| 1 |
SEA VIEW NURSING HOME |
485000 |
7500 BOLONGO BAY |
ST THOMAS |
VI |
802 |
2010-08-25 |
240 |
K |
0 |
1 |
MZE911 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based upon observations, medical record review, resident family interviews and staff interviews, it was determined that the facility failed to care for residents in a manner and in an environment that promotes maintenance or enhancement of each resident's quality of life. Specifically, several residents are forced to live in bed in their rooms for three to four days each week due to the lack of a sufficient number of Geri-chairs and/or other assistive devices needed to accommodate them when out of bed. The facility implements a rotating schedule which allows on average, two residents to be out of bed in Geri Cairs on alternating days. Those residents who are gotten out of bed most frequently are those described by staff as physically most active or most cognitively intact. In effect, these residents are confined in their rooms in bed for a significant portion of every week. This is a quality of life issue with the potential to affect the resident's physical, emotional, and psycho-social well-being. The findings are: 1. Resident # 1 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. The resident is alert and cognitively intact. She has a history of uncontrolled blood glucose levels and a history of falls, with severe injury sustained in her room on 7/11/10 while attempting to self toilet. Observations conducted by the survey team reveal that this resident was left socially isolated and without adequate assistance from staff for 3 of 5 survey days. During a tour of Unit B conducted on 8/19/10, at 9:30 A.M. this resident was observed in her room, alone and in bed. At 10:45 A.M., the resident was observed to still remain in bed. At Approximately, 12:10 P.M., after completing the tour and while walking along the corridor of unit B in the direction of the Nursing station, the surveyor heard resident #1 calling for help. The resident was calling in a loud voice, help!, Help!, will somebody please help me. The surveyor observed that there were no staff present on the unit to hear or respond to the resident's call for help. As the surveyor entered the resident's room, the resident was observed to still be in bed. The resident stated Oh thank you, I really needed somebody to come help me. Thank you. I can't eat, I need help and I need to go to the bathroom first. I've been calling and calling and no one comes. It's like this every day. They just leave me here. I can't ever get anyone to help me. When asked why she was still in bed and not having lunch in the dining room with the other residents, she responded , no one came to get me up. Sometimes they do but not every day. The surveyor found a nurse on Unit A to assist the resident. On 8/20/10, at 10:20 a.m., Resident #1 was observed again in her room in bed. The resident was alone. On 08/20/10 at approximately 5 PM, upon approaching the resident ' s room, the surveyor heard resident #1 calling for help. On entering the resident ' s room, the surveyor observed the resident was sitting in bed, the side rails up, with a tray table across the bed. The following items were on the tray: a container of milk, a vegetable dish, a cup of juice, an 8oz cup of hot coffee, bread, and approximately 3 large stuffed Ravioli pasta shells. The resident was attempting to feed herself; she appeared to be struggling to cut the Ravioli. She was experiencing difficulty getting the food from the plate to her mouth which resulted in it spilling on her lap and on the bed. The resident shared with the surveyor, that it is difficult for her to get help from the staff and when asked about the meals, the resident stated The food usually tastes good but it was hard today. She went on to say, It is a good thing you were here today, otherwise I would not get to eat; I would still be fighting with it. The surveyor noted that after the food was cut into pieces, placed in the spoon for the resident , and the resident was cued that the food was on the spoon, she was able to continue to feed herself. An interview was conducted with a staff nurse (Registered Nurse) assigned to resident #1 immediately following this observation. The nurse was asked why the resident was receiving her dinner in her room, and she replied that she was not sure why. When she was asked to describe the resident ' s ADL needs specifically related to eating; she stated the CNA has to set-up her tray . When the nurse was asked, does resident #1 need assistance with cutting her food setting up she acknowledged that she should have the food cut for her. A review of the Registered Dietician's initial nutritional assessment notes found in the resident's medical record and dated 07/22/10 reveals that the resident requires Partial assist; type- set up, monitor- may need to be fed . Appears more confused, not getting out of bed much yet History of uncontrolled blood sugar. The Resident 's blood glucose levels are directly affected by her oral intake. Her Diabetic status has an impact on her overall quality of life. She requires close monitoring and facilitation of adequate food consumption. The resident's recent fall while attempting to self toilet resulted in a [MEDICAL CONDITION] which has affected her ability