{"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"}
{"rowid": 11482, "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": 371, "scope_severity": "F", "complaint": null, "standard": null, "eventid": "UFEY11", "inspection_text": "Based on observations and staff interview, the facility failed to assure foods were served under conditions which assured the prevention of contamination, and failed to reduce practices which have the potential to result in food contamination and compromised food safety. This practice has the potential to affect all residents who receive nourishment from the dietary department. Facility census: 113. Findings include: a) At 2:30 p.m. on 01/05/09, observations, during the initial tour of the dietary department, revealed two (2) trays of cups and five (5) trays of cereal bowls; the cups and bowls were inverted on a synthetic shelving mat on flat trays prior to air drying. The cups and bowls were observed with trapped moisture, creating a medium for bacterial growth. The assistant dietary manager (Employee #45) was present and confirmed the identified problem. b) Observation with the dietary manager (Employee #42), on the afternoon on 01/07/09, again revealed inverted cups on a flat tray with a shelving mat which prevented the cups from proper air drying. The tray was observed under the area where the residents' food trays were served in the dining room. .", "filedate": "2014-02-01"}
{"rowid": 11483, "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": 441, "scope_severity": "E", "complaint": null, "standard": null, "eventid": "UFEY11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Part I -- Based on record review, staff interview, resident interview, and review of the infection incidence rate reports, the facility did not maintain an effective infection control program whereby infectious organisms leading to urinary tract infections (UTIs) were identified. Subsequently, the facility had no data by which analyze infection control data for trends and clusters. Organisms were not identified on the infection incidence log, nor were they tracked for infection control purposes. There was no evidence that clusters were identified. This was evident for four (4) of twenty (20) sampled residents. Resident identifiers: #11, #65, #75, and #35. Also, Resident #97 reported improper perineal care that could potentially cause a UTI from fecal contamination. Facility census: 113. Findings include: a) Residents #11 and #85 Resident #11 experienced repeated UTIs colonized with Escherichia coli (E. coli), bacteria found in feces. Record review revealed positive urine cultures for E. coli on the following dates: 05/18/08, 06/21/08, 08/28/08, 10/20/08, 12/07/08. Other organisms cultured included Alpha Streptococcus and [MEDICATION NAME] species on 07/25/08. Resident #11's roommate, Resident #85, also experienced UTIs as evidenced by positive urine cultures of E. coli with colony counts greater than 100,000 for the following dates: 09/23/08 and 11/03/08. Resident #85 also had a UTI identified in the emergency roiagnom on [DATE] (which was treated with Cipro), but the facility was unable to produce that culture report. Review of the facility's most recent quarter's infection incidence rate report (October, November, and December 2008) found Resident #11's E. Coli infections were not recorded for either October or December. With permission, perineal care was observed for Resident #85 on 01/07/09 at 1:45 p.m., after an episode of urinary incontinence. The nursing assistant used a [MEDICATION NAME] Care body wash / shampoo product for cleansing. After the incontinence brief was removed and the resident was cleansed, the nursing assistant used her contaminated gloved hands to pull up the resident's covers and pull back the privacy curtain between the two (2) beds. During interview with the director of nursing (DON - Employee #2) on 01/07/09 at approximately 6:30 p.m., she produced the facility's most recent quarter (October through December 2008) of monthly incidence rates of infections. This form was to contain the names and room numbers of each resident with infection as well as the types of infection (i.e., respiratory, urinary, skin), the onset date, antibiotic prescribed, and the type of precautions utilized. All of the precautions for all of the infections (regardless if UTI, respiratory, or skin) were listed as \"standard\" precautions for those three (3) months. The accompanying infection surveillance worksheets listed the onset of symptoms, whether it was urinary or respiratory, the name of the antibiotic prescribed, and the start / stop dates of the antibiotic. Neither the organisms isolated, nor the antibiotics the organisms were resistant to, nor the date and site of the culture were listed on any of the infection surveillance worksheets, although there were designated places on the form for recording each these items. A breakdown of numbers of residents with infections were recorded during the most recent quarter as follows: - October - twenty-two (22) residents with sixteen (16) infection surveillance worksheets; - November - twenty-four (24) residents with nine (9) infection surveillance worksheets; - December - eighteen (18) residents with seven (7) infection surveillance worksheets. The DON stated she did not track the infectious organisms anywhere and was not aware of any method they used to assess for clusters of organisms (e.g., to determine whether staff may be communicating infectious organisms between residents on the same unit, etc.). b) Resident #65 During record review on 01/06/09, the record revealed Resident #65 had a urinalysis laboratory report showing a UTI, reported on 11/06/08. This urinalysis / urine culture report identified E. coli as the infecting organism. The record contained another urinalysis laboratory report showing a UTI, reported on 10/25/08. This urinalysis / urine culture report identified Citrobacter freundii as the infecting organism. On 01/07/09, review of the infection control report / log for November 2008 did not show this resident's name, the presence of a UTI, or the cultures infectious. Review of the October 2008 infection control report / log, on 01/07/09, revealed this resident's name and \"UTI\"; however, the infecting organism was not noted. On 01/07/09 at 6:30 p.m., the DON (who was also the infection control nurse) was made aware of these findings. No additional documentation was provided. c) Resident #75 Record review, on 01/07/09, revealed Resident #75 was seen at the emergency department at a local hospital on [DATE] - 12/19/08. The \"Hospital to Extended Care Facility Transfer Information\" form (dated 12/19/08) recorded a [DIAGNOSES REDACTED]. The facility subsequently obtained the laboratory report and provided copy to the surveyor on 01/08/09. This urine culture laboratory report identified Proteus mirabilis as the infecting organism. On 01/08/09, review of the infection control report / log for December 2008 revealed this resident's name with \"URI\" (upper respiratory infection) listed. The log did not show the resident's UTI or the infecting organism. d) Resident #35 Record review for Resident #35 revealed a urinalysis (UA) done on 12/19/08. The laboratory results indicated this resident had a UTI with E. coli present. This resident's UTI was treated, but there was no evidence the facility had monitored the infection and investigated the reason for this infection. This type of infection is often caused by inadequate perineal care. There was no evidence that the facility placed this resident on the facility's infection tracking form for tracking or trending. e) Resident #97 During an interview on 01/06/09, this resident stated, \"I have urinary tract infections a lot, and I am careful how I wash.\" The resident then explained that she does not like the facility staff to give her a bath or wash her, because \"they do not know how to do it right to keep you from getting an infection.\" She said, \"When I came in here, one of the nursing assistants gave me a shower and washed me back to front, and I will not let them wash me anymore.\" The resident stated she \"reported this to the desk\" and now they let her take a bath herself. --- Part II -- Based on random observations, the facility failed to ensure staff distributed ice water in a manner to prevent the potential development and transmission of disease and infection. This was evident for all the residents on the 300 Hall and 400 Hall who were allowed to have water pitchers at the bedside. Facility census: 113. a) First observation 01/05/09 at 3:00 p.m., and shortly thereafter on the 300 Hall, a nursing assistant was observed during ice pass holding water pitchers directly over the open ice chest while dipping ice into the residents' used water pitchers, a practice which could potentially transmit microorganisms from the exterior surface of the dirty pitcher to the clean ice which was served to the residents on that hall. The nursing assistant was observed filling two (2) pitchers from room [ROOM NUMBER], one (1) pitcher from room [ROOM NUMBER], and two (2) pitchers from room [ROOM NUMBER] in this manner. At 3:15 p.m., the above observations were reported to the nurse (Employee #27), who immediately spoke with the nursing assistant about the matter. On the 400 Hall, three (3) nursing assistants were observed during ice pass dipping ice into residents' used water pitchers directly over the open ice chest below. At 3:20 p.m., 3:21 p.m., and 3:22 p.m., three (3) nursing assistants were each observed filling two (2) pitchers at a time in this manner, and one (1) single pitcher filled at 3:25 p.m. At 3:26 p.m., this practice was relayed to the corporate nurse (Employee #100), as she also observed one (1) of the three (3) nursing assistants dipping ice into two (2) pitchers directly over the ice chest, and she immediately addressed the situation with that nursing assistant. The corporate nurse then relayed information regarding this practice of dispensing ice to the administrator (Employee #1). b) Second ice pass observation During an observation of medication administration on 01/06/09 at 9:10 a.m., a nursing assistant (Employee #58) was observed passing ice to the residents on the 400 hall. Employee #58 was observed to enter room [ROOM NUMBER] and remove two (2) ice pitchers. The nursing assistant held the ice pitchers over the ice chest and filled them with ice. Following the previous day's observations and management interventions, staff continued to pass ice in a manner which could lead to the spread of microorganisms. .", "filedate": "2014-02-01"}
{"rowid": 11484, "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": 328, "scope_severity": "E", "complaint": null, "standard": null, "eventid": "UFEY11", "inspection_text": "Based on random observation, staff interview, and policy review, the facility failed to ensure that residents received proper care for the special service of respiratory care as per facility policy. This was evident for four (4) of six (6) residents on the 300 Hall (Residents #2, #21, #26, and #108) and three (3) residents on the 400 Hall (Residents #48, #62, and #105), whose oxygen delivery supplies were not being changed weekly in accordance with facility policy. Facility census: 113. Findings include: a) Residents #2, #21, #26, and #108 During initial tour of the 300 Hall on 01/05/09 at approximately 2:30 p.m., observation found four (4) of the six (6) residents on that hall had oxygen (02) concentrators with oxygen delivery tubing dated 12/20/08. This was true for Residents #2, #21, #26, and #108. Resident #108 also had a nebulizer tubing and mask dated 12/20/08. (A fifth resident was receiving oxygen but refused the surveyor admittance into her room.) These findings were reported to the nurse (Employee #27) at approximately 2:55 p.m. 01/05/09, who reported that oxygen tubing was to be changed weekly. After checking the above referenced residents, she said she would see they were taken care of and would notify the nurse covering the 300 Hall. b) Residents #48, #62, and #105 On the morning of 01/07/09, observation found two (2) residents on the 400 Hall (Residents #48 and #62) with had no dates on their oxygen tubings. Also on 400 Hall, Resident #105 had a nebulizer tubing dated 12/02/08. These findings were reported, and the tubings were shown to the nurse (Employee #35). When asked who typically changed the oxygen tubing, she replied they were changed weekly, and that Employee #16 usually changed them. c) On 01/06/09 at approximately 2:00 p.m., the facility's Oxygen Administration policy was reviewed. In the revised January 2006 Respiratory Practice Manual, under Section 6.2.1. Oxygen Administration, the policy stated: \"Label nasal cannula (also humidifier) with resident name, date, and liter flow.\" Review of Section 2.2.1. General Requirements found, under the procedure for the subject of Disposable Equipment Change Schedule subset 1.n.: \"02 (Oxygen) delivery devices - for example Venturi masks, nasal cannulas, oxygen supply tubings - every 5 days and PRN (as needed).\" When asked on 01/06/09 approximately 2:30 p.m., the director of nursing (DON - Employee #2) said the facility's policy was to change nasal cannulas and tubings weekly. On 01/07/09 at approximately 6:30 p.m., the above findings were reported to the DON. .", "filedate": "2014-02-01"}
{"rowid": 11485, "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": 164, "scope_severity": "E", "complaint": null, "standard": null, "eventid": "UFEY11", "inspection_text": "Based on observation, resident interview, confidential resident group interview, and staff interview, the facility failed to maintain resident privacy during showers. This was evident for three (3) of twenty (20) sampled residents and one (1) anonymous resident at the confidential resident group meeting. Resident identifiers: #51, #11, and #85. Facility census: 113. Findings include: a) Resident #51 During an interview on 01/06/09 at approximately 3:00 p.m., Resident #51 reported a lack of privacy in the shower room. She stated she was able to see the buttocks and breasts of other female residents, and that she, too, was exposed to another person in the adjoining shower. There was a big curtain separating the doorway from the shower stalls, but she stated you could see around the curtain where it was not fully block the view. b) Resident #11 On 01/07/09 at 9:25 a.m., Resident #11 was observed during a shower with her permission. She was in the left shower stall being bathed by a nursing assistant, while another resident was in the right shower stall being bathed by a different nursing assistant. A divider shower curtain between the two (2) stalls was present but not being used. Rather, the shower curtain was against the wall behind a Hoyer lift. c) Resident #85 On 01/07/09 at 9:25 a.m., Resident #85 was observed during a shower with permission. She was in the right shower stall being bathed by a nursing assistant, while another resident was in the left shower stall being bathed by a different nursing assistant. A divider shower curtain between the two (2) stalls was present but not being used. Rather, the shower curtain was against the wall behind a Hoyer lift. d) Confidential resident group meeting interview On 01/06/09 at 10:30 a.m., a resident who attended the confidential group meeting reported the shower was not private. She also reported she was not always fully dressed properly when brought out of the shower. When asked for clarification in a separate interview on 01/07/09 at 2:00 p.m. regarding how the shower experience lacked privacy, she said she can see the breasts of residents in the adjoining shower while she is being showered. When asked about the blocks that extended part of the way up the shower stalls on each side facing the other stall, she replied she could see the residents' breasts over the blocks, as they were not high enough to block the view. When asked about the shower curtain between the stalls, she replied she had not ever noticed if there was a shower curtain between the stalls. She clarified she also saw the \"bottoms\" of other residents when they were brought out of the shower stall naked. When asked if there was a curtain between the showers and the main door, she replied in the affirmative but stated, for example, when she was brought in for a shower and was waiting her turn to get in, she could see the bodies of other residents around the curtains, as the curtains were not pulled fully closed and/or gapped open. e) The above findings were reported to the director of nursing (DON - Employee #2) at approximately 6:30 p.m. on 01/07/09. She stated she was not aware of these findings in the facility. .", "filedate": "2014-02-01"}
{"rowid": 11486, "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": 221, "scope_severity": "E", "complaint": null, "standard": null, "eventid": "UFEY11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observation, a review of the incident / accident reports, and staff interview, the facility failed to assure that devices, applied and/or attached to a resident to restrict voluntary movement and/or normal access to one's body, were ordered by a physician to treat a medical symptom after the completion of a comprehensive assessment, to include the development and implementation of plans to systematically and gradually reduce the use of these physical restraints. Staff applied socks to Resident #10's hands, which restricted movement, without a physicians' order. Documentation in the medical records of Residents #36, #5, #28, and #85 inconsistently addressed the purpose of lap buddies applied to prevent rising and subsequent falls; throughout their charts, staff referred to these devices as \"enablers\" instead of physical restraints. Resident #36 consistently resisted the use of her lap buddy, injuring herself when her device was being applied; a plan to address this, as well as a plan for the systematic / gradual reduction of the use of this device, was not initiated. Devices were not adequately addressed for five (5) of twenty (20) sampled residents. Resident identifiers: #10, #36, #35, #28, and #85. Facility census: 113. Findings include: a) Resident #10 During an observation on 01/05/09 at 2:30 p.m., Resident #10 was laying in the bed with a sock applied to her right hand. This sock covered the resident's entire hand and was pulled up to the resident's elbow. Another observation, on 01/06/09 at 10:00 a.m., found socks present on both of the resident's hands, pulled up to her elbows. Review of the resident's medical record, including the monthly recapitulation of physician's orders (dated 01/01/09 through 01/31/09) revealed no active physician's order for any type of physical restraint, including the application of socks on this resident's hands. Review of Resident #10's current care plan, dated 11/25/08, found a plan directing staff to apply \"socks to hands at all times\". The medical symptom for the use of this physical restraint was \"prevent scratching face, removal of O2 (oxygen)\". This care plan then said, \"D/C (discontinue) 12/19/2008.\" During an interview with the minimum data set assessment (MDS) nurse (Employee #23) on 01/07/08 at 10:45 a.m., the MDS nurse verified that the intervention to put socks on Resident #10's hands was discontinued on 12/19/08, and restraints should not have been in use on the days this surveyor observed the socks on this resident's hands on 01/05/09 and 01/06/09. b) Resident #36 Review of Resident #36's medical record found a physician's order, dated 12/05/08, stating, \"Resident may have standard size lap buddy to be used to protect resident from injury to herself or others as a therapeutic enabler to maintain the resident's highest physical & mental well being. Will re-evaluate prn (as needed), not to exceed 90 days. Will monitor use of this enabler @ least q (every) 30 minutes & release, assess & provide needs q2hr / prn (every two hours as needed). Resident may be enabler free during meal time while supervised. Use of this enabler is secondary to unsteady gait secondary to dementia.\" Further review of the medical record revealed that, on 12/05/08, a \"Physical Restraint / Enabler Assessment\" was completed. Documentation on this assessment stated the conditions and circumstances necessitating the use of the restraint were \"danger of harming self or others\", as well as \"to improve self functioning\" through promoting \"proper positioning\". Instructions on the section titled \"Restraining Device\" stated \"complete if device is a restraint to be used to enhance functioning\"; this section was left blank, even though the section above stated the device was being used \"to improve self function\". The next section on the assessment was titled \"Enabler Device\", which was to be completed if the device were an enabler to enhance functionality. The assessor recorded \"poor safety awareness with frequent falls\" as the medical symptom to be treated by the use of the device. The assessor also recorded that the device was to be used when the resident was in the wheelchair. Another form in the medical record titled \"Physical Restraint / Enabler Information\" was reviewed. There was a separate form for various devices used for this resident. These forms described if the device was a physical restraint or an enabler and the potential benefits and risks. (A separate form was completed for the perimeter mattress, the mobility alarm to the bed, the mobility alarm to the wheelchair, the low bed, and the lap buddy.) The form completed for the lap buddy identified was the device as an enabler of which this resident was cognitively aware. Among the benefits for using this device, the assessor recorded reduce risk of falls and maintenance of proper body positioning. The form contained a section titled \"Potential risks of a physical restraint / enabler use may include:\"; this section was left blank. Further review of the nursing notes and incident / accident reports revealed this resident did not want the lap buddy attached to her chair, and it caused increased agitation. An incident / accident report, dated 12/05/08 at 7:00 a.m., stated, \"Resident continually tries to get out of chair to bed or from bed to chair. Resident placed in chair, belt alarm on and checked, resident taken to area beside nurses station. Lap Buddy put on and seat belt alarm removed.\" An incident / accident report, dated 12/06/08 at 7:00 a.m., stated, \"Res (resident) was pushing at lap buddy while CNA (certified nursing assistant) was trying to put it on her wheelchair and residents wrist band slid and cut her arm.\" Further documentation on this report recorded the resident \"stated that she was mad over lap buddy and was trying to keep the CNA from putting it on the WC (wheelchair)\". Another incident / accident report, dated 12/11/08 at 11:30 a.m., stated, \"Res (resident) did not want lap buddy put back on after going to the restroom. She pushed on lap buddy, fighting against the CNA and she got a skin tear on R (right) forearm.\" Documentation on this incident / accident report indicated the resident was not compliant with the use of the prescribed assistive device and she tried to remove the lap buddy. An incident / accident report, dated 12/21/08 at 10:00 a.m., stated Resident #36 \"reopened a ST (skin tear) to the L (left) arm. Resident was fighting against CNA who was putting lap buddy on WC. She was flailing her arms around and hit arm on wheelchair.\" A nursing note, dated 12/21/08 at 4:30 p.m., recorded, \"Resident continues to kick and hit during the application of lap buddy. Will monitor use of new lap buddy.\" A nursing note, dated 12/25/08 at 1:00 p.m., recorded, \"Resident loud and verbal this a.m. (morning) Has made several attempts at removing lap buddy from chair, becomes physically aggressive with staff during care. Continue to monitor.\" A nursing note, dated 01/03/08 at 6:30 p.m., recorded, \"Res observed throwing water pitcher full of water onto floor of room. She had also pushed over the bedside table. Resident stated that she wanted her lap buddy removed. Will continue to monitor for adverse behavior.\" An interdisciplinary progress note, dated 12/15/08, recorded a new medication was being used and stated, \"She is also not always compliant with wearing double geri-gloves. She will take the off and not let the staff place them.\" There was nothing mentioned about the noncompliance with the lap buddy or the fact that this resident was resistant to its use and was injuring herself with this device, which was ordered for safety to prevent injury. The resident's physical restraint / enabler care plan, dated 12/05/08, did not contain a problem, goal, or interventions with respect to the use of the lap buddy to promote increased functioning; the care plan simply said, in the first section, \"Refer to the physical restraint / enabler assessment\"; the associated goal was: \"Will be free of negative effects with the use of an enabler.\" The interventions listed did not assist in achievement of the stated goal. The interventions were: apply the enabler (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 was reviewed and did not refer to the lap buddy in any way or resisting its use); refer to the falls assessment prevention and management plan of care (which did 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; and educate resident / family about physical restraints / enabler using the physical restraint / enabler information form (which was not complete). The care plan did not identify how the lap buddy was being used to increase the resident's level of functioning, nor did it address the fact that the resident became agitated / resisted using this device and sustained injuries when the device was applied. During a dinner observation at 6:00 p.m. on 01/06/09 and a lunch observation at 12:30 p.m. on 01/07/09, this resident was observed sitting in her room eating independently with the lap buddy still attached to her wheelchair. During an interview with the director of nursing (DON - Employee #2) on 01/07/09 at 6:30 p.m., she stated this device was not a physical restraint; it was an enabler. When questioned about the difference between a physical restraint and an enabler, she indicated that, if a resident could not get up own his/her own, it was not a restraint. She was made aware of the inconsistent documentation and the inadequate assessment of this device for Resident #36. c) Resident #35 Record review revealed the following physician's order dated 12/19/08: \"Lap buddy may be used to protect resident to maintain residents highest physical / mental well being. Will reevaluate prn (as needed) not to exceed 90 days. Will monitor use of this restraint at least 30 minutes and release q 2 hours prn to assess and provide needs as needed. May be restraint free during meal time while supervised. Use secondary to dementia.\" Further record review revealed a form titled \"Physical Restraint / Enabler Information\", dated 12/19/08, on which was written \"Lap Buddy\". Documentation on the form indicated the lap buddy was an enabler and the resident could remove it at will. The record contained another form titled \"Physical Restraint / Enabler Assessment. Documentation on this assessment form stated that the conditions for restraint consideration for this resident included \"danger of harming self or others\". Documentation at the bottom of the form indicated the device was an enabler to enhance functionality. According to this information, the enabler device was being used to treat the following medical symptom: \"Unable to ambulate independently secondary to [MEDICAL CONDITION]\". Review of the resident's current care plan, dated 12/05/08, found the statement: \"Refer to the physical restraint / enabler assessment.\" The goal associated with this statement was: \"Will be free of negative effects with the use of an enabler.\" The interventions were not pertinent to assist with the achievement of this goal. The interventions simply stated: \"Apply enabler, lap buddy, to wheelchair. Medical symptom: poor safety awareness secondary to dementia and [MEDICAL CONDITION]. Review the physical restraint / enabler sheet every 90 days.\" The care plan did not identify how the lap buddy was being used to increase the resident's level of functioning. The DON, when interviewed about the use of this lap buddy, verified that the use / purpose of this device was inconsistently documented, and she acknowledged it was ordered by the physician as a physical restraint but was treated by the facility as an enabler. d) Resident #28 Medical record review, conducted on 01/06/09 at 1:32 p.m., revealed Resident #28 had physician's orders for a pommel cushion and a lap buddy. Further review revealed both devices were identified as \"enablers\" to protect her from injury due to decreased safety awareness. Review of the facility document titled \"Physical Restraint / Enabler Information\" found the following difference between a physical restraint and an enabler: - \"A physical restraint is any manual or physical or mechanical device, material or equipment attached or adjacent to the resident body that cannot be easily removed by the resident and restricts freedom of movement or normal access to one's own body.\" - \"An enabler is a device, material or a piece of equipment attached or adjacent to the residents' body that the resident can easily remove and is cognitively aware of.\" The Centers for Medicare & Medicaid Services (CMS) state, \"Physical Restraints are defined as any manual method or physical or mechanical device, material, or equipment attached or adjacent to the resident's body that the individual cannot remove easily which restricts freedom of movement or normal access to one's body.\" On 01/06/09 at 5:30 p.m., the licensed practical nurse (LPN - Employee #36) identified that Resident #28 was not able to remove her lap buddy. Review of the resident's quarterly minimum data set assessment (MDS), dated [DATE], identified the resident's cognitive skills for daily decision making were moderately impaired. The use of the lap buddy with pommel cushion with Resident #28, therefore, did not meet the facility's own definition of an \"enabler\". Review of the facility policy titled \"5.2.1 Physical Restraint / Enabler Program\" revision date April 2006 identifies on page, in section 3-C: \"Select appropriate physical restraint alternative / enabler based on assessment. - Complete Restraining Device Section, if the device is a restraint used to enhance functionality. - Complete Enabler Device Section, if the device is an enabler used to enhance functionality.\" Review of the document titled \"Physical Restraint / Enabler Assessment\" for the lap buddy (initially completed on 11/28/07 updated on 02/03/08, 05/14/08, and 11/19/08) found the assessor never identified the lap buddy as a physical restraint. Review of the resident's current care plan, dated 11/26/08, found staff identified the lap buddy as an enabler, although the device met the facility's definition of a physical restraint (not an enabler). The care plan did not contain a systematic and gradual plan towards reducing the use of the restraint (e.g., gradually increasing the time for ambulation and muscle strengthening activities), nor did the care plan identify what care and services would be provided during the periods of time when the restraint would be released or what meaningful activities would be provided. e) Resident #85 Record review revealed Resident #85 used a lap buddy daily, but there was no systematic plan for restraint reduction, release, and meaningful activities to be provided. There was also a discrepancy within the facility's documentation as to whether her lap buddy was a physical restraint or enabler. Documentation on the physical restraint information sheet, dated 4/15/08, noted the application of a lap buddy to her wheelchair and defined a physical restraint as a device that \"cannot be easily removed by the resident and restricts freedom of movement or normal access to one's own body\". The assessor consistently documented in Section P4 of the resident's MDS assessments, dated 06/26/08, 09/25/08, and 12/2508, that a \"trunk restraint\" was in use. During an interview on 01/08/09 at 11:15 a.m., Employee #18 said the MDS assessments were coded incorrectly, and the lap buddy should have been coded as a chair preventing rising, and agreed they should have one (1) care plan per device. Review of Resident #85's current care plan found the use of a physical restraint was initially developed on 04/15/08. The care plan did not specify interventions of a systematic plan for restraint reduction nor for planned releases of the lap buddy. The care plan also did not specify meaningful activities, rather it stated to \"See Activity Pursuit POC\" (plan of care). Review of the activity pursuit plan of care found interventions of large music groups, socials, parties, and visits with family, but there were no plans to offer diversional activities as a part of a restraint reduction plan to keep the resident engaged, so that a physical restraint may not be necessary. Interview with the activities director (Employee #11), on 01/08/09 at 2:00 p.m., revealed her belief that Resident #85 had declined a lot the past few months and no longer took part in many activities; she estimated the resident's attention span to be ten (10) minutes at the most. She said she did provide for Resident #85 one-on-one activities two (2) or three (3) times per week. She cited the resident's illness in September as the beginning of her decline and produced an activity record for August that evidenced much more participation in activities. Random observation on 01/07/09, between 11:15 a.m. and 11:30 a.m., found her up in the wheelchair with the lap buddy in place. During this time, she entered four (4) residents' rooms. Housekeeping staff brought her out once, a nursing assistant brought her out once, and she left on her own accord twice. Another random observation on 01/07/09, between 11:33 a.m. and 11:41 a.m., revealed she was up in the wheelchair with the lap buddy in place. Her daughter came in for a visit to feed her and to walk around the building with her, and she continued to have the lap buddy in place throughout the family visit until the daughter left at 1:30 p.m. She was returned to bed at 1:45 p.m. after being in the wheelchair with the lap buddy for at least two and one-half (2-1/2) hours. On 01/07/09 at 6:15 p.m., the DON stated a \"restraint is anything that restricts you from standing up\", citing if a resident could not stand up voluntarily anyway, then the device was an enabler (not a physical restraint). She stated that, if a resident were leaning or scooting out of a chair, then the lap buddy would also be an enabler; she replied in the affirmative when asked if a tied restraint would also be an enabler in that same situation. She said she believed an enabler was coded as a trunk restraint on the MDS. .", "filedate": "2014-02-01"}
{"rowid": 11487, "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": 285, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "UFEY11", "inspection_text": "Based on record review and staff interview, the facility failed to assure that a Level II evaluation was completed, when indicated, prior to the admission of one (1) of twenty (20) sampled residents. Resident identifier: #108. Facility census: 113. Findings include: a) Resident #108 Record review, on 01/07/09, revealed Resident #108 was admitted to the facility in 2008. The Pre-Admission Screening and Resident Review (PASRR) Determination, dated eleven (11) days prior to the current admission, stated that a Level II evaluation was required for this individual. However, the Level II evaluation itself was not completed prior to this admission to this facility. These findings were reported to Employee #8 on the morning of 01/08/09. She, in turn, referred the matter to the admissions / social worker to see if more information was on record in the social worker's office. On 01/08/09 at approximately 11:55 a.m., Employee #8 produced a Level II assessment signed by a supervised psychologist that was dated six (6) days after Resident #108's current admission. Employee #8 stated they thought the PASRR had been completed by the transferring facility. The finding of the delinquent pre-admission Level II evaluation was reported to the director of nursing at approximately 6:30 p.m. on 01/07/09. .", "filedate": "2014-02-01"}
{"rowid": 11488, "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": 329, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "UFEY11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview, the facility did not ensure the medication regimen of one (1) of twenty (20) sampled residents was free from unnecessary drugs without adequate indications for use. Resident #62 was under the care of a psychiatrist for her mood / behavior, having been evaluated on 05/09/08; in addition to medication changes, the psychiatrist recommended a follow-up appointment within nine (9) weeks or as necessary. Additional psychoactive medications ([MEDICATION NAME] and [MEDICATION NAME] ER) were added to the resident's medication regimen without first assessing for [MEDICATION NAME] / extrinsic factors that may have caused or contributed to changes in the resident's behavior and/or without contacting the psychiatrist. Resident identifiers: #62. Facility census: 113. Findings include: a) Resident #62 1. Medical record review, on 01/06/09 at 4:15 p.m., revealed Resident #62 received several psychoactive medications for mood / behavior, including [MEDICATION NAME], and [MEDICATION NAME]. Further review revealed a psychiatric evaluation was completed on 05/09/08, after which the psychiatrist recommended increasing her [MEDICATION NAME] and instructed the facility to watch her for serotoni[DIAGNOSES REDACTED], since she was already receiving [MEDICATION NAME] and [MEDICATION NAME]. The psychiatrist also recommended a follow-up appointment in nine (9) weeks, or sooner if needed. Subsequent to the psychiatric consult, the resident's attending physician increased the [MEDICATION NAME] to 0.5 BID on 05/10/08 and decreased her [MEDICATION NAME] to 5 mg BID on 05/15/08. 2. At the beginning of June, Resident #62 began to exhibit increased anxiety, and in July, she had a panic attack. The facility did not contact the psychiatrist regarding these events. 3. On 09/30/08, she exhibited increased behaviors and was given [MEDICATION NAME] 1 mg intramuscularly (IM). Nursing progress notes did not contain any documentation to reflect an assessment for [MEDICATION NAME] or extrinsic factors that may have caused or contributed to the increase in behaviors. On 10/01/08, she again exhibited increased behaviors, and she was given [MEDICATION NAME] 1 mg IM. The facility did not contact the psychiatrist regarding these events. A urinalysis later revealed Resident #62 had a urinary tract infection [MEDICAL CONDITION]. The facility failed to rule out [MEDICATION NAME] or extrinsic causes of the increased behaviors prior medicating her with [MEDICATION NAME] IM. 4. On 11/12/08, the attending physician added [MEDICATION NAME] ER to the resident's medication regimen. There was no evidence to reflect the facility contacted the psychiatrist regarding changes in the resident's behaviors / condition for which the attending physician added the [MEDICATION NAME] ER. 5. On 01/07/09 at 4:15 p.m., the director of nursing (DON - Employee #2) was questioned if psychiatric services was consulted upon increase in behaviors. On 01/08/09, the DON was unable to provide any information to show that the facility had contacted the resident's psychiatrist after any of the episodes which resulted in changes in her psychoactive medications. .", "filedate": "2014-02-01"}
