN BUTTOCKS, PAT DRY. APPLY [MEDICATION NAME] TO BUTTOCKS QID . Stage I to coccyx effective 1/13/14 . Review of the Treatment Administration Record (TAR) for January 2014 documented, .CLEAN BUTTOCKS, PAT DRY, APPLY [MEDICATION NAME] TO BUTTOCKS QID (four times a day) . Diagnosis . … | 2017-10-01 |
| 7759 | 7759 | NHC HEALTHCARE, DICKSON | 445004 | 812 CHARLOTTE ST | DICKSON | TN | 37055 | 2014-02-05 | 319 | D | 0 | 1 | KG8011 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and interviews, it was determined the facility failed to ensure appropriate treatment and services were provided to correct the assessed behaviors of crying, agitation and restlessness for 1 of 3 (Resident #203) sampled residents with behavioral problems of the 37 residents included in the stage 2 Review. The findings included: Medical record review for Resident #203 documented an admission date of [DATE], with [DIAGNOSES REDACTED]. Review of a behavior assessment dated [DATE] documented, .Antipsychotic Drug Use . [MEDICATION NAME] 25mg (milligram) . Reason for Use Dementia . behavioral disturbance Hx (history) of hallucinations . Notify the drug review committee or consulting pharmacist that the resident is in the Fall Prevention Program and their use of antipsychotic medication should be reevaluated . Review of the care plan dated 12/13/13 revealed the care plan had not been updated to address the behavioral problems of crying, agitation and restlessness. Review of the Minimum Data Set ((MDS) dated [DATE], documented that Resident #203 exhibited hallucinations, delusions, other behavioral symptoms not directed toward others and rejection of care on 1 to 3 days during the 30 days after admission. Review of physician orders [REDACTED].(Increase) [MEDICATION NAME] to 25mg (milligrams) po (by mouth) BID (twice per day) . Review of physician's orders [REDACTED].(Decrease) [MEDICATION NAME] 0.5mg Q (every) 6 (hours) PRN (as needed) notify if sedation does not improve . Physician orders [REDACTED].Hold [MEDICATION NAME] until further order, (due to) lethargy, (increased) weakness . Physician orders [REDACTED].[MEDICATION NAME] 25mg (milligrams) at bedtime . Review of physician's orders [REDACTED].[MEDICATION NAME] 25 mg . TAKE 1 TABLET BY MOUTH TWICE DAILY AS NEEDED . Diagnosis: [REDACTED]. [MEDICAL CONDITION] . Diagnosis: [REDACTED]. Review of a physician's progress notes documented the following: a. 12/24/14 - .Pat… | 2017-10-01 |
| 7760 | 7760 | NHC HEALTHCARE, DICKSON | 445004 | 812 CHARLOTTE ST | DICKSON | TN | 37055 | 2014-02-05 | 323 | D | 0 | 1 | KG8011 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on policy review, medical record review, observation and interview, it was determined the facility failed to ensure a bed alarm intervention to prevent accidents/falls was implemented for 1 of 3 (Resident #233) sampled residents reviewed of 7 residents with falls of the 37 residents included in the stage 2 review. The findings included: Review of the facility's Post Falls Intervention policy documented, .Bed Alarm . Medical record review for Resident #233 documented an admission date of [DATE] with [DIAGNOSES REDACTED]. Review of the High-Risk Patient Selection Form dated 12/1/13 documented the resident was at risk for falls. Review of the care plan dated 12/6/13 and updated 1/10/14 documented, .PROBLEM PRIORITY . Falls, at risk for as evidenced by . is assisted with ambulation . APPROACHES . Bed alarms placed . Observations in Resident #233's room on 2/4/14 at 2:33 PM and 3:00 PM, and on 2/5/14 at 7:25 AM and 8:50 AM, revealed Resident #233 lying in bed, with no bed alarm in place. During an interview in Resident #233's room on 2/5/14 at 8:50 AM, Nurse #2 was asked to locate Resident #233's bed alarm. After checking the bed, Nurse #2 stated, I will, embarrassingly, tell you it's not there . | 2017-10-01 |
| 10112 | 10112 | NHC HEALTHCARE, DICKSON | 445004 | 812 CHARLOTTE ST | DICKSON | TN | 37055 | 2012-02-15 | 246 | D | 0 | 1 | KPFB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on policy review, medical record review, observation and interview, it was determined the facility failed to ensure the call light was within a resident's reach for 2 of 24 (Residents #10 and 17) sampled residents. The findings included: 1. Review of the facility's CALL LIGHTS policy documented, .8. Be sure the call light is always within easy reach of the patient . 2. Medical record review for Resident #10 documented an admission date of [DATE] with [DIAGNOSES REDACTED]. Review of the care plan dated 1/6/12 documented, .Call light within reach and answer promptly . Observations in Resident #10's room on 2/13/12 at 10:23 AM, 3:30 PM and 5:25 PM, revealed Resident #10 lying in bed with bilateral hand and arm contractures. The call light was under the pillow and out of Resident #10's reach. Observations in Resident #10's room on 2/14/12 at 7:55 AM, 9:00 AM and 10:00 AM, revealed the call light was lying between the headboard and the mattress out of Resident #10's reach. Observations in Resident #10's room on 2/14/12 at 4:20 PM, revealed Resident #10 resting in bed with the call light clipped to her gown at chest level. Resident #10 was unable to reach up to where the call light was clipped. During an interview in the 100 hall on 2/14/12 at 4:20 PM, Nurse #1 confirmed the call light was out of Resident #10's reach. 3. Medical record review for Resident #17 documented an admission date of [DATE] with [DIAGNOSES REDACTED]. Review of the care plan dated 1/30/12 documented, .Call light within reach and answer light promptly . Observations in Resident #17's room on 2/14/12 at 5:00 PM, revealed Resident #17 resting in bed with bilateral hand and elbow contractures. The call light was clipped to the overbed light string out of Resident #17's reach. During an interview in Resident #17's room on 2/14/12 at 5:05 PM, Nurse #2 confirmed the call light was clipped to the light string and out of Resident #17's reach. | 2016-07-01 |
| 10113 | 10113 | NHC HEALTHCARE, DICKSON | 445004 | 812 CHARLOTTE ST | DICKSON | TN | 37055 | 2012-02-15 | 272 | D | 0 | 1 | KPFB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and interview, it was determined the facility failed to initiate an accurate initial Minimum Data Set (MDS) assessment for 1 of 27 (Resident #19) sampled residents. The findings included: Medical record review for Resident #19 documented an admission date of [DATE] with [DIAGNOSES REDACTED]. Review of the physician's orders [REDACTED].[MEDICAL TREATMENT] MWF (Monday Wednesday Friday) . Review of the initial 5 day scheduled MDS dated [DATE] did not documented [MEDICAL TREATMENT] under Section O Special Treatments, Procedures, and Programs. During an interview in the education room on 2/15/12 at 11:00 AM, Nurse #4 was asked about the [MEDICAL TREATMENT] not being documented on the MDS. Nurse #4 stated, .It ([MEDICAL TREATMENT]) should have been marked . I'll have to correct that . | 2016-07-01 |
| 10114 | 10114 | NHC HEALTHCARE, DICKSON | 445004 | 812 CHARLOTTE ST | DICKSON | TN | 37055 | 2012-02-15 | 278 | E | 0 | 1 | KPFB11 | **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 the accuracy of the Minimum Data Set (MDS) related to the pneumonia vaccine requirement for 9 of 27 (Residents #1, 2, 4, 10, 11, 12, 17, 19 and 24) sampled residents. The findings included: 1. Medical record review for Resident #1 documented an admission date of [DATE] with [DIAGNOSES REDACTED]. Review of the Influenza / Pneumococcal Record labeled with an admission date of [DATE] documented, .Pneumoccocal Immunization . X Refused . Review of the admission 5-day MDS dated [DATE] and the 30-day MDS dated [DATE] documented, .O0300. Pneumococcal Vaccine . A. Is the resident's Pneumococcal vaccination up to date? .0 . O. NO . If Pneumococcal vaccine not received, state reason . B. If Pneumococcal vaccine not received, state reason: - (symbol for dash) . The MDS was not coded as to the reason why vaccine not received. 2. Medical record review for Resident #2 documented an admission date of [DATE] with [DIAGNOSES REDACTED]. Review of the Influenza/Pneumococcal Record labeled with admission date of [DATE] documented, .Pneumoccocal Immunization . X Refused . Review of the admission 5-day MDS dated [DATE] and the 30-day MDS dated [DATE] documented, .O0300. Pneumococcal Vaccine . A. Is the resident's Pneumococcal vaccination up to date? .0 . O. NO . If Pneumococcal vaccine not received, state reason . B. If Pneumococcal vaccine not received, state reason: - (symbol for dash) . The MDS was not coded as to the reason why vaccine not received. 3. Medical record review for Resident #4 documented an admission date of [DATE] with [DIAGNOSES REDACTED]. Review of the medical record contained no documentation of the Influenza and Pneumococcal Immunization history or education provided. Review of the admission MDS dated [DATE] documented, .O0300. Pneumococcal Vaccine . A. Is the resident's Pneumococcal vaccination up to date? .0 .O. NO . If Pneumococcal vaccine not rece… | 2016-07-01 |
| 10115 | 10115 | NHC HEALTHCARE, DICKSON | 445004 | 812 CHARLOTTE ST | DICKSON | TN | 37055 | 2012-02-15 | 279 | E | 0 | 1 | KPFB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on policy review, medical record review and interview, it was determined the facility failed to develop an interim plan of care upon admission to address the immediate needs of the resident for 5 of 27 (Residents #1, 2, 4, 11 and 19) sampled residents. The findings included: 1. Review of the facility's care plan development policy documented, .Time Frames for Care Plans: Interim plan of care within 24 hours of admission addressing the immediate needs of the patient . 2. Medical record review for Resident #1 documented an admission date of [DATE] with [DIAGNOSES REDACTED]. Review of the interim plan of care documented a start date of 12/30/11. The care plan was initiated greater than 24 hours after admission. During an interview in the education room on 2/15/12 at 10:25 AM, Nurse 34 was asked when the interim care plan should be initiated on new admissions. Nurse #4 stated, .In first 24 hours . Nurse #4 confirmed the interim care plan for Resident #1 had not been initiated within 24 hours of admission. 3. Medical record review for Resident #2 documented an admission date of [DATE] with [DIAGNOSES REDACTED]. Review of the interim plan of care documented a start date of 1/7/12. The care plan was initiated greater than 24 hours after admission. During an interview in the education room on 2/15/12 at 10:25 AM, Nurse #4 was asked when the interim care plan should be initiated on new admissions. Nurse #4 stated, .In first 24 hours . Nurse #4 confirmed the interim care plan for Resident #2 had not been initiated within 24 hours of admission. 4. Medical record review for Resident #4 documented an admission date of [DATE] with [DIAGNOSES REDACTED]. Review of the interim plan of care was dated 1/10/12 and was not initiated within the 24 hour time frame as per the facility's policy. During an interview in the education room on 2/15/12 at 9:20 AM, the Assistant Director of Nursing (ADON) confirmed Resident #4's interim plan of care was not initiated… | 2016-07-01 |
| 10116 | 10116 | NHC HEALTHCARE, DICKSON | 445004 | 812 CHARLOTTE ST | DICKSON | TN | 37055 | 2012-02-15 | 280 | E | 0 | 1 | KPFB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on policy review, medical record review, observation and interview, it was determined the facility failed to revise the comprehensive care plan to reflect the current status for elevating legs, [MEDICAL CONDITION]-embolic device (TED) hose, bleeding precautions, bed alarm, ortho boot, orastretcher, hand splint, a roll guard, feeding a resident at each meal and/or not to obtain weights for 6 of 27 (Residents #1, 5, 6, 10, 13 and 14) sampled residents. The findings included: 1. Review of the facility's care plan development policy documented, .9. Problems: a. Problems are patient conditions, needs, or weaknesses which currently do, or potentially could, prevent the patient from achieving or maintaining the highest practicable level of well being . 2. Medical record review for Resident #1 documented an admission date of [DATE] with [DIAGNOSES REDACTED]. Review of a physician's orders [REDACTED].Keep legs elevated when possible . Review of a physician's orders [REDACTED].Measure for TED hose, below knee, on Q (every) AM, off at HS (hour of sleep) . The care plan dated 1/12/12 was not updated to reflect interventions for elevating legs and TED hose. During an interview in the education room on 2/15/12 at 10:30 AM, Nurse #4 was asked if the interventions for elevating legs and TED hose were on the care plan. Nurse #4 stated, Its's (interventions for elevating legs and TED hose) not on there (care plan) because I haven't updated the care plan . 3. Review of the Nursing 2012 Drug Handbook, Lippincott Williams & (and) Wilkins documented, .[MEDICATION NAME] Sodium [MEDICATION NAME] Nursing Considerations: Regularly inspect patient for bleeding gums, bruises on arms or legs, petechiae, nosebleeds, melena, tarry stools, hematuria and hematemesis . Medical record review for Resident #5 documented an admission date of [DATE] with [DIAGNOSES REDACTED]. Review of a physician's orders [REDACTED].[MEDICATION NAME] 60 mg (milligram) sq (subcutaneous) q (e… | 2016-07-01 |
