| 10241 |
WELCH COMMUNITY HOSPITAL |
51A009 |
454 MCDOWELL STREET |
WELCH |
WV |
24801 |
2010-06-04 |
249 |
F |
0 |
1 |
5XSR11 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** . Based on a review of the key personnel worksheet, review of personnel files, review of the activity program documentation, observation, resident interview, and staff interview, the facility failed to involve the activity director in the assessment, development, implementation and/or revision of an individualized activity program for individual residents. The individual identified by the facility as being the activity director of record was only a consultant who visited the facility on a monthly basis to review the activity calendar and residents' activity plans. There was no evidence to reflect this individual's involvement in assessing the activity needs and interests of individual residents, developing and/or revising programs based on the assessed needs and interests for each resident, and/or implementing a schedule of activities for individuals and groups. The individual identified by the facility as being responsible for implementing the facility's activity program on a day-to-day basis (who had completed a State-approved activity director training course but was not the activity director of record) was Employee #1. There was no evidence Employee #1 assessed / recorded each resident's activity interests and needs, developed an individualized program of ongoing activities designed to appeal to each resident's interests and to enhance each resident's highest practicable level of physical, mental, and psychosocial well-being, and/or revised each resident's program of activities when changes occurred in the resident's overall plan of care (such as when a resident was confined to her room due to an infectious process). Additionally, on occasion, Employee #1 was not available to implement activities programming due to being pulled to work as a nursing assistant when a staffing shortage occurred. This practice had the potential to affect all residents in the facility. Resident identifiers: #45, #49, #52, #4, and #16. Facility census: 48. Findings include: a) On 05/26/10 at approximately 1:00 p.m., a review of key personnel information revealed the individual designated by the facility's management as its "activity director" of record was actually a consultant who came to the facility on a monthly basis to review the activity calendar and activity care plans. This individual was not involved in conducting assessments of residents' activity interests or needs or the development of initial activity care plan, nor was this person involved in the day-to-day implementation of the activities programming. When asked who was responsible for carrying out these responsibilities on a day-to-day basis, the facility identified Employee #1. Review of Employee #1's personnel file, on 05/26/10 at approximately 1:15 p.m., found this individual was a nursing assistant who had successfully completed a State-approved 45-hour activity director training course on 09/20/02. Review of Employee #1's job description found the nature of her work included: "Under general supervision, performs paraprofessional work at the full-performance level assisting professional staff in the care, treatment, habilitation and rehabilitation of mentally and/or physically challenged at state-operated facility's or in community setting. Acts as a lead worker or charge assistant in assigning, scheduling and reviewing the work of Health Service Workers. Develops, writes, implements and evaluates basic therapeutic treatment programs...." According to the facility's administrator in an interview on 05/26/10 at approximately 2:00 p.m., Employee #1 was responsible for carrying out the daily activity programming at the facility; however, on 05/25/10, Employee #1 had worked as a nursing assistant (rather than conducting activity programming) due to a shortage of nursing assistants on that particular day. The administrator provided a copy of a purchasing agreement between the facility and the consultant group that employed the individual identified as the facility's activity director. This agreement, dated 05/15/09, stated, "The proposal is for Activities Consultation for the fiscal year 2009-10 to be provided on a monthly basis. Consultation includes regulatory oversight, program review, and staff development. The proposed cost is for 12 monthly visits at a cost of $200 per visit or for a total cost of $2400.00 for the year." Employee #1 was on vacation during the last four (4) days of this resurvey, and her assistant (Employee #29 - whose primary duties were as a housekeeper) did not appear to have a great deal of knowledge of the day-to-day operation of the activity department. -- A review of the activity consultant's reports for the months of March, April and May 2010 found each contained a generalized statement with no discussion of any resident-specific issues or any new ideas / approaches for working with the types of debilitated residents present at this facility. The consultation report dated 04/30/10 included, "The activities calendar was reviewed and discussed. Calendar includes a nice variety of daily, evening and weekend activities. May calendar includes special activities for National Nursing Home Week. ..." Review of the May 2010 month's activity calendar found very little variety was offered to the residents on a day-to-day or week-to-week basis. Exclusive of additional activities offered only during the week of National Nursing Home Week from 05/09/10 through 05/15/10, the schedule of events was as follows: Sundays - 