{"rowid": 11489, "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": 520, "scope_severity": "E", "complaint": null, "standard": null, "eventid": "UFEY11", "inspection_text": "Based on medical record review, review of the facility's infection control tracking log, and staff interview, the facility failed to maintain a quality assessment and assurance (QAA) committee that identifies quality deficiencies (of which it should have been aware) and develops / implements plans of action to correct these deficiencies. The facility had a high number of residents with urinary tract infections (UTIs). The QAA committee failed to identify deficits in the infection control program (with respect to tracking infectious organisms, identifying trends through analysis of the facility's infection control data, and investigating the UTIs to identify any underlying causal or contributing factors) and failed develop / implement measures to address these deficits. Facility census: 113. Findings include: a) Record review, during the facility's annual certification resurvey conducted from 01/05/09 through 01/08/09, revealed multiple residents with UTIs, several of whom had the same infectious organism and resided in the same location (same room and/or hall within the facility). On the afternoon of 01/06/09, the director of nursing (DON - Employee #2) was identified as the individual designated as responsible for infection control tracking. At this time, a copy of the November and December 2008 infection control tracking logs was requested and received. A review of the infection control tracking logs revealed the DON / infection control nurse failed to log the organisms identified through cultures as being responsible for each infection. In an interview with the DON and administrator (Employee #1) on 01/07/09 at 4:30 p.m., the DON acknowledged that she did not record infectious organisms on the tracking logs. During interview with the director of nursing (DON) on 01/07/09 at approximately 6:30 p.m., she produced the facility's most recent quarter (October through December 2008) of monthly incidence rates of infections. This form was to contain the names and room numbers of each resident with infection as well as the types of infection (i.e., respiratory, urinary, skin), the onset date, antibiotic prescribed, and the type of precautions utilized. All of the precautions for all of the infections (regardless if UTI, respiratory, or skin) were listed as \"standard\" precautions for those three (3) months. The accompanying infection surveillance worksheets listed the onset of symptoms, whether it was urinary or respiratory, the name of the antibiotic prescribed, and the start / stop dates of the antibiotic. Neither the organisms isolated, nor the antibiotics the organisms were resistant to, nor the date and site of the culture were listed on any of the infection surveillance worksheets, although there were designated places on the form for recording each these items. A breakdown of numbers of residents with infections were recorded during the most recent quarter as follows: - October - twenty-two (22) residents with sixteen (16) infection surveillance worksheets; - November - twenty-four (24) residents with nine (9) infection surveillance worksheets; - December - eighteen (18) residents with seven (7) infection surveillance worksheets. The DON stated she did not track the infectious organisms anywhere and was not aware of any method they used to assess for clusters of organisms (e.g., to determine whether staff may be communicating infectious organisms between residents on the same unit, etc.). There was no evidence that the facility's QAA committee had been monitoring the effectiveness of the facility's infection control program. (See also citation at F441.) Quality deficiencies would have been evident had the QAA committee members reviewed the facility's infection incidence rate reports and/or infection surveillance worksheets, which were incomplete. .", "filedate": "2014-02-01"}
{"rowid": 11490, "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": 225, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "UFEY11", "inspection_text": "Based on a review of the facility's complaint files, observation, and staff interview, the facility failed to immediately report and/or thoroughly investigate injuries of unknown origin and allegations of abuse to the appropriate State agencies. For Resident #96, an allegation of abuse was reported to the facility and investigated, but the facility did not report the allegation to State agencies. Resident #75 had bruising of unknown origin to her leg and lower back area, and this was not reported or investigated. This was true for one (1) of six (6) randomly reviewed complaints (#96), and one (1) of twenty (20) sampled residents (#75). Facility census: 113. Findings include: a) Resident #96 Review of the facility's complaint files found a concern report, dated 12/02/08, documenting that this resident's daughter called and said her mother said her legs were hurting and, when the resident was given a shower, \"the aids (sic) hurt her legs and were rough with her\". The facility conducted an internal investigation and took statements from the aides, but the allegation of abuse / mistreatment was not immediately reported to State agencies as required, nor were the results of the facility's investigation forwarded to the State within five (5) working days of the incident. During an interview with the director of nursing (DON - Employee #2) on 01/07/09 at 6:30 p.m., she verified this incident was investigated but was not reported as abuse, stating it was already resolved by the time the concern was filed by the family. b) Resident #75 A record entry on a Physician Notification form, dated 01/07/09, noted bruises of unknown origin to the right inner thigh (measuring 18 cm x 0.25 cm) and the left inner thigh (measuring 1 cm x 8 cm) and a buttock abrasion (measuring 2.3 cm x 2 cm). The entry noted the physician was notified of these injuries at 8:40 a.m. on 01/07/09. During a review of the facility's incident / accident reports for that day, there was no evidence that an accident / incident report had been completed. There was also no evidence that this bruising of unknown origin was investigated or reported to the appropriate state agency. During an interview at 12 noon on 01/08/09, the DON stated she did not report the injuries. During an interview at 12:10 p.m. on 01/08/09, the administrator stated she would check into these injuries. She subsequently confirmed there was no accident / incident report and the injuries were not been reported to the State agencies. There was no formal investigation initiated to find the cause of the injuries. A \"late entry\" accident / incident report was shown to the surveyor at 1:30 p.m. on 01/08/09. .", "filedate": "2014-02-01"}
{"rowid": 11491, "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": 313, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "UFEY11", "inspection_text": "Based on observation, record review, and resident interview, the facility failed to assist residents with the use of assistive devices needed to maintain hearing or vision. Residents were observed without their assistive devices in place, which could affect their abilities to interact with their environment. This occurred for two (2) of twenty (20) sampled residents. Resident identifiers: #65 and #36. Facility census: 113. Findings include: a) Resident #65 On 01/07/09 at 10:00 a.m., Resident #65, when observed in physical therapy (PT), was not wearing eyeglasses. During resident interview, Resident #65 stated she needed her glasses both to read and to \"see all the time\". Staff members were present at the time this surveyor was questioning the resident, and one (1) staff member went to get the resident's glasses and returned to PT. She then placed the eyeglasses on the resident's face. b) Resident #36 During initial tour of the facility on 01/05/09 at 2:30 p.m., this surveyor spoke to Resident #36. The resident did not answer questions and looked at the surveyor with a puzzled look. The surveyor introduced herself and asked what her name was. She did not answer or give any sign that she understood what was being asked of her. During another visit on the morning of 01/06/09, Resident #36 was observed sitting up in her wheelchair; she had just finished eating her breakfast. This surveyor spoke to the resident, and again she looked puzzled as if she did not understand what was being said. The surveyor the leaned down and spoke louder and directly into the resident's left ear, asking how her breakfast was. The resident immediately started discussing her breakfast and responded appropriately to each question subsequently asked of her when it was spoken directly into her ear. The resident stated, \"I don't hear well.\" After this, all communication was understood by this resident. In a nursing note entry, dated 01/07/09 at 10:00 p.m., the nurse recorded, \"Resident noted to refuse to interact with staff members for brief period, ignored this nurse when asked to take medications. VS (vital signs) were WNL (within normal limits).\" The nurse then indicated that, when the nursing assistant addressed the resident, the resident responded cooperatively. During medical record review, the resident's hearing was reviewed. The admission assessment, dated 04/08/08, indicated the resident had hearing aids. The minimum data set (MDS) assessment indicated the resident did not have problems understanding others when a a hearing device was used. The care plan identified the resident was hard of hearing and contained an intervention - \"hearing aid clean\" . The care plan did not direct the caregiver to be sure the resident wore the hearing aids when she was up and/or to be sure that the hearing aids were working properly. A nursing assistant (Employee #63) was observed providing care for this resident at 12:30 p.m. on 01/08/09. She was asked if she had provided care to this resident in the past, and she said she had been here a while and had worked with this resident many times. When asked if she was aware the resident had hearing aids, she stated she was not aware of this and she had not seen them. At that time, Resident #36's roommate, from behind the privacy curtain, said, \"She has them in her drawer at her bedside.\" The nursing assistant looked in the drawer and found two (2) hearing aids in a small case. The nursing assistant tried them and said that they must need batteries, because they were not working. The facility did not assure this resident's assistive hearing devices were clean, working properly, and placed in her ears so that she could communicate with and understand others. .", "filedate": "2014-02-01"}
{"rowid": 11399, "facility_name": "GOLDEN LIVINGCENTER - MORGANTOWN", "facility_id": 515049, "address": "1379 VAN VOORHIS RD", "city": "MORGANTOWN", "state": "WV", "zip": 26505, "inspection_date": "2009-01-22", "deficiency_tag": 278, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "FRRZ11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, resident observation, and staff interview, the facility failed to ensure resident assessment information was accurate for one (1) of fifteen (15) sampled residents. Resident #61's medical record indicated a history of [MEDICAL CONDITIONS] with right-sided [MEDICAL CONDITION]. An abbreviated quarterly minimum data set assessment (MDS), with an assessment reference date of 09/10/08, indicated the resident did not have any limitations in range of motion or voluntary movement to his right arm and hand. Resident identifier: #61. Facility census: 89. Findings include : a) Resident #61 Resident #61 was observed and interviewed at 2:45 p.m. on 01/21/09, at which time he was noted to have a contracture and paralysis of the right hand. Resident #61 reported he had a stroke several years ago and did not have function of his right arm and hand. Medical record review, on 01/22/09 at 10:45 a.m., revealed the resident had a history of [REDACTED]. On 01/21/09 at 10:45 a.m., the MDS coordinator (Employee #98) was interviewed. The MDS coordinator provided the resident's most recent quarterly MDS, a significant change in status MDS, and the current care plan. Review of Section G4 of the MDS dated [DATE], revealed the information contained in this section was incorrect; the assessment indicated the resident had no limitation in function and voluntary movement to his arm or hand. The resident did have functional limitations of his right arm and hand due to post-[MEDICAL CONDITION] paralysis. .", "filedate": "2014-03-01"}
{"rowid": 11400, "facility_name": "GOLDEN LIVINGCENTER - MORGANTOWN", "facility_id": 515049, "address": "1379 VAN VOORHIS RD", "city": "MORGANTOWN", "state": "WV", "zip": 26505, "inspection_date": "2009-01-22", "deficiency_tag": 241, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "FRRZ11", "inspection_text": "Based on observation and staff interview, the facility failed to ensure care was promoted in a manner and in an environment that maintained the dignity of two (2) of fifteen (15) sampled residents. Resident #78 was observed in bed prior to having received morning care, while the maintenance man was painting the wall in the resident's room and was not interacting with the resident. Resident #86 was observed in a public area of the facility, crying and begging for help, and the resident's dentures were laying on her chest. Resident identifiers: #78 and #86. Facility census: 89. Findings include: a) Resident #78 On 01/20/09 at 8:15 a.m., observation found maintenance staff was painting the wall in this resident's room; the maintenance man was not engaging the resident in any conversation. The resident was still in bed, no morning care had been provided, and breakfast had not been served at this time. This resident should have been moved to another area of the facility after providing morning care and breakfast, and prior to the room being painted. During an interview on 01/21/09 at 3:30 p.m., the director of nursing (DON - Employee #62) agreed maintenance should not have painted in the resident's room at that time. b) Resident #86 On 01/20/09 at 2:10 p.m., observation found this resident was sitting in a wheelchair in the front lobby at the nurse's station. The resident was crying and begging this surveyor to help her, and her dentures were laying on her chest. Further observation found staff at the nurse's station and walking past the resident, paying no attention to the condition the resident was in. During an interview on 01/21/09 at 3:30 p.m., the DON agreed the resident should have been removed from the public area and the resident's discomfort assessed. .", "filedate": "2014-03-01"}
{"rowid": 11401, "facility_name": "GOLDEN LIVINGCENTER - MORGANTOWN", "facility_id": 515049, "address": "1379 VAN VOORHIS RD", "city": "MORGANTOWN", "state": "WV", "zip": 26505, "inspection_date": "2009-01-22", "deficiency_tag": 279, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "FRRZ11", "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 comprehensive care plans to include hospice services and review and revise a care plan for three (3) of fifteen (15) sampled residents. Residents #78 and #28 were receiving hospice services and the comprehensive care plan failed to include the services to be provided by hospice. A care plan had been developed for Resident #42 which did not accurately describe the resident's pain and had not been revised when reviewed. Resident identifiers: #78, #28, and #42. Facility census: 89. Findings include: a) Resident #78 Medical record review, on 01/20/09, revealed this resident had a [DIAGNOSES REDACTED]. Review of the comprehensive care plan, revised in November 2008, revealed the care plan did not include the services to be provided by hospice. The resident's comprehensive care plan failed to have an integrated care plan with hospice which included the services provided by hospice with interventions describing who would do them and when they would be done. During an interview on 01/22/09 at 2:00 p.m., the minimum data set assessment (MDS) coordinator confirmed the comprehensive care plan and the hospice care plan was not integrated ensuring continuity of care by both facility and hospice staff. b) Resident #42 Medical record review, on 01/20/09, and a review of the comprehensive care plan it was revealed during the review of the activity care plan this resident indicated she could not leave her room due to pain. During further review of the activity care plan dated September, 2008, under the heading of Problems / Strengths was a quote \"I want something to do, but I can't leave my room due to pain and need to be comfortable. I lie in bed most of the day.\" During a review of the estimated date of the goals it was discovered this activity plan had been reviewed on 01/19/09 with no changes made. During interviews on 01/21/09 at 4:00 p.m., the director of nursing (DON) and the MDS coordinator revealed this resident did not communicate well and would not be able to verbalize in this manner, and this statement and care plan did not accurately describe the resident's pain was not accurate. c) Resident #28 A review of the resident's medical record revealed [REDACTED]. A review of the resident's care plan revealed the hospice care plan was not integrated with the facility's care plan for the resident. .", "filedate": "2014-03-01"}
{"rowid": 11402, "facility_name": "GOLDEN LIVINGCENTER - MORGANTOWN", "facility_id": 515049, "address": "1379 VAN VOORHIS RD", "city": "MORGANTOWN", "state": "WV", "zip": 26505, "inspection_date": "2009-01-22", "deficiency_tag": 309, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "FRRZ11", "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 ensure care and services were provided in a manner to maintain the highest practicable physical well-being for one (1) of fifteen (15) sampled residents. Resident #78 had a medical history of [REDACTED]. Resident identifier: #78. Facility census: 89. Findings include: a) Resident #78 On 01/20/09 at 8:15 a.m., observation found maintenance staff was painting the wall in this resident's room. The resident was still in bed, no morning care had been provided, and breakfast had not been served at this time. The room smelled strongly of paint. Medical record review revealed Resident #78's [DIAGNOSES REDACTED]. This practice put the resident at risk for respiratory distress and can contribute to a poor appetite. This resident should have been moved to another area of the facility prior to the room being painted. During an interview on 01/21/09 at 3:30 p.m., the director of nursing (DON - Employee #62) agreed the room should not have been painted while the resident was in the room. .", "filedate": "2014-03-01"}
{"rowid": 11403, "facility_name": "GOLDEN LIVINGCENTER - MORGANTOWN", "facility_id": 515049, "address": "1379 VAN VOORHIS RD", "city": "MORGANTOWN", "state": "WV", "zip": 26505, "inspection_date": "2009-01-22", "deficiency_tag": 441, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "FRRZ11", "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 ensure a sanitary environment to prevent the spread of infections in the facility during treatments provided to residents with known infections. Observation of the treatment nurse (Employee #2) during a treatment found her kneeling beside the resident's bed while applying a dressing to Resident #86's wound; she contaminated her uniform by kneeling on the floor, as she wore no protective clothing during this dressing change. This resident (#86) had a history of [REDACTED]. Resident identifier: #86. Facility census: 89. Findings include: a) Employee #2 During treatment administration on 01/21/09 at 1:10 p.m., observation found the treatment nurse changing a dressing to a pressure sore on Resident #86's coccyx. The treatment nurse knelt on the floor beside the resident's bed while applying the dressing. Although the nurse used universal precautions during the procedure, she did not don protective clothing. By kneeling on the floor, the contaminated her uniform. Medical record review revealed the resident had a history of [REDACTED]. Observation found, upon entering the resident's room, a sign advised visitors of the need for contact isolation and to see the nurse before entering the room. During an interview on 01/21/09 at 4:15 p.m., the director of nursing (DON) agreed the treatment nurse should not have been on the floor of this resident's room while changing the dressing. .", "filedate": "2014-03-01"}
{"rowid": 11404, "facility_name": "GOLDEN LIVINGCENTER - MORGANTOWN", "facility_id": 515049, "address": "1379 VAN VOORHIS RD", "city": "MORGANTOWN", "state": "WV", "zip": 26505, "inspection_date": "2009-01-22", "deficiency_tag": 225, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "FRRZ11", "inspection_text": "Based on review of the facility's complaint / grievance log and staff interview, the facility did not ensure two (2) of twenty (20) sampled complaints / grievances containing allegations of neglect were immediately reported to the appropriate State agencies. Resident identifiers: #22 and #96. Facility census: 95. Findings include: a) Resident #22 On 01/01/09, Resident #22 alleged, \"he did not have a pad for his bed. CNA (named by resident) was asked to get one for his bed. The CNA told him no, that they took them out of the building. He reported that he had to sleep on a bath blanket which wrinkled and caused a sore to his buttocks.\" The facility's investigation revealed cloth pads were to be available for this resident, and the nurse had assessed the resident after he was placed on the bath blanket and found the resident's buttocks were more red and irritated. An interview with the social worker, on 01/20/09 at 10:00 a.m., revealed the facility had not reported this allegation of neglect to the appropriate State agencies. b) Resident #96 On 11/19/08, Resident #96 alleged, \"Resident had call light on for 50 minutes and roommate also call light on also and that fresh water on the 2:00 p.m. to 10:00 p.m. shift was not provided.\" The facility's investigation revealed the nursing assistant involved was identified and education would be provided for answering call lights and providing fresh water to residents. An interview with the social worker, on 01/20/09 at 10:00 a.m., revealed the facility had not reported this allegation of neglect to the appropriate State agencies. .", "filedate": "2014-03-01"}
{"rowid": 11015, "facility_name": "HEARTLAND OF KEYSER", "facility_id": 515122, "address": "135 SOUTHERN DRIVE", "city": "KEYSER", "state": "WV", "zip": 26726, "inspection_date": "2009-02-05", "deficiency_tag": 274, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "53ZE11", "inspection_text": "Based on medical record review, review of minimum data set (MDS) assessments, and staff interview, the facility failed to recognize a significant change and complete a comprehensive resident assessment for two (2) of twenty one (21) sampled residents. Resident identifiers: #84 and #92. Facility census: 121. Findings include: a) Resident #84 On 02/03/09 and 02/04/09, review of the resident's comprehensive admission MDS, with an assessment reference date (ARD) of 07/25/08, found the assessor indicated (in Section G1, subsections b, c, d, and e) that resident was independent in the following activities of daily living (ADLs): transfer, walking, and locomotion. In addition, assessor indicated the resident needed supervision and set-up help only for dressing (section G1g) and set-up help only for eating (section G1h). The resident was independent in toilet use (section G1i) and continent of bowel and bladder (sections H1a and b). Review of the resident's abbreviated quarterly MDS assessment, with an ARD of 10/26/08, revealed the assessor indicated the resident was now totally dependent for transfer and required the physical assistance of one (1) person to walk in his room. In addition, the assessor indicated the resident was totally dependent for dressing and feeding, requiring one (1) person to physically assist, and the resident was incontinent of bowel and bladder and totally dependent for toilet use. A comprehensive assessment was not conducted to address the significant decline in multiple ADLs that occurred to this resident over the preceding three (3) months. On 02/05/09 at 9:25 a.m., the MDS nurse (Employee #148) provided a quarterly MDS assessment, with an ARD of 01/18/09, which showed the significant changes had not resolved. The MDS nurse was interviewed at that time about the significant change. After reviewing the issue, she verified she \"could see where there could have been significant change (comprehensive) assessment.\" b) Resident #92 A review of the medical record revealed the facility had failed to determine there had been a significant change in the resident's physical condition. The comprehensive admission MDS, with an ARD of 07/29/08, indicated the resident exhibited a sad mood up to five (5) days a week; was totally dependent upon staff for transferring and eating; did not ambulate in the previous seven (7) days; was totally incontinent of bowel; and exhibited moderate pain less than daily. In the abbreviated quarterly MDS, with an ARD of 10/26/08, the resident exhibited NO moods; had improved to requiring extensive assistance for transfers and ambulation; was now independent after set-up for eating; had a significant weight loss of nine (9) pounds, and had NO bowel incontinence or pain. When these changes were discussed with the MDS nurse (Employee #171) at 4:15 p.m. on 02/04/09, she stated that all the assessments were correct, but the computer had not registered this as a significant change in status. .", "filedate": "2014-09-01"}
{"rowid": 11016, "facility_name": "HEARTLAND OF KEYSER", "facility_id": 515122, "address": "135 SOUTHERN DRIVE", "city": "KEYSER", "state": "WV", "zip": 26726, "inspection_date": "2009-02-05", "deficiency_tag": 514, "scope_severity": "B", "complaint": 0, "standard": 1, "eventid": "53ZE11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview, the facility failed to maintain complete and accurate clinical records for two (2) of twenty one (21) sampled residents. Resident identifiers: #53 and #92. Facility census: 121. Findings include: a) Resident #53 Record review, on 02/04/09, revealed a doctor's progress note indicating the resident lacked the capacity to make healthcare decisions. This progress note contained no date and time. A social worker (Employee #79) provided a copy of the doctor's progress note at 2:50 p.m. on 02/04/09. The social worker was interviewed at this time, reviewed the record, and verified the note contained no date and time. b) Resident #92 A review of the medical record revealed a social services progress note, dated 10/22/08, which contained the following: \"Resident is a full-code status per POST.\" Review of the Physician order [REDACTED]. These additional limitations would be contrary to a \"Full Code\". During an interview with the two (2) social workers (Employees #79 and #119) at 11:45 a.m. on 02/04/09, they reviewed the record and agreed that \"Full Code\" was an error in their notes. .", "filedate": "2014-09-01"}
{"rowid": 11017, "facility_name": "HEARTLAND OF KEYSER", "facility_id": 515122, "address": "135 SOUTHERN DRIVE", "city": "KEYSER", "state": "WV", "zip": 26726, "inspection_date": "2009-02-05", "deficiency_tag": 165, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "53ZE11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on resident interview, record review, and staff interview, the facility failed to address grievances in a timely manner. Resident #109 had resided in the facility for over seven (7) years, and the facility failed to adequately address his repeated requests to have a cool sleeping environment at night. This was evident for one (1) of twenty-one (21) sampled residents. Resident identifier: #109. Facility census: 121. Findings include: a) Resident #109 Record review revealed Resident #109 was an alert, oriented [AGE] year old male who resided in the facility for nearly eight (8) years. His physician had determined he had the capacity to understand and make his own informed healthcare decisions. Due to [DIAGNOSES REDACTED], he required total assistance from staff with the performance of activities of daily living. He was unable to leave his bed unless lifted out with a mechanical or other total lift, was unable to walk, and used a motorized wheelchair. During an interview on 02/04/09 at approximately 10:00 a.m., he stated his desire to keep his room warm by day and cool at night. Per the resident, he gets up in his scooter by day and feels cold. At night, he likes to cover up in bed with his warm blanket to keep his trunk and extremities warm, but he needs to have cooler air during sleep to facilitate breathing, feeling like he smothers if the air is too hot. He stated staff has known of these needs for years. He stated the heat last night was so unbearable he could not breathe, but staff refused to turn down the heat as he requested. He said he awoke drenched in sweat and had to get up at 2:30 a.m. to sit in his scooter for the remainder of the night, so he could breathe. He said he would like to have his room at 66 degrees Fahrenheit (F) while sleeping at night, although this was an estimated number as there was no thermometer in the room to measure the exact temperature. He was considering moving to another facility, but he stated his preference would be to stay where he was, since this was his home, if only the heat could be turned down at night. Interview with a social worker (Employee #119), on 02/04/09 at 2:15 p.m., revealed she was aware of his desire for coolness at night during sleep, and she admitted this had been an ongoing problem resulting in numerous roommate changes over the years. She said his current roommate, who had dementia, was placed there in the past week or so, and he was unable to speak for himself and say if he felt warm or cold. Interview with Resident #109's former roommate (Resident #9), on 02/04/09 at 2:45 p.m., revealed Resident #9 (aged 95) recently moved out of that room because it was too cold at night. He transferred to another room down the hall but, due to the television being too loud, he transferred again to the private room where he currently resides. At this time, Resident #9 was fully dressed and wore a heavy jacket over his street clothes and his room felt very warm, yet he stated he just felt comfortable at the moment. This resident had resided in the facility since 01/23/09. An attempt was made to interview Resident #109's current roommate on 02/04/09 a 3:15 p.m., but he was not interviewable due to his [DIAGNOSES REDACTED]. Interview with the assistant director of nursing (Employee #65), on 02/04/09 at approximately 3:00 p.m., revealed she, too, was aware of his desire for a cool room at night. She stated the water pipes in that room froze once about a year ago. She agreed the resident's stated desire for a 66 degree F temperature at night was not too cold for her, but there was no thermometer to objectively gauge the actual room temperature. She reported that, once, a nurse arrived to work at 7:00 a.m. and said she could see her breath in that room. Resident #109's unresolved desire for a cool sleeping environment was relayed to the administrator, the director of nursing, and other staff present on 02/04/09 at approximately 4:00 p.m., and they acknowledged this has been a recurring problem throughout the years trying to suit him with compatible roommates. On 02/05/09 at 8:45 a.m., the social worker (Employee #119) reported the facility obtained a thermometer for the resident's room and planned to keep the room between 72 degrees F and 81 degrees F, and she asked if the State regulation stipulated a room temperature between these two (2) parameters, as there was a roommate to consider who could not speak for himself. She stated that to her knowledge there had never been a thermometer in his room before. When asked if the facility was abiding by Resident #109's wishes for his comfort zone (citing his comfort as the right temperature for him), and about the facility's inability to find a suitable roommate in the seven (7) years Resident #109 had resided there, Employee #119 offered no further information at this time. On 02/05/09 at 9:45 a.m., observation found Resident #109 lying in his bed. When interviewed, he reported feeling \"completely beat\" due to two (2) nights in a row without good sleep due to the heat. He stated, \"I woke up and couldn't get my breath and was wringing wet.\" He stated the nurse told him, at 3:00 a.m., that it was 78 degrees F and informed him the room temperature had to be at least 72 degrees F and she would not lower the heat for him. Review of nursing notes, dated 02/05/09 at 3:00 a.m., found, \"Heat on set @ (at) 78 degrees per thermometer in room.\" A subsequent note, at 5:00 a.m., recorded the room temperature at 74 degrees, documented his complaint of sweating and not breathing well due to the heat, and documented verbal exchanges for the preceding twenty (20) minutes that acknowledged \"he is miserable\" but contained no documentation of comfort measures nor reassurances being offered. Clinical record review revealed a social services progress note, dated 01/29/09, documenting Resident #109 being upset about the food and reporting he could move to another facility, followed by staff advisement \"that we only wanted to keep both he and his roommate comfortable\". Another social services progress note, dated 02/03/09, documented a meeting with Resident #109, during which the author \"completed an assessment for possible transfer. . . . (Resident) has been unhappy with HOK (Heartland of Keyser) regarding room temperatures\". The note further indicated a plan to contact another facility when a bed becomes available. .", "filedate": "2014-09-01"}
{"rowid": 11018, "facility_name": "HEARTLAND OF KEYSER", "facility_id": 515122, "address": "135 SOUTHERN DRIVE", "city": "KEYSER", "state": "WV", "zip": 26726, "inspection_date": "2009-02-05", "deficiency_tag": 279, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "53ZE11", "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 plan of care to address a change in a resident's psychosocial well-being, and failed to plan non-pharmacologic interventions to address a resident's problem of anxiety with bathing prior to initiating psychoactive medications. Resident identifier: #94. Facility census: 121. Findings include: a) Resident #94 Record review revealed Resident #94 was an [AGE] year old female with [DIAGNOSES REDACTED]. Additionally, she suffered a fall in the facility October 2008 and sustained a fractured ankle requiring surgical repair. Further record review revealed a nursing note, dated 12/29/08 at noon, describing Resident #94's anxiety with bathing as evidenced by behaviors of \"yelling / screaming combative c/ (with) CNA's (certified nursing assistants) splashing bath water all over floor as well as CNA . . . hitting / hurting CNA.\" These behaviors were significant enough at this time for the nurse to notify the physician for \"possible Rx (prescription) d/t (due to) anxiety with bath\". On 12/30/08, the physician ordered anti-anxiety medication [MEDICATION NAME] 0.25 mg orally in the mornings on bath days Mondays and Fridays for a [DIAGNOSES REDACTED]. The resident had been on skilled care due to the fractured ankle, but nursing notes dated 01/13/09 documented that, on 01/12/09, she was skilled for wound dressing changes and for \"mood and behaviors\". A nursing note dated 01/19/09 cited the resident was still combative during bath time and \"difficult to give care to\", again necessitating physician notification on this date. Subsequently, injectable [MEDICATION NAME] 5 mg was ordered by the physician on 01/20/09, to be given an hour before bath time on Mondays and Fridays, instead of the [MEDICATION NAME] for increased agitation and anxiety. A minimum data set (MDS) assessment, with an assessment reference date of 01/13/09, cited behaviors and moods present under the corresponding subsets. However, there was no identification of the problem of anxiety during bathing on the resident's current care plan, nor were there goals to decrease the resident's behaviors or moods, nor interventions to address the bathing-related anxiety through non-pharmacologic measures. Review of all nursing notes from 12/15/08 through 02/03/09 revealed no documentation of any interventions addressing the bathing-related anxiety other than using psychoactive medications on bathing days. Throughout this time frame, there was only one notation of agitation at times other than bathing, which occurred at 5:30 p.m. on 01/22/09. On 02/04/09 at 9:00 a.m., a nursing assistant who provides whirlpool baths, when interviewed, reported Resident #94 has been resisting the bath for the past couple of months. At 9:15 a.m. on 02/04/09, a nurse (Employee #82) reported during interview her belief that the [MEDICATION NAME] (which was initiated on 12/30/08) did not help with the resident's combativeness at bath time, but the [MEDICATION NAME] seemed to help. The findings of medicating with [MEDICATION NAME] and [MEDICATION NAME] on bath days in the absence of identified problems and interventions on the current care plan was reported to the director of nursing and administrator the afternoon of 02/04/09. Several nursing assistants were also interviewed the morning of 02/05/09, and all agreed the resident was combative during bathing times, with one (1) noting they had even tried bathing her at different times of the day without success. .", "filedate": "2014-09-01"}
{"rowid": 11019, "facility_name": "HEARTLAND OF KEYSER", "facility_id": 515122, "address": "135 SOUTHERN DRIVE", "city": "KEYSER", "state": "WV", "zip": 26726, "inspection_date": "2009-02-05", "deficiency_tag": 371, "scope_severity": "F", "complaint": 0, "standard": 1, "eventid": "53ZE11", "inspection_text": "Based on observation and staff interview, the facility failed to ensure foods were stored and served under sanitary conditions, as evidenced by the absence of a thermometer in the kitchen's reach-in refrigerator, to allow monitoring of temperatures stored in this refrigerator. This practice had the potential to affect all residents in the facility who received nourishment from the facility's kitchen. Facility census: 121. Findings include: a) During service of the evening meal on 02/02/09 at 5:00 p.m., observation found dietary staff obtaining 8 oz cartons of milk from the kitchen's reach-in refrigerator and placing the milk cartons onto the residents' dining trays for the evening meal. No thermometer was visible in this refrigerator located beside the serving line, in which were stored numerous plastic crates containing cartons of milk. With no thermometer to measure the internal temperature of this storage area, it could not be assured that all the milk products were stored under proper temperatures. The assistant food service director (Employee #132) removed all crates from inside this refrigerator but was unable to locate a thermometer inside at this time. He agreed that each refrigerator and freezer in the dietary department should have a thermometer, and he reported this reach-in refrigerator generally had one, too. Subsequently, he located a thermometer and placed it inside the kitchen refrigerator. .", "filedate": "2014-09-01"}
{"rowid": 11020, "facility_name": "HEARTLAND OF KEYSER", "facility_id": 515122, "address": "135 SOUTHERN DRIVE", "city": "KEYSER", "state": "WV", "zip": 26726, "inspection_date": "2009-02-05", "deficiency_tag": 164, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "53ZE11", "inspection_text": "Based on an observation and staff interview, the facility did not ensure one (1) resident of random selection (#120) was afforded the right to confidentiality of clinical records. Facility census: 121. Findings include: a) Resident #120 An observation, on 02/03/09 at 9:25 a.m., revealed Resident #120's Medication Administration Record [REDACTED]. The medication cart was in the hallway and visible to anyone walking in the area. An interview with the nurse (Employee #139) revealed she forgot to close the medication binder after she dispensed the prescribed medications and walked into the room to administer the medications to the resident. .", "filedate": "2014-09-01"}
{"rowid": 11021, "facility_name": "HEARTLAND OF KEYSER", "facility_id": 515122, "address": "135 SOUTHERN DRIVE", "city": "KEYSER", "state": "WV", "zip": 26726, "inspection_date": "2009-02-05", "deficiency_tag": 152, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "53ZE11", "inspection_text": "Based on record review and staff interview, the facility failed to assure a resident, who had been determined to lack the capacity to understand and make informed healthcare decisions, had his decisions made by a legal surrogate designated in accordance with State law. The facility had Resident #92 sign an informed consent form authorizing the administration of the influenza vaccine, even though he had been determined to lack the capacity to make such healthcare decisions. Resident identifier: #92. Facility census: 121. Findings include: a) Resident #92 Medical record review revealed the attending physician determined Resident #92 lacked the capacity to understand and make healthcare decisions on 07/28/08. This determination was validated by a second determination made by a psychologist on 08/01/08. Further record review revealed Resident #92 had signed an informed consent form authorizing the administration of the influenza vaccine on 10/22/08. No other signature was on the form. During an interview with the social worker at 11:45 a.m. on 02/04/09, she acknowledged, after reviewing the chart, that Resident #92 should not have been asked to sign this form, as the resident did not have the capacity to understand and make healthcare decisions at that time. (Note: After the fact, on 11/19/08, the resident's attending physician reversed this and determined the resident had the capacity to formulate healthcare decisions. However, at the time the resident signed the vaccination consent form, he did not.) .", "filedate": "2014-09-01"}
