{"rowid": 2147, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "PO BOX 400", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2019-09-24", "deficiency_tag": 580, "scope_severity": "E", "complaint": 1, "standard": 0, "eventid": "9CH711", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on medical record review and staff interview, the facility failed to notify the physician when medications were not administered. This is true for two (2) out of five (5) residents Medication Administration Record [REDACTED]. Facility census: 59. Findings included: a) Resident #2 A review of Resident #2's MAR indicated [REDACTED]. --Apixaban 5 milligrams (mg) twice a day at 9:00 AM and 9:00 PM --Aspirin 81 mg daily at 9:00 AM --[MEDICATION NAME] ([MEDICATION NAME]) 0.5 mg twice a day at 9:00 AM and 9:00 PM - [MEDICATION NAME], a schedule IV medication, was signed off on the controlled substance book indicating the nurse had taken the medication out of the pack, but Nurse #1 signed her initial on the dates and times on the MAR indicated [REDACTED]. The medication [MEDICATION NAME] was not sign off with another nurse on the controlled substance book that the medication was wasted. This means the medication was not observed by another nurse the medication was disposed of properly. --Carvedilol 3.125 mg twice a day at 9:00 AM and 9:00 PM --[MEDICATION NAME] 25 mg daily at 9:00 AM --[MEDICATION NAME] 20 mg daily at 9:00 AM --[MEDICATION NAME] 10 mg daily at 9:00 AM --[MEDICATION NAME] 7.5 mg at 9:00 PM --[MEDICATION NAME] Chloride extended release 15 mg daily at 9:00 AM --[MEDICATION NAME] 20 mg daily for at 9:00 AM --Vitamin B 12 100 microgram (mcg) daily at 9:00 AM The Director of Nursing (DoN) stated the nurse who did not administer Resident #2's medication on 09/03/19 was Nurse #1. She further stated when a nurse circles her initals on the dates and times on the MAR, this indicates the nurse did not administer medication to the resident. Nurse #1 did not notify the physician why the medication were not administer to Resident #2. b) Resident #5 A review of Resident #5's MAR indicated [REDACTED]. When a nurse circles her initals on the date and times, this indicates the nurse did not administer these medication to the Resident #5. The Nurse did not notify the physician why they did not administer the following medication to Resident #5. On 06/01/19, 06/02/19 and 06/03/19 at 9:00 AM, Resident #5 was not administered the following medications: [REDACTED] --[MEDICATION NAME] Sodium 100 mg --[MEDICATION NAME] 1 mg On 06/01/19, 06/02/19, 06/03/19 and 06/05/19 at 2:00 PM, Resident #5 was not administered the following medication: --[MEDICATION NAME] 1 mg On 06/01/19, 06/02/19 and 06/03/19 at 2:00 PM, Resident #5 was not administered the following medication: --[MEDICATION NAME] ([MEDICATION NAME]) 1 mg - Resident #5's [MEDICATION NAME]- schedule IV medication was signed off on the controlled substance book on 06/01/19, 06/02/19, 06/03/19 to revealing the nurse had taken the medication out of the pack, signed their initial on the dates and times on the MAR indicated [REDACTED]. The medication [MEDICATION NAME] ([MEDICATION NAME]) was not sign off with another nurse on the controlled substance book that the medication was wasted. This means the medication was not observed by another nurse the medication was disposed of properly. On 06/01/19 and 06/02/19 at 9:00 AM, Resident #5 was not administered the following medication: --[MEDICATION NAME] 5 mg On 06/02/19 and 06/03/19 at 9:00 AM, Resident #5 was not administered the following medication: --[MEDICATION NAME] 24 mcg --[MEDICATION NAME] 0.5 mg Resident #5 was re-admitted on [DATE] at 11:12 AM. The physician (physician name) approved all admission orders [REDACTED] A review of Resident #5's MAR indicated [REDACTED]. The MAR indicated [REDACTED]. Resident #5 did not receive her medication [MEDICATION NAME] ([MEDICATION NAME]) 1 mg on 07/04/19 at 2:00 PM as ordered nor did the nurse notify the physician. A review of the controlled substance book to determine whether [MEDICATION NAME] - schedule IV medication to treat Resident #5's Anxiety had been removed on 07/04/19 at 2:00 PM, found no [MEDICATION NAME] ([MEDICATION NAME]) had been remove from the controlled substance pack. Therefore the [MEDICATION NAME] ([MEDICATION NAME]) one (1) MG by mouth was not administered to Resident #5. On 07/0419 07/07/19, 07/15/19 and 07/16/19, more than one nurse circled their initial on the dates and times for the following medication on the MAR, meaning the medication were not administered to the Resident #5. The nurses did not notify the physician why they did not administer the following medication to Resident #5. Resident #5 was not administered the following medication on 07/07/19 at 9:00 AM --[MEDICATION NAME] 24 mcg daily --[MEDICATION NAME] 5 mg --[MEDICATION NAME] 100 mg --[MEDICATION NAME] 2.5 mg Resident #5 was not administered the following medication on 07/1519 and 07/16/19 at 9:00 AM: --[MEDICATION NAME] 24 mcg was circled, indicating LPN #7 did not administer this medication. LPN #7 did write on the back of the MAR indicated [REDACTED]. Resident #5 was not administered the following medication on 07/15/19 and 07/16/19 at 9:00 AM: --[MEDICATION NAME] 5 mg --[MEDICATION NAME] 100 mg --[MEDICATION NAME] 2.5 mg --[MEDICATION NAME] 0.5 mg On 07/16/19 Resident #5 was sent to a Behavioral Health hospital (hospital name).The hospital performed a [MEDICATION NAME] Level on 07/17/19 in which the results were 15.5 ng/ml (A ng means- nanograms per ml - milliliter, which is abbreviated as ng/ml. This is the unit of measure most commonly used to express drug testing cut-off levels and quantitative test results. Normal range for [MEDICATION NAME] level range is from 50.0 - 240. The test detect presence of [MEDICATION NAME], a benzodiazepine sedative and anticonvulsant. A quantitative test tells you how much (the quantity) of an analyte is present. Hx benefits states [MEDICATION NAME] ([MEDICATION NAME]'s) half life is approximately 12 hours, which means that once you have taken your last dosage of [MEDICATION NAME] ([MEDICATION NAME]), it would take about 2.75 days for Lorazapam ([MEDICATION NAME]) to be full out of your body. A review of Resident #5's medical record finds on 09/24/19 at 11:40 AM, the physician was not notified Resident #2 and 5's medication were not administered as ordered. In an interview with the Director of Nursing (DoN) on 09/24/19 at 11:50 AM, she was shown the MAR'S for Resident #2 and #5. The DoN, stated that, the MAR indicated [REDACTED]. The DoN also revealed she could not provide evidence on whether the [MEDICATION NAME] ([MEDICATION NAME]) which is a (controlled Substance),( schedule IV)was given. The DoN stated all she can say is for Resident #2, the nurse took out the medication from the lock box, but what she did with the medication she cannot verify, because the nurse wrote the resident did not receive the medication [MEDICATION NAME] ([MEDICATION NAME]), and the medication was not wasted with another nurse on duty. On 06/01/19, 06/02/19 and 06/03/19 at 2:00 PM, the DoN confirmed the [MEDICATION NAME] ([MEDICATION NAME]) was removed from the pack and signed off as given, but the MAR indicated [REDACTED]. The DoN stated that on 07/04/19 Resident #5 did not receive her medication [MEDICATION NAME] ([MEDICATION NAME]) at 2:00 PM as ordered, because the medication was never taken out of the package when she should have received the medication. DoN revealed their policy is if a resident refuses the medication they are to circle their initals on that date and time and document the residents refusal of the medication on the back of the MAR, and if the medication is a controlled substance, the nurses must waste the medication with another nurse and sign off the resident refuses the medication. DoN stated her expectation would be if the resident refused any of their medication they should notify the physician. The DoN confirmed one (1) nurse did circle her initals, and wrote a rational for not administering the medication [MEDICATION NAME] on 07/15/19 and 07/16/19, but she did not notify the physician. The DoN stated, for the rest of the nurses they did not write on the back of the MAR, waste the [MEDICATION NAME] ([MEDICATION NAME]) with another nurse correctly and notify the physician the medication were not administered to Resident #2 and #5. The facility's policy for medication refused by resident, finds the nursing staff is to circle their initals, in the date and time space where that medication is ordered, and document patient's refusal of medication of the back of the MAR. The facility's pharmacy (pharmacy name) policy is to Wasted controlled substances should be destroyed with another appropriate observer and documented as a per facility policy. The pharmacy policy says to document omitted doses and why. A professional standard of practice of medication Administration -August 2013, reveals the nurse must notify the prescribing practitioner or supervisor when a resident refuses medication. RN. ORG finds that when controlled substances must be disposed of, the disposal should be witnessed by two (2) healthcare providers who are licensed to dispense drugs, such as two RNS, and the disposal documented with both healthcare providers signing. This should be done immediately after procuring the drug. The nurse should not carry the excess narcotic on a tray or in a pocket or place it in an unsecured medication drawer for later disposal because this increases the risk of diversion or errors in documentation but should immediately ask for a witness and dispose of the drug according to established protocol.", "filedate": "2020-09-01"}
{"rowid": 2148, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "PO BOX 400", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2019-10-23", "deficiency_tag": 583, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "8VRQ11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and interview, the facility failed to ensure a Resident's Medication Administration Record (MAR) and a Nurse Report Sheet were secured in a manner that protected personal, medical, and health information. Personal identifiers including resident's names, room numbers, code status, medications, medical interventions, allergies [REDACTED]. This was a random observation. This practice affected a limited number of residents. Facility census: 59. Findings included: a) Observation An observation of the 100 Hall, on 10/22/19 at 9:30 AM, revealed the medication cart was in the hall. The Medication Administration Record (MAR) and a Nurse Report Sheet were on top of the medication cart open and visibly available for anyone to view. No staff members were at the medication cart at the time of the observation. The MAR and the Nurse Report Sheet contained the following resident information: -Names -Room numbers -Code Status -Medications -Medical interventions -allergies [REDACTED]. b) Interview An interview with Licensed Practical Nurse (LPN) #16, on 10/22/19 at 9:35 AM, revealed the MAR and Nurse Report Sheet are supposed to be covered before she leaves the medication cart unattended. The LPN stated she forgot to do so.", "filedate": "2020-09-01"}
{"rowid": 2149, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "PO BOX 400", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2019-10-23", "deficiency_tag": 623, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "8VRQ11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to notify the ombudsman of the Resident's transfer to the hospital. This deficient practice was found for 1 of 4 residents reviewed in the care area of hospitalization . Resident identifiers: #59. Facility census: 59. Findings included: a) Resident #59 Record review indicated Resident #59 was transported to local hospital on [DATE] at 8:14 AM for an unplanned transfer and never returned the facility. Notification to the Ombudsman for this transfer was not documented. During an interview on 10/22/19 at 2:37 PM Social Services Specialist #54 verified the facility did not notify the ombudsman of the transfer or discharge and the reasons for the move in writing. Social Service Specialist #54 stated, I was not aware I should be sending those notifications to the ombudsman until recently when corporate questioned me about it. Review of the facility's Discharge and Transfer Policy, subtitled OPS404 Discharge and Transfer, effective date 06/01/96 Review date 01/16/10, revision date 02/01/19 stated - For patients transferred to a hospital copies of notices for emergency transfers must also be sent to the Ombudsman, but they may be sent when practicable, such as in a list of patients on a monthly basis or per state requirements.", "filedate": "2020-09-01"}
{"rowid": 2150, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "PO BOX 400", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2019-10-23", "deficiency_tag": 625, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "8VRQ11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to provide the Resident with Bed Hold Notice upon transfer. This deficient practice was found for one (1) of four (4) Residents reviewed in the care area of hospitalization . Resident identifier: #59. Facility census: 59. Findings included: a) Resident #59 Record review indicated Resident #59 was transported to local hospital on [DATE] at 8:14 AM for an unplanned transfer. Evidence that documented a Bed Hold Notice was provided to the Resident or Resident's legal representative was not found. During an interview on 10/22/19 at 2:37 PM Social Services Specialist #54 verified the facility did not provide the Resident or the Resident's legal representative with a Bed Hold Notice. Social Services Specialist #54 stated, Unless nursing done it, it wasn't done because when she left on the 9/14/19 it was a Saturday and I was not here. On 10/22/19 at 2:55 PM, Social Services Specialist #54 confirmed the facility did not have any documentation anywhere within medical records that a Bed Hold Notice had been provided for Resident #59's transfer on 09/14/19. Review of the facility's Accounts Receivable Policies and Procedures Policy subtitled: AR102 Bed Holds - effective date 03/15/00, review date 04/15/16, revision date 05/01/16 stated when a resident is transferred out of the service location to a hospital or on therapeutic leave, the designee will provide the resident/family member the written Bed Hold Policy Notice & Authorization form regardless of the payer.", "filedate": "2020-09-01"}
{"rowid": 2151, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "PO BOX 400", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2019-10-23", "deficiency_tag": 657, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "8VRQ11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to ensure a resident's care plan was revised based on the results of a comprehensive assessment. This failed practice had the potential to affect one (1) of 19 residents whose care plans were reviewed during the long term care survey process. Resident identifier: #53. Facility census: 59. Findings included: A record review for Resident #53 noted the resident was re-admitted to the facility on [DATE] with an order for [REDACTED]. A review of the comprehensive care plan dated 10/08/19, noted no problem or modality utilizing the oxygen therapy ordered to be administered to Resident #53. An interview, on 10/22/19 at 10:55 AM, with the Clinical Reimbursement Coordinator (CRC), revealed the oxygen therapy had been noted on the comprehensive assessment but not carried through to the care planning process. The CRC verified the oxygen should have been care planned but the facility missed that.", "filedate": "2020-09-01"}
{"rowid": 2152, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "PO BOX 400", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2019-10-23", "deficiency_tag": 695, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "8VRQ11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and interview, the facility failed to provide oxygen therapy in accordance with professional standards and practices. The failed practice had the potential to affect one (1) of seven (7) residents receiving oxygen therapy. Resident identifier: Resident #53. Census: 59 Findings included: A review of the policy, Oxygen Concentrator, revision date: 12/01/18. showed when oxygen was to be administered, the oxygen flow rate would-be set-in accordance with the physician's orders [REDACTED].>An observation, on 10/21/19 at 01:02 PM, revealed Resident #53 was receiving oxygen (O2) via nasal cannula at 2 liters per minute. An additional observation, on 10/22/19 at 08:15 AM revealed Resident #53 was receiving O2 at 1.5 liters per minute via nasal cannula. Medical record review for Resident #53 noted a physician's orders [REDACTED]. An interview, on 10/22/19 at 08:27 AM, with RN#7, verified Resident #53's O2 was set on 1.5 liters per minute but verified the order was for 3 liters per minute. An interview was conducted on 10/22/19 at 09:31 AM, with the Center Nursing Executive (CNE). When informed of the oxygen settings observed on 10/21/19 and 10/22/19, the CNE verified the oxygen was to be set at 3 liters per minute and verbalized understanding they were not set in accordance with physician's orders [REDACTED].", "filedate": "2020-09-01"}
{"rowid": 2153, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "PO BOX 400", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2019-10-23", "deficiency_tag": 842, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "8VRQ11", "inspection_text": "Based on record review and interview, the facility failed to maintain medical records on each resident that are complete and accurate. Resident #43's Nurses Notes included a fall with injury that occurred for Resident #11. This practice affected two (2) of nineteen (19) resident records reviewed during the Long Term Care Survey Process (LTCSP). Resident identifiers: #11 and #43. Facility census: 59. Findings included: a) Record Review A review of the Nurses Notes for Resident #43, on 10/22/19 at 11:17 AM, revealed the notes included a fall with injury that occurred on 09/03/19. No other indication of a fall could be found in Resident #43's record. b) Interview An interview with the Center Nurse Executive (CNE), on 10/22/19 at 11:30 AM, revealed Resident #43 did not have a fall on 09/03/19 with injury. The CNE stated a nurse mistakenly charted Resident #11's fall in Resident #43's Nurses Notes by mistake. The CNE stated she would ensure the mistake was corrected in both of the Resident's medical records.", "filedate": "2020-09-01"}
{"rowid": 2154, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "PO BOX 400", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2019-10-23", "deficiency_tag": 925, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "8VRQ11", "inspection_text": "Based on observation and interview, the facility failed to maintain an environment free from pests. The resident Dining Room and the 100 Hall was observed to have flies on multiple occasions. This practice affected a limited number of residents. Facility Census: 59. Findings included: a) Observations Multiple observations during the LTCSP on 10/21/19, 10/22/19, and 10/23/19, revealed flies in the Resident Dining Room and 100 Hall. b) Interviews Interviews with Resident #26 and #36, on 10/22/19 at 1:45 PM, revealed there are flies in the dining room daily. The Resident's stated they need fly swatters during meals. An interview with Administrator, on 10/23/19 at 8:15 AM, revealed the facility has a pest control company come monthly. The Administrator stated they noticed an increase in flies last week and had contacted the pest control company to come out and take care of the issue. The Administrator stated they have not showed up yet.", "filedate": "2020-09-01"}
{"rowid": 2155, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "PO BOX 400", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2018-11-08", "deficiency_tag": 561, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "I3US11", "inspection_text": "Based on medical record review and staff interview, the facility failed to ensure the resident's right to make choices about aspects of his/her life that are significant to the resident. Resident #38 said she was not offered the opportunity to vote in the mid-term election. This was evident for one (1) of fifteen (15) sampled residents. Resident identifier: #38. Facility census: 58. Findings included: a) Resident #38 An interview was conducted with the resident on 11/05/18 at 11:48 AM. She said she votes in every election. She said no one at the facility offered her the option of an absentee ballot and/or an on-site polling voting option for the 11/06/18 mid-term election. The medical record was reviewed on 11/07/18. The most recent minimum data set (MDS), with assessment reference date (ARD) 09/09/18, assessed her with a Brief Interview for Mental Status (BIMS) score of fourteen (14). A score of thirteen (13) to fifteen (15) indicates intact cognition. On 11/08/18 at 8:49 AM the licensed social worker (LSW) was interviewed. Upon inquiry, she said that the activities department takes care of finding out which residents wish to vote, and then assists them with voting. She said she has worked here only since April, and this is the first election since her hire date. She spoke awareness that one male resident went to the polls and voted in this week's mid-term election. An interview was conducted with the activity director on 11/08/18 at 8:52 AM. She said facility staff transported one (1) male resident to the polls to vote in the early voting period. She said no other residents in the facility voted this election either in person or by absentee ballot. Upon inquiry as to whether Resident #38 was given the option to exercise her right to vote in this year's election, she said they sometimes talk about the election in current events, but she could not recall if or when she spoke with this resident about her voting preference. She was asked if anyone canvassed the residents last month to see if anyone wanted an absentee ballot. She said they talked some about voting in current events, but she did not keep a record of it. She could provide no evidence that this resident had been asked about voting in this year's mid-term elections. She stated I did not ask her in (MONTH) or (MONTH) of this year. She said she does not know if this resident was registered to vote or not. She said someone will come to the facility upon request and register residents to vote. She said this resident stays in bed most of the time and most likely would not have gone out to the polls. She agreed that an absentee ballot can be obtained for a mostly bedfast resident. She said she could in the future fix something up on the activity participation record whereby she could ask residents individually about voting preference prior to the elections and record it. Upon inquiry as to whether they discussed in the morning meetings about residents voting in this year's mid-term election, she replied in the negative. She said that could have been added to the agenda, but it was not. An interview was conducted with the DON and the administrator on 11/08/18 at 1:30 PM. No further information was provided prior to exit related to this resident's desire to vote.", "filedate": "2020-09-01"}
{"rowid": 2156, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "PO BOX 400", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2018-11-08", "deficiency_tag": 641, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "I3US11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, medical record review, resident interview and staff interview the facility failed to ensure one (1) of fifteen (15) residents, had an assessment completed that accurately reflected their status. Resident #4's assessment did not reflect the resident's status concerning speech. This had the potential to affect more than a limited number of residents. Resident identifiers: #4 Facility census: 58 Findings included: a) Resident #4 On 11/05/18 at 02:30 PM during the initial interview with the resident this surveyor had difficulty understanding the resident at times due to the resident's speech abilities. The resident was slow to form some words at times and had to repeat herself to help this surveyor understand what she was trying to communicate. Review of Resident #4's quarterly minimum data set (MDS) with an assessment reference date (ARD) 11/04/18, on 11/06/18 at 11:51 AM, revealed the MDS was marked the resident had clear speech. Pertinent [DIAGNOSES REDACTED].) On 11/07/18 at 09:20 AM, observation of Licensed Practical Nurse (LPN#61) providing Pressure ulcer wound care to Resident #4, revealed LPN#61 had some difficulty communicating with and understanding Resident #4 due to the resident's speech abilities. LPN#61 had to ask the resident various times to repeat herself so the LPN could understand the resident. The same observations were made, on 11/07/18 at 10:10 AM, when LPN#61 provided supra pubic catheter to Resident #4. Interview with the back-up clinical reimbursement coordinator (CRC, the nurse responsible for completing the resident's MDS), on 11/07/18 at 01:16 PM, revealed 'clear speech' being marked on the MDS was inaccurate. The back-up CRC said, The resident has been here a while. I am familiar with the resident, and she does not have clear speech. The MDS is not accurate.", "filedate": "2020-09-01"}
{"rowid": 2157, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "PO BOX 400", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2018-11-08", "deficiency_tag": 655, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "I3US11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview, the facility failed to complete a baseline care plan for one (1) of one (1) closed record reviewed for death. Resident identifier: #58. Facility census: 58. Findings included: a) Resident #58 Resident #58 was admitted to the facility on [DATE]. A copy of Resident #58's baseline care plan was requested and reviewed on 11/07/18 during the Long Term Care Survey Process. The baseline care plan included problems, goals, and interventions related to nutrition and skin breakdown only. The initial nursing assessment completed on 09/22/18 revealed that Resident #58 had a urinary tract infection [MEDICAL CONDITION], urinary and bowel incontinence, recent falls, moderate hearing difficulty with need for a hearing aid, and limited mobility with wheelchair use. Per his admission orders [REDACTED]. On 11/07/18 at 4:00 PM, Clinical Reimbursement Coordinator (CRC) #8 stated that a baseline care plan should include, at a minimum, information related to nutrition, activities of daily living, skin integrity, and advance directives. She reviewed Resident #58's baseline care plan and agreed that it was incomplete. She said she did not know where the rest of the care plan was.", "filedate": "2020-09-01"}
{"rowid": 2158, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "PO BOX 400", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2018-11-08", "deficiency_tag": 656, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "I3US11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, staff interview, and observation the facility failed to develop and/or implement a comprehensive care plan related to psychosocial needs, the use of medication for [MEDICAL CONDITION], nutrition and activities. Resident identifiers: #40 and #48. Facility census: 58. a) Resident #40 Intermittent observations of his room on 11/05/18 found it devoid of any personal effects. The room had no music or television. He wore a hospital gown at every observation. The medical record was reviewed on 11/06/18. This resident first came to the facility the preceding month. He and/or his guardian elected hospice services on 10/04/18. Review of the care plan found it was not person-specific in the care area of things that formerly brought him comfort/pleasure, or past interests. The care plan contained a focus which was initiated on 10/05/18, that he was at risk for alterations in comfort related to chronic pain. Interventions included to Evaluate resident's past coping mechanism to determine what measures work best (relaxation, diversional activities, visualization). However, his past coping mechanisms were not included in the care plan. An interview was conducted with the licensed social worker (LSW) on 11/06/18 at 2:42 PM. We discussed that the care plan was not person-centered in that it did not include things that brought him comfort/pleasure or past interests. Also, his room was absent of any personal memorabilia or connections to his past life that might bring him comfort. The LSW said that mostly he likes for people to talk to him, although that was not included on the care plan. She said he has two (2) grandchildren who visit sometimes. Upon inquiry as to whether they were involved in care planning things that have brought him comfort/pleasure in the past such as favorite pets, type of music preferred, hobbies, pictures from his home, past employment, religious preference, she said she did not know. She added that activities usually assesses those types of things, and she would reach out to hospice for more input in these areas. An interview was conducted with the DON and the administrator on 11/08/18 at 1:30 PM related to the care plan which was not person-centered. No further information was provided prior to exit. b) Resident#48 Review of records, on 11/07/18 at 02:39 PM, revealed a care plan focus of Hypo [MEDICAL CONDITION] Disease [DIAGNOSES REDACTED] disease created and initiated on 07/23/18. The goal is TSH ([MEDICAL CONDITION] Stimulating Hormone) will remain within normal range X 90 days (times ninety days), created and initiated on 07/23/18. An intervention, initiated on 07/23/18, included monitor TSH annually and as ordered by the physician. Review of records revealed no lab for TSH was ever obtained. Interview with the Director of Nursing (DON) revealed no TSH had been obtained by the facility nor had the hospital obtained a TSH during a hospitalization . The DON said, I will contact the physician for orders for TSH for the next lab day. The DON agreed Resident#48 care plan was not implemented concerning this focus area.", "filedate": "2020-09-01"}
{"rowid": 2159, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "PO BOX 400", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2018-11-08", "deficiency_tag": 657, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "I3US11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, medical record review, staff interview, and policy review, the facility failed to revise a careplan for two (2) of fifteen (15) sampled residents. Resident #108's care plan was not revised when isolation was discontinued. Resident #5's care plan was not revised related to diet and nutritional supplements. Resident identifiers: #108 and #5. Facility census: 58. Findings included: a) Resident #108 The medical record was reviewed on 11/07/18. This resident was hospitalized for [REDACTED]. She returned to the facility on [DATE] and was placed on contact precautions. Review of the care plan provided by the facility found a focus for being at risk for complications of infection related to pneumonia. One of the interventions included Droplet Precautions, which was initiated on the current care plan with the date of 09/13/18, as it remains today. Observations found no evidence of any type of isolation set up for her room. On 11/07/18 at 4:00 PM an interview was conducted with the director of nursing (DON). She clarified that this resident is no longer on droplet precautions, nor has she been in droplet precautions for at least the past month. She said the care plan should have been revised to reflect that change, and it was not. b) Resident #5 During an interview on 11/06/18 at 3:16 PM, Resident #5 said he thought he was on a renal diet, but he was not sure because no one had explained his diet to him. He also stated that he was given a nutritional supplement via his feeding tube. A review of Resident #5's physician's orders [REDACTED]. Low sodium diet due to fluid overload. Another physician's orders [REDACTED]. A review of Resident #5's care plan revealed instructions to provide a pureed, no added salt (NAS) diet with a sugar substitute and no oranges, OJ, bananas, or tomatoes. Additionally, care plan diet instructions stated to provide double eggs at breakfast, double meats at lunch and dinner, and diet as ordered. Page seven (7) of the care plan instructed to give 720 cubic centimeters (cc) Glucerna. Page fifteen (15) of the care plan instructed to give one (1) can of Nepro (a nutritional supplement formulated for individuals with kidney disease) at 2:00 PM and at bedtime. A review of Resident #5's nutritional supplement orders revealed that he was to receive Nepro one (1) can at 2:00 PM and at bedtime daily, starting on 04/11/18. This order was discontinued on 05/16/18 and a new order was written on the same day to provide one (1) can of Glucerna 1.5 daily at 10:00 AM and at bedtime. Resident #5's Diet Order and Communication Form, dated 09/27/18, was used by the Director of Dining Services (DDS) to assist with preparation of Resident #5's meals. It stated that Resident #5's diet was to be Dysphagia Puree and NAS. It also indicated that the 2gm Sodium diet was to be discontinued. During an interview on 11/07/18 at 12:35 PM, the Director of Nursing (DoN) was asked about the diet the Medical Doctor (MD) had ordered for Resident #5. The DoN reviewed the paper chart and stated that Resident #5's ordered diet was a pureed two (2) gram sodium diet. When asked about the diet and supplement discrepancies between the physician's orders [REDACTED]. On 11/07/18 at 1:00 PM, the DDS was asked why Resident #5 was receiving a NAS diet when a 2 gm Sodium diet had been ordered by the physician. She stated that the facility's Registered Dietitian (RD) had recommended a NAS diet, so Resident #5's Diet Order and Communication Form was updated to reflect this. The DoN added that the diet order needed to be clarified with the MD and that the care plan needed to be updated accordingly.", "filedate": "2020-09-01"}
{"rowid": 2160, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "PO BOX 400", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2018-11-08", "deficiency_tag": 684, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "I3US11", "inspection_text": "Based on medical record review and staff interview, the facility failed to follow physician's orders for one (1) of fifteen (15) sampled residents. Resident identifier: #108. Facility census: 58. Findings included: a) Resident #108 On 11/07/18 the medical record was reviewed. On 09/19/18 the physician ordered an increase in supplements (house shake) from once daily at 10:00 AM to twice daily at 10:00 AM and 2:00 PM. A verbal order from (name of doctor) to licensed practical nurse #71 (LPN #71) was dated 09/19/18 stated House supplements BID (twice daily) at 10 a and 2 p. Review of the treatment administration record (TAR) found the supplement was offered and/or given only one time per day on 09/20/18, 09/21/18, 09/22/18, 09/23/18, 09/24/18, 09/25/18, 09/26/18, 09/27/18, 09/28/18, 09/29/18, and 09/30/18. The (MONTH) TAR contained directive for supplement twice daily as the physician ordered. On 11/07/18 at 4:00 PM the director of nursing (DON) agreed the physician's order for twice daily supplements was not placed on the TAR until 10/01/18, and that the twice daily supplements were not offered to her in September. She said the order was not transcribed on the (MONTH) TAR correctly as it should have been, and this error was not found until changeover of the monthly TAR occurred the beginning of October.", "filedate": "2020-09-01"}
{"rowid": 2161, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "PO BOX 400", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2018-11-08", "deficiency_tag": 693, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "I3US11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, record review, policy review, resident interview, and staff interview, the facility failed to ensure the administration of enteral nutrition is consistent with the physician orders. This was true for one (1) of one (1) residents reviewed for the care area of tube feeding status. This had the potential to affect more than a limited number of residents. Resident identifiers: #4 Facility census: 58 Findings included: a) Resident #4 On 11/05/18 at 02:31 PM the enteral feeding container of [MEDICATION NAME] HN was found hanging in the resident's room with no information filled out on the label as required. The 2000cal (calorie)/1000 ml. (milliliter) container had a considerable amount of residual sediment from the enteral feeding deposited on the inside top of the container, indicating the container had not been properly shook prior to being hung. Instructions on the container read, Shake well before each use. Hang product up to 48 hours after initial connection when clean technique and only when one new feeding set are used. Otherwise, hang no longer than 24 hours. On 11/05/18 the enteral feeding container had 900 ml. of [MEDICATION NAME] left in the container that had not been administered. The resident said she gets her feedings between 6:00 PM to 6:00 AM, but according to the resident the nurse hung the container now hanging at 3:00 AM that morning. There was nothing on the label to indicate the time it was hung. Review of Resident #4's quarterly minimum data set (MDS) with an assessment reference date (ARD) 11/04/18, on 11/06/18 at 11:51 AM, revealed the resident's Brief Interview for Mental Status (BIMS) with a score of fifteen (15) indicating the resident is cognitively intact. The resident is dependent for all activities of daily living. The resident has impairment in range of motion (ROM) in both sides upper and lower extremities. Resident #4 has a supra pubic catheter and is always incontinent of bowel. Pertinent [DIAGNOSES REDACTED]. The nutritional approach was a feeding tube. The proportion of total calories the resident was receiving through her tube feeding was marked 51% (percent) and more. On 11/06/18 at 01:13 PM, an interview with the unit manager nurse, RN#24, revealed nurses are supposed to label the enteral feeding container with the resident's name, room, date, start time, and rate each time a feeding container is hung. Observations, with RN#24, of the current enteral feeding container hanging in the resident's room revealed the container's label was left blank, it was not filled out with any required information. A layer of residual sediment was coating the inside top of the enteral feeding container and 300 ml. was left remaining in the container. This surveyor informed RN#24 this was the second day the container was found with the label blank and residue coating the inside top of the container. RN#24 said a nurse should not administer anything that was not labeled, especially when it did not indicate when it was opened or spiked. RN#24 said the container was going to have to be discarded and a new one hung at 6:00 PM. This survey requested all records on how the facility tracked the resident's enteral feeding that ensured the resident was receiving the nutrition that was ordered for her. On 11/06/18 at 01:33 PM, the unit manager nurse (RN#24) gave this surveyor (MONTH) (YEAR) Enteral Protocol sheet, the form RN#24 said was used for documenting and tracking the resident's feedings. The Enteral Protocol sheet was the (MONTH) orders for Resident#4's enteral feedings, and indicated the rate of the feeding, the time it was to be started and turned off (6:00 PM to 6:00 AM), and the orders for the total amount to be administered. Review of records did not indicate what the daily amounts of feeding were administer. It did not indicate the amount in the feeding container at the start or end times. It did not indicate if it was a new container bottle with 1000 ml in the container, or if the nurse administer part of what might have been left from the previous feeding before having to hang a new container. This surveyor observed 900 ml left in the container on 11/05/18 and on 11/06/18 observed 300 ml. remaining in the container. Review of orders revealed Two Cal PEG 16Fr (PEG stands for Percutaneous Endoscopic Gastrostomy, a procedure whereby a feeding tube is inserted orally into the stomach to feed patients that cannot swallow food. The size of Resident#4's tube is 16 French.) The rate, frequency, and duration of the tube feeding was ordered as seventy (70) ml per hour for twelve (12) hours a day. Run from 6:00 PM to 6:00 AM, down time was 6:00 AM to 6:00 PM. The total number of nutrients the resident is to receive is 840 ml. in a twenty-four (24) hour period. Flush with two hundred (200) ml. of water every four (4) hours. The total volume of flush is 1200 ml. in 24 hours (excluding medication flushes). The total volume of nutrient and flush is 2040 ml in 24 hours. On 11/06/18 at 02:40 PM, review of the resident's care plan revealed a focus area of Resident has an enteral feeding tube to meet nutritional needs due to TBI ([MEDICAL CONDITION]) and resulting dysphagia. (Definition of 'dysphagia' by Merriam-Webster dictionary is difficulty in swallowing.) The resident is NPO (nothing by mouth). Resident aspirates on all consistencies (indicating the resident breaths in or sucks in food into her airway no matter the texture or thickness). Review of Policy for Enteral feeding: Administration by pump, on 11/06/18 at 03:05 PM, revealed under #18 Set up feeding system instructions on how to set up a closed ready to hang system. Instructions in #18.1.2 were Fill in the information on the containers label (patient name, room number, date, start time, and flow rate). Instructions included in #18.1.3 were Label the administration set with start date and time. Instructions included in #18.1.4 were Turn container upside down and shake vigorously, using a twisting motion for at least 10 seconds. Under the instructions for documentation (#37) on enteral protocol (#24.1), instructions included #24.1.1 Formula and amount infused per feeding; and under #24.1.10 Enteral orders not administered and reason. Interview with the director of nursing (DON) and RN#24 concerning tracking Resident #4's nutritional intake, on 11/06/18 at 04:10 PM, revealed the DON spoke with the resident and was told the pump had been turned off awhile during the night due to the resident becoming sick. The DON said when she looked at the readings recorded on the pump, she was only able to view readings for the past 24-hour period. The DON said according to the pump's reading, it appeared the resident did not get about 100 ml of her prescribed feeding when it was last administered to the resident. This surveyor asked where that was documented in the resident's record, and how often did it occur when the pump might need to be turned off for any reason. The DON and RN#24 said the nurse should have charted that somewhere, and that they were going to have to look at how the facility tracked resident's tube feedings and make some changes. Review of Policy for Enteral feeding: Administration by pump, on 11/07/18 at 08:27 AM, revealed under #18 Set up feeding system instructions on how to set up a closed ready to hang system. Instructions included in #18.1.2 were Fill in the information on the containers label (patient name, room number, date, start time, and flow rate). Instructions included in #18.1.3 were Label the administration set with start date and time. Instructions included in #18.1.4 were Turn container upside down and shake vigorously, using a twisting motion for at least 10 seconds. Under the instructions for documentation (#37) on enteral protocol (#24.1), instructions included #24.1.1 Formula and amount infused per feeding; and under #24.1.10 Enteral orders not administered and reason. Observation and interview with LPN#61, on 11/07/18 at 09:35 AM, revealed a thick substance coating the inside top of the container. When LPN#61 was asked what she thought the substance was, LPN#61 replied that is sediment from the feeding where the nurse did not shake it and mix it up. LPN#61 confirmed the resident was not receiving the full nutritional value of the feeding with that much residual sediment clinging to the container. On 11/07/18 at 09:42 AM, observation with the DON present revealed the feeding sediment attached to the inside top of the feeding container. The DON agreed the resident was not getting full nutritional value with the amount of sediment present. There was also 350 ml left in the feeding container, which would indicate if the resident got a new 1000 ml container at 6:00 PM, then only 650 ml was administered, not 840 ml as ordered. RN#24 said the container was going to have to be discarded and so a new one hung at 6:00 PM due to the sediment to ensure the proper nutritional value. The DON said for tracking purposes they may have to start recording what the pump says was administered. The DON said, We need to track differently and not assume the resident is getting the correct amount just because nurses sign off the feeding is running 6:00 AM to 6:00 PM, because sometimes the feeding might be turned off for some reason and turn back on, like yesterday when the resident said it was turned off a while because she was sick.", "filedate": "2020-09-01"}
