cms_WV: 3276
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 3276 | MAPLES NURSING HOME | 515186 | 1600 BLAND STREET | BLUEFIELD | WV | 24701 | 2017-02-09 | 279 | D | 0 | 1 | UXFJ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on resident interview, record review and staff interview, the facility failed to develop a comprehensive care plan for one (1) one (1) resident reviewed for the care area of hydration during Stage 2 of the Quality Indicator Survey (QIS). The care plan failed to address how the physician ordered fluid restriction would be implemented and monitored by each discipline, including dietary, nursing and activities. Resident identifier: #40. Facility census: 58. Findings include: a) Resident #40 During Stage 1 of the QIS survey, at 12:17 p.m. on 02/06/17, an interview with Resident #40 found he said he did not receive the fluids he wanted between his meals. He said he thought it was due to a kidney problem. Record review at 4:43 p.m. on 2/07/17, found the resident had a physician's orders [REDACTED]. Further record review found a care plan addressing dehydration/fluid maintenance with a potential for dehydration due to fluid restriction and a [DIAGNOSES REDACTED]. The goal was the resident would remain free of signs/symptoms of dehydration through next review date. The care plan was updated on 02/02/17. The care plan approaches did not detail how much fluid the resident would receive from dietary and how much fluid from the nursing staff. An interview with Registered Nurse (RN) #26, author of the care plan, at 8:23 a.m. on 02/08/17, confirmed the fluid restriction was not detailed in the resident's care plan. At 8:51 a.m. on 02/08/17, the resident's Licensed Practical Nurse (LPN) #11 said the resident is not on a fluid restriction and she verified the resident had a pitcher with water in his room with a straw for drinking. At 8:56 a.m. on 02/08/17, the dietary manager (DM) #23, provided a copy of the tray card for the resident's noon meal on 02/08/17. The tray card directed the resident to receive 4 ounces (oz) of coffee or hot tea and 8 oz's of milk. She was asked how to convert ounces to cubic centimeters. She said she wasn't sure, but would tell me later. On 02/08/17, at 9:10 a.m., DM #23 said the resident would receive 840 milliliters a day from dietary and 1 cc would equal 1 milliliter. When asked how other nursing employees would know how much fluid the resident could receive, she replied, They could look in the computer. At 9:26 a.m. on 02/08/17, the resident's physician was interviewed. He said, I usually don't like fluid restrictions, why are we doing that, I will have to track that back to see. At 10:40 a.m. on 02/08/17, LPN #11 returned and said, I told you wrong, he is on a fluid restriction. I give about 120 cc of fluid with my medication pass. Sometimes the resident drinks it and sometimes he doesn't. She verified she does not record how many cc's of fluid the resident consumed with the medication pass. Review of the care plan for nutritional status contained an approach to, Invite to food related activities and offer food, beverages of choice to encourage intake. The activities assistant (AA) #37, was interviewed at 1:50 p.m. on 02/08/17. AA #37 confirmed she does not record any consumption of fluids or fluids consumed by any resident during activities. She said the resident sometimes comes to morning chat where we pass out coffee. She said the resident was allowed to have coffee. At 11:46 a.m. on 02/09/17, the Registered Dietician (RD) #93, was interviewed. The resident's tray card for lunch on 02/08/17 noted the resident would receive four (4) ounces (oz) of coffee or hot tea and 8 oz of milk. As the fluid restriction was 1500 cc, RD #93 was asked how to convert ounces to cubic centimeters. She said there were 30 cc in one ounce so the resident would be getting 12 ounces of fluid which would be 360 cc of fluid with this meal. She said the resident would receive 360 cc of fluid with each meal so dietary would be providing 1080 cc of fluid a day. At 11:54 a.m. on 02/09/17, the director of nursing (DON) said the facility has a new form they are going to start using to record the resident's daily fluid intake. The daily vitals report used by the nursing staff was reviewed with the DON. Variances were observed in the recordings. For example on 02/06/17, a registered nurse recorded the resident as having consumed 480 milliliters of fluid at 6:43 p.m. No other fluids were recorded on 02/06/17. The DON did not know if this was the only fluids consumed by this resident on this day. On 01/31/17, only one nurse aide recorded a fluid intake of 360 milliliters of fluids. The DON said that did not indicate this was all the resident drank for the day. The DON verified the fluid records were not consistent; therefore, a new form had been developed so the facility could track the daily fluids consumed by the resident. | 2020-09-01 |