cms_WV: 217
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 217 | ELKINS REGIONAL CONVALESCENT CENTER | 515025 | 1175 BEVERLY PIKE | ELKINS | WV | 26241 | 2018-02-16 | 742 | D | 1 | 0 | EN1S11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on medical record review, resident and family interview, and staff interview, the facility failed to ensure a resident with [MEDICAL CONDITION]'s Chorea received appropriate treatment and services to assist the resident to attain the highest practicable mental and psychosocial well-being. The facility failed to utilize outside resources to assist Resident #49 in coping with her progressive disease process. The facility failed to develop a care plan to provide guidance to direct care staff regarding the resident's individual needs. No individualized plans were in place to address her mental and physical expressions of distress. Diversional meaningful activities were not based on the resident's preferences, and/or abilities. This was found for one (1) of four (4) residents reviewed for behaviors. Resident identifier #49. Facility census: 102. Findings include: a) Resident #49 Review of the medical record on 02/12/18 at 1:20 PM, revealed Resident #49 is a [AGE] year-old admitted to the facility in (MONTH) (YEAR). [DIAGNOSES REDACTED]. Resident #49 was evaluated by a psychiatrist on 04/03/17. The summary notes for the evaluation noted Resident #49's [MEDICAL CONDITION]'s disease was currently being treated with Tetrabenzene ([MEDICATION NAME]) (a medicine used to treat involuntary movements of [MEDICAL CONDITION]'s disease) to suppress her motor symptoms. It is important to be aware that this treatment might aggravate mood problems such as depression. The treatment plan stated, The patient will benefit from the continued use of [MEDICATION NAME] 50 mg (milligrams) at bedtime. A smaller dose of 25 mg can be added in the daytime to reduce irritability. Because of the concern of [NAME]D ([MEDICAL CONDITION]) symptoms and possible development of depression, the patient might benefit from adding [MEDICATION NAME] 10 mg per day, which can be increased after two weeks to 20 mg per day. The Psychotherapy section stated (typed as written): Although the patient presents with some cognitive impairment, she might benefit from supportive psychotherapy to help her accepting and coping the changes in her living arrangement. The resident's medical record contained no evidence of supportive psychotherapy appointments or visits. The resident's electronic medical record included the following behaviors since 10/18/17: --10/18/17 The plan of care note stated, .She has a [DIAGNOSES REDACTED]. She takes [MEDICATION NAME], and Klonopin. She has obsessive thoughts/behaviors and compulsive behaviors. She is very impulsive and uncontrolled movements. She gets up on her own due to her impulsive and obsessive behaviors . --10/19/17 5:20 AM Resident's bed alarm going off and her call light was on, nurse found resident standing by bathroom door. Assisted to bathroom and returned to bed. --10/19/17 5:50 AM Resident found standing at nurse's station, bed alarm and call light sounding. Resident requested her morning medications. --10/21/17 6:37 PM Resident stumbling in hallway without assistance, chair alarm sounding. Redirection attempts ineffective. --10/22/17 11:21 AM Resident continues this morning to get up unassisted, one time she turned off her alarm and walked out into the hall. --10/30/17 6:37 PM Resident was tearful at 10:00 AM. Upset the Activities Director was busy. --11/19/17 6:35 AM Resident combative with staff during cares/attempted redirection. Striking at staff, attempting to bite staff. --11/20/17 5:59 AM Resident up at present in wheel chair, self transferring frequently through out shift. Adamant on getting up and calling her mom. Repeatedly asks about med times. Resident attempted to grab/strike write before/during transfers. --11/22/17 3:46 AM Up and down several times without assistance. Continues to be fixated on time, getting meds early, and using bathroom. Demands staff to be right with her when light or alarm sounds. --11/23/17 6:15 AM up in wheel chair fixated on finding the shower team --11/26/17 8:30 PM Nurse Aide (NA) heard alarm and found resident standing up by bed. --12/06/17 9:40 AM waiting for mother in hall and got up unassisted and fell . Resident is very anxious and tearful. --12/10/17 2:32 AM NA reported resident trying to throw herself to the ground while being assisted to the bathroom. Resident reported she had nothing to live for and acknowledged she was depressed. --12/18/17 Activity Director has attempted to redirect resident from being obsessed with her time for medications, bowel movements, calling her mother, whether or not her call bell is working and so forth on many occasions over the past several days. Resident has not been easily redirected most of the time. Resident states she has not been sleeping at night. --12/21/17 8:30 AM Resident agitated this morning, throwing self onto floor from wheel chair multiple times. States she is putting herself on the floor because no one will pay attention to her. --12/21/17 12:00 PM Spoke with physician regarding resident's intentional falls and informed him Medical Power of Attorney (MPOA)/mother was asking if he could adjust her meds since she is not sleeping at night. --12/22/17 4:14 AM Resident hit NA in face while assisting her with transferring --12/26/17 4:26 AM Resident self-transferring, ambulating ad-lib unassisted to bathroom, out of bed to chair. Demands immediate attention/help with requests. --12/29/17 3:40 PM Resident upset the activities director was not in the building and she could not reach her mother by phone. Threw herself to floor multiple times. Behaviors stopped once she talked to her mother. --01/18/18 10:44 AM The care plan meeting note included, .She has a [DIAGNOSES REDACTED]. She takes [MEDICATION NAME], and Klonopin. She has obsessive thoughts/behaviors and compulsive behaviors. She is very impulsive and uncontrolled movements. She gets up on her own due to her impulsive and obsessive behaviors .Resident does not sleep