{"rowid": 2162, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "PO BOX 400", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2018-11-08", "deficiency_tag": 838, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "I3US11", "inspection_text": "Based on record review, activity calendar review, facility assessment and staff interview the facility failed to ensure facility wide assessment was conducted to thoroughly assess the needs of residents and to determine the required resources needed to provide activity programing. This issue has the potential to affect more than an isolated number of residents. Resident identifiers: Facility census: 58. Findings included: Review of the activity calendar for the month of (MONTH) (YEAR) revealed the following: Thursday 11/01/18 9:30 Meal choice (activity staff gets meal choice from each resident) 10:30 Sensory 11:30 News and Views (right before lunch while waiting in the dining room) 1:00 Meal choice 2:30 Missing Letter 4:30 TV Land ( a channel with old shows the residents are familiar with) Friday 11/03/18 9:30 Meal choice 10:00 One to One 11:30 News View a:00 Meal choice 2:30 Let's get physical 4:30 TV Land Saturday 11/03/18 9:30 Meal choice 10:00 One to One 11:30 News & Views 1:00 Meal choice 2:30 Bingo 4:30 Pre-meal social Sunday 11/04/18 9:30 Meal choice 10:30 Sensory 11:30 News and Views 1:00 Meal choice 2:30 Church 4:30 Pre meal social Monday 11/05/18 9:30 Meal choice 10:00 One to One 11:30 News and Views 1:00 Meal choice 2:30 Baptist Ladies group 4:30 TV Land Tuesday 11/06/18 9:30 Meal choice 10:30 Sensory 11:30 News & Views 1:00 Meal choice 2:30 Bingo 6:00 Singing with the Perry's (volunteer group) Wednesday 11/07/18 9:30 Meal choice 10:00 One to One 11:30 News & Views 1:00 Meal choice 2:30 Creative time 4:30 TV Land The activity calendar continues with the same pattern, with a few changes for the remainder of (MONTH) (YEAR). During the month of October, September, (MONTH) of (YEAR) there was only one scheduled evening activity each month Singing with the Perry's. The month of (MONTH) (YEAR) had no scheduled evening activities. The activity calendars did not have weekend activities outside of the activity listings mentioned. A request was made to the activity director on 11/08/18 at 11:40 AM concerning the lack of group variety and evening activities. The AD explained; she is currently the only activity staff and the facility has had difficulty keeping activity staff, the budget had been recently cut from a little over $200.00 a month to $132.00 a month, and the lack of availability to use the facility van. The van priority is doctor appointments and activities have had to be canceled in order for the van to be used to transport residents for medical needs. The AD also explained the budget does not allow for food activities. The AD explained it is becoming more difficult to get volunteers for activities, and explained that a local church had recently donated funding to buy residents CD players. The budget does not allow for providing residents with individual activity needs. The current facility assessment, section 2.1, resident support/care needs, includes Provide person-centered/direct care: Psycho/social/spiritual support, but does not refer to creating and providing activities to meet residents needs. During an interview on 11/08/18 at 10:30 AM the facility administrator was not sure of the activity budget.", "filedate": "2020-09-01"}
{"rowid": 2163, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "PO BOX 400", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2017-12-06", "deficiency_tag": 583, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "BX2G11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, staff interview and policy review, the facility failed to protect the personal privacy of residents including medical and health information. A resident's medication box and a nurse report sheet was left unattended on medication cart in the hallway. Personal identifiers including residents' names, medications, and other health information were viewable by any person in the hall. This practice affected nine (9) residents. Resident identifiers: #14, #17, #19, #38, #39, #42, #47, #53, and #205. Facility census: 60. Findings include: a) Medication Box An observation during medication administration on 12/05/17 at 9:35 a.m., on the 200 Hall, revealed Resident #53's medication box for eye drops was left on top of the medication cart in the hallway. The medication cart was unattended. The medication box for Resident #53 contained the following information: --Resident's name --Medication prescribed --Physician's name b) Nurse Report Sheet An observation during medication administration on 12/05/17 at 9:35 a.m., on the 200 Hall, revealed a Nurse Report Sheet was left on top of the medication cart. The Nurse Report Sheet contained the following: --Resident #14-Resident's name, room number, and [MEDICATION NAME] 4:15 am. --Resident #17-Resident's name, room number, and fall, evening, witness. --Resident #19-Resident's name, room number, and no caffeine. --Resident #38-Resident's name, room number, and increased [MEDICATION NAME]-redraw-Thursday. --Resident #39-Resident's name, room number, and 3:30 am-Tylenol. --Resident #42-Resident's name, room number, and 2:15 Neb tx. --Resident #47-Resident's name, room number, and change R heel-skin prep. --Resident #205-Resident's name, room number, and Dr. Safely, p/u 12. An interview with Licensed Practical Nurse (LPN) #18 on 12/05/17 at 9:45 a.m. revealed the LPN should have not left the Nurse Report Sheet and medication box unattended on the medication cart. The LPN stated she knows better. A review of the facility's policy, on 12/05/17 at 11:45 a.m., titled OPS209 Privacy Rights with a revision date of 11/28/16 revealed The patient has a right to personal privacy and confidentiality oh his/her personal and medical records. b) Resident #53 During the medication observation on 12/05/17 at 9:37 AM, LPN #18 left the eye medication [MEDICATION NAME] 0.2-0.5% box on top of the medication cart for Resident #53. The box contained the resident's name, doctor name, medication name. The nurse also left the report sheet out on top of the medication cart which contained multiple resident's information on it. Resident #4, #14, #17, #19, #38, #39, #42, #47, #205 had identifiable medical information on the report sheet including name, room number, and medical information. During an interview on 12/05/17 at 9:45 AM, LPN #18 stated she usually turns the report sheet over when she walks away from her medication cart. The LPN stated she knows not to leave medication boxes and containers on top of the medication cart when she walks away. The LPN stated it is definitely a privacy issues and that she knows better. Facility Policy Review-Titled OPS209 Privacy Rights: Patient Revision Date-11/28/16 confirmed the patient has a right to personal privacy and confidentiality of his/her personal and medical records. Personal privacy includes accommodations, medical treatment, written, telephone and electronic communications, personal care, visits, and meetings of family and patient groups. ,", "filedate": "2020-09-01"}
{"rowid": 2164, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "PO BOX 400", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2017-12-06", "deficiency_tag": 584, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "BX2G11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and staff interview, the facility failed to provide maintenance services for one (1) of twenty seven (27) rooms observed during the Long Term Care Survey Process. The issue identified included a resident's bathroom with paint missing and hanging from the ceiling. Room identifier: #103. Facility census: 60. Findings include: a) room [ROOM NUMBER] The following observation was made on 12/04/17: --room [ROOM NUMBER]-The bathroom ceiling above the sink had paint missing as well as several large paint chips hanging from the ceiling. An interview with the facility's Administrator on 12/06/17 at 9:30 a.m. revealed the Administrator was not aware of the paint falling from the bathroom ceiling. The Administrator stated he would ensure that maintenance fixed the ceiling immediately.", "filedate": "2020-09-01"}
{"rowid": 2165, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "PO BOX 400", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2017-12-06", "deficiency_tag": 689, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "BX2G11", "inspection_text": "Based on observation and staff interview, the facility failed to provide an environment free from accident hazards over which the facility had control. Chemical substances, shaving razors, and skin treatments, were unsecured and accessible to residents in the 100 and 200 Hall Shower Rooms. This practice had the potential to affect more than a limited number of residents. Facility census: 60. Findings include: a) 100 Hall Shower Room A tour of the 100 Hall, on 12/04/17 at 11:15 a.m., revealed the Shower Room did not have a lock on the door. The room contained the following items: --Two (2) containers of Medspa Shave Cream with the warning Keep out of reach of children. --One (1) container of Gold Bond Body Powder with the warning Keep out of reach of children-If swallowed get medical help or contact a Poison Control Center. b) 200 Hall Shower Room A tour of the 200 Hall Shower Room, on 12/04/17 at 11:25 a.m., revealed the Shower Room did not have a lock on the door. The room contained the following items: --One (1)-container of Soothe and Cool Inzo Barrier Cream with 5% Dimethicone with the warning Keep out of reach of children-If swallowed get medical help or contact a Poison Control Center. --One (1)-container of Medline Remedy Phytoplex Z Guard Paste with the warning Keep out of reach of children-If swallowed get medical help or contact a Poison Contact Center. --Two (2) containers of Medspa Shave Cream with the warning Keep out of reach of children. --Fifteen (15) uncapped razors in an unlocked biohazard infectious waste container. --Eight (8) capped razors in a bucket. An interview with the Director of Nursing (DON) on 12/04/17 at 11:30 a.m. revealed the shower rooms are never locked. The DON stated the razors and other care products should be secured away from the residents. The DON stated I had no idea the items in the shower rooms were there.", "filedate": "2020-09-01"}
{"rowid": 2166, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "PO BOX 400", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2017-12-06", "deficiency_tag": 761, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "BX2G11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and staff interview, the facility failed to ensure expired medication and enteral feedings were removed after the expiration date. Twenty-two cans of enteral feeding supplies and a bottle of multivitamins were found expired on the shelves in the medication storage room. This had the potential to affect more than an isolated number of residents. Facility census: 60. Findings include: a) On [DATE] at 2:32 p.m. observations of the medication storage room revealed one bottle of stock multivitamins (Ondra One daily) had an expiration of date of (MONTH) (YEAR). The storage room also contained 20 cans of Glucerna and two (2) cans of Two Cal which had an expiration date of (MONTH) (YEAR). On [DATE] at 12:00 p.m. Center Nursing Executive Sr #13 confirmed the enteral feeding and multivitamins should have been discarded at the time they expired.", "filedate": "2020-09-01"}
{"rowid": 2167, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "PO BOX 400", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2017-12-06", "deficiency_tag": 880, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "BX2G11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and staff interview, the facility failed to maintain an infection prevention and control program to help prevent the development and transmission of communicable diseases and infection to the extent possible. During a random observation, a nurse was observed placing a bottle of lancets and a resident-shared glucometer directly onto a resident's overbed tray with no barrier, and in so doing contaminated the surface of the lancet bottle and glucometer. Prior to surveyor intervention, the nurse failed to disinfect the contaminated bottle of unused lancets before attempting to place the bottle back into the medication cart where some residents' medications were stored. Also, the nurse contaminated the clean surface of the medication cart by placing the contaminated glucometer and bottle of unused lancets directly onto the work area surface of the medication cart. This had the potential to affect more than a limited number of residents on the 100 hall. Facility census: 60. Findings include: a) On 12/04/17 at 12:24 p.m., Licensed Nurse #18 checked the blood sugar of a resident who received [MEDICAL TREATMENT] treatments three (3) times weekly. During the process, she laid the glucometer and a small bottle of unused lancets directly onto the resident's overbed tray without providing a barrier of any type. This contaminated the surface of the bottom of the glucometer and the outside of the bottle of unused lancets. After the blood sugar was completed, the nurse wiped the glucometer with an alcohol wipe, then left the resident's room. The nurse was asked if all of the residents used the same glucometer, and if all the residents used lancets from the bottle she held in her hand. The nurse replied that all of the diabetic residents on the 100 hall shared the same glucometer and the same bottle of unused lancets. She said they disinfect the glucometer with Micro-Kill bleach wipes after every patient use. She then entered the medication storage room, while still carrying the glucometer and the bottle of unused lancets. She accidentally dropped the glucometer onto the floor of the medication storage room. She picked up the glucometer from the floor, then placed both the glucometer and the small bottle of unused lancets directly onto the top of the medication cart. Those contaminated items were laid directly onto the area of the medication cart where nurses prepare medications to administer to residents on the 100 hall. The nurse obtained a Micro-Kill wipe and cleaned and disinfected the entire surface of the glucometer before returning it to the top drawer of the medication cart. However, she did not clean or disinfect the outside area of the bottle of unused lancets which had been in direct contact with the [MEDICAL TREATMENT] resident's overbed tray. She picked up the bottle of unused lancets off the top of the medication cart, and was in the process of laying the bottle of lancets in the top drawer of the medication cart, prior to surveyor intervention of stopping her. Upon inquiry as to what she should first do with the bottle of lancets before laying them in the top drawer of the medication cart, she was unable to say. When told that the bottle of lancets became potentially contaminated when she placed it directly onto the resident's overbed tray without a barrier, she agreed that she should have disinfected the outside of the bottle of lancets prior to returning it to the medication cart drawer. When told that she also contaminated the top of her medication cart when she laid the contaminated glucometer and bottle of lancets on it, she agreed that she had done so, but had not realized it. She then obtained Micro-Kill and disinfected the outside of the lancet bottle before returning it to the medication cart drawer. She also used Micro-Kill to disinfect the top of her medication cart. An interview was conducted with the director of nursing (DON) on 12/06/17 at 11:26 a.m. She said the nurse told her about not disinfecting the lancet bottle or medication cart, and not using a protective barrier in the resident's room. She allegedly told the DON that she was trying to recall all the correct steps and was nervous. The DON agreed that the nurse should not have placed the glucometer and bottle of unused lancets onto the unclean surface of the resident's overbed tray without a barrier. The DON agreed that the nurse should have disinfected the surface of the bottle of unused lancets before returning it to the medication cart drawer, and should have disinfected the top of the medication cart after she laid those potentially contaminated items on it. She said the facility has policies in place for preventing cross contamination of inanimate objects by using good nursing practices. She said the nurse knew better, but was nervous.", "filedate": "2020-09-01"}
{"rowid": 4390, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "PO BOX 400", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2016-11-09", "deficiency_tag": 241, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "B8Y111", "inspection_text": "Based on observation and staff interview, the facility failed to ensure the dignity of residents during the dining experience. This was evident for two (2) random observations. Resident #27 was fed by nursing staff while the staff member stood over her. The same was true for resident #52. Both residents were cognitively and physically impaired, and unable to feed themselves. Resident identifiers: #27, #52. Facility census: 59. Findings include: a) Resident #27 On 10/31/16 at 12:22 a.m., an observation revealed Resident #52 lying in her bed. Nurse Aide (NA) #76 stood by the resident's bed, and spoon fed her pureed meal. She stood over the resident through the entire meal. The resident was unable to be interviewed due to cognitive impairment. Review of the quarterly minimum data set (MDS), with assessment reference date (ARD) 08/03/16, revealed moderate cognitive impairment. She required extensive assistance of two (2) for bed mobility, and extensive assistance for eating. b) Resident #52 On 11/01/16 at 12:25 p.m., Registered Nurse #35 stood by the resident's bed, and spoon fed her meal. She stood over the resident while she fed her, rather than obtaining a chair and sitting down by the resident in a more dignified manner. The resident was unable to be interviewed due to cognitive impairment. Review of the quarterly minimum data set, (MDS) with assessment reference date (ARD) of 10/03/16, revealed severe cognitive impairment. She was totally dependent on staff for eating her mechanically altered diet. On 11/01/16 at 5:15 p.m., an interview was conducted with the director of nursing (DON) to ascertain if she felt the practice of standing over residents while feeding them was an acceptable standard at this facility. She replied in the negative. She said it is their practice at the facility to sit down beside the residents while feeding them, rather than standing over them. She said that standing over a resident while feeding them is undignified. She said she would speak to nursing staff about this finding. On 11/01/16 at 6:09 p.m., NA #62 said she often feeds Residents #27 and #52. She said she always pulls up a chair and sits down beside them as she feeds them. She was observed earlier this evening sitting down by a different resident as she fed her. NA #56 said staff are supposed to sit down and feed the residents casually and talk to them, and are not supposed to stand over residents as they feed them.", "filedate": "2019-11-01"}
{"rowid": 4391, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "PO BOX 400", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2016-11-09", "deficiency_tag": 246, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "B8Y111", "inspection_text": "Based on observation, staff and resident interview, it was determined the facility failed to provide Resident #24 an alternative to call for assistance due to the inability to always push the call light button. This practice affected one (1) of thirty (30) Stage 1 sampled residents for reasonable accommodation of individual needs. Resident identifier: #24. Facility census: 59. Findings include: a) Resident #24 When Resident #24 was asked, during Stage one (1) of the Quality Indicator Survey(QIS), to push the call bell button to test to see if it was functioning properly, Resident #24 replied, If I can. When asked what she meant by, If I can, the resident replied, I can't always push the button to make the call light work. Sometimes I just can't. The resident was asked what she did when she was unable to push the call light button. The resident replied, I get my roommate to push her call light. During the time of the interview the resident was alone in her room, the roommate was not present. The resident was then asked, What do you do when your roommate is not here? The resident replied, I holler for staff or just wait until somebody comes by. When asked if the resident had ever told any staff she had a problem pushing the call light button, the resident replied, Yes, several times. Resident #24 was unable to give any names of the staff she had told. An interview with Licensed Practical Nurse (LPN) #52, on 10/31/16 at 4:25 p.m., revealed Resident #24 had talked her about having difficulties pushing her call light button. LPN #52 stated, It has been a while ago since she talked to me about it. I did not know it was still a recent problem. The Director of Nursing (DON) was notified about the issue and was informed that the resident had informed the facility staff that she was unable at times to push the call light. The facility promptly provided a touch pad call bell for the resident. This occurred after surveyor intervention and after the facility confirmed the problem with Resident #24.", "filedate": "2019-11-01"}
{"rowid": 4392, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "PO BOX 400", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2016-11-09", "deficiency_tag": 280, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "B8Y111", "inspection_text": "Based on observation, record review, and staff interview the facility failed to revise the care plan to reflect the resident's current status. This failed practice had the potential to affect one (1) of twenty one (21) sampled residents. Resident identifier: # 57. Facility census: 59. Findings include: a) Resident #57 Interview with Nurse Aide (NA #50), on 11/02/16 at 11:05 a.m., revealed Resident #57 required total care and was dependent for activities of daily living (ADL). NA #50 said, We reposition her (Resident #57) every two (2) hours and check her briefs and change her. We use to get her up to the toilet, but not for a good while, she's not able. On 11/02/16 at 1:04 p.m., review of quarterly Minimum Data Set (MDS) with an assessment reference date (ARD) of 10/16/16 revealed a Brief Interview for Mental Status (BIMS) score of 3 indicating severe mental status impairment. Resident #57's MDS showed Resident #57 was dependent for care, including toileting, bathing, personal hygiene, and is always incontinent of bowel and bladder and is not on a toileting program. Review of the care plan, on 11/07/16 at 3:47 p.m., revealed a focus area which stated, Resident requires a limited assist to extensive at times with ADLs. She does have cognitive loss secondary to dementia. Resident does transfer and toilet herself independently at times . Other focus areas noted were, Resident is occasional incontinent of urine with potential for improved control or management of urinary elimination, and, Resident is occasional incontinent of bowel with potential for improved control or management of bowel elimination. Interventions included: --Assist resident to toilet at scheduled times --Discuss and plan voiding schedule with resident --Maximize physical activity to enhance general muscle tone, functioning of lower GI (gastrointestinal) tract, and ability to mobilize to bathroom in response to urge to defecate On 11/07/16 at 4:29 p.m., an interview with Registered Nurse (RN ) #38, revealed resident was dependent for care. RN #38 agreed Resident #57's care plan has not been revised to match her current status.", "filedate": "2019-11-01"}
{"rowid": 4393, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "PO BOX 400", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2016-11-09", "deficiency_tag": 309, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "B8Y111", "inspection_text": "Based on observation, record review, and staff interview, the facility failed to provide the necessary care and services to ensure residents attained or maintained good body alignment and comfortable positioning while the resident was lying in bed. This was true for one (1) of twenty one (21) sampled residents. Resident identifier: #57. Facility census: 59 Findings include: a) Resident #57 Observation of Resident #57, on 11/02/16 at 11:05 a.m., revealed she was lying on her bed in poor body alignment. After Nurse Aide (NA) #50 completed her peri-care, she assisted and positioned Resident #57 to lie on the resident's back. Both of the resident's legs were observed with the knees bent in an upright position perpendicular to the bed, with the soles of both feet laying flush on the bed. The resident stated she was cold, and NA #50 covered Resident #57 with a blanket. When the blanket was placed on the resident, her bent upright legs started to tilt to the right and the resident grimaced. NA #50 started to leave, the surveyor asked NA #50 if she would look at the resident and see if there were any issues. NA #50 acknowledged, after surveyor intervention, that Resident #57 needed a pillow to support her legs, and proceeded to reposition the resident with a pillow supporting both legs. On 11/02/16 at 1:04 p.m., review of quarterly Minimum Data Set (MDS) with an assessment reference date (ARD) of 10/16/16 revealed a Brief Interview for Mental Status (BIMs) score of 3 indicating severe mental status impairment. Resident #57's current MDS showed resident was dependent for care, including toileting, bathing, and personal hygiene. Review of the care plan, on 11/07/16 at 3:47 p.m., revealed she was to maintain good body alignment and she was at risk for alterations in comfort with an intervention to assist resident to a position of comfort, utilizing pillows as appropriate positioning device.", "filedate": "2019-11-01"}
{"rowid": 4394, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "PO BOX 400", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2016-11-09", "deficiency_tag": 431, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "B8Y111", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, staff interview, and policy review, the facility failed, in collaboration with the pharmacist, to ensure the safe and effective use of medications. A multi-dose vial of purified protein derivative (PPD), a medication injected beneath the skin to aid in the detection of exposure to [DIAGNOSES REDACTED], was not dated when initially opened. This had the potential to negatively impact the safety and/or potency of the medication, and had the potential to affect any resident who might receive an injection of medication/serum from this vial. Facility census: 59. Findings include: a) On 11/01/16 at 1:52 p.m., the facility's only medication room refrigerator was observed, accompanied by licensed practical nurse #41. An opened and partially used multi-dose vial of Aplisol purified protein derivative (PPD) was stored in the medication room refrigerator. When full, this vial held ten (10) doses. The vial was about half full, indicating that approximately five (5) doses remained. The vial contained no date to indicate the time interval since it was first opened. Nurse #41 said she believed the vial could only be used for thirty (30) days after opening it. She said since the vial was undated, it could not be determined when it was first opened, or when the thirty (30) day period was over. She disposed of the vial immediately. Review of the facility's policy entitled 3.8 Accessing a Multi-Dose Vial, with revision date 07/01/12, stated under section 7 that multi-dose vials are to be discarded if open and undated. It also stated that multi-dose vials are to be discarded within twenty-eight (28) days of opening, or as specified by the manufacturer for an open vial. On 11/01/16 at 5:15 p.m., the director of nursing (DON) was interviewed. She said that licensed nurses are supposed to date multi-dose vials when initially opened, then dispose of the vial thirty (30) days after first opened. She agreed that their policy was not followed in this case.", "filedate": "2019-11-01"}
{"rowid": 4395, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "PO BOX 400", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2016-11-09", "deficiency_tag": 441, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "B8Y111", "inspection_text": "Based on observation and staff interview the facility failed to provide a safe and sanitary environment, to help prevent the development and transmission of disease and infection. Resident care equipment was stored improperly in two (2) separate instances. Two (2) hoyer lift cloth slings were observed lying directly on an unclean surface, and a plastic cart used to store resident's personal care items inside its storage drawers, was observed under a sink resting directly on the floor. A breach in infection control principal and practices was also observed while staff was providing peri-care for Resident #57. These practices had the potential effect more than a limited number of residents in the facility. Resident identifier: #57. Facility census: 59 Findings include: a) Hoyer lift slings On Unit 1, during the initial tour on 10/31/16, hoyer lift cloth slings were observed hanging on hooks mounted to the wall beside the hoyer lifts. Each cloth sling was meant to be hung by the sling's strap and buckles on both sides of the sling, leaving the slings hanging half way down the wall. Two (2) hoyer lift cloth slings were observed with only one side of the slings hung on a hook. The two (2) slings hung by only one side, dangled all the way down the wall, leaving their other side's buckles, straps, and area of the cloth lying directly on the floor. On 10/31/16 at 11:40 a.m., Registered Nurse Unit 1 Manager (RN) #38, accompanied this surveyor and observed the two (2) hoyer lift cloth slings resting on the floor. RN #38 agreed this was an infection control issue, and the slings were not supposed to be on the floor. RN #38 stated, I will have them removed, and have to have them washed. b) Storage drawers On 11/02/16 at 11:05 a.m., a plastic cart, used to store resident's personal care items inside its storage drawers, was observed under a sink resting directly on the floor in Resident #57 room. An interview with Registered Nurse/Nurse Practice Educator/Infection Control (RN #29), on 11/02/16 at 11:18 a.m., verified the plastic cart with storage drawers should not be resting on the floor, and did not know why the wheels had been removed. RN #29 confirmed this was an infection control issue. c) Resident #57 (peri-care) Observation of Nurse Aide (NA) #50 providing peri-care to Resident #57, on 11/02/16 at 10:49 a.m., revealed a breach in infection control practice. During the provision of peri-care, NA #50 removed the soiled brief and placed it directly on the foot of bed without a barrier. An interview with RN #29, Nurse Practice Educator/ Infection Control, on 11/02/16 at 11:18 a.m., revealed RN #29 agreed a used soiled brief should never be placed directly on a resident's bed. RN #29 stated, The NA should not have placed a soil brief on the bed, it was a breach in infection control practice.", "filedate": "2019-11-01"}
{"rowid": 5005, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "PO BOX 400", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2016-04-20", "deficiency_tag": 165, "scope_severity": "D", "complaint": 1, "standard": 0, "eventid": "06GH11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on resident interview, family interview, staff interview, medical record review, and facility record review, the facility failed to ensure the rights of one (1) of six (6) sample residents to voice grievances without reprisal. Resident #33 related a Licensed Practical Nurse (LPN) and a Nurse Aide (NA) retaliated against the resident after a complaint was initiated over the administration of a medication. The nurse confronted the resident and the nurse aide did not assist with a transfer from chair to bed, and required the resident remain in his chair for over two (2) hours after dinner. Resident identifier: #33. Facility census: 57. Findings include: a) Resident #33 During an interview with Resident #33 and his wife on 04/18/16 from 4:04 p.m. to 4:45 p.m., Resident #33's wife said a complaint had been initiated about the administration of [MEDICATION NAME], but it was a misunderstanding. According to the resident's wife, the resident thought he received Tylenol instead of [MEDICATION NAME]. Resident #33 agreed with his wife's statement. Resident #33's wife related Licensed Practical Nurse (LPN) #20 came to the resident's room, and said they needed to talk. The nurse told Resident #33 She did not appreciate him reporting her to the administrator. The resident's wife indicated the nurse had said they had gotten her in trouble. Resident #33 and his wife also related LPN #20 had said to him that she had her medication cart at his door every day at 4:00 p.m. They also stated she asked him, Do you know what this is? and he had answered, Tylenol?, and the nurse had responded, No, it's (it is) your [MEDICATION NAME]. Resident #33's wife related the Center Nurse Executive (CNE) had entered the room and spoken with LPN #20, and they exited the room. Resident #33 related she had apologized to the nurse for the misunderstanding, and had called the facility and offered her apologies. Resident #33 related the day after the incident, he was in his chair for dinner and requested to return to bed. He said NA #82 (LPN #20's spouse) walked up and down the hallway assisting the other NA, looked in his room and glared, but did not attempt to assist with a transfer to bed. NA #82 was assigned to 100 hallway, but was helping the NAs on the 200 hall where the resident resided. According to the resident, he was left in his chair for two (2) hours and 20 minutes after dinner. The medical record, reviewed on 04/18/16 at 3:00 p.m., found a 90 day minimum data set (MDS) assessment, with an assessment reference date (ARD) of 04/09/16, identified the resident scored 13 of a possible 15 for the Brief Interview for Mental Status (BIMS) - indicating the resident was cognitively intact. The assessment also identified Resident #33 required the extensive assistance of two (2) persons for transfers. [DIAGNOSES REDACTED]. The pain assessment indicated he received scheduled pain medication, and received as needed (PRN) medication and/or was offered medication and received non-medication interventions for pain. The care plan, reviewed on 04/18/16 at 3:08 p.m., revealed he was dependent upon staff for transfers and locomotion due to left sided [MEDICAL CONDITION]. Progress notes, reviewed from the date of admission on 01/05/16, indicated a lift-transfer assessment was completed on 01/05/16. The assessment indicated the resident required a total lift for transfers. An interview with the social worker (SW) on 04/19/16 at 3:35 p.m., revealed she had no additional concerns and/or grievances other than what was provided on 04/18/16. The SW related the facility took allegations Very seriously. Resident #33 and his wife, interviewed on 04/19/16 at 3:45 p.m., related it was okay to speak with the Center Nurse Executive (CNE) and social worker, related to the incident involving LPN #20 and NA #82. During an interview on 04/19/16 at 4:30 p.m., CNE revealed she was aware of the concern related to the allegations Resident #33 and his wife had reported during the interview. She also said a concern had been filed with the corporate compliance line. Concern/grievance/complaint forms, reviewed with the CNE, found no evidence the complaint had been initiated. She related the information may have been placed in another file and exited the room. She returned with a complaint filed with the compliance line. She related it was a mixture of things which were misinterpreted. The CNE said she was standing three (3) doors down on the 200 hallway when the interaction with LPN #20 and Resident #33 occurred. When she heard the conversation, she went to the room and intervened. The CNE stated she instructed the LPN to allow the facility to handle the situation. She also confirmed NA #82 assisted on the hallway, and had spoken with him and LPN #20. The CNE indicated the staff informed her the resident had remained up in his chair for over two (2) hours 'because they were preparing him for discharge to home. The CNE confirmed she had not interviewed other staff working with NA #82, the date of the incident and could not provide evidence the facility had investigated thoroughly to refute the allegation of retaliation.", "filedate": "2019-04-01"}