| 10117 | 10117 | NHC HEALTHCARE, DICKSON | 445004 | 812 CHARLOTTE ST | DICKSON | TN | 37055 | 2012-02-15 | 328 | D | 0 | 1 | KPFB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on policy review, medical record review, observation and interview, it was determined the facility failed to ensure oxygen (O2) was administered at the rate prescribed by the physician for 2 of 7 (Residents #14 and 17) sampled residents receiving O2. The findings included: 1. Review of the facility's inhalation therapy policy documented, .Oxygen therapy will be initiated . on the order of a physician . 2. Medical record review for Resident #14 documented an admission date of [DATE] with [DIAGNOSES REDACTED]. Review of the physician's orders [REDACTED].O2 @ (at) 4 L (liters) PER NC (nasal cannula) CONTINUOUS . Observations in Resident #14's room on 2/13/12 at 11:30 AM, 3:30 PM and 5:30 PM, revealed Resident #14 receiving O2 per binasal cannula at a rate of 3.5 L. 3. Medical record review for Resident #17 documented an admission date of [DATE] with [DIAGNOSES REDACTED]. Review of the physician's orders [REDACTED].O2 @ 4 L/M (liters per minute) NC (nasal cannula) . Observations in Resident #17's room on 2/14/12 at 3:15 PM and 5:00 PM and on 2/15/12 at 7:50 AM and 8:25 AM, revealed Resident #17 receiving O2 at 2 L/M. During an interview in Resident #17's room on 2/15/12 at 8:25 AM, Nurse #3 was asked if Resident #17 was receiving O2 at 2 L/M. Nurse #3 stated, .yes . and confirmed the oxygen should be administered at 4 L/M per physician's orders [REDACTED].> | 2016-07-01 |
| 10118 | 10118 | NHC HEALTHCARE, DICKSON | 445004 | 812 CHARLOTTE ST | DICKSON | TN | 37055 | 2012-02-15 | 334 | E | 0 | 1 | KPFB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on policy review, medical record review and interview, it was determined the facility failed to provide the required components of the Influenza and Pneumococcal immunization program for 11 of 27 (Residents #1, 2, 4, 6, 7, 11, 12, 17, 19, 23 and 24) sampled residents. The findings included: 1. Review of the facility's Pneumonoccal Vaccination Policy documented, .A medical history of [REDACTED]. A Vaccine Information Sheet will be provided to the patient or Responsible Party . Pneumococcal Immunization will be kept in the patients medical record for patients receiving Pneumococcal Vaccine and will include: Immunization history, Education Provided, Administration of Vaccine, Name of person refusing vaccine for the patient, Post Immunization monitoring . Review of the facility's Influenza Vaccination Policy documented, .Each patient will be offered immunization against influenza October 1 through March 31 annually . A history will be obtained from the patient or responsible party to determine patient ability to receive the influenza vaccine and history of adverse reactions . A Vaccination Information Sheet will be provided to the patient or responsible party . Influenza Immunization Record will be kept in the patient's chart containing Immunization History, Education provided, Administration of vaccine, name of person refusing vaccine for patient, and Post Immunization Monitoring for patients receiving influenza injection . 2. Medical record review for Resident #1 documented an admission date of [DATE] with [DIAGNOSES REDACTED]. Review of the Influenza / Pneumococcal Immunization Record documented, .Administration Record: Vaccine Information Pneumococcal Immunization: Refused (marked with an X) . Review of the Influenza/Pneumococcal Immunization record contained no documentation of the name of the patient or responsible party refusing the Pneumococcal Vaccine for the patient and no documentation of vaccine information sheet education provi… | 2016-07-01 |
| 10119 | 10119 | NHC HEALTHCARE, DICKSON | 445004 | 812 CHARLOTTE ST | DICKSON | TN | 37055 | 2012-02-15 | 441 | D | 0 | 1 | KPFB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on policy review, medical record review, review of a Certified Nursing Assistant (CNA) information form, observation and interview, it was determined the facility failed to ensure practices to prevent the potential spread of infection were maintained by failing to institute consistent isolation practices for 1 of 1 (Resident #11) sampled residents and by failing to ensure sanitary hand hygiene practices during 1 of 2 (Lunch 2/14/12) dining observations. The findings included: 1. Review of the facility's Multidrug-Resistant Microorganisms policy documented, .Use Contact Precautions: for patients with known or suspected Clostridium difficile associated disease . Medical record review for Resident #11 documented an admission date of [DATE] with [DIAGNOSES REDACTED]. Review of the admitting orders dated 2/1/12 documented, .c-diff (Clostridium difficile) . as diagnosis. There was no order for isolation documented. Review of the Admission Nursing Assessment Report dated 2/1/12 did not document Clostridium difficile illness or initiation of isolation. Review of the interim plan of care dated 2/2/12 did not include isolation precautions. Review of the facility's CNA information form for Resident #11 did not document isolation precautions. During an interview in the education room on 2/16/12 at 10:30 AM, Nurse #8 was unable to locate documentation for isolation and could not verify that CNAs were informed of contact isolation precautions for Resident #11. 2. Review of the facility's Handwashing policy documented, .Turn water off with paper towel used to dry hands . During dining observations in room [ROOM NUMBER] on 2/14/12 at 11:38 AM, CNA #1 washed her hands with soap and water and turned off the water faucet with her bare hand. During dining observations in room [ROOM NUMBER] on 2/14/12 at 11:50 AM, CNA #2 moved the chair to the bedside and moved the overbed table then prepped the meal tray without washing her hands. During an interview in th… | 2016-07-01 |
| 10120 | 10120 | NHC HEALTHCARE, DICKSON | 445004 | 812 CHARLOTTE ST | DICKSON | TN | 37055 | 2012-02-15 | 502 | D | 0 | 1 | KPFB11 | **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 laboratory testing was obtained as ordered for 1 of 27 (Resident #3) sampled residents. The findings included: Medical record review for Resident #3 documented an admission date of [DATE] with [DIAGNOSES REDACTED]. Review of the physicians order dated 1/12/12 documented, .Stool for C (,[MEDICAL CONDITION].) Diff (Difficile) . The facility was unable to provide documentation that a stool sample for[DIAGNOSES REDACTED] was obtained as ordered. During an interview at Unit 1 nurses' station on 2/15/12 at 10:45 AM, the Assistant Director of Nursing (ADON) stated, .we are not able to produce the[DIAGNOSES REDACTED] results . | 2016-07-01 |
| 10121 | 10121 | NHC HEALTHCARE, DICKSON | 445004 | 812 CHARLOTTE ST | DICKSON | TN | 37055 | 2012-02-15 | 514 | D | 0 | 1 | KPFB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on policy review, medical record review and interview, it was determined the facility failed to ensure physician's orders were accurate for 2 of 27 (Residents #2 and 10) sampled residents. The findings included: 1. Review of the facility's DOCUMENTATION GUIDELINES documented, .A nurse reviews all current orders for content and clarity, deletes discontinued orders, signs the orders as recopied/reprinted . The nurses's signature indicates accountability for the accuracy of the updated orders as of the date signed . 2. Medical record review for Resident #2 documented an admission date of [DATE] with [DIAGNOSES REDACTED]. Review of the physician's admitting orders dated 1/3/12 documented, .Diet: Mechanical NAS (no added salt) .Labs ordered: BMP (basic metabolic panel), CBC (complete blood count), Thurs (Thursday) then q (every) 3 mo (months) . Review of the physician's recertification orders dated 2/8/12 documented, .DIET: MECHANICAL . BOTH HEELS: APPLY ALLEVYN HEELS AND [MEDICATION NAME] EVERY 3 DAYS & (and) PRN (as needed) . The physician's recertification orders did not include orders for the BMP and CBC to be done q 3 months or include NAS to the diet order. Review of the weekly wound assessment record dated 2/9 (2012) documented, .Lt (left) Hel (heel) . Healed . Review of all physician's orders documented no order to discontinue left heel dressing changes due to that the area had healed. During an interview in the education room on 2/15/12 at 10:10 AM, Nurse #5 confirmed the order for NAS diet and the CBC and BMP q 3 months had not been added to the current recertification orders. Nurse #5 was asked if there was an order to discontinue the dressing change to the left heel. Nurse #5 stated, .I don't see an order . During an interview in the education room on 2/15/11 at 4:35 PM, Nurse #6 confirmed an order should have been written to discontinue the dressing change to the left heel as it was healed on 2/9/12. 3. Medical record review for… | 2016-07-01 |
| 10122 | 10122 | NHC HEALTHCARE, DICKSON | 445004 | 812 CHARLOTTE ST | DICKSON | TN | 37055 | 2013-08-13 | 157 | D | 1 | 0 | R0PB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Intakes: TN 209 Based on policy review, medical record review and interview, it was determined the facility failed to notify the responsible party of a change in medication for 1 of 5 (Resident #1) sampled residents. The findings included: Review of the facility's POLICIES AND PROCEDURES REGARDING CHANGE IN PATIENT STATUS documented, .The patient or decision maker is encouraged to be involved in all decision-making regarding changes in the plan of care . Medical record review for Resident #1 documented an admission date of [DATE] and a discharge date of [DATE] with [DIAGNOSES REDACTED]. Review of the Nutritional Assessment Report dated 6/28/13 documented, .CBW (current body weight) 181 # (pounds); some variation since admit 16# (pound) (8.1% (percent)) compared to the stated UBW (usual body weight) 197# . Review of the physician's progress notes dated 7/1/13 documented, .This patient was referred by the dietician due to having trigger for malnourishment on a recent assessment. He has a significant weight loss due to poor intake and has chronic [DIAGNOSES REDACTED]. Add [DIAGNOSES REDACTED].o. (by mouth) q.h.s. (every hour of sleep) . Review of the physician's orders [REDACTED].[MEDICATION NAME] 15 mg po QHS . Review of the nurses' notes dated 7/1/13 documented, .N.O. (new order) rec'd (received) r/t (related to) wt (weight) loss . There was no documentation the family was notified of this change. During an interview in the Director of Nursing's (DON) office on 8/13/13 at 3:00 PM, the DON was asked what is the responsibility of staff in relation to family when a resident has a change in condition or medication. The DON stated, Family should be notified. The DON confirmed the responsible party was not notified of the new medication on 7/1/13 and stated, I did become aware of this . that nurse was educated . | 2016-07-01 |
| 10123 | 10123 | NHC HEALTHCARE, DICKSON | 445004 | 812 CHARLOTTE ST | DICKSON | TN | 37055 | 2013-08-13 | 282 | D | 1 | 0 | R0PB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and interview, it was determined the facility failed to follow the care plan interventions for bowel movement (BM) protocol for 1 of 5 (Resident #1) sampled residents. The findings included: Medical record review for Resident #1 documented an admission date of [DATE] and a discharge date of [DATE] with [DIAGNOSES REDACTED]. Review of the physician's orders [REDACTED].MILK OF MAGNESIA SUSPENSION Start Date: 7/11/2013 . IF NO BM IN 2 DAYS GIVE MOM (Milk of Magnesia) 30 ML (milliliters) AFTER BREAKFAST . [MEDICATION NAME] 10 MG (milligrams) SUPPOSITORY . Start Date: 7/11/2013 . IF NO BM AFTER MOM GIVE [MEDICATION NAME] . FLEET ENEMA . Start Date: 7/11/2013 . IF NO BM AFTER [MEDICATION NAME] GIVE FLEET ENEMA . Review of the physician's orders [REDACTED].SOAP SUD ENEMA . Start Date: 7/15/2013 . 1X (time) NOW . Review of the care plan dated 7/12/13 documented, .PROBLEM . Constipation, potential for . APPROACHES . Follow BM protocol if no BM is noted > (greater) (3) days . Review of Activities of Daily Living (ADL) tracking sheets for July, 2013 documented Resident #1 had no BM on 7/11/13, 7/12/13, 7/13/13 or 7/14/13. Review of the Medication and Treatment Administration Record Report documented Resident #1 did not receive anything to assist his bowels to move until 7/15/13, when he received MOM, a [MEDICATION NAME] Suppository, a Fleet Enema, and a Soap Sud Enema. Review of the ADL tracking sheets for July, 2013 documented Resident #1 did have a BM 7/15/13, then had no BM on 7/16/13, 7/17/13, 7/18/13 or 7/19/13, and did have a BM 7/20/13. Review of the Medication and Treatment Administration Record Report documented Resident #1 did not receive anything to assist his bowels to move from 7/16/13 through 7/20/13. During an interview in the Director of Nurses's (DON) office on 8/13/13 at 3:00 PM, the DON was asked what the process for the BM protocol was. The DON stated, On day 3, if no BM, give MOM, then if no BM, give a… | 2016-07-01 |