{"rowid": 11022, "facility_name": "HEARTLAND OF KEYSER", "facility_id": 515122, "address": "135 SOUTHERN DRIVE", "city": "KEYSER", "state": "WV", "zip": 26726, "inspection_date": "2009-02-05", "deficiency_tag": 155, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "53ZE11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility failed to assure that residents with capacity were involved in making decisions with respect to the advance directives documented on the Physician order [REDACTED]. Resident identifiers: #92 and #104. Facility census: 121. Findings include: a) Resident #92 A review of the medical record revealed a POST form indicating Resident #92 was to receive cardiopulmonary resuscitation (CPR) and \"Limited additional interventions\". This form was signed by the resident's medical power of attorney representative (MPOA) on [DATE]. The resident's attending physician determined Resident #92 lacked the capacity to understand and make healthcare decisions on [DATE]. This determination was validated by a second determination made by a psychologist on [DATE]. On [DATE], the resident's attending physician reversed this and determined the resident now had the capacity to formulate healthcare own decisions. However, there was no evidence in the record to indicate the advance directives recorded on the [DATE] POST form had been reviewed with the resident. During an interview at 11:45 a.m. on [DATE], the social worker (Employee #119) was asked if the advance directives noted on the POST form had been reviewed with the resident. The social worker could not remember and, at the time of exit, she had not produced any evidence to indicate the resident had been informed of the decisions made by the MPOA. b) Resident #104 A review of Resident #104's medical record revealed the resident was admitted on [DATE]. On [DATE], the social worker recorded in social services notes that the resident had the capacity to make his own healthcare decisions and he had \"Full Code\" status. His attending physician also determined, on [DATE], that Resident #104 had the capacity to make healthcare decisions. However, an attached form stated: \"It is my desire that (Name) , my (wife) , sign all forms on my behalf to admit me to Heartland of Keyser, as I am presently in a weakened condition and do not wish to sign all of the forms necessary for admission.\" The resident had several acute hospitalization s, and a social service note on [DATE] indicated his daughter was his health care surrogate and that he was still \"full-code status\". A new POST form, indicating the resident was not to be resuscitated and was to receive limited additional interventions, was signed by his wife on [DATE], while he was in the hospital. There was no evidence to show the wife had any legal authority to make healthcare decisions for him at that time. The resident was readmitted to the facility on [DATE], and all documentation indicated the resident had the capacity to form his own healthcare decisions. However, there was no evidence he had been involved in his healthcare decisions, including formulating the advance directives recorded on the POST form. In an interview with both social workers (Employees #79 and #119) at 2:40 p.m. on [DATE], they were asked if the resident was aware of his code status. Neither answered, nor was any documentation offered. They both verified the resident was alert, oriented, and able to make his needs known with sign language. .", "filedate": "2014-09-01"}
{"rowid": 11023, "facility_name": "HEARTLAND OF KEYSER", "facility_id": 515122, "address": "135 SOUTHERN DRIVE", "city": "KEYSER", "state": "WV", "zip": 26726, "inspection_date": "2009-02-05", "deficiency_tag": 159, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "53ZE11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, review of facility records, and staff interview, the facility failed to notify the responsible party an incapacitated Medicaid recipient when the amount in the resident's account was within $200.00 of the SSI resource limit, for one (1) of eighty-nine (89) residents with personal trust fund accounts managed by the facility. Resident identifier: #28. Facility census: 121. Findings include: a) Resident #28 A review of the Resident #28's medical record revealed this [AGE] year old female who had been determined to lack capacity and who had previously designated her daughter to serve as both her medical and financial power of attorney. The primary payer for her nursing home stay was MCD - Medicaid (West Virginia). The resident's trust statement, dated 02/03/09, stated the balance of funds in her account was $2,590.40. The balance had reached the total of $1800.00 on 12/01/08, at which time the facility should have notified the responsible party that the resident's account was within $200.00 of the allowed SSI limit. There was no evidence in the file to indicate the resident's responsible party had been notified of the account balance and the possible repercussions of this total (loss of Medicaid eligibility), although quarterly statements had been posted in January 2009. During an interview with Employee #159, who was responsible for handling resident funds, at 2:00 p.m. on 02/04/09, she stated she was aware of the balance and explained that she supplied a list of resident balances to the business office manager (Employee #154) each month. The business office manager was to notify families of high balances. Employee #154, when interviewed at 2:15 p.m. on 02/04/09, stated he had tried to contact Resident #28's responsible party by phone but had gotten no answer. He explained the practice of the facility was to notify the family when the balance reached $1800.00, and when the total reached $2000.00, he was to notify DHHR; he stated that he had already done this. He also stated he was going to send a form to the responsible party to sign for permission for the facility to purchase something for the resident, but he was not sure what it would be, and he had not done so when asked at 11:00 a.m. on 02/05/09. The social worker (Employee #79), when interviewed at 2:30 p.m. on 02/04/09, was asked if she was aware of the resident's amount of available funds. She stated she was not, that she was usually not informed of the amounts in the resident accounts and was not involved in contacting the family, although, if asked, she could suggest items the resident might need. When told that a review of the nurses' notes revealed evidence of family notification of changes in condition, she verified the family member was very involved in her mother's care, that she had not had a problem reaching her by phone, and more than one (1) contact number was listed for the responsible party on the resident's medical record. .", "filedate": "2014-09-01"}
{"rowid": 11024, "facility_name": "HEARTLAND OF KEYSER", "facility_id": 515122, "address": "135 SOUTHERN DRIVE", "city": "KEYSER", "state": "WV", "zip": 26726, "inspection_date": "2009-02-05", "deficiency_tag": 280, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "53ZE11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility failed to evaluate and revise the care plan as the resident's status changed, for one (1) of twenty-four (24) sampled residents. Resident identifier: #92. Facility census: 121. Findings include: a) Resident #92 A review of Resident #92's medical record revealed he was admitted on [DATE] after a lengthy hospitalization . His admission minimum data set (MDS) assessment indicated he was totally dependent for bed mobility, transfer, locomotion, dressing, eating, and hygiene, and there was no ambulation in the previous seven (7) days. A care plan was developed addressing these needs with appropriate goals for a severely debilitated resident. An abbreviated quarterly MDS, dated [DATE], indicated the resident required extensive assistance with bed mobility and transfer, limited assistance with ambulation and locomotion; and is now independent except for set-up with eating. However, the resident's most current care plan addressing activities of daily living (ADLs), last reviewed on 11/12/08, contained no evidence of revisions to the care plan to reflect an improvement in the resident's self-performance of ADLs. In an interview with the MDS nurse (Employee #171) at 4:00 p.m. on 02/04/09, she acknowledged, after reviewing the care plan, that it should have been revised as the resident was no longer totally dependent on others for the self-performance of ADLs. .", "filedate": "2014-09-01"}
{"rowid": 11288, "facility_name": "BRAXTON HEALTH CARE CENTER", "facility_id": 515180, "address": "859 DAYS DRIVE", "city": "SUTTON", "state": "WV", "zip": 26601, "inspection_date": "2009-02-10", "deficiency_tag": 225, "scope_severity": "D", "complaint": 1, "standard": 0, "eventid": "33YV11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility did not ensure an incident of possible neglect, whereby a resident sustained [REDACTED]. Resident identifier: #59. Facility census: 58. Findings include: a) Record review revealed a nursing note, dated 10/29/08, documenting Resident #59 was being transferred by two (2) NAs and a nurse utilizing a mechanical lift, when the resident sustained [REDACTED]. An interview with the director of nursing (DON), on 02/10/09 at 10:00 a.m., revealed the facility did not submit an immediate report and 5-day follow-up report to the State nurse aide registry for the nursing assistants involved. The DON had reported the incident to only the State survey and certification agency and Adult Protective Services. .", "filedate": "2014-07-01"}
{"rowid": 11289, "facility_name": "BRAXTON HEALTH CARE CENTER", "facility_id": 515180, "address": "859 DAYS DRIVE", "city": "SUTTON", "state": "WV", "zip": 26601, "inspection_date": "2009-02-10", "deficiency_tag": 309, "scope_severity": "D", "complaint": 1, "standard": 0, "eventid": "33YV11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interviews, the facility did not ensure one (1) of three (3) sampled residents received timely care and services to maintain physical well-being. Resident #59 sustained a [MEDICAL CONDITION] humerus and was not seen by an orthopedic specialist until eight (8) days later. Additionally, Resident #59 did not receive a skin assessment or skin care under an Ace wrap that was ordered by the physician to immobilize the fractured humerus, resulting in the development of an open area. Facility census: 58. Findings include: a) Resident #59 1. An interview with the director of social services, on 02/10/09 at 12:20 p.m., revealed she did not make medical appointments for the residents. She stated the admission coordinator was responsible for making these appointments. An interview with the admission coordinator, on 02/10/09 at 12:45 p.m., revealed she received a physician's telephone order from the nursing department requesting an appointment for Resident #59 to see an orthopedic specialist. The physician's orders [REDACTED]. She stated she told the specialist's office staff the resident had a fracture to her right elbow and needed to be seen as soon as possible. A nursing note, dated 10/29/08 at 3:50 p.m., revealed, \"Resident transferred from bed to wheelchair using total body lift with assist of 2 CNA's (certified nursing assistants) and this nurse. Resident transferred without difficulty. Some crying noted, but stopped crying when sitting in wheelchair. Bruise to right inner elbow with [MEDICAL CONDITION] noted. Sitting upright with good posture.\" Another nursing note at 4:00 p.m. revealed, \"Spoke with daughter about the bruising and swelling of elbow. Explained we are going to obtain a x-ray and will let her know of the results.\" A nursing note at 5:15 p.m. indicated, \"Imaging contacted this nurse by phone and reported right distal humerus non-displaced fracture to right elbow. MPOA stated I think it could of happened when being dressed, because she is stiff.\" Nursing notes continued from 10/29/08 to 11/03/08, describing the condition of the resident's right elbow area. An order was received from the physician on 10/30/08, to apply an immobilizer Ace wrap to the right arm and to leave in place until the orthopedic appointment. There was no evidence of attempts by any staff to call to schedule an appointment with the orthopedist until 11/03/08, when a telephone order was received from the physician to order an appointment with an orthopedic specialist. An interview with the director of nursing (DON), on 02/10/09 at 1:00 p.m., revealed it was very difficult to get an appointment with an orthopedic specialist in the area. She stated the nursing staff had attempted to get an appointment and was not able to do so. (There was no documented evidence of these efforts by the nursing staff to obtain an appointment for the resident.) The resident was diagnosed with [REDACTED]. 2. A review of the resident's medical record revealed [REDACTED]. At 5:15 p.m., a report from the x-ray department indicated the resident had a [MEDICAL CONDITION] distal humerus that was non-displaced. At 7:35 p.m., a nursing note described the resident as exhibiting signs of discomfort related to the right arm. A physician's orders [REDACTED].\" An interview with the DON, on 02/10/09 at 11:00 a.m., revealed the Ace wrap was placed on the resident in accordance with the physician's orders [REDACTED]. The resident returned to the facility without the wrap, which was removed at the physician's office. She further stated they did not remove the Ace bandage during this time, frame because the order from the physician clearly indicated the Ace wrap was not to be removed. The staff washed the resident around the Ace wrap but not under the wrap. When the resident returned to the facility from the physician's office she was assessed with [REDACTED]. The resident's hand remained in this position, resting against her breast for seven (7) days. On 11/06/08 at 4:40 p.m., the resident returned from the appointment with the orthopedic specialist without the Ace wrap. The specialist's report indicated the resident was not to have the Ace wrap applied and that the area would heal without problems. Surgery would not be necessary and to not passively extend the right elbow. A sling may be used for comfort. A nursing note, dated 11/06/08 at 7:20 p.m., indicated, \"This nurse entered room for assessment. MPOA (medical power of attorney) was upset with red areas to left breast and right hand. Measurement right thumb 1.5 cm length and 2 cm width. Right hand 2nd knuckle 1 cm x 2 cm outer wrist bone on right arm 1 cm x 1 cm left breast top red area 5 cm x ? cm area below. Skin is not open.\" At 9:30 p.m., a nursing note indicated, \"Red areas fading in color.\" An interview with the DON, on 02/10/09 at 1:00 p.m., confirmed the resident had an open area on the left breast. She continued to state they could not remove the Ace wrap, because they had an order not to remove. She further stated the resident could be very combative, and to attempt to remove the Ace wrap may have caused problems with the resident right elbow fracture. The facility failed to ensure the resident's skin was assessed and cleaned under the Ace wrap for seven (7) days. .", "filedate": "2014-07-01"}
{"rowid": 11179, "facility_name": "HEARTLAND OF PRESTON COUNTY", "facility_id": 515072, "address": "300 MILLER ROAD", "city": "KINGWOOD", "state": "WV", "zip": 26537, "inspection_date": "2009-02-12", "deficiency_tag": 319, "scope_severity": "G", "complaint": 1, "standard": 0, "eventid": "IH3P11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview, the facility did not obtain psychological / psychiatrics services for a [AGE] year old male resident (#107) who was exhibiting an escalation in behaviors towards other residents, visitors, and staff that were socially and sexually inappropriate, verbally abusive, and physically aggressive. Resident #107 frequently propelled his wheelchair backwards in the corridor, thereby creating a safety hazard for other residents. He also pushed an overbed table into the leg of his roommate, frequently engaged in unwanted physical contact of a sexual nature with female residents, staff, and visitors (when he would touch their buttocks, inner thighs, and/or breasts), verbally abused and physically struck female staff on the chest and buttocks, exposed his genitals to others, and repeatedly removed the incontinence brief and exposed the perineal area of a [AGE] year old cognitively impaired, totally dependent female resident. Medical record review found no evidence of current quantitative and/or qualitative tracking Resident #107's behaviors. However, review of nursing notes, from 10/28/08 to 02/04/09, revealed one hundred and eight (108) separate entries, occurring over a 100-day period, documenting socially and sexually inappropriate behaviors, verbally abusive and/or physically aggressive behaviors, and behaviors that presented safety hazards to others. These entries anecdotally recorded various behaviors occurring multiple times weekly, and sometimes multiple times daily. Record review found Resident #107 had been exhibiting sexually inappropriate behaviors for several years, for which he received evaluations on at least three (3) occasions since 2006. His last consult, with a neurologist on 07/14/08, identified concerns with tremors, urinary urgency, and sexually aggressive behaviors. The consulting physician recorded, \"His behavior problem is not responding to SSRI's (selective serotonin reuptake inhibitors). I wonder if a medication such as [MEDICATION NAME] might help reduce his libido to a more controllable level. We can focus on the tremor initially and left (sic) me know how he responds to the [MEDICATION NAME] (medication to treat tremors). Follow-up can be arranged as needed.\" The resident's attending physician and the facility's interdisciplinary care team members were aware that Resident #107's behaviors were escalating. However, no follow-up psychological or psychiatric services were sought by the facility after the increase in frequency of behaviors was noted by staff. Because of a lack of consistent qualitative and quantitative tracking of Resident #107's various behaviors, the extent to which other residents, staff, and visitors were affected by these behaviors could not be ascertained. Documentation revealed Resident #107 displayed abusive and inappropriate behaviors towards at least four (4) identified residents (#108, #30, #110, and #14), and multiple unidentified residents, as well as multiple female staff members and visitors, and his behavior resulted in actual harm to a female activity staff member who sustained four (4) bruises on the left inner thigh after having been \"grabbed\" by him. Facility census: 106. Findings include: a) Resident #107 Medical record review, on 02/05/09 at 3:00 p.m., revealed Resident #107, prior to being discharged from the facility at 2:10 p.m. on 02/04/09, engaged in verbally abusive / physically aggressive and socially and sexually inappropriate behaviors towards other residents, female staff, and female visitors. Further review revealed the facility failed to implement interventions to protect residents, staff, and visitors from this resident's actions, even though Resident #107 had been exhibiting these behaviors for years. ---- 1. Record review revealed a [AGE] year old male was admitted to the facility from a rehabilitation hospital on [DATE], with [DIAGNOSES REDACTED]. A neuropsychological evaluation, dated 02/27/06, revealed the following: \"(Resident #107) currently resides at Heartland of [MEDICATION NAME] County Nursing Home where he has lived for several years. He has had increasing behavior difficulties at the nursing home, particularly over the last 6 months. These involve inappropriate sexual touching of staff, other residents, and visitors. He is also described by nursing staff to masturbate frequently, perhaps several times per day. The staff has attempted to modify his behavior by providing objects for his hands, redirecting his attention, reprimanding him, and engaging him in activities. . . . With prompts, (Resident #107) was able to state the concerns regarding his behavior, but showed a lack of appreciation of their significance. . . . (Resident #107) demonstrates severe cognitive impairment secondary to his significant closed head injury. Particular deficits were noted in motor skills, memory, processing, and frontal lobe functions. The patient has some relatively preserved cognitive functioning, which makes it seems as if his behavior is willful. However, the results of this evaluation indicate that he lacks sufficient cognitive ability to fully appreciate his behavior and/or inhibit it. It is recommended that a structured program be developed in which appropriate behaviors are differentially reinforced. . . . In addition, it is suggested that staff be trained and the patient's environment be structured with the goal of limiting opportunities for inappropriate behavior. Re-referral to a psychiatrist, ideally a neuropsychiatrist, is strongly recommended to determine whether medication may be effective in minimizing the patient's libido and managing his behavior.\" A psychological consult, dated 05/08/06, contained the following recommendation: \". . . He currently displays a 'grasping reflex'. Any stimulation to the palm of the hand will engage a grabbing response. This may account for some of his 'inappropriate touching', as staff attempt to provide his care. He may benefit from grasping a substitute e.g. rolled washcloth, while care is being provided.\" A neurology consult, dated 07/14/08, revealed the following: \". . . He (Resident #107) is now on [MEDICATION NAME] 20 milligrams/day for behavioral problems. He has some sexual (sic) aggressive behaviors involving grabbing at the nursing staff and other clients. Reportedly the [MEDICATION NAME] is not working. . . . His behavior problem is not responding to SSRI's. I wonder if a medication such as [MEDICATION NAME] might help reduce his libido to a more controllable level. We can focus on the tremor initially and left (sic) me know how he responds to the [MEDICATION NAME] (medication to treat tremors). Follow-up can be arranged as needed.\" There was no evidence in Resident #107's medical record of efforts by the facility to obtain follow-up psychiatric and/or psychological services to address his sexually aggressive behaviors, after the 07/14/08 consult and prior to his discharge on 02/04/09. ---- 2. Review of Resident #107's medical record found no evidence of current quantitative and/or qualitative tracking of all of Resident #107's behaviors, although psychopharmacologic drug monthly flow records were completed for tracking the frequency at which Resident #107 was hitting, slamming doors, and intentionally backing his wheelchair into staff. However, review of nursing notes, from 10/28/08 to 02/04/09, revealed one hundred and eight (108) separate entries, over a 100-day period, documenting socially / sexually inappropriate behaviors, verbally abusive and/or physically aggressive behaviors, and behaviors that presented safety hazards to others. These entries anecdotally recorded various behaviors occurring multiple times weekly, and sometimes multiple times daily. Because of a lack of consistent qualitative and quantitative tracking of Resident #107's various behaviors, the extent to which other residents, staff, and visitors were affected by these behaviors could not be ascertained. Sixty-nine (69) entries recorded Resident #107 grabbing female staff, residents, and/or visitors on their breasts, buttocks, and inner thighs. Eighteen (18) entries recorded Resident #107 appearing outside of his room with no clothing on, exposing his genitalia to others. Twenty-seven (27) entries recorded Resident #107 wheeling his wheelchair backwards, creating a safety hazard for others. Twenty-seven (27) entries recorded episodes of Resident #107 verbally abusing / being physically aggressive towards others, including staff, other residents, and visitors; one (1) of these episodes resulted in an activity staff member receiving four (4) bruises to the left inner thigh. Four (4) entries recorded Resident #107 removing the incontinence brief from a severely cognitively impaired [AGE] year old female resident (#108), who was totally dependent upon staff for her activities of daily living. Entries included: On 10/28/08 at 2:45 p.m., \". . . Grabbing @ staff's bottom saying 'I want it.' Res became aggressive & mad @ staff when redirected & told him it was inappropriate behavior. Res hit two staff members & told this writter (sic) that if I ran my mouth he'd hit me too. . . . Tried to grab another staff member's bottom as he went down the hall.\" On 10/29/08 at 6:30 p.m., \". . . Res (resident) inappropriately grabbed a female visitor awaiting trick or treating activity. Staff telling res that inappropriate behavior is not tolerated. Res going 'yea'.\" On 11/05/08 at 11:40 p.m., \"Res tried to go into 400 hall main bathroom - alarm sounded. CNA's (certified nursing assistants) attempted to redirect res, whereupon res began yelling & hitting @ them. Res from room (number) was also in the hallway @ this x (time), mumbling to himself, which only made this res more upset. Res began yelling @ other man. . . .\" On 11/20/08 at 8:00 p.m., \"Res /c (with) behavior issues. Attempting to remove t-shirt while in dining room. Staff reporting Res became aggressive & went backwards in wc (wheelchair) spinning another res around in their wc. Notified nurse regarding other res to assess for any injuries. . . .\" (There was no incident report for this event; the identity of the other resident involved could not be ascertained.) On 11/22/08 at 7:00 p.m., \". . . It was reported by roommate that he (Resident #107) pushed table into roommate (sic) leg & messing /c TV.\" On 12/03/08 at 6:45 p.m., \"Res in room /c all clothes off, lying in bed, masturbating. CNA's pulled curtain around resident. Res angry, got (arrow pointing up) in w/c per self, hitting @ staff & kicking. Cursing at staff saying 'You whore & [***] '. Res begins to chase CNAs down hallway & cursing, backing one CNA into corner & hitting @ CNA. . . .\" On 12/03/08 at 7:30 p.m., \"Res returned to hallway. Into another female resident's room, female res yelling 'help me, help me.' Res in room uncovered other resident & was attempting to unfasten resident's wing (incontinence brief) & had hand over wing & thigh area. Res removed from room & states 'I was trying to help her to the BR.' . . .\" (The female resident involved in this incident was Resident #108.) On 12/04/08 at 7:30 p.m., \". . . Res is grabbing at residents & staff. When redirected he gets verbally abusive & rams w/c into wall. When this writer explains to res that he can't do this (sic) his statement is 'I don't care.' . . .\" On 12/05/08 at 8:30 a.m., \"CNA went to let res know it was time for Breakfast. Res went to grab CNA. CNA stated 'Don't grab me.' Res then punched CNA in stomach. . . .\" On 12/13/08 at 3:30 p.m., \"Res wheeling self backward down hallway from room /c pants & underwear off. When res asked to get dressed, res laughing (sic) states 'I don't have too (sic).'. . .\" On 12/17/08 at 6:00 a.m., \"Res in female resident (sic) room, unfastened & opened res incontinence brief. When redirected to leave room & that it was inappropriate for him to be removing female resident (sic) clothes, (Resident #107) became agitated and attempted to back w/c into this writer. Removed from female (sic) room . . .\" (The female resident involved in this incident was Resident #108.) On 12/20/08 at 4:40 a.m., \"Called to floor by CNA's who had found resident again in female resident room. Res had unfastened female's incontinence brief and pulled it down, exposing female's peri-area. When resident told he needed to leave room & not enter again, he became agitated and telling this writer to 'shut up'. . . .\" (The female resident involved in this incident was Resident #108.) On 12/20/08 at 1:00 p.m., \"Res motivating (sic) w/c backward & yelling. This nurse tried to redirect, started asking him his multiplications. He then saw another res coming (sic) said 'I'm going to hit him in the damn head.' He then started for other res. Other res stepped out of way. This res cont. This nurse held w/c to keep him from running into other res. He then started hitting at this nurse. CNA came to help. Redirected res to cafe. Res then stripped off clothes. When ask (sic) why res stated to this nurse 'Your (sic) mean (sic) you didn't let me hit him.' This nurse explained 'I could not let that happen.' Res said 'You could have turned your head.' . . .\" (There was no incident report for this event; the identity of the other resident involved could not be ascertained.) On 12/21/08 at 6:30 p.m., \"Res found in female resident's room, had unfastened incontinence wing (brief), exposing resident. Res asked to leave room & that it is inappropriate to re-enter room. Cursing at staff. Wheeled self backwards & to room.\" (The female resident involved in this incident was Resident #108.) On 12/23/08 at 2:20 p.m., \"Res going up hallway, Sally Ann's Dance girls, grabbing one of the dancers (sic) behind. Res redirected & taken to room.\" On 12/24/08 at 11:30 a.m., \"Upon walking up 400 hall, CNA voiced that '(Resident #107) is in that room & won't come out.' Res did come out of room. When asked res to 'give me (other resident)'s stuff.' Res became very aggressive and hitting this writer. Asked res to stop and go back over to his own room, res repeatedly yelled, 'shut up', 'don't touch me.' No staff had touched res. Res pushed back to 100 hall. This writer walked past res approx(imately) 10 min(utes) later, res stated, 'Your ass is mine. I want your butt.' Told res to stop. Res voiced, 'no, I want your butt.' Unable to redirect res. . . .\" On 12/28/08 at 6:30 p.m., \"Res in w/c @ 4:15 p.m. motivating (sic) self backward. Ran w/c in to walker of another res, knocking it sideway (sic), Res stumbled, this nurse stopped res from falling. When redirected to (symbol for change) direction, Res grabbed this nurse by the arm, refusing to let go. Called for help & res released arm.\" (There was no incident report for this event; the identity of the other resident involved could not be ascertained.) On 01/04/09 at 3:30 p.m., \". . . (Arrow pointing up) in w/c (wheelchair) at present, going down hallway in w/c. Grabs another female resident by the breast & let go. When asked why he did that, res states while laughing 'because I want to.' . . .\" (The female resident involved in this incident was Resident #30.) On 01/10/09 at 10:00 a.m., \". . . Wheeled self into hallway /c lower portion of body exposed. Staff assisted res in dressing & asked res to please not come out of room undressed. Res laughed. Grabbed several female staff this a.m. (morning) on the buttocks. When asked not to do this he smiles (sic) & and stated 'But I want to.' . . .\" On 01/10/09 at 12:00 p.m., \"Res grabbed a visitor's buttocks /s (without) permission. Res redirected by staff & staff apologized to visitor. Res also entered female res rooms (sic) this am (morning) while res dressing. Res removed from room and returned to his hall area and explained to (sic) that his behavior is unacceptable. Res states 'I don't care.'\" On 01/11/09 at 2:00 a.m., \"Res (arrow pointing up) in w/c (arrow pointing up) & (arrow pointing down) hallway - removing clothes & going nude. Very aggressive when assisted to put clothes back on. . . .\" On 01/18/09 at 3:25 a.m., \". . . Propelling self backwards (arrow pointing up) & (arrow pointing down) hallway. Enc to turn & go forward for safety - res refused. Explained risk of running into walls, furniture, other people - Res states 'I won't.' Had near miss /c female resident who was ambulating in hallway. Conts /c grabbing @staff @times. . . .\" (There was no incident report for this event; the identity of the other resident involved could not be ascertained.) On 01/19/09 at 3:35 a.m., \"(Arrow pointing up) in w/c, frequently motivating (sic) self backwards. When asked to turn around, res becomes angry, states 'No! I don't want to' . . . In hallway /c bottom ? of body exposed. Redirected to room to dress.\" On 01/20/09 at 3:40 a.m., \"Conts to propel self (arrow pointing up) hallway backwards. Attempts to redirect met /c aggression / swearing @ staff. Came (arrow pointing up) hallway /c bottom ? of body exposed. Asked to return to room to sleep or get clothes on. Res asked for assistance, then proceded (sic) to grope CNA repeatedly. Redirected /c res becoming verbally assaultive - calling staff '[***] es'. . . .\" On 12/22/08 at 4:00 a.m., \"Res in room (number) in bed #2. CNA (certified nursing assistant) awakened resident & told him to go to his own room/bed. Res got out of bed & into w/c. Grabbed CNA in chest and between legs. Redirected to inappropriateness of his actions. . . .\" On 01/25/09 at 6:40 p.m., \". . . Grabbing staff inappropriately (sic). This writer redirected him numerous x's (times). Res even grabed (sic) another res inapproately (sic). Was told he was not allowed to touch another res. His comment was 'Why not.'. . .\" (The female resident involved in this incident was Resident #14.) On 01/29/09 at 10:30 a.m., \"Reported to this nurse by activities director, activity person was grabbed on 1/27/09 by this Res. Activity staff person has (4) small round bruises on (L) (left) inner thigh at area.\" On 01/30/09 at 10:00 p.m., \"Res (arrow pointing up) in w/c hitting staff & grabbing visitors. Hit CNA in this chest & this writer in the buttocks. Res was redirected & told not to behave in such a manner. He said 'Come on [***] (sic) & tried to run into us with this wheelchair.\" On 02/02/09 at 8:30 p.m., \"Res in main lobby attempting to go out front door. Keepsafe alarm sounding. Res hitting nurse & CNA's attempting to re-direct res from door. Standing & yelling 'Come on [***] !' Cursed at visitor & young daughter, states 'F-ck you!' Re-directed to room /p (after) 5-10 mins (minutes). Res conts to yell at CNA's. . . .\" ---- 3. Review of Resident #107's physician progress notes [REDACTED]. On 07/15/08, \"(Resident #107) is generally stable. His (responsible party) did not want the use of jumpsuit. . . . He was seen by the neurologist and it was noted that he had a tremor, [MEDICAL CONDITION] bladder and behavior problems. . . .\" On 09/10/08, \". . . He has still been problematic with his aggressive sexual behavior here. Note from neurologist (from 07/14/08 consult) read regarding his tremor. . . . Also in regard to suggestion of [MEDICATION NAME] will try this in regard to his libido.\" On 10/15/08, \". . . No changes in regard to tremor or behavior.\" On 11/12/08, \". . . The same aggressive behavior still an issue here, especially among the female staff. . . . This pt (patient) will be transferred to services of Dr. (name). . . .\" On 12/10/08, \"(Resident #107) has a history of CHI (closed head injury) with secondary [DIAGNOSES REDACTED], dysarthria, gait disorder, sexual aggression, ? depression, overactive bladder and lately has been exhibiting some increasing aggression and inappropriate behavior including masturbating in front of anybody who may be around including children . . . History of CHI with increasing agitation and inappropriate behavior. We will continue his current meds but will also add on [MEDICATION NAME] 500 mg daily and monitor for affect (sic). . . .\" On 01/05/09, \". . . At last evaluation he was seen for some increasing aggression and inappropriate behavior and had [MEDICATION NAME] added. There has been minimal improvement with this and he actually had an interaction with another resident, which may result in him being removed from this facility. . . . There is the potential that the pt will be removed from the facility later this mth (month) due to his behavior. . . .\" ---- 4. Resident #107's social services progress notes recorded that Resident #107's behaviors, although chronic, were escalating. Although, medication adjustments were being made and (beginning in September 2008) the facility started exploring alternative placements for the resident, the resident's care plans were not revised when the interventions were found to be ineffective in controlling and/or reducing the resident's behaviors. ---- 5. During an interview on the afternoon of 02/10/09, the director of nursing (DON - Employee #5) identified that staff was to complete an incident /accident report when incidents resulted in resident injury; the DON reported Employee #21 was in charge of the incident / accident reports and additional questions would be needed directed to her. The DON also identified that the facility's administration did not believe Resident #107's behaviors were of a sexual nature (contrary to documentation found in nursing, social services, and physician progress notes [REDACTED]. When questioned about whether Resident #107 had received services from a mental health professional to address this increase in behaviors, since the resident's medical record revealed the last time he received the services of a psychologist was in 2006, the DON reviewed his record. Shortly thereafter, the DON acknowledged the facility did not refer Resident #107 for psychological or psychiatric services when he exhibited an increased frequency of behaviors at the end of October 2008. .", "filedate": "2014-07-01"}
{"rowid": 11180, "facility_name": "HEARTLAND OF PRESTON COUNTY", "facility_id": 515072, "address": "300 MILLER ROAD", "city": "KINGWOOD", "state": "WV", "zip": 26537, "inspection_date": "2009-02-12", "deficiency_tag": 329, "scope_severity": "D", "complaint": 1, "standard": 0, "eventid": "IH3P11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview, the facility did not, for one (1) of twenty-two (22) sampled residents, ensure medications were not given for an excessive duration and that monitoring was completed to evaluate the effectiveness of the medication. [MEDICATION NAME] was given for greater than three (3) months, and [MEDICATION NAME] was given without laboratory monitoring to determine efficacy. Resident identifier: #107. Facility census: 106. Findings include: a) Resident #107 1. Medical record review, conducted on the morning of 02/05/09, revealed Resident #107 was receiving [MEDICATION NAME] since 05/17/08. Review of the original physician order [REDACTED]. According to http://www.mayoclinic.com/health/[MEDICATION NAME]/NS_patient-[MEDICATION NAME]: \"[MEDICATION NAME] should be used for short term therapy three (3) months or less and possible side effects include fatigue, dizziness, headache, irritability and sleepiness.\" Review of the monthly drug regimen review found no evidence the consultant pharmacist had recognized as an irregularity that Resident #107 had been receiving this medication for an excessive duration. During an interview on the afternoon of 02/10/09, the director of nursing (DON - Employee #5) offered to review the medical record to determine whether the consultant pharmacist identified this irregularity. Shortly after this interview, the DON identified that the consultant pharmacist did not identify this irregularity until 02/02/09, and the consultant report was in a separate file for the physician to review; it was not in this resident's closed medical record. The facility failed to ensure that [MEDICATION NAME] was not given in an excessive duration. 2. Medical record review also revealed that, on 09/10/08, [MEDICATION NAME] 50 mg two (2) times a day for tremors was ordered. On 11/12/08, another order was written for [MEDICATION NAME] 25 mg every day at 1:00 p.m. On 12/17/08, laboratory testing revealed the resident's serum [MEDICATION NAME] level was 1.5 mg. Review of this document revealed the therapeutic range was 4-12 ug/ml. Following receipt of this laboratory report, the facility failed to make any adjustments to the medication in order to obtain the therapeutic drug range. According to http://www.rxlist.com/[MEDICATION NAME]-drug.htm: \"Dosage should be individualized to provide maximum benefit. In some cases, serum blood level determinations of [MEDICATION NAME] may be necessary for optimal dosage adjustment. The clinically effective serum level for [MEDICATION NAME] is between 5-12 ?g/mL.\" .", "filedate": "2014-07-01"}
