cms_WV: 10
Data source: Big Local News · About: big-local-datasette
| rowid | facility_name | facility_id | address | city | state | zip | inspection_date | deficiency_tag | scope_severity | complaint | standard | eventid | inspection_text | filedate |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 10 | PINE LODGE | 515001 | 405 STANAFORD ROAD | BECKLEY | WV | 25801 | 2017-06-02 | 279 | E | 0 | 1 | ELSQ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, staff interview, resident interview, and family interview, the facility failed to develop a care plan for a resident with bruises and a skin tear (#92), failed to establish measurable objectives to monitor a resident's progress related to activities (#143) and range of motion (ROM) (#43), and failed to develop a care plan timely related to assessing a thrill and bruit for a resident with an arteriovenous graft (#45). Four (4) of thirty-two (32) residents on the sample were affected. Facility census: 116. Resident identifiers: #143, #92, #45, and #43. Findings include: a) Resident #143 The resident's medical record included a Brief Interview for Mental Status (BIMS) on which the resident scored ten (10), indicating moderate cognitive impairment. During a Stage 1 interview on 05/16/17 at 2:12 p.m., a family member verbalized Resident #143 liked to attend Church services. Resident #143, interviewed on 05/31/17 at 1:56 a.m., exhibited symptoms of confusion related to time, but with inquiry, verbalized she liked to go to church and wanted to go every Sunday. The resident expressed she did not care what denomination it was, just Christian. The care plan noted Resident #143 would indicate satisfaction in daily routine/activities as evidenced by verbalizing satisfaction, increase in affect during participation, increased focus and attention to activities of choice. The interventions included to assist, as needed, to activities of interest church, parties, socials, crafts, pets, music, and reading. During review of the resident's care plan with the administrator on 05/31/17 at 6:12 p.m., when asked how the facility measured increased affect, focus and attention, the administrator acknowledged the goal was not measurable, shook her head in a yes motion, and said, I get you. b) Resident #92 An observation on 5/16/17 at 1:08 p.m., revealed bluish red bruised from Resident #92's hand to upper arm. A bandage was present on the left forearm, and the resident verbalized he had obtained a skin tear. During a wound care observation, on 05/23/17 at 11:40 a.m., the nurse removed a bandage from the resident's left great toe, revealing an open wound on the top of the toe. A physician's orders [REDACTED]. The care plan, reviewed on 05/24/17, revealed no evidence of bruising or of the toe wound. MDS Coordinator #108, interviewed at 2:01 p.m., voiced the nurses updated the care plans as new orders, concerns arose. She reviewed the care plan and verified a care plan was not developed related to the bruises or the skin tear on Resident #92's toe. c) Resident #45 Review of medical records revealed Resident #45 had an Arteriovenous Fistula (AV) for [MEDICAL TREATMENT] treatments. Review of the physician's orders [REDACTED]. The resident continued to have an AV fistula site at the time of the current survey beginning 05/15/17. Review of the resident's Medication Administration Record [REDACTED]. The MAR indicated [REDACTED]. There was no evidence the facility monitored the resident's AV fistula after 11/22/16 until a new order written on 05/02/17. On 05/24/17 at 4:21 p.m., Registered Nurse (RN) #126 stated the resident had had an AV fistula site for [MEDICAL TREATMENT] for at least three (3) years. Review of an article Caring for a patient's vascular access for [MEDICAL TREATMENT] in the 2010 Lippincott[NAME] & Wilkins medical surgery text book found it included a nurse should check the AV fistula site for patency at least every eight hours. On 05/24/17 at 3:18 p.m., the facility administrator agreed monitoring the bruit and thrill was not routinely completed, nor did the care plan include monitoring the AV fistula from 11/22/16 until 05/02/17. d) Resident #43 Review of the resident's medical record on 05/22/17 found the resident had [DIAGNOSES REDACTED]. The significant change minimum data set (MDS) with an assessment reference date (ARD) of 03/17/17, assessed contractures of the right upper extremity. Review of the care plan found it contained a focus where it identified her right side extremities were weaker than the left. The care plan identified that she had contractures of the right shoulder, elbow, wrist and hand; however, the care plan failed to provide individualized and measurable goals they wished to achieve related to the right upper extremity contractures. The care plan failed to provide individualized interventions to help prevent further loss of range of motion and/or other negative outcomes, related to the right upper extremity contractures. The care plan contained no directives for range of motion or for any splint/orthotic devices. During an interview on 05/22/17 at 4:01 p.m., Director of Rehabilitation Services #52, said (MONTH) (YEAR) was the last time occupational therapy (OT) had her on its case load. Their goals were for passive and active range of motion to the right upper extremities for three (3) sets of ten (10) repetitions daily to establish a contracture management program. Their goal was for her to work up to tolerate a right hand orthotic for four (4) hours per day. The final long term goal was to discharge her to the restorative program with 100% staff training for contracture management program. She said the director of nursing (DON) was the head of the restorative nursing department. In an interview on 05/22/17 at 4:22 p.m., the director of nursing (DON) said this resident used to have a Posey roll, and she used to have restorative nursing services for range of motion with restorative aides; however, she no longer received restorative services. She said she felt the regular nursing assistants on the units did enough range of motion during activities of daily living to make it count for range of motion. She said that the resident had a Posey roll for her right hand prior to a week-long hospital stay the first week in (MONTH) (YEAR), but it had not been re-ordered since the (MONTH) hospitalization . She said most likely restorative services order fell through the cracks and was not re-ordered upon her (MONTH) return to the facility. The DON provided a copy of the resident's care plan on 05/22/17 at 4:45 p.m. When asked to provide any evidence of care planned individualized and measurable goals and interventions related to contracture management, no further evidence was provided. Observation and interview with the resident on 05/23/17 at 9:41 a.m. found she could use her left hand and try to stretch out the fingers on her right hand. The little finger and the thumb of the right hand were not contracted. The three middle fingers on the right hand were contracted, and she could not stretch them out with her left hand. Those three fingers were bent downward, and then pointed back toward the wrist. She wore no splint device or palm protector when observed in Stage I of the Quality Indicator Survey. | 2020-09-01 |