| 10124 | 10124 | NHC HEALTHCARE, DICKSON | 445004 | 812 CHARLOTTE ST | DICKSON | TN | 37055 | 2013-08-13 | 309 | D | 1 | 0 | R0PB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on policy review, medical record review and interview, it was determined the facility failed to follow physician's orders or the bowel movement (BM) protocol for 1 of 5 (Resident #1) sampled residents. The findings included: Review of the facility's .Admitting Orders documented, .Bowel Protocol: If no BM in 2 days give MOM (Milk of Magnesia) 30 cc (cubic centimeters) po (by mouth) p (after) breakfast. If no BM following MOM give [MEDICATION NAME] Suppository rectally p evening meal. If no BM p [MEDICATION NAME] give Fleets enema @ (at) H.S. (Hour of Sleep) . The Director of Nursing stated this was their policy for the BM protocol. Medical record review for Resident #1 documented an admission date of [DATE] and a discharge date of [DATE] with [DIAGNOSES REDACTED]. Review of the physician's orders dated 7/17/13 documented, .MILK OF MAGNESIA SUSPENSION Start Date: 7/11/2013 . IF NO BM IN 2 DAYS GIVE MOM 30 ML (milliliters) AFTER BREAKFAST . [MEDICATION NAME] 10 MG (milligrams) SUPPOSITORY . Start Date: 7/11/2013 . IF NO BM AFTER MOM GIVE [MEDICATION NAME] . FLEET ENEMA . Start Date: 7/11/2013 . IF NO BM AFTER [MEDICATION NAME] GIVE FLEET ENEMA . Review of the physician's orders dated 7/18/13 documented, .SOAP SUD ENEMA . Start Date: 7/15/2013 . 1X (time) NOW . Review of the care plan dated 7/12/13 documented, .PROBLEM . Constipation, potential for . APPROACHES . Follow BM protocol if no BM is noted > (greater) (3) days . Review of Activities of Daily Living (ADL) tracking sheets for July, 2013 documented Resident #1 had no BM on 7/11/13, 7/12/13, 7/13/13 or 7/14/13. Review of the Medication and Treatment Administration Record Report documented Resident #1 did not receive anything to assist his bowels to move until 7/15/13, when he received MOM, a [MEDICATION NAME] Suppository, a Fleet Enema and a Soap Sud Enema. Review of the ADL tracking sheets for July, 2013 documented Resident #1 did have a BM 7/15/13, then had no BM on 7/16/13, 7/17/13… | 2016-07-01 |
| 12348 | 12348 | NHC HEALTHCARE, DICKSON | 445004 | 812 CHARLOTTE ST | DICKSON | TN | 37055 | 2010-11-17 | 328 | D | 0 | 1 | 9SDV11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observations and interviews, it was determined the facility failed to ensure oxygen (O2) was administered at the physician's prescribed rate for 1 of 12 (Resident #2) sampled residents receiving oxygen. The findings included: Medical record review for Resident #2 documented an admission date of [DATE] with [DIAGNOSES REDACTED]. Review of the physician's telephone orders dated 10/29/10 documented, "...change O2 to 2 (liters) PRN (as needed) for SOB (shortness of breath)..." Observations in Resident #2's room on 11/15/10 at 10:30 AM and 2:10 PM, revealed Resident #2 was receiving O2 at 3 liters per minute (LPM) per binasal cannula (BNC). Resident #2 was not receiving oxygen at the physician's prescribed rate of 2 LPM. Observations in Resident #2's room on 11/16/10 at 7:45 AM, revealed Resident #2 was receiving O2 at 3 1/2 LPM per BNC. Resident #2 was not receiving oxygen at the physician's prescribed rate of 2 LPM. During an interview in Resident #2's room on 11/16/10 at 7:45 AM, Nurse #7 was asked what rate was Resident #2's oxygen set on. Nurse #7 bent down and looked at the oxygen concentrator and stated, "It is on 3 and 1/2 liters." During an interview at the nurse's station on 11/16/10 at 9:55 AM, Nurse #8 was asked what rate was Resident #2's O2 ordered for. Nurse #8 stated, "2 Liters." | 2015-08-01 |
| 12349 | 12349 | NHC HEALTHCARE, DICKSON | 445004 | 812 CHARLOTTE ST | DICKSON | TN | 37055 | 2010-11-17 | 441 | E | 0 | 1 | 9SDV11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on policy reviews, observations and interviews, it was determined the facility failed to ensure practices to prevent the potential spread of infection were maintained by 2 of 2 (Nurses #9 and 10) nurses observed during wound care; 4 of 7 (Nurses #1, 2, 3 and 4) nurses observed during medication administration; and 6 of 14 Certified Nursing Assistants (CNAs #1, 2, 3, 4, 5 and 6) and Occupational Therapist (OT #1) obsered during dining observations. The findings included: 1. Review of the facility's "HANDWASHING" policy documented, "PURPOSE: To decrease the number of microorganisms, preventing cross contamination... ...Procedure wash hands after contact with each patient, after toileting, smoking or eating, and after removal of gloves..." 2. Observations during wound care in Resident #3's room on 11/16/10 at 9:00 AM, Nurse #9 pushed the paper towel dispenser handle for a paper towel, washed her hands, dried her hands with the paper towel, took the same paper towel and dispensed more paper towel, then dried her hands with the fresh paper towel and the towel she had used on the dispenser. Nurse #9 dried her hands in this same way three times during observation of the wound care. Nurse #9 cross contaminated her hands when she use the dirty paper towel to dry her hands. During an interview in the biohazard room on 11/16/10 at 9:15 AM, Nurse #9 stated, "...I should not have dried with the dirty paper towel..." Observations during wound care in Resident #11's room on 11/26/10 at 11:08 AM, revealed Nurse #10 dispensed some paper towel, washed her hands, dried her hands with that towel, used her bare index finger on her clean right hand to dispense more paper towel to turn the water off. Nurse #10 used this same technique contaminating her right hand 4 times during observation of her wound care. During an interview in the Director of Nursing's (DON) office on 11/16/10 at 11:35 AM, the DON stated, "...She (Nurse #9) should not have dried her hands… | 2015-08-01 |
| 12350 | 12350 | NHC HEALTHCARE, DICKSON | 445004 | 812 CHARLOTTE ST | DICKSON | TN | 37055 | 2010-11-17 | 282 | D | 0 | 1 | 9SDV11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record reviews, observations and interviews, it was determined the facility failed to follow interventions on the care plan for Reddy shakes or hand splints for 2 of 24 (Residents #3 and #9) sampled residents. The findings included: 1. Medical record review for Resident #3 documented an admission date of [DATE] with [DIAGNOSES REDACTED]. Review of the comprehensive care plan dated 10/29/10 documented, "Significant nutritional risk... Malnutrition... Supplement Use between meals... 1 (one) 4 oz (ounce) Reddy Shake c (with) each meal for add (additional) /Calories/Prot. (protein)." Observations in Resident #3's room on 11/16/10 at 8:00 AM and on 11/17/10 at 7:40 AM, revealed no Reddy Shake on Resident #3's meal tray as care planned. During an interview in the Director of Nursing's (DON) office on 11/17/10 at 8:00 AM, the DON was asked about the Reddy Shakes. The DON stated, "It would be between dietary and nursing to make sure the supplement is on the tray." During an interview in the education room on 11/17/10 at 10:00 AM, Dietician #1 was asked about the Reddy Shakes. Dietician #1 stated, "...The CNA (Certified Nursing Assistant) just didn't put it (Reddy shake) on her tray, it wasn't that she (Resident #3) refused it." 2. Medical record review for Resident #9 documented an admission date of [DATE] and a readmission date of [DATE] with [DIAGNOSES REDACTED]. Review of the comprehensive care plan dated 8/23/10 and updated 8/25/10 documented, "...ADL's (Activities of Daily Living), Dependent on staff for ADLS... Bilateral hand splints to both hands: On while facing the door and off while facing the window..." Observations in Resident #9's room on 11/15/10 at 5:10 PM, on 11/16/10 at 10:15 AM and 12:00 PM and on 11/17/10 at 7:35 AM, revealed Resident #9 lying in bed facing the door, with no bilateral hand splints on as care planned. During an interview in the 100 hall on 11/17/10 at 8:15 AM, Nurse #2 was asked about Resident #9 no… | 2015-08-01 |
| 12351 | 12351 | NHC HEALTHCARE, DICKSON | 445004 | 812 CHARLOTTE ST | DICKSON | TN | 37055 | 2010-11-17 | 280 | D | 0 | 1 | 9SDV11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record reviews, observations and interviews, it was determined the facility failed to revise the comprehensive care plan to address range of motion (ROM) and/or oxygen (O2) for 4 of 27 (Residents #4, 5, 19 and 22) sampled residents. The findings included: 1. Medical record review for Resident #4 documented an admission date of [DATE] with [DIAGNOSES REDACTED]. Review of the Minimum Data Set (MDS) with an assessment reference date of 10/16/10 documented Resident #4 had impairment on both sides of the upper and lower extremities for ROM. Review of the care plan dated 11/6/10 revealed no documentation to address ROM limitations. During an interview in the care plan office on 11/16/10 at 3:50 PM, MDS Coordinator #1 confirmed there was no care plan to address ROM and stated, "I am going to add it right now." 2. Medical record review for Resident #5 documented an admission date of [DATE] and a readmission date of [DATE] with [DIAGNOSES REDACTED]. Review of the MDS with an assessment reference date of 10/4/10 documented Resident #5 had impairment on both sides of the upper and lower extremities for ROM. Review of the care plan dated 10/5/10 revealed no documentation to address ROM limitations. During an interview at the unit 2 nurses' station on 11/17/10 at 8:30 AM, MDS Coordinator #1 stated, "No, it's (ROM) not in the ADL's (activities of daily living) where it (ROM) should be..." 3. Medical record review for Resident #19 documented an admission date of [DATE] with [DIAGNOSES REDACTED]. Review of Resident #19's physician's orders [REDACTED].@ (at) 3L (liters) PER NC (nasal cannula) CONTINUOUS..." Review of the nurse's notes dated 11/15/10 documented Resident #19 was receiving O2 continuous at 2 liters per minute (LPM). Review of the care plan dated 9/22/10 revealed no care plan for O2 therapy. Observations in room [ROOM NUMBER] on 11/15/10 at 10:15 AM, on 11/16/10 at 4:00 PM and on 11/17/10 at 9:25 AM, revealed Resident #19 lying i… | 2015-08-01 |
| 12352 | 12352 | NHC HEALTHCARE, DICKSON | 445004 | 812 CHARLOTTE ST | DICKSON | TN | 37055 | 2010-11-17 | 371 | E | 0 | 1 | 9SDV11 | Based on policy reviews, observations and interviews, it was determined 4 of 8 (dietary staff members #1, 2, 3 and 4) dietary staff members failed to ensure food was prepared or stored under sanitary conditions as evidenced by rice stored in an open bag; a Teflon skillet had scratches and a carbon build up; dirty towels and cloths on counters and carts; improper storage of a broom; cover their hair and beards or follow the handwashing policy. The findings included: 1. Review of the facility's "DRY STORAGE" policy documented, "...GUIDELINES... 6. Foods will be stored in their original packages, if possible. If opened, packages should be closed securely to protect product..." Observations in the kitchen on 11/15/10 at 10:00 AM and 4:18 PM and on 11/16/10 at 3:35 PM, revealed a large open bag of rice stored on a shelf in the food preparation area. During an interview in the kitchen on 11/16/10 at 3:35 PM, the Dietary Manager stated, "It (rice) should be in a closed container to keep something from getting in it." 2. Observations in the kitchen on 11/15/10 at 4:18 PM, revealed the cook preparing a grilled cheese sandwich in a skillet that had missing Teflon, multiple scratches on the inside and large amounts of carbon buildup along the top edge and bottom. During an interview in the Dietary Manager's (DM) office on 11/16/10 at 8:15 AM, the DM held the Teflon skillet and stated, "It has too much carbon. This one should have been taken out. It shouldn't be used." 3. Observations in the kitchen on 11/15/10 at 10:00 AM, revealed a dirty dry towel on the food preparation counter and on 11/15/10 at 4:38 PM revealed a dirty wet towel on the floor next to the racks of clean cups and bowls. Observations in the kitchen on 11/16/10 at 8:20 AM, revealed a dirty wet cloth hanging on top of the clean dish rack. Observations in the kitchen on 11/16/10 at 3:15 PM, revealed 2 dirty towels hanging on the end of a utility cart. During an interview in the kitchen on 11/16/10 at 3:15 PM, the DM was asked what he would expect staff to do … | 2015-08-01 |