well at night. She chooses to only eat lunch, however her weight is good. Her mother visits several times a week. Resident is very anxious and wants to sit up and wait on her mom until she arrives. She sleeps well in the afternoon and will nap when her mother is here .Facility has tried 1:1 care at times due to impulsivity and frequent falls . --01/30/18 4:17 AM Resident asked to brush teeth in bathroom and then refused once in bathroom. Push NA away and fell to floor while being assisted to bed. Refused help for NA and got self back to bed. --02/01/18 2:14 AM Nurse called to assist NA in restroom. Resident noted to be speaking non-sense. Resident fighting aide and fell to floor. Placed in scoop chair resident stated Why are you guys so mean all the time? --02/01/18 2:45 AM Resident out of bed and in scoop chair at nurse's station. Continually getting out of chair and throwing self into staff. --02/01/2:55 AM Physician notified and [MEDICATION NAME] 1 milligram IM ordered. --02/01/18 3:15 AM Resident O[NAME] (out of control) attempting to run down hallways falls in floor --02/01/18 3:16 AM Resident refuses assistance. O[NAME] again. Resident had hard impact fall --02/01/18 3:55 AM Three person assist back to bed and [MEDICATION NAME] injection given --02/01/18 6:06 AM [MEDICATION NAME] has not been effective. Resident still up and down out of chair. Still asking repetitive questions and worrying excessively about her shower. --02/01/18 11:06 AM Nurse discussed behaviors with physician. Dr. (name) stated he would try a neurology consult if needed. --02/04/18 4:54 AM rang call light several times between 3:30 and 4:30 AM. Got out of bed unassisted at 4:54 AM and fell into bathroom door. Repeatedly asked what time do I get my meds? --02/05/18 2:00 AM UP and down since midnight. Heard alarm and found resident opening curtain. --02/06/18 5:30 AM NA assisted resident back to bed from bathroom, resident stiffened arms and legs and both fell . Resident told NA Ha Ha I get my meds now. --2/11/18 2:25 PM At 7 AM resident was standing outside her door calling for the nurse to help her back to bed. Fifteen minutes later resident found sitting on floor near wheel chair. The care plan focus for anxiety stated (typed as written): Resident has anxiety r/t (related to) admission, long-standing history, medical condition as evidenced by worrying daily about activities, meal times, medication times, sleep patterns, bowel habits, progression of disease, staffing and family. Resident is easily distracted and can become preoccupied with several concerns or issues at once. Resident is persistent and will insist and demand at times that her needs and requests be met immediately. The goal was, Resident to have a reduction in anxious episodes to less than daily through next review. Interventions included, 1. Administer medication as ordered for anxiety. 2. Assist resident in calling her family when she is worried about them. 3. Dry erase added to resident's room to record daily staffing, and other frequently asked questions for resident. 4. Observe for and document and s/sx (signs/symptoms) of side effects such as, but not limited to [MEDICAL CONDITION], agitation and hallucinations. 5. Offer activities to help distract resident when she is feeling anxious. 6. Provide emotional support and calm reassurance to resident if she is sad, tearful or anxious. 7. Resident requires constant reassurance at times. Allow her to express feelings and reassure her that her concerns are being heard. The resident's care plan lacked specific approaches for staff to utilize in response to Resident #49's increased anxiety, and [MEDICAL CONDITION] ([NAME]D). The care plan lacked meaningful activities related to Resident #49's customary routines, interests, or preferences and failed to include diversional activities during the evening and nights when she displayed most of her behaviors and is unable to sleep. During an interview on 02/13/18 at 10:15 AM with Resident #49 and her mother/MPOA, Resident #49 reported she felt tired all the time, was unable to sleep at night, had trouble concentrating and often felt anxious. When asked to describe how she felt when she was anxious, Resident #49 stated, Very nervous, can't sit still. She acknowledged her jerking movements became more pronounced with her anxiety, that she got up independently at times which often resulted in a fall, and put herself on the floor at times for attention. Resident #49 stated she cannot concentrate, thoughts just flow through her head. Resident #49 stated she was not sure what would make her feel better, but would like to feel less anxious and more comfortable in her environment. Resident #49 and her mother/MPOA acknowledged Resident #49 had not been offered supportive psychotherapy as recommended by the psychiatrist. Resident #49 expressed she felt the facility was not meeting her psychosocial needs. During an interview on 02/13/18 at 1:00 PM, the Activities Director (AD) #194 reported Resident #49 was more anxious and had had a decreased attention span since her admission. She stated Resident #49 slept in the afternoon and was up most of the night. The AD reviewed the care plan during this interview and agreed it was not individualized to meet Resident #49's needs. There were no specific activities identified for Resident #49 to do during the night when she was awake and lacked specific activities to distract the resident when she was feeling anxious. The facility's Administrator reviewed the care plan and medication administration records (MARs) during an interview on 02/13/18 at 1:19 PM. She acknowledged the records were incomplete regarding the monitoring of behaviors and the efficacy of non-pharmacological interventions. She agreed Resident #49's care plan was not individualized and lacked interventions to guide staff in addressing Resident #49's anxiety, depression, and [NAME]D. The Administrator acknowledged the facility had not attempted to send Resident #49 to a neurologist or make follow up psychiatric appointments until the previous week, and no supportive psychotherapy counseling was arranged. | 2020-09-01 |