{"rowid": 5006, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "PO BOX 400", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2016-04-20", "deficiency_tag": 225, "scope_severity": "D", "complaint": 1, "standard": 0, "eventid": "06GH11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on resident interview, family interview, staff interview, facility record review, review of facility policies, and medical record review, the facility failed to ensure all alleged violations concerning mistreatment, abuse, and neglect were reported immediately to the administrator and/or to State agencies. Additionally, the facility failed to provide sufficient evidence that all alleged violations were thoroughly and/or investigated timely, and failed to prevent further potential abuse while the investigation was in progress. This practice affected two (2) of three (3) sample residents. Resident identifiers: #33 and #27. Facility census: 57. Findings include: a) Resident #33 During an interview with Resident #33 and his wife, on 04/18/16 from 4:04 p.m. to 4:45 p.m., an inquiry as to whether the resident had experienced abuse or neglect revealed an incident involving the administration of [MEDICATION NAME]. Resident #33's wife recounted an incident on 04/05/16 concerning the administration of [MEDICATION NAME], and how it was actually a misunderstanding. His wife said Resident #33 thought he was receiving Tylenol, but was actually receiving [MEDICATION NAME]. She related Licensed Practical Nurse (LPN) #60 came to the room and said, We need to talk. Resident #33 and his wife related the nurse told the resident that she did not appreciate him reporting her to the administrator. His wife indicated the nurse spoke in an angry and confrontational manner and that LPN #60 thought Resident #33 should have known what he was receiving. She said the nurse came in again the next evening and asked, Do you know what this is? The resident had replied, Tylenol? and the nurse responded, No it's (it is) your [MEDICATION NAME]. The resident related his wife had apologized to LPN #60 for the misunderstanding. During the interview on 04/18/16, Resident #33's wife said she called her husband on 04/06/16, the evening after the confrontation with LPN #60. She related the resident informed her that he was up in his chair and they would not put him to bed. The resident had told her LPN #60's husband, Nurse Aide (NA) #82, who was a nurse aide on the 100 hallway, was helping on the 200 hallway and would walk by and glare, but would not come into the room and did not help put him to bed. Resident #33's wife further added, RN #20 had come to the room the date of the confrontation by LPN #60 and the LPN exited the room with the RN. Both the resident and his wife related no one had responded to their concern about the way they were treated by the nurse and the nurse aide. The wife related she had contacted the corporate office. Resident #33 and his wife related she had spoken with Registered Nurse (RN) #20 and the social worker on a three (3) way call on 04/08/16. The concern/grievance log book and reportable allegation log book, reviewed on 04/18/16 at 5:00 p.m., revealed no evidence of Resident #33's concerns. During an interview on 04/19/16 at 4:30 p.m., RN #20, acknowledged she was aware of Resident #33's allegations. She said it was a concern that was a mixture of things which were misinterpreted, and the complaint had come through the compliance line from the corporate office. RN #20 related she would check the administrator's office, and returned with the complaint reported on the compliance line. The RN related, It was all a big misunderstanding. She said Resident #33 thought he had not been given his medication and had reported it to administration. She related LPN #60 did speak with the resident about the incident on 04/05/16, and the next evening (04/06/16), and NA #82 was assigned to Hallway 100, but assisted the NA on Hallway 200, where Resident #33 resided. RN #20 stated the nurse aide had informed her he may have glanced at the room as he was passing by and related he did not assist to transfer the resident to bed. According to RN #20, the resident was not assisted to bed when requested, and was returned to bed about 8:10 p.m. She related when she had inquired, LPN #60 related she wanted him to stay up for two (2) hours after dinner, to prepare him for discharge. Review of the care plan, on 04/19/16, revealed no evidence of a care plan requiring the resident to stay up in his chair. The care plan indicated staff should encourage the resident, but that he should remain up in his chair as tolerated. The RN added that during this time, the social worker had called Resident #33's wife on 04/06/16 to set up a discharge-planning meeting and his wife had expressed to the social worker that she thought it was retaliation because of reporting the concern about the [MEDICATION NAME]. RN #20 related she had received the complaint from the compliance line on 04/07/16 and responded to corporate office on 04/08/16. She related she did not report the allegations because she believed it was all a misunderstanding. The compliance line information received by the facility on 04/07/16, reviewed with RN #20 at 4:40 p.m., revealed the caller stated her husband waited for over two (2) hours to be transferred to his bed after the dinner meal. The caller also stated that (LPN #60's name) jumped on her and the resident for reporting her (the nurse); and that (names of NA #82 and LPN #60) walked by the resident, staring at him to cause an uncomfortable situation. The complaint also indicated the social worker left her a message of a meeting on 04/11/16 to discuss Resident #33's discharge and that he was not ready to be discharged . RN #20's written response to the allegations made on the compliance line, dated 04/08/16, indicated she and the social worker contacted Resident #33's wife regarding her complaint. The report included, The nurse previously confirmed that the conversation had occurred Additionally, the report indicated RN #20 spoke with NA #82 regarding the incident and NA #82 acknowledged being on the hallway assisting another NA. The report indicated the facility would be observant of any behaviors exhibited by (names of NA #82 and LPN #60) which may be perceived as making (Resident #33 and his wife) uncomfortable. The incident details of the report noted Resident #33, Was gotten out of bed a few minutes after 5 pm to eat dinner. He was assisted back to be at 8:10 pm that evening. During the interview with RN #20 on 04/19/16 at 4:30 p.m., she acknowledged the facility failed to complete a thorough investigation, as only the alleged perpetrators were interviewed related to Resident #33's allegation of verbal abuse, mental abuse, and neglect. Additionally, she acknowledged the allegations of abuse and neglect had not been reported to the appropriate State agencies. While reviewing the written response to the compliance line with RN #20, on 04/19/16 at 4:40 p.m., she related she had not interviewed any staff on duty the night of the allegation of neglect (leaving the resident up for over two (2) hours after dinner), or regarding NA #82's demeanor. The RN related she did not realize the allegations required reporting, because the complaint was received on the compliance line. b) Resident #27 Reportable allegations, reviewed on 04/20/16, revealed a substantiated allegation of verbal abuse with an incident date of 03/19/16. The immediate reporting form indicated the facility reported the allegation late to the appropriate State agencies. According to the report, Nurse Aide #103 made derogatory remarks to Resident #27 and told her to Shut her damn mouth. The report noted the resident was resisting with transfers and (NA #103's name) said, You need to stop it or I will have to put your ass on the floor The report also noted Resident #27 was mentally incapacitated, elderly, frail, and in a wheelchair (w/c). Witness statements indicated the allegation was first reported to Licensed Practical Nurse #47, who was working as an NA on that date (03/19/16). The nurse's statement included that she did not feel it was her place to act, and that it should have been reported to the charge nurse on duty. Registered Nurse #49's statement noted she was informed of the allegation on 03/21/16, and after speaking with NA #71, informed DON (director of nursing) of what I had been told. The witness statement by the social worker indicated she became aware of the incident on 03/23/16, at which time she reported it. During an interview with the administrator on 04/20/16 at 11:42 a.m., she related, We marked it as reporting late didn't (did not) we? The administrator agreed the incident should have been reported when identified. NA #103's time card, reviewed with Bookkeeper #28, on 04/20/16 at 11:55 a.m. revealed the NA worked on: -- 03/19/16 from 5:58 a.m. - 2:06 p.m.; -- 03/20/16 from 5:59 a.m. - 10:30 p.m.; and -- 03/22/16 from 5:59 a.m. - 2:00 p.m. (a double shift). A follow-up interview with the administrator, on 04/20/16 at 1:30 p.m., confirmed NA #103 had worked during the interim when the allegation was first reported to LPN #47 on 03/19/16 and the date reported on 03/23/16. She confirmed the facility had not ensured the safety of the resident(s). During the interview with the administrator on 04/20/16 at 12:30 p.m., she acknowledged the facility failed to ensure Resident #27's safety by allowing NA #103 to work on 03/19/16, 03/20/16, and 03/22/16. The administrator acknowledged the allegation of verbal abuse should have been reported to the appropriate State agencies immediately.", "filedate": "2019-04-01"}
{"rowid": 5007, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "PO BOX 400", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2016-04-20", "deficiency_tag": 226, "scope_severity": "D", "complaint": 1, "standard": 0, "eventid": "06GH11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on resident interview, staff interview, facility record review, and policy review, the facility failed to implement its written policies prohibiting mistreatment, neglect, and abuse of residents. The facility failed to conduct a thorough investigation, failed to report occurrences, and failed to ensure residents were protected from harm during an investigation. This affected two (2) of three (3) residents reviewed for allegations of abuse. Resident identifiers: #33 and #27. Facility census: 57 Findings include: a) Resident #33 During an interview with Resident #33 and his wife, on 04/18/16 from 4:04 p.m. to 4:45 p.m., an inquiry as to whether the resident had experienced abuse or neglect, revealed an incident involving the administration of [MEDICATION NAME]. Resident #33's wife recounted an incident on 04/05/16, concerning the administration of [MEDICATION NAME], and how it was actually a misunderstanding. His wife said Resident #33 thought he was receiving Tylenol, but was actually receiving [MEDICATION NAME]. She related Licensed Practical Nurse (LPN) #60 came to the room and said, We need to talk. Resident #33 and his wife related the nurse told the resident that she did not appreciate him reporting her to the administrator. His wife indicated the nurse spoke in an angry and confrontational manner and that LPN #60 thought Resident #33 should have known what he was receiving. She said the nurse came in again the next evening and asked, Do you know what this is? The resident had replied, Tylenol? and the nurse responded, No it's (it is) your [MEDICATION NAME]. The resident related his wife had apologized to LPN #60 for the misunderstanding. During the interview, on 04/18/16, Resident #33's wife said she called her husband on 04/06/16, the evening after the confrontation with LPN #60. She related the resident informed her that he was up in his chair and they would not put him to bed. The resident had told her LPN #60's husband, Nurse Aide (NA) #82, who was a nurse aide on the 100 hallway, was helping on the 200 hallway and would walk by and glare, but would not come into the room and did not help put him to bed. Resident #33's wife further added, RN #20 had come to the room the date of the confrontation by LPN #60 and the LPN exited the room with the RN. Both the resident and his wife related no one had responded to their concern about the way they were treated by the nurse and the nurse aide. The wife related she had contacted the corporate office. Resident #33 and his wife related she had spoken with Registered Nurse (RN) #20 and the social worker on a three (3) way call on 04/08/16. The concern/grievance log book and reportable allegation log book, reviewed on 04/18/16 at 5:00 p.m., revealed no evidence of Resident #33's concerns. During an interview on 04/19/16 at 4:30 p.m., RN #20, acknowledged she was aware of Resident #33's allegations. She said it was a concern that was a mixture of things which were misinterpreted, and the complaint had come through the compliance line from the corporate office. RN #20 related she would check the administrator's office, and returned with the complaint reported on the compliance line. The RN related, It was all a big misunderstanding. She said Resident #33 thought he had not been given his medication and had reported it to administration. She related LPN #60 did speak with the resident about the incident on 04/05/16, and the next evening (04/06/16), and NA #82 was assigned to Hallway 100, but assisted the NA on Hallway 200, where Resident #33 resided. RN #20 stated the nurse aide had informed her he may have glanced at the room as he was passing by and related he did not assist to transfer the resident to bed. According to RN #20, the resident was not assisted to bed when requested, and was returned to bed about 8:10 p.m. She related when she had inquired, LPN #60 related she wanted him to stay up for two (2) hours after dinner, to prepare him for discharge. Review of the care plan, on 04/19/16, revealed no evidence of a care plan requiring the resident to stay up in his chair. The care plan indicated staff should encourage the resident, but that he should remain up in his chair as tolerated. The RN added that during this time, the social worker had called Resident #33's wife on 04/06/16 to set up a discharge-planning meeting and his wife had expressed to the social worker that she thought it was retaliation because of reporting the concern about the [MEDICATION NAME]. RN #20 related she had received the complaint from the compliance line on 04/07/16 and responded to corporate office on 04/08/16. She related she did not report the allegations because she believed it was all a misunderstanding. The compliance line information received by the facility on 04/07/16, reviewed with RN #20 at 4:40 p.m., revealed the caller stated her husband waited for over two (2) hours to be transferred to his bed after the dinner meal. The caller also stated that (LPN #60's name) jumped on her and the resident for reporting her (the nurse); and that (names of NA #82 and LPN #60) walked by the resident, staring at him to cause an uncomfortable situation. The complaint also indicated the social worker left her a message of a meeting on 04/11/16 to discuss Resident #33's discharge and that he was not ready to be discharged . RN #20's written response to the allegations made on the compliance line, dated 04/08/16, indicated she and the social worker contacted Resident #33's wife regarding her complaint. The report included, The nurse previously confirmed that the conversation had occurred Additionally, the report indicated RN #20 spoke with NA #82 regarding the incident and NA #82 acknowledged being on the hallway assisting another NA. The report indicated the facility would be observant of any behaviors exhibited by (names of NA #82 and LPN #60) which may be perceived as making (Resident #33 and his wife) uncomfortable. The incident details of the report noted Resident #33, Was gotten out of bed a few minutes after 5 pm to eat dinner. He was assisted back to be at 8:10 pm that evening. During the interview with RN #20 on 04/19/16 at 4:30 p.m., she acknowledged the facility failed to complete a thorough investigation, as only the alleged perpetrators were interviewed related to Resident #33's allegation of verbal abuse, mental abuse, and neglect. Additionally, she acknowledged the allegations of abuse and neglect had not been reported to the appropriate State agencies. While reviewing the written response to the compliance line with RN #20, on 04/19/16 at 4:40 p.m., she related she had not interviewed any staff on duty the night of the allegation of neglect (leaving the resident up for over two (2) hours after dinner), or regarding NA #82's demeanor. The RN related she did not realize the allegations required reporting, because the complaint was received on the compliance line. An interview with the social worker, on 04/20/16 at 9:00 a.m., revealed she had participated in the phone conversation related to the issue about medications, but could not remember exactly what was discussed. She related she did not follow-up on the allegations, and did not handle that situation. During an interview with Unit Manager (UM) #58 and the administrator, on 04/20/16 at 9:50 a.m., the administrator related, Yes, I see where you are going with this. We did not report it and should have. b) Resident #27 Reportable allegations, reviewed on 04/20/16, revealed a substantiated allegation of verbal abuse with an incident date of 03/19/16. The immediate reporting form indicated the facility reported the allegation late to the appropriate State agencies. According to the report, Nurse Aide #103 made derogatory remarks to Resident #27 and told her to Shut her damn mouth. The report noted the resident was resisting with transfers and (NA #103's name) said, You need to stop it or I will have to put your ass on the floor The report also noted Resident #27 was mentally incapacitated, elderly, frail, and in a wheelchair (w/c). Witness statements indicated the allegation was first reported to Licensed Practical Nurse #47, who was working as an NA on that date (03/19/16). The nurse's statement included that she did not feel it was her place to act, and that it should have been reported to the charge nurse on duty. Registered Nurse #49's statement noted she was informed of the allegation on 03/21/16, and after speaking with NA #71, informed DON (director of nursing) of what I had been told. The witness statement by the social worker indicated she became aware of the incident on 03/23/16, at which time she reported it. During an interview with the administrator on 04/20/16 at 11:42 a.m., she related, We marked it as reporting late didn't (did not) we? The administrator agreed the incident should have been reported when identified. NA #103's time card, reviewed with Bookkeeper #28, on 04/20/16 at 11:55 a.m. revealed the NA worked on: -- 03/19/16 from 5:58 a.m. - 2:06 p.m.; -- 03/20/16 from 5:59 a.m. - 10:30 p.m.; and -- 03/22/16 from 5:59 a.m. - 2:00 p.m. (a double shift). During the interview with the administrator on 04/20/16 at 12:30 p.m., she acknowledged the facility failed to ensure Resident #27's safety by allowing NA #103 to work on 03/19/16, 03/20/16, and 03/22/16. The administrator acknowledged the allegation of verbal abuse should have been reported to the appropriate State agencies immediately. A follow-up interview with the administrator, on 04/20/16 at 1:30 p.m., confirmed NA #103 had worked during the interim when the allegation was first reported to LPN #47 on 03/19/16 and the date reported on 03/23/16. She confirmed the facility had not ensured the safety of the resident(s). c) The abuse prohibition policy, reviewed on 04/20/16 at 8:45 a.m., indicated the center staff would do all that was within their control to prevent occurrences of abuse, neglect . Section 4.1 indicated the facility would provide patients, families, and staff with information on how and to whom they may report concerns, incidents, and grievances without fear of retribution and provide feedback regarding the concerns that have been expressed. Section 5 indicated the notified supervisor will report the suspected abuse immediately (not to exceed 24 hours) to the Administrator or designee and other officials in accordance with state law The employee alleged to have committed the act of abuse will be immediately removed from duty, pending investigation Section 6 noted the facility would conduct an immediate and thorough investigation that focused on whether abuse or neglect occurred and to what extent, clinical examination for signs of injuries, if indicated; causative factors; and interventions to prevent further injury and Ensure that documentation of witnessed interviews is included.", "filedate": "2019-04-01"}
{"rowid": 5008, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "PO BOX 400", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2016-04-20", "deficiency_tag": 253, "scope_severity": "E", "complaint": 1, "standard": 0, "eventid": "06GH11", "inspection_text": "> Based on observation, resident interview, staff interview, family interview, facility record review, and policy review, the facility failed to provide housekeeping services necessary to maintain a sanitary, orderly, and comfortable interior. Curtain tracks were coated with dust/grime, garbage was overflowing on to the resident's floor, and floors were dirty. This practice affected eight (8) residents. Resident identifier: #33. Rooms: 200, 201, 204, and 208. Facility census: 57. Findings include: a) Resident #33 1. During an interview and observation on 04/18/16 at 4:04 p.m., Resident #33 related the curtain track over his bed was filthy. Observation revealed a layer of dust/grime along the track. The resident and his wife pointed to a dark pink mark on the wall/window border about midway down the window area. Resident #33 also related the floor on the right side of his bed, between the bed and the window was dirty, and pointed to dark brown/black areas. The resident said the areas had been there for at least three (3) days. Resident #33 and his wife stated staff only mopped every two (2) to three (3) days. She related staff buffed, but only from the entry across the room and bathroom. Another observation on 04/19/16 at 9:05 a.m., revealed the dark areas on the floor on the far side of the bed by the window remained. An interview with the housekeeping supervisor, on 04/19/16 at 10:50 a.m., revealed she only had two (2) housekeeping staff, one (1) from 8:00 a.m. to 4:00 p.m. and one (1) from 11:00 a.m. to 7:00 p.m. She said the housekeeper who came on duty at 11:00 a.m., was the one who completed the detailed cleaning of the rooms, and upon completion, she assisted with cleaning other rooms. During rounds with the supervisor she confirmed the floor area on the right side of Resident #33's bed was dirty, and the curtain guide over the bed was coated with grime and dust balls. 2. While reviewing information about the admission process and residents rights with Resident #33 and his wife on 04/20/16 at 1:30 p.m., his wife retrieved an admission folder from the night stand bottom drawer. The folder belonged to the resident who had resided in that room just prior to Resident #33's admission. An interview with the administrator immediately following the observation confirmed the folder would have been removed from the drawer had the housekeeper cleaned the nightstand. b) Rooms 204 and 208 Additionally, rooms 204 and 208 also had curtain guides covered with grime and dust. The supervisor confirmed the guides should have been cleaned during room detail. The supervisor related the room scheduled was accurate and rooms had been detailed. c) The maintaining/detail/cleaning calendar, dated (MONTH) (YEAR), reviewed on 04/19/16 at 9:15 a.m., indicated Room 200 A/B (Resident #33's room) had been cleaned on 04/11/16, Room 204 A/B had been cleaned on 04/16/16 and Room 208A/B had been cleaned on 04/18/16. The supervisor reviewed the schedule and confirmed all rooms had not been cleaned as scheduled. d) During an interview on 04/20/16 at 9:20 a.m., Housekeeper #105 related each room was mopped once a day and might be mopped more often when there were spills. She confirmed Resident #33's room had not yet been cleaned. The housekeeper also acknowledged only the walking area from the doorway to the bathroom was mopped. e) The detail cleaning policy, reviewed on 04/19/16 at 11:36 a.m., indicated the purpose was to ensure an optimal level of cleanliness of resident/patient rooms and to enhance the overall appearance of their environment. f) Waste management An observation on 04/19/16 at 8:30 a.m., revealed garbage overflowing onto the floor in Room 201, and garbage on the floor in the bathroom of Room 200. Other observations at 9:05 a.m. and 10:30 a.m., found the garbage remained on the floor. An interview with Housekeeper #105 revealed the housekeepers were responsible for disposing of garbage and cleaning the rooms. Upon inquiry, the housekeeper related nursing staff did not assist with garbage disposal. Housekeeper #105 related she was the only housekeeper on duty from 8:00 a.m. until 11:00 a.m., and indicated a walk-through was completed each morning, and the areas which required the most cleaning were done first. The waste management policy, reviewed on 04/20/16 at 10:00 a.m., required waste bags be closed and removed from the area when three quarters (3/4) full. During an interview with the Center Nurse Executive (CNE) on 04/19/16 at 3:30 p.m., she related the garbage should not have been allowed to overflow onto the floor and nursing staff should have emptied the garbage as needed.", "filedate": "2019-04-01"}
{"rowid": 5388, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "PO BOX 400", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2015-09-02", "deficiency_tag": 272, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "ZG3O11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, medical record review, and staff interview, the facility failed to conduct accurate comprehensive assessments for one (1) of twenty-three (23) Stage 2 sample residents. The comprehensive assessment for Resident #47 did not accurately reflect the resident's dental status. Resident identifiers: #47. Facility census: 53. Findings include: a) Resident #47 On 08/25/15 at 8:47 a.m., an observation of Resident #47 revealed most of the residents teeth were missing and the remaining teeth were carious. A review of the medical record, on 08/27/15 at 11:18 a.m., revealed Resident #47 was admitted on [DATE]. [DIAGNOSES REDACTED]. A review of the annual minimum data set (MDS) on 08/27/15 at 1:07 p.m., with an assessment review date (ARD) of 03/18/15, revealed, Section L0200 (Oral/Dental Status) (Z), had been marked as none of the above. Section L0200 (D) stated (obvious or likely cavity or broken natural teeth), which accurately reflected the oral/dental status for Resident #47. However, this selection was not marked. The concurrent review of the significant change MDS, with an ARD of 04/15/15, revealed Section L0200 (Z) marked as none of the above. This again was an inaccurate assessment of Resident #47. In an interview with the MDS coordinator and director of nursing (DON), on 08/27/15 at 1:44 p.m., revealed they were in agreement the oral/dental status, on the 03/18/15 and 04/15/15 MDSs, were incorrectly coded and would submit an immediate correction.", "filedate": "2019-01-01"}
{"rowid": 5389, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "PO BOX 400", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2015-09-02", "deficiency_tag": 278, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "ZG3O11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview the facility failed to ensure one (1) of 23 residents, had an assessment completed that accurately reflected their status. Resident #18's assessment did not reflect a diganosis of [MEDICAL CONDITION] disorder. Resident identifier: #18. Facility census: 53. Findings include: a) Resident #18 On 09/01/15 at 10:21 a.m., a review, of the medical record for Resident #18, revealed this resident was readmitted from an acute psychiatric admission on 07/16/15. An new [DIAGNOSES REDACTED]. A concurrent review of the five (5) day MDS, with an ARD of 07/23/15, the fourteen (14) day MDS, with an ARD of 07/28/15 and the quarterly MDS, with an ARD of 08/01/15 did not reflect the [DIAGNOSES REDACTED]. An interview with the MDS coordinator, on 09/01/15 at 10:48 a.m., revealed she was in agreement the MDSs had not been coded to reflect the [DIAGNOSES REDACTED].", "filedate": "2019-01-01"}
{"rowid": 5390, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "PO BOX 400", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2015-09-02", "deficiency_tag": 279, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "ZG3O11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview, the facility failed to develop a care plan to meet the needs for one (1) of twenty-three (23) Stage 2 residents. Resident #9, a [MEDICAL TREATMENT] patient did not have a care plan that described the services or interventions needed to attain or maintain the resident's highest practicable physical needs. Resident identifier: #9. Facility census: 53. Findings include: a) Resident #9 Review of the medical record, on 08/27/15 at 12:00 p.m., revealed this [AGE] year old resident came to the facility on [DATE]. She received [MEDICAL TREATMENT] treatments at a [MEDICAL TREATMENT] center three (3) times per week. Review of the care plan at this time found a focus on complications related to [MEDICAL TREATMENT]. One (1) intervention directed to monitor blood pressure and pulses, and report to the physician as indicated. However, the care plan did not offer directives as to when and how often to check vital signs, nor the parameter the facility desired for the vital signs. On 08/27/15 at 3:00 p.m., during an interview the director of nursing (DON) revealed it was her expectation that residents receiving [MEDICAL TREATMENT] treatments have their vital signs assessed before going out to [MEDICAL TREATMENT], and immediately upon their return to the facility following a [MEDICAL TREATMENT] treatment. She agreed that the care plan did not contain those directives, and it did not include parameters for the vital signs.", "filedate": "2019-01-01"}
{"rowid": 5391, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "PO BOX 400", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2015-09-02", "deficiency_tag": 280, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "ZG3O11", "inspection_text": "Based on observation, resident interview, medical record review and staff interview the facility failed to revise the care plan for one (1) of 23 residents. Resident #59 ' s care plan was not revised to reflect the resident's status regarding the use of a hand splint. Resident identifier: #59. Facility census: 53. Findings include: a) Resident #59 On 08/25/15 at 12:51 p.m., an observation of Resident #59 revealed he had a bed control remote in his left hand. Medical record review, on 08/25/15 at 1:00 p.m., a care plan intervention with an initiated date of 04/28/14 of Left hand splint from morning ADL's (activities of daily living) and remove by evening meal. At 1:45 p.m., on 08/26/15 during an interview, Resident #59 stated he does not wear the left hand splint during the day or night. Instead, he demonstrated how he holds the remote in the palm of his left hand, which he stated he has done for several months.", "filedate": "2019-01-01"}
{"rowid": 5392, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "PO BOX 400", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2015-09-02", "deficiency_tag": 282, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "ZG3O11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview, the facility failed to implement the care plan for one (1) of twenty-three (23) Stage 2 sampled residents. The care plan directed nursing staff to administer a medicated rectal suppository every night at bedtime, and after each bowel movement. Nursing staff failed to follow the care plan, by not administering the rectal suppository as ordered by the physician. Resident identifier: #36. Facility census: 53. Findings include: a) Resident #36 Review of the medical record, on 08/25/15 at 4:00 p.m., found [DIAGNOSES REDACTED]. A signed physician's orders [REDACTED]. The revised care plan, dated 08/11/15, read the same. The Medication Administration Record [REDACTED]. The activities of daily living (ADL) and medical record review found the resident did not receive a rectal suppository, or have a documented refusal, following twenty-five (25) bowel movements between 08/7/15 and 08/25/15. On 08/25/15 at 5:00 p.m., the director of nursing agreed that the signed physician's orders [REDACTED]. She acknowledged the care plan was not followed, as the resident received only one (1) rectal suppository and had only two (2) documented refusals between 08/07/15 and 08/24/15.", "filedate": "2019-01-01"}
{"rowid": 5393, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "PO BOX 400", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2015-09-02", "deficiency_tag": 309, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "ZG3O11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, medical record review, resident interview, and staff interview, the facility failed to provide care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being for two (2) of twenty-three (23) Stage 2 sampled residents. Resident #36 did not receive medicated rectal suppositories as ordered by the physician. Resident #9 did not receive vital signs assessment timely upon her return to the facility following a [MEDICAL TREATMENT] treatment. Resident identifiers: #36 and #9. Facility census: 53. Findings include: a) Resident #36 Review of the medical record, on 08/25/15 at 4:00 p.m., found [DIAGNOSES REDACTED]. A signed physician's orders [REDACTED]. Nursing staff documented family notification of this new physician's orders [REDACTED].>The Medication Administration Record [REDACTED]. Review of the medical record and the activities of daily living (ADL) record, found the resident did not receive a rectal suppository, or have a documented refusal, following any of the twenty-five (25) documented bowel movements between 08/07/15 and 08/25/15. During an interview with the director of nursing (DON) on 08/25/15 at 5:00 p.m., she acknowledged that the signed physician's orders [REDACTED]. She agreed that it appeared the resident received only one (1) rectal suppository and had only two (2) documented refusals of the rectal suppository between 08/07/15 and 08/24/15. The DON acknowledged that the order was written in a confusing manner on the MAR, which caused the resident not to receive the prescribed medication. On 08/26/15 at 8:30 a.m., the DON said she spoke with the nurse who wrote the original order for the [MEDICATION NAME] suppositories. The DON said the nurse did not mean to write it that way. The DON said nursing staff contacted the physician this morning, and received a clarification for the [MEDICATION NAME] order. The physician's orders [REDACTED]. b) Resident #9 Review of the medical record, on 08/26/15 at 12:00 p.m., revealed this [AGE] year old resident came to the facility on [DATE]. While residing at the facility, she received [MEDICAL TREATMENT] treatments at a [MEDICAL TREATMENT] center three (3) times per week. An interview, conducted with Licensed Practical Nurse #14 on 08/26/15 at 12:50 p.m., revealed this resident goes out to [MEDICAL TREATMENT] on the night shift three (3) times weekly. Upon return to the facility from [MEDICAL TREATMENT], the day shift nurse immediately assessed the resident. This assessment includes checking the fistula site for redness, drainage, bleeding or pain, checking for thrill and bruit, and obtaining vital signs. Observation, on 08/27/15 at 1:10 p.m., found Resident #9 had returned from the [MEDICAL TREATMENT] center via ambulance transport. Observation, on 08/27/15 at 1:33 p.m., found the resident eating lunch in her room. Upon inquiry, she said no one had checked her blood pressure since she returned from the [MEDICAL TREATMENT] center today. During an interview with Registered Nurse #55 on 08/27/15 at 1:35 p.m., he said the aides obtain the vital signs upon the resident's return from [MEDICAL TREATMENT], and he did not know if the aide had obtained Resident #9's vital signs yet. He said he assessed the access site after her return to the facility today. During an interview with Nursing Assistant #35 on 08/27/15 at 1:37 p.m., she spoke her belief that the nurse is supposed to check the blood pressure when the resident first returns from [MEDICAL TREATMENT]. She said she would check it now if needed. She said she usually does not work this hall. Observation on 08/27/15 at 1:43 p.m. found Nursing Assistant (NA) #30 in Resident #9's room as she obtained the resident's vital signs. Upon inquiry, she said Registered Nurse #55 directed her about a minute ago to obtain the resident's vital signs. NA#30 said she was new to day shift, and was unaware of the need to get vital signs upon the resident's return to the facility from [MEDICAL TREATMENT]. She said the aide who was permanently assigned to this hall was off today. At 2:00 p.m. on 08/27/15, Registered Nurse #55 said he should have obtained the vital signs when the resident returned to the facility from [MEDICAL TREATMENT]. He said he does not typically work day shift, and the nurse who is usually assigned to this hall is off today. During an interview with the director of nursing (DON) on 08/27/15 at 3:00 p.m., she said it was her expectation that nurses obtain vital signs prior to sending the resident out for [MEDICAL TREATMENT], and immediately upon the resident's return from [MEDICAL TREATMENT] treatments. She said it was the nurse's responsibility to take the vital signs, assess the resident, and assess the access site upon return to the facility from [MEDICAL TREATMENT].", "filedate": "2019-01-01"}
{"rowid": 5394, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "PO BOX 400", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2015-09-02", "deficiency_tag": 332, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "ZG3O11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, staff interviews, medical record review, manufacturer's instructions, and policy and procedure review, the facility failed to ensure it had a medication error rate of less than five percent (5%). Resident #61 was administered two (2) different inhalers without waiting at least one (1) minute between the different inhalers. Resident #18 was administered an inhaler without waiting between puffs. Medication errors were identified for two (2) of six (6) residents observed for medication pass. There were three (3) medication errors in forty-two (42) opportunities for error, resulting in a medication error rate of 7.14% (per cent). Resident identifiers: #61 and #18. Facility census: 53. Findings include: a) Resident #61 On 08/26/15 at 8:57 a.m., during a medication observation with a Licensed Practical Nurse (LPN)#23 revealed this employee prepared [MEDICATION NAME] Diskus and [MEDICATION NAME] hand held inhaler for Resident #61. These medications were ordered for [MEDICAL CONDITION]. LPN #23 placed each inhaler on the overbed table, Resident #61 picked up the [MEDICATION NAME] inhaler and inhaled one (1) puff and proceeded to pick up the [MEDICATION NAME] Diskus and inhale one (1) puff. LPN #23 then gave Resident #61 a plastic medication cup which contained multiple medications. After exiting Resident #61's room, in a discussion with LPN #23 regarding Resident #61 administering the inhalers, she stated this is the way she always does it. When asked about the pharmacy instructions on both inhaler boxes stating, Wait at least 1 minute between different inhaled medications. Rinse mouth after each use. she stated she did not know this and had not read the instructions on the boxes, and this is the way she does this. A review of the physician orders, on 08/26/15 at 1:33 p.m., revealed orders, dated 06/18/15, for [MEDICATION NAME] Diskus Aerosol Powder Breath Activated 250-50 mcg/dose ([MEDICATION NAME]-Salmeterol ( 1 inhalation inhale orally two times a day related to [MEDICAL CONDITION] and Tiotropin [MEDICATION NAME] ([MEDICATION NAME]) 18 mcg 1 inhalation inhale orally one time a day related to [MEDICAL CONDITION]. In addition, there was a physician's order, dated 06/18/15, stating this resident may not administer own meds (medications). A review of the medical record, on 08/26/15 at 1:46 p.m., revealed Resident #61 was readmitted to the facility on [DATE] from an acute care hospital. [DIAGNOSES REDACTED]. The manufacturers instructions for the use of the [MEDICATION NAME] Diskus were reviewed on 08/26/15 at 2:03 p.m Step 3 of the instructions stated put the mouthpiece to your lips. Breathe in quickly and deeply through the Diskus. Remove the Diskus from your mouth and hold your breath for about 10 seconds, or for as long as is comfortable for you. Step 5 Rinse your mouth with water after breathing in the medicine. Spit out the water. Do not swallow it. Resident #61 was not given any of these instructions by LPN #23. A review of the facility policy and procedure titled Medication Administration: Diskus Inhaler was conducted on 08/26/15 2:26 p.m In Section 3. Administer medication stated the following: 3.6 Hold the diskus in a level, horizontal position with the mouthpiece toward the patient. 3.7 Slide the lever . 3.8 To avoid releasing . 3.9 Instruct the patient to exhale fully through the mouth. 3.10 Hold the diskus level and away from patient's mouth; 3.11 Instruct patient to breathe medication in through mouth and not exhale into the diskus; 3.12 Remove the diskus . 3.13 Instruct the patient to continue inhaling slowly and deeply, hold breath for about 10 seconds, and the exhale. 3.14 Close the diskus 3.15 Instruct patient to rinse mouth with water. A concurrent review of the facility policy and procedure titled Medication Administration: Inhaled metered dose inhaler (MDIs). In Section 3. Administer medication stated the following: 3.7 Put on gloves 3.8 Instruct patient to slowly exhale through pursed lips. 3.9 Place spacer . If not using spacer, hold MDI 1 1/2 inches away from patient's open mouth. 3.10 Instruct patient to begin inhaling slowly, while actuating the MDI. 3.11 Instruct patient to continue inhaling slowly and deeply, hold breath for 5 to 10 seconds, the exhale. 3.12 Wait for one (1) minute between puffs of the same medication and five minutes between puffs of different medications. Section 5. Instruct patient to rinse mouth. b) Resident #18. On 08/26/15 at 9:20 a.m., during a medication observation with an LPN (Employee #14), Resident #18 was administered [MEDICATION NAME] HFA two (2) puffs by E#14. There was no wait time between puffs. In a discussion with E#14, following the administration of the [MEDICATION NAME] HFA, she agreed she did not wait between puffs. A review of Resident #18's medical record, on 08/26/15 at 9:30 a.m., revealed this resident was admitted on [DATE]. [DIAGNOSES REDACTED]. A concurrent review of the physician orders, dated 07/16/15, revealed an order for [REDACTED]. The manufacture's instructions for the use of [MEDICATION NAME] HFA were reviewed, on 08/26/15 at 9:46 a.m. The instructions were as follows: 1. Take the cap off the . 2. Hold the inhaler . 3. Push the top of the canister all the way down while you breathe in deeply and slowly through your mouth. 4. Hold your breath as long as you can, up to ten (10) seconds; then breathe normally. 5. Wait about thirty (30) seconds and shake the inhaler well for five (5) seconds. Repeat steps two (2) through four (4). c) Physician interview During an additional interview with the attending physician, on 09/01/15 at 2:30 p.m., he stated he was not aware of the need to wait prior to giving a second inhaler or the need to rinse out the mouth after using inhalers. He stated he would investigate this and write more specific orders for the use of inhalers.", "filedate": "2019-01-01"}
{"rowid": 5395, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "PO BOX 400", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2015-09-02", "deficiency_tag": 441, "scope_severity": "F", "complaint": 0, "standard": 1, "eventid": "ZG3O11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, staff interview, medical record review, policy and procedure review, and infection control surveillance record review; the facility failed to provide a safe, sanitary, and comfortable environment, to help prevent the development and transmission of disease and infection. The infection- control surveillance records were not completed and maintained in their entirety. A bedpan was stored improperly in a bathroom shared by two (2) residents. Nursing staff administered medication to a resident after the medication fell on the top of an unclean medication cart. In addition, two (2) of two (2) medication carts were observed to be dirty with dust and debris. These practices had the potential to affect all residents in the facility. Resident identifiers: #93, #100, #61. Facility census: 53. Findings include: a) Infection control log surveillance records Review of the infection control surveillance records was completed on 08/31/15 at 2:00 p.m. (Surveillance refers to the ongoing, systematic collection, analysis, interpretation, and dissemination of data to identify infections and infection risks to try to reduce morbidity and mortality and to improve resident health status.) Findings were as follows: 1. The (MONTH) (YEAR) infection control monthly line listing contained the names of twelve (12) residents with newly developed infections. None of the twelve residents with newly developed infections were documented as having had resolution of the infections. Nine (9) residents lacked an admitted . Eight (8) residents had no recorded dates of onset of the infections. Nine (9) residents had no room numbers recorded. Eleven (11) infections were not differentiated as to whether they were healthcare acquired or community acquired. Eight (8) cultures did not include the dates of the cultures. All five (5) of the urine cultures lacked the results of the organisms, which grew. In addition, the start dates for eight (8) of the antibiotics prescribed were not documented. 2. Review of the infection control monthly line listings for (MONTH) through (MONTH) found similar results. Many lacked valuable information such as room numbers, admitted s, onset dates of the infections, whether the infections were healthcare acquired or community acquired, the date of the cultures, the results of the cultures, the start dates of treatment, the precaution type, and the date the infections resolved. 3. The Multi-Drug Resistant Organism (MDRO) line listing for Methicillin Resistant Staphylococcus Aureus (MRSA), [MEDICATION NAME] Resistant [MEDICATION NAME] (VRE), Carbapenem-Resistant [MEDICATION NAME] (CRE), Extended-Spectrum Beta Lactamase (ESBL), and Clostridium Difficile (C-Diff) all lacked the admitted fo the affected residents, dates of cultures, and the discharge date s. 4. discharged Resident #93 was listed on the (MONTH) monthly line listing as having Clostridium Difficile (C-Diff), but was not listed on the Multidrug-Resistant Organism (MDRO)[DIAGNOSES REDACTED] line listing. During interview with the infection control nurse, Registered Nurse #13, on 08/31/15 at 2:00 p.m., she said she did not know why she did not complete the infection- control surveillance records more thoroughly. She said the monthly line listing form was changed to a corporate form in (MONTH) (YEAR), and for some reason she was not completing the new form in its entirety. 08/31/15 was her last working day at the facility, and her predecessor would take over the infection control monitoring tomorrow. She agreed that the predecessor would not have enough information from the surveillance records to comprehend the tracking and trending for the most recent months. She agreed that the infection control monthly line listings lacked valuable information such as room numbers, admitted s, onset date of the infections, whether the infections were healthcare or community acquired, the dates of all the cultures, and the culture results. She said she discusses the infection control status with the administrative staff once monthly in a special meeting. She utilized a dry- erase board in these meetings to communicate the types of infection present, and where they were located in the facility. This board as the staff looked for trends or patterns of infections. After the meeting, they erased the board. An interview was completed with the director of nursing (DON) on 08/31/15 at 3:30 p.m. She said she was not present in (MONTH) for the monthly infection control meeting. She agreed that the information on the (MONTH) infection control monthly line listing, and for the MDRO line listings, lacked necessary information to be complete. She said a new infection control nurse was starting on 09/01/15, and would need all that information. She agreed that the new infection control nurse would have inadequate knowledge of the past trending and tracking information based on these surveillance records. At 4:00 p.m. on 08/31/15, the DON provided copies of the (MONTH) through (MONTH) infection control monthly line listings. She acknowledged they were similar in lacking needed information. When informed that Resident #93 was not listed on the Clostridium difficile (C-Diff) Multidrug-Resistant Organism (MDRO) line listing, the DON said she would see that Resident #93's name was added. c) Resident #61 On 08/26/15 at 8:47 a.m., during a medication observation, Licensed Practical Nurse (LPN) #23 attempted to place a tablet into a plastic cup from a blister package, the pill landed on the top of the medication cart. LPN #23 picked up the tablet with bare hands and put it into the plastic medicine cup. LPN #23 then administered the oral medication to Resident #61. During an interview with LPN #23, on 08/26/15 at 8:55 a.m., the LPN stated she did not know what to do when a resident ' s medication was dropped. A review of the facility policy and procedure General Dose Preparation and Medication Administration, on 08/26/15 at 10:27 a.m., revealed the following: 2. Dose Preparation 2.4 Do not touch the medication when opening a bottle or unit dose package. 2.5 If a medication, which is not in a protective container is dropped, discard per policy. During an interview, with the director of nursing (DON), on 08/26/15 at 10:35 a.m., she agreed the oral medication should have been discarded and facility policy and procedure had not been followed by LPN #23. d) Hall 1 & 2 Medication Cart On 08/24/15 at 1:15 p.m., an observation, of Hall 2 medication cart, with Licensed Practical Nurse (LPN) #19 revealed dust and brown debris in each drawer of the medication cart. Hall 2 medication cart, which contained liquid medication, revealed a spilled substance, which had been covered with a paper towel. LPN #19 attempted to remove the paper towel but was not successful. This employee agreed the medication cart was dirty and needed to be cleaned. A concurrent observation of the Hall 1 medication cart, with an LPN #14 revealed dust and brown debris in each drawer of the medication cart. LPN #14 stated she had no idea when the medication cart had been cleaned, and agreed the medication cart needed cleaned. e) On 08/24/15 at 3:00 p.m., an unbagged, unlabeled bed pan was found lying in the bathroom floor of Resident #100. Resident #100 stated the bedpan was for her use. Resident #100 shared the bathroom with another resident. At 3:45 p.m., the director of nursing, stated the bedpan should have been labeled and bagged, and the bedpan would be removed from the room and replaced with a new one, with proper labeling.", "filedate": "2019-01-01"}
