cms_VT: 379
Data source: Big Local News · About: big-local-datasette
| rowid | facility_name | facility_id | address | city | state | zip | inspection_date | deficiency_tag | scope_severity | complaint | standard | eventid | inspection_text | filedate |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 379 | BARRE GARDENS NURSING AND REHAB LLC | 475037 | 378 PROSPECT STREET | BARRE | VT | 5641 | 2018-02-07 | 725 | E | 0 | 1 | 0GXJ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, review of facility assessment, and confirmed by family and staff interviews, the facility failed to have sufficient nursing staff to provide nursing and related services assuring resident safety and maintaining the highest practicable physical, mental and psychosocial well-being for each resident. Consideration for the number of residents who reside in the home, the resident assessments, individual care plans, the acuity and [DIAGNOSES REDACTED]. This is a repeated citation from November, (YEAR). The findings include the following: 1. Per review of the facility assessment dated [DATE], the Nursing staffing plan is as follows: Full time Director of Nurses-Registered Nurse (RN); Full time Assistant Director of Nurses-RN; 2 RN/LPN on each unit (8 hours each)-RN's and LPN's are used interchangeably for both day and evening shifts and 1 nurse on each unit on the over night shift; Direct Care Staff: 4 Licensed Nurse Aides (LNA'S) on each unit for both day and evening shifts (8 hours each) and 2 LNA's on the over night shift (8 hours each). During the three days of survey (2/5, 2/6 and 2/7/18), the facility had numerous direct care staff calling out of work for various reasons. The staffing pattern identified was not met as follows: Review of the LNA assignments for the entire building, average 9 residents each on the day and evening shifts, with the census being 74, if the staffing pattern is met. Of those 74 residents, 20 require the assistance of 2 to transfer the resident from one location to another using a mechanical lift, 8 residents require 2 assistants for transfer from one location to another, and 19 require the assistance of 1. 52 of the 74 residents require incontinent care and/or assistance with toileting. 17 of the 74 residents require 2 assistants for bathing and dressing. 2. Per interview with family members during the 3 day survey, concerns were voiced related to untimely call light answering, lack of facility staff for the management of personal care, resident preferences not being followed, lack of communication between care givers and residents, as well as lack of care plan follow through. One family reported that their relative had to wait for staff to find the mechanical lift to assist him/her to get out of bed. This family further reported that when it takes 2 staff to help with lifting residents in and out of bed, staff are not readily available to answer call lights in a timely fashion. During resident interviews, on 2/6/18, one resident, who wishes to be anonymous, stated that staffing was not always sufficient and reported that on several occasions a delay in answering the call light, sometimes 30-45 minutes, had resulted in episodes of incontinence. 3. During the 3 days of survey, facility staff voiced concerns related to rushing through care, providing showers/baths in the afternoon hours, being left with only 2 LNA's on a unit between the hours of 9-11 PM, and often times their inability to have an evening meal or break. An LNA also reported during interview on 2/06/2018, that s/he was asked to interrupt personal care with which s/he was assisting a resident, in order go to another unit to take a resident outside. 4. The facility in the past 2 weeks has discharged 13 residents from the facility, but they have also admitted 12 new residents to the home, despite the staffing challenges. 5. Per interview with the Administrator on 2/7/18 at 11:15 AM, the facility is currently employing 70 % agency contracted nurses. Per interview with the Administrator, the Director of Nurses and the Regional Director of Clinical Services on 2/7/18 at approximately 1:30 PM, confirmation is made that the facility currently does not have a Staff Development Nurse. H/She is responsible for staff education, orientation and review of competencies. The Administrator confirms at this time that they will not be replacing that position, but rather sharing the responsibilities among the DNS, ADNS and Clinical Nurse Manager. 6. During observations on wing 2 on 2/6/18, at 8:31 AM Resident #51 walked from his/her room to the unit kitchenette and took 5 ice cream cups back to his/her room. No LNA or auxiliary staff were in the area of the nurses' station, the kitchenette, the nearby sunroom, or the two halls, so the surveyor interrupted a nurse during medication administration to advise him/her of the situation. The nurse came away from medication administration duties to engage with Resident #51 regarding the 5 cups of ice cream. 7. During observations on wing 2 on 2/6/18, Resident #38 was returned from breakfast to the area of the nurses' station by a Licensed Nurse Assistant (LNA). Both nurses and all three LNAs were then engaged in medication administration or direct care while Resident #38 and Resident #50 were near the nurses' station. Resident #38, per the care plan, has behaviors of wandering, intrusion, and inappropriateness toward females. At 9:13 AM Resident #38 tried to bump the wheelchair of Resident #50 and was intercepted by the nurse who was on the way to the medication cart. Once left alone, Resident #38 proceeded to and intruded into the room of Resident #19 (who was still in bed). The nurse came away from the medication cart and redirected Resident #38 back to the nurses' station, then returned to duties. At 9:20 AM Resident #38 again proceeded to and intruded into the room of Resident #19; the nurse again came away from medication duties to redirect, then returned to duties. At 9:48 AM Resident #38 tried to bump the wheelchair of Resident #50 again, and was redirected by the social worker who had just come to the nurses' station on a survey-related task. Activity staff then removed Resident #38 to a 10:00 AM activity. It was confirmed with the clinical supervisor that there had not been an activity from 9-10 AM on the unit, that there were 3 nurse aids on duty instead of 4 for the 2 halls of both wings, and that the clinical supervisor was on duty this shift as the medication nurse. | 2020-09-01 |