| 317 |
VERMONT VETERANS' HOME |
475032 |
325 NORTH STREET |
BENNINGTON |
VT |
5201 |
2017-06-21 |
242 |
D |
0 |
1 |
0EBD11 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews, record review, and observations, 3 of 22 residents did not have their preferences about aspects of their life in the facility that are significant to them, honored. (Residents #122, #8 and #13) Findings include: 1. Based upon interview, observations and record review for Resident #122, the facility failed to honor the resident's preferences for showering frequency. During interview on 06/20/17 at 09:19 AM when asked about bathing preferences, the resident stated that's the big problem, I am told I can only have one a week, when I was younger I would take sometimes two a day. Review of the bathing schedule demonstrates that the resident receives his/her shower weekly and in the evening. During a follow up conversation, the resident made his/her preference known but stated it is not worth it (to tell staff again) .they don't listen anyway, but gosh it could be twice a week which would be ok (with me). The most recent Care Plan is for one person assist, stand by guard for ADLs (activities of daily living). Observation during the three days of survey shows the resident ambulates with a walker but can be unsteady at times. During interview on 06/20/17 at 5:00 PM, the DNS (director of nursing services) identified that the residents' preferences are made known during the admission process conducted by the Activity Department. During interview on 06/21/17 at 9:21 AM, the Activity Director (AD) acknowledged that upon admission, the resident (or the responsible person) will fill out an 'Activities Hello' sheet. The AD explained that this is a set of questions pertaining to the resident's likes, favorite situations and preferences and stated It is like their personal history so that we get to know them better and what is important to them. Resident #122 filled out this form with a preference under #3- 'my usual daily routine' .get up, shower, dress, breakfast, read the newspaper. The nurse surveyor asked if this preference sheet is shared with other staff and the AD stated that the whole team does look at it. When asked if a question regarding showering is asked the AD stated oh yes we also fill out the MDS {minimum data set} Section F. Review of MDS Section F indicates that the resident chose to receive a shower rather than a tub bath, but no frequency is noted. Per interview on 06/21/17 at 11:57 AM the interim Unit Manager acknowledged that resident #122's showering schedule does not reflect the resident's preference. 2. Based upon interviews and record review, the facility failed to make necessary adjustments to Resident #8's bathing schedule on the care plan. Per interview on 06/19/17 at 4:19 PM, Resident #8 stated I've had only one shower since I've been here .but I do get a pan of water every morning, some nights, but sometimes I want more. When asked if (s/he/) told staff, the resident stated .well, last week someone said they'll be back but then they never showed. Per record review on 06/20/17, the resident is care planned to receive weekly showers on the evening shift. The LNA bathing schedule for (MONTH) 1-20, (YEAR) demonstrates Resident #8 received one shower (on 06/09/17, two days late) and refused a shower on 6/14/17. There is no documentation for the refusal or whether the staff made the necessary adjustments to accommodate (resident's) preferences for showers. In addition, a physician visit note of 06/07/17 stated the resident complained of diarrhea, rash and pain (to buttocks) and a Skin & wound assessment of 06/16/17 & 06/19/17 is noted as Moisture Associated Skin Damage (MASD), redness to coccyx. Per interview on 06/20/17 at 2:07 PM the interim Unit Manager thought the refusal for a shower was due to it being late (in the evening) and confirmed there was no documentation of the reason for the refusal or whether staff followed up and/or offered another time for the shower. 3. Based upon interview, record review and observations, Resident #13 was not able to exercise her/his food choices. Per interview on 06/19/17 at 1:26 PM with Resident #13, who was identified as interviewable, as part of the resident council, stated that (s/he) would like bacon but was told I can't have any . The Resident repeated this statement throughout the interview and repeatedly asked if (he/she) could have bacon, saying other people can get it. The resident acknowledged that not getting bacon could be related to a medical issue. Per record review, there is an order for [REDACTED]. The nurse further stated that bacon can't be cut up because the consistency is too hard to swallow, but maybe we can cut up some Canadian bacon. The Nurse surveyor then returned back to the resident and asked the resident if perhaps Canadian bacon can be cut up and the resident said well if I have to compromise then I guess that would be ok. Per interview, a short time later, the Food Service Supervisor (FSS), acknowledged that the resident was on a mechanical diet (for several months), but of course I'll put in a request for speech therapy to evaluate it; we can serve it cut up into pieces. I can't see why not. The FSS stated bacon was being served on Wednesday (06/21/17) . Per observation and interview on 06/21/17 at 8:37 AM the speech therapist (ST) stated a previous evaluation was conducted last fall (2016) but staff are able to put in a request for a change in diet preference. Then a new evaluation would be conducted, since food is important for this resident. Small pieces of bacon were noted on the plate and the resident stated well its not the way I usually eat but it is ok. ST stated that it appears that the resident would be able to have bacon mixed with a liquid and staff would probably have to cue (resident). During staff interview at 11:43 AM on 6/21/17, the LNA stated that the resident was in bed and at first declined to get up for breakfast, but the staff then stated that they were having bacon for breakfast and (resident) would be able to have some with ST, so (he/she) got up right away. The Unit manager later that same day, acknowledged that a reminder about resident's choices was made to the nurse and stated that (s/he) will continue to educate staff regarding residents rights and having a voice. |
2020-09-01 |