{"rowid": 5396, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "PO BOX 400", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2015-09-02", "deficiency_tag": 520, "scope_severity": "F", "complaint": 0, "standard": 1, "eventid": "ZG3O11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, staff interview, medical record review, policy and procedure review, infection control program review; the quality assessment and assurance (QAA) committee failed to identify and or act upon a quality deficiency within the facility's operations of which it did have or should have had knowledge. Infection Control: The QA & A committee failed to identify the need to develop and implement processes to implement an effective infection control program to prevent, recognize, and control, to the extent possible, the onset and spread of infections within the facility. This had the potentital to affect all residents in the facility. Facility census: 53. Findings include: a) Infection control log surveillance records Review of the infection control surveillance records was completed on 08/31/15 at 2:00 p.m. (Surveillance refers to the ongoing, systematic collection, analysis, interpretation, and dissemination of data to identify infections and infection risks to try to reduce morbidity and mortality and to improve resident health status.) Findings were as follows: 1. The (MONTH) (YEAR) infection control monthly line listing contained the names of twelve (12) residents with newly developed infections. None of the twelve residents with newly developed infections was documented as having had resolution of the infections. Nine (9) residents lacked an admitted . Eight (8) residents had no recorded dates of onset of the infections. Nine (9) residents had no room numbers recorded. Eleven (11) infections were not differentiated as to whether they were healthcare acquired or community acquired. Eight (8) cultures did not include the dates of the cultures. All five (5) of the urine cultures lacked the results of the organisms, which grew. In addition the start dates for eight (8) of the antibiotics prescribed were not documented. 2. Review of the infection control monthly line listings for (MONTH) through (MONTH) found similar results. Many lacked valuable information such as room numbers, admitted s, onset dates of the infections, whether the infections were healthcare acquired or community acquired, the date of the cultures, the results of the cultures, the start dates of treatment, the precaution type, and the date the infections resolved. 3. The multi-drug resistant organism (MDRO) line listing for [MEDICAL CONDITION] (MRSA), [MEDICATION NAME] resistant [MEDICATION NAME] (VRE), Carbapenem-Resistant [MEDICATION NAME] (CRE), Extended-Spectrum Beta Lactamase (ESBL), and [MEDICAL CONDITIONS] all lacked the admitted fo the affected residents, dates of cultures, and the discharge date s. 4. discharged Resident #93 was listed on the (MONTH) monthly line listing as having [MEDICAL CONDITIONS], but was not listed on the [MEDICAL CONDITION] (MDRO) [MEDICAL CONDITION] line listing. During interview with the infection control nurse, Registered Nurse #13, on 08/31/15 at 2:00 p.m., she said she did not know why she did not complete the infection- control surveillance records more thoroughly. She said the monthly line listing form was changed to a corporate form in (MONTH) (YEAR), and for some reason she was not completing the new form in its entirety. 08/31/15 was her last working day at the facility, and her predecessor would take over the infection control monitoring tomorrow. She agreed that the predecessor would not have enough information from the surveillance records to comprehend the tracking and trending for the most recent months. She agreed that the infection control monthly line listings lacked valuable information such as room numbers, admitted s, onset date of the infections, whether the infections were healthcare or community acquired, the dates of all the cultures, and the culture results. She said she discusses the infection control status with the administrative staff once monthly in a special meeting. She utilized a dry- erase board in these meetings to communicate the types of infection present, and where they were located in the facility. This board as the staff looked for trends or patterns of infections. After the meeting, they erased the board. An interview was completed with the director of nursing (DON) on 08/31/15 at 3:30 p.m. She said she was not present in (MONTH) for the monthly infection control meeting. She agreed that the information on the (MONTH) infection control monthly line listing, and for the MDRO line listings, lacked necessary information to be complete. She said a new infection control nurse was starting on 09/01/15, and would need all that information. She agreed that the new infection control nurse would have inadequate knowledge of the past trending and tracking information based on these surveillance records. At 4:00 p.m. on 08/31/15, the DON provided copies of the (MONTH) through (MONTH) infection control monthly line listings. She acknowledged they were similar in lacking needed information. When informed that Resident #93 was not listed on the [MEDICAL CONDITION] [MEDICAL CONDITIONS] (MDRO) line listing, the DON said she would see that Resident #93's name was added. b) Resident #61 On 08/26/15 at 8:47 a.m., during a medication observation, Licensed Practical Nurse (LPN) #23 attempted to place a tablet into a plastic cup from a blister package, the pill landed on the top of the medication cart. LPN #23 picked up the tablet with bare hands and put it into the plastic medicine cup. LPN #23 then administered the oral medication to Resident #61. During an interview with LPN #23, on 08/26/15 at 8:55 a.m., the LPN stated she did not know what to do when a resident ' s medication was dropped. A review of the facility policy and procedure General Dose Preparation and Medication Administration, on 08/26/15 at 10:27 a.m., revealed the following: 2. Dose Preparation 2.4 Do not touch the medication when opening a bottle or unit dose package. 2.5 If a medication, which is not in a protective container, is dropped, discard per policy. During an interview, with the director of nursing (DON), on 08/26/15 at 10:35 a.m., she agreed the oral medication should have been discarded, and facility policy and procedure had not been followed by LPN #23. c) Resident #61 On 08/26/15 at 8:47 a.m., during a medication observation, Licensed Practical Nurse (LPN) #23 attempted to place a tablet into a plastic cup from a blister package, the pill landed on the top of the medication cart. LPN #23 picked up the tablet with bare hands and put it into the plastic medicine cup. LPN #23 then administered the oral medication to Resident #61. During an interview with LPN #23, on 08/26/15 at 8:55 a.m., the LPN stated she did not know what to do when a resident's medication was dropped. A review of the facility policy and procedure General Dose Preparation and Medication Administration, on 08/26/15 at 10:27 a.m., revealed the following: 2. Dose Preparation 2.4 Do not touch the medication when opening a bottle or unit dose package. 2.5 If a medication, which is not in a protective container, is dropped, discard per policy. During an interview, with the director of nursing (DON), on 08/26/15 at 10:35 a.m., she agreed the oral medication should have been discarded, and facility policy and procedure had not been followed by LPN #23. d) Hall 1 & 2 Medication Cart On 08/24/15 at 1:15 p.m., an observation, of Hall 2 medication cart, with Licensed Practical Nurse (LPN) #19 revealed dust and brown debris in each drawer of the medication cart. Hall 2 medication cart, which contained liquid medication, revealed a spilled substance, which had been covered with a paper towel. LPN #19 attempted to remove the paper towel but was not successful. This employee agreed the medication cart was dirty and needed to be cleaned. A concurrent observation of the Hall 1 medication cart, with an LPN #14 revealed dust and brown debris in each drawer of the medication cart. LPN #14 stated she had no idea when the medication cart had been cleaned, and agreed the medication cart needed cleaned. e) On 08/24/15 at 3:00 p.m., an unbagged, unlabeled bedpan was found to be lying in the bathroom floor of Resident #100. Resident #100 stated the bedpan was for her use. Resident #100 shared the bathroom with another resident. At 3:45 p.m., the director of nursing stated the bedpan should have been labeled and bagged. The director of nursing said the bedpan would be removed from the room and replaced with a new one that was labeled properly. On 09/02/15 at 1:30 p.m., the facility administrator was interviewed concerning infection control issues found during the current QIS, including infection control surveillance, soiled medication carts, administering medication in a clean and sanitary manner, and bagging and labeling bedpans. The administrator stated the facility was in the process of completing a study on urinary tract infections but had no specific current infection control quality control interventions related to the areas of concern found during the current QIS.", "filedate": "2019-01-01"}
{"rowid": 6530, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "PO BOX 400", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2014-06-04", "deficiency_tag": 253, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "N2BW11", "inspection_text": "Based on observation and staff interview, it was determined the facility failed to ensure effective maintenance services. The physical environment was not in good repair. The walls had holes, the cove base was loose and hanging from the walls in resident's rooms, and a toilet seat was missing a seat bumper in a resident's bathroom. This practice affected seven (7) of twenty (20) rooms observed. This practice had the potential to affect more than an isolated number of residents. Room numbers of affected rooms: #105, #107, #109, #114, #206, #213, and #215. Facility census: 54. Findings include: a) Observations of the facility during Stage I and Stage II of the Quality Indicator Survey revealed the following rooms had environmental concerns: 1) Room #105 - The wall under the television had several holes. 2) Room #107 - The cove base was loose and hanging from the wall. 3) Room #109 - The cove base was loose and hanging from the wall. 4) Room #114 - The wall behind bed B had several holes. 5) Room #206 - The cove base was loose and hanging from the wall. 6) Room #213 - The toilet seat in the bathroom was missing a seat bumper. 7) Room #215 - The cove base was loose and hanging from the wall.", "filedate": "2018-02-01"}
{"rowid": 6531, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "PO BOX 400", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2014-06-04", "deficiency_tag": 323, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "N2BW11", "inspection_text": "Based on observation and staff interview, the facility failed to provide an environment that was free from accident hazards over which the facility had control. The soiled utility closet on the 100 Hall was unlocked on several occasions. The closet contained cleaning supplies, soiled linens, sharps containers, laboratory supplies, and trash. This practice had the potential to affect more than an isolated number of residents. Facility census: 54. Findings include: a) During the initial tour of the facility on 05/27/14 at 11:30 a.m., the soiled utility room on the 100 Hall was observed unlocked. Employee #53 (Nursing Assistant-NA) witnessed the door unlocked and stated the door should be locked at all times. The NA stated she would ensure the door was locked. The room contained cleaning supplies, soiled linens, sharps containers, laboratory supplies, and trash. An observation on 05/27/14 at 12:15 p.m. revealed the soiled utility room on the 100 Hall was again unlocked. Employee #53 (NA) witnessed the door unlocked and stated she was not sure why the door was not locking, but had informed the maintenance department to look at the door. An interview with Employee #79 (Maintenance Director), on 06/04/14 at 10:00 a.m., revealed the soiled utility room doors were to be locked at all times. The maintenance director stated the door was unlocked on 05/27/14 because someone had accidentally unlocked the door causing it not to lock when shut.", "filedate": "2018-02-01"}
{"rowid": 6532, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "PO BOX 400", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2014-06-04", "deficiency_tag": 431, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "N2BW11", "inspection_text": "Based on observation, staff interview, policy review, and information obtained from the Centers for Disease Control and Prevention (CDC), the facility failed to ensure the safe administration of medications. Opened vials of medications were not labeled with the dates they were opened for use. This date is essential to ensure the medications were not used beyond their safe and/or effective dates after opening. This practice had the potential to affect more than an isolated number of residents. Facility census: 54. Findings include: a) On 06/02/14 at 1:10 p.m., observation of the medication storage area behind the nursing desk was completed with Employee #33, the Director of Nursing (DON), and Employee #43, a Licensed Practical Nurse. Novolog 70/30, Lantus, and two (2) vials of Tuberculin purified protein had no dates indicating when they were opened. b) During an interview with the DON, at 11:15 a.m. on 06/04/14, she agreed medications were to be labeled and dated according to common nursing and pharmacy standards of practice. Facility policies were provided by the DON on 06/04/14 at 12:55 p.m. The facility used the consulting pharmacy recommendations which stated, All vials should be dated when opened and discarded 28 days after opening (except for Levemir (insulin detemir), Novolin R, Novolin N, and Novolin 70/30 which can be used up to 42 days after opening and Humulin which can be used up to 31 days after opening). Other multiple-dose vials for injection should be dated when opened and discarded after 28 days or in accordance with the manufacturer's recommendation. On 06/04/14 at 11:15 a.m. the DON confirmed medications were to be labeled and dated in accordance with the consulting pharmacy's recommendations. c) According to the Centers for Disease Control and Prevention(CDC), multi-dose vials of medications which have been opened or accessed should be dated and discarded within 28 days unless the manufacturer specifies a different (shorter or longer) date for that opened vial.", "filedate": "2018-02-01"}
{"rowid": 6533, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "PO BOX 400", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2014-06-04", "deficiency_tag": 441, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "N2BW11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and employee interview, the facility failed to provide a safe and sanitary environment. The shower rooms on the 100 and 200 Halls contained soiled linens, gloves on the floor, unlabeled clothing, unlabeled grooming products, soiled toilet seats, and a pool of emesis was on the floor. Resident #19's catheter bag was touching the floor, and intravenous (IV) tubing was hanging from the pump and touching the floor in a resident's room. These practices affected four (4) rooms of twenty (20) rooms observed and had the potential to affect more than an isolated number of residents. Affected room identifiers: Shower room-100 Hall, Shower room-200 Hall, #209, #211. Resident identifier: #19. Facility census: 54. Findings include: a) Observations of the facility on 06/02/14 revealed the following infection control concerns: 1) Shower room-100 Hall - The shower room was observed on 06/02/14 at 10:40 a.m. The toilet seat was covered in a brown, foul smelling, substance. There were two gloves, inside-out, on the floor. An unlabeled container of body wash was on the shower chair. 2) Shower room-200 Hall - The shower room was observed on 06/02/14 at 10:50 a.m. There was emesis with intact food (noodles) on the floor. A wet soiled washcloth was on the floor. A pair of unlabeled shoes were in a wheelchair. Employee #32 (Registered Nurse-RN) witnessed both shower rooms on 06/02/14 at 10:50 a.m. The RN stated the shower rooms should never be in their current condition and she would see they were attended to immediately. 3) room [ROOM NUMBER] - An observation of this room was completed on 06/02/14 at 10:55 a.m. Resident #19's catheter bag was touching the floor. Employee #48(Licensed Practical Nurse-LPN) verified this observation. The LPN stated the catheter bags should never be on the floor. 4) room [ROOM NUMBER] - The room was observed on 06/02/14 at 11:00 a.m. The Intravenous (IV) pump in the room had tubing touching the floor. Employee #48(LPN) verified this observation. The employee stated the tubing should never be on the floor and discarded it.", "filedate": "2018-02-01"}
{"rowid": 6534, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "PO BOX 400", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2014-06-04", "deficiency_tag": 514, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "N2BW11", "inspection_text": "Based on medical record review, resident interview, staff interview, and facility policy review, the facility failed to ensure the accuracy of the medical record for one (1) of one (1) resident reviewed for notification of room change. Resident identifier: #77. Facility census: 54. Findings Include: a) Resident #77 While conducting the Stage 1 interview with Resident #77, she stated she had not been informed she would have a new roommate. On 05/28/14 at 11:00 a.m., registered nurse, Employee #35 stated on 05/24/14 she had informed Resident #77 she would receive a new roommate sometime within the next twenty-four hours. Resident #77 received a new roommate on 05/25/14. Review of the medical records found no evidence Resident #77 or Resident #77's medical power of attorney (MPOA) were informed Resident #77 would receive a new roommate. After interviewing Employee #35, she stated she would create a late entry note concerning notification of a new roommate. The note was created. The facility policy and procedures concerning room transfers was received from Employee #35 at 9:50 a.m. on 06/04/14. Section 10 included, All room changes will be documented in a progress note or on the Room Transfer Form and placed in the medical records.", "filedate": "2018-02-01"}
{"rowid": 7929, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "96 TYREE STREET", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2012-12-11", "deficiency_tag": 253, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "K06L11", "inspection_text": "Based on observation and staff interview, the facility failed to provide a sanitary, orderly and comfortable environment in resident rooms and facility hallways. Hallways and resident rooms were in poor repair. There were scuffed floors, scraped walls with peeling paint, damaged furniture and curtains were incorrectly hung, creating an unkempt appearance. This had the potential to affect more than a minimal number of residents who resided in the facility. Facility Census: 60. Findings include: a) During the initial tour of the facility, on 12/03/12, at approximately 11:30 a.m., and with further observations during the course of the survey, it was noted the facility hallways and resident rooms were in need of numerous repairs. The following maintenance/housekeeping issues were observed: 1) The hallways on both units in resident living areas were observed to have dark marks running along the walls. 2) Numerous interior and exterior door jams, both entrance doors and bathroom doors, were observed with damage beginning at the floor and proceeding up to approximately eighteen (18) inches from the floor. This damage included multiple dark scratched areas and chipped paint. 3) Dark marks were observed on the floor covering under several resident beds. 4) Many of the walls behind resident beds had peeling drywall and chipped paint. Also, the paint on the walls in resident bathrooms had dark marks. 5) A few bathrooms had towel rack hooks (no rack attached) remaining on the wall and painted over. This left dangerously sharp protrusions from the walls. 6) Many bathroom floor coverings had separation cracks along the walls, making the area unable to be thoroughly cleaned. 7) A large portion of the baseboards in both the resident rooms and resident bathrooms were soiled. 8) Curtains in many resident rooms were not correctly fastened to the rod causing the curtain to hang in an unkempt manner. b) During observation of specific rooms the following were observed: 1) Room 100 had a wall lighting fixture hanging to one side. 2) Room 104 had two (2) resident dressers in poor repair. On each dresser, the two (2) bottom drawers were dented, chipped, and scratched until they did not have the same appearance as the top drawers. 3) Room 203 had a hole in the bottom of the bathroom door. 4) Room 210 had the baseboard missing just inside the entrance door. c) The facility administrator was interviewed on 12/11/12, at approximately 10:00 a.m. She stated the facility was aware of the maintenance/housekeeping issues and was working toward completing needed repairs. When particular areas of concern were brought to the administrator's attention, such as dry wall in need of repair, she stated the facility was in the beginning of the process of getting bids for supplies needed to make repairs.", "filedate": "2016-12-01"}
{"rowid": 7930, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "96 TYREE STREET", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2012-12-11", "deficiency_tag": 279, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "K06L11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, resident interview, family interview, and staff interview, the facility failed to develop a comprehensive care plan for five (5) of thirty-one (31) Stage 2 sample residents. The facility failed to develop a care plan related to the use of antidepressants, prevention of contractures, care of pressure ulcers, measurement of urinary output, nausea and vomiting, [MEDICAL CONDITION] reflux disease, and insulin usage. Resident identifiers: #61, #10, #26, #19, and #62. Facility census: 60. Findings include: a) Resident #61 Review of the medical record identified Resident #61 received the antidepressant [MEDICATION NAME] for a [DIAGNOSES REDACTED]. No interventions were in place for staff to follow related to the use of this medication. Additionally, no side effects were identified for staff awareness and observation. This information was confirmed with Employee #36, the director of nursing (DON), on 12/06/12 at 9:14 a.m. b) Resident #62 Medical record review found the resident had a Foley catheter for a [DIAGNOSES REDACTED]. Further review of the physician's orders [REDACTED]. Review of the resident's current care plan, dated 03/30/12, found a problem: Resident requires indwelling Foley catheter due to: stage 3/4 pressure ulcer and quadriparesis at risk for infection. The care plan failed to address measuring urinary output on each shift. The DON was interviewed on 12/06/12 at 10:00 a.m. She acknowledged the care plan did not address the physician's orders [REDACTED]. c) Resident #10 During a stage one interview, on 12/03/12 at 2:53 p.m., the nurse stated Resident #10 had a contracture of the left hand. She related the resident did not wear a splint, and did not receive range of motion services. An observation and interview was completed with Resident #10 on 12/04/12 at 2:18 p.m. Observation of the resident revealed a contracture of her left hand. She stated services were not performed to maintain range of motion. She stated her contracture was related to a stroke. Review of the medical record, on 12/05/12, revealed the care plan did not address the contracture of the resident's left hand. The minimum data set (MDS) was reviewed on 12/11/12 at 9:00 a.m. The assessment dated [DATE] indicated the resident had an impairment of one of her upper extremities. Section S of the comprehensive assessment, dated April 2012, indicated the resident had a contracture of the left hand. Employee #57, a certified nursing assistant and family member, was interviewed on 12/11/12 at 10:10 a.m. She stated the resident did not receive therapy for the contracture of her left hand. The resident was interviewed on 12/11/12 at 10:15 a.m. She was alert, verbal and coherent. She said her hand had been this way since my stroke. She again stated the staff did not provide range of motion, nor encourage her to perform range of motion on her left hand. Employee #35, a registered nurse care plan coordinator (RN CPC), was interviewed on 12/11/12 at approximately 3:00 p.m. She acknowledged the contracture was not addressed on the care plan. Employee #31, another RN CPC, was also interviewed on 12/11/12 at approximately 3:00 p.m. She stated the MDS identified the contracture of Resident #10's left hand on the April 2012 assessment. She indicated the contracture was not addressed because it did not pull to section V for care area assessment. Employee #31 agreed the contracture of the the resident's left hand was not addressed in the care plan. d) Resident #26 Medical record review, completed on 12/10/12, indicated Resident #26 received seventeen (17) units of [MEDICATION NAME] subcutaneously daily. Additionally, the resident received [MEDICATION NAME] R solution 100 units/ml subcutaneously with sliding scale coverage four (4) times daily. The care plan was was reviewed on 12/05/12 and again on 12/11/12. It did not identify clinically significant adverse effects related to [DIAGNOSES REDACTED] or [MEDICAL CONDITION] that facility staff should be prepared to recognize. physician's orders [REDACTED]. The care plan was reviewed on 12/06/12 and again on 12/11/12. It did not address nausea, vomiting or the use of [MEDICATION NAME]. A physicians order review, completed on 12/06/12, indicated Resident #26 was started on [MEDICATION NAME] 20 mg by mouth twice daily related to [MEDICAL CONDITION] reflux disease (GERD). Review of the care plan on 12/06/12 and again 12/11/12 revealed [MEDICAL CONDITION] the use of [MEDICATION NAME] was addressed. . e) Resident #19 On 12/10/12 at 11:51 a.m., a medical record review was conducted revealing Resident #19 had a treatment order for wound vac therapy (delivery of negative pressure to promote healing) for a pressure ulcer to the coccyx area. This treatment continued until the resident was discharged to the hospital on [DATE]. On 12/10/12, the most recent care plan for this resident was reviewed. It indicated the last revision by the facility was completed on 08/08/12. This care plan made no mention of the implementation of the wound vac treatment for [REDACTED]. During an interview, on 12/11/12 at 1:21 p.m., with the DON, she confirmed the care plan did not address the wound vac therapy as treatment for [REDACTED].", "filedate": "2016-12-01"}
{"rowid": 7931, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "96 TYREE STREET", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2012-12-11", "deficiency_tag": 280, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "K06L11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, policy review, and staff interview, the facility failed to revise the care plans for four (4) of thirty-one (31) Stage 2 sample residents. The care plans were not revised to reflect changes in lift transfer status, contact precautions, wound status, dental needs, feeding tube removal, and constipation. Resident identifiers: #26, #47, #54 and #66. Facility census: 60 Findings include: a) Resident #26 1) The current care plan was reviewed on 12/04/12 at 3:19 p.m., and again on 12/12/12 at 10:00 a.m. It indicated Resident #26 had decreased ability to self perform activities of daily living (ADLs) secondary to recent hospitalization for repair of a right [MEDICAL CONDITION]. Additionally, the care plan noted she required the assistance of a Total Lift 450/FB/Green sling to get out of bed. Review of the medical record, on 12/05/12, at approximately 4:00 p.m., revealed a physician's orders [REDACTED]. Employee #53, a nursing assistant (NA), was interviewed on 12/06/12 at 8:40 a.m. She stated the resident utilized the sit to stand lift for transfers. The care plan had not been revised to accurately reflect the resident's current needs. 2) A physician's orders [REDACTED]. Additionally, an order dated 12/01/12 was written to maintain contact precautions. The care plan did not contain this information Employee #7, a registered nurse (RN), was interviewed on 12/11/12. She stated the care plan was updated daily utilizing the pink slips from the physician's telephone orders. She reviewed the medical record and compared it to the care plan. The employee acknowledged the care plan did not accurately reflect the physician's orders [REDACTED]. 3) The residents's skin integrity report was reviewed on 12/05/1/2 at approximately 2:00 p.m. The resident had a pressure ulcer which was noted as a deep tissue injury (DTI). The information on the skin integrity reports, dated 11/23/12 and 11/30/12, noted a scab in the center of the wound. The facility's skin integrity policy was reviewed on 12/05/12. It described that a pressure ulcer in which the base was covered with eschar was an unstageable wound. Employee #36, the director of nurses (DON), evaluated the wound bed on 12/11/12. She stated the wound bed was a scab. When questioned regarding the stage of the wound, she replied, unstageable. The care plan, reviewed on 12/11/12 at approximately 4:00 p.m., noted the right heel pressure area as deep tissue injury. b) Resident #47 Review of the resident's current care plan, dated 04/07/12, found a problem, Resident exhibits or is at risk for oral health or dental care problems as evidenced by missing and carious teeth that resident and POA (power of attorney) do not wish to address at this time. At risk for pain, infection, and chewing difficulty. Resident frequently refuses to allow staff to brush his teeth and refuses to assist with brushing his own teeth. (residents MPOA (medical power of attorney) aware and also unsuccessful at getting resident to go to dentist or brush his teeth.) Resident will refuse to go to dentist for oral consult. Further review of the medical record revealed a nurse's note, dated 09/04/12, stating, Resident has a broken tooth located on the bottom side, dental appointment made. Review of the medical record found the resident went to the dentist on 09/11/12 for treatment, and had a tooth extracted. He returned to the facility with a proposed detailed treatment plan from the dentist which included seven (7) extractions and six (6) fillings. The care plan did not include this information. Employee #34, an administrative registered nurse, and Employee #79, a registered nurse, were interviewed at 9:00 a.m. on 12/06/12 regarding the failure to update the care plan with the resident's visit to the dentist and the proposed dental plan. Employee #79 agreed the facility should have updated the care plan after the dental appointment on 09/11/12. c) Resident #54 Review of the medical record found the resident had removed her own feeding tube on 11/22/12. The nurse contacted the resident's physician upon discovery of the removal of the feeding tube. The resident's physician did not want the resident to be transferred out of the facility for replacement of her feeding tube. At the time of survey, the resident did not have a feeding tube. The resident was eating well, taking medications by mouth and there were no plans for placement of a feeding tube. Review of the current plan of care, dated, 04/07/11, found a problem: Resident has an enteral feeding tube to assist with meeting nutritional needs as needed The DON was interviewed on 12/05/12 at 2:00 p.m. She agreed the care plan was not updated after removal of the feeding tube. d) Resident #66 Medical record review identified Resident #66 had a [DIAGNOSES REDACTED]. Medical record review revealed the resident was ordered iron 325 mg to be given twice a day on 09/16/12. The administration of iron further complicates constipation. No interventions were put in place to relieve the resident of constipation. The facility continued the use of the standing orders. The care plan was not updated with goals and interventions regarding the resident's problems with constipation. Review of the medical record identified the attending physician ordered, on 10/23/12, Senna S two (2) capsules to be given at bedtime. The care plan was not revised to reflect this new intervention. Although the resident had continuing constipation, the care had no revisions had for constipation since 01/19/12. On 12/06/12 at 1:30 p.m., the DON confirmed the facility failed to revise the care plan for this resident. .", "filedate": "2016-12-01"}
{"rowid": 7932, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "96 TYREE STREET", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2012-12-11", "deficiency_tag": 282, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "K06L11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview, the facility failed to implement the care plan related to behavioral flow sheets for one (1) of thirty-one (31) Stage 2 sample residents. Resident identifier: #57. Facility census: 60. Findings Include: a) Resident #57 Review of the resident's current care plan, with a review date of 10/31/12, revealed the problem, Resident at risk for complications related to the use of [MEDICAL CONDITION] drugs antianxiety and antidepressant medications, with a goal of complete behavior monitoring flow sheet. Review of physician orders [REDACTED]. On 12/06/12, at approximately 3:00 p.m., the director of nursing, Employee #36, was interviewed concerning the completion of behavioral flow sheets for Resident #57. Employee #36 stated a behavioral flow sheet was not completed when a resident is on antidepressants. A behavioral flow sheet was not implemented and/or completed as directed by the current care plan.", "filedate": "2016-12-01"}
{"rowid": 7933, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "96 TYREE STREET", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2012-12-11", "deficiency_tag": 309, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "K06L11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, physician interview, staff interview, and policy and procedure review, the facility failed to follow their protocol/policy and procedure for care of a resident receiving [MEDICAL TREATMENT]; failed to follow physician's orders to monitor the urinary output for two (2) residents with indwelling catheters; and failed to provide individualized interventions for one (1) resident with continuing constipation. This was identified for four (4) of thirty-one (31) stage 2 residents during the quality indicator survey (QIS). Resident identifiers: #45, #62, #66, and #74. Facility census: 60. Findings include: a) Resident #45 Medical record review found the resident was diagnosed with [REDACTED]. Review of the facility policy and procedure for [MEDICAL TREATMENT]: Graft and Fistula Care, dated 11/01/07, found the following: .Perform routine observation of access site daily and on return from [MEDICAL TREATMENT] center. Observe for signs of complications including, but not limited to: 2.1 Pain, swelling, redness, odor, hardness, bleeding or drainage at site: 2.2 Color, temperature of extremity; 2.3 Presence of pain or numbness in extremity; 2.4 Pulses distal to access site (fistula/graft); 2.5 Presence of bruit on auscultation with stethoscope; 2.6 Presence of thrill (vibration) by palpation The director of nursing (DON) was interviewed at 12:15 p.m. on 12/10/12. She stated the facility used a weekly [MEDICAL TREATMENT] evaluation tool to document the resident's condition before and after return from the [MEDICAL TREATMENT] center. The weekly [MEDICAL TREATMENT] evaluation tool was reviewed for the months of October and November 2012. Documentation (pre and post [MEDICAL TREATMENT]) was missing from the tool on the following days: 10/06/12 no pre-[MEDICAL TREATMENT] documentation, 10/11/12 no post-[MEDICAL TREATMENT] documentation, 10/18/12 no pre-[MEDICAL TREATMENT] documentation, 10/20/12 no documentation pre or post [MEDICAL TREATMENT], 10/23/12 no post-[MEDICAL TREATMENT] documentation, 10/25/12 no post-[MEDICAL TREATMENT] documentation, 10/27/12 no post-[MEDICAL TREATMENT] documentation 10/29/12 no pre-[MEDICAL TREATMENT] documentation 11/13/12 no post-[MEDICAL TREATMENT] documentation 11/17/12 no post-[MEDICAL TREATMENT] documentation 11/27/12 no post-[MEDICAL TREATMENT] documentation 11/29/12 no post-[MEDICAL TREATMENT] documentation Further review of the [MEDICAL TREATMENT] tool found the facility did not document the resident's pre or post [MEDICAL TREATMENT] weight on any of her [MEDICAL TREATMENT] days in October and November. The DON stated, during an interview on 12/10/12 at 12:15 p.m., the [MEDICAL TREATMENT] center was responsible for weighting the resident before and after [MEDICAL TREATMENT] and the [MEDICAL TREATMENT] center was to communicate the weights to the facility. The DON was unable to find any documentation the resident's pre and post [MEDICAL TREATMENT] weights, obtained at the [MEDICAL TREATMENT] center, were communicated to the facility. The DON also acknowledged the facility failed to complete the pre and post [MEDICAL TREATMENT] assessment of the resident on the above dates. b) Resident #62 Medical record review found the resident was re-admitted to the facility on [DATE] with an indwelling Foley catheter. There was a physician's order to measure the resident's urinary output on every shift. Further review of the facility's form for output shift totals for November 2012 found the urinary output was not completed on the following shifts for the following days: 11/01/12, 7-3 shift 11/03/12, 11-7 shift 11/04/12, 3-11 shift 11/06/12, 3-11 shift 11/09/12, 7-3 shift 11/11/12, 3-11 shift 11/13/12, 7-3 and 3-11 shifts 11/15/12, 11-7 and 3-11 shifts 11/16/12, 11-7, 7-3, and 3-11 shifts 11/17/12, 3-11 shift 11/19/12, 11-7 and 3-11 shifts 11/20/12, 11-7 and 3-11 shifts 11/21/12, 11-7 shift 11/27/12, 11-7 and 3-11 shifts 11/29/12, 11-7 and 3-11 shifts An interview with the DON, at 3:30 p.m. on 12/05/12, verified the facility failed to consistently measure the resident's urinary output as directed by the physician's order. c) Resident #66 Medical record review identified Resident #66 had a [DIAGNOSES REDACTED]. According to the medical record, the resident had frequently been given medications from the facility's standing orders for constipation. Medical record review also identified the resident was ordered iron 325 mg to be given twice a day beginning on 09/16/12. The administration of iron further complicates constipation. No other interventions were put in place to relieve the resident of constipation. The facility continued the use of the standing orders for constipation. There was no evidence the physician was notified of any issues of constipation with this resident. The following laxatives were given to the resident for constipation. This included giving an invasive suppository on a regular basis. -- 08/25/12 - Milk of Magnesia given -- 09/15/12 - [MEDICATION NAME] suppository given -- 09/26/12 - Milk of Magnesia -- 10/03/12 - Milk of Magnesia -- 10/09/12 - Milk of Magnesia -- 10/13/12 - Milk of Magnesia Review of the medical record identified an order dated 10/23/12, by the attending physician, for the resident to have Senna S two (2) capsules at bedtime. During an interview with the DON, on 12/06/12 at 1:30 p.m., it was confirmed this resident was never ordered routine medication for constipation until 10/23/12. Further review of the medical record identified the Senna was ineffective, and the facility continued to use the standing orders. No evidence was found the facility identified the Senna was not working and/or notified the physician. The facility continued to administer laxatives, including the invasive suppository, as a regular routine for constipation: -- 10/24/12 - Milk of Magnesia -- 11/06/12 - Milk of Magnesia -- 11/07/12 - [MEDICATION NAME] suppository -- 11/11/12 - Milk of magnesia -- 11/12/12 - [MEDICATION NAME] suppository -- 11/16/12 - Milk of magnesia -- 11/17/12 - [MEDICATION NAME] suppository -- 11/20/12 - Milk of magnesia -- 11/21/12 - [MEDICATION NAME] suppository -- 11/24/12 - Milk of magnesia -- 11/25/12 - [MEDICATION NAME] suppository -- 11/28/12 - Milk of Magnesia -- 11/29/12 - [MEDICATION NAME] suppository -- 12/02/12 - Milk of Magnesia -- 12/03/12 - [MEDICATION NAME] suppository -- 12/07/12 - Milk of Magnesia -- 12/08/12 - [MEDICATION NAME] suppository On 12/06/12 at 1:30 p.m., the DON confirmed the facility failed to recognize the resident was receiving multiple doses of laxatives on a regular basis from the standing orders. Further confirmation was obtained from the physician, with the DON present, during a conference call on 12/11/12 at 2:30 p.m. He confirmed there was a failure to recognize the resident was receiving multiple doses of medication for constipation. He stated the facility now had a plan in place for additional interventions for constipation for this resident. d) Resident #74 Review of the medical record for Resident #74 identified he was admitted to the facility with a Foley catheter and a gastrostomy ([DEVICE]). The physician's orders indicated this resident was to have input and output monitored related to the Foley catheter and the [DEVICE]. Intake and output records were reviewed. This revealed the facility failed to consistently monitor the intake and output of both the [DEVICE] and Foley catheter. Review of the physician's orders identified the physician ordered the facility to monitor output for twenty-four (24) hours on 07/24/12 related to the resident pulling the catheter out. Further review of the output record for 07/24/12 identified the facility failed to monitor the output for 07/24/12 according to the physician order. The intake/output two (2) week shift totals for 07/24/12 was blank for this day. On 12/11/12 at 10:45 a.m., the DON confirmed the facility did not monitor the output according to the physician's order. Further review of the intake/output two (2) week shift totals for the months of July 2012 and August 2012 identified the facility also failed to consistently monitor the intake for the [DEVICE] for the months of July 2012 and August 2012. On 12/11/12 at 10:45 a.m., the DON confirmed the facility failed to monitor the intake as ordered.", "filedate": "2016-12-01"}