| 12353 | 12353 | NHC HEALTHCARE, DICKSON | 445004 | 812 CHARLOTTE ST | DICKSON | TN | 37055 | 2010-11-17 | 514 | D | 0 | 1 | 9SDV11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record reviews and interviews, it was determined the facility failed to ensure physician's orders were accurate for 2 of 27 (Residents #11 and 16) sampled residents. The findings included: 1. Medical record review for Resident #11 documented an admission date of [DATE] with [DIAGNOSES REDACTED]. Review of a physician's telephone order dated 9/29/10 documented, "Dec (decrease) [MEDICATION NAME] to 25mg (milligrams) po (by mouth) every hs (bedtime)." The physician's recertification orders dated 10/6/10 failed to reflect the decrease of [MEDICATION NAME]. During an interview at the unit 4 nurses' station on 11/16/10 at 12:15 PM, Nurse #8 and Nurse #7 reviewed Resident #11's chart. Nurse #7 stated, "The PPOC (recertification orders) has [MEDICATION NAME] 50mg and she is receiving [MEDICATION NAME] 25mg." 2. Medical record review for Resident #16 documented an admission date of [DATE] with [DIAGNOSES REDACTED]. Review of a physician's telephone order dated 11/9/10 documented, "Increase O2 (oxygen) BNC (binasal cannula) to 4 LPM (liters per minute)..." The physician's recertification orders dated 11/11/10 failed to reflect the increase of oxygen. During an interview at the unit 4 nurses' station on 11/17/10 at 10:05 AM, Nurse #8 stated, "PPOC is wrong means they did not pick up the order. Pharmacy generates the PPOC from the supplemental (orders)." | 2015-08-01 |
| 12354 | 12354 | NHC HEALTHCARE, DICKSON | 445004 | 812 CHARLOTTE ST | DICKSON | TN | 37055 | 2012-08-29 | 253 | D | 1 | 0 | SINC11 | Intakes: TN 160 Based on observations and interviews, it was determined the facility failed to provide maintenance services as evidenced by the presence of a ? to ? inch open air space between the frame of an air conditioner and the air conditioner in 1 of 5 (Resident #1) sampled residents' rooms. The findings included: Observations in Resident #1's room on 8/20/12 at 9:51 AM, revealed a ? to ? inch open space between the room's air conditioner and the frame around the air conditioner which allowed light and outside air to come through to the inside of the room. During an interview in Resident #1's room on 8/20/12 at 9:51 AM, Nurse #1 was shown the open space between the air conditioner and the frame of air conditioner. Nurse #1 stated, "...Oh, my, that's not good..." During an interview in Resident #1's room on 8/20/12 at 9:53 AM, following an inspection of the area around the air conditioner on the outside of the building and inside of the room, Maintenance worker #1 stated, "...The light is coming through the vent on the outside. Inside is this 1 by (x) 4 inch trim but it is sticking out too far and won't allow the air conditioner to completely close (around the unit..." | 2015-08-01 |
| 12355 | 12355 | NHC HEALTHCARE, DICKSON | 445004 | 812 CHARLOTTE ST | DICKSON | TN | 37055 | 2012-08-29 | 315 | D | 1 | 0 | SINC11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Intakes: TN 160 Based on policy review, observations, and interview, it was determined the facility failed to provide appropriate care of the catheter tubing or catheter drainage bag for 3 of 5 (Residents #1, 2, and #4) sampled residents observed with Foley catheters. The findings included: 1. Review of the facility's "CATHETER DRAINAGE SYSTEM, CLOSED" policy documented, "...POINTS TO REMEMBER... Never allow the drainage bag to touch the floor... PROCEDURE: 1. Attach drainage bag to bed frame..." 2. Medical record review for Resident #1 documented an admission date of [DATE] and readmission date of [DATE] with [DIAGNOSES REDACTED]. Observations in the dependent dining room outside the 300 hall on 8/20/12 at 10:50 AM and on 8/20/12 at 11:00 AM, approximately 4 inches of Resident #1's Foley catheter tubing was laying on the floor underneath the wheelchair in which Resident #1 was sitting. Observations in the activity room on 8/20/12 at 1:35 PM, on 8/21/12 at 12:05 PM, and on 8/22/12 at 10:30 AM, approximately 4 inches of Resident #1's Foley catheter tubing was laying on the floor underneath the wheelchair in which Resident #1 was sitting. 3. Medical record review for Resident #2 documented an admission date of [DATE] with [DIAGNOSES REDACTED]. Observations in Resident #2's room on 8/20/12 at 1:10 PM, revealed the Foley catheter drainage bag was laying on the bed, beside Resident #2's right leg. The tubing contained yellow colored urine. The catheter tubing was not positioned below Resident #2's bladder. During an interview in Resident #2's room on 8/20/12 at 1:45 PM, Nurse #2 was shown the position of the Foley catheter drainage bag. Nurse #2 took the catheter drainage bag off the bed and secured it to the bed frame, moving the catheter bag below Resident #2's bladder. 4. Medical record review for Resident #4 documented an admission date of [DATE] with [DIAGNOSES REDACTED]. Observations in Resident #4's room on 8/21/12 at 1:15 PM, revealed the … | 2015-08-01 |
| 12356 | 12356 | NHC HEALTHCARE, DICKSON | 445004 | 812 CHARLOTTE ST | DICKSON | TN | 37055 | 2012-08-29 | 441 | D | 1 | 0 | SINC11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Intakes: TN 308 Based on policy review, observation, and interview, it was determined 2 of 2 (Nurse #4 and Nurse #5) nurses failed to perform a dressing change to prevent the potential spread of infection by not placing a barrier on the over-bed table prior to placing supplies on the overbed table; not cleansing a wound in a circular motion from inside to outside; and not washing hands or regloving after handling a soiled dressing. The findings included: 1. Review of the facility's "DRESSING: WOUND CHANGES" policy documented, "...PROCEDURES... 14. Remove soiled dressing... NOTE: do not use scissors to cut soiled dressings 15. Remove gloves, wash hands, and reglove 16. Using prescribed cleanser, cleanse wound from center out... Remove gloves dispose in red bag, wash hands and reglove 17. Apply prescribed treatment/ dressing, secure the dated, initialed tape 18. Remove gloves and wash hands 19. Reglove and dispose of red bag in biohazard room [ROOM NUMBER]. Remove gloves and wash hands..." 2. Observations in Random Resident (RR) #1's room (on the 100 hall) on 8/20/12 at 4:10 PM, Nurse #4 performed a dressing change on a wound on RR #1's right leg. Using a saline saturated 4 by (x) 4, Nurse #4 cleaned the lower half of the wound, ending the cleansing with up and down motions over the length of the lower half of the wound. Using a different, saline soaked 4x4, Nurse #4 cleaned the upper half of the wound and then dabbed up and down the length of the entire wound which at this point was bleeding. Nurse #4 then used a new, dry 4x4 and dabbed the entire length of the wound with up and down strokes. During the up and down motions taken, part of the 4x4 veered off onto the skin area, lateral to the middle of the wound. After the [MEDICATION NAME] was applied to the wound, a non-adhesive dressing was placed over the wound; as the non-adhesive dressing was applied, it touched the stuffed arm of the recliner in which RR #1 was sitting. After the wound ca… | 2015-08-01 |
| 12357 | 12357 | NHC HEALTHCARE, DICKSON | 445004 | 812 CHARLOTTE ST | DICKSON | TN | 37055 | 2012-08-29 | 514 | D | 1 | 0 | SINC11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Intakes: TN 160 Based on medical record review, observations, and interviews, it was determined that the facility failed to ensure the accuracy of documentation in the record for 1 of 5 (Resident #1) sampled residents. The findings included: Medical record review for Resident #1 documented an admission date of [DATE] and readmission date of [DATE] with [DIAGNOSES REDACTED]. Review of a physician's orders [REDACTED]. During an interview in the education classroom on 8/22/12, Nurse #3 was asked if there should be nursing documentation concerning the condition of Resident #1's eyes since there was an order for [REDACTED].#3 stated, "...Yes, you would expect documentation..." Observations in the activity area off of the 100 hall on 8/22/12 at 10:30 AM, revealed Resident #1 with a soft brace on her right knee and a metal leg brace attached to a shoe on her left leg. Observations in Resident #1's room on 8/22/12 at 3:15 PM, during a skin assessment revealed Resident #1 with a soft brace on her right knee and a metal leg brace attached to a shoe on her left leg. The braces were taken off for the assessment and reapplied after the assessment was done. Review of physician's orders [REDACTED]. [REDACTED]. [REDACTED]. During an interview in the education classroom on 8/22/12 at 3:40 PM, Nurse #3 was asked if there should be orders for the braces. Nurse #3 stated, "...If they have them (braces) on, they should have orders..." During an interview in the education classroom on 8/23/12 at 10:30 AM, Nurse #3 was asked about orders for the braces observed on Resident #1. Nurse #3 stated, "...she (Resident #1) came back from the hospital on 2/13/(12). There was no order (for the brace) but kept doing it (applying the brace)..." During an interview during a phone conversation on 8/24/12 at 2:05 PM, the Director of Nurses (DON) stated, "After (Resident #1) came in (back from hospitalization ), there were no new orders written for leg brace or knee splint or arm … | 2015-08-01 |
| 8 | 8 | ST BARNABAS AT SISKIN HOSPITAL | 445008 | 1 SISKEN PLAZA | CHATTANOOGA | TN | 37403 | 2019-01-16 | 842 | D | 0 | 1 | 6O2811 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and interview the facility failed to ensure Physician order [REDACTED].#340 and #341) of 3 residents reviewed of 29 residents sampled. The findings include: Medical record review revealed Resident #340 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Medical record review of the POLST form, undated, revealed the physician had not signed and dated the resident's POLST form. Medical record review revealed Resident #341 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Medical record review of the POLST form dated 1/4/19 revealed the POLST form was not signed by the resident and the health care professional preparer of the form. Interview with the Director of Nursing (DON) on 1/16/19 at 8:47 AM, in the DON's office, confirmed the POLST forms were to be completed within 24 hours of admission to the facility. Continued interview confirmed the facility failed to ensure the POLST forms were complete for Resident #340 and #341. | 2020-09-01 |
| 9 | 9 | ST BARNABAS AT SISKIN HOSPITAL | 445008 | 1 SISKEN PLAZA | CHATTANOOGA | TN | 37403 | 2020-02-20 | 574 | C | 0 | 1 | UNET11 | Based on facility policy review, admission packet review, interview, and observation, the facility failed to support each resident's rights by ensuring the required State Survey Agency's contact information was made available for 3 of 3 residents (Resident #1, Resident #2, and Resident #16). Interviews obtained during the resident group meeting revealed the residents had not been given information on how to file a complaint with the State Survey Agency. This failure had the potential to affect all 43 residents of the facility who may want to exercise their right to file a complaint directly with the State Survey Agency. Findings include: Review of the facility's policy titled, Patient Rights and Responsibilities-Siskin West Subacute, undated, revealed the residents had the right to .contact the Tennessee Department of Health directly at (telephone number) to lodge any concerns you may have about your care. Review of the facility's policy titled, Resident Rights, undated, located in the facility's admission packet provided during the entrance conference, revealed at the time of admission, and periodically through their stay, the facility would inform each resident, orally and in writing, of their rights. The policy stated the resident had the right to voice grievances to the facility, or other agency or entity that hears grievances, without discrimination or reprisa,l and without fear of discrimination or reprisal. The policy also stated the resident had the right to be afforded the opportunity to contact these agencies. The policy stated the resident had the right to immediate access to any of the following: any representative of the Secretary of the U.S. Department of Health and Human Services, any representative of the State, the resident's individual physician, the State's long-term care ombudsman, and the agency responsible for the protection of, and advocacy system for, mentally or developmentally disabled individuals. Review of an untitled and undated form, located in the Admission Packet provided by the fa… | 2020-09-01 |
