cms_WV: 10950
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 10950 | GREENBRIER MANOR | 515185 | ROUTE 2, BOX 159A | LEWISBURG | WV | 24901 | 2009-05-22 | 309 | E | 0 | 1 | T34S11 | **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. . | 2014-11-01 |