{"rowid": 7934, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "96 TYREE STREET", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2012-12-11", "deficiency_tag": 318, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "K06L11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on resident interview, resident observation, staff interview, and record review, the facility failed to ensure one (1) of three (3) residents sampled for range of motion during Stage two (2) of the survey, received appropriate treatment to increase range of motion or prevent further decrease in range of motion. A resident with a contracture did not receive range of motion services. Resident identifier: #10. Facility census: 60. Findings include: a) Resident #10 A stage one staff interview, on 12/03/12 at 2:53 p.m., revealed Resident #10 had a contracture of the left hand. Additionally, it revealed the resident did not wear a splint, nor receive range of motion services. An observation and interview was completed with Resident #10 on 12/04/12 at 2:18 p.m. Observation revealed a contracture of her left hand. She stated services were not performed to maintain range of motion. The resident stated her contracture was related to a stroke. Review of the medical record, on 12/05/12, revealed a [DIAGNOSES REDACTED]. The minimum data set (MDS) was reviewed on 12/11/12 at 9:00 a.m. The assessment, dated 10/03/12, indicated the resident had an impairment of one (1) of her upper extremities. Section S of the comprehensive assessment, dated 04/02/12, indicated the resident had a contracture of the left hand. Employee #57 (a nursing assistant) was interviewed on 12/11/12 at 10:10 a.m. She stated the resident did not receive therapy or range of motion services for the contracture of her left hand. The resident was interviewed again on 12/11/12 at 10:15 a.m. She was alert, verbal and coherent. She said her hand had been this way since my stroke. She again stated the staff did not provide range of motion, nor encourage her to perform range of motion of her left hand. Employee #35, a registered nurse care plan coordinator (RN CPC) was interviewed on 12/11/12 at 3:00 p.m. She acknowledged the contracture was not addressed on the care plan and no routine preventive treatment was provided to prevent worsening of the contracture. Employee #31, another RN CPC, was also interviewed on 12/11/12 at 3:00 p.m. She stated the MDS identified the contracture of Resident #10's left hand on the April 2012 assessment. She indicated the contracture was not addressed because it did not pull to Section V for care area assessment. Employee #31 agreed the contracture of the the resident's left hand was not addressed in the care plan, nor addressed in the care area assessment. treatment of [REDACTED]. There was no evidence the resident received any services to increase range of motion and/or to prevent further decrease in range of motion.", "filedate": "2016-12-01"}
{"rowid": 7935, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "96 TYREE STREET", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2012-12-11", "deficiency_tag": 329, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "K06L11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, physician interview, and staff interview, the facility failed to ensure two (2) of ten (10) sample residents' medication regimens were free from unnecessary medications. One (1) resident received multiple doses of laxatives, including invasive laxatives, and the antipsychotic [MEDICATION NAME] with no indication for its use. Another resident received [MEDICATION NAME] without adequate indication for its use and without an attempt at a gradual dose reduction. Resident identifiers: #66 and #11. Facility census: 60. Findings include: a) Resident #66 (Laxatives) 1) Medical record review identified Resident #66 had a diagnoses of constipation. Further review of the medical record identified this resident did not have an individualized medication regimen for the constipation. According to the medical record, the resident had frequently been given medications from the facility's standing orders for constipation. No interventions, other than frequent use of laxatives, were put in place to relieve the resident of constipation. The facility continued the use of the standing orders for constipation. There was no evidence the physician was notified of any issues of constipation with this resident. The following laxatives were given to the resident for constipation. This included giving an invasive suppository on a regular basis. -- 08/25/12 - Milk of Magnesia given -- 09/15/12 - [MEDICATION NAME] suppository given -- 09/26/12 - Milk of Magnesia -- 10/03/12 - Milk of Magnesia -- 10/09/12 - Milk of Magnesia -- 10/13/12 - Milk of Magnesia Review of the medical record identified an order dated 10/23/12, by the attending physician, for the resident to have Senna S two (2) capsules at bedtime. During an interview with the DON, on 12/06/12 at 1:30 p.m., it was confirmed this resident was never ordered routine medication for constipation until 10/23/12. Further review of the medical record identified the Senna was ineffective, and the facility continued to use the standing orders. No evidence was found the facility identified the Senna was not working and/or notified the physician. The facility continued to administer laxatives, including the invasive suppository, as a regular routine for constipation: -- 10/24/12 - Milk of Magnesia -- 11/06/12 - Milk of Magnesia -- 11/07/12 - [MEDICATION NAME] suppository -- 11/11/12 - Milk of magnesia -- 11/12/12 - [MEDICATION NAME] suppository -- 11/16/12 - Milk of magnesia -- 11/17/12 - [MEDICATION NAME] suppository -- 11/20/12 - Milk of magnesia -- 11/21/12 - [MEDICATION NAME] suppository -- 11/24/12 - Milk of magnesia -- 11/25/12 - [MEDICATION NAME] suppository -- 11/28/12 - Milk of Magnesia -- 11/29/12 - [MEDICATION NAME] suppository -- 12/02/12 - Milk of Magnesia -- 12/03/12 - [MEDICATION NAME] suppository -- 12/07/12 - Milk of Magnesia -- 12/08/12 - [MEDICATION NAME] suppository On 12/06/12 at 1:30 p.m., the DON confirmed the facility failed to recognize the resident was receiving multiple doses of laxatives on a regular basis from the standing orders. Further confirmation was obtained from the physician, with the DON present, during a conference call on 12/11/12 at 2:30 p.m. He confirmed there was a failure to recognize the resident was receiving multiple doses of medication for constipation. He stated the facility now had a plan in place for additional interventions for constipation for this resident. 2) Resident #66 ([MEDICATION NAME]) Review of the medical record identified Resident #66 was given [MEDICATION NAME], an anti-psychotic medication, for dementia with behaviors. During an interview with the DON on, 12/11/12 at 1:45 p.m., it was identified the medication was ordered related to the resident pacing, wandering, and walking with a shuffling gait. An interview was conducted with the attending physician and the DON, via a telephone conference on 12/11/12 at 2:30 p.m. The physician stated the medication was given so Resident #66 would not get up without asking for assistance, possibly resulting in a fall. The attending physician stated the [MEDICATION NAME] would keep the resident from pacing and shuffling, and he felt this out weighed the risk of her falling. Review of the medical record revealed no behaviors which warranted the use of [MEDICATION NAME]. On 12/11/12 at 1:45 p.m., the DON provided the following documentation which she referred to as behaviors: 02/09/12 -- Gait shuffled and unsteady 02/11/12 -- Resident pacing x 3 from bed 02/11/12 -- Has unsteady shuffling gait 02/19/12 -- shuffle gait 02/22/12 -- has a shuffle gait, staff reminds resident to take steps 02/22/12 -- up x 5 ambulating from room to hallway 02/22/12 -- resident has a shuffle gait 02/23/12 -- has a steady shuffle gait 02/23/12 -- less shuffling noted Medical record review found no current documentation related to the resident wandering and walking with a shuffling gait. Resident #66 used a wheelchair for ambulation and sometimes used a walker. She also required assistance of one (1) with a gait bait. On 10/03/12, Employee #35 (a registered nurse) updated the care plan for Resident #66. It stated, . resident rarely leaves room and she does not wander. This finding was confirmed with the DON on 12/11/12 at 1:10 p.m. Review of the care plan for the use of [MEDICAL CONDITION] medications found no evidence [MEDICATION NAME] was used for shuffling gait or wandering. In addition, there was no evidence of any behaviors which warranted the use of an antipsychotic medication. The care plan for [MEDICAL CONDITION] medications was last updated on 01/19/12. Further review of the care plan found no interventions had been added to the care plan since 01/19/12. Review of the social service assessments, dated 04/25/12 and 08/01/12, identified the resident had not experienced any of the following behaviors: -- hitting others -- kicking -- pushing -- scratching -- grabbing -- abusing others sexually -- threatening others -- pacing This resident was given the antipsychotic medication, [MEDICATION NAME], without adequate indications for its use. b) Resident #11 Medical record review, on 12/10/12, revealed a pharmacy consultation report dated 10/17/12. The report stated Resident #11 had a physician's orders [REDACTED]. As of 12/10/12, the order dated 09/11/12 had not been initiated. The resident was currently receiving the medication two (2) times daily. When interviewed, on 12/10/12, regarding why the ordered medication decrease had not been instituted, the DON stated the medical power of attorney for Resident #11 refused to allow suggested medication reductions. The pharmacy consultant report, dated 10/17/12, was signed by the DON. It stated, Family had been contacted regarding change & had not given consent for medication change. The report did not indicate which family member made that decision and/or if that person was the resident's medical decision maker. Additionally, there was no evidence the medical decision maker had been made aware of the pros and cons related to continuing the use of [MEDICAL CONDITION] medication for this ninety-one (91) year old resident. Further review of the medical record revealed [MEDICATION NAME] XR 150 mg twice a day was prescribed for Resident #11 for [MEDICAL CONDITION] not elsewhere classified and dementia conditions classified elsewhere (CCE) with behavioral disturbances. There was no [DIAGNOSES REDACTED]. The minimum data set (MDS) with an assessment reference date (ARD) of 11/12/12, Section E, revealed Resident #11 did not display potential indicators of [MEDICAL CONDITION] and did not display: a) physical behavioral symptoms directed toward others, b) verbal behavioral symptoms directed toward others c) other behavioral symptoms not directed toward others. In addition, behavioral flow sheets for the months of October and November 2012 revealed Resident #11 did not display any of the above behaviors. An inquiry was made regarding what behaviors the resident displayed that would necessitate this medication. Nursing note documentation, beginning in 2008, was provided by the DON. It indicated the resident once exhibited acting out behaviors, such as striking out at other residents. However, no recent behavior problems were noted. The only recent negative behavior was noted on an incident report dated 06/21/12. It stated Resident #11 hit another resident while in the dining room. Further review of a change in condition nursing note dated 06/20/12, near the time of the incident, revealed Resident #11 was positive for [MEDICATION NAME] cloacae (a urinary tract infection). Urinary tract infections can cause behavior changes in the elderly population. The resident did not display behaviors that would necessitate the continued use of the [MEDICATION NAME]. The use of this medication, without adequate indication for its use and/or without evidence attempts at a dose reduction was clinically contraindicated, resulted in this resident being provided an unnecessary medication.", "filedate": "2016-12-01"}
{"rowid": 7936, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "96 TYREE STREET", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2012-12-11", "deficiency_tag": 428, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "K06L11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, physician interview, and staff interview, the pharmacist failed to recognize and report the excessive use of laxatives for one (1) of ten (10) sample residents. Resident #66 received frequent doses of laxatives, including invasive laxatives, for constipation. The facility was using standing orders for this resident's constipation, and did not implement an individualized plan for the resident who had frequent episodes of constipation. The pharmacist did not identify this irregularity. Additionally, the pharmacist did not identify and report the resident was prescribed an iron supplement which contributes to constipation. Resident identifier: #66. Facility census: 60. Findings include: a) Resident #66 Medical record review identified Resident #66 had a [DIAGNOSES REDACTED]. According to the medical record, the resident had frequently been given medications from the facility's standing orders for constipation. No interventions, other than frequent use of laxatives, were put in place to relieve the resident of constipation. The facility continued the use of the standing orders for constipation. There was no evidence the physician was notified of any issues of constipation with this resident. The following laxatives were given to the resident for constipation. This included giving an invasive suppository on a regular basis. -- 08/25/12 - Milk of Magnesia given -- 09/15/12 - Dulcolax suppository given -- 09/26/12 - Milk of Magnesia -- 10/03/12 - Milk of Magnesia -- 10/09/12 - Milk of Magnesia -- 10/13/12 - Milk of Magnesia Review of the medical record identified an order dated 10/23/12, by the attending physician, for the resident to have Senna S two (2) capsules at bedtime. Further review of the medical record identified the Senna was ineffective, and the facility continued to use the standing orders. No evidence was found the facility identified the Senna was not working and/or notified the physician. The facility continued to administer laxatives, including the invasive suppository, as a routine intervention for the resident's constipation: -- 10/24/12 - Milk of Magnesia -- 11/06/12 - Milk of Magnesia -- 11/07/12 - Dulcolax suppository -- 11/11/12 - Milk of magnesia -- 11/12/12 - Dulcolax suppository -- 11/16/12 - Milk of magnesia -- 11/17/12 - Dulcolax suppository -- 11/20/12 - Milk of magnesia -- 11/21/12 - Dulcolax suppository -- 11/24/12 - Milk of magnesia -- 11/25/12 - Dulcolax suppository -- 11/28/12 - Milk of Magnesia -- 11/29/12 - Dulcolax suppository -- 12/02/12 - Milk of Magnesia -- 12/03/12 - Dulcolax suppository -- 12/07/12 - Milk of Magnesia -- 12/08/12 - Dulcolax suppository On 12/06/12 at 1:30 p.m., the DON confirmed the facility failed to recognize the resident was receiving multiple doses of laxatives on a regular basis from the standing orders. Further confirmation was obtained from the physician, with the DON present, during a conference call on 12/11/12 at 2:30 p.m. He confirmed there was a failure to recognize the resident was receiving multiple doses of medication for constipation. He stated the facility now had a plan in place for additional interventions for constipation for this resident. Review of the medication regimen review conducted by the pharmacist identified the pharmacist had reviewed the medications for Resident #66 every month since January 2012. The pharmacist had not identified the excessive use of laxatives, and had not identified the use of the standing orders for constipation had not decreased after the implementation of a routine dose of Senna at bedtime. Additionally, on 09/16/12, the physician ordered iron 325 mg to be given twice a day. The administration of iron further complicates constipation. The pharmacist did not identify and report this medication had a potential to increase the resident's problems with constipation.", "filedate": "2016-12-01"}
{"rowid": 7937, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "96 TYREE STREET", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2012-12-11", "deficiency_tag": 431, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "K06L11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, review of manufacturer's package inserts, review of CDC guidelines for storage of flu vaccine, and staff interview, the facility failed to maintain and/or label medications in a manner which ensured safe usage. Observation of the medication room found expired stock medications, and observation of medication Cart Two revealed open medications with no date to indicate when the medications were opened. These practices had the potential to affect more than a limited number of residents. Facility census: 60. Findings include: a) Observation of the medication storage area, on [DATE] at 11:06 a.m., found three (3) bottles of 325 mg aspirin with an expiration date of ,[DATE]. This finding was confirmed with Employee #36 (director of nursing) at the time of discovery. b) Inspection of medication Cart Two, with Employee #69, a licensed practical nurse, revealed an open vial of Lantus insulin which contained no date indicating when it was opened, to ensure the medication was still safe for use. (The manufacturer's package insert includes Open vials, whether or not refrigerated, must be used within 28 days after the first use. They must be discarded if not used within 28 days . Also, Cart Two contained an open vial of influenza vaccine. It had no date indicating when it was opened. This finding was also confirmed with Employee #36 at 11:06 a.m. (The Centers for Disease Control guidelines note multidose vials should be discarded after 28 days.)", "filedate": "2016-12-01"}
{"rowid": 7938, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "96 TYREE STREET", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2012-12-11", "deficiency_tag": 441, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "K06L11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, staff interview, medical record review, and policy review, the facility failed to maintain an infection control program to help prevent the development and spread of infection. Linens were handled improperly, gloves were not changed during a dressing change, floor coverings in bathrooms were cracked, gloves were not worn in an isolation room when removing a water pitcher from the room, and a potentially contaminated water pitcher was placed on a cart with other items. This affected one (1) resident and had the potential to affect more than a limited number of residents. Resident identifier: #26. Facility census: 60 Findings Include: a) An ice pass was observed on 12/03/12 at 11:35 a.m. Employee #45, a nursing assistant (NA), touched the inside surface of the ice receptacle with her fingers. An interview with Employee #36, the director of nursing (DON), on 12/03/12, confirmed this was an infection control issue. b) During observations on 12/03/12, the floor covering was noted to be cracked in three (3) of eight (8) bathrooms observed. This impeded proper sanitation. During an interview with Employee #5 (executive director), on 12/06/12, she acknowledged the floor covering was in disrepair and would be replaced. c) Employee #45 (NA) was again observed passing ice on 12/05/12 at 1:30 p.m. She removed two (2) pitchers from the room of a resident on contact precautions related to a [DIAGNOSES REDACTED]. Additionally, she did not wear gloves when touching the water pitchers, and she did not wash her hands. Employee #76, a licensed practical nurse (LPN) was present and acknowledged the nursing assistant violated acceptable infection control practices. d) Resident #26 This resident's wound dressing change was observed on 12/05/12 at 1:45 p.m. Resident #26 was on contact precautions related to clostridium difficile. Employee #76 (LPN) removed the soiled dressing, cleansed the wound, and applied a new dressing without changing gloves and washing her hands. Additionally, a clean barrier was not placed on the over-the-bed table for the bag utilized to contain the dressing items which had been stored in the cart. The bag for soiled items was placed at the foot of the bed, which potentially contaminated the outside of the bag. The bag was not placed inside a clean bag before removing it from the room, creating another opportunity for cross contamination. An interview with the DON, on 12/05/12 at 2:15 p.m., verified the nurse did not maintain aseptic technique according to the facility's policy :14.1 dressing: Aseptic policy. e) Observation on 12/10/12 at 11:25 a.m., revealed Employee #42 making a bed. Linens for use on bed A were lying on bed B. A resident was assigned to each bed. Use of the linens lying on bed B for bed A created a potential for cross contamination of infectious organisms. This failure to follow infection control measures was confirmed with Employee #76 (licensed practical nurse), who was in the room at the time of the observation. .", "filedate": "2016-12-01"}
{"rowid": 7939, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "96 TYREE STREET", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2012-12-11", "deficiency_tag": 514, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "K06L11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview, the facility failed to ensure medical records were accurate for two (2) residents. Nursing staff continued to document a resident was receiving medication via her gastrostomy tube ([DEVICE]), after the tube had been removed. Another resident was ordered medications to be administered via [DEVICE], but the order read administer via mouth. Resident identifiers: #54 and #74. Facility census: 60. Finding include: a) Resident #54 Medical record review found this resident removed her [DEVICE] on 11/22/12. Nursing staff continued to document, on the Medication Administration Record [REDACTED]. A clarification order was written on 11/26/12 for the resident to receive her medications by mouth. An interview with the director of nursing, on 12/05/12 at 2:00 p.m., confirmed the facility should have clarified the route the resident's medications would be administered on 11/22/12 when the [DEVICE] was removed. b) Resident #74 Review of the medical record for Resident #74 identified this resident was admitted to the facility on [DATE]. Resident #74 had an order in place to be NPO (nothing by mouth). Review of the Medication Administration Record [REDACTED]. The nurses signed the Medication Administration Record [REDACTED]. During an interview with Employee #36 (director of nursing) on 12/11/12, at 10:45 a.m., it was verified the medications were given via the [DEVICE], but the Medication Administration Record [REDACTED]. It was confirmed the Medication Administration Record [REDACTED].", "filedate": "2016-12-01"}
{"rowid": 9652, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "106 TYREE STREET OPERATIONS, LLC /P.O DRAWER 400", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2011-02-02", "deficiency_tag": 156, "scope_severity": "C", "complaint": 0, "standard": 1, "eventid": "860Y11", "inspection_text": "Based on observation and staff interview, the facility failed to ensure the names, addresses and phone numbers of advocacy groups remained posted and accessible at all times to residents and members of the general public. This practice had the potential to affect all residents. Facility census: 59. Findings include: a) Surveyors were unable to find the posted information related to advocacy groups as is required by regulation. Observations, made on 02/01/11, found a bulletin board where other information was located; however, there was no information regarding the names, addresses and phone numbers for all advocacy groups. The surveyor, on 02/01/11 at 10:36 a.m., then questioned the director of nursing (DON - Employee #15) and the administrator (Employee #25) as to where this information might be. After searching for the missing data, the administrator informed the surveyor that it had been found in a notebook that a confused resident (#61) had been given to put paperwork in. This resident had been known to remove posted items from bulletin boards, and staff would be unable to locate them. The facility provided her with a notebook, which would give staff some idea where to begin looking when things were missing. According to the administrator, this happened frequently, and staff would look once a week to see things were posted as necessary. If not, they would search the notebook.", "filedate": "2015-10-01"}
{"rowid": 9653, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "106 TYREE STREET OPERATIONS, LLC /P.O DRAWER 400", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2011-02-02", "deficiency_tag": 279, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "860Y11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility failed to develop a comprehensive care plan for the use of an antipsychotic medication for one (1) of twenty-eight (28) Stage II sample residents. Resident #56 was prescribed [MEDICATION NAME] on 10/11/10 for a [DIAGNOSES REDACTED].#56. The facility must develop a comprehensive care plan for each resident that includes measurable objectives to meet a residents medical, nursing, mental, and psychosocial needs that are identified in the comprehensive assessment. Resident identifier: #56. Facility census: 59. Findings include: a) Resident #56 Record review revealed Resident #56 was sent to a psychiatrist on 10/11/10 for evaluation. The psychiatrist diagnosed the resident with depression, rule out dementia, and anxiety. [MEDICATION NAME] is an antipsychotic used to treat [MEDICAL CONDITION], schizo-affective disorder, and mood disorders (e.g. mania, [MEDICAL CONDITION] disorder, and depression with psychotic features). Resident #56 was prescribed 0.5 mg of [MEDICATION NAME] to be given at bedtime on 10/11/10. Resident #56 returned to the psychiatrist on 12/06/10, and the [MEDICATION NAME] was increased to 1 mg at bedtime. Review of the medical record revealed no comprehensive care plan to identify the use of the [MEDICATION NAME]. This information was brought to the attention of the director of nursing (DON - Employee #15) at 1:30 p.m. on 01/31/11.", "filedate": "2015-10-01"}
{"rowid": 9654, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "106 TYREE STREET OPERATIONS, LLC /P.O DRAWER 400", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2011-02-02", "deficiency_tag": 281, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "860Y11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, staff interview, and review of Criteria for Determining Scope of Practice for Licensed Nurses and Guidelines for Determining Acts That May Be Delegated or Assigned by Licensed Nurses (Delegation Guidelines), the facility failed to provide services in accordance with accepted standards of clinical practice. Review of Resident #26's medication administration records (MARs) revealed the orders that offered the option to the licensed practical nurse (LPN) of administering by mouth or via enteral tube, with no parameters to guide the LPN's decision-making process. This practice allows an LPN to act outside his or her scope of practice as established by the WV Boards of Nursing. Resident identifier: #26. Facility census: 59. Findings include: a) Review of Resident #26's MARs found orders that offered the option to the LPNs of administering medications by mouth or through the resident's enteral feeding tube, with no parameters to guide a LPN's decision-making process. Review of the Delegation Guidelines, revised by the West Virginia Board of Examiners for Registered Professional Nurses and the West Virginia State Board of Examiners for Licensed Practical Nurses on 06/17/09, found the following information on Page 13: ACTIVITIES THAT MAY BE DELEGATED TO THE LPN Activities appropriate for delegation to the LPN should be those that, after careful evaluation by the supervising RN, are expected to contain only one option. That is, the LPN is expected to be able to proceed through the established steps or an activity without encountering an unexpected response or reaction and competence in performance of the activity has been demonstrated. ACTIVITIES THAT SHOULD NOT BE DELEGATED TO THE LPN Activities that are NOT appropriate for delegation to an LPN are those that are likely to present decision making options, requiring in depth assessment and professional judgment in determining the next step to take as the provider proceeds through the steps of the activity. During an interview with an LPN (Employee #56) on 01/27/11 at 2:34 p.m., Employee #56 stated, He can only take his medication thru his [DEVICE]. This information was related to the facility's director of nursing (DON - Employee #15) at 11:00 a.m. on 02/01/11.", "filedate": "2015-10-01"}
{"rowid": 9655, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "106 TYREE STREET OPERATIONS, LLC /P.O DRAWER 400", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2011-02-02", "deficiency_tag": 329, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "860Y11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility failed to ensure the medication regimen of one (1) of twenty-eight (28) Stage II sample residents was free from unnecessary drugs. Resident #56 was ordered [MEDICATION NAME] (an antipsychotic medication) on 10/11/10 for the [DIAGNOSES REDACTED].#56 had an appropriate [DIAGNOSES REDACTED]. Resident identifier: #56. Facility census: 59. Findings include: a) Resident #56 Record review revealed Resident #56 was sent to a psychiatrist on 10/11/10 for evaluation. The psychiatrist diagnosed the resident with depression, rule out dementia, and anxiety. [MEDICATION NAME] is an antipsychotic used to treat [MEDICAL CONDITION], schizo-affective disorder, and mood disorders (e.g. mania, [MEDICAL CONDITION] disorder, and depression with psychotic features). Resident #56 was prescribed 0.5 mg of [MEDICATION NAME] to be given at bedtime on 10/11/10. Resident #56 returned to the psychiatrist on 12/06/10, and the [MEDICATION NAME] was increased to 1 mg at bedtime. Further review of the medical record found the consulting pharmacist had reported to the physician and the facility, on 10/18/10, that Resident #56 did not have an appropriate [DIAGNOSES REDACTED]. In addition, the clinical condition being treated did not meet the criteria for the use of [MEDICATION NAME]. The physician responded to the pharmacist's recommendation by stating, Still (symbol for 'with') repetitive health related complaints. GDR (gradual dose recommendation) not appropriate. This information was brought to the attention of the director of nursing (DON - Employee #15) at 1:30 p.m. on 01/31/11.", "filedate": "2015-10-01"}
{"rowid": 9656, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "106 TYREE STREET OPERATIONS, LLC /P.O DRAWER 400", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2011-02-02", "deficiency_tag": 425, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "860Y11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility failed to provide medications as prescribed for one (1) of twenty-eight (28) Stage II sample residents. Resident #80 was admitted to the facility on [DATE], for rehabilitation after surgery requiring cemented left triathlon total knee arthroplasty. A dose of routine pain medication was not given as prescribed at 9:00 a.m. on 10/30/10. According to staff interview, the medication was not available for administration at that time. Resident identifier: #80. Facility census: 59. Findings include: a) Resident #80 Record review revealed Resident #80 was admitted to the facility on [DATE], for rehabilitation services related to a total knee replacement. The resident was ordered Morphine Sulfate ER 30 mg twice a day for pain related to the knee surgery. Review of the Medication Administration Record [REDACTED]. During a telephone interview with a nurse (Employee #16) confirmed the medication was not available to give to the resident that morning. She further stated she called the physician at approximately 10:30 a.m. on 10/30/10 to report the medication was not in the facility. The physician discontinued the morphine at this time. During an interview with the director of nursing (DON - Employee #15 on 02/01/11 at 12:35 p.m., she verified the medication was not available for administration to Resident #80 at that time.", "filedate": "2015-10-01"}
{"rowid": 9657, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "106 TYREE STREET OPERATIONS, LLC /P.O DRAWER 400", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2011-02-02", "deficiency_tag": 428, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "860Y11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility failed, for one (1) of twenty-eight (28) Stage II sample residents, to ensure the physician acted upon reports of irregularities in a resident's medication regimen. Resident #56 was ordered Risperdal (an antipsychotic medication) on 10/11/10 for the [DIAGNOSES REDACTED].#56 had an appropriate [DIAGNOSES REDACTED]. The consulting pharmacist identified and reported to the facility and the physician that Resident #56 did not have an appropriate [DIAGNOSES REDACTED]. Resident identifier: #56. Facility census: 59. Findings include: a) Resident #56 Record review revealed Resident #56 was sent to a psychiatrist on 10/11/10 for evaluation. The psychiatrist diagnosed the resident with depression, rule out dementia, and anxiety. Risperdal is an antipsychotic used to treat schizophrenia, schizo-affective disorder, and mood disorders (e.g. mania, bipolar disorder, and depression with psychotic features). Resident #56 was prescribed 0.5 mg of Risperdal to be given at bedtime on 10/11/10. Resident #56 returned to the psychiatrist on 12/06/10, and the Risperdal was increased to 1 mg at bedtime. Further review of the medical record found the consulting pharmacist had reported to the physician and the facility, on 10/18/10, that Resident #56 did not have an appropriate [DIAGNOSES REDACTED]. In addition, he reported the clinical condition being treated did not meet the criteria for the use of Risperdal. The physician responded to the pharmacist's recommendation on 11/05/10, by stating, Still (symbol for 'with') repetitive health related complaints. GDR (gradual dose recommendation) not appropriate. However, the physician did not provide documentation of the clinical rationale for using this antipsychotic medication to treat this behavior (repetitive health complaints). This information was brought to the attention of the director of nursing (DON - Employee #15) at 1:30 p.m. on 01/31/11.", "filedate": "2015-10-01"}
{"rowid": 9658, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "106 TYREE STREET OPERATIONS, LLC /P.O DRAWER 400", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2011-02-02", "deficiency_tag": 441, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "860Y11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, review of the facility's listing of residents with histories of Methicillin-resistant Staphylococcus aureus (MRSA), observation, and staff interview, the facility failed to assure Resident #49 was appropriately cohorted with roommates to prevent the potential spread of infection. The facility placed Resident #74 in a four-bed ward with Resident #49, when Resident #74 was receiving treatment for [REDACTED].#74 at risk of contracting a MRSA infection to her open wounds. This deficient practice affected one (1) of twenty-eight (28) residents in the Stage II sample. Resident identifiers: #74. Facility census: 59. Findings include: a) Resident #74 Review of the facility's listing of residents with a history of MRSA infection, on 01/27/11, found Resident #49 had a history of [REDACTED]. Review of Resident #74's medical record found she was receiving treatment for [REDACTED]. Observation of the facility found Resident #74 had been placed in the same room as Resident #49. When this issue was brought to the facility's attention, Resident #49 was moved to a private room. An interview with the director of nursing (DON - Employee #15), on the afternoon of 02/02/11, revealed Resident #49 was moved to a private room for infection control purposes on 01/31/11.", "filedate": "2015-10-01"}
{"rowid": 11225, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "106 TYREE STREET OPERATIONS, LLC /P.O DRAWER 400", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2009-09-24", "deficiency_tag": 250, "scope_severity": "E", "complaint": 1, "standard": 0, "eventid": "0T3Z11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, a review of the facility's policy and procedure titled \"4.1 Social Service Progress Notes\" and staff interview, the facility failed to assure the residents were assessed for unmet social service needs. The facility did not complete assessments to identify the need for social services and to promote actions by staff to enhance each resident's individuality. There was no evidence the facility assessed the current mental / psychological status, education level, prior living arrangements, and pertinent events affecting each resident's condition to assure his/her social service needs were met. This was found for four (4) of nine (9) sampled residents. Resident identifiers: #58, #38, #23, and #19. Facility census: 57. Findings include: a) Resident #58 Record review revealed Resident #58, a [AGE] year old female, was admitted to the facility from the hospital with chronic health problems. Prior to admission, her husband had been caring for her at home. The physician determined this resident had the capacity to understand and make her own health care decisions. It was also noted that her diabetes was very unstable and required close monitoring and frequent changes to her insulin. She experienced blood pressure elevations, and her medications were frequently changed. She received dialysis three (3) times a week. She had severe peripheral vascular disease (PVD), and her skin condition was very poor. She was admitted to the facility with extensive skin treatments. Further documentation in her record revealed she verbalized frequently that she wanted to go home. There was evidence in the progress notes that the Medicaid aged and disabled waiver program had told the facility the resident was a danger to herself due to her unsafe medical decisions. There was also evidence that the adult protective service worker (APS) had stated the husband could not care for her at home. Review of the resident's social history found no assessment to determine the social service needs of this resident either upon admission or throughout the entire time the resident was in the facility. b) Resident #38 Record review revealed this resident was admitted on [DATE]. As of 09/24/09, there was no evidence this resident was assessed to identify any unmet social service needs. In fact, there was nothing entered in the social service section of his medical record. Documentation noted the physician had determined he possessed the capacity to understand and make informed health care decision, and his care plan stated the facility's social service staff would assess the resident's response to the new situation. There was no evidence in the record to reflect this had occurred. During an interview on 09/24/09 at 10:45 a.m., the social worker confirmed she had not completed an assessment for this resident as required by facility policy to assess his needs. c) Resident #23 Record review revealed this [AGE] year old resident with multiple medical complications [REDACTED]. The social worker completed a mini-mental examination of the resident on 09/10/09. This was the only social service-related assessment completed for this resident. There was nothing to address his illness and his lifestyle prior to his hospitalization . During an interview on 09/24/09 at 10:45 a.m., the social worker confirmed she had not completed an assessment for this resident as required by facility policy to assess his needs. d) Resident #19 Record review revealed this resident was admitted to the facility on [DATE]. There was no evidence of a social service assessment completed since her admission. Her social service note simply stated, \"Resident was admitted on [DATE] from the hospital for rehab to home care.\" This resident received dialysis three (3) times a week and had multiple chronic medical issues. Her care plan, established on 08/19/09, stated that social services would assess the resident's response to the new situation. There was no evidence to reflect this had occurred or that an assessment was completed to identify any unmet social service needs. During an interview on 09/24/09 at 10:45 a.m., the social worker confirmed she had not completed an assessment for this resident as required by facility policy to assess his needs. e) The corporate nurse, when asked for a copy of the facility's social service policy and procedures, produced a policy titled \"4.1 Social Services Progress Notes\" with an effective date of 06/01/01. Review of this policy revealed the facility's social service staff was to complete a progress note / check-off form which correlated with the interdisciplinary care plan (ICP) upon admission and at least quarterly. The social service staff was also to document the significant events occurring between quarterly reviews (i.e. change in health, discharge, transfer, hospitalization ) with interim notes. The policy stated the customer's progress and status was be assessed by an interview with the customer, observation, and medical record review. The concurrent note should include the following information: - 3.1 Review of the customers rights (first note, annually and as needed) - 3.2 Events leading to the admission (first note only) - 3.3 Adjustment issues (first note and ongoing) - 3.4 Functional ability and rehabilitation potential (first note and ongoing) - 3.5 Medical / cognitive / emotional status (first note and ongoing) - 3.6 Family / responsible party involvement (first note and ongoing) - 3.7 Psychotropic drug use (first note and ongoing) - 3.8 Advance directives (first note and as needed) - 3.9 Center therapeutic recreation involvement (first note and ongoing) - 3.10 Social Service intervention / involvement (first note and ongoing) - 3.11 Goals and approaches implemented by Social Service staff (first note and ongoing) - 3.12 Input from customer / responsible party (first note and ongoing) - 3.13 Discharge potential (first note and ongoing) - 3.14 Progress toward goals and effectiveness of approaches (ongoing) - 3.15 Level of peer interaction (first note and ongoing) - 3.16 Addressing of concerns / issues / interventions (first note and ongoing) - 3.17 Restraint assessment and use (first note and ongoing) - 3.18 Sensory concerns (first note and ongoing) - 3.19 Mood state and behavior problems / psychosocial adjustment (first note and ongoing) - 3.20 Personal needs / pay status (first note and ongoing) - 3.21 Referrals and use of outside resources (first note and ongoing) - 3.22 Functional abilities (first note and ongoing) - 3.23 Federal / state specific requirements - 3.24 Others as appropriate. According to the policy, whether writing in narrative format or using the check-off form, social service staff was to complete a progress note upon admission, quarterly, as needed, and at the time of the annual ICP meeting. The check-off note covered most of the above mentioned areas; however, in the comment section (on the reverse side of the form), one was able to add additional narrative information. This documentation was observed in some of the residents' records, but it was not found for these four (4) residents. .", "filedate": "2014-07-01"}