{"rowid": 11181, "facility_name": "HEARTLAND OF PRESTON COUNTY", "facility_id": 515072, "address": "300 MILLER ROAD", "city": "KINGWOOD", "state": "WV", "zip": 26537, "inspection_date": "2009-02-12", "deficiency_tag": 428, "scope_severity": "E", "complaint": 1, "standard": 0, "eventid": "IH3P11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, review of manufacturer's dosing instructions, and staff interviews, it was determined the pharmacist had not identified drug irregularities for five (5) residents. The pharmacist had not identified the facility's current scheduling of antibiotics as an irregularity. The current schedules for antibiotics did not maintain blood levels of the medication for optimal effect. Two (2) of nineteen (19) residents on the sample were identified as being affected, and review of the February medication administration records (MAR) for the 100 hall identified an additional two (2) residents. Additionally, the pharmacist had not identified that Resident #107 was receiving Melatonin for an excessive duration. Resident identifiers: #52, #15, #95, and #51. Facility census: 106. Findings include: a) Residents #15, #51, #52, and #95 1. Resident #15 Review of the resident's medical record found that, on 01/19/09, Augmentin (an antibiotic) had been ordered given three (3) times a day pending the culture of the resident's tracheostomy site. Review of his MARs revealed the antibiotic had been scheduled for administration at 8:00 a.m., 12:00 p.m., and 5:00 p.m. That meant the three (3) antibiotic doses were given in an approximately nine (9) hour period, leaving fifteen (15) hours between the 5:00 p.m. dose and the 8:00 a.m. dose on the following day. 2. Resident #51 The resident's current orders included Bactrim DS to be given twice a day for five (5) days. The antibiotic was scheduled for administration at 9:00 a.m. and 5:00 p.m. on the MAR. This schedule provided for the doses for one (1) day to be given eight (8) hours apart, and the next dose would not be given for approximately sixteen (16) hours. Review of the pharmacist's drug regimen review for Resident #51, dated 02/02/09, found the schedule for the Augmentin the resident received in January 2009 had not been noted as an irregularity. 3. Resident #52 The resident's current MAR indicated [REDACTED]. The antibiotic was scheduled for administration at 8:00 a.m., 12:00 p.m., and 5:00 p.m. 4. Resident #95 A current order for Bactrim DS to be given twice a day for ten (10) days was noted on the resident's current MAR. The medication was scheduled to be given at 8:00 a.m. and 5:00 p.m. 5. The director of nursing was interviewed on 02/11/09. When asked about the scheduling of antibiotics, she was unable to offer a reason for the current schedules. She said that these were the schedules used for the medications ordered given two (2) or three (3) times a day - that she had not thought about the antibiotics. When asked whether the pharmacist had identified this as an irregularity in the reports she received, she said he/she had not. 6. Review of package inserts (obtained for in the Food and Drug Administration's website) from the pharmaceutical companies for each of these antibiotics found that, under the section for \"Dosage and Administration\", each included instructions that doses should be administered every twelve (12) hours if the medication was given twice a day and every eight (8) hours if given three (3) times a day. e) Resident #107 Medical record review, conducted on the morning of 02/05/09, revealed Resident #107 was receiving Melatonin since 05/17/08. Review of the original physician order [REDACTED]. According to http://www.mayoclinic.com/health/melatonin/NS_patient-melatonin: \"Melatonin should be used for short term therapy three (3) months or less and possible side effects include fatigue, dizziness, headache, irritability and sleepiness.\" Review of the monthly drug regimen review found no evidence the consultant pharmacist had recognized as an irregularity that Resident #107 had been receiving this medication for an excessive duration. During an interview on the afternoon of 02/10/09, the director of nursing (DON - Employee #5) offered to review the medical record to determine whether the consultant pharmacist identified this irregularity. Shortly after this interview, the DON identified that the consultant pharmacist did not identify this irregularity until 02/02/09, and the consultant report was in a separate file for the physician to review; it was not in this resident's closed medical record. The facility failed to ensure that Melatonin was not given in an excessive duration.", "filedate": "2014-07-01"}
{"rowid": 11182, "facility_name": "HEARTLAND OF PRESTON COUNTY", "facility_id": 515072, "address": "300 MILLER ROAD", "city": "KINGWOOD", "state": "WV", "zip": 26537, "inspection_date": "2009-02-12", "deficiency_tag": 498, "scope_severity": "D", "complaint": 1, "standard": 0, "eventid": "IH3P11", "inspection_text": "Based on observations, it was determined the facility had not ensured each nurse aide demonstrated competency in techniques necessary to care for residents' needs. A nursing assistant (NA) was observed assisting back to bed one (1) resident of random opportunity. The NA pulled a belt from under the resident after the resident was lying on her bed, creating a potential for shearing and/or friction injury to the resident. Resident identifier: #9. Facility census: 106. Findings include: a) Resident #9 On 02/10/09 at approximately 8:45 a.m., a NA (Employee #106) was observed assisting the resident from the bathroom to her bed. After the resident had lain down on the bed, she turned onto her left side. The NA released the fastening device and pulled the belt and the larger part of the fastening device under the resident's body, creating a potential for injury from shearing or friction, especially as the larger portion of the clasp was pulled beneath the resident. .", "filedate": "2014-07-01"}
{"rowid": 11183, "facility_name": "HEARTLAND OF PRESTON COUNTY", "facility_id": 515072, "address": "300 MILLER ROAD", "city": "KINGWOOD", "state": "WV", "zip": 26537, "inspection_date": "2009-02-12", "deficiency_tag": 323, "scope_severity": "G", "complaint": 1, "standard": 0, "eventid": "IH3P11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview, the facility did not provide adequate supervision to prevent a [AGE] year old male resident (#107) from being socially and sexually inappropriate, verbally abusive, and physically aggressive towards staff, other residents, and visitors. Resident #107 frequently propelled his wheelchair backwards in the corridor, thereby creating a safety hazard for other residents. He also pushed an overbed table into the leg of his roommate, frequently engaged in unwanted physical contact of a sexual nature with female residents, staff, and visitors (when he would touch their buttocks, inner thighs, and/or breasts), verbally abused and physically struck female staff on the chest and buttocks, exposed his genitals to others, and repeatedly removed the incontinence brief and exposed the perineal area of a [AGE] year old cognitively impaired, totally dependent female resident. Medical record review found no evidence of current quantitative and/or qualitative tracking Resident #107's behaviors. However, review of nursing notes, from 10/28/08 to 02/04/09, revealed one hundred and eight (108) separate entries, occurring over a 100-day period, documenting socially and sexually inappropriate behaviors, verbally abusive and/or physically aggressive behaviors, and behaviors that presented safety hazards to others. These entries anecdotally recorded various behaviors occurring multiple times weekly, and sometimes multiple times daily. Record review found Resident #107 had been exhibiting sexually inappropriate behaviors for several years, for which he received evaluations on at least three (3) occasions since 2006. His last consult, with a neurologist on 07/14/08, identified concerns with tremors, urinary urgency, and sexually aggressive behaviors. The consulting physician recorded, \"His behavior problem is not responding to SSRI's (selective serotonin reuptake inhibitors). I wonder if a medication such as Proscar might help reduce his libido to a more controllable level. We can focus on the tremor initially and left (sic) me know how he responds to the Primidone (medication to treat tremors). Follow-up can be arranged as needed.\" The resident's attending physician and the facility's interdisciplinary care team members were aware that Resident #107's behaviors were escalating. However, no follow-up psychological or psychiatric services were sought by the facility after the increase in frequency of behaviors was noted by staff. Although the resident's medication regimen was periodically adjusted to address his behaviors, review of his care plans for \"inappropriate touching\", physical and verbal aggression, \"inappropriate dressing\", and wheeling his wheelchair backwards revealed the goals were not always realistic and/or measurable, and the interventions were not revised when it should have been evident to the interdisciplinary care team, based on the numerous entries in the nursing notes from October 2008 to the date of the resident's discharge on 02/04/09, that the interventions were not effective in achieving the stated goals. Although the facility, according to social service progress notes beginning in 09/18/08, identified the need for alternative placement for this very young resident with sexually aggressive behaviors, none of the care plans included providing increased supervision to protect other residents, staff, and visitors from Resident #107's behaviors until such alternative placement could be found. Because of a lack of consistent qualitative and quantitative tracking of Resident #107's various behaviors, the extent to which other residents, staff, and visitors were affected by these behaviors could not be ascertained. Documentation revealed Resident #107 displayed abusive and inappropriate behaviors towards at least four (4) identified residents (#108, #30, #110, and #14), and multiple unidentified residents, as well as multiple female staff members and visitors, and his behavior resulted in actual harm to a female activity staff member who sustained four (4) bruises on the left inner thigh after having been \"grabbed\" by him. Facility census: 106. Findings include: a) Resident #107 Medical record review, on 02/05/09 at 3:00 p.m., revealed Resident #107, prior to being discharged from the facility at 2:10 p.m. on 02/04/09, engaged in verbally abusive / physically aggressive and socially and sexually inappropriate behaviors towards other residents, female staff, and female visitors. Further review revealed the facility failed to implement interventions to protect residents, staff, and visitors from this resident's actions, even though Resident #107 had been exhibiting these behaviors for years. ---- 1. Record review revealed a [AGE] year old male was admitted to the facility from a rehabilitation hospital on [DATE], with [DIAGNOSES REDACTED]. A neuropsychological evaluation, dated 02/27/06, revealed the following: \"(Resident #107) currently resides at Heartland of Preston County Nursing Home where he has lived for several years. He has had increasing behavior difficulties at the nursing home, particularly over the last 6 months. These involve inappropriate sexual touching of staff, other residents, and visitors. He is also described by nursing staff to masturbate frequently, perhaps several times per day. The staff has attempted to modify his behavior by providing objects for his hands, redirecting his attention, reprimanding him, and engaging him in activities. . . . With prompts, (Resident #107) was able to state the concerns regarding his behavior, but showed a lack of appreciation of their significance. . . . (Resident #107) demonstrates severe cognitive impairment secondary to his significant closed head injury. Particular deficits were noted in motor skills, memory, processing, and frontal lobe functions. The patient has some relatively preserved cognitive functioning, which makes it seems as if his behavior is willful. However, the results of this evaluation indicate that he lacks sufficient cognitive ability to fully appreciate his behavior and/or inhibit it. It is recommended that a structured program be developed in which appropriate behaviors are differentially reinforced. . . . In addition, it is suggested that staff be trained and the patient's environment be structured with the goal of limiting opportunities for inappropriate behavior. Re-referral to a psychiatrist, ideally a neuropsychiatrist, is strongly recommended to determine whether medication may be effective in minimizing the patient's libido and managing his behavior.\" A psychological consult, dated 05/08/06, contained the following recommendation: \". . . He currently displays a 'grasping reflex'. Any stimulation to the palm of the hand will engage a grabbing response. This may account for some of his 'inappropriate touching', as staff attempt to provide his care. He may benefit from grasping a substitute e.g. rolled washcloth, while care is being provided.\" A neurology consult, dated 07/14/08, revealed the following: \". . . He (Resident #107) is now on Paxil 20 milligrams/day for behavioral problems. He has some sexual (sic) aggressive behaviors involving grabbing at the nursing staff and other clients. Reportedly the Paxil is not working. . . . His behavior problem is not responding to SSRI's. I wonder if a medication such as Proscar might help reduce his libido to a more controllable level. We can focus on the tremor initially and left (sic) me know how he responds to the Primidone (medication to treat tremors). Follow-up can be arranged as needed.\" There was no evidence in Resident #107's medical record of efforts by the facility to obtain follow-up psychiatric and/or psychological services to address his sexually aggressive behaviors, after the 07/14/08 consult and prior to his discharge on 02/04/09. ---- 2. Review of Resident #107's medical record found no evidence of current quantitative and/or qualitative tracking of all of Resident #107's behaviors, although psychopharmacologic drug monthly flow records were completed for tracking the frequency at which Resident #107 was hitting, slamming doors, and intentionally backing his wheelchair into staff. However, review of nursing notes, from 10/28/08 to 02/04/09, revealed one hundred and eight (108) separate entries, over a 100-day period, documenting socially / sexually inappropriate behaviors, verbally abusive and/or physically aggressive behaviors, and behaviors that presented safety hazards to others. These entries anecdotally recorded various behaviors occurring multiple times weekly, and sometimes multiple times daily. Because of a lack of consistent qualitative and quantitative tracking of Resident #107's various behaviors, the extent to which other residents, staff, and visitors were affected by these behaviors could not be ascertained. --- Sixty-nine (69) entries recorded Resident #107 grabbing female staff, residents, and/or visitors on their breasts, buttocks, and inner thighs. Examples of these entries include: On 10/29/08 at 6:30 p.m., \". . . Res (resident) inappropriately grabbed a female visitor awaiting trick or treating activity. Staff telling res that inappropriate behavior is not tolerated. Res going 'yea'.\" On 12/22/08 at 4:00 a.m., \"Res in room (number) in bed #2. CNA (certified nursing assistant) awakened resident & told him to go to his own room/bed. Res got out of bed & into w/c. Grabbed CNA in chest and between legs. Redirected to inappropriateness of his actions. . . .\" On 12/23/08 at 2:20 p.m., \"Res going up hallway, Sally Ann's Dance girls, grabbing one of the dancers (sic) behind. Res redirected & taken to room.\" On 01/04/09 at 3:30 p.m., \". . . (Arrow pointing up) in w/c (wheelchair) at present, going down hallway in w/c. Grabs another female resident by the breast & let go. When asked why he did that, res states while laughing 'because I want to.' . . .\" (The female resident involved in this incident was Resident #30.) On 01/10/09 at 12:00 p.m., \"Res grabbed a visitor's buttocks /s (without) permission. Res redirected by staff & staff apologized to visitor. Res also entered female res rooms (sic) this am (morning) while res dressing. Res removed from room and returned to his hall area and explained to (sic) that his behavior is unacceptable. Res states 'I don't care.'\" On 01/10/09 at 7:40 p.m., \"Res repeatedly unzipped pants asking asking (sic) staff to zip them now. Res entered soil (sic) utility room grabbing laundry person.\" On 01/14/09 at 4:00 a.m., \". . . Conts (continues) to grab @ staff @ times. Re-directed, res just grins @ staff and reaches for staff again. . . .\" On 01/25/09 at 6:40 p.m., \". . . Grabbing staff inappropriately (sic). This writer redirected him numerous x's (times). Res even grabed (sic) another res inapproately (sic). Was told he was not allowed to touch another res. His comment was 'Why not.'. . .\" (The female resident involved in this incident was Resident #14.) On 01/29/09 at 10:30 a.m., \"Reported to this nurse by activities director, activity person was grabbed on 1/27/09 by this Res. Activity staff person has (4) small round bruises on (L) (left) inner thigh at area.\" --- Eighteen (18) entries recorded Resident #107 appearing outside of his room with no clothing on, exposing his genitalia to others. Examples of these entries include: On 12/13/08 at 3:30 p.m., \"Res wheeling self backward down hallway from room /c pants & underwear off. When res asked to get dressed, res laughing (sic) states 'I don't have too (sic).'. . .\" On 01/10/09 at 10:00 a.m., \". . . Wheeled self into hallway /c lower portion of body exposed. Staff assisted res in dressing & asked res to please not come out of room undressed. Res laughed. Grabbed several female staff this a.m. (morning) on the buttocks. When asked not to do this he smiles (sic) & and stated 'But I want to.' . . .\" On 01/11/09 at 2:00 a.m., \"Res (arrow pointing up) in w/c (arrow pointing up) & (arrow pointing down) hallway - removing clothes & going nude. Very aggressive when assisted to put clothes back on. . . .\" On 01/19/09 at 3:35 a.m., \"(Arrow pointing up) in w/c, frequently motivating (sic) self backwards. When asked to turn around, res becomes angry, states 'No! I don't want to' . . . In hallway /c bottom ? of body exposed. Redirected to room to dress.\" --- Twenty-seven (27) entries recorded Resident #107 wheeling his wheelchair backwards, creating a safety hazard for others. Examples of these entries include: On 11/20/08 at 8:00 p.m., \"Res /c (with) behavior issues. Attempting to remove t-shirt while in dining room. Staff reporting Res became aggressive & went backwards in wc (wheelchair) spinning another res around in their wc. Notified nurse regarding other res to assess for any injuries. . . .\" (There was no incident report for this event; the identity of the other resident involved could not be ascertained.) On 12/28/08 at 6:30 p.m., \"Res in w/c @ 4:15 p.m. motivating (sic) self backward. Ran w/c in to walker of another res, knocking it sideway (sic), Res stumbled, this nurse stopped res from falling. When redirected to (symbol for change) direction, Res grabbed this nurse by the arm, refusing to let go. Called for help & res released arm.\" (There was no incident report for this event; the identity of the other resident involved could not be ascertained.) On 01/18/09 at 3:25 a.m., \". . . Propelling self backwards (arrow pointing up) & (arrow pointing down) hallway. Enc to turn & go forward for safety - res refused. Explained risk of running into walls, furniture, other people - Res states 'I won't.' Had near miss /c female resident who was ambulating in hallway. Conts /c grabbing @staff @times. . . .\" (There was no incident report for this event; the identity of the other resident involved could not be ascertained.) --- Twenty-seven (27) entries recorded episodes of Resident #107 verbally abusing / being physically aggressive towards others, including staff, other residents, and visitors. Examples of these entries include: On 10/28/08 at 2:45 p.m., \". . . Grabbing @ staff's bottom saying 'I want it.' Res became aggressive & mad @ staff when redirected & told him it was inappropriate behavior. Res hit two staff members & told this writter (sic) that if I ran my mouth he'd hit me too. . . . Tried to grab another staff member's bottom as he went down the hall.\" On 11/05/08 at 11:40 p.m., \"Res tried to go into 400 hall main bathroom - alarm sounded. CNA's (certified nursing assistants) attempted to redirect res, whereupon res began yelling & hitting @ them. Res from room (number) was also in the hallway @ this x (time), mumbling to himself, which only made this res more upset. Res began yelling @ other man. . . .\" On 11/22/08 at 7:00 p.m., \". . . It was reported by roommate that he (Resident #107) pushed table into roommate (sic) leg & messing /c TV.\" On 12/03/08 at 6:45 p.m., \"Res in room /c all clothes off, lying in bed, masturbating. CNA's pulled curtain around resident. Res angry, got (arrow pointing up) in w/c per self, hitting @ staff & kicking. Cursing at staff saying 'You whore & [***] '. Res begins to chase CNAs down hallway & cursing, backing one CNA into corner & hitting @ CNA. . . .\" On 12/04/08 at 7:30 p.m., \". . . Res is grabbing at residents & staff. When redirected he gets verbally abusive & rams w/c into wall. When this writer explains to res that he can't do this (sic) his statement is 'I don't care.' . . .\" On 12/05/08 at 8:30 a.m., \"CNA went to let res know it was time for Breakfast. Res went to grab CNA. CNA stated 'Don't grab me.' Res then punched CNA in stomach. . . .\" On 12/20/08 at 1:00 p.m., \"Res motivating (sic) w/c backward & yelling. This nurse tried to redirect, started asking him his multiplications. He then saw another res coming (sic) said 'I'm going to hit him in the damn head.' He then started for other res. Other res stepped out of way. This res cont. This nurse held w/c to keep him from running into other res. He then started hitting at this nurse. CNA came to help. Redirected res to cafe. Res then stripped off clothes. When ask (sic) why res stated to this nurse 'Your (sic) mean (sic) you didn't let me hit him.' This nurse explained 'I could not let that happen.' Res said 'You could have turned your head.' . . .\" (There was no incident report for this event; the identity of the other resident involved could not be ascertained.) On 12/24/08 at 11:30 a.m., \"Upon walking up 400 hall, CNA voiced that '(Resident #107) is in that room & won't come out.' Res did come out of room. When asked res to 'give me (other resident)'s stuff.' Res became very aggressive and hitting this writer. Asked res to stop and go back over to his own room, res repeatedly yelled, 'shut up', 'don't touch me.' No staff had touched res. Res pushed back to 100 hall. This writer walked past res approx(imately) 10 min(utes) later, res stated, 'Your ass is mine. I want your butt.' Told res to stop. Res voiced, 'no, I want your butt.' Unable to redirect res. . . .\" On 01/20/09 at 3:40 a.m., \"Conts to propel self (arrow pointing up) hallway backwards. Attempts to redirect met /c aggression / swearing @ staff. Came (arrow pointing up) hallway /c bottom ? of body exposed. Asked to return to room to sleep or get clothes on. Res asked for assistance, then proceded (sic) to grope CNA repeatedly. Redirected /c res becoming verbally assaultive - calling staff '[***] es'. . . .\" On 01/30/09 at 10:00 p.m., \"Res (arrow pointing up) in w/c hitting staff & grabbing visitors. Hit CNA in this chest & this writer in the buttocks. Res was redirected & told not to behave in such a manner. He said 'Come on [***] (sic) & tried to run into us with this wheelchair.\" On 02/02/09 at 8:30 p.m., \"Res in main lobby attempting to go out front door. Keepsafe alarm sounding. Res hitting nurse & CNA's attempting to re-direct res from door. Standing & yelling 'Come on [***] !' Cursed at visitor & young daughter, states 'F-ck you!' Re-directed to room /p (after) 5-10 mins (minutes). Res conts to yell at CNA's. . . .\" --- Four (4) entries recorded Resident #107 removing the incontinence brief from a severely cognitively impaired [AGE] year old female resident (#108), who was totally dependent upon staff for her activities of daily living. On 12/03/08 at 7:30 p.m., \"Res returned to hallway. Into another female resident's room, female res yelling 'help me, help me.' Res in room uncovered other resident & was attempting to unfasten resident's wing (incontinence brief) & had hand over wing & thigh area. Res removed from room & states 'I was trying to help her to the BR.' . . .\" On 12/17/08 at 6:00 a.m., \"Res in female resident (sic) room, unfastened & opened res incontinence brief. When redirected to leave room & that it was inappropriate for him to be removing female resident (sic) clothes, (Resident #107) became agitated and attempted to back w/c into this writer. Removed from female (sic) room . . .\" On 12/20/08 at 4:40 a.m., \"Called to floor by CNA's who had found resident again in female resident room. Res had unfastened female's incontinence brief and pulled it down, exposing female's peri-area. When resident told he needed to leave room & not enter again, he became agitated and telling this writer to 'shut up'. . . .\" On 12/21/08 at 6:30 p.m., \"Res found in female resident's room, had unfastened incontinence wing (brief), exposing resident. Res asked to leave room & that it is inappropriate to re-enter room. Cursing at staff. Wheeled self backwards & to room.\" (Note that Resident #108 was discharged from the facility on 01/06/09.) ---- 3. Review of Resident #107's physician progress notes [REDACTED]. On 12/17/07, \". . . There have been no acute episodes although his behavior is not any better. . . .\" On 01/16/08, \". . . His behavior however has not improved. . . .\" On 02/13/08, \". . . His behavior is about the same. . . .\" On 05/15/08, \" . . His behaviors are not improved. . . .\" On 06/13/08, \"I have an extensive conversation with (Resident #107's responsible party). There have been some behavioral problems in regard to exposing himself and also with smearing feces. . . . A jumpsuit has been ordered and the use of this and timing were discussed. . . .\" On 07/15/08, \"(Resident #107) is generally stable. His (responsible party) did not want the use of jumpsuit. . . . He was seen by the neurologist and it was noted that he had a tremor, neurogenic bladder and behavior problems. . . .\" On 09/10/08, \". . . He has still been problematic with his aggressive sexual behavior here. Note from neurologist (from 07/14/08 consult) read regarding his tremor. . . . Also in regard to suggestion of Proscar will try this in regard to his libido.\" On 10/15/08, \". . . No changes in regard to tremor or behavior.\" On 11/12/08, \". . . The same aggressive behavior still an issue here, especially among the female staff. . . . This pt (patient) will be transferred to services of Dr. (name). . . .\" On 12/10/08, \"(Resident #107) has a history of CHI (closed head injury) with secondary [DIAGNOSES REDACTED], dysarthria, gait disorder, sexual aggression, ? depression, overactive bladder and lately has been exhibiting some increasing aggression and inappropriate behavior including masturbating in front of anybody who may be around including children . . . History of CHI with increasing agitation and inappropriate behavior. We will continue his current meds but will also add on Depakote 500 mg daily and monitor for affect (sic). . . .\" On 01/05/09, \". . . At last evaluation he was seen for some increasing aggression and inappropriate behavior and had Depakote added. There has been minimal improvement with this and he actually had an interaction with another resident, which may result in him being removed from this facility. . . . There is the potential that the pt will be removed from the facility later this mth (month) due to his behavior. . . .\" ---- 4. Resident #107's social services progress notes recorded that Resident #107's behaviors, although chronic, were escalating. Although, medication adjustments were being made and (beginning in September 2008) the facility started exploring alternative placements for the resident, the resident's care plans were not revised when the interventions were found to be ineffective in controlling and/or reducing the resident's behaviors. Examples of entries include: On 12/20/07, \". . . he has been displaying the following behavior problems: exit seeking (he is in the Exit (sic) seeking program & has orders for a secure care bracelet), resisting care (refusing medications - stating 'I don't want it') and socially inappropriate behavior AEB (as evidence by) defacating (sic) in his bed & then eating the feces. Care plans for these problems have been developed, revised, and/or continued. Res has not shown the following behavior problems during this assessment period. However, the care plans will be continued @ least until next review: (1) taking things that don't belong to him (ex. food), inappropriate dressing AEB being naked in public area, physical aggression d/t wheeling backward when upset (Res hit someone while doing this previously), and inappropriate sexual behavior as evidenced by grabbing or touching others on private areas of their bodies. . . .\" On 03/20/08, \". . . Resident has Behavior (sic) problems i (1) episode of verbal abuse to staff (sic) ii (2) episodes of lacking clothes off & Being (sic) in hallway naked. . . .\" On 04/07/08, \". . . Apparently, Res was in his room /c the door closed during the (fire) drill. A CNA went down the hallway opening Resident's (sic) doors. She opened (Resident #107)'s door & he allegedly slammed it shut on her fingers & toe which caused minor injuries. . . .\" On 06/20/08, \". . . He continues to have other behaviors such as grabbing other individuals on inappropriate areas of their bodies, yelling @ staff, hitting @ staff, refusing medications, & wheeling his w/c backwards. . . .\" On 09/18/08, \". . . Res is still exhibiting several behavior problems that include: exit seeking, physically & verbally abusive, going backward in his w/c, coming out into public areas /c 0 (no) pants on, touching / grabbing others inappropriately & refusing medications. . . This writer spoke with Res about all of these behaviors. He denied being physically abusive to staff. Otherwise, he had no explanation for the remaining behaviors. MD did order Proscar 5 mg q (every) day for (arrow pointing up)'d libido. . . .\" On 12/12/08, \"This writer was on telephone /c a family member when Res came into office unnoticed a (sic) grabbed this writer around waist / stomach area from behind. This writer attempted to push his arm / hand away. When I finally got him to remove his arm, I turned around & he had his arm raised, hand balled in a fist, as if he were going to punch this writer. However, he did not. . . .\" On 12/18/08, \"Resident's behavior seems to have been escalating over the last couple of months. Behaviors include: verbally abusive behavior (cursing @ staff), physically abusive behavior (hitting & punching staff, chasing staff, running into other /c w/c while going backward), socially inappropriate / disruptive behavior (slamming doors, going into other residents' rooms, removing his clothing in public, attempting to fondle female Resident & grabbing others on inappropriate areas of their bodies (sic), and resisting care (refusing meds). . . . MD did order Proscar for (arrow pointing up) libido but this does not appear effective. On 12/10/08, MD ordered 500 mg q day for CHI /c behaviors.\" On 12/18/08, \"Late entry for 11/25/08. Res moved to room (number). Will monitor for any adjustment problems.\" On 12/18/08, \"This writer has talked to Res about his new room a couple x's (times) & he has stated that he likes it. Res is having behaviors problems - but these are chronic & started escalating prior to his move.\" On 12/22/08, \"(Resident's responsible party) (sic) in person @ facility. Res behaviors were explained to her & that they are now not only affecting staff but other residents as well. She agreed to work /c us on a transfer to a more appropriate facility. . . (Resident's responsible party) will look over info from other facilities & we will proceed /c any other referrals per her request. NHA (nursing home administrator) did explain that facility was going to issue a d/c (discharge) notice. (Responsible party) was understanding. . .\" On 01/02/09, \"(Resident #107)'s roommate requested a rm (room) (symbol for change) stating he could not be in room /c (Resident #107) for one more day d/t behaviors. Roommate to be moved this evening.\" On 02/04/09, \"Res transferred to (area hospital) in hopes of admission to (area in-patient psychiatric facility) for behavioral eval. His Depakote was d/c'd (discontinued) d/t (arrow pointing up) liver enzymes & this may present a problem.\" ---- 5. During an interview on the afternoon of 02/10/09, the director of nursing (DON - Employee #5) identified that staff was to complete an incident /accident report when incidents resulted in resident injury; the DON reported Employee #21 was in charge of the incident / accident reports and additional questions would be needed directed to her. The DON also identified that the facility's administration did not believe Resident #107's behaviors were of a sexual nature (contrary to documentation found in nursing, social services, and physician progress notes [REDACTED]. When questioned about whether Resident #107 had received services from a mental health professional to address this increase in behaviors, since the resident's medical record revealed the last time he received the services of a psychologist was in 2006, the DON reviewed his record. Shortly thereafter, the DON acknowledged the facility did not refer Resident #107 for psychological or psychiatric services when he exhibited an increased frequency of behaviors at the end of October 2008. During an interview on the morning of 02/12/09, the director of care delivery (Employee #21) confirmed that incident / accident reports were completed on incidents resulting in resident injuries. However, no incident / accident reports were completed for the occurrences referenced above, nor was the frequency of these occurrences (verbally abusive / physically aggressive and/or socially and sexually inappropriate behaviors) being tracked in any way. (See citation at N362 for non-compliance with the State licensure rule, for failing to complete written reports for incidents / accidents involving residents either inside or outside of the nursing home.) ---- 6. Review of the resident's nursing notes revealed that, when Resident #107 exhibited these behaviors, staff responded by attempting to \"redirect\" him and informing him that his behaviors were \"inappropriate\". As evidenced by the frequent recurrence of the behaviors, these interventions were ineffective. Review of his care plan revealed a plan to address \"inappropriate touching behavior\" which was initiated on 12/19/06. The goal for this problem (\"Reduced incidents of inappropriate sexual behavior thru next care plan review\") was initiated on 12/19/06 and remained unchanged through present date; this goal was not measurable, as the facility failed to establish a baseline frequency for this behavior and failed to quantitatively and qualitatively document when Resident #107 exhibited this behavior. The interventions to achieve this goal remained essentially unchanged since revised on 12/18/08, although two (2) interventions were revised on 02/05/09, the day after he was discharged from the facility. Documentation in the nursing notes, from December 2008 through his date of discharge on 02/04/09, revealed he engaged in this behavior multiple times weekly, even multiple times daily, yet these interventions were not reviewed and revised when it should have been evident to the interdisciplinary care team that they were not effective. Review of his care plan revealed a plan to address physical and verbal aggression (\"Physical and verbal aggression (hitting, punching, cursing at others {sic} (usually staff) and slamming doors related to: closed head injury.\"), which was initiated on 06/19/07. The goals for this problem (\"Will not harm self or others during periods of physical aggression\" and \"Will not verbally abuse others\") were initiated on 06/19/07 and remained unchanged since that date. The interventions were last revised on 09/19/08. Documentation in the nursing notes, from October 2008 through his date of discharge on 02/04/09, revealed he engaged in this behaviors multiple times weekly, sometimes multiple times daily, yet these interventions were not reviewed and revised when it should have been evident to the interdisciplinary care team that they were not effective. Review of his care plan revealed a plan to address \"wheeling his wheelchair backwards into other individuals\", which was initiated n 06/20/08. The goal for this problem (\"Resident will wheel himself forward in his wheelchair.\") was initiated on 06/20/08 and remained unchanged since that date. The interventions were last revised on 06/20/08, and consisted of the following: \"Notify physician of behaviors as necessary. Ask resident nicely to turn his wheelchair around. Explain to resident in simple terms that he could hurt someone d/t (due to) not being able to see where he is going. Don't lecture Resident (sic). Present resolution of turning wheelchair around as a huge favor to you.\" Documentation in the nursing notes, from October 2008 through his date of discharge on 02/04/09, revealed he engaged in this behaviors multiple times weekly, yet these interventions were not reviewed and revised when it should have been evident to the interdisciplinary care team that they were not effective. Review of his care plan revealed a plan to address \"inappropriate dressing (being in public area without appropriate clothing on)\", which was initiated on 09/17/07. The goal for this problem (\"Will have neat and", "filedate": "2014-07-01"}
{"rowid": 11323, "facility_name": "HEARTLAND OF PRESTON COUNTY", "facility_id": 515072, "address": "300 MILLER ROAD", "city": "KINGWOOD", "state": "WV", "zip": 26537, "inspection_date": "2009-02-12", "deficiency_tag": 364, "scope_severity": "B", "complaint": 0, "standard": 1, "eventid": "IH3P11", "inspection_text": "Based on observation and staff interview, the facility failed to provide food that was attractive in appearance for the evening meal on 02/09/09. The food items served during evening meal provided only white, brown, and yellow as colors on the resident trays. This had the potential to affect all residents who chose the main entree for dinner on 02/09/09. Facility census: 106. Findings include: a) Observation of the dinner meal, on 02/09/09 at 5:00 p.m., found the meal consisted of chicken nuggets, cauliflower, and hashbrown casserole, which were brown and white in color. Pineapple was the dessert and was yellow in color. The appearance of the items on the residents' plates offered no variety in color and texture. An interview with the dietary manager ,and a review of the menus on the late morning of 02/12/09, found that fruit ambrosia was supposed to have been on the menu for that day. .", "filedate": "2014-06-01"}
{"rowid": 11324, "facility_name": "HEARTLAND OF PRESTON COUNTY", "facility_id": 515072, "address": "300 MILLER ROAD", "city": "KINGWOOD", "state": "WV", "zip": 26537, "inspection_date": "2009-02-12", "deficiency_tag": 371, "scope_severity": "F", "complaint": 0, "standard": 1, "eventid": "IH3P11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and staff interview, the facility failed to ensure pre-poured containers of thickened milk and [MEDICATION NAME] milk were held at acceptable temperatures of 41 degrees Fahrenheit or less. This had the potential the affect all ten (10) residents who were to receive these beverages. The facility also did not keep records to make sure that cold foods were at appropriate temperatures when received from the food supplier. This had the potential to affect all residents. Facility census: 106. Findings include: a) Five (5) glasses of thickened milk and five (5) glasses of Lactacid milk were on a tray sitting on the counter during observation of the evening meal at 5:00 p.m. on 02/09/09. Temperatures taken of sampled glasses found the beverages were held at 42.9 and 43 degrees Fahrenheit. An interview with the dietary manager, after this observation, found the milks were on a tray with ice packs under it, but this method did not ensure the milk was being held at a cool enough temperature. b) During the dietary observation on 02/09/09 at 5:00 p.m., the dietary manager indicated that, when food was received from the food supplier, temperatures were taken but were not recorded in order to ensure that foods were kept at proper temperatures. .", "filedate": "2014-06-01"}
{"rowid": 11325, "facility_name": "HEARTLAND OF PRESTON COUNTY", "facility_id": 515072, "address": "300 MILLER ROAD", "city": "KINGWOOD", "state": "WV", "zip": 26537, "inspection_date": "2009-02-12", "deficiency_tag": 441, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "IH3P11", "inspection_text": "Based on observation, it was determined the infection control program failed to ensure staff practices were consistent with appropriate infection control techniques. A nurse donned gloves, then contaminated the gloves prior to dressing the resident's wound. One (1) of nineteen (19) current residents on the sample was affected. Resident identifier: #45. Facility census: 106. Findings include: a) Resident #45 On the mid-morning of 02/11/09, a nurse (Employee #112) was observed providing treatment to an unstageable wound on the resident's left heel. The wound was covered with eschar that had loosened from the healthy skin surrounding the wound. After cleaning the wound, the nurse removed her gloves, washed her hands, and donned new gloves. After donning the clean gloves, she opened the packages containing the dressing supplies, then put her hand in her pocket to extract an ink pen. The pen was uncapped, and she used it to label the dressing. The dressing was then applied to the resident's heel wound. The nurse's pocket would be considered an unclean area, as would the pen. This created a potential to introduce nonresident organisms into the resident's wound. .", "filedate": "2014-06-01"}