10:00 a.m. - Sunday school or church service 2:00 p.m. - "Heart and Soul", church service, or President's trivia quiz 4:00 p.m. - "One-on-one" (three times monthly) or "Memory Sharing" (twice monthly) 6:00 p.m. - "In-room act (activity)" Mondays - 9:00 a.m. - "Greetings" and/or "One-on-one" (twice monthly) 10:00 a.m. - "Group or Individual Exercise" 2:00 p.m. - "Current events" (three times monthly), Bingo (once monthly), or horseshoes (once monthly) 4:00 p.m. - "One-on-one" (four times monthly) or "Coloring time" (once monthly) 6:00 p.m. - "Bible reading w/ (with) Judge Stephens" Tuesdays - 9:00 a.m. - "Beauty & Barber Shop" 10:00 a.m. - "Manicures" 2:00 p.m. - "Ice cream social" (or birthday party once monthly) 4:00 p.m. - "One-on-one" 6:00 p.m. - "Martha Rose" or "St. James Baptist Singers" Wednesdays - 10:00 a.m. - "Care Plans w/ Residents" 2:00 p.m. - "Red Hat", "Ice cream floats", "Gray Cappers", or "Bingo" 4:00 p.m. - "One-on-one" (or Resident Council Meeting once monthly) 6:00 p.m. - "In-room act" Thursdays - 9:00 a.m. - "Greetings & One-on-one" 2:00 p.m. - "Memory Sharing" (twice monthly), "Bean bag toss" (once monthly), or "Ice cream social" (once monthly) 4:00 p.m. - "One-on-one" 6:00 a.m. - "In-room act" (twice monthly) or "FUMS" (once monthly) 7:00 p.m. - "Triplett Family" (once monthly) Fridays - 9:00 a.m. - "Beauty & Barber Shop" 10:00 a.m. - "Manicures" (three times monthly) 2:00 p.m. - "Freddie Lewis" 4:00 p.m. - "One-on-one" 6:00 p.m. - "In-room act" (two times monthly) or "Joseph Baptist Church" (once monthly) Saturdays - 9:00 a.m. - "Greetings & One-on-one" (twice monthly) 10:00 a.m. - "Group or Individual Exercise" (three times monthly) 1:00 p.m. - "Church w/ Cindi" 2:00 p.m. - "Bingo" 4:00 p.m. - "One-on-one" Of the one hundred twenty-nine (129) events found on the May 2010 activity calendar, "One-on-one" was offered twenty-nine (29) times; this activity did not promote interactions between residents. Church services, Sunday school, Bible reading, and church singing groups were scheduled at least nineteen (19) times. "Beauty & Barber Shop" and "Manicures" together were offered fifteen (15) times. "In-room act" (the most frequently scheduled evening activity) was offered thirteen (13) times; this activity was primarily self-directed and did not involve staff-to-resident interactions. "Care plans (with) residents" was identified as an activity four (4) times. No outings were offered. The calendar also noted, "Shopping day will be on Fridays unless something changes. Have your list ready for pick up!" This "shopping" did not involve taking residents out of the facility to a store; instead, residents gave their shopping lists to staff, and a staff member would make the purchases and bring them back to the residents. -- Observations, over the course of the eight (8) day on-site resurvey, found very few resident-centered group activities that engaged and/or stimulated the participants, and residents with special activity needs and interests were not provided individualized activity programing to meet their needs. 1. Resident #45 Observations, conducted from 05/24/10 through 05/27/10, noted Resident #45 to be out of her room ambulating in the hallways, participating in activities, and dining with other residents. On the return visit the following week, beginning on 06/01/10, observation found Resident #45 had been moved to an isolation room and was not observed to leave her room throughout the day. Review of Resident #45's medical record found a physician's orders [REDACTED]. Review of the resident's current care plan, effective through 08/25/10, found the following, "Has a special friendship / relationship with a male resident. Thinks of him as her boyfriend." Review of the planned interventions included, "Provide activities that res (resident) and friend can attend together, such as parties, movies, singings, outings.... Provide private space for physical relations if both residents desire." Review of an activities progress note, dated, 02/01/10, found the following, "Resident enjoys all activities, loves to talk to staff and residents. She does her own AM (morning) care. Is able to feed, and dress self. She enjoys singing, and all socials. Will go out on field trips. Loves to talk about her family, mother, father, brothers. Enjoys walking around drinking her coffee. She is out of her room most of the day. She is a joy. Will continue with her care plans. Will keep her encouraged." Review of the May 2010 activity attendance record for Resident #45 found she participated in church services, current events, Bingo, group exercise, ice cream socials, trivia time, etc., until she was placed in isolation on 05/27/10. Other than two (2) in-room activities (which were documented after inquiry by surveyor on 06/01/10), her activity participation was marked with an "I", indicating she was in "isolation". A nursing note, dated 05/27/10 at 2:25 p.m., documented that the resident continued in respiratory isolation per order. "Client (resident) continues to be reoriented, confusion noted in regards to isolation room. Client continues to attempt to leave. Staff continues to redirect back to room...". An interview with the individual responsible for the day-to-day planning and organization of the activities department (Employee #1) was conducted at 4:14 p.m. on 06/01/10. She was asked what planned activities had been developed to address Resident #45's activity needs while she was alone and confined in the isolation room. Employee #1 stated she had not initiated a plan of activities related to the resident being confined to her room. When asked if she had visited