| 11361 |
BOONE HEALTH CARE CENTER |
515117 |
P.O. BOX 605 |
DANVILLE |
WV |
25053 |
2010-12-09 |
279 |
E |
|
|
GCMN11 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** . Based on medical record review, observation, staff interview, family interview, and resident interview, the facility failed to develop comprehensive care plans and/or interventions for four (4) of thirty-two (32) Stage II sample residents. There was no care plan for intentional weight loss for Resident #43; no care plan for foot care for Resident #5; no interventions for behaviors for Resident #35; and no restorative care plan for Resident #115. Resident identifiers: #43, #5, #35, and #115. Facility census: 83. Findings include: a) Resident #43 During an interview with the resident on 12/08/10 at 3:15 p.m., the resident revealed she was trying to lose weight, stating, "I really want to get rid of my belly." Review of the dietary progress notes, dated 08/26/10 and 09/29/10, revealed the registered dietician had noted the resident was trying to lose weight. Review of the dietary progress notes, dated 10/26/10, revealed the dietary supervisor (Employee #68) also noted: "Resident wants to lose wt (weight)." Review of the dietary progress notes, dated 11/30/10, revealed the dietary supervisor noted: "Resident wants to continue to lose wt per her choice due to history of diabetes." An interview on 12/08/10 at 2:15 p.m., with a registered nurse (RN - Employee #77), revealed the resident frequently requested junk food and had yet to mention to her (Employee #77) that she wanted to lose weight. Review of the resident's care plan found no mention of a plan to assist the resident in achieving intentional weight loss. b) Resident #5 On 12/06/10, a family interview was conducted with this resident's sister. During the interviewed, the sister expressed concern that the resident's feet were not routinely cleaned by facility staff. She stated the resident's feet were often dry and flaky, and that she (the sister) often soaked and cleaned them herself. Interview with the resident, at 1:00 p.m. on 12/07/10, revealed her feet were always cold, so she wore socks all the time. Further interview revealed the resident was rarely showered due to her severe pain, and she preferred bed baths. Upon inquiry, the resident stated she did not feel her feet received the care they required, and that her sister often had to soak them and clean them. She stated staff did not perform this care routinely. Review of the resident's care plan, on 12/07/10, revealed no specific care plan regarding the resident's foot care. On 12/08/10 at 9:00 a.m., this resident's feet were observed with an RN (Employee #20). The resident's feet were dry and flaky. According to Employee #20, the resident needed foot care. Employee #20 stated she would assure the resident received this care. c) Resident #35 Medical record review revealed this resident was admitted to the facility on [DATE] for a long-term stay. According to the facility's interdisciplinary discharge plan dated 2/09/10, the plan for discharge on admission was for "definite long-term stay". He was admitted with [DIAGNOSES REDACTED]. Review of the medical record also revealed the resident's vision was poor, and his hearing was so poor he used a communication board to communicate his needs. Medical record review revealed the resident resided at the facility from 02/08/10 until 07/03/10 with no inappropriate behaviors. According to the medical record, on 07/03/10, the resident smashed the light in his room with his trapeze bar. On 07/26/10, he was witnessed hitting the wall with the trapeze bar. On 07/29/10, he slammed the bedside chair and water pitcher into the wall and hit the nurse. On 08/01/10, he was pounding on the wall with the trapeze bar. On 08/08/10, he made vulgar comments to a nursing assistant. On 08/16/10, he was found outside in the courtyard smoking. The cigarette was taken from him and he was told the facility is a non-smoking facility. On 08/17/10, he hit the wall with the trapeze bar. The facility did not initiate a care plan to address behaviors until 08/26/10, when the resident exhibited inappropriate sexual behaviors toward staff, and the intervention was to "redirect resident". No other behaviors were identified and/or addressed on the care plan. The care plan provided no methods for implementing this redirection. d) Resident #115 During an observations of the dinner meal on 11/29/10 at 6:00 p.m., Resident #115 was observed to be eating in the area designated as the restorative dining area. She was falling asleep. After the others were served, the restorative nursing assistant fed the resident her meal. The medical record, when reviewed on 11/30/10, found Resident #115 had been evaluated by the speech-language pathologies (SLP) for dysphagia with recommendations made on 11/12/10. The SLP stated the goal for this resident was "to decrease risk of aspiration and increase PO (by mouth) intake". The recommendations included: placement of the resident in the restorative feeding program; she was not to have straws in her drinks, she was to be provided verbal cueing to swallow with her meals due to her issue of pocketing food in her mouth; and she was to have two (2) to three (3) bites of food alternated with one (1) drink. The resident's most recent interdisciplinary care plan, dated 11/22/10, was reviewed. This plan did not include a restorative nursing care plan, did not identify this resident was at risk for aspiration, and did not include interventions to prevent aspiration and address the resident's swallowing problems as recommended by the SLP. The restorative nursing assistant (Employee #94) was observed feeding this resident lunch at 12:15 p.m. on 12/02/10. The resident had a straw in her milk and was given four (4) to five (5) bites between drinks, instead of two (2) to three (3) bites as recommended by the SLP. The director of nursing (DON), when interviewed at 3:30 p.m. on 12/03/10, reviewed the resident's care plan and verified there was no restorative care plan. . |
2014-04-01 |