{"rowid": 11326, "facility_name": "HEARTLAND OF PRESTON COUNTY", "facility_id": 515072, "address": "300 MILLER ROAD", "city": "KINGWOOD", "state": "WV", "zip": 26537, "inspection_date": "2009-02-12", "deficiency_tag": 309, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "IH3P11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, review of manufacturer's dosing instructions, and staff interviews, the facility did not ensure antibiotics were administered at times that would maintain blood levels of the medication for optimal effect. Two (2) of nineteen (19) residents on the sample were identified as being affected, and review of the February medication administration records (MAR) for the 100 hall identified an additional two (2) residents. Resident identifiers: #52, #15, #95, and #51. Facility census: 106. Findings include: a) Resident #15 Review of the resident's medical record found that, on 01/19/09, [MEDICATION NAME] (an antibiotic) had been ordered given three (3) times a day pending the culture of the resident's [MEDICAL CONDITION] site. Review of his MARs revealed the antibiotic had been scheduled for administration at 8:00 a.m., 12:00 p.m., and 5:00 p.m. That meant the three (3) antibiotic doses were given in an approximately nine (9) hour period, leaving fifteen (15) hours between the 5:00 p.m. dose and the 8:00 a.m. dose on the following day. b) Resident #51 The resident's current orders included Bactrim DS to be given twice a day for five (5) days. The antibiotic was scheduled for administration at 9:00 a.m. and 5:00 p.m. on the MAR. This schedule provided for the doses for one (1) day to be given eight (8) hours apart, and the next dose would not be given for approximately sixteen (16) hours. c) Resident #52 The resident's current MAR indicated [REDACTED]. The antibiotic was scheduled for administration at 8:00 a.m., 12:00 p.m., and 5:00 p.m. d) Resident #95 A current order for Bactrim DS to be given twice a day for ten (10) days was noted on the resident's current MAR. The medication was scheduled to be given at 8:00 a.m. and 5:00 p.m. e) The director of nursing was interviewed on 02/11/09. When asked about the scheduling of antibiotics, she was unable to offer a reason for the current schedules. During a discussion regarding maintaining serum levels of certain drugs, especially antibiotics, she acknowledged it would be important to maintain the levels. f) Review of package inserts (obtained for in the Food and Drug Administration's website) from the pharmaceutical companies for each of these antibiotics found that, under the section for \"Dosage and Administration\", each included instructions that doses should be administered every twelve (12) hours if the medication was given twice a day and every eight (8) hours if given three (3) times a day. .", "filedate": "2014-06-01"}
{"rowid": 11327, "facility_name": "HEARTLAND OF PRESTON COUNTY", "facility_id": 515072, "address": "300 MILLER ROAD", "city": "KINGWOOD", "state": "WV", "zip": 26537, "inspection_date": "2009-02-12", "deficiency_tag": 279, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "IH3P11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of medical records, observations, and staff interviews, the facility did not develop a care plan for each resident which was based on the comprehensive assessment and included measurable goals. For example, residents were assessed as being on scheduled toileting plans, yet their care plans did not include a plan for incontinence management. Goals were not stated in measurable terms, so that progress toward the goal or a need to alter the approaches to the problem could be determined. Additionally, in some instances, the interventions did not lend to achievement of the stated goal. Resident identifiers: #82, #30, #80, and #15. Facility census: 106. Findings include: a) Resident #82 1. Review of the resident's most recent minimum data set (MDS) assessment, with an assessment reference date (ARD) of 12/01/08, revealed she had both short-term and long-term memory problems. She had been assessed as having severe impairment in the area of decision-making; as being understood sometimes; and as rarely being able to understand what was said to her. Her [DIAGNOSES REDACTED]. She was able to move about in her wheelchair independently. Observations of the resident, on 02/11/09, found she had wandered into a room near her own room at 3:30 p.m., and at 3:45 p.m., she had maneuvered her wheelchair into another room nearby. A nursing assistant (Employee #77) was asked whether the resident often wandered into other residents' rooms and replied that she did. Review of the resident's care plan found no care plan to address the issue of this resident wandering into other residents' rooms. 2. Review of the medical record found a nursing entry on 10/03/08 regarding the resident licking her bedside table. Subsequent nurses' notes also described the resident licking things such as the desk at the nurses' station. On 02/11/09, in mid morning, Employee #112 was asked whether the resident still licked things. She said the resident continued to lick things and that the doctor was aware. She also said the resident would usually stop when instructed to do so. Review of the resident's care plan found no plan had been developed to address this behavior. 3. The following goal had been established: \"Will maintain existing ADL (activities of daily living) self performance thru next care plan review.\" This goal was not measurable. 4. Another goal was: \"'Res(ident) will remain oriented to self thru next care plan review.\" The interventions were to attempt to have her imitate the activity staff wanted her to perform, to attempt to provide consistent routines and caregivers, provide access to a clock and calendar, etc. None of the interventions offered guidance to care givers regarding how the resident was to be \"oriented to self.\" 5. Another goal was: \"Ensure needs will be met AEB (as evidenced by) res will be kept clean, dry and well groomed daily thru next care plan review.\" The interventions were: \"When talking to resident, use gestures and simple sentences while maintaining eye contact. Monitor for and report any changes in communication abilities / efforts. Provide reassurance and patience when communicating with resident. Gain individual's attention before beginning to converse.\" These interventions were related to communication, which did not address the stated goal regarding grooming and hygiene. Additionally, the goal was staff-oriented (what staff would do for the resident), not resident-oriented (what the resident would do for herself). b) Resident #30 1. The goal was: \"Resident will show less frequent experiences of sundown type of anxiouness (sic) by next care plan review.\" This goal included no parameters by which a determination of \"less frequent\" could be made. 2. Another goal was: \"Will maintain existing ADL self performance. Resident will be clean well groomed and dressed daily thru next care plan review.\" There were no parameters included in this part of the care plan to render it measurable. 3. Another goal was: \"Will be oriented to self thru next care plan review.\" The interventions associated with this goal did not provide insight as to how the resident would be oriented to self. 4. Another goal was: \"Ensure needs will be met by staff AEB (as evidenced by) resident will be clean, well groomed and dressed daily thru next care plan review.\" The interventions were: \"When talking to resident, use gestures and simple sentences while maintaining eye contact. Monitor for and report any changes in communication abilities/efforts. Provide reassurance and patience when communicating with resident.\" The interventions were related to communication, which did not address the stated goal regarding grooming and hygiene. Additionally, the goal was not resident-oriented. 5. Another goal was: \"To show minimal/no side effects of medications thru next care plan review.\" The problem statement include the resident was on an antipsychotic medication, but the medications was not identified anywhere in this plan. The interventions were: \"Monitor for and report to physician signs of adverse reaction such as .... Review medication regimen. Evaluate effectiveness and side effects of medications for possible decrease/elimination of [MEDICAL CONDITION] drugs. Monitor mood state/ behavior. AIMS (abnormal involuntary movement scale) testing q (every) 6 months & prn (as needed). [MEDICAL CONDITION] drug gradual dose reduction if not clinically contraindicated.\" None of the interventions would prevent side effects of medications. 6. According to the resident's most recent quarterly MDS, with an ARD of 01/09/09, the resident was able to feed herself with supervision. She was also noted to have chewing and swallowing problems. These factors had not been incorporated in the resident's care plan. 7. The resident's quarterly assessment also indicated she had been assessed as continent of bowel and frequently incontinent of bladder. She was coded as being on a scheduled toileting plan, however, the care plan did not include anything regarding incontinence management. c) Resident #80 1. A goal was: \"Will improve ADL self performance as evidenced by (sic) thru next care plan review.\" There was nothing included in the goal to identify how improvement would be evidenced. The goal was not measurable. According to the quarterly MDS, with an ARD of 01/02/09, the resident required limited to extensive assistance with most ADLs. 2. Another goal was: \"Demonstrate understanding by completing task when requested thru next care plan review.\" No frequency of the expectation of occurrence was included. The problem statement associated with this goal was: \"Difficulty communicating as evidenced by expressive / communication impairment related to multi-infarct dementia.\" According to her quarterly MDS, she usually understood what was said to her and she could usually be understood. Therefore, there was an inconsistency between the assessment and this care plan. 3. Another problem was: \"Dental or oral cavity health problem as evidenced by res with carious, broken, missing teeth.\" The goal was: \"will (sic) be able to chew food sufficiently to swallow safely / without pain thru next care plan review.\" The interventions were: \"Assist with oral hygiene as needed. Monitor for and report any changes in oral cavity, chewing ability, S&S (signs and symptoms) oral pain, etc.\" The plan did not address how the resident was to be enabled to chew food sufficiently in order to swallow safely / without pain. 4. The resident's assessment of 01/02/09, identified the resident as requiring the extensive assistance of one (1) for toileting. She was noted to be occasionally incontinent of bladder and usually continent of bowel and to be on a scheduled toileting plan. Incontinence management was not addressed in the resident's care plan. d) Resident #15 1. A goal was: \"Res. will not have any complications r/t (related to)[MEDICAL CONDITION]([MEDICAL CONDITION] reflux disease) by next care plan review.\" The interventions were: \"Monitor effectiveness of medication taken. Administer med per MD order. Notify MD prn.\" Although the goal was stated in preventative terms, the interventions, other than administration of medications, were not preventative in nature. Additionally, no nursing interventions were described in the plan. 2. A goal was established for the resident to show improvement in his balance, range of motion, mobility, ability to transfer, sitting tolerance, and shaping of his stump. The goal did not include any parameters so that progress, or lack of progress, toward the goal could be determined. 3. A problem statement was: \"Decreased safety and I (independence) with self-care ADL's (sic)\" with a goal of \"Maximize safety and I with self-care ADL's\". The only intervention was: \"there ex, there act, ADL (therapeutic exercise, therapeutic activity, activities of daily living).\" This plan offered little insight into the resident's needs. Additionally, it was not stated in measurable terms. .", "filedate": "2014-06-01"}
{"rowid": 11368, "facility_name": "VALLEY HAVEN GERIATRIC CENTER", "facility_id": 515123, "address": "RD 2, BOX 44", "city": "WELLSBURG", "state": "WV", "zip": 26070, "inspection_date": "2009-03-18", "deficiency_tag": 431, "scope_severity": "E", "complaint": null, "standard": null, "eventid": "IFJQ11", "inspection_text": "Based on an observation and staff interview, the facility did not ensure that two (2) of two (2) treatment carts were entered only by authorized personnel. A nursing assistant was permitted to have a key to open both treatment carts, which contained supplies and topical medications prescribed to residents by the physician. Facility census: 53. Findings include: a) An observation, on 03/18/09 at 10:00 a.m., revealed a nursing assistant (NA) was assisting the treatment nurse with resident treatments on 200 hall of the facility. The NA was observed using a key to enter the treatment cart and remove treatment supplies. An interview the NA, on 03/18/09 at 10:30 a.m., revealed she assisted the treatment nurse and was permitted to have a key to open both treatment carts. She also stated she would retrieve the necessary supplies and treatments (which would include physician-ordered topical medications) for the nurse. .", "filedate": "2014-04-01"}
{"rowid": 11369, "facility_name": "VALLEY HAVEN GERIATRIC CENTER", "facility_id": 515123, "address": "RD 2, BOX 44", "city": "WELLSBURG", "state": "WV", "zip": 26070, "inspection_date": "2009-03-18", "deficiency_tag": 225, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "IFJQ11", "inspection_text": "Based on facility record review and staff interview, the facility failed to make reasonable efforts to uncover criminal histories of two (2) sampled employees, by failing to conduct criminal background checks in all States in which these employees had previously worked. Employee identifiers: #1 and #4. Facility census: 53. Findings include: a) Employee #1 A review of the personnel file of Employee #1, who was hired on 01/21/08, revealed she possessed a nursing license from the Commonwealth of Pennsylvania, and information on her her employment application indicated prior work history in that State. However, there was no evidence of efforts by the facility to inquire about possible criminal convictions in that State which would have made her unsuited to work in a nursing facility. This was verified by the administrator after he had reviewed the file himself. b) Employee #4 A review of the personnel file of Employee #4, who was hired on 12/23/08, revealed prior work history in the State of Ohio. However, there was no evidence of efforts by the facility to inquire about possible criminal convictions in that State which would have made her unsuited to work in a nursing facility. This was verified by the administrator after he had reviewed the file himself. .", "filedate": "2014-04-01"}
{"rowid": 11370, "facility_name": "VALLEY HAVEN GERIATRIC CENTER", "facility_id": 515123, "address": "RD 2, BOX 44", "city": "WELLSBURG", "state": "WV", "zip": 26070, "inspection_date": "2009-03-18", "deficiency_tag": 314, "scope_severity": "G", "complaint": null, "standard": null, "eventid": "IFJQ11", "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 provide the necessary care and services to prevent new pressure sores from developing for one (1) of three (3) residents whose medical records were reviewed for pressure ulcers. Resident #16 had been assessed as being at low risk for development of pressure ulcers. Medical record review revealed the resident developed a pressure ulcer, which was treated, healed, and then re-opened, because the facility failed to provide a pressure relieving device for chairs in which the resident spent most of the day sitting. Resident identifier: #16. Facility census: 53. Findings include: a) Resident #16 Medical record review revealed Resident #16 developed a pressure ulcer on 01/08/09. The resident was treated, and staff recorded the wound was healed on 02/16/09, after which preventive treatment was used. Review of the resident's Braden Scale, used to predicting pressure sore risk, revealed the resident was rated as being at mild risk for the development of pressure sores. During a treatment on 03/17/09 at 10:00 a.m., observation revealed the resident had a red area on the lower coccyx at the cleft of the buttocks. When the treatment nurse cleansed the red area, observation revealed two (2) small areas open areas which measured 0.2 x 0.2. Interview with the treatment nurse (Employee #80) during this observation revealed the area had been healed and these two (2) areas had just re-opened. When the treatment nurse was questioned as to why the resident had developed a pressure ulcer and why the area had re-opened, the nurse indicated the resident spent a large part of her day sitting in a chair at the nurse's station, and she stated the resident probably needed a pressure relieving cushion. On 03/17/09, observations found the resident moved independently in bed and was ambulatory with a walker and staff assistance. Observations beginning at 11:00 a.m. found the resident sitting in a chair in front of the nurse's station; at 2:15 p.m., staff assisted the resident to bed to be seen by the physician. The chair in which the resident sat was wooden with a curved back and a small flat cushion built onto the chair seat. Review of physician's orders [REDACTED]. On 03/18/09 at 11:30 a.m., observation again found the resident sitting in the wooden chair in front of the nurse's station. During a subsequent interview at 12:05 p.m. on 03/18/09, the treatment nurse (Employee #80) was asked if the small flat cushion which was built onto the resident's chair was adequate as a pressure relieving device, and she stated it was not adequate. .", "filedate": "2014-04-01"}
{"rowid": 11371, "facility_name": "VALLEY HAVEN GERIATRIC CENTER", "facility_id": 515123, "address": "RD 2, BOX 44", "city": "WELLSBURG", "state": "WV", "zip": 26070, "inspection_date": "2009-03-18", "deficiency_tag": 329, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "IFJQ11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observations, and staff interview, the facility failed to ensure the medication regimen of one (1) of ten (10) sampled residents was free of unnecessary drugs. Resident #21, who was receiving 2 mg a day of [MEDICATION NAME] (greater than the maximum daily dosage recommended for geriatric residents), was exhibiting no behaviors for which the medication was originally ordered, had the medication held on several occasions due to sleeping, and had no attempted gradual dose reduction for ten (10) months. Resident identifier: #21. Facility census: 53. Findings include: a) Resident #21 A review of the resident's medical record indicated this [AGE] year old female was admitted to the nursing facility on 05/07/08, with a physician's orders [REDACTED].\" The resident continued to the present to receive the original dose [MEDICATION NAME] 0.5 mg four (4) times a day, for a total of 2 mg a day. A review of the facility's behavior record indicated that, for the months of February 2009, January 2009, December 2008 , November 2008, and October 2008, the resident did not exhibit any behaviors. The behaviors identified on this record for monitoring included agitation over need to leave and exit-seeking behavior. A review of the physician's progress notes revealed that only one (1) entry addressing the [MEDICATION NAME], dated 11/25/08, in which the physician indicated, \"Continue [MEDICATION NAME] less overall anxiety and less of a fall risk at present.\" Observations of the resident, on 03/11/09 at 3:30 p.m. and 03/12/09 at 11:00 a.m., revealed the resident sitting in a wheelchair with the staff moving the resident to other locations in the facility. An observation of the resident, on 03/16/09 at 10:30 a.m.. revealed the resident lying in bed sleeping. Later at 2:30 p.m., the resident was again observed lying in bed sleeping. A nursing note, dated 02/26/09 (no time was documented), indicated the resident was lethargic related to not sleeping most of the night. The resident's [MEDICATION NAME] was held for the 1:00 p.m. dose. On 02/27/09 at 9:00 a.m., a nursing note indicated the resident was sleeping and the breakfast tray was held. On 03/01/09 at 9:00 a.m., a nursing note again indicated the resident was sleeping and the breakfast tray was held. A review of the CMS Appendix N for unnecessary medication revealed the recommended daily dose for the geriatric resident for the short acting benzodiazepine drugs ([MEDICATION NAME]) was 0.75 mg. A gradual dose reduction should be attempted at least twice within one (1) year. Resident #21 was receiving 2 mg a day and with no attempted dose reduction for ten (10) months. .", "filedate": "2014-04-01"}
{"rowid": 11216, "facility_name": "REYNOLDS MEMORIAL HOSPITAL, D/P", "facility_id": 515112, "address": "800 WHEELING AVENUE", "city": "GLEN DALE", "state": "WV", "zip": 26038, "inspection_date": "2009-03-27", "deficiency_tag": 329, "scope_severity": "G", "complaint": 1, "standard": 0, "eventid": "1UMJ11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview, the facility failed, for one (1) of eight (8) sampled residents, to ensure medications were not given without adequate indications of use and at an excessive dosage. The facility also failed to ensure that alternative causes for behaviors were ruled out and non-pharmacologic interventions were attempted without success prior to the use of psychoactive medications. Resident #19 experienced harm as evidenced by oversedation and decreased respirations after administration psychoactive medications. Resident identifier: #19. Facility census: 18. Findings include: a) Resident #19 Medical record review, on 03/25/09, revealed Resident #19 was admitted to the facility on [DATE]. On 09/15/08, a physician order [REDACTED]. Review of the nursing progress notes failed to record any behaviors to indicate the need for [MEDICATION NAME]. On 09/16/08 at 13:49 (2:49 p.m.), nursing progress note indicated, \". . . had been resting in chair very drowsy arouse when name called tho very weak, color dusky O2 sat on 3 liters 96 %, apical rate 92 and regular, faint bowel sounds, abdomen firm and distended had small loose stool this am (morning).\" On 09/18/08, the physician ordered [MEDICATION NAME] 0.5 mg by mouth now for agitation and then [MEDICATION NAME] 0.5 mg every six (6) hours as needed for constant position changes, along with [MEDICATION NAME] 12.5 mg by mouth at night for the [DIAGNOSES REDACTED]. A nursing progress note, dated 09/18/08 at 18:23 (6:23 p.m.), revealed, \"Pt becoming more restless and confused, attempts to get out of bed unassisted, family members cannot reason with him, medicated for pain.\" A subsequent nursing progress note, dated 09/19/08 at 00:19 (12:19 a.m.), stated, \"1915 Pt voice was heard loudly from room out at nurses station, wife was holding pt's hands. Pt was agitated was to leave, she was trying to calm and reported by daughter bent her fingers back, he was out one side of the bed then the other, up in a chair.\" A nursing progress note, dated 09/20/08 at 06:06 (6:06 a.m.), stated, \"Pt rested at long intervals tho when awake is confused, bed alarm sounded several times when pt turned in bed, wanting to go home pt reassured that he will need to stay here for breakfast, to seemed satisfied with answers.\" Nursing progress note, dated 09/20/08 at 23:31 (11:31 p.m.), stated, \"@22:45 notified Dr. (name) patient is disrobing, pulling at TLC, IV, and O2 tubing getting out of bed unassisted. Insisting on going home, wife is present and can not calm patient . Order received for [MEDICATION NAME] 0.5 mg IM X 1 dose now.\" A physician's orders [REDACTED].\" A nursing progress note, dated 09/20/08 at 23:57 (11:57 p.m.), stated, \"Pt very drowsy and lethargic, skin warm and dry, responded weakly when pt into bed from recliner chair by son and 2 staff members, O2 per nasal canula at 3 liters, sat 97 -100 %, after pt in bed, very sedated, Cheyne Stokes respirations.\" A nursing progress note, dated 09/20/08 at 23:57 (11:57 p.m.), stated, \"periods of apnea [MEDICATION NAME] for 1 minute and more, when breathing 24 resp over 30 seconds wit exp wheezing, dr chin beeped X 1, apical rate 60 and irregular blood sugar 117.\" An entry, dated 09/21/08 at 00:05 (12:05 a.m.), stated, \"Sa tx given by Rt resp regular, pt responds by opening eyes.\" Following this excessive sedation, the physician ordered, on 09/21/08, \"(arrow up) [MEDICATION NAME] 25 mg at hs (hour of sleep) at pm (night).\" A nursing progress note, dated 09/23/08 at 14:33 (2:33 p.m.), stated, \"[MEDICATION NAME] for [MEDICAL CONDITION] AEB abusive behaviors. No adverse reactions noted at this time.\" On 09/28/08, Resident #19 was transported to the emergency room after the nurse was unable to find pedal pulses; he was subsequently admitted to the hospital for a blood clot. The facility failed to adequately identify behaviors, complete a thorough assessment to determine possible causes of the behaviors, and provide non-pharmacological interventions to help eliminate behaviors prior to administering psychoactive medications. The facility used pharmacologic interventions which sedated and depressed his respirations. On the evening of 03/25/09, the head nurse (Employee #7) revealed this resident was at the facility prior to her employment. Following review of the medical record, she did not produce any additional information to dispute these findings. .", "filedate": "2014-07-01"}
{"rowid": 11307, "facility_name": "WELCH COMMUNITY HOSPITAL", "facility_id": "51A009", "address": "454 MCDOWELL STREET", "city": "WELCH", "state": "WV", "zip": 24801, "inspection_date": "2009-04-10", "deficiency_tag": 323, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "4JJY11", "inspection_text": "Based on observations, medical record review, and staff interviews, the facility failed to ensure the residents' environment was as free of accident hazards as possible. One (1) of the three (3) styles of beds in use in the facility exhibited gaps between the side rail and the mattress sufficient to pose a risk of entrapment to a resident's arm or leg. Six (6) of nine (9) residents on the sample were affected. Additionally, a housekeeper was observed mopping the floor in the hall. She mopped across the entire hall and did not leave a dry lane for residents who were traveling through the hall. One (1) resident was observed removing the bar from a Merrywalker-type chair so she could sit on her bed. She had difficulty lifting her foot over the strap of the chair, which passed between her legs, in order to exit the chair. This created a falls hazard. Resident identifiers: #5, #9, #22, #34, #35, #47, and #12, and any residents ambulating through the hall. Facility census: 47. Findings include: a) Residents #5, #9, #22, #34, #35, and #47 These residents had been observed periodically throughout the survey to have their side rails elevated when they were in bed. On the morning of 04/10/09, nine (9) of the twelve (12) residents on the sample were still in bed. The space between the side rails and the mattresses were evaluated. It was found that one could easily pass one's arm (to a height above the elbow) through the space between the mattress and below the the end of the side rails on these residents' beds. The thin arms and legs of the residents could easily become entrapped between the rails and the mattress. Resident #47's bed rails were covered with fitted pads, but the pads did not prevent passage of one's arm between the rails and the mattress. Three (3) styles of beds and side rails were assessed. Two (2) styles did not pose a problem. However, the third type of bed had side rails that were offset from the frame, resulting in a gap between the side rail and mattress. b) Housekeeping On 04/09/09 at 10:40 a.m., a housekeeper was observed mopping the hallway. She would mop a section of the hall from one (1) side to the other, then move to the next part of the hall and again mop clear across the hall. This resulted in residents and staff having to walk on wet, or partially wet, tiles increasing the potential for falls. c) Resident #12 On the morning of 04/10/09, while assessing this resident's ability to release herself from a Merrywalker-type chair, the resident was observed to enter her room and remove the bar from the front of the chair. She was wanting to sit on her bed. She tried to stand and lift her right foot over the strap that went from the front of the device, between her legs, and to the seat of the chair. She was unable to lift her foot high enough to clear the strap. She then sat on the seat of the chair and began to try to lift her foot over the strap. After several attempts, she was able to clear the strap, get out of the chair, and sit on the side of her bed. The director of nursing was present during this observation. The possibility of the resident becoming entangled in the strap was discussed. She later related the strap had been removed from the chair. .", "filedate": "2014-07-01"}
{"rowid": 11025, "facility_name": "HEARTLAND OF KEYSER", "facility_id": 515122, "address": "135 SOUTHERN DRIVE", "city": "KEYSER", "state": "WV", "zip": 26726, "inspection_date": "2009-04-27", "deficiency_tag": 323, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "53ZE12", "inspection_text": "Based on observation and staff interview, the facility failed to ensure medication carts were locked when left unattended by the nurse. This occurred for two (2) of four (4) medication carts observed during tour on 04/19/09. Facility census: 114. Findings include: a) Observations, on 04/19/09 at 9:15 p.m., found the medication cart was left unlocked by the nurse. The nurse (a registered nurse - Employee #24) was not within sight of the cart, and the corridor door to the room in which the nurse was passing medications. Upon coming out of the room, the nurse was notified the medication cart was not locked. b) Observations, on 04/19/09 at 9:30 p.m., found the medication cart was left unlocked by the nurse. The nurse (a licensed practical nurse - Employee #11) was not within sight of the cart, and the corridor door to the room in which the nurse was passing medications was closed. There were sixteen (16) vials of insulin located on the top of the medication cart in a box. .", "filedate": "2014-09-01"}
{"rowid": 11115, "facility_name": "NEW MARTINSVILLE CENTER", "facility_id": 515074, "address": "225 RUSSELL  AVENUE", "city": "NEW MARTINSVILLE", "state": "WV", "zip": 26155, "inspection_date": "2009-04-30", "deficiency_tag": 279, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "6TSD11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, resident interview, observation, and staff interview, the facility failed to initiate a care plan and/or adequately address problems identified in the comprehensive resident assessment for five (5) of thirteen (13) sampled residents. Resident identifiers: #83, #78, #24, #43, and #158. Facility census: 101. Findings include: a) Resident #83 A review of Resident #83's medical revealed an [AGE] year old female with [DIAGNOSES REDACTED]. She was identified, on her quarterly minimum data set assessment (MDS) completed on 04/08/09, as exhibiting the behavior of wandering, and there were two (2) recorded incidents of resident-to-resident conflicts (08/01/08 and 03/06/09) involving her wandering behavior. A resident assessment protocol indicated this behavior would be care planned, but a review of the resident's entire current care plan failed to find wandering identified as a care plan problem with measurable goals and/or nursing interventions to be implemented. During an interview with the administrator and the director of nursing (DON) at 5:15 p.m. on 04/28/09, the DON acknowledged that, except for general interventions for cognitive deficiency, the resident's wandering behaviors were not addressed in her current care plan. On 04/30/09, the DON presented copies of an addendum to the resident's care plan addressing, \"Resident @ risk for injury R/T (related to) wandering with-in facility.\" b) Resident #78 A review of Resident #78's medical record revealed a [AGE] year old female with [DIAGNOSES REDACTED]. At the confidential resident group meeting held at 3:00 p.m. on 04/28/09, five (5) residents in attendance complained about Resident #78 wandering in and out of their rooms many times during the night. Resident #78 was also observed walking in a random manner several times throughout the survey. Review of her significant change in status MDS (02/07/08) and the most recent quarterly MDS (03/04/09) revealed the assessor indicated the resident exhibiting wandering during the assessment reference periods, and a resident assessment protocol (RAP) completed in conjunction with the significant change in status MDS indicated this behavior would be addressed in the resident's care plan. A review of the resident's entire current care plan failed to find wandering identified as a care plan problem with measurable goals and/or nursing interventions to be implemented. During an interview with the administrator and the DON at 5:15 p.m. on 04/28/09, the DON acknowledged that, except for general interventions for cognitive deficiency, the resident's wandering behaviors were not addressed in her current care plan. On 04/30/09, the DON presented copies of an addendum to the resident's care plan addressing, \"Resident @ risk for injury R/T wandering with-in facility.\" c) Resident #24 A review of Resident #24's medical record revealed an [AGE] year old male with [DIAGNOSES REDACTED]. At the confidential resident group meeting held at 3:00 p.m. on 04/28/09, five (5) residents in attendance complained about Resident #24 wandering in and out of their rooms many times during the night. Nurses notes documented the following: - On 02/19/09, \"... up all night. Physically combative when redirected.\" - On 03/06/09, \"... up ambulating all hours day and night. Only sleeps short periods.\" - On 04/27/09, \"Wandered throughout night.\" The quarterly MDS (03/25/09) identified the resident as exhibiting wandering behaviors which are not easily redirected, and there was an incident report regarding elopement, when he exited the building on 04/27/09. A review of the resident's entire current care plan failed to find wandering identified as a care plan problem with measurable goals and/or nursing interventions to be implemented. During an interview with the administrator and the DON at 5:15 p.m. on 04/28/09, the DON acknowledged that, except for general interventions for cognitive deficiency, the resident's wandering behaviors were not addressed in her current care plan. On 04/30/09, the DON presented copies of an addendum to the resident's care plan addressing, \"Resident @ risk for injury R/T wandering with-infacility.\" d) Resident #43 Review of Resident #43's current care plan, on 04/27/09, revealed the facility had not addressed wandering as a care problem for this resident. Observations of Resident #43, on 04/28/09 and 04/29/09, revealed the resident would wander into the rooms of other residents. Observation, on 04/29/09 at 2:20 p.m., found Resident #43 in the hallway her scooter chair removing the soft Velcro bars from the door frame of another's resident room and entering hallway into the room. Interview with the resident occupying the room into which Resident #43 entered revealed this occurred frequently. In an interview on the late afternoon of 04/29/09, Employee #80 acknowledged Resident #43 did wander into other residents' room. e) Resident #158 A review of nursing notes found an entry, dated 01/22/09, recording the resident was found in a male resident's room, sitting on the male resident's bed. The male resident had his hand on Resident #158's thigh, and staff believed the male resident through Resident #158 was his wife. A subsequent nursing note, later on 01/22/09, indicated Resident #158 was still wandering into other residents' rooms. A review of the nurse's notes found the resident was put on one-on-one monitoring, and a care plan was developed on 01/27/09, which was later discontinued on 01/30/09. On 01/30/09, the resident's care plan was updated to indicate staff was to monitor the resident every fifteen (15) minutes; this intervention was discontinued on 02/03/09. Further record review revealed a nursing note, dated 02/11/09 at 11:35 a.m., recording this resident drank approximately 1 teaspoon of green apple hand sanitizer. A review of the incident report and accompanying investigation found the resident accessed the hand sanitizer in the housekeeping supervisor's office. A review of the 02/11/09 interim care plan found the resident was to be in areas of supervision. On 02/22/09, the resident continued to wander in and out of other residents' rooms and was hard to redirect. The resident described was \"combative and unwilling to leave other's rooms.\" Nursing notes, dated 03/06/09, 03/08/09, 03/22/09, and 03/26/09, contained descriptions of wandering, difficulty redirecting, rummaging in other residents' closets, drinking other residents' drinks, and waking up other residents. On 04/11/09, the resident's care plan was revised in response to Resident #158 striking out at another resident. Interventions included: \"redirect, remind of inappropriate behavior and not to strike, and monitor activity...\" On 04/12/09, the resident was found outside. The care plan included interventions, such as: \"Maintain Watchmate sensor per orders, monitor whereabouts through shifts, and answer alarms promptly.\" The care plan did not include interventions developed specifically for the resident. A review of the resident's entire current care plan found a care plan had not been developed to address the identification what might be precipitating the resident's behaviors. Interventions in the care plans only addressed interim and temporary solutions but did not address ongoing and specific interventions for the resident. . d) Resident #43 Review of Resident #43's current care plan, on 04/27/09, revealed the facility had not addressed wandering as a care problem for this resident. Observations of Resident #43, on 04/28/09 and 04/29/09, revealed the resident would wander into the rooms of other residents. Observation, on 04/29/09 at 2:20 p.m., found Resident #43 in the hallway her scooter chair removing the soft Velcro bars from the door frame of another's resident room and entering hallway into the room. Interview with the resident occupying the room into which Resident #43 entered revealed this occurred frequently. In an interview on the late afternoon of 04/29/09, Employee #80 acknowledged Resident #43 did wander into other residents' room. e) Resident #158 A review of nursing notes found an entry, dated 01/22/09, recording the resident was found in a male resident's room, sitting on the male resident's bed. The male resident had his hand on Resident #158's thigh, and staff believed the male resident through Resident #158 was his wife. A subsequent nursing note, later on 01/22/09, indicated Resident #158 was still wandering into other residents' rooms. A review of the nurse's notes found the resident was put on one-on-one monitoring, and a care plan was developed on 01/27/09, which was later discontinued on 01/30/09. On 01/30/09, the resident's care plan was updated to indicate staff was to monitor the resident every fifteen (15) minutes; this intervention was discontinued on 02/03/09. Further record review revealed a nursing note, dated 02/11/09 at 11:35 a.m., recording the this resident drank approximately 1 teaspoon of green apple hand sanitizer. A review of the incident report and accompanying investigation found the resident accessed the hand sanitizer in the housekeeping supervisor's office. A review of the 02/11/09 interim care plan found the resident was to be in areas of supervision. On 02/22/09, the resident continued to wander in and out of other residents' rooms and was hard to redirect. The resident described was \"combative and unwilling to leave other's rooms.\" Nursing notes, dated 03/06/09, 03/08/09, 03/22/09, and 03/26/09, contained descriptions of wandering, difficulty redirecting, rummaging in other residents' closets, drinking other residents' drinks, and waking up other residents. On 04/11/09, the resident's care plan was revised in response to Resident #158 striking out at another resident. Interventions included: \"redirect, remind of inappropriate behavior and not to strike, and monitor activity...\" On 04/12/09, the resident was found outside. The care plan included interventions, such as: \"Maintain Watchmate sensor per orders, monitor whereabouts through shifts, and answer alarms promptly.\" The care plan did not include interventions developed specifically for the resident. A review of the resident's entire current care plan found a care plan had not been developed to address the identification what might be precipitating the resident's behaviors. Interventions in the care plans only addressed interim and temporary solutions but did not address ongoing and specific interventions for the resident. .", "filedate": "2014-08-01"}