| 10 | 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 a… | 2020-09-01 |
| 3623 | 3623 | ST BARNABAS AT SISKIN HOSPITAL | 445008 | 1 SISKEN PLAZA | CHATTANOOGA | TN | 37403 | 2017-01-25 | 279 | D | 0 | 1 | BSB511 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on facility policy review, medical record review, observation, and interview, the facility failed to develop a specific care plan for allergies and non- pressure related skin conditions that included measurable goals and interventions to ensure that Resident #30's skin concerns would be addressed in a timely fashion for 1resident (#30) of 21 residents reviewed. The findings included: Review of the facility's policy, Nursing Plan of Care, undated, revealed the following information: .1. Registered nurses initiate Nursing Plans of Care to identify teaching and discharge needs. Both RNs (Registered Nurses) and LPNs (Licensed Practical Nurses) may maintain/update Nursing Plan of Cares. RNs are to supervise LPN care and documentation on the Nursing Plan of Care. 2. Nursing Plans of Care reflect the nursing process of assessment, planning, implementing and evaluating of care. The Care Plan is to be reassessed no less than weekly and updated or resolved by assigned nurse. 3. The Nursing Plan of Care is initiated within the first 24 hours of admission. It reflects nursing care provided and discharge planning. 4. The Nursing Plan of Care reflects nursing interventions and responses . Review of the medical record for Resident #30 revealed that she was readmitted to this facility on 3/2/12 with [DIAGNOSES REDACTED]. Review of the medical record and the physician's orders [REDACTED].#30 had allergies to antibiotics such as, [MEDICATION NAME], Cephalosporin, Cipro, and Carbapenems. She was also allergic to vaccines such as Tetanus and [MEDICATION NAME]. Per the physician's orders [REDACTED]. The order was dated 6/22/15. Review of the plans of care for Resident #30 revealed a care plan for allergies which was dated 3/15/12. The Goal &Target Date included Will have no allergic reactions during review period which was revised on 9/13/16 and 12/23/16. The target date was 3/20/17. The Approaches included: List of all know allergies will be kept on physic… | 2020-04-01 |
| 3624 | 3624 | ST BARNABAS AT SISKIN HOSPITAL | 445008 | 1 SISKEN PLAZA | CHATTANOOGA | TN | 37403 | 2017-01-25 | 309 | D | 0 | 1 | BSB511 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation, and interview, the facility failed to provide the necessary care and services for one resident (#30), of one resident reviewed for non-pressure related skin conditions of 21 residents reviewed. The findings included: Review of the medical record for Resident #30 revealed the resident was readmitted to this facility on 3/2/12 which [DIAGNOSES REDACTED]. Review of the medical record and the physician's orders [REDACTED].#30 had allergies [REDACTED]. She was also allergic to vaccines such as Tetanus and [MEDICATION NAME]. Per the physician's orders [REDACTED]. The order was dated 6/22/15. Review of the Treatment Administration Record (TAR) dated 10/15/16 - 1/24/17 revealed the PRN order for [MEDICATION NAME] 0.5% cream had not been added to the TAR. Review of the Medication Administration Record [REDACTED]. Observation of Resident #30 on 1/24/17 at 8:37 AM revealed the resident was lying in bed eating her breakfast. Resident #30 had several large red blotches, approximately the size of a quarter on her neck. In addition, she had red scaly areas all over her face and scalp. Resident #30 continuously scratched and picked at her head, neck and face. An interview with Resident #30 on 1/24/17 at 8:37 AM, revealed she had some kind of allergic reaction that caused her to scratch and pick at her skin continuously. When interviewed about if she had shared her symptoms with the nursing staff, Resident #30 stated that she thought that she had but she could not be sure. Resident #30 stated that she would like for the red, scaly blotches on her face, neck and scalp to go away. An interview on 1/24/17 at 1:00 PM with Certified Nursing Assistant (CNA) #1 who was assigned to Resident #30, revealed that while she was providing activities of daily living with Resident #30 she had noticed that she had a rash on her neck, face and scalp. When interviewed about what she had done relative for Resident #30's skin rash, CNA… | 2020-04-01 |
| 3625 | 3625 | ST BARNABAS AT SISKIN HOSPITAL | 445008 | 1 SISKEN PLAZA | CHATTANOOGA | TN | 37403 | 2017-01-25 | 362 | F | 0 | 1 | BSB511 | Based on facility policy and procedure review, dish machine log review, personnel file review, observation, and interview, the facility failed to employee sufficient kitchen staff and provide them with the appropriate training to ensure they could perform their duties and responsibilities effectively. This deficient practice had the potential to affect all of the residents who resided in this Long-Term Care (LTC) facility. The findings included Review of the facility's policies and procedures revealed a document titled, HACCP (hazard analysis critical control points)/Food Safety Program. Food Safety Standards & Requirements dated 8/17/16 which provided the following information: .Employee Training: Employees must be trained in safe food handling practices, per company policy, when hired and must complete on-going training during the course of their employment. The Unit Manager is responsible to ensure food safety training programs are in place and properly conducted . Review of the Dishwashing/Warewashing Machine Temperature Log(s) dated from (MONTH) (YEAR) through (MONTH) (YEAR) revealed the water temperature during the wash cycle was documented below the manufacturer's recommendations for safe water temperatures on most of the days of the month. In (MONTH) (YEAR), the temperature of the water during the wash cycle reached the minimum of 160 degrees F only on 8 days of the month; 11/1/16, 11/6/16, 11/7/16, 11/8/16, 11/10/16, 11/14/16, 11/24/16, and on 11/27/16. The remaining days in the month of (MONTH) (YEAR), the temperature of the water during the wash cycle averaged about 155 degrees F (Fahrenheit) which was below the manufacturers recommendation. Review of the temperature log for the month of (MONTH) (YEAR), revealed that the temperature of the water during the wash cycle only reached the minimum temperature of 160 degrees F on 5 days of the month. Review of the temperature log for the month of (MONTH) (YEAR), revealed the temperature of the water during the wash cycle only reached the minimum temperature o… | 2020-04-01 |
| 3626 | 3626 | ST BARNABAS AT SISKIN HOSPITAL | 445008 | 1 SISKEN PLAZA | CHATTANOOGA | TN | 37403 | 2017-01-25 | 371 | F | 0 | 1 | BSB511 | Based on observation and interview, the facility failed to ensure food safety when they failed to clean and sanitize the meat slicer after use and when they failed to discard potentially hazardous food in a timely fashion. This deficient practice had the potential to affect all of the residents (57) who consume food orally in this Long-Term Care (LTC) facility. The findings include: 1. Observation of the kitchen on 1/23/17 at 9:30 AM revealed a kitchen employee, Cook #1, was preparing lunch for the residents. He was preparing sandwiches on the Cook's preparation counter. At the end of the Cook's preparation counter there was a large meat slicer. When interviewed about the use of the meat slicer, Cook #1 stated the slicer was clean and ready for use. Observation of the metal blade on the meat slicer revealed it was covered with food debris. There was a thick continuous line of debris around the entire edge of the blade. The line of debris was orange in color and was easily wiped off. An interview with the General Manager of the Food Service Department (GM) on 1/23/17 at 9:35 AM confirmed the slicer had been used the previous day and had not been cleaned and sanitized effectively. 2. Observation of the 3rd floor nursing unit on 1/25/17 at 3:00 PM revealed a nourishment room that contained a refrigerator. The refrigerator was observed to have 40 individual health shakes that were defrosted and ready for use. An interview with the GM, at that time, revealed the health shakes were used for those residents who had a nutritional concern. Review of the manufacturer's recommendations, which were posted under the spout on each health shake, revealed the health shakes needed to be stored frozen and discarded 14 days after defrost. The 40 defrosted health shakes did not contain a defrost date or a use by date. Review of the undated LTC Patient /Diets list that was provided by the GM revealed the facility had 3 residents who were ordered health shakes on a daily basis. An interview with the GM and the Assistant Director of Nu… | 2020-04-01 |
| 3627 | 3627 | ST BARNABAS AT SISKIN HOSPITAL | 445008 | 1 SISKEN PLAZA | CHATTANOOGA | TN | 37403 | 2017-01-25 | 456 | F | 0 | 1 | BSB511 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and interview, the facility failed to ensure their essential kitchen equipment specifically, the [NAME]ot Coupe blades and the dish machine, were maintained in a safe operating fashion. The deficient practice had the potential to affect each of the 62 residents who resided in the facility. The findings included: 1. Observation of the kitchen on 1/23/17 at 10:15 AM, revealed the kitchen staff utilized 2 [NAME]ot Coupes (blenders) to grind and puree food for residents who had a physician ordered therapeutic diet. Closer inspection of the inside of the blender revealed the metal blade was chipped and missing pieces of metal. Observation of the counter above the [NAME]ot Coupes revealed 2 more metal blades that were used as spares. They were also chipped and missing small pieces of metal. When the smooth-edged metal blades became chipped, there was a potential for small pieces of metal to become dislodged and enter the resident's food. An interview with the General Manager of the Food Service Department (GM) on 1/23/17 at 10:20 AM confirmed the facility utilized the [NAME]ot Coupes to grind and puree food for those residents who had difficulties chewing and swallowing. The GM stated she was unaware the blades were chipped and missing metal pieces. Review of the undated, LTC Patients/Diets list that was provided by the GM revealed that the facility had 10 residents who had a physician's orders [REDACTED]. 2. Observation of the kitchen on 1/24/17 at 11:15 AM, revealed the dish machine was in operation. During observation of five separate trials revealed the water temperature during the wash cycle only reached 143.9 degrees F. Observation of the dish machine on 1/24/17 at 12:05 PM, revealed a metal label which was affixed to the underside of the dish machine. The metal label contained information about the use of the dish machine and it included the manufacturer's minimum water temperature for wash cycle of 160 degrees Fahrenhei… | 2020-04-01 |
| 5462 | 5462 | ST BARNABAS AT SISKIN HOSPITAL | 445008 | 1 SISKEN PLAZA | CHATTANOOGA | TN | 37403 | 2015-12-16 | 242 | D | 0 | 1 | 69C911 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and interview, the facility failed to ensure personal choices were honored for 1 resident (#29) of 35 residents reviewed for choices. The findings included: Medical record review revealed Resident #29 was admitted to the facility on [DATE] and readmitted [DATE] with [DIAGNOSES REDACTED]. Interview with Resident #29 on 12/15/15 at 9:53 AM, in the residents room revealed don't put me to bed when I want to go to bed .I asked to go back to bed Friday (12/11/15) around 5:30 PM .they came in and told me they would put me back as soon as they could .the shift changed and second shift put back to bed after 7 .I called and I went out in the hall a couple of timesl .they were at the desk .I called my brother and he called them .they just didn't come put me back to bed .they were just sitting at the desk . Medical record review of the 30 day Minimum Data Set ((MDS) dated [DATE] revealed the resident was cognitively intact and requires assist with tranfers to be from the wheelchair. Interview with Certified Nurse Aide (CNA) #2/Unit Clerk on 12/15/15 at 2:00 PM at the 300 nursing station confirmed when the call light rings .I tell whoever the person is that is working with the resident or find someone to go take care of the problem, or I do it myself .I work 8-4:30 (8 AM-4:30 PM) Monday through Friday .after that everyone answers the call lights .shifts change at 7:00 PM . Interview with Licensed Practical Nurse (LPN) #2 Nursing Supervisor for 300 hall on 12/15/15 at 4:35 PM at the 300 nursing station confirmed (resident) had requested to go to bed Friday at approximately 5:30 PM and wasn't assisted to bed until after 7 PM when night shift came on . Continued interview confirmed .my expectation is within 30 minutes of the request depending on what is going on, on the unit or if there is extenuating circumstances .any staff certified or licensed can put residents to bed or get them up . Interview with CNA #1 on 12/16/15 at 12… | 2019-02-01 |
