cms_WV: 3277
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 3277 | MAPLES NURSING HOME | 515186 | 1600 BLAND STREET | BLUEFIELD | WV | 24701 | 2017-02-09 | 280 | E | 0 | 1 | UXFJ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview the facility failed to revise the care plans for Residents #30, #9 and Resident #43's when there was a change in their treatment. Resident #30 and #43 did not have their care plans revised when changes were made to their medication regimen. Resident #9's care plan was not revised when her pressure ulcer interventions changed. For Resident #97 the facility failed to involve him in his care planning process as it related to his preference to have meat for breakfast. This was true for four (4) of seventeen (17) stage 2 sampled residents. Resident Identifiers: #30, #97, #9 and #43. Facility census: 58. Findings include: a) Resident #30 A review of Resident #30's medical record, at 9:22 a.m. on 02/08/17, found a physician's orders [REDACTED]. This order had a discontinue date of 07/08/16. A review of Resident #30's care plan found the following intervention related to her nutritional status problem statement, Administer medications as ordered and monitor for side effects. Med Pass and sliding scale insulin. This intervention had a start date of 03/16/16. An interview with the Director of Nursing (DON) on 02/09/17 at 10:02 a.m., confirmed Resident #30 no longer received sliding scale insulin and the care plan was not revised when this medication was discontinued. b) Resident #97 The medical record was reviewed on 02/07/17 at 11:53 a.m. which revealed a diet order dated 2/01/17 for the resident to receive, double meat/egg portions on trays. On 02/08/17 at 7:54 a.m. Staff #94 stated the resident discussed food preferences with the Registered Dietician on 02/07/17 and because the resident receives [MEDICAL TREATMENT], cannot receive meats served at breakfast. Observed Resident #97 breakfast tray on 02/08/17 at 8:17 a.m., no meat observed on tray. Resident stated understanding of diet recommendations. Resident does not want meat all the time but would like meat sometimes at breakfast but has not received meat with breakfast since admission. On 02/8/17 at 8:49 a.m., an interview with the Registered Dietician stated diet plans came from corporate and cannot be changed. The Registered Dietician stated a conversation will be held with the resident to discuss food preferences and together they can determine what menu options will work. The Dietician stated that perhaps bacon or sausage can be offered occasionally. On 02/08/17 at 10:49 a.m. Staff #94 stated a conversation was held with the resident and meat will be offered at breakfast. c) Resident #9 On 02/07/17 the medical record was reviewed. This resident first came to the facility in 2012. Pertinent [DIAGNOSES REDACTED]. She was always incontinent of bladder. She was totally dependent on staff for toileting. She had impairments of one side of both the upper and the lower extremity. A wheelchair was her only mobility device. Review of a nurse progress note dated 01/20/16, found that a nurse aide brought to the attention of a licensed practical nurse the discovery of a pressure ulcer. Review of the wound assessment and progress review sheets found nursing staff assessed this resident on 01/20/16 with a Stage III pressure ulcer on the coccyx. The tissue type assessed at that time was necrotic slough. Nursing assessed the size at that time as 1.0 centimeter (cm) by 1.5 cm by less than 0.5 cm. The wound had a scant amount of exudate. The facility utilized a Pressure Ulcer Scale for Healing (PUSH) scale that was developed by the national Pressure Ulcer Advisory Panel (NPUAP) as a tool to monitor the improvement or deterioration in pressure ulcer healing using a numerical score. Zero is the best possible score. Review of PUSH scores from 01/20/16 through 02/01/17 found that the pressure ulcer alternately improved and worsened throughout its course. The PUSH scores have ranged from as low as two (2) to as high as nine (9). The most recent PUSH score was seven (7) on 02/01/17. An interview was conducted with wound care registered nurse #80 on 02/07/2017 at 12:44 p.m. She said the pressure ulcer was first identified on 01/20/16 as a Stage III. She said the wound was in-house acquired. When asked about impediments to healing, she said this resident sits a lot. During an interview on 02/07/17 at 12:44 p.m. with licensed practical nurse #22, she said the resident prefers to get up at 3:30 a.m. or 4:00 a.m. daily. She said the resident stays up all day, and goes to bed around 3:30 p.m. or thereafter. An interview was completed with nurse aide (NA) #69 on 02/07/17 at 2:00 p.m. She said the resident gets up really early and sits up in her wheelchair all day. She said sometimes the resident can shift her weight in the wheelchair herself, but some days cannot or does not. The current care plan was reviewed. It directed incontinence care every two (2) hours and as needed, to turn and reposition her at least every two (2) hours. The care plan was silent regarding the resident's preference to stay up in the wheelchair all day long up to twelve (12) hours per day. The care plan was silent regarding the need to shift her position in the wheelchair at set parameters. An interview was completed with the director of nursing (DON) on 02/07/17 at 4:00 p.m. The DON said the resident prefers to stay up in the wheelchair all day long. When asked if she had individualized care planning revisions to note that she is up all day in the wheelchair and required shifts of position when sitting in the wheelchair per set parameters by the facility, she said the aides change her incontinence brief every two (2) hours, so she would be assisted to reposition throughout the day at least every two (2) hours. The facility's policy on the prevention of pressure ulcers was requested to the DON on 02/09/17 at 9:00 a.m., and was soon provided. Review of this policy found general preventive measures for a person in a chair included to change their position at least every hour. When repositioning, reduce friction and shear by lifting (using appropriate lifting technique and equipment) rather than dragging. Review of the current care plan found neither of these interventions listed. During an interview with the DON on 02/09/17 at 1:10 p.m., no further information was provided when informed of the findings of the absence of individualized care plan revisions for this resident who sits up in the chair half of each day. d) Resident #43 Minimum Data Set (MDS) review, with an Assessment Reference Date (ARD) of 02/05/17, revealed this resident received antianxiety, antidepressant, and diuretic. He did not receive antipsychotic, hypnotic, anticoagulant, and antibiotic. Review of the care plan found the identification of the use of Ivanz (antibiotic), [MEDICATION NAME] (antidepressant), [MEDICATION NAME] (heart and blood pressure), [MEDICATION NAME] (diabetes) and Two cal HN ( protein supplement). During interview with the MDS nurse #24, on 02/09/17 at 9:15 a.m., review of the current physician orders [REDACTED]. The MDS nurse #24 confirmed the resident no longer was ordered Inanz, [MEDICATION NAME] and Two cal HN. She further acknowledged she needed to revise Resident #43's care plan. | 2020-09-01 |