{"rowid": 11116, "facility_name": "NEW MARTINSVILLE CENTER", "facility_id": 515074, "address": "225 RUSSELL  AVENUE", "city": "NEW MARTINSVILLE", "state": "WV", "zip": 26155, "inspection_date": "2009-04-30", "deficiency_tag": 152, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "6TSD11", "inspection_text": "Based on record review and staff interview, the facility failed to ensure that the persons making healthcare decisions for two (2) of thirteen (13) sampled residents, who had been determined to lack the capacity to make such decisions for themselves, were appointed in accordance with State law. Resident identifiers: #45 and #60. Facility census: 101. Findings include: a) Resident #45 A review of Resident #45's medical record revealed a copy of a document appointing the resident's son as her medical power of attorney representative (MPOA). Review of the resident's advance directives, consents for vaccination, and other legal documents revealed these healthcare decisions had been made by the resident's daughter as evidenced by her signatures on these documents. During an interview with the director of nursing (DON) at 5:15 p.m. on 04/28/09, she stated the son was the MPOA of record, but the facility accepted the daughter's signature because she was the one who came in most often. b) Resident #60 A review of Resident #60's medical recordrevealed the individual who gave consent for a do not resuscitate order and for use of psychoactive medications, and who made other healthcare decisions for Resident #60 was not the person designated by the resident to serve as MPOA. During an interview with the DON at 5:15 p.m. on 04/28/09, she acknowledged that the person making the resident's healthcare decisions was not the resident's legally appointed MPOA.", "filedate": "2014-08-01"}
{"rowid": 11117, "facility_name": "NEW MARTINSVILLE CENTER", "facility_id": 515074, "address": "225 RUSSELL  AVENUE", "city": "NEW MARTINSVILLE", "state": "WV", "zip": 26155, "inspection_date": "2009-04-30", "deficiency_tag": 150, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "6TSD11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview, the facility failed to act upon a resident's wish to change her advance directives. Resident #54, who was determined to possess the capacity to understand and make her own medical decisions, upon admission indicated she wished to receive cardiopulmonary resuscitation (CPR) in the event of cardiac or [MEDICAL CONDITION] arrest. Shortly after admission, she decided she did not want to receive CPR, and the facility failed to act upon her request for do not resuscitate (DNR). Resident identifier: #54. Facility census: 101. Findings include: a) Resident #54 Record review, on [DATE], revealed Resident #54 was admitted to the facility on [DATE]. Review of her interdisciplinary progress notes (by nursing) revealed an entry, dated [DATE], stating the resident was a \"full code at this time\", meaning the resident was to receive CPR in the event of cardiac or [MEDICAL CONDITION] arrest. A physician's orders [REDACTED]. Review of a subsequent entry in the interdisciplinary progress notes (by social services), dated [DATE], revealed, \"POST (physician's orders [REDACTED]. Code status DNR.\" This form was completed by the resident and Employee #133, but there was no physician's signature on it. Interview with Employee #80 on [DATE], and with other staff reviewing the resident's medical record on [DATE], confirmed the facility had not followed through to ensure the resident's request for DNR was confirmed by an order signed by the attending physician. .", "filedate": "2014-08-01"}
{"rowid": 11118, "facility_name": "NEW MARTINSVILLE CENTER", "facility_id": 515074, "address": "225 RUSSELL  AVENUE", "city": "NEW MARTINSVILLE", "state": "WV", "zip": 26155, "inspection_date": "2009-04-30", "deficiency_tag": 156, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "6TSD11", "inspection_text": "Based on record review and staff interview, this Medicare-participating facility failed, for four (4) of four (4) residents reviewed, for whom a determination was made by the facility that Medicare will not pay for skilled nursing or specialized rehabilitative services and that an otherwise covered item or service may be denied as not reasonable and necessary, to notify the resident or his/her legal representative in writing why these specific services may not be covered; the beneficiary ' s potential liability for payment for the non-covered services; the beneficiary right to have a claim submitted to Medicare; and the beneficiary ' s standard claim appeal rights that apply if the claim is denied by Medicare. This practice had the potential to affect all residents for whom a determination of non-coverage by Medicare had been made by the facility. Resident identifiers: #52, #99, #66, and #4. Facility census: 101. Findings include: a) Residents #52, #99, and #66 A review of the forms entitled \"SNF Determination on Continued Stay\" for these residents revealed only the date that Medicare-covered services would be discontinued; there was no mention in writing of what specific service may no longer be covered or why. The only verbiage included in the form was \"no longer requires skilled services\" or \"exhausted benefits\". During an interview with the administrator and the office person responsible for providing this notification at 3:20 p.m. on 04/27/09, they acknowledged that this was form given to the resident and/or the responsible party as the notification of discontinuance of Medicare-covered skilled services and of their right to appeal this decision. They also agreed, after reviewing the forms, that the documentation did not on these residents' forms did not specify the service that was no longer being covered. When asked, neither person was able to state, during the interview, exactly what service had been discontinued for each of these three (3) residents. b) Resident #4 A review of the Notice of Medicare Provider Non-coverage notice provided to Resident #4 and/or her responsible party revealed: \"Resident will no longer receive speech therapy effective 4/26/09.\" However, this notice did not include any reason for why the service was being discontinued. During an interview with the administrator and the office person responsible for notification at 3:20 p.m. on 04/27/09, they acknowledged that this was the only documentation given to the resident. c) In the interview of 04/27/09, the person responsible for obtaining signatures on the non-coverage notification forms stated she assumed that someone else had explained the service involved and why it was being stopped prior to the notification being signed, but both she and the administrator acknowledged, after reviewing the above residents' forms, that the Medicare-covered skilled services being discontinued and/or the reasons for discontinuation were not there. .", "filedate": "2014-08-01"}
{"rowid": 11120, "facility_name": "UNITED TRANSITIONAL CARE CENTER", "facility_id": 515107, "address": "327 MEDICAL PARK DRIVE", "city": "BRIDGEPORT", "state": "WV", "zip": 26330, "inspection_date": "2009-05-08", "deficiency_tag": 323, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "V73M11", "inspection_text": "Based on observation and staff interview, the facility failed to ensure the environment was as free of accident hazards as possible. During the medication pass observation, one (1) of four (4) nurses observed failed to ensure filled syringes and medications were locked in the medication cart when the cart was left unattended and out of the nurse's line of sight. Facility census: 27. Findings include: a) During the medication pass on 05/06/09 at 9:05 a.m., when approaching the medication cart on the 260 hall, observation found the cart was unattended in the hall. Further observation found two (2) 10 cc syringes containing a clear liquid and two (2) 50 cc bags which contained IV (intravenous) medications on top of the cart. Observation of the 260 hall found the medication nurse (Employee #29) was in a resident's room and not within sight of the medication cart. During an interview on 05/06/09 at 10:30 a.m., the director of nursing confirmed that the practice of leaving filled syringes and medications unattended on top of a medication cart presented an accident hazard and the medications should have been locked in the cart. .", "filedate": "2014-08-01"}
{"rowid": 11121, "facility_name": "UNITED TRANSITIONAL CARE CENTER", "facility_id": 515107, "address": "327 MEDICAL PARK DRIVE", "city": "BRIDGEPORT", "state": "WV", "zip": 26330, "inspection_date": "2009-05-08", "deficiency_tag": 431, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "V73M11", "inspection_text": "Based on observation and staff interview, the facility failed to ensure drugs used in the facility were stored under proper temperature controls. Observation of one (1) of one (1) refrigerator in the facility, used to store drugs requiring refrigeration, found the internal temperature was 50 degrees Fahrenheit (F). The refrigerator contained three (3) vials of Novolin R insulin, two (2) boxes containing vials of influenza virus vaccine, and one (1) 50 cc bag of IV (intravenous) Vancomycin which required refrigeration. Both the insulin and the influenza vaccines are to be stored in a refrigerator with an internal temperature between 36 degrees F and 46 degrees F. This practice had the potential to alter the effectiveness of temperature-sensitive drugs. Facility census: 27. Findings include: a) Inspection of the refrigerator in the medication room, on 05/06/09 at 9:45 a.m., found the thermometer inside the refrigerator indicated an internal temperature reading of 50 degrees F. Review of May 2009 temperature log for this refrigerator revealed temperatures of 50 degrees F on the 05/01/09, 05/03/09, and 05/05/09. The temperature log for April 2009 recorded readings of 50 degrees F on 04/23/09 and 48 degrees F on 04/24/09 and 04/26/09. The temperature log for March 2009 recorded temperatures of 48 degrees F on 03/04/09 and 03/06/09, with a high reading of 60 degrees F on 03/08/09. Inspection of the contents of the refrigerator revealed three (3) vials of Novolin R insulin, two (2) boxes containing vials of influenza vaccine, and one (1) 50 cc bag of IV Vancomycin which had been mixed. According to Lexi-Comp's Drug Information Handbook for Nursing 2007 (8th edition), unopened vials of Novolin R insulin are to be stored in a refrigerator with an internal temperature between 36 degrees F and 46 degrees F. Review of the instructions on one (1) of the boxes of influenza vaccine revealed this, too, was to be kept refrigerated between 36 degrees F and 46 degrees F. During an interview on the morning of 05/06/09, the facility's pharmacist confirmed the temperature of the refrigerator was too high for the proper storage of temperature-sensitive drugs, and this should have been reported. .", "filedate": "2014-08-01"}
{"rowid": 11122, "facility_name": "UNITED TRANSITIONAL CARE CENTER", "facility_id": 515107, "address": "327 MEDICAL PARK DRIVE", "city": "BRIDGEPORT", "state": "WV", "zip": 26330, "inspection_date": "2009-05-08", "deficiency_tag": 225, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "V73M11", "inspection_text": "Based on a review of facility complaint records and staff interview, the facility failed to implement its policy regarding the reporting of neglect for one (1) of three complaints reviewed. Complaint #l included allegations of a nursing assistant refusing to assist a resident to find her shoes and refusing to bath the resident. There was no evidence to reflect this allegation of neglect had been reported to State agencies, including the Nurse Aide Abuse Registry, as required by State law. Facility census: 27. Findings include: a) Complaint #1 Review of the facility's complaint records revealed Complaint #1, dated 12/11/08, which documented a resident's report that a nursing assistant had refused to help find her shoes and refused to give her a bath because she was going home. Further review revealed no evidence the facility reported this allegation of neglect to State agencies, including the Nurse Aide Abuse Registry, as required by State law and in accordance with the facility's abuse policy (which was reviewed on 05/07/09). During an interview on 05/07/09 at 1:30 p.m., the director of nursing (Employee # 49) confirmed this allegation of neglect had not been reported to State agencies as required. .", "filedate": "2014-08-01"}
{"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": 11184, "facility_name": "WEIRTON MEDICAL CENTER, D/P", "facility_id": 515077, "address": "601 COLLIERS WAY", "city": "WEIRTON", "state": "WV", "zip": 26062, "inspection_date": "2009-05-20", "deficiency_tag": 465, "scope_severity": "D", "complaint": 1, "standard": 0, "eventid": "V0TW11", "inspection_text": "Guidelines for Design and Construction of Health Care Facilities 2 Building Systems 2.1 Plumbing 2.1.1 General. Unless otherwise specified herein, all plumbing systems shall be designed and installed in accordance with the International Plumbing Code. 2.1.2 Plumbing and Other Piping Systems 2.1.2.1 Hot water systems. The following standards shall apply to hot water systems: *(1) Capacity. The water-heating system shall have sufficient supply capacity at the temperatures and amounts indicated in the applicable table. Storage of water at higher temperatures shall be permitted. (2) Hot water distribution systems serving patient/resident care areas shall be under constant recirculation to provide continuous hot water. This Standard is Not Met as evidenced by: Based on measured water temperatures, the facility failed to provide continuous hot water at the required temperatures indicated in Table 4.1-3 (95 - 110 degrees Fahrenheit (F)). Facility census: 28. Findings include: a) At approximately 10:50 a.m. on 05/19/09, hot water temperature was measured in the sink serving resident room #630. The hot water temperature at this sink was measured to be 65.9 degrees F after heavily flowing water for four (4) minutes. The hot water temperature at a second sink serving the Ante-room portion of this resident room was measured at 66.0 degrees F initially and rose to 108.0 degrees F after three (3) minutes. The hot water temperature of the first sink was re-measured and found to be 108 degrees F. To conclude, a time frame of seven (7) minutes was required to obtain an acceptable hot water temperature and continuous hot water is not provided. As such, the comfort of the resident is compromised. .", "filedate": "2014-07-01"}
{"rowid": 11285, "facility_name": "CANTERBURY CENTER", "facility_id": 515179, "address": "80 MADDEX DRIVE", "city": "SHEPHERDSTOWN", "state": "WV", "zip": 25443, "inspection_date": "2009-05-21", "deficiency_tag": 279, "scope_severity": "D", "complaint": 1, "standard": 0, "eventid": "JD6Y11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on closed record review and staff interview, the facility failed to develop a comprehensive care plan for one (1) of eight (8) sampled residents. A resident was admitted to the facility with an antibiotic-resistant respiratory infection and was ordered antibiotic therapy by the physician. The facility did not address the respiratory infection on the resident's care plan. Resident identifier: #59. Facility census: 56. Findings include: a) Resident #59 Resident #59's closed medical record, when reviewed on 05/20/09, revealed the resident was admitted to the facility on [DATE], with [DIAGNOSES REDACTED]. On 02/05/09, the physician ordered, \"[MEDICATION NAME] 600 milligrams BID (twice daily) [MEDICAL CONDITIONS]-resistant Staphylococcus aureus).\" The resident's admission minimum data set assessment (MDS), dated [DATE], in Section I, 2., indicated the resident had an antibiotic-resistant infection. Review of the resident's care plan, dated 02/05/09, found no mention of the resident's antibiotic-resistant respiratory infection. The assistant director of nursing (ADON - Employee #1), when interviewed on 05/21/09 at 10:20 a.m., stated she was the facility's infection control nurse and confirmed the resident's care plan did not address the respiratory infection. The ADON further stated it was the facility's policy to [MEDICAL CONDITION] infections on the care plan. .", "filedate": "2014-07-01"}
{"rowid": 11286, "facility_name": "CANTERBURY CENTER", "facility_id": 515179, "address": "80 MADDEX DRIVE", "city": "SHEPHERDSTOWN", "state": "WV", "zip": 25443, "inspection_date": "2009-05-21", "deficiency_tag": 323, "scope_severity": "G", "complaint": 1, "standard": 0, "eventid": "JD6Y11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, family interview, and staff interview, the facility failed to assure the safety of one (1) of eight (8) sampled residents, by not providing adequate supervision to prevent an accident with injury requiring emergency medical intervention. Resident identifier: #57. Facility census: 56. Findings include: a) Resident #57 Review of Resident #57's closed medical record revealed a [AGE] year old female with [DIAGNOSES REDACTED]. The resident fell in her room on 06/04/08, striking her head and requiring an emergency transport to the hospital for closure of the laceration. The resident's daughter, when interviewed, reported the resident was standing at the sink while a nursing assistant was making her bed when she fell , although her mother was supposed to have the assistance of two (2) staff members when up. The resident's daughter stated she questioned the facility about the lack of assistance at the time of the fall. Documentation on the incident report of the fall stated, \"Pt. (patient) was ambulating in walker and CNA (certified nursing assistant), lost balance and fell backwards.\" While the description of the circumstances surrounding the fall varied between these two (2) sources, both the incident report and the resident's daughter indicated only one (1) staff member was present at the time of Resident #57's fall. A review of Resident #57's care plan revealed a nursing intervention indicating the resident required the assistance of two (2) staff members when getting out of bed. An activities of daily living (ADL) assistance form communicated to the nursing assistants, on 09/26/07 and again on 04/24/08, that the number of staff Resident #57 required for bed mobility, transfers, and toileting as \"2+\" (two (2) or more). Documentation by the nursing assistants on the ADL flow sheet, for 06/04/08, recorded Resident #57 required maximum physical help or total dependence of staff for bed mobility, transfers, and toileting. The daughter's concern about the lack of adequate staff assistance when the fall occurred (an allegation of neglect) was not reported to the appropriate State agencies, and there was no documentation to indicate the facility conducted a thorough investigation into the daughter's concerns even though the nurses' notes indicated the resident's daughter returned to the facility with the resident and spoke to the director of nursing (DON) about the fall. During an interview with the administrator at 11:05 a.m. on 05/21/09, she acknowledged the daughter had been upset at the fact that there were not two (2) persons assisting Resident #57 at the time of the fall, but the administrator stated there was a nursing assistant in the room and the resident had a walker. She also stated the resident had gotten herself out of bed, although there was no evidence of this, and it was not mentioned in either the nurses' notes or the incident report. The administrator did acknowledge, after reviewing the record, there should have been two (2) nursing assistants present to assist the resident whenever she was out of bed. .", "filedate": "2014-07-01"}
{"rowid": 11287, "facility_name": "CANTERBURY CENTER", "facility_id": 515179, "address": "80 MADDEX DRIVE", "city": "SHEPHERDSTOWN", "state": "WV", "zip": 25443, "inspection_date": "2009-05-21", "deficiency_tag": 225, "scope_severity": "D", "complaint": 1, "standard": 0, "eventid": "JD6Y11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on closed record review, family interview, and staff interview, the facility failed to immediately report and/or thoroughly investigate an allegation of neglect, when one (1) of eight (8) sampled residents, who did not receive the assistance of two (2) staff members with transfer or ambulation, fell and sustained an injury. Resident identifier: #57. Facility census: 56. Findings include: a) Resident #57 Review of Resident #57's closed medical record revealed a [AGE] year old female with [DIAGNOSES REDACTED]. The resident fell in her room on 06/04/08, striking her head and requiring an emergency transport to the hospital for closure of the laceration. The resident's daughter, when interviewed, reported the resident was standing at the sink while a nursing assistant was making her bed when she fell , although her mother was supposed to have the assistance of two (2) staff members when up. The resident's daughter stated she questioned the facility about the lack of assistance at the time of the fall. Documentation on the incident report of the fall stated, \"Pt. (patient) was ambulating in walker and CNA (certified nursing assistant), lost balance and fell backwards.\" While the description of the circumstances surrounding the fall varied between these two (2) sources, both the incident report and the resident's daughter indicated only one (1) staff member was present at the time of Resident #57's fall. A review of Resident #57's care plan revealed a nursing intervention indicating the resident required the assistance of two (2) staff members when getting out of bed. An activities of daily living (ADL) assistance form communicated to the nursing assistants, on 09/26/07 and again on 04/24/08, that the number of staff Resident #57 required for bed mobility, transfers, and toileting as \"2+\" (two (2) or more). Documentation by the nursing assistants on the ADL flow sheet, for 06/04/08, recorded Resident #57 required maximum physical help or total dependence of staff for bed mobility, transfers, and toileting. The daughter's concern about the lack of adequate staff assistance when the fall occurred (an allegation of neglect) was not reported to the appropriate State agencies, and there was no documentation to indicate the facility conducted a thorough investigation into the daughter's concerns even though the nurses' notes indicated the resident's daughter returned to the facility with the resident and spoke to the director of nursing (DON) about the fall. During an interview with the administrator at 11:05 a.m. on 05/21/09, she acknowledged the daughter had been upset at the fact that there were not two (2) persons assisting Resident #57 at the time of the fall, but the administrator stated there was a nursing assistant in the room and the resident had a walker. She also stated the resident had gotten herself out of bed, although there was no evidence of this. When asked why the allegation of neglect by the daughter had not been reported and investigated, she stated they did not recognize it as an allegation at the time, although she admitted there should have been two (2) nursing assistants present. .", "filedate": "2014-07-01"}
{"rowid": 10593, "facility_name": "PLEASANT VALLEY NSG. & REHAB C", "facility_id": 515064, "address": "1200 SAND HILL ROAD", "city": "POINT PLEASANT", "state": "WV", "zip": 25550, "inspection_date": "2009-05-22", "deficiency_tag": 225, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "5BYT11", "inspection_text": "Based on a review of personnel files and staff interview, the facility failed to adequately screen employees to ensure they were free from personal histories of criminal conviction which would indicate unfitness for service in a nursing facility. The facility did not complete statewide criminal background checks for four (4) of five (5) sampled employees who lived in Ohio. Employees: #1, #2, #3, and #4. Facility census: 95. Findings include: a) Employees #1, #2, #3, and #4 Review of sampled personnel files revealed four (4) of five (5) new employees lived in another State (Ohio). Further review failed to find evidence of statewide criminal background checks completed for this individuals in that State. Interview with human resources personnel, on the late morning of 05/22/09, verified the above findings. .", "filedate": "2015-01-01"}
{"rowid": 10594, "facility_name": "PLEASANT VALLEY NSG. & REHAB C", "facility_id": 515064, "address": "1200 SAND HILL ROAD", "city": "POINT PLEASANT", "state": "WV", "zip": 25550, "inspection_date": "2009-05-22", "deficiency_tag": 253, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "5BYT11", "inspection_text": "Based on observation and staff interview, the facility failed to assure the doors to resident rooms, bathrooms, and closets were in good repair. Ten (10) doors observed on the 200 Hall were in need of repair, with deep scratches and holes in the doors making these surfaces difficult to clean thoroughly. This was true for one (1) of four (4) hallways observed. Facility census: 95. Findings include: a) 200 Hall During a tour of the facility on 05/19/09 at 9:30 a.m., observation found doors to resident rooms, bathrooms, and closets on the 200 Hall were in poor condition, with deep scratches and holes in need of repair. The doors were for the following rooms: 201, 202, 204,205, 206, 207, 209 210, 211, and 212. During a tour with the maintenance personnel, staff confirmed these doors were scratched and/or had holes in them. .", "filedate": "2015-01-01"}
{"rowid": 10595, "facility_name": "PLEASANT VALLEY NSG. & REHAB C", "facility_id": 515064, "address": "1200 SAND HILL ROAD", "city": "POINT PLEASANT", "state": "WV", "zip": 25550, "inspection_date": "2009-05-22", "deficiency_tag": 272, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "5BYT11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, resident interview, and staff interview, the facility failed to ensure one (1) of thirty-two (32) residents reviewed during Stage II of the survey was assessed for fluid needs. Resident #106, admitted about one (1) week ago, was receiving [MEDICAL TREATMENT] three (3) times a week, and her record contained no evidence of any assessment with respect to daily fluid needs. After surveyor intervention, the [MEDICAL TREATMENT] center's physician ordered a fluid restriction of 1500 cc daily. Facility census: 95. Findings include: a) Resident #106 Resident #106 was a fairly new admission of one (1) week's duration whose interim care plan did not address her daily fluid needs. Interview with Resident #106, on 05/21/09 at 11:30 a.m., revealed she was unaware of any type of fluid restriction. She also seemed somewhat confused at this time. Medical record review, on 05/21/09 at 2:35 p.m., revealed no physician orders dictating the amount of daily fluids allowed for this resident who received [MEDICAL TREATMENT] treatments three (3) times weekly. On 05/21/09 at 2:35 p.m., a staff nurse (Employee #25), when interviewed regarding fluid needs for this resident, reviewed the medical record and plan of care and agreed there was no order regarding daily fluid intake. She stated she thought there was no fluid restriction for this resident or, perhaps, the order got lost between the physicians. She immediately called the [MEDICAL TREATMENT] center, received an order for [REDACTED]. .", "filedate": "2015-01-01"}
{"rowid": 10596, "facility_name": "PLEASANT VALLEY NSG. & REHAB C", "facility_id": 515064, "address": "1200 SAND HILL ROAD", "city": "POINT PLEASANT", "state": "WV", "zip": 25550, "inspection_date": "2009-05-22", "deficiency_tag": 279, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "5BYT11", "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 comprehensive care plan for two (2) of thirty-two (32) residents in Stage II. The antipsychotic medication of Resident #53, with a history prior to admission of exhibiting violent behavior, was discontinued, and the care plan did not direct staff to monitor the resident for a resurgence of violent behavior following discontinuation of the drug, did not identify non-pharmacologic approaches to use when the behavior occurred, and did not specify the therapeutic goal(s) of the other psychoactive medications the resident was still receiving. Resident #219 was admitted for falls and decreased mobility, and care plans for not developed to address either of these concerns. Facility census: 95. Findings include: a) Resident #53 Resident #53 was admitted to the facility on [DATE], with [DIAGNOSES REDACTED]. The 04/02/09 hospital discharge summary revealed the resident had been admitted from another hospital on [DATE], due to violent behavior and increased confusion. \"According to the facility administrator, the patient the day prior to admission (on 03/26/09) became very violent and punched 2 female staff members and attempting to twist the wrist of another one, and as a result, was sent to the Emergency Department at __________(on 03/27/09).\" Record review resident's admission orders [REDACTED]\"agitation\", and [MEDICATION NAME] 0.5 mg every six (6) hours PRN for \"anxiety.\" A hospital history and physical examination [REDACTED].\" A review of the nursing notes found an entry, dated 04/04/09 at 2300, recording, \"Wakeful - numerous attempts to get OOB (out of bed) unassisted. Alert - confused x 3.\" On 04/05/09 the 10:00 a.m., a nurse wrote, \"In bed with legs hanging out over the edge - When this nurse attempted to put legs back in bed Resident attempted kick and then striked (sic) at this nurse.\" A 04/12/09 nursing note recorded the physician's discontinuation of [MEDICATION NAME]. On 05/14/09 the 9:00 a.m., a nurse wrote, \"Rsdt (resident) down in bed Nursing Assistants at bedside providing care rsdt. Bent thumb of (nursing assistant) back while turning to change soiled brief.\" A confidential interview with a nursing assistant who periodically cared for Resident #53, on day shift on 05/21/09, the resident would sometimes try to \"stabilize himself ... like reaching out for support, rather than trying to be abusive.\" On 05/21/09 at 2:00 p.m., the administrator, when interviewed, verified a care plan was developed for the resident and included the use of psychoactive medications, but no plan was developed with respect to monitoring for and responding to violent behaviors after the [MEDICATION NAME] was discontinued. The 04/15/09 care plan for the use of psychoactive medication used terms such as: \"He becomes agitated easily and becomes anxious due to the confusion.\" One (1) intervention was: \"Monitor behavior every shift and document.\" However, it did not describe the type of the behaviors to be monitored (violent physical aggression), did not provide direction to staff regarding how to respond to those behaviors, nor did the care plan provide any therapeutic goals for the resident's use of these psychoactive medication. The stated goal was: \"Resident will be free of any discomfort of adverse side effects.\" b) Resident #219 Review of Resident #219's medical record revealed he was admitted at 6:50 p.m. on 05/18/09, with [DIAGNOSES REDACTED].\" The initial care plan, developed to capture the immediate care needs for this resident, did not address falls. The pre-printed initial care plan for \"fall / safety risk\" was blank, even though this was why he was admitted to the facility. According to the nursing notes, on 05/20/09 at 11:30 p.m., the resident was outside smoking when he fell while getting up from a chair. There was no evidence a falls care plan was initiated after this fall occurred. .", "filedate": "2015-01-01"}
{"rowid": 10597, "facility_name": "PLEASANT VALLEY NSG. & REHAB C", "facility_id": 515064, "address": "1200 SAND HILL ROAD", "city": "POINT PLEASANT", "state": "WV", "zip": 25550, "inspection_date": "2009-05-22", "deficiency_tag": 280, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "5BYT11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview, the facility failed to review and revise a resident's care plan when the reason for use of an indwelling Foley urinary catheter changed. This was true for one (1) of thirty-two (32) residents in the Stage II sample. Resident identifier: #78. Facility census: 95. Findings include: a) Resident #78 Medical record review revealed a care plan, written on 02/05/09, addressing the presence of an indwelling Foley urinary catheter. According to this care plan, the problem stated: \"Risk for infection indwelling catheter d/t (due to) pressure area (hx of UTI'S) (history of urinary tract infections). The three (3) goals associated with this problem were: 1) \"Resident will be free of complications of indwelling catheter daily\", 2) \"Will remain free from s/s (signs and symptoms) of UTI by next review date, and 3) \"Foley will be d/c (discontinued) as condition and mobility improve prior to d/c (discharge) home.\" There was no evidence found in the medical record to show that, on 02/05/09, Resident #78 had pressure ulcers necessitating the use of an indwelling urinary catheter as stated in the plan of care. A quarterly care conference was held on 04/29/09, but the use of this catheter was not reviewed. There was no evidence, as of 05/20/09, to reflect this care plan had been reviewed or revised. Further review of the medical record revealed this catheter had been discontinued and was subsequently reinserted due to the resident's [MEDICAL CONDITION]. During an interview on 05/22/09 at 10:30 a.m., the care plan nurse confirmed this care plan should have been reviewed and revised during the 04/29/09 care plan meeting. After surveyor intervention, a new physician's orders [REDACTED]. .", "filedate": "2015-01-01"}
{"rowid": 10598, "facility_name": "PLEASANT VALLEY NSG. & REHAB C", "facility_id": 515064, "address": "1200 SAND HILL ROAD", "city": "POINT PLEASANT", "state": "WV", "zip": 25550, "inspection_date": "2009-05-22", "deficiency_tag": 309, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "5BYT11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, staff interview, family interview, resident interview, and policy review, the facility failed to establish parameters for the administration of pain medication when multiple pains medications were ordered; failed to document the effectiveness of PRN pain medication after it was given; and failed to report to the physician when \"as needed\" (PRN) medications were used frequently, so the physician would order around-the-clock pain medication for increased pain management. This was evident for three (3) of thirty-two (32) Stage II residents reviewed for pain management. Resident identifiers: #135, #9, and #137. Facility census: 95. Findings include: a) Resident #135 During an interview on the afternoon of 05/19/09, Resident #135 expressed pain in his stomach. Interview with the resident's nursing assistant (Employee #83), at 9:10 a.m. on 05/21/09, revealed Resident #135 did reported stomach pain and received medication for this symptom. Interview with the licensed practical nurse (LPN - Employee #16), at 10:45 a.m. on 05/21/09, revealed the resident expressed stomach discomfort, and this had also been reported by the resident's wife. The wife confirmed this at lunch time when interviewed on 05/21/09. She reported he had an ongoing problem with stomach pain for which they had not been able to determine the cause. He received [MEDICATION NAME], and this brought relief. A review of his medical record revealed Resident #135 had orders for Tylenol 325 mg two (2) tablets by mouth every four (4) hours PRN for pain and [MEDICATION NAME] with [MEDICATION NAME] 10-500 mg tablet by mouth every six (6) hours PRN for pain with a pain assessment to be completed every morning. The pain assessment was to include asking the resident what level the pain he was experiencing prior to medication administration on a scale from \"0\" to \"10\", with \"10\" being the worst. Review of the May 2009 Medication Administration Record [REDACTED]. On the reverse side of the MAR, staff did not always record whether the medication was effective, with such documentation found on only eight (8) or twenty-two (22) days. The notations on the reverse of the form indicated Resident #135 received this medication for back pain on six (6) of the eight (8) dates and for general pain on the other two (2) dates. The presence of back pain had not been identified until these entries were reviewed. There were no parameters to direct staff as to which of these pain medications (Tylenol or [MEDICATION NAME]) was to be administered when the resident reported pain or discomfort, leaving the choice of medication to the discretion of the nurse. During a discussion with the administrator, on the mid-morning of 05/22/09, it was confirmed that the nursing staff failed to obtain clarification orders from the physician to establish the parameters for administering these pain medications. A written policy (with an effective of August 2000) was presented to the surveyors indicated the attending physician must periodically review the resident's use and need for PRN medications, to determine if it needs to be changed or discontinued. No evidence that this occurred was presented by the time of survey exit. b) Resident #9 Review of the May 2009 monthly recapitulation of physician's orders [REDACTED]. The orders did not provide parameters to direct the nursing staff as to when to select one (1) pain medication over specify another for the treatment of [REDACTED]. c) Resident #137 Review of the May 2009 monthly recapitulation of physician's orders [REDACTED]. The orders did not provide parameters to direct the nursing staff as to when to select one (1) pain medication over specify the other for the treatment of [REDACTED]. .", "filedate": "2015-01-01"}
{"rowid": 10599, "facility_name": "PLEASANT VALLEY NSG. & REHAB C", "facility_id": 515064, "address": "1200 SAND HILL ROAD", "city": "POINT PLEASANT", "state": "WV", "zip": 25550, "inspection_date": "2009-05-22", "deficiency_tag": 323, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "5BYT11", "inspection_text": "Based on observation, review of manufacturer's instructions for the application of a wrist restraint, and staff interview, the facility failed to apply a physical restraint, to one (1) of thirty-two (32) residents in the Stage II sample, in accordance with the manufacturer's instructions. Resident #137 was observed with the wrist restraint secured to the side rail, rather than the bed frame per the manufacturer's instructions. This practice placed the resident at risk for an accident. Facility census: 95. Findings include: a) Resident #137 On 05/21/09 at 11:00 a.m., observation by two (2) surveyors found the resident with a wrist restraint tied to the side rail. The side rail was a one-quarter length rail raised to an approximate forty five degree position, and the wrist restraint was tied to the bottom part of the rail. The resident was then observed with the director of nursing (DON) immediately after the first observation. Per the DON, the wrist restraint was applied to prevent the resident from pulling out a tracheostomy and a feeding tube. The DON indicated, during the observation, that the wrist restraint should not have been tied to the side rail, but should have been tied to the bed frame. According to the product's instructions, the device should have been secured to the movable part of the bed frame. .", "filedate": "2015-01-01"}
{"rowid": 10600, "facility_name": "PLEASANT VALLEY NSG. & REHAB C", "facility_id": 515064, "address": "1200 SAND HILL ROAD", "city": "POINT PLEASANT", "state": "WV", "zip": 25550, "inspection_date": "2009-05-22", "deficiency_tag": 329, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "5BYT11", "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 each resident's drug regimen was free from unnecessary drugs for one (1) of thirty-two (32) residents in the Stage II sample. Resident #53 was admitted to the facility on [DATE] with physician's orders [REDACTED].\", and [MEDICATION NAME] 0.5 mg every six (6) hours PRN for \"anxiety.\" These medications were used in an excessive dose (duplicate therapy), without adequate monitoring for the resurgence of behaviors after the Zyprex was discontinued, and without monitoring to evaluate the efficacy of the medications and for possible adverse side effects. Facility census: 95. Findings include: a) Resident #53 Resident #53 was admitted to the facility on [DATE], with [DIAGNOSES REDACTED]. The 04/02/09 hospital discharge summary revealed the resident had been admitted from another hospital on [DATE], due to violent behavior and increased confusion. \"According to the facility administrator, the patient the day prior to admission (on 03/26/09) became very violent and punched 2 female staff members and attempting to twist the wrist of another one, and as a result, was sent to the Emergency Department at __________(on 03/27/09).\" Record review resident's admission orders [REDACTED]\"agitation\", and [MEDICATION NAME] 0.5 mg every six (6) hours PRN for \"anxiety.\" A hospital history and physical examination [REDACTED].\" A review of the nursing notes found an entry, dated 04/04/09 at 2300, recording, \"Wakeful - numerous attempts to get OOB (out of bed) unassisted. Alert - confused x 3.\" On 04/05/09 the 10:00 a.m., a nurse wrote, \"In bed with legs hanging out over the edge - When this nurse attempted to put legs back in bed Resident attempted kick and then striked (sic) at this nurse.\" A 04/12/09 nursing note recorded the physician's discontinuation of [MEDICATION NAME]. On 05/14/09 the 9:00 a.m., a nurse wrote, \"Rsdt (resident) down in bed Nursing Assistants at bedside providing care rsdt. Bent thumb of (nursing assistant) back while turning to change soiled brief.\" A confidential interview with a nursing assistant who periodically cared for Resident #53, on day shift on 05/21/09, the resident would sometimes try to \"stabilize himself ... like reaching out for support, rather than trying to be abusive.\" On 05/21/09 at 2:00 p.m., the administrator, when interviewed, verified a care plan was developed for the resident and included the use of psychoactive medications, but no plan was developed with respect to monitoring for and responding to violent behaviors after the [MEDICATION NAME] was discontinued. The 04/15/09 care plan for the use of psychoactive medication used terms such as: \"He becomes agitated easily and becomes anxious due to the confusion.\" One (1) intervention was: \"Monitor behavior every shift and document.\" However, it did not describe the type of the behaviors to be monitored (violent physical aggression), did not provide direction to staff regarding how to respond to those behaviors, nor did the care plan provide any therapeutic goals for the resident's use of these psychoactive medication. The stated goal was: \"Resident will be free of any discomfort of adverse side effects.\" Medical record review also an absence of monitoring for target behaviors to assess the efficacy of the medications and for possible adverse side effects. An interview with the director of nursing, on the late afternoon of 05/21/09, found the forms used by facility staff for monitoring of behaviors and adverse side effects of psychoactive medications; these forms had not been completed for Resident #53 for either April or May 2009. .", "filedate": "2015-01-01"}