| 5463 | 5463 | ST BARNABAS AT SISKIN HOSPITAL | 445008 | 1 SISKEN PLAZA | CHATTANOOGA | TN | 37403 | 2015-12-16 | 329 | D | 0 | 1 | 69C911 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation, and interview, the facility failed to attempt a Gradual Dose Reduction (GDR) of a [MEDICAL CONDITION] medication, or document the reason the [MEDICAL CONDITION] medication should not be reduced for 1 (#23) resident of 5 residents reviewed for unnescessary medications. The findings included: Medical record review revealed Resident #23 was admitted to the facility on [DATE], and readmitted on [DATE] with [DIAGNOSES REDACTED]. Medical record review of the Physician's Rcapitulation Orders dated from 9/1/14 to present revealed Resident #23 received [MEDICATION NAME] (antidepressant) 60 milligrams (mg) daily, and on 9/12/14, the dosage for the [MEDICATION NAME] was changed to 60 mg in the morning and 30 mg at bedtime. Continued review revealed the [MEDICATION NAME] was changed again on 10/23/15, to 60 mg in the morning and 60 mg at bed time, no other changes noted for the [MEDICATION NAME]. Medical record review of the Psych Services note dated 9/11/14 revealed the Psych Services Nurse Practitioner (NP) recommended to increase the [MEDICATION NAME] to 60 mg in the morning and 30 mg at bedtime due to the resident had increased Depression and was verbally aggressive with staff at times. Continued review of the Psych Services NP notes dated 10/5/15 revealed .Patients' current Status: Stable/Manageable w/o (without) Clinical Complications .Reason for this Encounter: Maintenance Medication Monitoring .remains sad and irritable at times. Verbally aggressive with staff. Presently alert, oriented X 2 (times 2 knows; her name and where she is). Compliant with meds . Continued review of the Psych Services notes dated from 11/2014 to present revealed no recommendations for reducing the dosage of [MEDICATION NAME] or documentation of the reason to not reduce the dosage of the [MEDICATION NAME]. Medical record review of the Consultant Pharmacist Progress Notes dated 1/6/15 to 12/2/15 revealed the Consultant Pharmacis… | 2019-02-01 |
| 7242 | 7242 | ST BARNABAS AT SISKIN HOSPITAL | 445008 | 1 SISKEN PLAZA | CHATTANOOGA | TN | 37403 | 2014-10-22 | 333 | D | 0 | 1 | UNTM11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and interview, the facility failed to ensure significant medication errors did not occur for one resident (#18) of four residents reviewed for medications. The findings included: Resident #18 was admitted to the facility on [DATE], with [DIAGNOSES REDACTED]. Medical record review of a physician order [REDACTED]. Medical record review of a communication form from the [MEDICAL TREATMENT] center dated October 8, 2014, revealed the [MEDICAL TREATMENT] center desired the Phoslo 667 mg be increased to two tablets three times a day to lower the phosphorus level of 7.4 to a goal of 3.5-5.5. The recommendation was noted by the physician on October 9, 2014, but the order was not written until October 10, 2014. Further medical record review of a physician order [REDACTED]. Medical record review of a Medication Administration Record (MAR) for October 2014, revealed Phoslo 667 mg 1 tablet was being given three times a day with meals from October 1, 2014, through October 14, 2014. Further review of the MAR revealed the Phoslo 667 mg was not increased to 2 tablets three times a day until October 14, 2014, at 5:00 p.m. Interview with Licensed Practical Nurse (LPN) #1 on October 22, 2014, at 1:40 p.m., at the 300 nursing station, confirmed the resident was receiving Phoslo 1 tablet since September 5, 2014. Further interview confirmed the LPN noticed a lot of pills in the medication drawer, checked the physician's orders [REDACTED]. Interview with the Director of Nursing on October 22, 2014, at 2:45 p.m., in the conference room, confirmed the order was not documented on the MAR and the patient did not receive the medication as was ordered for four days. | 2018-02-01 |
| 7243 | 7243 | ST BARNABAS AT SISKIN HOSPITAL | 445008 | 1 SISKEN PLAZA | CHATTANOOGA | TN | 37403 | 2014-10-22 | 371 | F | 0 | 1 | UNTM11 | Based on observation, interview, review of facility policy, an review of manufacturer's recommendations, the facility dietary department failed to maintain food temperatures on the steam table for two of three tray lines observed during one of two meal times; failed to sanitize dishes according to manufacturer's recommendations for one of one three compartment sink; and failed to maintain a sanitary environment in the food service area and the dish room. The findings included: Observation and interview on October 20, 2014, at 11:37 a.m., of the Third Floor Resident Dining Room, revealed the food temperatures were obtained by a dietary staff member (DA) #1 with a calibrated thermometer. The following temperatures were obtained: 1. Marinated Chicken Breasts were 130 degrees Fahrenheit (F). 2. Country Fried Steaks were 112 degrees F. 3. Chopped Country Fried Steak was 118 degrees F. 4. Mashed Potatoes were 128 degrees F. 5. Gravy was 133 degrees F. Interview with the Certified Dietary Manager (CDM) on October 20, 2014, at 11:50 a.m., at the Third Floor Dining Room tray line, confirmed the foods were not at or greater than 135 degrees F and the Ground Chicken temperature was not obtained due to the pan was barely warm to touch. Further observation revealed the following: 1. All hot foods less than 135 degrees F were removed from the steam table at 11:53 a.m., and transported to be reheated. 2. The reheated food items were delivered to the Third Floor Dining Room from the main kitchen at 12:48 p.m., (55 minutes from the time the food left the floor). The reheated food temperatures obtained by the CDM on October 20, 2014, at 12:52 p.m., revealed the Ground Chicken was 129 degrees F and was not in the appropriate temperature range. Interview with the CDM on October 20, 2014, at 12:55 p.m., at the Third Floor Dining Room tray line, confirmed the reheated Ground Chicken was not at an appropriate temperature. Observation on October 20, 2014, at 11:58 a.m., of the Second Floor Resident Dining Room, revealed the food tempera… | 2018-02-01 |
| 7244 | 7244 | ST BARNABAS AT SISKIN HOSPITAL | 445008 | 1 SISKEN PLAZA | CHATTANOOGA | TN | 37403 | 2014-10-22 | 431 | E | 0 | 1 | UNTM11 | Based on observation and interview, the facility failed to ensure expired medications and supplies were removed from the shelves and not available for resident use in one (second floor) of two medication storage rooms. The findings included: Observation of the medication storage room on the second floor on October 21, 2014, at 3:00 p.m., revealed nine Intravenous Start Kits (all supplies needed to start an intravenous line) in the Intravenous start basket had an expiration date of February 2014, and were available for resident use. Observation of a basket containing lancets (used to test blood glucose) revealed a screwdriver, three batteries, a 20 milliliter syringe, an insulin syringe, and rubber bands in the same basket, and the lancets were available for resident use. Observation of the stock medication cabinets revealed: 1. one bottle of Bisacodyl (laxative) with an expiration date of January 2014. 2. one bottle of Pain Reliever Plus with an expiration dated of September 2014. 3. one tube of Desitin (used for diaper rash) with an expiration date of October 2013. 4. one tube of 1% Hydrocortisone with an expiration date of April 2014. 5. one tube of Itch Relief Cream with an expiration date of August 2014. 6. one tube of Miconazole 2% (used for yeast infections) with an expiration date of November 2013. 7. three packets of Hemorrhoidal suppositories with an expiration date of January 2014. 8. one tube of Muscle and Joint Ointment with an expiration date of November 2013. Interview with Licensed Practical Nurse #2, who was administering medications, on October 21, 2014, at 3:30 p.m., in the second floor medication room, confirmed the medications and supplies were expired and were still available for resident use. | 2018-02-01 |
| 9108 | 9108 | ST BARNABAS AT SISKIN HOSPITAL | 445008 | 1 SISKEN PLAZA | CHATTANOOGA | TN | 37403 | 2013-09-11 | 221 | D | 0 | 1 | 3NWZ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation, and interview, the facility failed to complete a restraint assessment and attempt restraint reduction for one resident (#48) of thirty residents reviewed. The findings included: Resident #48 was admitted to the facility on [DATE], with [DIAGNOSES REDACTED]. Medical record review of the Annual Minimum Data Set, dated dated dated [DATE], revealed the resident had severely impaired cognitive skills for daily decision making and used a trunk restraint daily. Medical record review of the Physical Restraint Reduction assessment dated [DATE], revealed Instructions: Restrained individuals should be reviewed at least quarterly to determine whether or not they are candidates for restraint reduction, less restrictive restraining measures, or total restraint elimination. For each category listed below, assess the resident by circling the corresponding score(s) that best describe his/her current status in the appropriate assessment column. Add the column of numbers to obtain the total score. Continue evaluation and review on the reverse . Medical record review of the Physical Restraint Reduction assessment dated [DATE], revealed the resident scored a 25 (21-35 Good Candidate). Medical record review of the reverse side of the Physical Restraint Reduction Assessment revealed no documentation of the continued evaluation and review of the restraint assessment on August 18, 2013. Medical record review of a physician's orders [REDACTED].soft self release velcro belt while up in chair .check restraint and release per facility protocol . Observation and interview on September 10, 2013, at 7:45 a.m., with Licensed Practical Nurse (LPN) #3, in front of the nursing station, revealed the resident seated in a tilt/recline chair, with a soft velcro seat belt in place. Continued observation revealed the resident was unable to self release the seat belt when asked by LPN #3. Observation on September 11, 2013, at 7:45 a.m., rev… | 2017-02-01 |
| 9109 | 9109 | ST BARNABAS AT SISKIN HOSPITAL | 445008 | 1 SISKEN PLAZA | CHATTANOOGA | TN | 37403 | 2013-09-11 | 246 | D | 0 | 1 | 3NWZ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation, and interview, the facility failed to ensure the call light was within reach for one resident (#58) of thirty residents reviewed. The findings included: Resident #58 was admitted to the facility on [DATE], and readmitted on [DATE], with [DIAGNOSES REDACTED]. Medical record review of the admission Minimum Data Set, dated dated dated [DATE], revealed the resident scored fourteen on the Brief Interview for Mental Status (BIMS) indicating the resident was independent with daily decision making and was able to be understood, and understood others. Observation and interview with the resident on September 9, 2013, at 2:10 p.m., revealed the resident seated in a wheelchair on the left side of the bed and the call light was wrapped around the assist bar on the right side of the bed. Interview with the resident at the time of the observation revealed the resident needed the call light to ask for assistance with transfers. Continued interview revealed the resident had previously asked the staff to ensure the call light was within reach. Observation and interview with Licensed Practical Nurse (LPN) #2 on September 9, 2013, at 2:15 p.m., confirmed the resident's call light was not within the resident's reach. | 2017-02-01 |