{"rowid": 11226, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "106 TYREE STREET OPERATIONS, LLC /P.O DRAWER 400", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2009-09-24", "deficiency_tag": 309, "scope_severity": "D", "complaint": 1, "standard": 0, "eventid": "0T3Z11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview, the facility failed to assure staff routinely monitored the bowel habits of residents and monitored / recorded interventions that were initiated in accordance with the physician's standing orders when a resident was experiencing problems with constipation. According to the medical record, Resident #58 went five (5) days without a bowel movement before interventions were initiated in accordance with the standing orders. Resident #31 went four (4) days without a bowel movement, and the physician's standing orders were not initiated until Day 5, contrary to the established bowel protocol. The bowel protocol was not followed for two (2) of nine (9) sampled residents. Resident identifiers: #58 and #31. Facility census: 57. Findings include: a) Resident #58 Record review revealed Resident #58 had experienced problems with constipation. In May 2009, the resident's bowel records indicated there was no bowel movements from 05/15/09 through 05/19/09. The facility's bowel protocol was requested for review. The director of nursing (DON) provided a \"standing orders template\" and indicated the interventions listed under the section titled \"constipation\" were what they do if there is not a bowel movement. According to these orders for constipation, if there is no bowel movement in three (3) days, staff is to give the resident one (1) dose of 30 cc Milk of Magnesia or [MEDICATION NAME] tablets. If there is still no bowel movement on Day 4, staff is to give the resident a [MEDICATION NAME] rectal suppository PRN x 1. If there is no bowel movement on Day 5, staff is to give the resident a Fleets enema. If there are no results from the enema, staff is to call the doctor for further orders. These standing orders were not followed for Resident #58. According to the resident's nurse aide flow sheet, she did not have a bowel movement on 05/15/09, 05/16/09, 05/17/09, 05/18/09, and 05/19/09. On Day 6, staff administered a [MEDICATION NAME] rectal suppository. The facility did not follow the standing physician orders [REDACTED]. The DON, when interviewed on 09/22/09 at 3:00 p.m., reported the information recorded on the nurse aide flow sheet in the resident's medical record was not used to monitor the resident's bowel elimination patterns. Instead, the nurses used information recorded on a separate bowel sheet to guide the administration of the standing orders for constipation. She confirmed these bowel sheets were not part of the resident's medical record, and they did not keep these sheets for more than a couple of months, after which they threw them away. (The facility did not have bowel sheets for the time frame being reviewed for this resident.) The DON did confirm that, based on the data available in the medical record, there was no evidence the resident had a bowel movement on the days in question. The DON also confirmed the standing orders were not followed as written. b) Resident #31 Record review revealed the resident's September 2009 nurse aide flow sheet was not complete related to her bowel elimination. (See citation at F514.) A separate bowel sheet (not maintained on the resident's medical record) revealed she had gone four (4) days without a bowel movement, and the physician's standing orders were not initiated until Day 5. As of the date of this review (09/24/09), Resident #31's record indicated her last bowel movement occurred on 09/19/09. She received Milk of Magnesia on 09/22/09, which was three (3) days after her last bowel movement. She still did not have a bowel movement and on the next day (09/23/09), she was given Senakot four (4) tablets. The DON, when questioned about the bowel movements for this resident on 09/24/09 at 4:00 p.m., verified the facility's standing orders had not been properly implemented and there was no documentation to explain why these orders were not followed. According to the DON, the resident should have received a rectal suppository on Day 4 and a Fleets enema on Day 5. According to the medical record, the resident had no bowel movement for four (4) consecutive days and was on Day 5 without a bowel movement when this surveyor identified this issue. .", "filedate": "2014-07-01"}
{"rowid": 11227, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "106 TYREE STREET OPERATIONS, LLC /P.O DRAWER 400", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2009-09-24", "deficiency_tag": 514, "scope_severity": "D", "complaint": 1, "standard": 0, "eventid": "0T3Z11", "inspection_text": "Based on a review of the medical record and staff interview, the facility failed to assure residents' bowel records were complete and accurate. Without accurate records of a resident's bowel movements, the facility could not assure interventions were initiated when needed to prevent complications. Residents' bowel movements were recorded on two (2) different places, and a comparison of these forms revealed the documentation did not match. The nurses kept track of each resident's bowel movements on a bowel sheet which was not part of the resident's medical record, and the information on the bowel sheets did not match the records kept by the nursing assistants which was part of the medical record. Bowel elimination records were not complete for two (2) of nine (9) sampled residents. Resident #58, and #31. Facility census: 57. Findings include: a) Resident #58 Record review revealed Resident #58 had experienced problems with constipation. In May 2009, documentation of the resident's bowel movements on the nurse aide flow sheet indicated there were no bowel movements from 05/15/09 through 05/19/09. During this five (5) day period, the form for recording bowel movements had blanks, and it could not be determined whether the resident had a bowel movement or not. The director of nursing (DON), when interviewed on 09/22/09 at 3:00 p.m., reported the information recorded on the nurse aide flow sheet in the resident's medical record was not used to monitor the resident's bowel elimination patterns. Instead, the nurses used information recorded on a separate bowel sheet to guide the administration of the standing orders for constipation. She confirmed these bowel sheets were not part of the resident's medical record, and they did not keep these sheets for more than a couple of months, after which they threw them away. The facility did not have bowel sheets for the time frame being reviewed for this resident, and the information in her medical record related to bowel elimination was incomplete. b) Resident #31 Record review revealed the resident's September 2009 nurse aide flow sheet was not complete related to her bowel elimination. There were many blank days where the bowel movements for those days were not recorded in the record. The DON, when interviewed on 09/22/09 at 3:00 p.m., reported the information recorded on the nurse aide flow sheet in the resident's medical record was not used to monitor the resident's bowel elimination patterns. Instead, the nurses used information recorded on a separate bowel sheet to guide the administration of the standing orders for constipation. She also confirmed the nurse aide flow sheet did have a lot of blanks on it, and it was difficult to determined when the resident actually had a bowel movement.", "filedate": "2014-07-01"}
{"rowid": 11228, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "106 TYREE STREET OPERATIONS, LLC /P.O DRAWER 400", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2009-11-13", "deficiency_tag": 323, "scope_severity": "E", "complaint": 1, "standard": 0, "eventid": "0T3Z12", "inspection_text": "Based on observation, staff interview, and record review, the facility failed to assure the resident environment remained as free of accident hazards as is possible. Staff disabled the alarming system and propped the front door open at 10:00 p.m. on the night of 11/10/09. This deficient practice placed all residents at risk should an unauthorized individual with nefarious intentions enter the facility undetected, or a confused resident not equipped with a WanderGuard device exit the facility undetected. Facility census: 54. Findings include: a) Upon arrival at the facility to conduct an unannounced follow-up survey at 10:00 p.m. on 11/10/09, observation found the front interior entrance doors were propped open with the use of the survey results notebook. When the door was pulled opened, no alarm sounded to alert staff members that someone had either entered or exited the facility. When inquiry was made of the registered nurse (RN) supervisor as to the practice of propping open the front door and turning off the alarm, the RN stated it was shift change and they did not want to have to keep getting up, unlocking the door, and turning off the alarm to let in staff members. An interview was conducted with the administrator at 12:15 a.m. on 11/11/09. He stated the doors were to be locked and the alarm turned on prior to the 9:00 p.m. medication pass. He stated the alarm that had been turned off was recently installed to provide added security, and it required a key to turn it on and off. He stated it was not acceptable for the doors to be propped open and the alarm disabled. The administrator was asked, on the afternoon of 11/11/09, to assist in a test of the front door under the conditions found upon entrance to the facility. The interior front doors were propped open with the survey results notebook, and the administrator utilized a key to disable the alarm. Observation and performance testing found the facility could be entered and exited without audible detection. A WanderGuard device was obtained and tested with the door propped open and the alarm turned off. The WanderGuard system did sound an alarm. .", "filedate": "2014-07-01"}
{"rowid": 11229, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "106 TYREE STREET OPERATIONS, LLC /P.O DRAWER 400", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2009-11-13", "deficiency_tag": 492, "scope_severity": "E", "complaint": 1, "standard": 0, "eventid": "0T3Z12", "inspection_text": "Based on record review, review of West Virginia State Codes 9-6-1(2) and 9-6-11(c) and West Virginia Administrative Rule 19CSR3-14.1bb, and staff interview, the facility failed to assure allegations of abuse and/or neglect were reported to the State or Regional Ombudsman and the West Virginia State Board of Examiners for Licensed Practical Nurses (LPNs) in accordance with State law for two (2) of two (2) allegations reviewed. This deficient practice involved two (2) of five (5) sampled residents and had the potential to affect more than an isolated number of facility residents. Resident identifiers: #40 and #33. Facility census: 54. Findings include: a) Resident #40 Review of facility documents found that. on 08/11/09 at 8:30 a.m., a licensed practical nurse (LPN) was informed that Resident #40 was complaining of not feeling well and experiencing pain. A registered nurse (RN) reported to the social worker the LPN made the statement that the resident \"needs a pillow over her face\". Review of West Virginia State Code 9-6-1(2) found the definition of abuse to be the following: \"Abuse means the infliction or threat to inflict physical pain or injury on or the imprisonment of any incapacitated adult or facility resident.\" Further review of West Virginia State Code 9-6-11(c) found the following language: \"If the person who is alleged to be abused or neglected is a resident of a nursing home or other residential facility, a copy of the report shall also be filed with the state or regional ombudsman and the administrator of the nursing home or facility\". Review of West Virginia Administrative Rule 19CSR3-14.1.bb found that the RN who reported the abusive statement was required to report this act of abuse to the West Virginia State Board of Examiners for Licensed Practical Nurses. The following language was found: \"14.1.bb. failed to report through proper channels a violation of any applicable state law or rule, any applicable federal law or regulation or the incompetent, unethical, illegal, or impaired practice of another person who provided health care; ...\" An interview with the director of nursing (DON), who is a registered nurse, on the afternoon of 11/11/09 revealed the LPN who made the abusive statement had not been reported to the LPN Licensing Board as required. An interview with the social worker, on 11/13/09 at 4:30 p.m., revealed this allegation of abuse was not reported to the state or regional ombudsman as required by State law. b) Resident #33 Review of facility documents found that, on the evening shift on 10/13/09, family members alleged staff left the resident incontinent of urine for one (1) hour to one-and-one-half hour (1.5) after being informed the resident was in need of care. Further review found no evidence this allegation of neglect was reported to the state or regional ombudsman as required by State law. An interview with the social worker, on 11/13/09 at 4:30 p.m., confirmed no report of this allegation of neglect was sent to the state or regional ombudsman as required. .", "filedate": "2014-07-01"}
{"rowid": 11230, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "106 TYREE STREET OPERATIONS, LLC /P.O DRAWER 400", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2009-11-13", "deficiency_tag": 371, "scope_severity": "D", "complaint": 1, "standard": 0, "eventid": "0T3Z12", "inspection_text": "Based on random observation, the facility failed to assure food was distributed under sanitary conditions for residents electing to remain in their rooms for meals. Facility census: 54. Findings include: a) Random observations of the noon meal food service, on 11/13/09 at 12:10 p.m., found meal trays intended for residents to eat in their rooms were stacked on shelves on an open cart. Further observation found two (2) trays on the cart for the 200 hallway and one (1) tray on the cart for the 100 hallway were not adequately covered to prevent contamination of the residents' food. Closer inspection of the pellet system noted, in each case, the top lid had slid off the bottom portion of the pellet system, exposing a small bowl and other food items to potential contamination. .", "filedate": "2014-07-01"}
{"rowid": 11231, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "106 TYREE STREET OPERATIONS, LLC /P.O DRAWER 400", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2010-11-05", "deficiency_tag": 225, "scope_severity": "D", "complaint": 1, "standard": 0, "eventid": "OEKS11", "inspection_text": ". Based on review of facility documents, medical record review, and staff interview,the facility failed to assure one (1) of three (3) allegations of abuse / neglect was reported immediately to State officials in accordance with State law, and failed to thoroughly investigate this allegation of abuse / neglect. This deficient practice affected one (1) of three (3) sampled residents. Resident identifier: #60. Facility census: 57. Findings include: a) Resident #60 Review of facility documents found that, on 07/03/10, Resident #60 sustained lacerations to his face which required transport to an acute care facility for placement of thirty-four (34) stiches to close the wounds. Review of the medical record found a nursing note, written at 11:41 a.m. on 07/02/10, stating, \"Nursing assistant pushing resident in w/c (wheelchair) when his foot dropped onto floor, he fell forward onto floor, laceration noted above and below left eye, resident remained alert at all times, denies pain anywhere else, able to move all other extremities... pressure applied as well as ice pack, notified POA (power of attorney) and (name of physician), transferred to (name of hospital) for eval (evaluation) and treatment.\" Review of facility documentation found a summary of the incident signed by the director of nursing (DON - Employee #14). Review of the summary found that, on 07/11/10, the resident's spouse spoke with the facility's physician concerning the 07/03/10 incident. The summary documented that the spouse stated, \"This is neglect and abuse and you know it.\" Review of other facility documents found the facility did not report the incident until 07/21/10. Further review found that, following the delayed reporting, the facility did not complete a thorough investigation to determine if the resident's injuries were the result of abuse / neglect on the part of the staff member who was transporting the resident. The facility determined which employees were working at the time of the incident, but did not interview or collect statements from them. The facility also failed to collect a statement from the resident, who was alert and oriented and was determined to have capacity to make his own decisions. .", "filedate": "2014-07-01"}
{"rowid": 11232, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "106 TYREE STREET OPERATIONS, LLC /P.O DRAWER 400", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2010-11-05", "deficiency_tag": 323, "scope_severity": "E", "complaint": 1, "standard": 0, "eventid": "OEKS11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** . Based on review of facility documents, observations, and staff interview, the facility failed to assure nursing staff followed the practice instituted by the facility for the safe transport of residents in wheelchairs, after a male resident was injured after falling forward out of his wheelchair while being transported. Additionally, the facility failed to assure licensed nursing staff secured a stocked medication cart against unauthorized access prior to leaving the cart unattended in the resident hallway. These practices affected four (4) randomly observed residents being transported in wheelchairs without leg rests, and had the potential to affect any wandering and/or confused resident with the potential to access the medications in the cart. Resident identifiers: #46, #28, #54, and #17. Facility census: 52. Findings include: a) Residents #46, #18, #54, and #17 Review of facility documents found a male resident (Resident #60) fell forward from his wheelchair while being propelled by staff on 07/03/10. The resident sustained [REDACTED]. On 07/05/10, the facility instituted a practice to ensure leg rests were placed on the wheelchairs of all residents before being transported more that three (3) feet by staff. Random observations of the evening meal on 11/05/10, between the hours of 4:15 p.m. and 4:45 p.m., found four (4) staff members transporting four (4) residents in wheelchairs without leg rests. 1. Resident #36 A nursing assistant (Employee #19) transported Resident #46 from her room to the dining room at 4:05 p.m.; the resident was seated in a wheelchair with no leg rests. 2. Resident #28 The activities director (Employee #11) transported Resident #28 from her room to the dining room at 4:22 p.m.; the resident was seated in a wheelchair with no leg rests. 3. Resident #54 A nursing assistant (Employee #7) transported Resident #54 from her room to the dining room at 4:30 p.m.; the resident was seated in a wheelchair with no leg rests. 4. Resident #17 A nursing assistant (Employee #13) transported Resident #17 from her room to the dining room at 4:45 p.m.; the resident was seated in a wheelchair with no leg rests. The director of nursing (DON - Employee #14) was informed of the observation. She agreed these residents should have had leg rests on their wheelchairs. When asked where staff would locate leg rests to place on the residents' wheelchairs, she directed this surveyor to a locked storage building in the back of the facility. -- b) Random observations of the resident environment found an unlocked medication cart sitting in the 200 hallway of the facility. Observations found no nurse was present in the vicinity of the unlocked cart. A registered nurse (RN - Employee #2) was asked to come with this surveyor to determine if the medications in the cart were accessible. Testing found the drawers of the cart containing medications were unlocked and easily opened.", "filedate": "2014-07-01"}
{"rowid": 11233, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "106 TYREE STREET OPERATIONS, LLC /P.O DRAWER 400", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2009-08-05", "deficiency_tag": 241, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "Q61611", "inspection_text": "Based on an observation and staff interview, the facility did not provide care in an environment that maintained or enhanced dignity and respect for five (5) residents of a random observation. Residents were parked in wheelchairs and a reclining chair, lined up against a wall in the hallway awaiting transportation to the dining room for a meal. Resident identifiers: #1, #2, #14, #27, and #34. Facility census: 55. Findings include: a) On the mid-morning of 07/28/09, observation revealed five (5) residents (#1, #2, #14, #27, and #34) lined up in the 100 hallway. Four (4) residents were sitting in wheelchairs, and one (1) resident was in a reclining chair. The residents were parked in a line against the right side of the hallway. Interview with the activity director, on 07/28/09 at 12:00 p.m., revealed the nursing staff brought the residents out of their rooms and placed them in the hallway to await transportation to the dining room. She could not give a reason for why they were lined up against the wall. Interview with the director of nursing, on 07/28/09 at 4:00 p.m., revealed the residents should not be placed in a line in the hallway. She confirmed the residents were waiting to go to lunch. .", "filedate": "2014-07-01"}
{"rowid": 11234, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "106 TYREE STREET OPERATIONS, LLC /P.O DRAWER 400", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2009-08-05", "deficiency_tag": 309, "scope_severity": "D", "complaint": 1, "standard": 0, "eventid": "Q61612", "inspection_text": "Based on a review of the medical record and staff interview, the facility failed to assure residents' bowel records were complete and accurate. Without accurate records of a resident's bowel movements, the facility could not assure interventions were initiated when needed to prevent complications. Residents' bowel movements were recorded on two (2) different places, and a comparison of these forms revealed the documentation did not match. The nurses kept track of each resident's bowel movements on a bowel sheet which was not part of the resident's medical record, and the information on the bowel sheets did not match the records kept by the nursing assistants which was part of the medical record. Bowel elimination records were not complete for two (2) of nine (9) sampled residents. Resident #58, and #31. Facility census: 57. Findings include: a) Resident #58 Record review revealed Resident #58 had experienced problems with constipation. In May 2009, documentation of the resident's bowel movements on the nurse aide flow sheet indicated there were no bowel movements from 05/15/09 through 05/19/09. During this five (5) day period, the form for recording bowel movements had blanks, and it could not be determined whether the resident had a bowel movement or not. The director of nursing (DON), when interviewed on 09/22/09 at 3:00 p.m., reported the information recorded on the nurse aide flow sheet in the resident's medical record was not used to monitor the resident's bowel elimination patterns. Instead, the nurses used information recorded on a separate bowel sheet to guide the administration of the standing orders for constipation. She confirmed these bowel sheets were not part of the resident's medical record, and they did not keep these sheets for more than a couple of months, after which they threw them away. The facility did not have bowel sheets for the time frame being reviewed for this resident, and the information in her medical record related to bowel elimination was incomplete. b) Resident #31 Record review revealed the resident's September 2009 nurse aide flow sheet was not complete related to her bowel elimination. There were many blank days where the bowel movements for those days were not recorded in the record. The DON, when interviewed on 09/22/09 at 3:00 p.m., reported the information recorded on the nurse aide flow sheet in the resident's medical record was not used to monitor the resident's bowel elimination patterns. Instead, the nurses used information recorded on a separate bowel sheet to guide the administration of the standing orders for constipation. She also confirmed the nurse aide flow sheet did have a lot of blanks on it, and it was difficult to determined when the resident actually had a bowel movement.", "filedate": "2014-07-01"}
{"rowid": 11235, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "106 TYREE STREET OPERATIONS, LLC /P.O DRAWER 400", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2009-08-05", "deficiency_tag": 314, "scope_severity": "G", "complaint": 1, "standard": 0, "eventid": "Q61611", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility failed to monitor / assess and obtain timely medical intervention for one (1) of twelve (12) residents of the sample selection with an infected pressure sore. Resident #40 exhibited sign and symptoms of an infected pressure sore and did not receive physician intervention; the resident was taken to a [MEDICAL TREATMENT] center for treatment and was immediately transferred by the [MEDICAL TREATMENT] center to the hospital [MEDICAL CONDITION]. Facility census: 55. Findings include: a) Resident #40 A review of Resident #40's medical record revealed a skin integrity report, dated 07/02/09, which indicated the resident's Stage IV pressure ulcer had purulent drainage. There was no corresponding entry in the nursing notes to reflect the resident's physician was notified of this finding. Nursing notes, dated 07/03/09 at 7:15 p.m., recorded, \"New order noted for Tylenol 650 mg every 4 hours for elevated temp. Temperature 100.8 F.\" At 10:30 p.m., the resident's temperature was 99 F. On 07/06/09 at 6:30 a.m., a nursing note indicated, \"Temperature 99.2 F and 99.4 F. ... Ambulance to take resident to [MEDICAL TREATMENT] treatment per family's request. Family wants resident to have an extra treatment.\" Later on 07/06/09 (no time given), a nursing note recorded, \"[MEDICAL TREATMENT] center called to inform me resident's temp was 102 F and the resident is septic and unresponsive and was sent to the hospital.\" A discharge summary from the hospital, dated 07/08/09, revealed a [DIAGNOSES REDACTED]. The resident's pressure ulcer was necrotic and was debrided at the hospital. A wound VAC was placed, and resident was given [MEDICATION NAME] (an antibiotic) after [MEDICAL TREATMENT] and received two (2) units of blood. In an interview on 07/28/09 at 2:00 p.m., the director of nursing related that the nurses had called the physician on 07/02/09, when the resident was exhibiting purulent drainage and an elevated temperature. A review of the nursing notes for 07/02/09 found no evidence to reflect the physician was notified of purulent drainage in the pressure sore. .", "filedate": "2014-07-01"}
{"rowid": 11236, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "106 TYREE STREET OPERATIONS, LLC /P.O DRAWER 400", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2009-08-05", "deficiency_tag": 310, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "Q61611", "inspection_text": "Based on an observation and staff interview, the facility did not ensure one (1) resident of a random sample received proper positioning for meals to promote self-feeding. Observation found Resident #34 in the dining area attempting to drink a cup of coffee before the lunch meal was served. The resident was seated at a table that was elevated to the level of the resident's chin. Facility census 55. Findings include: a) Resident #34 Observation, on 07/28/09 at 12:30 p.m., found Resident #34 seated at a table in the dining room. The table was elevated to the level of the resident's chin. The resident was attempting to drink a cup of coffee that was served before lunch. The resident was stating to a staff person that she wanted to be placed at another table, because the table was too high. Interview with the activity director, on 07/28/09 at 12:35 p.m., revealed the resident was able to help herself with drinking and eating, and she related that the table at that height helped her to move the cup over to her mouth. Interview with the director of nursing, on 07/28/09 at 12:37 p.m., revealed the resident needed to be placed at a table with an appropriate height; she acknowledged the table at which Resident #34 was seated was too high for her to eat and drink and the resident had requested to be moved to another table. .", "filedate": "2014-07-01"}
{"rowid": 11237, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "106 TYREE STREET OPERATIONS, LLC /P.O DRAWER 400", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2009-08-05", "deficiency_tag": 371, "scope_severity": "F", "complaint": 0, "standard": 1, "eventid": "Q61611", "inspection_text": "Based on record review and staff interview, the facility failed to serve food under sanitary conditions; dietary staff failed to routinely monitor the concentration of sanitizing solution and the water temperatures of the wash and final rinse cycles in the dishwasher, to ensure they were maintained within the proper range to effectively sanitize dishware between uses. This practice has the potential to affect all residents in the facility. Facility census: 55. Findings include: a) On 07/28/09, review of the facility's July 2009 dishwasher temperature and sanitizer check log revealed places to record the concentration of sanitizing solution, wash temperature, and final rinse temperature of the dishwasher three (3) times each day, for the breakfast, lunch, and dinner meals; each of these items would have been measured and recorded eighty-one (81) times from 07/01/09 through 07/27/09. The concentration of the sanitizing solution was omitted forty-six (46) times, with no recordings during any meal time on 07/02/09, 07/12/09, 07/13/09, and 07/14/09, and no recordings during any lunch meal on any day. The wash and final rinse temperatures were omitted a total of forty-eight (48) times, with most of the omissions occurring during the dinner meal. During an interview on 07/28/09 at 11:30 a.m., the dietary manager agreed the dietary staff needed to keep up better with temperature and chemical recordings in the washing area. She noted the kitchen had a lot of temporary employees working in the kitchen lately and she would re-inservice them. Readings taken at this time, of the sanitizer concentration and the water temperatures of the wash and final rinse cycles, were found to be acceptable limits. .", "filedate": "2014-07-01"}
{"rowid": 11238, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "106 TYREE STREET OPERATIONS, LLC /P.O DRAWER 400", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2009-08-05", "deficiency_tag": 203, "scope_severity": "C", "complaint": 0, "standard": 1, "eventid": "Q61611", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of the facility's uniform notification of transfer / discharge form, the facility failed to correctly communicate to all residents and responsible parties the contact information of the single State agency responsible for reviewing all appeals of the transfer / discharge decision. Instead, the uniform notice gave residents / responsible parties the option to file such an appeal with five (5) different agencies. This error in the uniform notice may led a resident to mistakenly file an appeal request with the wrong agency and may interfere in the resident's ability to exercise his or her right to the appeal. Additionally, the uniform discharge notice provided incorrect information regarding the current State long-term care (LTC) ombudsman, who has held this position since May 2008, and the agency designated in West Virginia to provide protection and advocacy to individuals with mental [MEDICAL CONDITION] and mental illness. This deficient practice has the potential to affect all residents of the facility. Facility census: 55. Findings include: a) Review of the uniform notification of transfer / discharge form provided by the facility revealed the following: \"You have the right to appeal this action to:\" This was followed by the names and contact information of the Office of Inspector General Board of Review, the State Ombudsman, and the Regional Ombudsman. Immediately following the above list of names and addresses was: \"Or, for the resident with developmental disabilities or those who are mentally ill, you may contact:\" This was followed by the names and contact information for \"West Virginia Advocates Local Mental Health\" and \"Medicaid Fraud\". This uniform notification form contained the following errors: 1. The Office of Inspector General is the only agency in WV to which appeals of transfer / discharge decisions may be made. None of the four (4) other agencies identified in the notice is responsible for this activity. This error in the uniform notice may led a resident to mistakenly file an appeal with the wrong agency and may interfere in the resident's ability to exercise his or her right to the appeal. 2. The name of the State LTC ombudsman was incorrect. The current State LTC ombudsman assumed the position in May 2008, and the facility's uniform notice was not revised to reflect this. 3. The single agency designated in WV to provide protection and advocacy to individuals with both mental [MEDICAL CONDITION] and mental illness is \"West Virginia Advocates, Inc.\" (not \"West Virginia Advocates Local Mental Health\"). \"Medicaid Fraud\" does not provide these services. .", "filedate": "2014-07-01"}
{"rowid": 11239, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "106 TYREE STREET OPERATIONS, LLC /P.O DRAWER 400", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2009-08-05", "deficiency_tag": 280, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "Q61611", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility failed to revise the care plans for two (2) of twelve (12) sampled residents when they exhibited signs and symptoms of infections. Facility census: 55. Findings include: a) Resident #17 On 07/16/09, Resident #17 tested positive for [MEDICAL CONDITIONS] Toxins A and B. Subsequently, the physician ordered an antibiotic ([MEDICATION NAME] 500 mg) every eight (8) hours for ten (10) days beginning 07/16/09. During an interview on 07/29/09 at 10:30 a.m., the director of nursing (DON) reported contact precautions were no longer employed, since Resident #17 no longer had diarrhea and had completed the ten (10) day course of antibiotics. A copy of the care plan, produced by the DON on 07/28/09 at approximately 5:00 p.m., contained no mention of the [MEDICAL CONDITION] [DIAGNOSES REDACTED]. The lack of care planning for this issue was shared with the DON during the exit conference with no additional information provided. b) Resident #40 Record review revealed a skin integrity report, dated 07/02/09, which documented a Stage IV pressure ulcer with purulent drainage. On 07/03/09, a nursing note recorded Resident #40 had an elevated temperature which was treated with Tylenol 650 mg. The interdisciplinary care team did not revise the resident's care plan when signs and symptoms of an active infection were exhibited. The resident was subsequently hospitalized for [REDACTED]. .", "filedate": "2014-07-01"}
{"rowid": 11240, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "106 TYREE STREET OPERATIONS, LLC /P.O DRAWER 400", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2009-08-05", "deficiency_tag": 225, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "Q61611", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility failed to screen applicants for employment for findings entered into the State nurse aide registry concerning abuse, neglect, mistreatment of [REDACTED]. Employee identifiers: #84 and #88. Facility census: 55. Findings include: a) Employees #84 and #88 On 07/28/09, review of the personnel files of a random sample of five (5) recently hired employees and five (5) employees hired greater than one (1) year ago revealed a registered nurse (Employee #84) was hired in May 2009, and a licensed practical nurse (Employee #88) was hired in June 2009. Neither employee's personnel file contained evidence to reflect the facility had screened them for adverse findings on the WV Nursing Assistant Abuse Registry. Facility staff in charge of personnel files and health records was unable to produce evidence of checks against the Abuse Registry for these two (2) employees. After surveyor inquiry, staff ran checks of these employees on the afternoon 07/28/09; no adverse results were found, and copies of these checks were placed in the employees' records for future reference. .", "filedate": "2014-07-01"}
{"rowid": 11241, "facility_name": "ANSTED CENTER", "facility_id": 515133, "address": "106 TYREE STREET OPERATIONS, LLC /P.O DRAWER 400", "city": "ANSTED", "state": "WV", "zip": 25812, "inspection_date": "2009-08-05", "deficiency_tag": 465, "scope_severity": "C", "complaint": 0, "standard": 1, "eventid": "Q61611", "inspection_text": "Based on observations and testing conducted on 08/04/09 and 08/05/09, the facility failed to provide a safe, functional environment with respect to resident room toilets. Facility census: 58. Findings include: a) Observations and testing, conducted on 08/04/09 and 08/05/09, found the facility had installed toilet seat risers to the low type toilets in an effort to accommodate the needs of the resident in each resident rest room. The seat risers were found to move and be unstable, creating a potential fall hazard for the residents. .", "filedate": "2014-07-01"}
{"rowid": 10082, "facility_name": "ARBORS AT FAIRMONT", "facility_id": 515189, "address": "130 KAUFMAN DRIVE", "city": "FAIRMONT", "state": "WV", "zip": 26554, "inspection_date": "2010-03-04", "deficiency_tag": 502, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "FFCS11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** . Based on record review and staff interview, the facility failed to ensure laboratory tests were completed as ordered by the physician. This was true for four (4) of twenty-three (23) sampled residents' records. The facility failed to obtain laboratory test timely for Residents #45, #92, #115, and #108. Facility census: 112. Findings include: a) Resident #45 Resident #45's medical record, when reviewed on 03/02/10 at 8:45 a.m., revealed a [AGE] year old female with a history of [MEDICAL CONDITION]. Review of the current physician orders, dated 02/17/10, revealed the physician ordered a complete blood count (CBC) test monthly. Review of the laboratory test results revealed the CBC test was not done as ordered. The registered nurse (RN - Employee #25), when interviewed on 03/02/10 at 9:30 a.m., confirmed the CBC was not completed for 02/2010 as ordered. b) Resident #92 Resident #92's medical record, when reviewed on 03/02/10 at 10:00 a.m., revealed a [AGE] year old female who was admitted to the facility on [DATE] with a [DIAGNOSES REDACTED]. Review of the current physician orders [REDACTED]. Review of the laboratory test results revealed the [MEDICAL CONDITION] level was not done as ordered. Employee #25, when interviewed on 03/2/10 at 3:30 p.m., confirmed the [MEDICAL CONDITION] test was not completed as ordered. c) Resident #115 Resident #115's closed medical record, when reviewed on 03/04/10 at 10:00 a.m., revealed a [AGE] year old resident with end stage [MEDICAL CONDITION]. The resident received outpatient [MEDICAL TREATMENT] treatments three (3) times a week at a [MEDICAL TREATMENT] center. Review of the 08/17/09 physician orders [REDACTED]. Review of the medical record noted there was no hematological laboratory results in the medical record. The director of nurses (DON - Employee #2 ), when interviewed on 03/04/10 at 11:37 a.m., acknowledged the PTT test were not completed as ordered by the physician. d) Resident #108 Review of Resident #108's medical record, on 03/02/10, revealed a physician's orders [REDACTED]. Further review of the medical record revealed the most recent lab results for BUN, creatinine, and electrolytes were dated 08/31/09. There were no lab results for November 2009 or February 2010. Interview with medical records staff (Employee #12), on 03/02/10, revealed there were no lab results for the BUN, creatinine, or electrolytes found on the resident's thinned chart. These findings were reported to the DON on 03/02/10 at approximately 11:15 a.m.; subsequently, she stated she would contact the physician and request an order for [REDACTED].) .", "filedate": "2015-07-01"}