the resident at all that day to provide in-room activities, Employee #1 stated she had not. Employee #1 reported the resident wanted to come out, stating, "I let her know that she can't come out. Her boyfriend (Resident #20) thinks she's dead. (Resident #45) likes to do anything and everything we do, parties, snacks, music, church, and bluegrass the other night. She don't (sic) like it; she don't (sic) like to be in her room. She likes to be with (Resident #20). She does not like being away from him at all." Observations of the medication administration pass were conducted with a licensed practical nurse (LPN - Employee #44) at 10:00 a.m. on 06/02/10. Resident #45 stated to the nurse that she wanted to go home, that there wasn't anything wrong with her chest. Employee #44 related that the resident referred to her room (prior to isolation room) as "home". The resident was interviewed following Employee #44's departure. When asked how she liked her new room, she stated that there wasn't anything to do and there wasn't even a clock in her room. Observation confirmed there was no clock nor any activity items (such as magazines, books, etc.) in her room. The resident stated her boyfriend must be "worrying his brains out", because he did not know where she was. Resident #45 was required to remain alone in a single occupancy isolation room with no planned in-room activities or interventions to prevent the resident from being socially isolated from other residents who were important to her, which caused her distress. 2. Resident #49 Review of Resident #49's medical record found she was placed in contact isolation and confined to her room on the morning of 05/29/10, related to [MEDICAL CONDITION]-infected wound on her right ankle. Observation of the resident's ankle found it was covered with a dressing with no evidence of drainage or seepage; the infectious organism was fully contained in the dressing, with no evidence to suggest the need for her to be confined to her room. Review of a care plan note, dated 04/06/10, found the following: "Likes to attend most activities. She likes talking to staff and, the other residents. She attends socials, church, and some of the games such as horseshoes and bean bag toss." Review of the resident's current care plan, dated 01/10 with a goal date of 08/12/10, found no goals or interventions addressing her activity needs while she was being confined to her room. Resident #49 was required to remain alone in isolation with no planned in-room activities or other interventions to prevent the resident from being socially isolated. 3. Resident #52 Review of Resident #52's current care plan, dated 04/12/10 through 07/14/10, revealed the interdisciplinary care team identified a problem with his nutritional status, which was to be addressed by having the resident attend food-related activities. However, because this resident was confined to his room due to an infection ([MEDICAL CONDITION]), he was not permitted to leave his room to attend these food-related activities. There was no evidence his care plan was revised when he was placed in isolation, to address his inability to attend out-of-room activities of any kind. (See also citation at F280.) This was discussed with the administrator on the afternoon of 06/03/10. No further information was provided to surveyors regarding this concern prior to exit on 06/04/10. 4. Resident #16 Medical record review, on 06/03/10, revealed this resident had a [DIAGNOSES REDACTED]. She was non-verbal and unable to communicate. At 12:00 p.m. on 06/03/10, the resident was observed in her room with a nurse. When the nurse spoke or touched the resident, the resident smiled and laughed. According to the nurse, the resident always responded in this manner when spoken to and touched. Review of the resident's assessments and care plans revealed no plans to provide activities for this resident to include talking with her and touching her. There was no evidence the facility identified this resident's interests and needs in an effort to develop an ongoing individualized program of activities to enhance this resident's highest level of mental and psychosocial well-being. 5. Resident #4 A review of the activity information provided by the office assistant III (Employee #47) for Resident #4 did not include an assessment of this resident's past interests / hobbies. This resident had lived at the facility for several years and had little family involvement. The resident was able to communicate and relate things she enjoyed doing; however, the activity director or designee did not collect and/or record this information for use in developing an individualized activity plan for her. The activity attendance record for May 2010 indicated Resident #4 participated in events such as going to the beauty shop and going "out shopping". However, this facility did not take its residents out shopping; instead, staff went to the store and purchased items for the residents. This record also listed as an activity "feeding pets"; however, at no time did this resident ever go outside to feed a pet, nor did the facility have any indoor pets. Resident #4's daily activity attendance record for May 2010 contained the same activities as were listed on the monthly activity calendar. No individual activities unique for this resident were noted. Further review of other sampled residents' daily activity attendance records revealed they also reiterated, verbatim, the events listed on the monthly activity calendar with no evidence to reflect individualized activity programming had been provided to any resident. -- See also citation at F248. . |
2015-06-01 |