| 9110 | 9110 | ST BARNABAS AT SISKIN HOSPITAL | 445008 | 1 SISKEN PLAZA | CHATTANOOGA | TN | 37403 | 2013-09-11 | 279 | D | 0 | 1 | 3NWZ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation, and interview, the facility failed to develop a comprehensive care plan for one (#118) of thirty residents reviewed. The findings included: Resident #118 was admitted to the facility on [DATE], with [DIAGNOSES REDACTED]. Medical record review of the [MEDICAL CONDITION] Medical Management Progress Note dated July 25, 2013, revealed .Long and short term memory impaired, chronic (scored 5 on a scale with 10 indicating the most severe impairment); Recall impaired, chronic with a score of 5; Attention and Judgement impaired; and Appetite - Decreased with a score of 7, Acute . Record review of the Monthly Weight Record revealed a weight of 137 pounds in March 2013 and 124 pounds in August 2013 with the weight decreasing each month. Review revealed the September weight of 123 pounds represented a 10% weight loss over the previous six months. Review of the Certified Dietary Manager (CDM) Dietary Notes for May 8, 2013, revealed .Weight showing a trending down x (for) 90 days. Review of the CDM's Dietary Notes dated August 9, 2013, revealed Recommendation placed in MD (doctor) communication book for [MEDICATION NAME] for increased appetite due to poor intake and weight decline . Review of the resident's Care Plan Meeting held on August 7, 2013, revealed the family .concerned .weight. Noted Ensure seems to give (resident) diarrhea. Review of the Care Plan approaches to address the Problem/Need of a Therapeutic Diet on admission in June 2012 revealed Offer foods high in protein, Praise resident's attempts to follow diet, and Provide calculated diabetic diet, including snack. Review of the Care Plan dated May 8, 2013, at the annual review after the resident had been identified with significant weight loss revealed no approaches were developed to address the weight loss. Review of the quarterly Care Plan update of August 8, 2013, revealed no new approaches to address the continued weight loss. Review revealed an… | 2017-02-01 |
| 9111 | 9111 | ST BARNABAS AT SISKIN HOSPITAL | 445008 | 1 SISKEN PLAZA | CHATTANOOGA | TN | 37403 | 2013-09-11 | 312 | D | 0 | 1 | 3NWZ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation, and interview, the facility failed to provide adequate grooming assistance for one resident (#64) of thirty residents reviewed. The findings included: Resident #64 was admitted to the facility on [DATE], with [DIAGNOSES REDACTED]. Record review of the Care Plan revealed under the problem of .decreased functional status .approaches .Nail care done weekly .Assist with dressing .grooming as needed. Observation and interview with the resident on September 9, 2013, at 12:10 p.m., in the resident's room revealed the resident remained in the bed, had a beard, and dirt under long fingernails on each hand. Observation revealed the resident's glasses were on the bedside table and the lenses were visibly dirty. Continued interview revealed the resident stated shaving was done on shower days. Interview with the Certified Nursing Assistant (CNA #3) on September 9, 2013, at 12:30 p.m., after the CNA prepared the lunch tray for the resident (who remained in the bed) and began to exit the room confirmed the resident usually wore glasses during the day and confirmed they were dirty and had not been cleaned or provided for the resident. Interview with the Interim Charge Nurse at the third floor nursing station on September 11, 2013, at 9:30 a.m., confirmed the resident required assistance with all activities of daily living, had a beard on Monday, September 9, 2013, and on that day the Charge Nurse had requested (the resident) be shaved. Interview confirmed residents should be shaved even on days they are not showered. Continued interview confirmed the resident had long fingernails and dirt under the nails of both hands. Interview confirmed the expectation for assistance with daily care needs included nail care and shaving if needed. | 2017-02-01 |
| 9112 | 9112 | ST BARNABAS AT SISKIN HOSPITAL | 445008 | 1 SISKEN PLAZA | CHATTANOOGA | TN | 37403 | 2013-09-11 | 325 | D | 0 | 1 | 3NWZ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation, and interview, the facility failed to prevent weight loss for two residents (#118, #79) of thirty residents reviewed for weight loss. The findings included: Resident #118 was admitted to the facility on [DATE], with [DIAGNOSES REDACTED]. Record review of the Monthly Weight Record revealed a weight of 137 pounds in March 2013. Review of the Certified Dietary Manager's (CDM) Dietary Notes dated May 8, 2013, revealed .Weight showing a trending down x (for) 90 days. Medical record review of the [MEDICAL CONDITION] Medical Management Progress Note dated July 25, 2013, revealed .Long and short term memory impaired, chronic (scored 5 on a scale with 10 indicating the most severe impairment); Recall impaired, chronic with a score of 5; Attention and Judgement impaired; and Appetite - Decreased with a score of 7, Acute . Review of the resident's Care Plan Meeting held on August 7, 2013, revealed the family .concerned .weight. Noted Ensure (liquid dietary supplement) seems to give (resident) diarrhea. Review of the CDM's Dietary Notes dated August 9, 2013, revealed Recommendation placed in MD (doctor) communication book for [MEDICATION NAME] (medication) for increased appetite due to poor intake and weight decline . Record review of the Monthly Weight Record revealed the resident weighed 124 pounds in August 2013. Continued review revealed the September weight was 123 pounds. Observation and interview of the resident on September 10, 2013, at 8:45 a.m., revealed the resident was unable to recall any information about what was served or eaten for breakfast. Interview with the Director of Nurse's (DON), in the DON's office at 4:55 p.m., on September 10, 2013, confirmed the resident had experienced significant weight loss. Interview confirmed the Registered Dietitian (RD) had not provided evaluation or input on the resident's weight loss. Continued interview confirmed the resident's labwork results on May 9, 20… | 2017-02-01 |
| 9113 | 9113 | ST BARNABAS AT SISKIN HOSPITAL | 445008 | 1 SISKEN PLAZA | CHATTANOOGA | TN | 37403 | 2013-09-11 | 327 | D | 0 | 1 | 3NWZ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, policy review, observation, and interview, the facility failed to ensure a physician's order for fluid restriction was being maintained for one (#13) of thirty sampled residents. The findings included: Resident #13 was admitted to the facility on [DATE], with [DIAGNOSES REDACTED]. Medical record review of a Physician's order dated October 10, 2012, revealed 1500 ml (milliliters) fluid restriction per day. Medical record review of the Care Plan revealed, 10/10/12 Fluid restriction 1500 ml/day. Medical record review of Dietary notes revealed no documentation of the breakdown of fluids to be provided by dietary and or nursing for the the resident each shift. Review of facility policy, Restricted Fluids, revealed .1. Licensed Nurse will note the Physician's order in regard to fluid restriction and develop and/or follow a plan for the amount of fluids to be consumed by the resident each shift .3. The resident with an order for [REDACTED]. A door identifier will be placed on the resident's door to identify resident's on fluid restriction .8. If the resident is not consuming the amount of fluid ordered (under or over the amount ordered), the Licensed Nurse will notify the physician and document further orders. Observation of the resident's room, on September 11, 2013, at 10:05 a.m., revealed a water pitcher at bedside and no door identifier to indicate the resident was on restricted fluids. Interview on September 11, 2013, at 10:10 a.m., with the Certified Nursing Assistant (CNA #1) providing the resident's care revealed CNA #1 was unaware of how much fluid the resident was allowed per shift. Interview Licensed Practical Nurse (LPN #1) on September 11, 2013, at 10:15 a.m., in the 200 hallway revealed LPN #1 was unaware of the breakdown of fluid to be given by dietary and nursing. Further interview revealed LPN #1 was unaware how many milliliters the resident was allowed each shift. Interview with the Dietary Manager o… | 2017-02-01 |
| 9114 | 9114 | ST BARNABAS AT SISKIN HOSPITAL | 445008 | 1 SISKEN PLAZA | CHATTANOOGA | TN | 37403 | 2013-09-11 | 332 | D | 0 | 1 | 3NWZ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation, and interview, the facility failed to ensure a five percent or less medication error rate in 4 of 32 opportunities observed. The findings included: Medical record review of the physician's orders [REDACTED].#119 revealed .[MEDICATION NAME] [MEDICATION]) 250 mg (milligram) tablet Take 1 tab by mouth twice daily .Aspirin EC ([MEDICATION NAME] coated) take 1 tab by mouth every day . Observation with Licensed Practical Nurse (LPN) #3 of a medication pass for resident #119 on September 10, 2013, at 8:00 a.m., revealed LPN #3 omitted [MEDICATION NAME] 250 mg and Aspirin 81 mg. Medical record review of the physician's orders [REDACTED].Vitamin D (D3) 1000 IU (international units) cap take 1 by mouth every day .[MEDICATION NAME] (gastric acid pump inhibitor) (20 mg) take 1 cap by mouth every day . Observation with LPN #4 of a medication pass for resident #4, on September 10, 2013, at 8:40 a.m., revealed LPN #4 administered Vitamin D 400 IU and omitted [MEDICATION NAME] 20 mg. Interview with LPN #3 on September 10, 2013 at 8:20 a.m., in the hall confirmed the [MEDICATION NAME] and Aspirin had not been administered to resident #119. Interview with LPN #4 on September 10, 2013, at 8:45 a.m., in the hall confirmed vitamin D 400 IU was administered to resident #4 and the [MEDICATION NAME] had not been administered. | 2017-02-01 |
| 9115 | 9115 | ST BARNABAS AT SISKIN HOSPITAL | 445008 | 1 SISKEN PLAZA | CHATTANOOGA | TN | 37403 | 2013-09-11 | 431 | D | 0 | 1 | 3NWZ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and interview, the facility failed to ensure medications were secured on one of five medication carts. The findings included: Observation on September 11, 2013, at 8:57 a.m., revealed an unattended medication cart in the hallway outside of room [ROOM NUMBER]. Further observation revealed a plastic cup containing approximately 60 ml. (milliliters) of a watery mixture. Continued observation revealed the cart remained unattended for three minutes until the nurse returned. Interview with Licensed Practical Nurse #1 at that time revealed the cup contained a Carafate tablet mixed in water. Continued interview confirmed the medication had been left unsecured for a period of time and had not been properly stored. | 2017-02-01 |
| 9116 | 9116 | ST BARNABAS AT SISKIN HOSPITAL | 445008 | 1 SISKEN PLAZA | CHATTANOOGA | TN | 37403 | 2013-09-11 | 502 | D | 0 | 1 | 3NWZ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and interview, the facility failed to ensure a laboratory test was completed for one resident (#22) of thirty residents reviewed. The findings included: Resident #22 was admitted to the facility on [DATE], with [DIAGNOSES REDACTED]. Medical record review of a physician's orders [REDACTED].TSH ([MEDICAL CONDITION] Stimulating Hormone) every six months. First draw to be done 9-2-13 . Medical record review revealed no laboratory report for the TSH level on September 2, 2013. Interview with Licensed Practical Nurse #5 on September 11, 2013, at 8:30 a.m., at the nursing station confirmed the TSH level had not been obtained. | 2017-02-01 |
| 11429 | 11429 | ST BARNABAS AT SISKIN HOSPITAL | 445008 | 1 SISKEN PLAZA | CHATTANOOGA | TN | 37403 | 2012-03-07 | 166 | D | 0 | 1 | 51I011 | Based on review of the resident council meeting minutes and group interview, the facility failed to resolve grievances regarding staffing shortages and not enough linen on weekends. The findings included: Review of the Resident Council Meeting minutes dated August 3, 2011, September 9, 2011, October 6, 2011, November 10, 2011, December 2, 2011, January 5, 2012, and February 3, 2012, revealed residents complained of not enough nursing staff and the continued need for more help. Continued review revealed resident complaints of not enough linen on the weekends. Interview with residents at a group meeting on March 5, 2012, at 2:30 p.m., in the chapel room, revealed complaints of the facility not addressing the issue of needing more staff during meal trays time, and answering call lights. Continued interview revealed the residents had complained of not having enough linen on the weekends. Continued interview revealed the residents' complaints had not been addressed. Interview with the Activities Director on March 5, 2012, at 3:30 p.m., in the Activities Director office, revealed if concerns during the resident council meetings are identified, the information is given to the respectful department. Interview with the Director of Nursing and Administrator on March 7, 2012, at 9:30 a.m., in the Administrator's office, confirmed there was no documentation of the investigation for the resident council complaints or follow up for the grievances. | 2016-01-01 |