{"rowid": 10083, "facility_name": "ARBORS AT FAIRMONT", "facility_id": 515189, "address": "130 KAUFMAN DRIVE", "city": "FAIRMONT", "state": "WV", "zip": 26554, "inspection_date": "2010-03-04", "deficiency_tag": 507, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "FFCS11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** . Based on record review and staff interview, the facility failed to ensure laboratory reports were maintained on file in each resident's medical record. This was true for two (2) of twenty-three (23) sampled residents. Resident identifiers: #115 and #28. Facility census: 112. Findings include: a) Resident #115 Resident #115's closed medical record, when reviewed on 03/04/10 at 10:00 a.m., revealed a [AGE] year old resident with end-stage [MEDICAL CONDITION]. The resident received outpatient [MEDICAL TREATMENT] treatments three (3) times a week. Review of the 08/17/09 physician orders [REDACTED]. Review of the medical record found no hematological laboratory results in the medical record. The director of nurses (DON - Employee #2), when interviewed on 03/04/10 at 11:40 a.m., acknowledged the laboratory tests were not maintained in the medical record as required. b) Resident #25 Record review revealed, on 06/02/09, the physician ordered a complete blood count (CBC) each month, magnesium every three (3) months, fasting blood sugars each month, and magnesium and transferrin every three (3) months. Review of the medical record only found a lab report for a CBC dated 08/31/09; reports for fasting blood sugars dated 10/29/09, 12/17/09, 01/14/10, and 02/14/10; and reports for magnesium and transferrin for 08/31/09 only. The DON, on 03/02/10 at 4:00 p.m., reported the missing labs were pulled from the computer. .", "filedate": "2015-07-01"}
{"rowid": 10084, "facility_name": "ARBORS AT FAIRMONT", "facility_id": 515189, "address": "130 KAUFMAN DRIVE", "city": "FAIRMONT", "state": "WV", "zip": 26554, "inspection_date": "2010-03-04", "deficiency_tag": 161, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "FFCS11", "inspection_text": ". Based on record review and staff interview, the facility failed to obtain a current surety bond to protect all personal funds of residents deposited with the facility. This had the potential to affect all residents who elected to have their funds managed by the facility. Facility census: 112. Findings include: a) Shortly after entrance to the facility, facility staff provided requested information regarding the surety bond. Review of the surety bond revealed an accompanying letter from the Office of Health Facility Licensure and Certification (OHFLAC - the State agency designated to serve as the holder of such bonds for nursing homes in WV) dated 01/11/10, relaying a request from the Attorney General's Office to make necessary corrections and return the surety bond to the OHFLAC. Furthermore, the letter instructed the facility to contact the Attorney General's Office for any further questions regarding the corrections. Interview with the business office director (Employee #3), on 03/04/10 at 9:30 a.m., revealed the surety bond was signed by the representative authorized by the corporation to do so, although he was neither the president or vice-president of the corporation nor owner or general partner of the company as specified by the Attorney General's office. She said the corporate office takes care of this, not the facility, and they were in the process of trying to clarify this. On 03/04/10 at 10:15 a.m., a representative from OHFLAC, when interviewed, reported that, as of this date, the facility's surety bond covering the period of 08/15/09 through 08/15/10 had not been approved by the Attorney General's Office. .", "filedate": "2015-07-01"}
{"rowid": 10085, "facility_name": "ARBORS AT FAIRMONT", "facility_id": 515189, "address": "130 KAUFMAN DRIVE", "city": "FAIRMONT", "state": "WV", "zip": 26554, "inspection_date": "2010-03-04", "deficiency_tag": 203, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "FFCS11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** . Based on closed record review, the facility failed to provide correct contact information on its uniform transfer / discharge notice for the State long-term care ombudsman and the single State agency responsible for the protection and advocacy of persons with [DIAGNOSES REDACTED]. This had the potential to affect any resident who might need to contact these organizations. Facility census: 112. Finding include: a) Resident #114 Closed record review of Resident #114 revealed she was given a uniform transfer / discharge notice which contained inaccurate information. The notice she received directed persons with a developmental disability or mental illness to contact the \"West Virginia Developmental Disabilities Council\" for assistance. However, the single agency designated in West Virginia to provide protection and advocacy to individuals with both mental [MEDICAL CONDITION] and mental illness is \"West Virginia Advocates, Inc.\" (not West Virginia Developmental Disabilities Council). Also, the appeals notice lacked the name of the State long-term care ombudsman, although it did list the name of the regional ombudsman. .", "filedate": "2015-07-01"}
{"rowid": 10086, "facility_name": "ARBORS AT FAIRMONT", "facility_id": 515189, "address": "130 KAUFMAN DRIVE", "city": "FAIRMONT", "state": "WV", "zip": 26554, "inspection_date": "2010-03-04", "deficiency_tag": 281, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "FFCS11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** . Based on observation, staff interview, and record review, the facility failed to ensure two (2) of twenty (20) sampled residents received medications in accordance with physician orders. Resident identifiers: #35 and #81. Facility census: 112. Findings include: a) Resident #35 Observation of the medication pass, on 03/02/10 at 8:45 a.m., with the licensed practical nurse (LPN - Employee #204), found she administered [MEDICATION NAME] 100 mg to Resident #35. Review of the March 2010 monthly recapitulation of physician's orders [REDACTED]. During the observation and review of the medication with the nurse on 03/02/10 at 9:00 a.m., she stated, \"I owe her (Resident #35) a half tablet.\" b) Resident #81 Medication pass observation, on 03/01/10 at 4:20 p.m., found Resident #81 received Calcium 500 mg from a bottle of stock medication. At 5:00 p.m., the nurse (Employee #25) passing medications stated she should have given this resident Calcium 500 mg with 200 mg Vitamin D from a bottle of stock medication, but took from the wrong bottle. During reconciliation, the physician's orders [REDACTED]. .", "filedate": "2015-07-01"}
{"rowid": 10087, "facility_name": "ARBORS AT FAIRMONT", "facility_id": 515189, "address": "130 KAUFMAN DRIVE", "city": "FAIRMONT", "state": "WV", "zip": 26554, "inspection_date": "2010-03-04", "deficiency_tag": 441, "scope_severity": "F", "complaint": 0, "standard": 1, "eventid": "FFCS11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** . Part I -- Based on a review of the facility's hand hygiene procedure and staff interview, the facility failed to establish handwashing guidelines in accordance with current professional standards of practice as recommended by the Centers for Disease Control and Prevention (CDC). This had the potential to affect all residents. Facility census: 122. Findings include: a) Review of the facility's hand hygiene procedure found, at Step 6, \"Rub hand together vigorously for 10-15 seconds, generating fraction on all surfaces of the hands and fingers.\" The policy was reviewed with the director of nursing on 03/03/10 at 12:00 p.m., at which time it was discussed that current CDC guidelines for hand washing indicate hands should be rubbed together for 15-20 seconds. --- Part II -- Based on record review, staff interview, and policy review, the facility failed to follow its own policy on [DIAGNOSES REDACTED] (TB) screening to assure all newly admitted residents were tested and found to be free of this communicable disease. This was evident for one (1) of three (3) residents' closed records. Resident identifier: #114. Facility census: 112. Findings include: a) Resident #114 Review of the facility's policy on TB screening (dated November 2008) revealed all new residents must have a 2-step Mantoux Purified Protein Derivative (PPD) on admission. The first step is to be completed within seven (7) days of admission or according State / Federal regulation, and the second step is to be completed within seven (7) to twenty-one (21) days after a negative result from the first step or according to State / Federal regulation, always following the more strict requirement. The administration and results are then to be documented on the TB Screening Record in millimeters (mm). Review of Resident #114's medical record, on 03/04/10, revealed the Step 1 PPD was administered on 09/21/09 in the left forearm to be read on 09/23/09; however, on 09/23/09, the results of the test were not read as evidenced by a blank space where the area of \"mm of induration\" was supposed to have been recorded and by a blank space where the nurse was supposed to have initialed as having read the results. Additionally, the Step 2 PPD was scheduled to be given on 10/05/09 and read on 10/07/09, but spaces were left blank regarding the manufacturer, lot number, dose, nurse's initials when the PPD was given, and \"mm of induration\" and nurse's initials when read, signifying that a second PPD was not given. Interview with a nurse (Employee #25), on 03/04/10 at approximately 10:00 a.m., revealed the PPD tests were also recorded on the medication administration record (MAR). Review of the resident's September 2009 MAR for 09/21/10 found a typed notation to \"check PPD on 09/23/09\", but the space to record the results on 09/23/09 was left blank. Employee #25 agreed there was no documentation of test results for the Step 1 PPD. Review of the October 2009 MAR revealed a PPD was initialed as having been given on 10/05/09, and there was a minus (-) sign on 10/07/09 with a nurse's initials signifying a negative PPD result. The 10/07/09 PPD test result was not recorded on the TB Screening Record, and there was no evidence of a second step having been completed seven (7) to twenty-one (21) days after the only PPD on record. .", "filedate": "2015-07-01"}
{"rowid": 10088, "facility_name": "ARBORS AT FAIRMONT", "facility_id": 515189, "address": "130 KAUFMAN DRIVE", "city": "FAIRMONT", "state": "WV", "zip": 26554, "inspection_date": "2010-03-04", "deficiency_tag": 309, "scope_severity": "G", "complaint": 0, "standard": 1, "eventid": "FFCS11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** . Based on record review, observation, resident interview, staff interview, and physician interview, the facility failed to provide necessary care and services to assist one (1) of twenty (20) sampled residents in attaining or maintaining her highest practicable level of physical well-being, by failing to obtain routine laboratory testing as ordered by the physician for a resident with a [DIAGNOSES REDACTED].#108, who was subsequently found to be dehydrated and hyperkalemic. Labs, obtained only after surveyor intervention, revealed the resident was dehydrated and hyperkalemic (elevated serum potassium level), and the physician discontinued the diuretic therapy and ordered the administration of intravenous IV fluids (to rehydrate the resident), medications to alter the resident's serum potassium level, and repeat labs. During this period of active physician intervention, the facility failed to document periodic nursing assessments (including vital signs) and the resident's response to treatment. Resident identifier: #108. Facility census: 112. Findings include: a) Resident #108 Review of Resident #108's medical record revealed an [AGE] year old female admitted to the facility on [DATE] with the following Diagnoses: [REDACTED]. 1. Record review, on 03/02/10, revealed physician orders [REDACTED]. However, the most recent test results, dated 08/31/09, revealed the following abnormal lab values: - Potassium - high at 5.6 (normal range 3.5 - 5.2) - Chloride - high at 115 (normal range 97 - 108) - Carbon [MEDICATION NAME] - low at 17 (normal range 20 - 32) - BUN - high at 39 (normal range 5 - 26) - Creatinine - high at 3.02 (normal range 0.57 - 1.00) - Estimated Glomerular Flow Rate (eGRF - a test for monitoring kidney function) - low at 15 (normal range > 59) (Note: Abnormally high values of BUN, creatinine, and potassium are indicative of impaired kidney function; abnormally low values of eGFR are indicative of kidney damage. Abnormally high values of BUN, creatinine, and potassium are also indicative of dehydration.) Further record review revealed the addition of a diuretic, [MEDICATION NAME] 40 mg daily, which was initiated on 12/02/09. No lab results were available for November 2009 or February 2010. Observation of, and interview with, this resident, on 03/02/10 at 8:30 a.m., revealed a pleasantly confused lady who was clean in appearance and well groomed. During this conversation, she threw back the covers and spoke of her TED hose lying at the foot of her bed, saying she would need them on. Both of her legs were [MEDICAL CONDITION], more so on the left, and her finger made an imprint on her left lower thigh when she touched it. On 03/02/10, a medical records person (Employee #12) reviewed the resident's thinned record on file and was unable to find the physician-ordered laboratory tests listed above since 08/31/09. On 03/02/10 at approximately 11:15 a.m., these findings were reported to the director of nursing (DON), who stated she would notify the physician and request an order for [REDACTED]. 2. Medical record review, on 03/03/10, revealed a physician notification form dated 03/02/10 at 11:45, regarding the missing November 2009 and February 2010 labs (BUN, creatinine, and electrolytes). Labs, collected at 12:04 p.m. and reported at 2:12 p.m. on 03/02/10, yielded the following abnormal results: - Potassium - high at 6.1 (normal range 3.5 - 5.2) - Chloride - high at 111 (normal range 97 - 108) - BUN - high at 51 (normal range 5 - 26) - Creatinine - high at 3.53 (normal range 0.57 - 1.00) - eGRF - low at 12 (normal range > 59) Upon notification of these abnormal results, the physician gave orders, on 03/02/10 (with no timed entry for the telephone order), to discontinue the [MEDICATION NAME], give Potassium Chloride 30 meq (additional potassium for an individual who already had an abnormally high serum potassium level), and administer 1000 cc intravenous fluids of D5W (5% [MEDICATION NAME] and water) at a rate of 100 cc per hour with repeat labs in the morning. Review of the Medication Administration Record [REDACTED]. 3. Record review, on 03/04/10, revealed repeat labs, collected at 7:23 a.m. and reported at 12:13 p.m. on 03/03/10, yielded the following abnormal results: - BUN - high at 49 (normal range 5 - 26) - Creatinine - high at 3.29 (normal range 0.57 - 1.00) - eGFR - low at 13 (normal range > 59) Review of physician's orders [REDACTED]. Review of nursing notes found an entry, dated 03/03/10 at noon, stating, \"2nd (second) blood draw done to confirm K+ (potassium) level before administering [MEDICATION NAME].\" A subsequent entry, at 2:00 p.m. on 03/03/10, noted an elevated potassium level of 5.8 with [MEDICATION NAME] given. Another entry, also at 2:00 p.m. on 03/03/10, noted more lab work was scheduled for the morning. 4. Labs, collected at 1:21 a.m. and reported on 03/04/10 (time of report not noted), yielded the following abnormal results: - Potassium - within normal limits at 4.8 (normal range 3.5 - 5.2) - BUN - high at 45 (normal range 5 - 26) - Creatinine - high at 3.42 (normal range 0.57 - 1.00) - eGFR - low at 13 (normal range > 59) 5. Interview with the nurse (Employee #38), on 03/04/10 at 11:45 a.m., revealed the facility uses a tickler file in a file box at each nurse's station to record the months or the weeks in a month when repeating lab work is due for specific residents. When asked, she said this is the third hall in which this resident has resided since admission to the facility last year. 6. Interview with the assistant director of nursing (ADON - Employee #4), on 03/04/10 at 2:00 p.m., revealed they were wondering about the physician's orders [REDACTED].#21 at home today and asked if she understood the order correctly (in reference to discontinuing the [MEDICATION NAME], giving IV fluids, and administering potassium chloride); Employee #21 replied in the affirmative. According to the ADON, Employee #21 said she called the physician the next morning, on 03/03/10, before giving the [MEDICATION NAME]. 7. During interview with the physician on 03/04/10 at 2:15 p.m., he said his primary focus initially was to hydrate the resident. He said the nurse told him about the 6.1 potassium level 03/02/10. When asked about the order for potassium chloride, he explained he knew the potassium level would drop when she was re-hydrated. 8. Review of nursing notes for 03/02/10, 03/03/10, and the night shift on 03/04/10, found no assessments or vital signs documented during the time the resident was being re-hydrated and being treated for [REDACTED]. 9. Review of the resident assessment protocol (RAP) summary on the resident's comprehensive admission assessment (dated as completed on 06/06/09) found the interdisciplinary care team decided to not address dehydration / fluid maintenance on this resident's care plan, even though her admitting [DIAGNOSES REDACTED]. Review of the current care plan revealed the problem statement: \"At nutritional risk r/t (related to): Therapeutic diet r/t Stg IV CRF (Stage IV [MEDICAL CONDITION]).\" There was a box to also mark \"Dehydration\", but the interdisciplinary care team chose not to mark this. The goals associated with this problem statement were: \"Resident will consume at least 75% of most meals\" and \"Weight will remain stable +/- 5 lbs adm (admission weight) 135 lb (also noted +3 [MEDICAL CONDITION] to BLE (bilateral lower extremities)\". The interventions to assist the resident in achieving these goals included: \"Monitor labs as ordered / available.\" .", "filedate": "2015-07-01"}
{"rowid": 10089, "facility_name": "ARBORS AT FAIRMONT", "facility_id": 515189, "address": "130 KAUFMAN DRIVE", "city": "FAIRMONT", "state": "WV", "zip": 26554, "inspection_date": "2010-03-04", "deficiency_tag": 225, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "FFCS11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** . Based on personnel record review and staff interview, the facility failed to screen individuals, prior to permitting them to have resident contact, for convictions of abuse, neglect, or mistreatment residents by a court of law and/or findings entered into the State nurse aide registry concerning abuse, neglect, mistreatment of [REDACTED]. Five (5) of five (5) contracted nursing employees reviewed did not have evidence of a statewide background check (Employees #97, #103, #108, #111, and #113), and there was no evidence of screening against the State nurse aide registry for four (4) of five (5) contracted employees and one (1) of five (5) regular employee reviewed (Employees #38, #97, #108, #111, and #113). Facility census: 112. Findings include: a) Employees #97, #103, #108, #111, and #113 Review of sampled personnel files, with the payroll clerk at 4:00 p.m. on 03/03/10, failed to find evidence of statewide background checks for contracted Employees #97, #103, #108, #111, and #113, in an effort to uncover information about any past criminal prosecutions that would indicate unfitness for service in a nursing facility caring for vulnerable adults. On 03/04/10 at 10:00 a.m., the payroll clerk confirmed there were no statewide background checks completed for these individuals. b) Employees #38, #97, #108, #111, and #113 Review of sampled personnel files, with the payroll clerk at 4:00 p.m. on 03/03/10, failed to find evidence the State nurse aide registry was checked for Employees #38, #97, #108, #111, and #113. On 03/04/10 at 10:00 a.m., the payroll clerk confirmed the State nurse aide registry had not been checked for these individuals. .", "filedate": "2015-07-01"}
{"rowid": 10090, "facility_name": "ARBORS AT FAIRMONT", "facility_id": 515189, "address": "130 KAUFMAN DRIVE", "city": "FAIRMONT", "state": "WV", "zip": 26554, "inspection_date": "2010-03-04", "deficiency_tag": 156, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "FFCS11", "inspection_text": ". Based on observation and staff interview, the facility failed to post the correct names, addresses, and telephone numbers of all pertinent State agencies. Incorrect contact information was posted for the State survey and certification agency and the local Medicaid office. This had the potential to affect any resident who might need to contact these agencies. Facility census: 112. Findings include: a) Observation of the posted contact information for pertinent State agencies, in the company of the administrator at 10:30 a.m. on 03/04/10, found the following: 1. The address of the State survey and certification agency was incorrect. 2. The address and telephone number of the local Medicaid office address were incorrect. The administrator confirmed these errors at the time of the observation. .", "filedate": "2015-07-01"}
{"rowid": 10091, "facility_name": "ARBORS AT FAIRMONT", "facility_id": 515189, "address": "130 KAUFMAN DRIVE", "city": "FAIRMONT", "state": "WV", "zip": 26554, "inspection_date": "2010-03-04", "deficiency_tag": 329, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "FFCS11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** . Based on medical record review and staff interview, the facility failed to ensure the drug regimen of one (1) of twenty (20) sampled residents was free from unnecessary drugs. Resident #28 was ordered [MEDICATION NAME] 0.5 mg on 01/15/10 for Mild Mental [MEDICAL CONDITION] in the absence of adequate indications for it use. Facility census: 112. Findings include: a) Resident #28 Record review revealed Resident #28 was admitted to the facility on [DATE], and the hospital discharge summary for that date indicated the resident was receiving [MEDICATION NAME] 0.5 mg prior to admission to the facility. Copies of hospital records on the resident's medical record, when reviewed, contained no information explaining why the resident required this medication. The resident's 01/15/10 admission physician's orders [REDACTED]. Review of the physician's progress notes from 01/15/10 forward failed to find any documentation of the indications for use of the [MEDICATION NAME]. Review of the resident's 01/26/10 care plan found the resident was receiving [MEDICATION NAME] for \"MR with behaviors\" and \"Behavioral symptoms drug is intended to treat: Resists care\". This information was reviewed with the director of nursing on 03/04/10 at 4:00 p.m., and she agreed the indications for giving this resident [MEDICATION NAME] were inadequate. She reported having reviewed the medical record and finding no additional information concerning this matter. .", "filedate": "2015-07-01"}
{"rowid": 10092, "facility_name": "ARBORS AT FAIRMONT", "facility_id": 515189, "address": "130 KAUFMAN DRIVE", "city": "FAIRMONT", "state": "WV", "zip": 26554, "inspection_date": "2010-03-04", "deficiency_tag": 248, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "FFCS11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** . Based on confidential resident group interview, resident interview, and staff interview, the facility failed to provide an ongoing program of activities designed to meet the interests and psychosocial well-being of each resident. This was evident by six (6) of eight (8) residents in attendance at a confidential group meeting who reported they were unable to participate in outings as a group and for one (1) of twenty (20) sampled residents (#6) who reported being unable to participate in outings as desired. Facility census: 112. Findings include: a) During a confidential resident group meeting on 03/02/10 at 10:30 a.m., six (6) of eight (8) residents in attendance reported they had never been able to attend outings as a group outside the facility as they desired. When asked, several of the residents reported they would like to visit the local Senior Center but noted transporting more than one (1) or two (2) residents in wheelchairs on the transit bus would be a problem. Group members stated the facility had no van of its own. During a confidential interview with an employee on 03/03/10 at approximately 3:00 p.m., this employee confirmed no group outings had been held for residents for at least the past two (2) years. Interview with the assistant activity director (Employee #6), on 03/04/10 at 11:15 a.m. revealed, only a few residents over the past few years have asked her about having a group outing. She stated the activities department has contacted the Marion County Transit Authority to transport individual residents for such things as shopping at Wal-Mart when requested, but the facility has not requested the Transit Authority to transport a group of residents at the same time. Interview with the activity director (Employee #10), on 03/04/10 at 2:45 p.m., revealed there have been no group outings since she has been working at the facility in July 2009. She recalled last year, in August or September, residents mentioned wanting group outings. However, she said, due to difficulties with transporting numerous residents on the Transit Authority bus, associated legalities, the need for having enough staff to accompany the residents, etc., she explained to residents the barriers to having group outing. Since that time, Employee #10 reported no one had mentioned it to her again. She acknowledged the facility had no van or bus of their own for transporting residents. She stated she would be glad to put this request for group outings \"on the table\" at the next resident council meeting to see what residents want and to see if the facility can help meet those needs. b) Resident #6 Resident #6's medical record, when reviewed on 03/03/10 at 10:00 a.m., revealed a [AGE] year old male who was admitted to the facility on [DATE]. The physician determined the resident possessed the capacity to understand and make his own medical decisions. The resident was non-ambulatory due to paralysis and utilized a motorized wheelchair for mobility. This alert and oriented resident, when interviewed on 03/03/10 at 2:30 p.m., revealed he attended some of the planned activities offered by the facility. The resident stated the facility did not provide outings and stated, \"I wish they would. It would be nice to get out once in a while.\" The resident reported that, if the facility would offer facility outings, \"I would like to go.\" .", "filedate": "2015-07-01"}
{"rowid": 10093, "facility_name": "ARBORS AT FAIRMONT", "facility_id": 515189, "address": "130 KAUFMAN DRIVE", "city": "FAIRMONT", "state": "WV", "zip": 26554, "inspection_date": "2010-03-04", "deficiency_tag": 327, "scope_severity": "G", "complaint": 0, "standard": 1, "eventid": "FFCS11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** . Based on record review, observation, resident interview, staff interview, and physician interview, the facility failed to provide necessary care and services to assist one (1) of twenty (20) sampled residents to ensure the resident maintained acceptable parameters of fluid and electrolyte balance, by failing to develop and implement a care plan to address fluid and electrolyte balance for a resident with a [DIAGNOSES REDACTED]. These failures resulted in actual harm to Resident #108, who was subsequently found to be dehydrated and hyperkalemic. Labs, obtained only after surveyor intervention, revealed the resident was dehydrated and hyperkalemic (elevated serum potassium level), and the physician discontinued the diuretic therapy and ordered the administration of intravenous IV fluids (to rehydrate the resident), medications to alter the resident's serum potassium level, and repeat labs. Resident identifier: #108. Facility census: 112. Findings include: a) Resident #108 Review of Resident #108's medical record revealed an [AGE] year old female admitted to the facility on [DATE] with the following Diagnoses: [REDACTED]. 1. Record review, on 03/02/10, revealed physician orders [REDACTED]. However, the most recent test results, dated 08/31/09, revealed the following abnormal lab values: - Potassium - high at 5.6 (normal range 3.5 - 5.2) - Chloride - high at 115 (normal range 97 - 108) - Carbon [MEDICATION NAME] - low at 17 (normal range 20 - 32) - BUN - high at 39 (normal range 5 - 26) - Creatinine - high at 3.02 (normal range 0.57 - 1.00) - Estimated Glomerular Flow Rate (eGRF - a test for monitoring kidney function) - low at 15 (normal range > 59) (Note: Abnormally high values of BUN, creatinine, and potassium are indicative of impaired kidney function; abnormally low values of eGFR are indicative of kidney damage. Abnormally high values of BUN, creatinine, and potassium are also indicative of dehydration.) Further record review revealed the addition of a diuretic, [MEDICATION NAME] 40 mg daily, which was initiated on 12/02/09. No lab results were available for November 2009 or February 2010. Observation of, and interview with, this resident, on 03/02/10 at 8:30 a.m., revealed a pleasantly confused lady who was clean in appearance and well groomed. During this conversation, she threw back the covers and spoke of her TED hose lying at the foot of her bed, saying she would need them on. Both of her legs were [MEDICAL CONDITION], more so on the left, and her finger made an imprint on her left lower thigh when she touched it. On 03/02/10, a medical records person (Employee #12) reviewed the resident's thinned record on file and was unable to find the physician-ordered laboratory tests listed above since 08/31/09. On 03/02/10 at approximately 11:15 a.m., these findings were reported to the director of nursing (DON), who stated she would notify the physician and request an order for [REDACTED]. 2. Medical record review, on 03/03/10, revealed a physician notification form dated 03/02/10 at 11:45, regarding the missing November 2009 and February 2010 labs (BUN, creatinine, and electrolytes). Labs, collected at 12:04 p.m. and reported at 2:12 p.m. on 03/02/10, yielded the following abnormal results: - Potassium - high at 6.1 (normal range 3.5 - 5.2) - Chloride - high at 111 (normal range 97 - 108) - BUN - high at 51 (normal range 5 - 26) - Creatinine - high at 3.53 (normal range 0.57 - 1.00) - eGRF - low at 12 (normal range > 59) Upon notification of these abnormal results, the physician gave orders, on 03/02/10 (with no timed entry for the telephone order), to discontinue the [MEDICATION NAME], give Potassium Chloride 30 meq (additional potassium for an individual who already had an abnormally high serum potassium level), and administer 1000 cc intravenous fluids of D5W (5% [MEDICATION NAME] and water) at a rate of 100 cc per hour with repeat labs in the morning. Review of the Medication Administration Record [REDACTED]. 3. Record review, on 03/04/10, revealed repeat labs, collected at 7:23 a.m. and reported at 12:13 p.m. on 03/03/10, yielded the following abnormal results: - BUN - high at 49 (normal range 5 - 26) - Creatinine - high at 3.29 (normal range 0.57 - 1.00) - eGFR - low at 13 (normal range > 59) Review of physician's orders [REDACTED]. Review of nursing notes found an entry, dated 03/03/10 at noon, stating, \"2nd (second) blood draw done to confirm K+ (potassium) level before administering [MEDICATION NAME].\" A subsequent entry, at 2:00 p.m. on 03/03/10, noted an elevated potassium level of 5.8 with [MEDICATION NAME] given. Another entry, also at 2:00 p.m. on 03/03/10, noted more lab work was scheduled for the morning. 4. Labs, collected at 1:21 a.m. and reported on 03/04/10 (time of report not noted), yielded the following abnormal results: - Potassium - within normal limits at 4.8 (normal range 3.5 - 5.2) - BUN - high at 45 (normal range 5 - 26) - Creatinine - high at 3.42 (normal range 0.57 - 1.00) - eGFR - low at 13 (normal range > 59) 5. During interview with the physician on 03/04/10 at 2:15 p.m., he said his primary focus initially was to hydrate the resident. He said the nurse told him about the 6.1 potassium level 03/02/10. When asked about the order for potassium chloride, he explained he knew the potassium level would drop when she was re-hydrated. 6. Review of the resident assessment protocol (RAP) summary on the resident's comprehensive admission assessment (dated as completed on 06/06/09) found the interdisciplinary care team decided to not address dehydration / fluid maintenance on this resident's care plan, even though her admitting [DIAGNOSES REDACTED]. Review of the current care plan revealed the problem statement: \"At nutritional risk r/t (related to): Therapeutic diet r/t Stg IV CRF (Stage IV [MEDICAL CONDITION]).\" There was a box to also mark \"Dehydration\", but the interdisciplinary care team chose not to mark this. The goals associated with this problem statement were: \"Resident will consume at least 75% of most meals\" and \"Weight will remain stable +/- 5 lbs adm (admission weight) 135 lb (also noted +3 [MEDICAL CONDITION] to BLE (bilateral lower extremities)\". The interventions to assist the resident in achieving these goals included: \"Monitor labs as ordered / available.\" .", "filedate": "2015-07-01"}
{"rowid": 10094, "facility_name": "ARBORS AT FAIRMONT", "facility_id": 515189, "address": "130 KAUFMAN DRIVE", "city": "FAIRMONT", "state": "WV", "zip": 26554, "inspection_date": "2010-03-04", "deficiency_tag": 279, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "FFCS11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** . Based on record review, observation, resident interview, and staff interview, the facility failed to provide necessary care and services to assist one (1) of twenty (20) sampled residents to ensure the resident maintained acceptable parameters of fluid and electrolyte balance, by failing to develop and implement a care plan to address fluid and electrolyte balance for a resident with a [DIAGNOSES REDACTED]. Resident identifier: #108. Facility census: 112. Findings include: a) Resident #108 Review of Resident #108's medical record revealed an [AGE] year old female admitted to the facility on [DATE] with the following Diagnoses: [REDACTED]. 1. Record review, on 03/02/10, revealed physician orders [REDACTED]. However, the most recent test results, dated 08/31/09, revealed the following abnormal lab values: - Potassium - high at 5.6 (normal range 3.5 - 5.2) - Chloride - high at 115 (normal range 97 - 108) - Carbon [MEDICATION NAME] - low at 17 (normal range 20 - 32) - BUN - high at 39 (normal range 5 - 26) - Creatinine - high at 3.02 (normal range 0.57 - 1.00) - Estimated Glomerular Flow Rate (eGRF - a test for monitoring kidney function) - low at 15 (normal range > 59) (Note: Abnormally high values of BUN, creatinine, and potassium are indicative of impaired kidney function; abnormally low values of eGFR are indicative of kidney damage. Abnormally high values of BUN, creatinine, and potassium are also indicative of dehydration.) Further record review revealed the addition of a diuretic, [MEDICATION NAME] 40 mg daily, which was initiated on 12/02/09. No lab results were available for November 2009 or February 2010. Observation of, and interview with, this resident, on 03/02/10 at 8:30 a.m., revealed a pleasantly confused lady who was clean in appearance and well groomed. During this conversation, she threw back the covers and spoke of her TED hose lying at the foot of her bed, saying she would need them on. Both of her legs were [MEDICAL CONDITION], more so on the left, and her finger made an imprint on her left lower thigh when she touched it. On 03/02/10, a medical records person (Employee #12) reviewed the resident's thinned record on file and was unable to find the physician-ordered laboratory tests listed above since 08/31/09. On 03/02/10 at approximately 11:15 a.m., these findings were reported to the director of nursing (DON), who stated she would notify the physician and request an order for [REDACTED]. 2. Medical record review, on 03/03/10, revealed a physician notification form dated 03/02/10 at 11:45, regarding the missing November 2009 and February 2010 labs (BUN, creatinine, and electrolytes). Labs, collected at 12:04 p.m. and reported at 2:12 p.m. on 03/02/10, yielded the following abnormal results: - Potassium - high at 6.1 (normal range 3.5 - 5.2) - Chloride - high at 111 (normal range 97 - 108) - BUN - high at 51 (normal range 5 - 26) - Creatinine - high at 3.53 (normal range 0.57 - 1.00) - eGRF - low at 12 (normal range > 59) Upon notification of these abnormal results, the physician gave orders, on 03/02/10 (with no timed entry for the telephone order), to discontinue the [MEDICATION NAME], give Potassium Chloride 30 meq (additional potassium for an individual who already had an abnormally high serum potassium level), and administer 1000 cc intravenous fluids of D5W (5% [MEDICATION NAME] and water) at a rate of 100 cc per hour with repeat labs in the morning. 3. Record review, on 03/04/10, revealed repeat labs, collected at 7:23 a.m. and reported at 12:13 p.m. on 03/03/10, yielded the following abnormal results: - BUN - high at 49 (normal range 5 - 26) - Creatinine - high at 3.29 (normal range 0.57 - 1.00) - eGFR - low at 13 (normal range > 59) Review of physician's orders [REDACTED]. Review of nursing notes found an entry, dated 03/03/10 at noon, stating, \"2nd (second) blood draw done to confirm K+ (potassium) level before administering [MEDICATION NAME].\" A subsequent entry, at 2:00 p.m. on 03/03/10, noted an elevated potassium level of 5.8 with [MEDICATION NAME] given. Another entry, also at 2:00 p.m. on 03/03/10, noted more lab work was scheduled for the morning. 4. Labs, collected at 1:21 a.m. and reported on 03/04/10 (time of report not noted), yielded the following abnormal results: - Potassium - within normal limits at 4.8 (normal range 3.5 - 5.2) - BUN - high at 45 (normal range 5 - 26) - Creatinine - high at 3.42 (normal range 0.57 - 1.00) - eGFR - low at 13 (normal range > 59) 5. Review of the resident assessment protocol (RAP) summary on the resident's comprehensive admission assessment (dated as completed on 06/06/09) found the interdisciplinary care team decided to not address dehydration / fluid maintenance on this resident's care plan, even though her admitting [DIAGNOSES REDACTED]. Review of the current care plan revealed the problem statement: \"At nutritional risk r/t (related to): Therapeutic diet r/t Stg IV CRF (Stage IV [MEDICAL CONDITION]).\" There was a box to also mark \"Dehydration\", but the interdisciplinary care team chose not to mark this. The goals associated with this problem statement were: \"Resident will consume at least 75% of most meals\" and \"Weight will remain stable +/- 5 lbs adm (admission weight) 135 lb (also noted +3 [MEDICAL CONDITION] to BLE (bilateral lower extremities)\". The interventions to assist the resident in achieving these goals included: \"Monitor labs as ordered / available.\" .", "filedate": "2015-07-01"}
{"rowid": 11295, "facility_name": "ARBORS AT FAIRMONT", "facility_id": 515189, "address": "130 KAUFMAN DRIVE", "city": "FAIRMONT", "state": "WV", "zip": 26554, "inspection_date": "2009-05-14", "deficiency_tag": 353, "scope_severity": "E", "complaint": 1, "standard": 0, "eventid": "674B11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, staff, and resident interview, and a review of assignment sheets and schedules, the facility failed to deploy sufficient direct care staff across all shifts and units to meet the assessed care needs of dependent residents. This deficient practice affected more than an isolated number of residents. Facility census: 119. Findings include: a) On the evening of 05/10/09 (from 7:30 p.m. through 12:00 a.m.) continuing into the early morning of 05/11/09, observations revealed the following: - On the 3:00 p.m. to 11:00 p.m. (3-11) shift on 05/10/09, there were four (4) nurses and six (6) nursing assistants present for one hundred nineteen (119) residents. Per the planned nursing schedule, there should have been four (4) licensed nurses and eleven (11) nursing assistants in the facility. - On the 11:00 p.m. to 7:00 a.m. (11-7) shift beginning on 05/10/09 through 05/11/09, there were four (4) nurses and four (4) nursing assistants present in the facility. Per the planned nursing schedule, there should have been four (4) licensed nurses and four (4) nursing assistants in the facility. On 05/10/09, all nursing staff members who were present in the facility for the 3-11 and 11-7 shifts were confidentially interviewed. A review of the twenty-four (24) hour nursing reports for the 11-7 shift revealed: - On 05/13/09, there were only three (3) licensed nurses and four (4) nursing assistants for the entire shift. - On 05/08/09 from 11:00 p.m. through 3:00 a.m., there were only four (4) licensed nurses and three (3) nursing assistants. - On 05/07/09 from 11:00 p.m. through 3:00 a.m., there were only three (3) nurses and three (3) nursing assistants, with a fourth coming in from 3:00 a.m. to 7:00 a.m. - On 05/06/09 from 11:00 p.m. through 3:00 a.m., there were three (3) nurses and three (3) nursing assistants until 3:00 a.m., when a fourth (4) nursing assistant came in from 3:00 a.m. to 7:00 a.m. - On 05/05/09, there were four (4) nurses and three (3) nursing assistants for the entire shift. - On 05/04/09, there were two (2) nurses and three (3) nursing assistants for the entire shift. - On 05/02/09, there were three (3) nurses and two (2) nursing assistants for the entire shift. - On 04/29/09, there were four (4) nurses and three (3) nursing assistants for the entire shift. - On 04/17/09, there were four (4) nurses and three (3) nursing assistants for the entire shift. - On 04/15/09, there were three (3) nurses and three (3) nursing assistants for the entire shift. - On 04/02/09, there were four (4) nurses and three (3) nursing assistants from 3:00 a.m. through 7:00 a.m. Review of the staffing calculation worksheet found there were less than sixty (60) nursing hours for the 11-7 shift for the 2009 dates of 02/02/09, 02/13/09, 02/14/09, 02/16/09, 02/17/09, 02/20/09, 03/13/09, 03/19/09, 03/25/09 - 03/29/09, 04/04/09, 04/13/09, 04/15/09, 04/29/09, and 05/01/09 - 05/09/09. The facility's census varied from one hundred fourteen (114) to one hundred nineteen (119) residents for these days. The resident census and conditions of residents (CMS-672), dated 05/10/09, indicated there were one hundred eighteen (118) residents in the facility. Seventy (70) residents were occasionally or frequently incontinent of bladder, and seventy (70) residents were occasionally or frequently incontinent of bowel. Fifty-six (56) residents were in a chair all or most of the time. Forty-one (41) residents had documented psychiatric diagnoses, sixty-nine (69) residents had a [DIAGNOSES REDACTED]. Five (5) residents developed pressure ulcers since admission, and one-hundred eighteen (118) residents were receiving preventive skin care. Confidential interviews held with nursing staff from the 3-11 shift and the 11-7 shift found that rounds were to be made every two (2) hours on the 11-7 shift, and most agreed this was not always possible. The nursing staff agreed the licensed nurses would help by answering call lights and turning residents, but none of them made rounds with the nursing assistants. On 05/10/09, the 3-11 nursing assistants were interviewed from 9:30 p.m. through 10:30 p.m., and most agreed they had not been able to complete their assignments for the 3-11 shift at times. This happened when there was not enough staff present at the facility. Tasks not completed included final rounds (including turning / repositioning and incontinence care), denture care, emptying urinary catheter drainage bags, and charting in the kiosk. On one (1) hallway, the 8:00 p.m. snacks had not been passed. The 11-7 shift nursing assistants indicated on some nights there was only one (1) nursing assistant for half of the facility (with a total of one hundred twenty (120) beds), and they are not always able to complete their rounds. An interview with the staffing coordinator, on 05/13/09 at 11:50 a.m., found she scheduled four (4) licensed nurses for 7:00 p.m. through 7:00 a.m., with eight (8) nursing assistants for the 3-11 shift and four (4) nursing assistants for the 11-7 shift. She reported having no control over \"call-offs\", and the licenses nurses were to call out other nursing assistants if there were \"call-offs\". An interview with the director of nursing (DON) and the assistant director of nursing (ADON), on 05/13/09, found the licensed nurses were supposed to call out nursing assistants or to try to get nursing assistants to stay over or come in early in order to cover part or all of the affected shift. The nurses were supposed to let the DON or ADON know if there was not enough staff, but the nurses had not been doing so.", "filedate": "2014-07-01"}
