| 11469 |
EASTBROOK CENTER LLC |
515089 |
3819 CHESTERFIELD AVENUE |
CHARLESTON |
WV |
25304 |
2010-10-07 |
318 |
D |
|
|
UP4G11 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** . Based on observation, staff interview, and medical record review, the facility failed to ensure one (1) of four (4) sampled residents, who had limited range of motion (ROM) of the left hand, received appropriate treatment and services to prevent further decrease in ROM. Resident identifier: #134. Facility census: 140. Findings include: a) Resident #134 Review of the resident's medical record did not find any evidence that a brace was supposed to be put on the resident. Observations made on 10/06/10, during the day at 9:00 a.m., 12:00 p.m. and 2:00 p.m., did not find evidence of a brace on the resident's left hand and wrist. On 10/07/10, a brace was found on the resident's left hand at 10:25 a.m., and the nursing assistant (NA - Employee #17) was in the room providing care for the resident, when interviewed, stated he did not care for the resident on a regular basis and did not know about the splint. A licensed practical nurse (LPN - Employee #132) who provided care for the resident, when interviewed at 10:30 a.m. on 10/07/10, said she thought therapy was supposed to get the resident a new brace, but she was not sure if it had been ordered yet. At 11:00 a.m. on 10/07/10, the interim director of nursing (DON) reported the resident was "on the therapy board" but, due to issues with payment, therapy was only doing evaluations for her. Interview with the assessment nurse, on 10/07/10 at 1:30 p.m., found the resident did not have a care plan for a splint, as there was no physician's order for one. Interview the rehab program director (Employee #105), at 1:45 p.m. on 10/07/10, found she did not start here until July 2010 and did not know about any issues regarding this resident. Employee #105 later said the rehab program was going to pick up the resident again and try to do some therapy for her. At 2:10 p.m. on 10/07/10, the occupational therapist (OT - Employee #162) said a new brace with finger separators would be ordered for the resident, and she would set up a splinting schedule with training for the resident's family and staff. She also reported she performed a new evaluation of the resident on 10/07/10, compared it to an OT evaluation that was completed on 05/06/10, and found the resident had not lost any ROM in that hand. A review of the resident's comprehensive annual assessment, with an assessment reference date (ARD) of 05/12/10, found in Section G the resident had limited ROM of one (1) hand with full loss of voluntary movement. In Section S, the assessor noted the resident's left hand had a contracture. Review of the resident assessment protocol (RAP) for activities of daily living / functional rehabilitation potential, dated 05/19/10, found it did not address the resident's contracture. Review of the resident's current care plan, with a created date of 03/19/10, confirmed the interdisciplinary team identified the resident was at risk for loss of ROM "r/t (related) to existing contractures of her left hand and ankle, but the care plan did not include an intervention to apply a splinting device to the resident's left hand. Review of the OT Evaluation, with a signature date of 05/11/10, noted, "... Pt is @ (arrow pointing up) risk for contractures & presenting /c (with) (arrow pointing down) PROM (passive range of motion) in (L) UE (left upper extremity) (symbol for 'secondary to') [MEDICAL CONDITION]/[MEDICAL CONDITION] Dx ([DIAGNOSES REDACTED]. Pt would benefit from skilled OT services for contracture Mgt (management) programs (illegible) splinting, positioning & staff education for (L) UE." found the resident to have 0-70 degree ROM in the left wrist and she was at high risk of developing a contracture due to a [DIAGNOSES REDACTED]. A request was made of Employee #105, on the afternoon of 10/07/10, for any other information about the resident's therapy plan; Employee #105 reported the only information she had was on the resident's medical record. Review of the resident's medical record found a form titled "Rehabilitation Screening", dated 04/01/10, with an entry by Physical Therapy which stated; "Pt (patient) not appropriate for contracture management program due to poor rehab potential for functional outcome." Review of an OT Rehabilitation Summary, dated 06/08/10, noted the resident was being discontinued from OT, stating, "Pt participated in all tx (therapy) sessions and has met all LTG's (long-term goals) @ this time. Pt is currently utilizing a resting hand splint on (L) hand to assist /c positioning (in order to (arrow pointing down) risk of further contracture). ..." The author of this entry further noted staff and family were educated on the resident's splint schedule, and the resident was to receive passive ROM before having the splint applied. Review of the 10/07/10 OT Evaluation found the long-term goal for the resident was: "Pt to tolerate WHO (wrist-hand orthotic) /c out complaints of skin irritation / breakdown to prevent further deformity and management of (L) UE contractures." Treatment approaches included: "Splint Evaluation, Splint training, and Contracture management." |
2014-02-01 |