cms_WV: 10129
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 10129 | MERCER NURSING AND REHABILITATION CENTER, LLC | 515052 | PO BOX 410 | BLUEFIELD | WV | 24701 | 2012-02-09 | 250 | D | 1 | 0 | MC4611 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** . Based on medical record review and staff interview, the facility failed to ensure medically-related social services were provided to one (1) of four (4) residents on the sample. Resident #55 left the facility against medical advice (AMA) with his family on 10/28/12. The resident experienced aggressive behaviors related to a [DIAGNOSES REDACTED]. The facility had planned to transfer him to an inpatient psychiatric unit. The resident's family did not want the facility to seek this type of medical intervention to try and stabilize these behaviors. The family at one time asked to come to the facility and restrain the resident. The facility did not contact adult protective services to make them aware of the situation. Resident identifier: #55. Facility census: 52. Findings include: a) Resident #55 The medical record review for Resident #55 revealed he came to the facility from home on 09/28/11. He had a [DIAGNOSES REDACTED].). The resident's care plan addressed issues such as impaired cognitive function and impaired thought processes due to the dementia. It also addressed the resident's physical behaviors (kicking, hitting, scratching) related to dementia. The following progress notes related to the resident's behaviors and the family's resistance to inpatient psychiatric care. -10/01/11 2:45 p.m. "Resident has been at nurses station with staff; has had 1:1 all day without success. As staff attempted to reposition resident in his wheelchair to keep him from falling, he punched the nurse in the stomach, pulled back his fist and said (cursing) 'I'll punch your nose' resident then grabbed nurses arm and twisted it tightly. Haldol 5 mg po (by mouth) x 1 dose now and Ativan 1 mg IM x 1 dose now. Daughter notified that if behavior continues resident will most likely be transferred OOF (out of facility) for eval (evaluation) of behaviors. She replied 'oh try to hold off, we could come see him but it probably wouldn't do any good ... he's done me like that before.'" - 10/04/11 "Resident awake the entire night hollering 'HELP ME, HELP ME,' and attempting to get out of the bed. Resident also made a fist and attempted to hit staff while providing care." - 10/09/11: "Resident family in to visit with resident. Family concerned about 'psych' meds being too strong for resident. Spoke with MPOA in length about resident need for medicine in order for facility to be able to meet resident's needs. Resident family concerned that resident did not need appointment with psychiatrist. Explained to MPOA that the psychiatrist would be more able to better manage behavior meds. " - 10/10/11 "RUE (right upper extremity) completed earlier today at (local hospital) radiology dept. physician's orders [REDACTED]. Ambulance staff stated that resident became combative with radiology staff while being filmed." - 10/10/11 "(Daughter) has called facility several times today to check on her father. When she was informed that resident had been combative this am she replied 'I'm sorry, I know how he is ... we were up there this weekend and he tried to beat us up too.'" - 10/11/11 "Residents' daughter still concerned regarding resident's medications. Daughter states resident is 'always sleepy.' Attempted to explain that resident's meds had been adjusted yesterday and that the effects had not had time to be visualized; also explained that resident had been OOF for a procedure this morning and could be sleepy from that. Explained that the physician would be in the facility later and that we would have him review his meds further." - 10/12/11 "Resident continued on Augmentin 875/125 mg bid x 14 days for pneumonia." - 10/13/11 2:29 p.m. "MPOA (medical power of attorney) concerned that residents' psych meds are too strong, resident seen by (facility physician) and has an appointment to see (psychiatrist) on 10/19/11 at 1:45 p.m. MPOA also concerned that we are unable to physically restrain resident and asked if she could come in and restrain him herself." - 10/16/11 5:21 p.m. "Resident is up to chair several hours out of the day and night d/t agitation from dementia." -10/19/11 6:11 p.m. "Attending physician notified of resident's return to facility with new orders from (psychiatrist) office. Dementia with Levy (Lewy) Body disease; behaviors worse at night, frequent falls and combative at times. New orders received to decrease Seroquel to 100 mg bid (twice a day); decrease Remeron to 15 mg qhs (at night); continue Klonopin as ordered; and discontinue Haldol." -10/21/11 5:54 p.m. Resident was started on Augmentin (antibiotic) 875 mg bid (twice per day) due to pneumonia. - 10/22/11 11:44 a.m. "Resident was combative with CNA this morning while she was attempting to give him a shower, he attempted kicking, biting, and wrapped his legs around her body." - 10/22/11 1:20 p.m. "Staff attempted to calm resident without success. Resident continued to be combative while nurse was dressing wounds, attempting to hit the CNA with the bed control, bite the nurse, and was kicking both legs. Physician gave ok for transfer to (local hospital psychiatric unit)." - 10/22/11 1:32 p.m. "(family member) has called the facility and ask to speak with me, RD (registered dietitian) had answered the phone, and (family member) became extremely rude with the RD, yelling and stating that 'I'm leaving the house now and he better be there when I get there.'" - 10/22/11 3:45 p.m. "Resident has left the facility AMA (against medical advice); resident's daughter arrived at the facility, yelling 'All I said was that I didn't want him sent to (local hospital name), I never said anything about anywhere else. Explained that we had attempted to reach her on her cell phone to inquire about another suggestion, even though (local hospital) is the preference d/t (due to) the psych expertise as well as geriatric expertise. Informed her that we had attempted to reach her to inform her of the physician's orders [REDACTED]. Discussed that resident is a threat to the well-being of himself as well as staff and other residents. Daughter asked 'Did you give him the injection already?' Informed her at that time we had. She demanded 'Why?' Informed her that we were unable to reach her on the cell number that was given to us, and that it was the only option since she refused transfer. Family agitated; stating 'We are taking him home now ... we took care of him for three years and you all couldn't handle him for three weeks' adding that 'You all are supposed to be professionals, and be able to handle Alzheimer's patients.' Resident left the facility AMA with the family. Explained that resident is likely to be combative with them at home. ... " On 02/08/12, at approximately 3:00 p.m., the social worker (Employee #47) and the executive director (Employee #66) confirmed the resident's responsible party had resistance to any psychiatric treatment for [REDACTED]. Based on comments the family made about him beating them up too, it was apparent the behaviors displayed at the facility were not new. During a telephone interview with the responsible party, on 02/09/12, at approximately 10:00 a.m., she indicated she had needed to tie her father in the bed before because she feared he would fall and hit his head as he had in the past. The social worker and executive director indicated they did not feel a contact to adult protective services was necessary when the resident's family took him from the facility against medical advice. They commented he never seemed fearful of the family when they visited. They stated they did not have knowledge the responsible party restrained the resident at home, but they did have documentation the responsible party had requested to come in and restrain him at the facility. The social worker and executive director indicated the responsible party adamantly did not want the resident sent to an inpatient psychiatric hospital. They were unable to determine why she did not want this type of care for the resident. The social worker said prior to admission the responsible party had cared for the resident at home. The responsible party told her the resident received medical care from a small community clinic. The facility knew the resident needed an inpatient psychiatric evaluation due to his aggressive behaviors, and made a referral to a local in-patient psychiatric unit. He was going to be transferred there on the day his family removed him from the nursing facility against medical advice (AMA). The responsible party's unwillingness to seek needed psychiatric evaluation and treatment, the family's removal of the resident from the nursing facility AMA, and knowledge the family wanted the resident restrained in the nursing facility, all created the necessity to refer the case to adult protective services. . | 2015-06-01 |