| 11430 | 11430 | ST BARNABAS AT SISKIN HOSPITAL | 445008 | 1 SISKEN PLAZA | CHATTANOOGA | TN | 37403 | 2012-03-07 | 221 | D | 0 | 1 | 51I011 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation, and interview, the facility failed to assess for restraint reduction for three residents (#3, #15 & #10) of twenty residents reviewed. The findings included: Resident #3 was admitted to the facility on [DATE], with [DIAGNOSES REDACTED]. Medical record review of a physician's orders [REDACTED].self releasing belt . Observation on March 5, 2012, at 10:02 a.m., in the resident room, revealed resident #3 in bed. Continued observation revealed the resident's wheelchair in the bathroom had a self releasing belt in place available for use. Medical record review of a Physical Restraint Reduction Assessment last completion date May 1, 2011, revealed no quarterly restraint assessments where completed for the months of August 2011, November 2011, and February 2012. Interview with the Director of Nursing (DON) on March 5, 2012, at 2:20 p.m., in the facility conference room, confirmed the resident was not assessed quarterly for a least restrictive device. Resident # 15 was admitted to the facility on [DATE], with [DIAGNOSES REDACTED]. Medical record review of a physicians order dated April 8, 2009, revealed .lap belt while up out of bed . Observation on March 7, 2012, at 7:48 a.m., revealed resident #15 sitting in front of the third floor nurse's station in a gerichair (type of wheelchair) with a lap belt (restraint) in place. Medical record review of a Physical Restraint Reduction Assessment last completion date August 1, 2011, revealed no quarterly restraint assessments where completed for the months of November 2011, and February 2012. Interview and medical record review, with the Director of Nursing on March 7, 2012, at 8:03 a.m., in the facility conference room, confirmed the resident was not assessed quarterly for a less restrictive device. Resident #10 was admitted to the facility on [DATE], with [DIAGNOSES REDACTED]. Medical record review revealed a physician's orders [REDACTED]. Review of the Physical … | 2016-01-01 |
| 11431 | 11431 | ST BARNABAS AT SISKIN HOSPITAL | 445008 | 1 SISKEN PLAZA | CHATTANOOGA | TN | 37403 | 2012-03-07 | 281 | D | 0 | 1 | 51I011 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and interview, the facility failed to follow a physician's order for medication administration for one (#7) and failed to obtain psych services timely for two (#10 & #14) of twenty residents reviewed. The findings included: Resident #7 was admitted to the facility on [DATE], with [DIAGNOSES REDACTED]. Medical Record review of a physician's order dated March 2, 2012, revealed order for [MEDICATION NAME] written as follows: [MEDICATION NAME] .5, TID prn (three times per day as needed). Medical record review of Medication Record from March 2012, revealed the resident was receiving [MEDICATION NAME] 0.5 mg (milligrams) three times per day at the following times: 6:00 a.m., 2:00 p.m., 10:00 p.m., and [MEDICATION NAME] 0.5 mg as needed for anxiety. Further review of Medication record revealed the resident received the [MEDICATION NAME] on March 2, 2012 at 10:00 p.m., March 3, 2012, at 6:00 a.m. and 2:00 p.m., and received another dose March 3, 2012, with no time indicated. Interview with the second floor Charge Nurse March 5, 2012, at 2:20 p.m. at the second floor nurse's station confirmed the physician's order was [MEDICATION NAME] 0.5 mg three times a day as needed. Further interview confirmed the medication had been incorrectly transcribed to the Medication Record and incorrectly administered three times per day on a routine basis instead of an as need basis. Resident #10 was admitted to the facility on [DATE], with [DIAGNOSES REDACTED]. Medical record review revealed a physician's order dated December 27, 2011, for psych (psychological) eval (evaluation) related to refusal of meds. Medical record review revealed a physician's order for [MEDICATION NAME] (antidepressant) 50 mg. to be given at bedtime. Further review revealed the resident had been refusing the medication at night. Psych services evaluated the resident on January 17, 2012, (twenty-one days later) increasing the dosage of [MEDICATION NAME] to 100 mg. … | 2016-01-01 |
| 11432 | 11432 | ST BARNABAS AT SISKIN HOSPITAL | 445008 | 1 SISKEN PLAZA | CHATTANOOGA | TN | 37403 | 2012-03-07 | 323 | D | 0 | 1 | 51I011 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation, and interview, the facility failed to ensure safety devices were in place for one resident (#3) of twenty residents reviewed. The findings included: Resident #3 was admitted to the facility on [DATE], with [DIAGNOSES REDACTED]. Medical record review of the resident current care plan revealed .Problem Potential for Injury .June 24, 2011 status [REDACTED].Approaches .pressure sensitive mat while in bed . Medial record review of a facility fall investigation report dated November 22, 2011, revealed .pt (patient) slid self out of bed .alerted by patient calls .no injury noted . Continued review of the fall investigation revealed .educated CNA (certified nurse assistant) to utilize alarms in place and make sure they are on and working . Interview on March 7, 2012, at 8:42 a.m., with Licensed Practical Nurse (LPN) #3 the nurse present at the time of the fall, on the 200 hall, confirmed the alarm was not on at the time of the fall. | 2016-01-01 |
| 11433 | 11433 | ST BARNABAS AT SISKIN HOSPITAL | 445008 | 1 SISKEN PLAZA | CHATTANOOGA | TN | 37403 | 2012-03-07 | 329 | D | 0 | 1 | 51I011 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation and interview, the facility failed to ensure unnecessary medications were not administered for one resident (#7) of 20 residents reviewed. The findings included: Resident #7 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Observation of the resident and interview with residents Power of Attorney (POA) on March 5, 2012, at 10:40 a.m. in resident's room revealed resident was in bed awake and confused. Further interview with POA revealed the resident had received [MEDICATION NAME] (anti-anxiety medication) on a routine schedule over the weekend which caused resident to be oversedated and family thought the [MEDICATION NAME] was only to be administered as needed. Medical record review of the facility's Medication Record from March 2012, revealed the resident was receiving [MEDICATION NAME] 0.5 mg (milligrams) three times per day scheduled for the following times: 6:00 a.m., 2:00 p.m., 10:00 p.m., and [MEDICATION NAME] 0.5 mg as needed for anxiety. Further review of Medication Record revealed resident received the [MEDICATION NAME] on March 2, 2012, at 10:00 p.m.; March 3, 2012, at 6:00 a.m., and 2:00 p.m.; and received another dose March 3, 2012, with no time indicated. Further review of the Medication Record revealed the [MEDICATION NAME] was held March 3, 2012, at 10:00 p.m., for drowsiness and family requested the [MEDICATION NAME] be held on March 4, 2012, at 6:00 a.m., 2:00 p.m., and 10:00 p.m. and March 5, 2012, at 6:00 a.m. Medical Record Review of a physician's orders [REDACTED]. [REDACTED]. Further interview confirmed the medication had been incorrectly administered three times per day routinely. | 2016-01-01 |
| 11434 | 11434 | ST BARNABAS AT SISKIN HOSPITAL | 445008 | 1 SISKEN PLAZA | CHATTANOOGA | TN | 37403 | 2012-03-07 | 368 | D | 0 | 1 | 51I011 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and interview, the facility failed to provide breakfast for one resident (#13) leaving the facility early for [MEDICAL TREATMENT] treatment of [REDACTED]. The findings included: Resident #13 was readmitted to the facility on [DATE], with [DIAGNOSES REDACTED]. Medical record review of the Minimum Data Set, dated dated dated [DATE], revealed the resident scored 15 on the Brief Interview for Mental Status (BIMS) (score of 15 indicates cognitive intact). Continued review of the medical record revealed the resident received [MEDICAL TREATMENT] treatment three times per week at an outpatient clinic. Interview with the resident on March 5, 2012, at 2:30 p.m., in the chapel room, revealed the resident left the faciity on [MEDICAL TREATMENT] treatment days at approximately 5:30 a.m. to 6:00 a.m. Continued interview revealed the resident was not offered any breakfast or provided a snack to take to the outpatient [MEDICAL TREATMENT] clinic. Further interview revealed the resident did not return to the facility until 10:30 a.m. to 11:00 a.m., and stated was very hungry when returned to facility. Review of the resident meal times revealed the dinner meal was provided between 4:30 p.m. and 6:30 p.m. Eleven hours between resident's dinner meal and lunch meal provided after returning to the facility from the [MEDICAL TREATMENT] treatment. Interview with the Charge Nurse on March 7, 2012, at 9:30 a.m., in the Assistant Director of Nursing office, confirmed the resident was not provided a meal before leaving the facility and was not provided any snack to take to the clinic. The Charge Nurse confirmed the resident was not provided a meal from the dinner meal until the lunch meal (over 16 hours). | 2016-01-01 |
| 11435 | 11435 | ST BARNABAS AT SISKIN HOSPITAL | 445008 | 1 SISKEN PLAZA | CHATTANOOGA | TN | 37403 | 2012-03-07 | 428 | D | 0 | 1 | 51I011 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and interview the facility failed to notify the physician timely of a pharmacy consultant report for one resident (#15) of twenty residents reviewed. The findings included: Resident # 15 was admitted to the facility on [DATE], with [DIAGNOSES REDACTED]. Medical record review of a Pharmacy Consultant Recommendation to the Physician dated January 5, 2012, revealed .has taken Risperidal (antipsychotic) .since February 3, 2010 .please consider a trial discontinuation . Continued review of the Pharmacy Recommendation revealed the Physician was not notified until January 29, 2012 (a twenty-four day delay). Interview with the Director of Nursing (DON) on March 7, 2012, at 8:03 a.m., in the facility conference room, confirmed the facility failed to ensure that the Pharmacy Recommendation was acted upon timely. | 2016-01-01 |
| 13579 | 13579 | ST BARNABAS NURSING HOME | 445008 | 950 SISKIN DRIVE | CHATTANOOGA | TN | 37403 | 2010-10-21 | 280 | D | 0 | 1 | HTP811 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation, and interview, the facility failed to revise the care plan for one (#5) of twenty-six residents reviewed. The findings included: Resident #5 was admitted to the facility on [DATE], and readmitted on [DATE], with [DIAGNOSES REDACTED]. Medical record review of a physician's orders [REDACTED]. Talked to spouse..." Medical record review of the current Care Plan, reviewed on [DATE], revealed "...CPR (Cardiopulmonary Resuscitation) Full Treatment...Will abide by resident and family's wishes...Perform Cardiac [MEDICAL CONDITION] Resuscitation (CPR)...Use intubation, advanced airway interventions, mechanical ventilation and cardioversion as indicated..." Observation on [DATE], at 10:15 a.m., revealed the resident lying on the bed receiving oxygen, with bilateral fall mats in place on the floor. Interview on [DATE], at 1:55 p.m., with Minimum Data Set Coordinator #1, in the nursing station, confirmed the current Care Plan was not revised to indicate the correct DNR status as ordered by the physician on [DATE]. | 2014-11-01 |
| 13580 | 13580 | ST BARNABAS NURSING HOME | 445008 | 950 SISKIN DRIVE | CHATTANOOGA | TN | 37403 | 2010-10-21 | 328 | D | 0 | 1 | HTP811 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, policy review, observation, and interview, the facility failed to obtain podiatry services for one (#5) of twenty-six residents reviewed. The findings included: Resident #5 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 required extensive assistance with personal hygiene and bathing. Medical record review of a physician's progress note dated July 26, 2010, revealed "...toenail(s) need trimming..." Observation on October 19, 2010, at 10:15 a.m., revealed the resident lying on the bed with the feet exposed. Observation revealed a dressing covered the right foot, and the toenails of the left foot were long. Observation and interview on October 19, 2010, at 2:05 p.m., with MDS Coordinator #2 revealed the resident lying on the bed, and the great toenail on the left foot was described as extending approximately 1/4 inch past the fat pad of the toe, the third and fourth toenails on the left foot described as extending approximately 1/2 inch beyond the fat pads of the toes. Continued interview with MDS Coordinator #2 confirmed the toenails were in need of trimming. Review of the facility's policy Fingernails/Toenails, Care of revealed "...do not trim the nails of diabetic residents or residents with circulatory impairments..." Interview on October 19, 2010, at 2:15 p.m., with the Director of Nursing, in the nursing station, revealed a podiatrist would be required to trim the toenails due to the resident's [DIAGNOSES REDACTED]. | 2014-11-01 |
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CREATE TABLE [cms_TN] ( [facility_name] TEXT, [facility_id] INTEGER, [address] TEXT, [city] TEXT, [state] TEXT, [zip] INTEGER, [inspection_date] TEXT, [deficiency_tag] INTEGER, [scope_severity] TEXT, [complaint] INTEGER, [standard] INTEGER, [eventid] TEXT, [inspection_text] TEXT, [filedate] TEXT );