{"rowid": 11296, "facility_name": "ARBORS AT FAIRMONT", "facility_id": 515189, "address": "130 KAUFMAN DRIVE", "city": "FAIRMONT", "state": "WV", "zip": 26554, "inspection_date": "2009-07-27", "deficiency_tag": 356, "scope_severity": "C", "complaint": 1, "standard": 0, "eventid": "ONIB11", "inspection_text": "Based on observation and staff interview, the facility failed to accurately post the actual resident census and actual numbers of licensed practical nurses (LPNs) and nursing assistants (NAs) working on the day shift on 07/26/09. Facility census: 112. Findings include: a) On 07/26/09 at 1:15 p.m., observation found a nursing staff posting form titled \"Daily Nurse Staffing Form\", dated 07/26/09, in the main dining room. The form did not specify the actual numbers of LPNs and NAs currently working in the facility on the day shift, nor did it specify the current resident census. The form reported fifteen and nine-tenths (15.9) NAs were on duty, yet observation revealed thirteen (13) NAs working on the day shift. The form also reported four and nine-tenths (4.9) LPNs were on duty, yet observation revealed four (4) LPNs working on the day shift. The day shift registered nurse supervisor (Employee #27), when interviewed on 07/26/09 at 2:00 p.m., confirmed the form was not accurate and complete. .", "filedate": "2014-07-01"}
{"rowid": 11297, "facility_name": "ARBORS AT FAIRMONT", "facility_id": 515189, "address": "130 KAUFMAN DRIVE", "city": "FAIRMONT", "state": "WV", "zip": 26554, "inspection_date": "2009-07-27", "deficiency_tag": 441, "scope_severity": "E", "complaint": 1, "standard": 0, "eventid": "ONIB11", "inspection_text": "Based on observations, medical record review, policy review, and staff interviews, the facility failed to change each resident's oxygen tubing weekly, as required. This was true for two (2) of seven (7) sampled and seven (7) randomly observed residents prescribed oxygen therapy by their physician. Residents who were using oxygen therapy did not have their oxygen supply tubing changed weekly, as ordered by the physician and in accordance with the facility's infection control policy revised on October 2008. Resident identifiers: #2, #17, #46, #66, #77, #87, #91, # 97, and #107. Facility census: 112. Finding include: a) Resident #2 On 07/27/09 at 9:15 a.m., observation found Resident #2's oxygen tubing was dated 07/11/09. Resident #2's treatment sheet for July 2009, when reviewed on 07/27/09 at 10:00 a.m., disclosed the oxygen tubing was last changed on 07/06/09. b) Resident #17 On 07/27/09 at 8:45 a.m., observation found Resident #17's oxygen tubing was dated 06/09/09. c) Resident #46 On 07/27/09 at 9:20 a.m., observation found Resident #46's oxygen tubing was dated 07/07/09. d) Resident# 66 On 07/26/09 at 12:40 p. m., observation found Resident #66's oxygen tubing was dated 07/12/09. e) Resident #77 On 07/27/09 at 8:50 a.m., observation found Resident #77 in bed receiving oxygen therapy via nasal cannula at 2 liters per minute. The oxygen tubing was dated 07/11/09. f) Resident #87 On 07/26/09 at 12:45 p.m., observation found Resident #87's oxygen tubing was dated 07/07/09. g) Resident #91 On 07/27/09 at 7:45 a.m., observation found Resident #91 in bed using his oxygen via nasal cannula. The oxygen tubing was dated 07/11/09. The nursing supervisor (Employee #27), when interviewed on 07/27/09 at 7:50 a.m., confirmed the facility's policy was to \"change the oxygen tubing weekly\". h) Resident #97 On 07/26/09 at 2:30 p.m., observation found Resident #97 in her room using her oxygen via nasal cannula. The oxygen supply tubing was dated 07/11/09. i) Resident #107 On 07/27/09 at 7:45 a.m., observation found Resident #107's oxygen tubing was dated 07/11/09. j) The director of nurses (Employee #2), on 07/27/09 at 2:30 p.m., provided a copy of the facility's policy titled \"Disposal Equipment Change Schedule\". Page 2 of the policy stated oxygen supply tubing is to be changed weekly.", "filedate": "2014-07-01"}
{"rowid": 11298, "facility_name": "ARBORS AT FAIRMONT", "facility_id": 515189, "address": "130 KAUFMAN DRIVE", "city": "FAIRMONT", "state": "WV", "zip": 26554, "inspection_date": "2010-08-12", "deficiency_tag": 323, "scope_severity": "G", "complaint": 1, "standard": 0, "eventid": "RZPN11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** . Based on record review, staff interview, confidential family interview, and review of facility incident / accident reports, the facility failed to ensure the resident environment remained as free of accident hazards as was possible, including freedom from the aggressive behaviors of Resident #119, and that each resident received adequate supervision to prevent physical abuse by Resident #119. Documentation throughout Resident #119's medical record and facility incident reports revealed numerous episodes of aggressive behavior, including entering other resident rooms and rummaging in their things, as well as striking and pinching others on at least six (6) occasions during his seventy-seven (77) day stay at the facility. The aggressive behaviors of Resident #119 resulted in at least six (6) recorded resident-to-resident physical altercations (involving Residents #23, #30, #45, #17, #7, and #25). The final aggressive episode resulted in physical injury to Resident #25, who sustained a bruised eye and skin tears to his arm. In the weeks and months leading up to Resident #25's injuries, the facility's administrative staff and interdisciplinary team failed to: - Identify the need for increased supervision in the facility (occupied by other elderly, debilitated residents) related to Resident #119's behaviors. (The resident had a prior personal history of frequent aggressive behaviors with his family members of which facility staff should have been aware.) - Evaluate and analyze the frequency, intensity, and duration of his physically abusive behaviors and identify causal / contributing factors, in order to develop appropriate interventions to reduce / eliminate these behaviors and ensure the safety of others; - Implement interventions, including providing adequate supervision, consistent with the needs, goals, and plans of care of both Resident #119 (the aggressor) and the other residents of the facility, in order to reduce the risk of resident-to-resident altercations; and/or - Monitor the effectiveness of the interventions and modify the interventions as necessary when it was apparent the interventions did not result in sustainable changes in Resident #119's aggressive behavior. One (1) family member, who was confidentially interviewed, revealed they voiced concerns about the safety of other residents (due to Resident #119's behavior) to nursing staff of the facility; however, there was no documented evidence by facility staff of this conversation. (Identifiers withheld due to request for confidentiality.) The failure of the facility to identify and eliminate or effectively mitigate the potential hazards in the environment posed by Resident #119's aggressive behaviors resulted in the physical abuse of six (6) residents (Residents #23, #30, #45, #17, #7, and #25) with resulting injury to Resident #25. It also presented the potential for more than minimal harm to all residents of the facility who were subjected to the overall hostile environment created by Resident #119. Facility census: 117. Findings include: a) Resident #119 Review of the medical record of Resident #119 revealed the resident had been admitted to an area acute care hospital from his home on 04/12/10. The history and physical examination [REDACTED].\" The resident was admitted to the nursing home from this hospitalization on [DATE]. Review of the resident's care plan revealed, on 06/09/10, a plan of care for psychotropic drug use had been implemented which listed all of the resident's mood altering medications and the behaviors which they were intended to treat. The only changes made to the plan were hand written entries at the time of medication changes. There was no mention of non-pharmacologic interventions to prevent (e.g., modification of environmental triggers, additional supervision, diversional activities, etc.) or resolve aggressive behaviors, nor were changes made to interventions to be used by staff following incidents where Resident #119 had physically attacked other residents. - b) Resident #30 A facility incident report stated that, on 06/15/10 at 1:40 p.m., Resident #119 approached Resident #30, who was sitting in the hallway, and \"hit him in the face\". There was no noted physical injury to Resident #30. The report further stated staff \"separated residents\". Review of Resident #30's most recent minimum data set (MDS), an abbreviated quarterly assessment with an assessment reference date (ARD) of 04/07/10, described this resident as weighing 134# and being totally dependent on staff for bed mobility, ambulation, etc. He could provide for none of his own needs. This resident would not have been able to independently walk or get away from Resident #119. - c) Resident #45 A facility incident report stated that, on 06/15/10 at 9:00 p.m., after hitting a different resident earlier in the day, Resident #119 was \"ambulating in the hallway, went into room (room # of Resident #45) and hit resident on L (left) arm\". The report stated there was no injury to Resident #45 and the residents were separated. The physician for Resident #119 was notified, and an order for [REDACTED]. The order was changed the next day to two (2) mg two (2) times daily. - d) Resident #17 A facility incident report stated that, on 07/11/10 at 8:10 p.m., Resident #119 entered the room of Resident #17 while the resident was lying in the bed and \"hit the resident (#17) multiple times in the head\". Again, there was no injury noted and the residents were separated. The most recent MDS for Resident #17, an abbreviated quarterly assessment with an ARD of 06/16/10, stated this resident [AGE] year old could only walk and move about in the bed with the assistance of two (2) staff; this resident would not have been able to independently walk or get away from Resident #119. - e) Resident #7 A facility incident report stated that, on 07/11/10 at 8:30 p.m., twenty (20) minutes after hitting Resident #17, Resident #119 entered the room of Resident #7 and, when asked to leave, \"struck (Resident #7) beside the R (right) side of the mouth\". The report stated Resident #7 was not injured and a stop sign was put on his door. - f) Resident #23 A facility incident report stated that, on 07/21/10 at 7:50 a.m., this resident was lying in bed and Resident #119 came into her room and started pinching her legs. This report also stated that Resident #23 was not injured and \"other resident was removed from her room\". Review of Resident #23's most recent available MDS, an abbreviated quarterly assessment with an ARD of 04/21/10, stated this [AGE] year old resident weighed 139# and was dependent on staff for any transfer. This resident would not have been able to independently walk or get away from Resident #119. - g) Resident #25 A facility incident report stated that, on 08/06/10, Resident #25 reported to facility staff that Resident #119 entered his room and walked over to his bed. When he (#25) yelled for him (#119) to leave, Resident #119 hit him (#25). Two (2) skin tears were noted on the resident's left arm and his right cheek was slightly edematous when assessed by staff immediately after the incident. The resident complained of no pain. When observed on 08/11/10 at 11:00 a.m., Resident #25 was noted to have a bruised discoloration on the outside parameter of his right eye. This resident had experienced a stroke and had minimal use of his right side. He was able to call out for help. - h) A facility registered nurse (RN - Employee #26), who was designated as in charge in the absence of the administrator and the director of nurses, was interviewed on several occasions during the two (2) day investigation. This nurse confirmed there was no evidence of attempt by facility staff to identify and eliminate causative factors of Resident #119's aggressive behaviors or to assign additional supervision for the resident and avoid aggressive behaviors. She was unaware that some of the physical altercations had been repeated in short time spans on the same days. This nurse felt there had been attempts to move the resident to a more appropriate setting without success, but no evidence of these attempts could be provided. This nurse did also confirm that Resident #119 was not confined to the unit of the facility on which he resided, but he did wonder throughout the facility. This nurse stated that staff was aware of the behaviors of Resident #119 since his admission, but they did not expect it to escalate to the point it did when he hit Resident #25. - i) Social service progress notes found on the medical record of Resident #119 disclosed no evidence of attempts to transfer / move the resident to another setting to assure the safety of other facility residents prior to his transfer on 08/09/10. A facility social worker (Employee #5), when interviewed on 08/11/10 at approximately 4:00 p.m., confirmed these notes as accurate and complete.", "filedate": "2014-07-01"}
{"rowid": 11479, "facility_name": "ARBORS AT FAIRMONT", "facility_id": 515189, "address": "130 KAUFMAN DRIVE", "city": "FAIRMONT", "state": "WV", "zip": 26554, "inspection_date": "2009-01-08", "deficiency_tag": 278, "scope_severity": "B", "complaint": null, "standard": null, "eventid": "UFEY11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, review of minimum data set (MDS) assessments, and staff interview, the facility failed to accurately document assessment data on the MDS relative to pressure ulcers, infections, and toileting plans for four (4) of twenty (20) sampled residents. Resident identifiers: #65, #3, #4, and #81. Facility census: 113. Findings include: a) Resident #65 Record review (on 01/06/09) revealed the resident had a Stage II pressure ulcer to the coccyx which was recorded as being healed on 12/02/08. This information was noted on the December 2008 treatment administration record and a nurse's note dated 12/02/08. A skin assessment, dated 12/20/08, recorded no pressure ulcer(s) present at that time. Review of the resident's MDS, with an assessment reference date (ARD) of 12/24/08, found the assessor recorded in Section M1 the resident had one (1) Stage II ulcer. The MDS nurse (Employee #23) was interviewed on 01/07/09 about the information coded in Section M1 of the MDS. After reviewing the issue, she verified the MDS was coded incorrectly. On 01/08/09 at 11:05 a.m., the MDS nurse provided a copy of a corrected MDS, with an ARD of 12/24/08. In Section M1, the assessor documented no pressure ulcer(s). b) Resident #31 Review (on 01/07/09) of the admission MDS, completed on 12/24/08, revealed the assessor indicated, in Section I2, the resident had an antibiotic-resistant infection. Interview with the director of nursing (DON - Employee #2), at about 6:00 p.m. on 01/07/09, and review of the laboratory reports confirmed that, when the resident was admitted on [DATE], the resident had a [DIAGNOSES REDACTED]. c) Resident #40 Review (on 01/06/09) of the quarterly MDS, completed on 11/12/08, revealed the assessor indicated the resident was non-ambulatory and incontinent of bladder. In addition, the assessor marked Item H3a to indicate the resident was on a scheduled toileting plan. Interview with a nursing assistant (Employee #63), on 01/06/09 at 1:05 p.m., confirmed the resident was not on a toileting plan but was checked regularly for bladder incontinence. d) Resident #81 Review (on 01/06/09) of the quarterly MDS, completed on 11/23/08, revealed the assessor indicated the resident was non-ambulatory and incontinent of bladder. In addition, the assessor marked Item H3a to indicate the resident was on a scheduled toileting plan. Interview with a nursing assistant (Employee #63), on 01/06/09 at about 1:00 p.m., confirmed the resident was not on a toileting plan. .", "filedate": "2014-02-01"}
{"rowid": 11480, "facility_name": "ARBORS AT FAIRMONT", "facility_id": 515189, "address": "130 KAUFMAN DRIVE", "city": "FAIRMONT", "state": "WV", "zip": 26554, "inspection_date": "2009-01-08", "deficiency_tag": 279, "scope_severity": "E", "complaint": null, "standard": null, "eventid": "UFEY11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation, and staff interview, the facility failed to develop individualized comprehensive care plans for each resident to include services / treatments to be provided and appropriate interventions to assist with achievement of established goals. Care plans were not developed and individualized to reflect the actual care and services to be provided for six (6) of twenty (20) sampled residents. Resident identifiers: #36, #10, #97, #28, #62, and #81. Facility census: 113. Findings include: a) Resident #36 Review of the interdisciplinary care plan for Resident #36, found a sixty-four (64) paged document consisting of pre-printed problems, goals, and interventions with blanks to be filled in to make the care plan individualized. The care plan was hard to follow, and it did not always accurately reflect what problems the resident was experiencing for which specific interventions were being applied. 1. This resident had a history of [REDACTED]. devices. There was a different care plan for each device. The problem statements and goals were the same for each device, and each began with the statement: \"Refer to the physical restraint / enabler assessment.\" 2. The physical restraint / enabler care plan was reviewed. This care plan was dated 12/05/08. The plan did not have a problem statement, goal, or interventions to achieve the goal. The care plan simply said, \"Refer to the physical restraint / enabler assessment.\" The goal associated with this problem was \"(Resident) will be free of negative effects with the use of an enabler.\" This goal did not address what the resident would achieve through the use of the device, i.e., improve functioning, increased independence, etc.) Review of the interventions associated with this goal found no measures to assist the resident in achieving the stated goal. The interventions simply said to apply the enabler (a lap buddy) when in the wheelchair for poor safety awareness with frequent falls; review the enabler information sheet every ninety (90) days; refer to the Mood and Behavior Symptom Assessment plan of care (which, when reviewed, did not refer to the lap buddy in any way); refer to the falls assessment prevention and management plan of care (which did not include the lap buddy use); refer to the skin integrity assessment (which did not contain information about the lap buddy): prevention and management plan of care; maintain resident bowel and bladder routine; educate resident / family about physical restraints / enabler using the physical restraint / enabler information form (which was incomplete). The care plan for this resident's lap buddy use did not specify the problem necessitating the application of the device. Additionally, record review revealed the resident became agitated and had sustained injuries when the device was applied, and this response was not addressed in the resident's care plan. b) Resident #10 Review of the interdisciplinary care plan for Resident #10, found a fifty (50) paged document consisting of pre-printed problems, goals, and interventions with blanks to be filled in to make the care plan individualized. The care plan stated, \"Recent or chronic history of incontinence. Contributing factors included laxative use PRN and cognitive / perceptual impairment, loss of sphincter control, and decreased physical activity.\" One (1) goal for problem statement was: \"Will ingest adequate fluids evidenced by resident's skin turgor.\" Other goals were: \"Will have bowel movement every three days\" and \"Will be cooperative with assisted toileting.\" The interventions to assist with achievement of these goals included, \"See nutritional care plan\" and \"See skin integrity prevention and management plan of care.\" The stated interventions did not address the identified problem and would not lead to achievement of the established goals. c) Resident #97 1. Record review found a nursing note recording the resident requested pain medication at 10:50 a.m. on 12/18/08. The nurse noted having instructed the resident that her \"pain medications are scheduled\". There was no evidence that the nurse assessed the pain or offered her one (1) of her prescribed PRN medications for breakthrough pain. Another nursing note, dated 12/30/08 at 1:30 p.m., stated, \"Resident belligerent with staff today about her pain medicine ([MEDICATION NAME]). Resident is on pain medication around the clock, offered Tylenol in between doses, resident refused meds (Tylenol). \" Another note, dated 01/01/09 at 4:35 a.m., stated, \"Resident requested this nurse to give pain pill early, when this nurse refused resident became upset mumbled statements under her breath, and accepted her set schedule resting at this time.\" A nursing note, dated 01/01/09 at 1:35 p.m., stated, \"Resident upset pain meds are on a scheduled basis instead of PRN. Attempted redirection but resident became more agitated. Continue to monitor.\" There was no evidence of further monitoring in the nursing notes, and this was the last nursing note written as of 01/06/09, which was the date of this medical record review. During an interview with Resident #97 on 01/06/09 at 10:00 a.m., she identified that her scheduled pain medication was not always effective. She stated that, sometimes, the pain in her back and shoulder was severe. A review of the resident's care plan, dated 11/25/08, revealed this resident had persistent (chronic) pain with \"an alteration in comfort related to pain secondary to L (left) shoulder pain.\" Pre-printed goals were checked for this problem statement as follows: \"Decrease persistent pain to a tolerated level so resident can function in daily life\"; \"Resident will report pain relief within 30 - 60 minutes receiving pain medication or treatment as ordered; and \"Will have not signs and symptoms of unrelieved pain no complaints of pain when questioned, no vocalization related to pain, no non-verbal signs, verbalization of pain, no decline in activity.\" Also included were the following functional goals: \"Participate in ADL's\"; \"Participate in therapies\"; \"Will not experience decline in functioning related to pain\"; and \"Non-pharmacological measures will be used as alternatives to medication when appropriate.\" The interventions for achieving the goals written above were as follows: \"Administer pain medication as ordered, Tylenol 650 mg po (by mouth), monitor and record effectiveness, side effects of medication PRN (as needed) observe and notify provider for s/s (signs / symptoms) of constipation, administer bowel care per protocol, assess for verbal and non-verbal signs and symptoms of distress or pain unrelieved by ordered treatments / medications, observe during rest and during movement for pain, [MEDICATION NAME] 50 mg po (by mouth) q4h (every four hours) PRN, [MEDICATION NAME] 5/500 ([MEDICATION NAME]) q4h PRN, position changes, encourage mobility, physical activity as tolerated to prevent stiffness / contractures, Physical therapy and Occupational therapy to evaluate and treat as ordered to improve functional states, refer to pain management clinic PRN, discuss progress toward or maintenance goals for medication therapy, review medication regimen with the provider and the pharmacist PRN.\" This care plan was not individualized to address Resident #97's pain. 2. The resident's care plan also contained the following problem statement: \"Refer to the physical restraint / enabler assessment.\" The goal stated: \"Will be free of negative effects with the use of an enabler.\" (There was no mention about how the enabling device was intended to improve the resident's functionality.) One (1) intervention simply stated what device was to be used (1/2 top side rail) to aid in turning and reposition. The only other intervention was \"Refer to the mood and behavior symptom plan of care.\" Review of the mood and behavior plan of care found no interventions related to the use of an enabler. There were no interventions written to assist in achieving the goal established. 3. The director of nursing (DON - Employee #2) was made aware of the inconsistencies in Resident #97's care plan at 10:00 a.m. on 01/08/09. She stated she was aware there were a lot of pages in the care plan, but this was the way their corporation required them to do the care plans. She was made aware that the resident's true problems often could not be identified and the treatment they were to receiving often did not match the care plans. d) Resident #28 Medical record review, on 01/06/09 at 1:32 p.m., revealed Resident #28 was on several medications for moods / behaviors, including [MEDICATION NAME] 12.5 mg via g tube BID (two-times-a-day), [MEDICATION NAME] 0.5 mg via g tube TID (three-times-a-day), and [MEDICATION NAME] 10 mg via g tube QD (every day). Review of the resident's most current care plan, dated 11/26/08, found the facility identified the resident was at risk for depression as evidence by \"unhappy behavior symptoms\" and persistent anger with self or others. The goal included reduction / elimination of unhappy behavior symptoms. Interventions to achieve the goal included: \"offer time to express feelings and concerns; separate from stressful situations; 1:1 (one on one) conversation to maintain trust of staff; offer reassurance; and depression scale q3 (every three) months.\" Another problem was behavioral symptoms that may be harmful to self or others or interfere with function or care as evidence by yells out loud and grabs, combative with staff. The goal included no injury to self or others. Interventions included: \"administer medications, see nsg (nursing) mar (medication administration record), redirect to activity of 1:1 diversion, offer time to express feelings and concerns, separate from stressful situations, redirect to act. or 1:1 act (activity or one-on-one activity) offer to call son.\" Review of the resident's minimum data set assessment (MDS), dated [DATE], revealed Resident #28 had short and long term memory problems and moderately impaired cognitive skills for daily decision making, and she exhibited repetitive verbalizations, repetitive anxious complaints, sad pained worried facial expressions crying and tearfulness (of which all were easily altered). Review of the behavior tracking report, from 06/01/08 through 11/30/08, found the following: - 06/17/08 - crying and \"mood persistence\" (each one time). - 07/27/08 - crying - 08/08/08 - crying and \"mood persistence\" - 08/21/08 and 08/30/08 - crying - 09/02/08 and 09/03/08 - physical abuse (a behavior which was not described) - 10/03/08 - crying - 10/04/08 - crying and \"mood persistence\" - 10/06/08 - sad / pained / worried facial expression and \"mood persistence\" - 10/07/08 - crying two (2) times and \"mood persistence\" - 10/26/08 - crying and repetitive verbal, unrealistic fears, repetitive anxious, sad / pained / worried facial expression, and \"mood persistence\" - 10/27/08 - crying and \"mood persistence\" - 11/15/08, 11/21/08, and 11/25/08 - crying and \"mood persistence\" The facility failed to develop an individualized care plan to address specifically identified behaviors exhibited by the resident based on a comprehensive assessment of factors causing or contributing to these behaviors, and failed to develop individualized, realistic interventions in recognition of this resident's limited cognitive ability and identified triggers. e) Resident #62 Medical record review, on 01/06/09 at 4:15 p.m., revealed Resident #62 received several medications for moods / behaviors. Her physician's orders [REDACTED]. - On 10/31/07 - [MEDICATION NAME] tablets 20 mg PO (by mouth) Q AM (every morning) and [MEDICATION NAME] 50 mg po BID; - On 02/20/08 - [MEDICATION NAME] 200 mg PO QD and [MEDICATION NAME] 100 mg PO QD; - On 05/15/08 - [MEDICATION NAME] 5 mg po BID; - On 11/12/08 - [MEDICATION NAME] 0.25 mg PO Q AM, [MEDICATION NAME] 0.5 mg PO Q HS (every night), and [MEDICATION NAME] ER 250 mg PO QD. Review of resident's current care plan, last updated on 10/15/08, revealed the interdisciplinary care team identified Resident #62 exhibited behavioral symptoms that may be harmful to self and/or others or that interfered with function or care, as evidenced by \"cognitive deficit Alzheimer's, doesn't understand the need to be here.\" The goals associated with this problem statement were no injury to self or others and to reduce the frequency of behavioral symptoms. Interventions included: \"1:1 conservation to calm, reminisce, see act poc (see activity plan of care), offer to call family.\" Another problem statement addressed: \"Socially inappropriate - yells out loud for nurses to help her. Yells that she's sick or has to go to the bathroom; anxious / repetitive questions, statements.\" The goal associated with this problem statement was: \"Will exhibit socially appropriate behaviors.\" Intervention included: \"offer reassurance, encourage rest encourage activities, separate from stressful situations, offer to call son, take for a walk.\" Review of the resident's most recent MDS, dated [DATE], revealed Resident #62 had short and long term memory problems and moderately impaired cognitive skills for daily decision making, and she exhibited negative statements, repetitive questions, repetitive verbalizations, unrealistic fears, recurrent statements that something terrible was about to happen, repetitive anxious complaints, [MEDICAL CONDITION], sad / pained / worried facial expressions, crying / tearfulness, and repetitive movements (all of which were not easily altered). Additionally, the assessor identified that the resident exhibited wandering, verbally abusive, physical abusive, and socially inappropriate behaviors and resists care (all of which were not easily altered). Review of the behavior tracking report, from 09/11/08 through 10/10/08, revealed she exhibited behaviors on only four (4) days during the two-month period (09/30/08, 10/06/08, 10/07/08, and 10/10/08). The behaviors being tracked were: negative statements, repetitive questions, repetitive verbal, persistent anger, self deprecation, unrealistic fears, terrible things to happen, repetitive health, unpleasant mood, [MEDICAL CONDITION], sad / pained / worried facial expression, crying, repetitive physical, mood persistence, wandering, wandering altercation, verbal abuse, verbal altercation, physical abuse, physical altercation, socially inappropriate, social altercations, and resists care. Specific examples of these behaviors (such as what constituted \"mood persistence\") were not identified in either the resident's assessments, care plan, or behavior tracking report. The facility failed to develop an individualized care plan to address specifically identified behaviors exhibited by the resident based on a comprehensive assessment of factors causing or contributing to these behaviors, and failed to develop individualized, realistic interventions in recognition of this resident's limited cognitive ability and identified triggers. f) Resident # 81 Medical record review (on 01/06/09) of the physical restraint / enabler plan of care, dated 09/24/08, revealed the following problem statement: \"Refer to the physical restraint / enabler assessment.\" The associated goal was: \"Will be free of negative effects with the use of the enabler\". The plan did not identify the reason for use of the enabler and did not establish a goal based on the assessment and the use of the enabler. .", "filedate": "2014-02-01"}
{"rowid": 11481, "facility_name": "ARBORS AT FAIRMONT", "facility_id": 515189, "address": "130 KAUFMAN DRIVE", "city": "FAIRMONT", "state": "WV", "zip": 26554, "inspection_date": "2009-01-08", "deficiency_tag": 309, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "UFEY11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, resident interview, and staff interview, the facility failed to provide care in accordance with each resident's plan of care for three (3) of twenty (20) sampled residents. Resident #97 indicated she was in pain, and this expressed pain was not further assessed or treated. Resident #10 was receiving intravenous (IV) fluids on an \"as needed\" (PRN) basis for her poor fluid intake, and her fluid intake and output were not being accurately monitored; this same resident was observed to have severely contracted hands, and she did not have rolled wash cloths or any type of devices in her hands for positioning to prevent further contractures. The facility also failed to staff applied double geri-gloves and elevated the heels of Resident #40 as ordered by the physician. Resident identifiers: #97, #10, and #40. Facility census: 113. Findings include: a) Resident #97 Record review found a nursing note recording the resident requested pain medication at 10:50 a.m. on 12/18/08. The nurse noted having instructed the resident that her \"pain medications are scheduled\". There was no evidence that the nurse assessed the pain or offered her one (1) of her prescribed PRN medications for breakthrough pain. Another nursing note, dated 12/30/08 at 1:30 p.m., stated, \"Resident belligerent with staff today about her pain medicine ([MEDICATION NAME]). Resident is on pain medication around the clock, offered Tylenol in between doses, resident refused meds (Tylenol). \" Another note, dated 01/01/09 at 4:35 a.m., stated, \"Resident requested this nurse to give pain pill early, when this nurse refused resident became upset mumbled statements under her breath, and accepted her set schedule resting at this time.\" A nursing note, dated 01/01/09 at 1:35 p.m., stated, \"Resident upset pain meds are on a scheduled basis instead of PRN. Attempted redirection but resident became more agitated. Continue to monitor.\" There was no evidence of further monitoring in the nursing notes, and this was the last nursing note written as of 01/06/09, which was the date of this medical record review. A review of the physician orders [REDACTED]. The resident also had a PRN order for [MEDICATION NAME]. There was no evidence in Resident #97 that staff offered the [MEDICATION NAME] for breakthrough pain between the scheduled doses of [MEDICATION NAME]. During an interview with Resident #97 on 01/06/09 at 10:00 a.m., she identified that her scheduled pain medication was not always effective. She stated that, sometimes, the pain in her back and shoulder was severe. A review of the resident's care plan, dated 11/25/08, revealed this resident had persistent (chronic) pain with \"an alteration in comfort related to pain secondary to L (left) shoulder pain.\" Pre-printed goals were checked for this problem statement as follows: \"Decrease persistent pain to a tolerated level so resident can function in daily life\"; \"Resident will report pain relief within 30 - 60 minutes receiving pain medication or treatment as ordered; and \"Will have not signs and symptoms of unrelieved pain no complaints of pain when questioned, no vocalization related to pain, no non-verbal signs, verbalization of pain, no decline in activity.\" Also included were the following functional goals: \"Participate in ADL's\"; \"Participate in therapies\"; \"Will not experience decline in functioning related to pain\"; and \"Non-pharmacological measures will be used as alternatives to medication when appropriate.\" The interventions for achieving the goals written above were as follows: \"Administer pain medication as ordered, Tylenol 650 mg po (by mouth), monitor and record effectiveness, side effects of medication PRN (as needed) observe and notify provider for s/s (signs / symptoms) of constipation, administer bowel care per protocol, assess for verbal and non-verbal signs and symptoms of distress or pain unrelieved by ordered treatments / medications, observe during rest and during movement for pain, [MEDICATION NAME] 50 mg po (by mouth) q4h (every four hours) PRN, [MEDICATION NAME] 5/500 ([MEDICATION NAME]) q4h PRN, position changes, encourage mobility, physical activity as tolerated to prevent stiffness / contractures, Physical therapy and Occupational therapy to evaluate and treat as ordered to improve functional states, refer to pain management clinic PRN, discuss progress toward or maintenance goals for medication therapy, review medication regimen with the provider and the pharmacist PRN.\" This care plan was not individualized, and the stated interventions were not initiated when the resident expressed that her routine pain medication was not effective. The nurse did not offer her the PRN [MEDICATION NAME] for breakthrough pain, and there was no evidence that, when the resident expressed continued pain between the routine doses of [MEDICATION NAME], the nurse assessed the pain (type, location, severity, etc.) and provided alternate interventions. The director of nursing (DON - Employee #2) was notified, on 01/07/09 at 6:30 p.m., of the episodes of pain which were not thoroughly assessed and treated by the nurse. The DON agreed the nurse did not intervene according to the standards of practice when the resident expressed the need for additional pain medication. b) Resident #10 1. The physician' s orders, dated 01/01/09, contained an entry for: \"0.45% NS (normal saline) infuse at 75cc/hr PRN if not eating / drinking.\" Medical record review revealed the resident was not eating, and she was receiving comfort care. The family did not desire a feeding tube, but they did want the IV fluids for hydration. This resident was observed on 01/05/09 at 2:30 p.m. with IV fluids infusing into her right hand. Another observation, at 6:00 p.m. on 01/06/09, found two (2) different nursing assistants attempting to feed this resident. She would not eat, spitting the food out and turning her head. She also was not drinking. The IV fluids were infusing at 75cc/hour at that time. Review of the medical record revealed staff was not accurately recording the amounts of fluid received by the resident on a daily basis. This IV fluid was ordered \"as needed\" and not continuously, and there was no record of accurate intake of these fluids per shift. There was no intake and output (I&O) record in the medical record on 01/01/09 or 01/05/09. It could not be determined, from the medical record, how much fluid intake this resident. Additionally, the resident's fluid output was not recorded on the I&O worksheets. This resident had an indwelling Foley urinary catheter, which would facilitate the measurement of the resident's urinary output. However, the urinary output was not recorded, and there was no evidence that anyone had compared the resident's output to the intake to check for a fluid balance. The Medication Administration Record [MEDICATION ADMINISTRATION RECORD DETAILS REDACTED]. According to the MAR, there was no documentation to reflect IV fluids were administered on 01/06/09, and there was no intake records found for that day; however, this surveyor observed IV fluids being administered on 01/06/09 at a rate of 75cc/hour. During an interview with the minimum data set assessment (MDS) nurse (Employee #23) at 10:45 a.m. on 01/07/09, on she was asked if fluid I&Os were recorded elsewhere. She was unable to locate any further records of fluid I&O, and she verified there was no evidence the resident's fluid balance was being adequately monitored. 2. Resident #10 also had contractures to both hands. The resident's most current plan, updated on 11/25/08, specified as an intervention: \"Rolled up washcloths in left hand at all times.\" The care plan also stated, \"Place resting splint on right hand from 9:00 a.m. to 3:30 p.m.\"; staff was to place a rolled up washcloth in her right hand after the splint was removed. On multiple occasions on 01/05/09, 01/06/09, 01/07/09, and 01/08/09, observation found nothing in this resident's hands to prevent further contractures. On two (2) different occasions, the resident was wearing socks over her hands, but there were no devices in place to address the resident's contractures. During an interview with the MDS nurse at 10:45 a.m. on 01/07/09, she stated this resident should have had something for positioning in her hands due to the contractures. c) Resident #40 1. Medical record review, observation, and staff interview (on 01/06/09 and 01/07/09) revealed Resident #40 did not have on the \"double Geri gloves at all times\" as ordered by her physician. Observation of the resident, with the MDS nurse on 01/06/08 at about 11:00 a.m., found the geri gloves were above her wrist and were not the double gloves. 2. The resident also had a physician's orders [REDACTED].@ all times\". Observation of the resident, with the MDS nurse on 01/06/08 at about 11:00 a.m., found both heels were resting directly on the beds. .", "filedate": "2014-02-01"}