{"rowid": 10601, "facility_name": "PLEASANT VALLEY NSG. & REHAB C", "facility_id": 515064, "address": "1200 SAND HILL ROAD", "city": "POINT PLEASANT", "state": "WV", "zip": 25550, "inspection_date": "2009-05-22", "deficiency_tag": 463, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "5BYT11", "inspection_text": "Based on observation and staff interview, the facility's call alarm system was altered and not functioning as intended for the 100 Hall. The ceiling-mounted speaker used for the nurse call system's auditory alarm was covered with tape to make the volume too low to be heard by staff on the unit; the auditory alarm could only be heard at the nurses' station. Additionally, the length of the pull cord for call light in the bathroom of Room #113 was too short to be reached from the toilet if the resident needed to summon staff assistance. This deficient practice had the potential to affect all twenty-five (25) residents residing on 100 Hall. Facility census: 95. Findings include: a) Nurse call system on 100 Hall When verifying the functionality of the nurse call system on the 100 Hall on 05/21/09 at 11:00 a.m., observation revealed the visual alarm activated in the corridors above each resident doorway, and an auditory alarm sounded at the nurses' station. However, an auditory alarm could not be heard sounding on the hall itself. The environmental supervisor (Employee #103) went to the speaker where the sound should have been coming out and found the speaker was covered with surgical tape, which muted the auditory alarm. When the tape was removed, the alarm was audible from the speaker. The environmental supervisor verified the tape should not have been on the speaker. b) Call light for Room 113's bathroom Observation of the nurse call system serving the bathroom in Room 113 revealed the pull was only approximately 2 inches in length. A resident using the toilet, or a resident having fallen to the floor, would not have been able to reach the pull cord to summon assistance. The environmental supervisor was made aware of light, and a new pull cord was installed. . Resident 1: call alarms were covered with tape and inaudible", "filedate": "2015-01-01"}
{"rowid": 10602, "facility_name": "PLEASANT VALLEY NSG. & REHAB C", "facility_id": 515064, "address": "1200 SAND HILL ROAD", "city": "POINT PLEASANT", "state": "WV", "zip": 25550, "inspection_date": "2009-05-22", "deficiency_tag": 514, "scope_severity": "B", "complaint": 0, "standard": 1, "eventid": "5BYT11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Resident 1: oxygen tubing treatment sheets not complete Based on observation, medical record review, and staff interview, the facility failed to each resident's clinical record was accurate and complete. Staff failed to document weekly oxygen tubing changes ordered by the physician. Resident identifiers: #2188 and #3439 on the 400 Hall, and Residents #3163 and #1889 on the 100 Hall. Facility census : 95. Findings include: a) Residents #2188, #3439, #3163, and #1889 During random observations during tour on 05/19/09 and during resident interviews on the day of entry, four (4) residents were observed to have no dates on their oxygen tubings to indicate when they had most recently been changed. Also, there was no documentation on the residents' treatment records to reflect the tubing had been changed weekly as the physician had ordered. 1. Residents #2188 and #3439 On the 400 Hall on 05/19/09 at 9:30 a.m., Residents #2188 and #3439 were noted to have oxygen concentrators in use with no dates to show when the tubing had been changed. The filters on both concentrators were dirty. On 05/20/09 at 9:55 a.m., interview with the charge nurse (Employee #26) revealed the facility did not have a separate respiratory therapy department. Rather, a nurse came to the facility twice weekly, and she changed all the oxygen tubing in the facility on Fridays. Employee #26 also reported they had aides change the tubing if the nurse is not there. The charge nurse and surveyor checked the residents' treatment records and found Resident #2188's tubing change was not recorded for 05/08/09, and Resident #3439's tubing change was not recorded for 05/08/09 or 05/15/09. Both residents had orders for oxygen tubing to be changed weekly. The director of nursing (DON), who was present at this time, stated oxygen tubing was changed weekly in the facility and, when told of the above findings, said they would take care of it right away. 2. Residents #3163 and #1889 On the 100 Hall on 05/19/09 at 4:30 p.m., Residents #3163 and #1889 were noted to have oxygen concentrators with no dates on their tubings to indicate then they had last been changed. Also, Resident #3163's humidifier bottle contained about one-half inch of water, and Resident #3163's humidifier bottle had less than one-half inch of water. Review of the residents' treatment records revealed blank spaces where oxygen tubing changes were to have been recorded. Neither resident's record had been written on or initialed in the month of May 2009. Physician orders [REDACTED]. On 05/20/09 at 5:00 p.m., the nurse (Employee #15) said Resident #3163 receives nebulizer treatment four (4) times daily and wears her oxygen about two days weekly, and Resident #1889 wears oxygen two (2) to three (3) days per week. This surveyor observed both residents wearing oxygen for intervals on every day of the survey. 3. On 05/22/09 at 11:00 a.m., this surveyor asked the administrator for the facility's policy on changing oxygen tubing. She said they had no written policy, but staff changed the tubings weekly and recorded the changes on the residents' treatment records. This surveyor then gave her the names and room numbers of the above four (4) residents who had no documentation of weekly tubing changes as ordered by the physician.", "filedate": "2015-01-01"}
{"rowid": 10944, "facility_name": "GREENBRIER MANOR", "facility_id": 515185, "address": "ROUTE 2, BOX 159A", "city": "LEWISBURG", "state": "WV", "zip": 24901, "inspection_date": "2009-05-22", "deficiency_tag": 154, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "T34S11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of medical records, review of the facility's policy regarding cardiopulmonary resuscitation (CPR), and staff interview, the facility failed to ensure residents were fully informed in advance of care or treatment that might affect their well-being. Resident #94's medical record included a Physician order [REDACTED]. There was no evidence the resident / responsible party had been made aware of the facility's policy. One (1) of eight (8) residents whose closed record was reviewed was affected. Resident identifier: #94. Facility census: 86. Findings include: a) Resident #94 Review of the resident's medical record found a POST form had been completed by the resident's medical power of attorney representative (MPOA) on [DATE]. The MPOA had checked the POST form, indicating the resident was to be resuscitated. Further review of the medical record found an entry, dated [DATE] at 3:00 a.m., recording, \"Called to residents (sic) room by staff at 12:30 AM (sic) No pulse - radial/carotid. No respirations. Skin cold to touch. Pupils fixed / dilated /c (with) pupil indented. Tem (temperature) 87.2 (degree mark) F....\" The note continued, and the MPOA was quoted as saying, \"I spent a long time with her a couple of days ago and I have been expecting this.\" No attempts were made to provide CPR. The director of nursing (DON), when interviewed regarding these findings at 7:45 a.m. on [DATE], stated they have night time briefs so staff do not have to disturb residents so often. She said staff does not go in and check to see whether residents are still breathing every two (2) hours, as this would disturb the sleeping residents. The DON said this resident had been stiff when she was found, and the resident's death was \"very unexpected\". The DON was asked whether there was a policy regarding when CPR would be provided. Shortly after, she provided a copy of the facility's policy entitled \"Cardiopulmonary Resuscitation.\" The policy included, \"Cardiopulmonary resuscitation (CPR) will be instituted in cases of witnessed cessation of cardiac and/or [MEDICAL CONDITION] function until advanced cardiac life support is available on any resident who does not have a 'Do Not Resuscitate' order.\" (The policy did not have a date, so it could not be ascertained whether it had been in place in 2005.) When asked whether residents or their responsible parties were informed of this when they completed the POST form, the DON said the social workers explain this when the POST form is signed. Approximately one (1) hour later, Employee #51 (a facility social worker) was asked about what she told people when they were deciding how to fill out the POST form. She provided a thorough explanation but did not mention the facility's CPR policy. When specifically asked about this policy, she said she was not aware of it. She added that, fortunately, she had not had admitted anyone who had wanted CPR. It was suggested she obtain a copy of the policy. .", "filedate": "2014-11-01"}
{"rowid": 10945, "facility_name": "GREENBRIER MANOR", "facility_id": 515185, "address": "ROUTE 2, BOX 159A", "city": "LEWISBURG", "state": "WV", "zip": 24901, "inspection_date": "2009-05-22", "deficiency_tag": 156, "scope_severity": "C", "complaint": 0, "standard": 1, "eventid": "T34S11", "inspection_text": "Based on observation and staff interview, the facility failed to post accurate information regarding the regional ombudsman. This practice had the potential to affect all residents. Facility census: 86. Findings include: a) During the initial tour of the facility on 05/18/09 at approximately 3:45 p.m., observation revealed the signs posted in the front lobby area of the building contained the incorrect telephone number and no name listed for the regional ombudsman. Other signs containing this same type of information were posted in various locations throughout the building and did have to correct information related to the regional ombudsman. At approximately 5:00 p.m. on 05/18/09, the administrator agreed the sign in the front area of the building needed to be corrected. .", "filedate": "2014-11-01"}
{"rowid": 10946, "facility_name": "GREENBRIER MANOR", "facility_id": 515185, "address": "ROUTE 2, BOX 159A", "city": "LEWISBURG", "state": "WV", "zip": 24901, "inspection_date": "2009-05-22", "deficiency_tag": 157, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "T34S11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of medical records and staff interview, the facility failed to notify the physician when a resident repeatedly refused a medication in the evenings. The resident's medication administration records (MARs) indicated she had refused an evening dose of [MEDICATION NAME] for at least the last four (4) months. There was no evidence the physician had been notified of the resident's continued refusal to take the medication. Resident identifier: #51. Facility census: 86. Findings include: a) Resident #51 A nurse (Employee #7) was observed administering medications to this resident at approximately 7:10 p.m. on 05/20/09. She poured the resident's dose of [MEDICATION NAME], then initialed and circled the space for the resident's evening dose of [MEDICATION NAME] (ordered for constipation). As she did so, she explained the resident had been refusing to take the medication. On 05/22/09, the resident's MARs for February, March, April, and May 2009 were reviewed. The medication had consistently been circled, and an \"R\" had been written under the nurses' initials to indicate she had refused the medication. There was no evidence the physician had been notified so that he/she would be aware and might determine whether the resident's medication regimen needed to be changed. .", "filedate": "2014-11-01"}
{"rowid": 10947, "facility_name": "GREENBRIER MANOR", "facility_id": 515185, "address": "ROUTE 2, BOX 159A", "city": "LEWISBURG", "state": "WV", "zip": 24901, "inspection_date": "2009-05-22", "deficiency_tag": 240, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "T34S11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, resident interview, staff interview, and medical record review, the facility did not ensure staff provided residents with care and services in a manner and in an environment that promoted comfort and/or enhanced quality of life, affecting three (3) of fifteen (15) sampled residents. Resident #57 did not have access to her bedside table which contained a glass of water. Resident #74's call light was not placed within her reach to allow her to summon staff assistance when needed. Resident #44 complained of being cold. She told the nurse she had asked staff for a blanket three (3) times but had not yet received one. The nurse assured her one would be provided for her, but the nurse forgot to do so after she administered the resident's medications. Resident identifiers: #57, #74, and #44. Facility census: 86. Findings include: a) Resident #57 On 05/20/09 at approximately 8:20 a.m., Resident #57 asked for something to drink. Her bedside table was pushed up against the wall out of her reach. The resident had fall mats beside her bed, making it difficult to place the bedside table within her reach. Employee #17 (a licensed practical nurse) indicated the resident could not get her own water without pouring it out onto her clothing. On 05/20/09 at approximately 1:05 p.m., the director of nursing indicated the resident probably could drink from her glass but could not pour water out of her pitcher. The DON said the fall mats should not prevent the resident's table from being within her reach. She also felt it was important for the resident to have access to fluids, even though she does get fluids during the scheduled hydration pass. The minimum data set (MDS) quarterly review, with an assessment reference date (ARD) of 04/12/09, indicated the resident needed set up help only with eating. The resident also had a care plan in place for dehydration. b) Resident #74 On 05/19/09 at approximately 1:00 p.m., residents were eating lunch in their rooms. Resident #74 asked to go to the bathroom. She was sitting in a geri chair with her meal tray in front of her. She did not have a call light within her reach. The call light, which was hanging from the wall, was not accessible to the resident. The resident also could not ambulate due to a recent [MEDICAL CONDITION] (stroke). At approximately 1:05 p.m., a staff member (Employee #10) was asked to come and assist the resident. Staff interviews verified the resident could utilize her call light if it was within her reach. c) Resident #44 When the nurse (Employee #11) went into the resident's room to administer her morning medications at approximated 8:30 a.m. on 05/19/09, the resident stated, \"I'm freezing!\" The nurse asked the resident whether she wanted another blanket. The resident replied she did, and said, \"I've asked three (3) people this morning\" and had not gotten one. After the nurse administered the resident's oral medications and eye drops, she washed her hands and started to take the cart down the hall toward the nurses' station. When reminded about her promise to get the resident a blanket, she said she had forgotten and went to get a blanket. The resident expressed her appreciation. At 10:00 a.m., the resident was asked whether she was still cold. She said the blanket the nurse had put on her a little while before made her warm enough. At approximately 2:00 p.m. on 05/22/09, the resident again said she had asked three (3) staff members for a blanket that morning but did not receive one until the nurse got one for her after she had taken her medications. .", "filedate": "2014-11-01"}
{"rowid": 10948, "facility_name": "GREENBRIER MANOR", "facility_id": 515185, "address": "ROUTE 2, BOX 159A", "city": "LEWISBURG", "state": "WV", "zip": 24901, "inspection_date": "2009-05-22", "deficiency_tag": 279, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "T34S11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on care plan review and staff interview, the facility failed to ensure all interventions being used to prevent one (1) of fifteen (15) residents from having skin breakdown were included in the section of the care plan pertaining to this issue. Resident identifier: #53. Facility census: 86. Findings include: a) Resident #53 A review of Resident #53's care plan revealed the following problem statement: \"Potential altered skin integrity R/T (related to): urinary / bowel incontinence.\" The resident had a physician's orders [REDACTED]. This intervention was not listed on the care plan. The director of nursing agreed this intervention needed included in the care plan. .", "filedate": "2014-11-01"}
{"rowid": 10949, "facility_name": "GREENBRIER MANOR", "facility_id": 515185, "address": "ROUTE 2, BOX 159A", "city": "LEWISBURG", "state": "WV", "zip": 24901, "inspection_date": "2009-05-22", "deficiency_tag": 281, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "T34S11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of medical records, resident interview, staff interview, and review of the facility's policy regarding medications, the facility failed to ensure staff followed facility policy and generally accepted guidelines when a resident repeatedly refused a medication in the evenings. The resident's medication administration records (MARs) indicated she had refused an evening dose of [MEDICATION NAME] for at least the last four (4) months. There was no evidence the physician had been notified, nor was there documentation found to indicate nurses had explored why the resident did not take the medication. Resident identifier: #51. Facility census: 86. Findings include: a) Resident #51 The nurse (Employee #7), when administering medications to this resident at approximately 7:10 p.m. on 05/20/09, initialed and circled the space for the resident's evening dose of [MEDICATION NAME], saying the resident had been refusing to take the medication. She did not check with the resident first, nor did she make a notation regarding why the medication was not given other than to put an \"R\" to indicate it had been refused. On 05/22/09, the resident's MAR for February, March, April, and May 2009 were reviewed. The medication had consistently been circled, and an \"R\" had been written under the nurses' initials to indicate she had refused the medication. Review of the backs of the MARs and the nursing entries for these months found nothing to indicate why the resident had refused the medication. On 05/22/09 at 9:55 a.m., the resident was asked why she refused the medication in the evening. She replied she received the medication twice a day and did not feel she needed it twice a day every day. Review of the facility's policy entitled \"Preparation and General Guidelines\" found, \"If a dose of regularly scheduled medication is withheld, refused, or given other than the scheduled time... the space of the front of the MAR for that dosage administration is (initialed and circled). An explanatory note is entered on the reverse side of the record provided for PRN (as needed) medication. ...\" .", "filedate": "2014-11-01"}
{"rowid": 10950, "facility_name": "GREENBRIER MANOR", "facility_id": 515185, "address": "ROUTE 2, BOX 159A", "city": "LEWISBURG", "state": "WV", "zip": 24901, "inspection_date": "2009-05-22", "deficiency_tag": 309, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "T34S11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, review of medical records, staff interviews, and resident interviews, the facility failed to ensure residents were assessed for efficacy of treatment changes; positioned to facilitate comfort and/or good body alignment; and received adaptive equipment as ordered by the physician. A resident had [MEDICAL CONDITION] for which the dosage of her diuretic was changed, but there was no evidence the effectiveness of this medication was monitored. Two (2) residents were observed while in bed without benefit of having been positioned for comfort, to enhance their physical abilities, and/or to maintain good body alignment. Two (2) residents had orders for specific devices for their wheelchairs which were no employed. Five (5) of fifteen (15) current residents on the sample were affected. Resident identifiers: #61, #44, #86, #47, and #53. Facility census: 86. Findings include: a) Resident #61 During the initial tour of the facility on 05/18/09 at approximately 4:15 p.m., observation found this resident sitting in her wheelchair in her room. Her feet were propped up on her bed, and her ankles and feet appeared [MEDICAL CONDITION]. After lunch on 05/20/09, the resident put her feet up on her bed while she was sitting in her wheelchair, She said, \"They don't even go down at night anymore.\" She added that the [MEDICAL CONDITION] in her feet and legs used to go \"down\" at night while she was in bed. On 05/20/09 at 6:10 p.m., the resident was again observed. She again was sitting in her wheelchair with her feet propped up on her bed. Her feet, ankles, and lower legs were [MEDICAL CONDITION]. She said, \"They haven't told me what's wrong, but it's getting so they don't go down at night.\" Review of the resident's medical record found the following: 1. She had been initially admitted to the facility on [DATE], with readmitted s of 02/12/09 and 03/19/09. 2. Her [DIAGNOSES REDACTED]. 3. A history and physical completed by the physician, dated 03/19/09, after her return from the hospital, noted she had been in the hospital for [MEDICAL CONDITION] bilaterally. Under \"Extremities\", the physician had circled \"[MEDICAL CONDITION]\" and noted \"Lt (left) leg\". The hospital discharge summary for this date noted she had bilateral lower leg [MEDICAL CONDITION]. \"Patient had a Doppler ultrasound done which revealed a [MEDICAL CONDITION] involving the right common femoral vein and the left common and superficial vein.\" 4. A physician's progress note, dated 03/11/09, indicated the resident had 1+ [MEDICAL CONDITION]. \"[MEDICAL CONDITION]\" had been circled related to her extremities and written in beside decreased mobility on a progress note dated 03/04/09. \"Legs (+) (positive) [MEDICAL CONDITION]\" had been noted by the physician in a notation on 04/10/09. A progress note, dated 04/21/09, had a circle drawn around pedal [MEDICAL CONDITION] under the section for \"Cardiac\", another drawn around the word [MEDICAL CONDITION] under \"Extremities\", and \"Peripheral [MEDICAL CONDITION]\" had been noted under the diagnoses. It was also noted, \"Will increase [MEDICATION NAME] & monitor BMP (a lab test).\" On 05/06/09, the physician again circled pedal [MEDICAL CONDITIONS], and wrote [MEDICAL CONDITION]. The resident was noted to have dyspnea, and a chest x-ray was ordered. 5. Review of her physician's orders [REDACTED]. The [MEDICATION NAME] was increased to 40 mg daily on 04/21/09. On 05/06/09, the physician increased the dose of [MEDICATION NAME] to 60 mg daily and ordered a chest x-ray (as was noted in the corresponding physician's progress note of that date). On 05/11/09, the dose of [MEDICATION NAME] was changed to 40 mg twice a day. 6. Review of nursing entries on the \"Daily Skilled Nurses Notes\" found the forms had been checked for 1+ pitting pedal [MEDICAL CONDITION] of the left leg on all three (3) shifts on 04/30/09 through 05/04/09. On 05/05/09, day shift and evening shift also checked this. On 05/07/09 at 9:00 a.m., on the back of the form, a nurse noted, \"Received [MEDICATION NAME] 60 mgm this am left leg much more [MEDICAL CONDITION]. ...\" Nothing regarding [MEDICAL CONDITION] had been checked on the front of the form. There was no further documentation regarding the [MEDICAL CONDITION] until 05/12/09. \"[MEDICAL CONDITION] legs\" had been written in on the front of the \"Daily Skilled Nurses Notes\" form and checked by all three (3) shifts. As on 05/22/09, no further nursing entries regarding the resident's [MEDICAL CONDITION]. 7. The resident had been observed to have pedal and lower leg [MEDICAL CONDITION] on 05/18/09, 05/19/09, 05/20/09, and 05/21/09. There was no evidence in the resident's medical record to indicate the [MEDICAL CONDITION] was being monitored by staff so the effectiveness of treatment could be assessed. On 05/22/09 at 8:40 a.m., it was noted the [MEDICAL CONDITION] had diminished. When this was mentioned to the resident, she said she did not know why, but they had gone down. She said she had been up and down to the bathroom all night, and her feet and legs had finally gone down. -- b) Resident #44 During the observation of morning medication pass on 05/19/09, the resident was in bed, leaning to her right. Periodic observations, on 05/19/09, 05/20/09, and 05/21/09, found her in essentially the same position. On 05/22/09 at 9:00 a.m., the resident was again observed while in bed. The head of the bed was elevated approximately 30 degrees, and the resident was leaning to her right. This placed her head and shoulder near the edge of the bed and the side rail. It was noted the resident used her right arm, but this was limited because of her leaning to her right. She did not move her left hand / arm. On 05/22/09 at 9:05 a.m., Employee #11 was asked whether the resident was able to move her left arm at all and replied, \"No.\" The resident was asked whether she would be more comfortable if her shoulders were moved to the left. She looked at a label on the side rail, that was inches from her eyes, and said, \"Yes, the sign says not to lay against the side rail.\" Staff was informed of the resident's wish to be repositioned. Resident #44 stated she was more comfortable after she had been repositioned and her body was in better alignment. No positioning devices were used and, within approximately ninety (90) minutes, the resident had again slid over to her right. -- c) Resident #86 This resident was observed at approximately 5:30 p.m. on 05/20/09. It was noted this resident had slid down in her bed, so that her lower [MEDICATION NAME] and upper lumbar spine were where her hips should have been. On 05/20/09 at approximately 6:10 p.m., the call light was on in this resident's room. The room was entered, and the resident was engaged in conversation. She said she had been lying like that for a while. When asked whether she was comfortable, she said, \"No, my back hurts.\" At 6:19 p.m., a staff member entered the room to see what the resident who had rung the call bell needed. The staff member left the room without offering to reposition Resident #44. At approximately 6:30 p.m., staff was informed the resident needed to be repositioned. At approximately 7:00 p.m., the resident was asked whether being repositioned had helped her back, and she said it had. -- d) Resident #47 This resident was observed during wound care rounds on 05/20/09. She was sitting in a wheelchair with a soft cushion behind her back. The resident had severe kyphosis. She had one (1) area on her spine with scar tissue from a recently healed pressure area. Another area on her spine was still open and being treated. Review of the resident's medical record found the physician had written the following order on 05/07/09: \"Obtain foam pillow /c (with) window cut in center to put behind her [MEDICATION NAME] spine when sitting.\" The corresponding physician's progress note identified the resident had a 1 cm pressure ulcer on the [MEDICATION NAME] spine which was improving. The plan was to improve padding to relieve pressure. The cushion that was observed did not have a window cut out for the [MEDICATION NAME] spine as ordered. In exit conference, the medical director, who had also made wound care rounds on 05/20/09, noted the soft pillow that had been put behind the resident. She agreed, however, that the attending physician needed to be made aware and to change the order if desired. -- e) Resident #53 The medical record review for Resident #53, conducted on 05/20/09 at approximately 1:00 p.m., revealed the physician had written an order, dated 04/28/09, for the resident to have a pressure reducing device in her chair. On 05/20/09 at approximately 10:30 a.m., the resident did not have a pressure reducing cushion in her chair. The administrator was made aware of this observation at approximately 5:00 p.m. on 05/20/09. .", "filedate": "2014-11-01"}
{"rowid": 10951, "facility_name": "GREENBRIER MANOR", "facility_id": 515185, "address": "ROUTE 2, BOX 159A", "city": "LEWISBURG", "state": "WV", "zip": 24901, "inspection_date": "2009-05-22", "deficiency_tag": 310, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "T34S11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on random observations during meal times, the facility failed to ensure a resident's ability to eat did not diminish unless the individual's clinical condition made the diminution unavoidable. Residents were not seated and/or positioned to enable them to feed themselves with optimal comfort and ease. Eight (8) residents were observed to be in need of repositioning and/or changes in the height of the surface on which their meals were served relative to their bodies. Resident identifiers: #59, #64, #38, #1, #19, #54, #2, and #44. Facility census: 86. Findings include: a) Resident #59 At approximately 12:40 p.m. on 05/20/09, the resident was seated at a round table with three (3) other residents in the first floor dining room. The resident was seated in a reclining geri-chair. The top of the table was at the level of the resident's axilla. This resident was observed during the evening meal, at approximately 6:05 p.m., in the first floor dining room. She was seated in a geri-chair, and her meal tray had been placed on a table. The height of the table relative to her chair resulted in her plate being at the height of the base of her neck. b) Resident #64 On 05/20/09, this resident was observed at approximately 12:40 p.m. while eating in the first floor dining room. Her meal was at the height of the resident's axillary region. c) Resident #38 During lunch on 05/20/09, the resident was observed in her bed eating lunch. The head of her bed had been elevated to almost 90 degrees, and she had slid down in the bed until her subscapular region was resting near where her hips should have been in the angle of the bed. Her right shoulder was lower than the left. She was trying to eat with her left hand. It was noted she had not touched her Jello. When asked, she said she did not know it was there. At that time, Employee #97 entered the room, moved the bowl of Jello nearer to the resident, and told her it was Jello with bananas. The resident began to eat the Jello after it she had been made aware of its presence and was able to reach the item. d) Resident #1 On 05/20/09, this resident was observed eating while lying in bed. The head of her bed was elevated at approximately 70 degrees. The resident was lying on her right side and trying to eat with her dependent right hand. e) Resident #19 This resident was observed at lunch time on 05/20/09. She was lying in bed with a pillow behind her head resulting an elevation of approximately 45 degrees. This did not facilitate ease in feeding herself. f) Resident #54 At lunch on 05/20/09, the resident was observed in her room. She was in bed and had slid down so her back was bent in the lumbar-[MEDICATION NAME] area. When asked whether she was comfortable, she said, \"No.\" She said, \"Yes\", when asked whether she needed to be pulled up in bed. When asked if she would like staff to be informed of her need to be repositioned she said, \"Yes\", then added, \"You can try\", when advised this surveyor would let staff know of her need. Staff did reposition the resident shortly thereafter. Approximately fifteen (15) minutes later, the resident was asked whether she was more comfortable, she said she was. g) Resident #2 A nursing assistant was observed feeding this resident who was in bed, at approximately 6:15 p.m. on 05/20/09. The resident was lying on her right side at approximately 45 degrees. The nursing assistant was sitting on the resident's left side. The resident had to turn her head to receive her food. This did not facilitate the resident's ability to swallow, as her head and neck were turned instead of being in a straight line. h) Resident #44 On 05/20/09, the resident was feeding her self her evening meal. Her head, neck, and torso had slid to the right side of her bed. She was using her right hand to feed herself, but she had to keep her elbow against the bed to keep from sliding further to the right. .", "filedate": "2014-11-01"}
{"rowid": 10952, "facility_name": "GREENBRIER MANOR", "facility_id": 515185, "address": "ROUTE 2, BOX 159A", "city": "LEWISBURG", "state": "WV", "zip": 24901, "inspection_date": "2009-05-22", "deficiency_tag": 371, "scope_severity": "F", "complaint": 0, "standard": 1, "eventid": "T34S11", "inspection_text": "Based on observations made during the initial tour of the facility's kitchen and staff interview, the facility failed to store and prepare foods under sanitary conditions. A dented can was noted in the dry storage area, and equipment used to prepare food was noted to be in need of cleaning. This had the potential to affect any resident who received foods from the kitchen. Facility census: 86. Findings include: a) During the initial tour of the kitchen, a #10 can of peaches was noted on the shelf in the dry storage area. The can had a dented area involving the rim of the can and another dent greater than 45 degrees near the bottom of the can. Employee #64, when asked how dented cans were handled, said they were returned to the vendor. The can of peaches should not have been on the shelf. b) The Hobart floor stand mixer was noted to have bits of food hanging off of the head of the machine and food debris on the outside of the vessel. c) The Robot Coupe was noted to have the lid placed on the container in the closed position. There was moisture inside of the container, and a small bit of meat was adhering to the inside of the container. .", "filedate": "2014-11-01"}
{"rowid": 10953, "facility_name": "GREENBRIER MANOR", "facility_id": 515185, "address": "ROUTE 2, BOX 159A", "city": "LEWISBURG", "state": "WV", "zip": 24901, "inspection_date": "2009-05-22", "deficiency_tag": 441, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "T34S11", "inspection_text": "Based on observations, the facility's infection control program was not effective in ensuring staff practiced aseptic techniques during dressing changes. The nurse removed a pen from her pocket after donning gloves, then had direct contact with the resident's wound; 4 x 4s came in direct contact with a can of saline spray used for multiple residents; a Sharpie was place on the clean field; and a measuring device was placed directly against a wound after having been placed on the resident's bed. Resident identifiers: #9, #47, #40, and #11. Facility census: 86. Findings include: a) Resident #9 On 05/20/09 at 7:50 a.m., a nurse (Employee #10) was observed providing care to a wound on the resident's right medial ankle. The nurse donned gloves then removed a pen from her uniform pocket. While wearing the same gloves, she had contact with the wound area. This created a potential to transfer organisms from her pocket and the pen to the resident's wound. When cleansing the wound, the nurse sprayed saline onto the sponges with her left hand. After moistening the sponges, she transferred them from her right hand to the left hand and cleansed the wound. The can of saline spray had been on the treatment cart and had been used for other residents. When the nurse transferred the sponges from her right hand to her left, a potential for transfer of organisms from the can to the resident's wound was created. b) Resident #47 Employee #10 was observed providing care to an open area on the resident's spine in the morning on 05/20/09. She sprayed Wound Wash Saline onto some gauze (4 x 4s), then allowed the 4 x 4s to come in contact with the can of spray. c) Resident #40 On the morning of 05/20/09, Employee #10 provided care to the resident's wound. Again the can of saline spray came in contact with the clean 4 x 4s. d) Resident #11 During the treatment procedure for this resident on the morning of 05/20/09, Employee #10 place a Sharpie she had removed from her pocket on her dressing field. The Sharpie would be considered a contaminated item. Additionally, the plastic sheet used to measure the resident's wound was placed on the bed, then placed directly against the wound. .", "filedate": "2014-11-01"}
{"rowid": 10954, "facility_name": "GREENBRIER MANOR", "facility_id": 515185, "address": "ROUTE 2, BOX 159A", "city": "LEWISBURG", "state": "WV", "zip": 24901, "inspection_date": "2009-05-22", "deficiency_tag": 492, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "T34S11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of medical records and staff interviews, the facility failed to ensure determinations of incapacity were completed in accordance with the requirements of the West Virginia Code (Chapter 16 Article 30) and Physician order [REDACTED].?[DATE]. Three (3) of the fifteen (15) current residents on the sample were affected. Two (2) residents had been determined to lack the capacity to make medical decisions, but the determinations did not identify the nature of the incapacity and/or only included a [DIAGNOSES REDACTED]. One (1) resident's POST form had not been completed in accordance with the form's instructions. Resident identifiers: #20, #14, and #57. Facility census: 86. Findings include: a) Resident #20 The POST form, as specified in ?[DATE] of the West Virginia Code, includes the following instruction in Section F: \"If I lose decision-making capacity, I authorize my medical power of attorney representative / health care surrogate to make all medical decisions for me, including those regarding CPR and other life-sustaining treatment and to complete a new form. (Initials in box indicate patient acceptance of this statement).\" The form signed by the resident, on [DATE], had a check mark in the box instead of the resident's initials as specified on the form. The initials were intended to verify the resident had made the choice to allow another to change his or her wishes should he or she no longer be able to express his or her wishes regarding end of life care. b) Resident #14 Review of the resident's determination of incapacity dated [DATE] found the only cause listed was \"Dementia\". There was no additional informations provided to indicate how advanced the resident's dementia was to establish she was no longer capable of making decisions on her own behalf. Additionally, under the section \"Nature\" nothing had been checked. The West Virginia Code includes the following: \"?[DATE]. Determination of incapacity. \"(a) For the purposes of this article, a person may not be presumed to be incapacitated merely by reason of advanced age or disability. With respect to a person who has a [DIAGNOSES REDACTED]. A determination that a person is incapacitated shall be made by the attending physician, a qualified physician, a qualified psychologist or an advanced nurse practitioner who has personally examined the person. \"(b) The determination of incapacity shall be recorded contemporaneously in the person's medical record by the attending physician, a qualified physician, advanced nurse practitioner or a qualified psychologist. The recording shall state the basis for the determination of incapacity, including the cause, nature and expected duration of the person's incapacity, if these are known.\" .", "filedate": "2014-11-01"}