to ambulate and has affected her overall quality of life. 0n 8/24/10, after the survey team brought to the facility's attention the lack of monitoring, social interaction and assistance given to this resident , The resident was observed to have been taken out of her room and placed with the larger resident population. It was also noted that she was receiving assistance during meals as needed. Resident #2 is a [AGE] year old female diagnosed with [REDACTED]. The resident was admitted to the facility 0n 6/15/09. Minimum Data Set (MDS) assessments dated 6/15/09 and 6/15/10 indicate the resident is severely cognitively impaired and requires extensive assistance for bed mobility, transfers and ADLs. The resident is tube fed. Weights recorded on Nutritional Assessments indicate the resident's weight fluctuates between 76-84 lbs. Monthly Nursing Summaries from 9/2009 through 6/2010 describe the resident as alert and well-adjusted, has intact hearing and visual acuity, but does not speak, and does not attend activities on a daily, weekly, or monthly basis. The resident resides in a two-person shared room . Although her roommate is verbally responsive and physically active, she was not observed on any survey day to interact with resident #2, and according to Nursing staff, prefers to be left alone. Comprehensive Care Plans 6/15/09-5/17/10 identifies a problem list for resident #2 that includes: 1. allergies [REDACTED]. Geri -chair 3. Hypertension 4. Inability to make needs known 5. Potential for alteration in nutrition 6. Potential for alteration in respiratory status 7. Skin break down 8. Social Isolation Care Plan interventions include: 1. Requires Geri-chair to be out of bed. 2. Provide opportunities for Socialization daily: a) Out of room b) Take to lounge for socialization c) Involve in activities A Risk Predictor for Skin Breakdown Assessment form categorizes the resident as at high risk with a score of 10. The resident currently has multiple pressure sores including a Stage 3 at the right hip, Stage 3 at the left hip, a Sacral ulcer, Stage 3, and toe wounds. The initial nursing admission assessment for 6/15/09 documents only stage 2 pressure sores at the buttocks, left shoulder and earlobes. Rehabilitation Screening Forms dated 7/13/09, 9/14/09, and 7/1/10 indicate the resident is non-weight bearing and requires a wheelchair for mobility and transfers. Recommendations for other adaptive devices include a Geri-chair. An initial recreation assessment documented on Activity Progress Notes dated 6/15/09 reads R.T. (Recreational Therapist) met with this [AGE] year-old female in her room during P.M. hours. Pt. was in bed in an upright position, looking around the room; is unresponsive, disoriented x3, requires maximum assistance for ADL care, and with attending activities. Being that pt. is unresponsive and disoriented x3 to time, place and person, sensory stimulating activity would benefit her the most. Soft music, touch therapy, aroma therapy would benefit her the most .RT will also try to get her up in a Geri-chair 2-3 x weekly. A recreational Services Treatment Plan dated 9/21/09 documents in the questionnaire section that the resident is unable to speak . The rest of the assessment including a section identifying possible barriers to leisure programs is blank. No interventions are recommended for Physical Therapy, Occupational therapy or Speech therapy. Documentation on Activity Assessments for 9/28/09 -6/17/10 indicate the resident has psychosocial needs for sensory stimulation, is unresponsive to one to one programming, responsive to one to one visits, and prefers to be out of room. The resident is said to enjoy small groups, enjoys visits with family and friends, but is unable to make needs known. She is described as dependent on others for wheelchair support and requires assistance to attend activities. . Social Services documents on a Social Services Quarterly Summary on 9/23/09 that the resident appears to hear, but with variable response. A recent Nursing Readmission assessment dated [DATE] documents the resident does not ambulate and does not respond verbally, only at times when her daughter and grandson visits. A Review of Nursing Notes, Monthly Summaries, CNA documents including the Resident's Turn and position logs as well as interviews with staff revealed that from 6/7/10 until 8/25/10 the resident spent a total of 68 days confined in bed. In June 2010, the resident was maintained in bed for of 19 of 30 days. From 6/7/10 until 6/14/10 , the resident was left in for bed 7 consecutive days; from 6/16/10, until 6/25/10 she was left in bed for 9 days and from 6/27/10 through 6/30/10, left in bed for 3 days. Nursing and CNA documentation for July, 2010 reveals that the resident was left in bed for 26 of 31 days and spent 23 days in bed in August 2010. The resident was closely observed by the surveyor throughout the survey from 8/19/10 through 8/25/10. These observations revealed that the resident makes direct eye contact, is able to look around her environment, is responsive to tactile stimuli, responsive to painful stimuli, and cries when emotionally painful subjects like her mother, daughter and grandson are discussed. The resident was observed to spend all day on each survey day ( 4 of 5 days) in bed. Staff interactions with the resident were limited to providing AM. and P.M. care, medication administration, and wound care. The resident was not observed to be in daily activities programs or other resident social activities. The resident was not observed to have visitors. The resident's roommate was observed to not attempt to interact with the resident in any way. Interviews were conducted with CNA and Nursing staff responsible for care of this resident on both day and evening shifts, were conducted with housekeeping staff responsible for cleaning the resident's room and with the resident's family by telephone contact. On 8/19/10 during the initial facility tour, resident #2 was identified by a staff nurse as one of eight residents who do not get out of bed very much. According to the nurse, We don't have enough Geri.-chairs to get everyone up at the same time. On 8/19/10 during interview with a CNA at 10:30 a.m. regarding the resident's in bed status, the CNA explained that the resident had to stay in bed because we don't have a chair to put her in. We had some more, but they broke, we had three but now we only have two. the other one we can't use because the back drops down and the residents would get hurt. A second CNA interviewed at 11:30 a.m. told the surveyor that the resident spends most days in bed. She used to be up more, but not now. She needs a chair and we don't have one for her. At 4:00 P.M. on 8/20/10, an interview was conducted with a CNA working the evening shift and caring for resident #2. This CNA stated She hasn't been out of bed in a long time. We don't have enough chairs for her. We need new Geri-Chairs, the other ones broke. They (the residents) have to take turns to get up On 8/19/10, the Director of Nursing (DON) was interviewed at 1:00 P.M. and when asked about the facility's supply of Geri- Chairs, stated There aren't enough for everyone who needs one. We have to use a rotating schedule. We keep a schedule of who is supposed to get up every day. They have to take turns. If one gets up today, then we get another resident up tomorrow. There are eight residents that we have to rotate and we only have three chairs. The DON continued explaining the administrator knows about it, and was supposed to order some more Geri-chairs but I don't know what happened, I keep asking about them. We did have more but they all broke. In response to questions about the length of time the facility has been without an adequate number of these Chairs, the DON stated for about two months. When asked about the potential for the residents currently observed in bed to be put in wheelchairs, the DON admitted that some residents might be able to use a wheel chair, but I'm not sure we even have enough of those. We don't have one that could accommodate Ms. _____. ( Resident #2) At the conclusion of this interview, the surveyors requested a copy of the Ger Chair Schedule; the DON replied, I'll see if I can find it. It should be here somewhere. Several minutes later, the DON informed the surveyor, I can't find it but I can make you one. At 3:45 P.M., the surveyor was given a document titled Geri Chair Schedule. Seven resident names were listed on this document. Resident #2 was not listed on the schedule. The seven residents listed on the schedule were observed at various times throughout each day on 8/19/10, 8/20/10, and 8/23/10. Each resident was observed to remain in bed for the entire day, on all three days. A Housekeeping staff responsible for cleaning resident #2's room was interviewed on 8/20/10 at 1:15 P.M. stated no she doesn't get up. I see her in the bed every day. I don't think they have enough chairs, the chairs are broken There are other residents too, who can't get out of bed. There is one char in the shower room but it's broken. A telephone interview was conducted with the resident's mother on 8/23/10. During this interview the Mother explained that resident #2 used to be outgoing, loved being outside, loved going to the beach because she loved the water and she likes being with people. I think she recognizes me when I visit her. The Mother admitted that she has never seen the resident out of her room or out of bed during her visitations. No, I've never seen her out of the room. Everytime I come she's in the bed. Interviews were held with the Administrator on 8/23/10 regarding residents who were forced to stay in bed. The Administrator informed the surveyor that she was aware of the shortage of Geri-chairs and had told the CEO that new ones needed to be ordered. She said she would order some. I don' t know why she didn't. The Survey team met with the Administrator , Chief Executive Officer and Director of Nursing Services on 8/23/10 to discuss the team's observations of resident isolation, the inadequate supply of Geri-Chairs or other Assistive device needed for residents to be gotten out of bed, and the lack of recreational, Social interaction or other activity needed to prevent Physical and psychological harm to these residents. On 8/24/10, the following day, upon entering the facility, the survey team observed that with the exception of one of the residents listed on the Rotating Geri-chair log, all residents had been gotten out of bed including resident #2. On 8/24/10, the CEO informed the team that a new supply of six Geri-Chairs were ordered for immediate delivery |
2017-01-01 |