{"rowid": 10955, "facility_name": "GREENBRIER MANOR", "facility_id": 515185, "address": "ROUTE 2, BOX 159A", "city": "LEWISBURG", "state": "WV", "zip": 24901, "inspection_date": "2009-05-22", "deficiency_tag": 514, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "T34S11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of medical records, the facility failed to ensure the clinical record of each resident was accurate and complete. One (1) resident was listed as living in another facility on the face sheet. Another resident had an order for [REDACTED]. Two (2) of fifteen (15) current residents on the sample were affected. Resident identifiers: #45 and #68. Facility census: 86. Findings include: a) Resident #68 According to nursing entries, contact isolation was ordered for this resident on 02/06/09, but the order was not written until sometime between 02/16/09 and 02/19/09. When the order was written, it was noted as being late, but no specific date was included in the order. Review of the nursing entries, between 02/06/09 and 02/19/09, did not find any evidence the resident had been placed on contact precautions other than the one (1) entry made by the nurse who later wrote the order. b) Resident #45 During the medical record review for Resident #45 on 05/19/09, the face sheet revealed the resident's address as being that of a neighboring facility. At approximately 4:30 p.m. on 05/19/09, the administrator agreed the face sheet needed changed to reflect the resident's current address.", "filedate": "2014-11-01"}
{"rowid": 11037, "facility_name": "FAYETTE NURSING AND REHABILITATION CENTER, LLC", "facility_id": 515153, "address": "100 HRESAN BOULEVARD", "city": "FAYETTEVILLE", "state": "WV", "zip": 25840, "inspection_date": "2009-05-22", "deficiency_tag": 323, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "ETK911", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on water temperature measurements, staff interview, and observation, the facility failed to assure the residents' environment was as free of accident hazards as possible. Water temperatures were too hot in residents' hand sinks, a resident was not ambulated as ordered to prevent falls, and a treatment cart was left unlocked and unattended in the hallway. These practices had the potential to affect one (1) sampled resident and all residents who could ambulate independently. Resident identifier: #51. Facility census: 55. Findings include: a) Water temperatures On 05/22/09, temperatures of hot water were taken with the facility's environment services supervisor (ESS). The water temperatures were taken of the hand sinks on \"B,\" \"C,\" and \"D\" Halls, with the following findings which exceeded the maximum safe temperature (110 degrees F): - B-2 was 118 degrees F at 10:08 a.m. - C-3 was 116 degrees F at 10:10 a.m. - D-1 was 116.8 degrees F at 10:10 a.m. Interview with the ESS, at 9:45 a.m. on 05/22/09, revealed he mistakenly believed 110 degrees F was the minimum allowable temperature in resident areas, instead of the maximum allowable temperature. Record review revealed water temperatures were being taken, but the exact temperatures were not being recorded. A check mark was being placed beside 110 degrees F. According to the ESS, this check meant the hot water was 110 degrees F or above. b) Resident #51 Medical record review revealed an order for [REDACTED]. This information was also found on the closet sheet. At noon on 05/22/09, this resident was observed being ambulated to and from the dining room without being followed with a wheelchair, creating an accident hazard for this resident. c) Treatment cart On 05/21/09 at 11:45 a.m., random observations of the resident environment found s treatment cart parked in the \"C\" hallway with no staff members present in the hallway. Inspection of the treatment cart found it had been left unlocked and stocked with treatment supplies which included numerous creams and ointments. The treatment cart remained unsupervised and unlocked in the resident hallway for five (5) minutes. A nursing staff member was observed to exit a resident room, which previously had the door closed. She stated she had forgotten to lock her cart. .", "filedate": "2014-09-01"}
{"rowid": 11038, "facility_name": "FAYETTE NURSING AND REHABILITATION CENTER, LLC", "facility_id": 515153, "address": "100 HRESAN BOULEVARD", "city": "FAYETTEVILLE", "state": "WV", "zip": 25840, "inspection_date": "2009-05-22", "deficiency_tag": 332, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "ETK911", "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 assure medication were administered with an error rate below 5 percent (5%). Facility nursing staff members made three (3) medication errors with an opportunity for fifty-three (53) errors for an overall error rate of 5.6 %. This deficient practice affected three (3) of seven (7) residents receiving medications. Resident identifiers: #55, #37, and #35. Facility census: 55. Findings include: a) Resident #55 Observations of the medication administration pass, on 05/20/09 at 9:10 a.m., found the nurse pouring liquid Potassium into a plastic medication cup. Review of the medication administration record (MAR) noted the physician ordered Resident #55 to receive 7.5 cc of liquid Potassium. The nurse was asked to measure the amount of liquid Potassium present in the cup by using a syringe. The nurse determined the cup only contained 6.25 cc of liquid Potassium. b) Resident #37 Observation of the medication administration pass, on 05/21/09 at 9:15 a.m., found the nurse preparing medications for Resident #37. Review of the MAR noted the resident was to receive 150 mg of [MEDICATION NAME]. Inspection of the bottle of [MEDICATION NAME] utilized by the nurse revealed each tablet contained 75 mg. of [MEDICATION NAME]. The nurse placed one (1) tablet of [MEDICATION NAME] into the resident's medication cup and administered it to the resident along with her other medications. The nurse was asked to again review the MAR and bottle of medication following the administration. She agreed the she should have administered two (2) tablets of [MEDICATION NAME] to the resident. c) Resident #35 Review of the medical record found Resident #35 was prescribed [MEDICATION NAME] 120 mg three-times-a-day (TID) before each meal for treatment of [REDACTED]. Observations of the resident, on the morning of 05/21/09, found no nurse administered [MEDICATION NAME] prior to the noon meal. Review of the MAR, on 05/21/09 at 1:30 p.m., found a nurse had not initialed the [MEDICATION NAME] had been administered to the resident. An interview with the assigned nurse, on 05/21/09 at 1:30 p.m., confirmed the nurse did not administer the [MEDICATION NAME] prior to the noon meal. .", "filedate": "2014-09-01"}
{"rowid": 11039, "facility_name": "FAYETTE NURSING AND REHABILITATION CENTER, LLC", "facility_id": 515153, "address": "100 HRESAN BOULEVARD", "city": "FAYETTEVILLE", "state": "WV", "zip": 25840, "inspection_date": "2009-05-22", "deficiency_tag": 428, "scope_severity": "F", "complaint": 0, "standard": 1, "eventid": "ETK911", "inspection_text": "Based on medical record review and staff interview, the facility failed to assure a licensed pharmacist conducted a review of each resident's drug regimen at least once a month. This deficient practice affected all residents currently residing in the facility. Facility census: 55. Findings include: a) Review of thirteen (13) medical records found no evidence a licensed pharmacist conducted a drug regimen review for the month of April 2009. An interview with the director of nursing (DON), on the morning of 05/20/09, confirmed a drug regimen review was not conducted by a licensed pharmacist in April 2009. .", "filedate": "2014-09-01"}
{"rowid": 11040, "facility_name": "FAYETTE NURSING AND REHABILITATION CENTER, LLC", "facility_id": 515153, "address": "100 HRESAN BOULEVARD", "city": "FAYETTEVILLE", "state": "WV", "zip": 25840, "inspection_date": "2009-05-22", "deficiency_tag": 441, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "ETK911", "inspection_text": "Based on random observation and review of facility policy, the facility failed to assure nurses administered eye drops in a manner to prevent the potential spread of infection for two (2) of two (2) eye drop administrations observed. Resident identifiers: #55 and #50. Facility census: 55. Findings include: a) Resident #55 During observations of the medication administration pass on 05/21/09 at 9:10 a.m., the nurse (Employee #52) administered eye drops to Resident #55. The nurse did not wash or sanitize her hands. She removed gloves from a box in the room, wadded them up in her hands, carried the resident's oral medications and bottle of eye drops into the resident's room, then removed another pair of gloves from the box in the room and placed them into her uniform pocket. The nurse administered the resident's oral medications. She then removed a pair of gloves from her uniform pocket, donned the contaminated gloves, and administered one (1) drop of medication into each of the resident's eyes. The director of nursing (DON) provided the facility's policy on the instillation of eye drops at 10:30 a.m. on 05/20/09. Review of the policy section entitled \"Infection Control Protocol and Safety\" (revised August 2002) found the following instructions: \"1. Wash your hands thoroughly with soap and water at the following intervals: a. before the procedure; ... .\" b) Resident #50 On 05/21/09 at 9:15 a.m., the nurse (Employee #30) administered eye drops to each of Resident #50's eyes. During this administration, the nurse allowed the tip of the eye drop bottle to come into contact with the lashes of the resident's left eye. .", "filedate": "2014-09-01"}
{"rowid": 11041, "facility_name": "FAYETTE NURSING AND REHABILITATION CENTER, LLC", "facility_id": 515153, "address": "100 HRESAN BOULEVARD", "city": "FAYETTEVILLE", "state": "WV", "zip": 25840, "inspection_date": "2009-05-22", "deficiency_tag": 502, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "ETK911", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview, the facility failed to obtain laboratory services to meet the needs of one (1) of thirteen (13) sampled residents. Resident identifier: #1. Facility census: 55. Findings include: a) Resident #1 Review of the medical record found a physician's orders [REDACTED]. The medical record contained no evidence the facility had obtained the ordered laboratory test for this resident. An interview with the director of nursing (DON), on 05/21/09 at 12:00 p.m., confirmed the facility did not obtain the ordered laboratory test. .", "filedate": "2014-09-01"}
{"rowid": 11042, "facility_name": "FAYETTE NURSING AND REHABILITATION CENTER, LLC", "facility_id": 515153, "address": "100 HRESAN BOULEVARD", "city": "FAYETTEVILLE", "state": "WV", "zip": 25840, "inspection_date": "2009-05-22", "deficiency_tag": 225, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "ETK911", "inspection_text": "Based on review of the facility's complaint records and staff interview, the facility failed to thoroughly investigate allegations of neglect upon receipt, and failed to report licensed healthcare professionals involved in instances of neglect to the appropriate licensing boards, and failed to assure staff immediately reported all allegations of neglect to the facility's administrator. These practices were evident for six (6) of ten (10) allegations reviewed. Resident identifiers: #5, #6, #35, #57, and #58. Facility census: 55. Findings include: a) Resident #6 On 01/06/09, Resident #6 reported to the facility she sometimes turned on her bathroom light and was not assisted for several minutes. The facility interviewed assigned nursing assistants and took statements. In one (1) of these statements, a nursing assistant identified by name another nursing assistant who had also helped the resident on the 7-3 shift on 01/06/09. The facility did not interview this other nursing assistant and/or obtained a statement from him/her. b) Resident #35 On 01/30/09, Resident #35's family expressed concern that the resident might not be getting showers on her scheduled shower days. The facility's investigation indicated statements were collected from nursing staff; however, upon request, the facility could not produce these statements. On 03/10/09, this resident's family again expressed concern that the resident was not receiving her scheduled showers. There was no investigation of this allegation; the facility only obtained statements from staff regarding what was supposed to occur regarding residents and their shower days. In addition, the family also expressed concern that the resident's personal items were being used for other residents. This concern was not addressed at all. c) Resident #5 On 02/20/09, Resident #5 reported she had not been receiving her medications for her mouth since admission on 02/05/09. The facility investigated the situation and disciplined several nurses for failing to order the medication and/or failing to assure the resident received the medication as ordered; however, the facility did not report the nurses involved in this neglect to the appropriate licensing board. d) Resident #57 On 03/04/09, the nursing assistant for this resident (who no longer resides in the facility) provided a statement indicating she had informed C.L., a licensed practical nurse (LPN), the resident had a scratch on her leg which needed to be checked by the LPN. The facility investigated the situation and substantiated the LPN did not assess the resident's leg. The facility did not report this neglect to the appropriate licensing board. e) Resident #58 On 03/02/09, a nursing assistant (Employee #17) made a complaint regarding C.L. (LPN) regarding the nurse's failure to check on Resident #58. The nursing assistant stated, \"Around a week and a half ago ... she (the resident) was really pale in color and had diarrhea X 6.\" The nursing assistant stated the LPN did not do anything for the resident after she was given this information. The nursing assistant did not immediately report this allegation of neglect to facility administration, and there was no evidence this failure to report was addressed. f) During an interview on the afternoon of 05/20/09, the social worker was unable to provide any additional information regarding the above-referenced concerns. .", "filedate": "2014-09-01"}
{"rowid": 11043, "facility_name": "FAYETTE NURSING AND REHABILITATION CENTER, LLC", "facility_id": 515153, "address": "100 HRESAN BOULEVARD", "city": "FAYETTEVILLE", "state": "WV", "zip": 25840, "inspection_date": "2009-05-22", "deficiency_tag": 364, "scope_severity": "F", "complaint": 0, "standard": 1, "eventid": "ETK911", "inspection_text": "Based on observation and staff interview, the facility failed to assure potatoes were prepared by a method which conserved nutritional value. They were soaked in water, creating a loss of nutrients. This practice had the potential to affect all residents who received nourishment from the dietary department. Facility census: 55. Finding include: a) On 05/18/09 at 2:00 p.m., observation revealed a large pan of potatoes in a large amount of water in the cooler. Upon inquiry, at that time, the cook stated the potatoes were for the following day. Further inquiry revealed the water would be drained off and discarded. This practice creates a loss of potassium in the potatoes. This process is called \"leaching\" and is used when potassium needs to be removed from potatoes for potassium restricted diets.", "filedate": "2014-09-01"}
{"rowid": 11044, "facility_name": "FAYETTE NURSING AND REHABILITATION CENTER, LLC", "facility_id": 515153, "address": "100 HRESAN BOULEVARD", "city": "FAYETTEVILLE", "state": "WV", "zip": 25840, "inspection_date": "2009-05-22", "deficiency_tag": 315, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "ETK911", "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 provide services and treatment to restore as much normal bladder function as possible for one (1) of twelve (12) sampled residents. The facility did not assess one (1) of thirteen (13) sampled residents or put individualized measures in place to help restore continence when a resident had a decline in bladder continence. Resident identifier: #12. Facility census: 55. Findings include: a) Resident #12 Medical record review, on 05/20/09, revealed this resident had an indwelling Foley urinary catheter when she was admitted on [DATE]. The facility implemented a bladder training schedule for discontinuation of the catheter on 08/20/08, 08/21/08 and 08/23/08, and the catheter was discontinued at 12:00 a.m. on 08/23/08. A bladder assessment was completed on 10/13/08. This assessment indicated the resident was continent of bladder. Review of the resident's minimum data set assessment (MDS), with an assessment reference date (ARD) of 02/08/09, revealed the resident's bladder continence was coded \"2\", indicating occasional bladder incontinence. This coding represents incontinence two (2) or more times a week, but not daily. Review of the resident's MDS, with an ARD of 05/03/09, revealed the resident was coded \"3\", indicating frequent bladder incontinence. This coding represents incontinence daily. Review of the resident's care plan, dated 05/05/09, revealed the following problem: \"Having incontinence of bowel and bladder which has worsened.\" The interventions for this problem did not include anything regarding assessment for causal factors. The interventions described the resident had declined a toileting schedule. There was no evidence of any other plans to assist the resident in becoming continent and/or less incontinent. The facility's urinary continence and incontinence assessment and management policy, provided by the director of nursing (DON), instructed facility staff to complete ongoing assessments of a resident's diagnoses, physical and cognitive functioning, and environment factors, to name a few, to determine possible causal factors for incontinence. The policy also directed staff to identify risk factors, complete a review of medications, assess voiding patterns, and to identify other risk factors for becoming incontinent or for worsening of current incontinence. There was no evidence that this had been done for this resident. On 05/22/09 at 3:30 p.m., a discussion was held with the DON regarding this resident's incontinence and what assessment the facility had initiated to determine causal factors and/or appropriate plans to assist the resident in becoming continent, or less incontinent. At that time, the DON had no additional information to provide regarding what the facility had implemented to assess whether this resident's worsening incontinence had the potential to be reversed. .", "filedate": "2014-09-01"}
{"rowid": 11045, "facility_name": "FAYETTE NURSING AND REHABILITATION CENTER, LLC", "facility_id": 515153, "address": "100 HRESAN BOULEVARD", "city": "FAYETTEVILLE", "state": "WV", "zip": 25840, "inspection_date": "2009-05-22", "deficiency_tag": 246, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "ETK911", "inspection_text": "Based on observation and staff interview, the facility failed to made reasonable accommodations with staff's routine and/or practices to ensure residents received timely assistance with toileting to maintain independent functioning and dignity. This affected two (2) residents of random observation. Resident identifiers: #39 and #51. Facility census: 55. Findings include: a) Residents #51 and #39 After the noon meal on 05/22/09 at 1:45 p.m., observation found Resident #51 waiting for a staff member to take her to the bathroom. Upon inquiry, the resident stated she had already asked staff to take her, but they have not \"gotten to me yet\". The resident then stated, \"If I don't go to the bathroom soon, I'm gonna go. I know what everyone feels like now when they've gotta go and no one to take them.\" Further discussion revealed staff told the resident she would have to wait until the trays were picked up to be taken to the bathroom. A few minutes later, the resident was taken to her room and into the bathroom. While Resident #51 was in the bathroom, her roommate (Resident #39) was brought to the entrance of their room to be taken to the bathroom. When Resident #39 was informed Resident #51 was in the bathroom, Resident #39 stated she had to go \"now\" and \"I am about to wet myself.\" A nursing assistant and a nurse were just outside the door when this occurred. When asked what should be done in this situation, the nurse stated, \"That's a good question. This has not come up before.\" Neither nursing staff member considered, or took, Resident #39 to a different bathroom. .", "filedate": "2014-09-01"}
{"rowid": 11505, "facility_name": "MONTGOMERY GENERAL HOSP., D/P", "facility_id": 515081, "address": "WASHINGTON STREET AND 6TH AVENUE", "city": "MONTGOMERY", "state": "WV", "zip": 25136, "inspection_date": "2009-05-29", "deficiency_tag": 152, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "E5O711", "inspection_text": "Based on medical record review, and staff interview, the facility failed to assure the right to make medical decisions for one (1) of ten (10) sampled residents was exercised in accordance with State law (the West Virginia Health Care Decisions Act). The facility allowed a health care surrogate (HCS) to transfer decision-making authority to a different family member when the HCS was unavailable. Resident identifier: #4. Facility census: 29. Findings include: a) Resident #4 Review of Resident #4's medical record found the treating physician determined the resident lacked capacity to understand and make informed medical decisions on 04/17/09. The physician appointed Family Member #1 to act as the resident's HCS. Further review found a handwritten, notarized document which appeared to be authored by Family Member #1, transferring the health care decision-making authority to Family Member #2 in the event Family Member #1 could not be reached. On 05/28/09 at 1:00 p.m., the document was shown to two (2) facility nurses (Employees #24 and #27). Each was asked what they would do if Family Member #1 could not be reached to make a health care decision. Both stated that, because the document was notarized, they would contact Family Member #2 to make health care decisions. Review of section 16-30-8 (a) of the West Virginia Health Care Decisions Act found the following language, \"When a person is or becomes incapacitated, the attending physician or the advanced nurse practitioner with the assistance of other health care providers as necessary, shall select, in writing, a surrogate.\" The facility allowed a HCS to transfer medical decision-making authority to another individual in violation of the West Virginia Health Care Decisions Act. Only the attending physician or advanced nurse practitioner may select a surrogate decision-maker. .", "filedate": "2014-01-01"}
{"rowid": 11506, "facility_name": "MONTGOMERY GENERAL HOSP., D/P", "facility_id": 515081, "address": "WASHINGTON STREET AND 6TH AVENUE", "city": "MONTGOMERY", "state": "WV", "zip": 25136, "inspection_date": "2009-05-29", "deficiency_tag": 225, "scope_severity": "E", "complaint": null, "standard": null, "eventid": "E5O711", "inspection_text": "Based on review of personnel records and other facility documents and staff interview, the facility failed to assure comprehensive screening was completed for three (3) of five (5) newly hired employees. Additionally, the facility failed to report an allegation of abuse involving one (1) resident to the State survey and certification agency and other officials in accordance with State Law. These deficient practices had the potential of affecting more than an isolated number of residents currently residing in the facility. Employee identifiers: #7, #14, and #76. Resident identifier: #2. Facility census: 29. Findings include: a) Employees #7, #14, and #76 1. Review of personnel records, on the afternoon of 05/29/0,9 found the facility did not obtain references from two (2) known previous employers prior to hiring Employee #7. 2. Further review found the facility did not obtain a criminal background check for the state of Ohio, when this state was listed as a previous residence of Employee #14. 3. It was also found the facility failed to access the Nurse Aide Abuse Registry to assure Employee #76 did not have findings of abuse or neglect registered with this state agency. Employee #32, who was assisting with review of the personnel records, was unable to provide evidence to show the required pre-employment screening for Employees #7, #14, and #76 was obtained by the facility. b) Resident #2 Review of facility records found, on 05/04/09, the daughter of Resident #2 sent an e-mail to the social services director alleging Employee #3 was \"... smacking Mom's behind for wanting up at night to use the potty chair ... The woman may be teasing with Mom, but Mom is taking it as a punishment. Mom should not have to receive this treatment.\" Further review could find no evidence this allegation of abuse was reported to the State survey and certification agency or adult protective services in accordance with State law. An interview with Employee #32, on the afternoon of 05/29/09, confirmed this allegation had not been reported as required. .", "filedate": "2014-01-01"}
{"rowid": 11507, "facility_name": "MONTGOMERY GENERAL HOSP., D/P", "facility_id": 515081, "address": "WASHINGTON STREET AND 6TH AVENUE", "city": "MONTGOMERY", "state": "WV", "zip": 25136, "inspection_date": "2009-05-29", "deficiency_tag": 329, "scope_severity": "E", "complaint": null, "standard": null, "eventid": "E5O711", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and pharmacist recommendation, the facility failed to assure the drug regimens of three (3) of ten (10) residents remained free from unnecessary drugs, used in excessive dose, for an excessive duration, and/or without indications for use. Resident identifiers: #1, #14, and #10. Facility census: 29. Findings include: a) Resident #1 1. Review of the medical record found Resident #1 was currently receiving [MEDICATION NAME] 50 mg twice-a-day (BID) and [MEDICATION NAME] 100 mg BID. Further review found a 03/17/09 recommendation from the consultant pharmacist informing the physician these two (2) drugs were considered duplication of therapy. The pharmacist asked the physician to consider stopping one (1) of the drugs. The physician did not acknowledge the pharmacist's recommendation. 2. Further review found the resident received [MEDICATION NAME] 1 mg at bedtime. A pharmacy recommendation, dated 01/20/08 (more than fifteen (15) months earlier) notified the physician that a gradual dose reduction needed to be attempted every six (6) months. The physician did not acknowledge the pharmacist's recommendation, and the resident remained on [MEDICATION NAME] 1 mg at bedtime. b) Resident #14 Review of the medical record found a physician's orders [REDACTED]. The resident was [MEDICATION NAME] mg BID for ten (10) days. On 04/13/09, an order for [REDACTED]. The medical record contained the urine culture report, marked as having been received at 5:01 p.m. on 04/13/09. The report documented no growth of bacteria after forty-eight (48) hours. There was no documentation to reflect the treating physician was notified of this laboratory report. The nurses administered [MEDICATION NAME] 500 mg for a total of eight (8) days beginning at 2:00 p.m. on 04/13/09, and continued [MEDICATION NAME] mg for seven (7) days after receiving the laboratory report. c) Resident #10 The physician [MEDICATION NAME] mg BID for ten (10) days for treatment of [REDACTED]. On 03/24/09 at 9:31 a.m., the facility received a laboratory report which determined the bacteria present in the resident's urine (Escherichia Coli) were resistant to Cipro. A handwritten note indicated the report was faxed to the physician at 10:00 a.m. on 03/24/09. The resident continued to [MEDICATION NAME] the evening shift on 03/24/09 and the day and evening shifts on 03/25/09, after being notified by the laboratory the bacteria present in the resident's urine were resistant to Cipro. The facility did not receive orders for an appropriate antibiotic until 5:00 a.m. on 03/26/09. .", "filedate": "2014-01-01"}
{"rowid": 11508, "facility_name": "MONTGOMERY GENERAL HOSP., D/P", "facility_id": 515081, "address": "WASHINGTON STREET AND 6TH AVENUE", "city": "MONTGOMERY", "state": "WV", "zip": 25136, "inspection_date": "2009-05-29", "deficiency_tag": 428, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "E5O711", "inspection_text": "Based on medical record review and review of a pharmacy report of irregularities for two (2) of ten (10) sampled residents, the facility failed to assure the pharmacist's recommendation for a gradual dose reduction of Ativan was acted upon by the physician. Resident identifiers: #1 and #14. Facility census: 29. Findings include: a) Resident #1 Review of the medical record found Resident #1 was currently receiving Lyrica 50 mg twice-a-day (BID) and Neurontin 100 mg BID. Further review found a 03/17/09 recommendation from the consultant pharmacist informing the physician these two (2) drugs were considered duplication of therapy. The pharmacist asked the physician to consider stopping one (1) of the drugs. The physician did not acknowledge or act upon the pharmacist's recommendation. b) Resident #14 Review of the medical record found a pharmacy's consult to the physician dated 04/22/09. The pharmacist notified the physician the resident was ordered MS (morphine sulfate) 30 mg BID on 04/06/09, in addition to a current order for Oxycodone 10/650 every six (6) hours as needed (PRN) for pain. The pharmacist noted the order for Oxycodone did not contain parameters for nursing as to when the PRN Oxycodone should be administered. The physician failed to acknowledge or act upon the pharmacy recommendation. .", "filedate": "2014-01-01"}
{"rowid": 11509, "facility_name": "MONTGOMERY GENERAL HOSP., D/P", "facility_id": 515081, "address": "WASHINGTON STREET AND 6TH AVENUE", "city": "MONTGOMERY", "state": "WV", "zip": 25136, "inspection_date": "2009-05-29", "deficiency_tag": 502, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "E5O711", "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 laboratory services were obtained for one (1) of ten (10) sampled residents. Resident identifier: #10. Facility census: 29. Findings include: a) Resident #10 Review of the medical record found the resident was administered antibiotics for treatment of [REDACTED]. The treating physician ordered a repeat urinalysis with urine culture on 04/12/09. Review of the medical record found no evidence the laboratory test was obtained. An interview with a member of the nursing staff (Employee #27), on 05/28/09 at 9:50 a.m., confirmed the facility had not obtained the ordered test. .", "filedate": "2014-01-01"}
{"rowid": 11510, "facility_name": "MONTGOMERY GENERAL HOSP., D/P", "facility_id": 515081, "address": "WASHINGTON STREET AND 6TH AVENUE", "city": "MONTGOMERY", "state": "WV", "zip": 25136, "inspection_date": "2009-05-29", "deficiency_tag": 505, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "E5O711", "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 the physician was promptly notified of laboratory findings for two (2) of ten (10) sampled residents. Resident identifiers: #14 and #10. Facility census: 29. Findings include: a) Resident #14 Review of the medical record found a physician's orders [REDACTED]. The resident was [MEDICATION NAME] mg BID for ten (10) days on 04/10/09. On 04/13/09, an order for [REDACTED]. The medical record contained the urine culture report, marked as having been received at 5:01 p.m. on 04/13/09. The report documented no growth of bacteria after forty-eight (48) hours. There was no documentation to reflect the treating physician was notified of this laboratory report. The nurses continued to administer both [MEDICATION NAME] 500 mg [MEDICATION NAME] mg after receiving the laboratory culture which indicated no bacteria growth after forty-eight (48) hours. The medical record contained no evidence the facility notified the physician of the laboratory results. An interview with a member of nursing staff (Employee #27), on the morning of 05/29/09, confirmed the facility could provide no evidence the physician was notified. c) Resident #10 The physician [MEDICATION NAME] mg BID for ten (10) days for treatment of [REDACTED]. On 03/24/09 at 9:31 a.m., the facility received a laboratory report which determined the bacteria present in the resident's urine (Escherichia Coli) were resistant to Cipro. A handwritten note indicated the report was faxed to the physician at 10:00 a.m. on 03/24/09. The resident continued to [MEDICATION NAME] the evening shift on 03/24/09 and the day and evening shifts on 03/25/09, after being notified by the laboratory the bacteria present in the resident's urine were resistant to Cipro. The facility did not receive orders for an appropriate antibiotic until 5:00 a.m. on 03/26/09. The facility could provide no evidence the physician was notified in a timely manner of the laboratory results to assure Resident #10 received the appropriate antibiotic to treat her UTI in a timely manner. .", "filedate": "2014-01-01"}
{"rowid": 11511, "facility_name": "MONTGOMERY GENERAL HOSP., D/P", "facility_id": 515081, "address": "WASHINGTON STREET AND 6TH AVENUE", "city": "MONTGOMERY", "state": "WV", "zip": 25136, "inspection_date": "2009-05-29", "deficiency_tag": 309, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "E5O711", "inspection_text": "Based on medical record review and staff interview, the facility failed to assure appropriate follow-up nursing assessment was provided to one (1) of ten (10) sampled residents. Nursing staff documented Resident #10 experienced bright red bleeding from the perineal area with no evidence of continued monitoring or assessment. Resident identifier: #10. Facility census: 29. Findings include: a) Resident #10 Review of the medical record found a 04/20/09 nursing note which documented the resident was having a small amount of bright red bleeding from the perineal area during her bed bath at 10:30 a.m. The nursing note documented that, upon assessment, the bleeding appeared to be coming from the urinary meatus. The medical record contained no further information concerning the bleeding from the resident's perineal area. The next nursing note was not written until the weekly note on 04/24/09. An interview with a member of the nursing staff, on the morning of 05/29/09, could provide no evidence the resident received further assessment or monitoring of the area. .", "filedate": "2014-01-01"}
{"rowid": 11075, "facility_name": "NICHOLAS COUNTY NURSING AND REHABILITATION CENTER", "facility_id": 515190, "address": "18 FOURTH STREET", "city": "RICHWOOD", "state": "WV", "zip": 26261, "inspection_date": "2009-06-04", "deficiency_tag": 241, "scope_severity": "D", "complaint": 0, "standard": 1, "eventid": "CKVD11", "inspection_text": "Based on observation and staff interview, the facility did not assure residents with lap buddies were given the opportunity to dine in dignity in the community dining area free from restrictive devices while being directly supervised. This was evident for three (3) of fifteen (15) sampled residents. Resident identifiers: #13, #62, and #51. Facility census: 89. Findings include: a) Resident #13 On 06/02/09 at 8:55 a.m., observation found Resident #13 eating at the dining room table while sitting in her wheelchair with a lap buddy attached. Interview with Employee #17 revealed this resident always had on the lap buddy on while she ate. On 06/03/09 at 4:00 p.m., Employee #17 clarified, after checking with her supervisor, and reported Resident #13 was not supposed to use the lap buddy while dining. Employee #17 said this must have been an oversight. b) Resident #62 On 06/02/09 at 12:30 p.m., observation found Resident #62 sitting at the dining room table in her wheelchair with a lap buddy attached. Two (2) nursing assistants were setting up the lunch tray, which was on the dining room table in front of the resident. The lap buddy was not removed until surveyor intervention. c) Resident #51 On 06/02/09 at 12:30 p.m., observation found Resident #51 sitting at the dining room table in her wheelchair with a lap buddy attached. Two (2) nursing assistants were setting up the lunch tray, which was on the dining room table in front of the resident. The lap buddy was not removed until surveyor intervention. d) Review of the care plans for Residents #13, #62, and #51 found no documentation regarding removing the lap buddies while in the facility's dining room under supervision. These findings were reported to the director of nursing on 06/03/09 prior to leaving the facility at 5:00 p.m. .", "filedate": "2014-09-01"}
{"rowid": 11076, "facility_name": "NICHOLAS COUNTY NURSING AND REHABILITATION CENTER", "facility_id": 515190, "address": "18 FOURTH STREET", "city": "RICHWOOD", "state": "WV", "zip": 26261, "inspection_date": "2009-06-04", "deficiency_tag": 279, "scope_severity": "E", "complaint": 0, "standard": 1, "eventid": "CKVD11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record reviews, resident interview, and staff interview, the facility failed to develop comprehensive care plans to address the individualized needs of four (4) of fifteen (15) sampled residents. Resident identifiers: #13, #51, #62, and #68. Facility census: 89. Findings include: a) Resident #68 Resident #68, when interviewed on 06/02/09 at 1:30 p.m. and on 06/03/09 at 3:00 p.m., reported he had a stroke approximately six (6) years ago resulting in [MEDICAL CONDITION]. The resident was divorced and rarely received any visitors. He had a fall resulting in a [MEDICAL CONDITION] in April 2009 and was admitted to the facility for rehabilitative therapy services. The resident reported his life work was sports, having been a sports writer for a newspaper and a golf coach, and his primary interest was in sports, but the facility did not provide any activities relating to his interest in sports. The resident's activity assessment, dated 05/12/09, identified the resident had been a golf coach and sports writer. Review of Resident #68's medical record, on 06/04/09 at 10:00 a.m., found the resident's current plan of care, dated 05/30/09, did not address specific activity / social needs, likes, and/or interest for this [AGE] year old blind resident. When interviewed on 06/04/09 at 11:00 a.m., the registered nurse care plan coordinator (Employee #107) was unable to produce any additional evidence that the care plan addressed this resident's social needs and sports interest. b) Resident #13 Review of Resident #13's care plan revealed a goal indicating she will participate in an activity of choice three (3) times weekly. Two (2) interventions were listed to meet this goal - to encourage the resident to make decisions such as which activity to attend daily and to invite and take the resident to activities she may enjoy daily. However, the care plan did not identify any specific activities Resident #13 enjoyed and could do. Review of her participation record in activities for May 2009 revealed she attended some church services, pre-meal activities in the dining room, exercise with the rhythm band, and received one-on-one visits daily from staff of the activities department and visits from family and friends. Interview with the activity director (Employee #64), on 06/03/09 at 3:15 p.m., revealed Resident #13 enjoyed church, music, visits, and talking. She said she can see the care plan was not specific to Resident #13's interests. c) Resident #62 Review of Resident #62's care plan revealed a goal to attend and participate in exercise twice weekly, with interventions to include providing an activity calendar and encouraging her to go to activities. However, the care plan did not identify any specific activities Resident #62 enjoyed and could do. Review of her participation record for May 2009 found that, besides one-on-one visits and watching television, she took part in pre-meal activities in the dining room, exercise and rhythm band, and occasionally a trivia game or visits with family. Interview with the activity director, on 06/03/09 at 3:15 p.m., revealed Resident #62 enjoyed visiting and talking, and music, and she likes touch. She also reported Resident #62 got her nails done, which was not recorded in her participation record. She said she can see the care plan was not specific to Resident #62's interests. d) Resident #51 Review of Resident #51's care plan revealed a goal to attend and participate in activities two (2) or more times weekly, with an intervention to provide an activity calendar. However, the care plan did not identify any specific activities Resident #51 enjoyed or could do. Review of her participation record for May 2009 revealed she attended one (1) church service, exercised with the rhythm band, watched television, and received one-on-one visits in the room with activities personnel or family. Interview with the activity director, on 06/03/09 at 3:15 p.m., revealed Resident #51 especially liked to touch and hold hands or have her back rubbed, and she would often come into their department for that, as well as getting her nails done weekly. However, these activities were not recorded on her participation record, although she received them. The activity director reported Resident #51 enjoyed music at exercise class and church music. She agreed the care plan was not specific to Resident #51's interests. .", "filedate": "2014-09-01"}