cms_WV: 3304
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| rowid | facility_name | facility_id | address | city | state | zip | inspection_date | deficiency_tag | scope_severity | complaint | standard | eventid | inspection_text | filedate |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 3304 | MAPLES NURSING HOME | 515186 | 1600 BLAND STREET | BLUEFIELD | WV | 24701 | 2018-04-05 | 726 | D | 0 | 1 | NWDF11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, policy review, staff interview, and family interview the facility failed to have nursing staff with the appropriate competencies and skills set to provide nursing and related services to attain or maintain the highest practicable physical mental and psychosocial well-being of each resident. Resident identifiers: #18 and #98. Facility census: 46. Findings included: a) Pressure ulcers Resident #18 was found to have six (6) pressure ulcers, some of which may have developed in-house. The facility failed to ensure Resident #18's pressure areas were assessed and when assessed, that they were assessed correctly and timely, and failed to implement timely interventions. The facility also failed to provide care for an unstageable pressure ulcer for Resident #98 for three (3) days. 1. Resident #18 Review of the facility's policy titled, Wound Care, revised (MONTH) 2002, found it directed the following information should be recorded in the resident's medical record: - The type of wound care given. - The date and time the wound care was given. - The position in which the resident was placed. - The name and title of the individual performing the wound care. - Any changes in the resident's condition. - All assessment data (i.e., wound bed color, size, drainage, etc.) obtained when inspecting the wound. - If the resident refused the treatment and the reason(s) why. Review of Resident #18's medical records found she was transferred to a local hospital on [DATE] and returned to the facility on [DATE] at 5:07 PM. Licensed Practical Nurse (LPN) #42's re-admission assessment stated that Resident #18 returned with a dressing to her inner and outer ankle and top of her left foot and bruising to both upper extremities. No evidence was found of pressure ulcers. During an interview, on 04/02/18 at 4:05 PM, LPN #39 stated that Resident #18 only had a Band-Aid to the second toe on the left foot and had no pressure ulcers. LPN #39 stated that Resident #18 was admitted on [DATE] and had no pressure ulcers in the past year. Registered Nurse (RN) #44 showed LPN #39 a nursing note stating that a pressure ulcer on the left heel 1/2018 was a deep tissue injury but had since healed. On 04/03/18 a review of the evidence from the Wound Assessment and Progress Review noted on 04/02/18 at 6:19 PM the following: - Unstageable Deep Tissue Injury (DTI) measuring 2 x 2 cm (centimeter) with eschar measuring 1.8 cm on the left heel. - Unstageable DTI measuring 1.7 x 2 cm on the right heel. - Stage II pressure ulcer measuring 2.4 x 2 cm on the sacrum. - Unstageable DTI measuring 2.4 x 2.2 cm on the left toe. Noted to be purple in color and was not blanchable. - Unstageable DTI measuring 1.2 x 1.5 cm on the right toe with eschar (a collection of dead tissue within the wound bed and indicates full thickness tissue loss) in the center. During an observation of wound care on 04/03/18 at 2:58 PM, by Licensed Practical Nurse (LPN) #39 for Resident #18 revealed there was a dressing of an ABD (absorbent dressing) pad, which was secured with gauze to the left heel. There was no dressing on the right foot. LPN #39 removed the dressing from the left heel which showed eschar with no drainage. No measurements were taken at that time. LPN #39 wiped the area of the left heel with moistened gauze, covered the heel with an ABD pad and wrapped it with gauze. The right heel did not have a dressing. LPN #39 wiped the right heel with moistened gauze and applied skin prep (a protective barrier). She proceeded to cover the right heel with an ABD pad and secure it with gauze. No care was provided to the toes on the left or right foot and/or the sacrum area. On 04/03/18 at 03:25 PM, Registered Nurse (RN/Wound Nurse) #36 came in the Resident's #18's room. RN #36 further explained that it was her opinion that Resident #18 developed those places on her (Resident #18) toes from the hospital and she (RN #36) just saw her (Resident #18) yesterday (04/02/18). During an interview on 04/04/18 at 11:02 AM, when asked how the pressure ulcer on the resident's left heel was staged and what tool(s) did she use, RN/Wound Nurse #36 stated that the wound on the left heel was a Deep Tissue Injury (DTI) because a wound cannot be staged when there was eschar. In addition, she stated that she did not have any tools to refer to, that she did not stage pressure ulcers, and she was not a doctor. RN/Wound Nurse #36 stated that she had only had the Wound Care Nurse position for two (2) weeks and had not had any training. (Note: The presence of eschar indicate a full thickness wound and would be considered an unstageable pressure ulcer due to eschar.) A review of the form titled Wound Assessment and Progress Review found the resident had a suspected deep tissue injury (SDTI) on the left heel on 01/11/18. On 02/28/18, 03/07/18, and 03/14/18, the documentation noted the SDTI was closed on each of these dates. When asked what closed meant, RN/Wound Nurse #36 stated there was a scab on the wound and she put closed because the nurse before her put closed. During an interview on 04/04/18 at 11:33 AM, RN #23 was asked about writing closed on the wound assessment and she said that the wound was closed meaning the wound was clear with no scabs or anything. During an interview on 04/05/18 at 9:08 AM with Resident #18s attending physician, he stated that he had not looked at Resident #18 feet and that's on him. He stated that he relied on the nurses' charting and notes at face value and failed to look at them (Resident #18's feet) himself. In addition, he agreed that the nursing documentation was not consistent or accurate. The attending physician's assessment dated [DATE] included, ASSESSMENT: Deep tissue injury to the left heel, suspected deep tissue injury to the right heel, blister to the right great toe, [DIAGNOSES REDACTED] to the left great toe, likely stage II pressure area on the second toe, and stage II pressure area on the lumbosacral area. During an interview on 04/05/18 at 10:26 AM, the DoN and Administrator agreed that the wounds for Resident #18 were never assessed until 04/02/18. On 04/05/18 at 4:30 PM, the DON was asked again for the report of a skin check for this resident prior to being transferred to the local hospital and the DoN reported that a skin check was not completed, and on readmission there was no evidence Resident #18 returned to the facility with pressure ulcers or unstageable DTIs. 2. Resident #98 Review of the admission nursing assessment dated [DATE] revealed Resident #98 had a blister like area on the left heel that has a protective dressing intact. Record review revealed a physician's orders [REDACTED]. The left heel wound was described as an unstageable area 4.5 centimeters (cm) by 4.0 cm with eschar (a collection of dead tissue within the wound bed and indicates full thickness tissue loss). On 04/04/18 at 10:30 AM, the DON agreed the wound identified on 03/17/18 did not receive medical interventions until 03/19/18. b) The facility failed to develop and implement an accurate baseline care plan for Resident #98. The resident's baseline care plan did not include fall risk or care for a wound on the foot, both present at the time of admission. 1. Resident #98 Medical records review revealed Resident #98 was admitted to the facility on [DATE]. Review of discharge summary from the hospital where Resident #98 was treated prior to being admitted to the facility, revealed the reason for admission to the hospital was a subtrochanteric fracture (a [MEDICAL CONDITION] bone near the hip) of left hip on 03/03/18. Review of the baseline care plan, with a date of 03/16/18, was absent of any evidence Resident #98 had a risk for falls. physician's orders [REDACTED]. Review of nursing admission assessment with a date of 03/17/18 revealed Resident #98, .was admitted to (initials) Nursing after sustaining a fall in previous nursing home facility. The fall evaluation completed on admission also revealed a high fall risk. Fall risk was not included in the base line care plan. The nursing assessment dated [DATE] identified Resident #98 had a, blister like area on the left heel that has a protective dressing intact. The baseline care plan with a date of 03/16/18 did not include actual skin breakdown or treatment for [REDACTED]. Record review revealed a physician's orders [REDACTED]. The left heel wound was described as an unstageable area 4.5 centimeters (cm) by 4.0 cm with eschar (a collection of dead tissue within the wound bed indicating full thickness tissue loss). On 04/04/18 at 10:30 AM, the DON agreed, the resident's risk of falls and the wound observation on the nursing admission were not identified on the baseline care plan. | 2020-09-01 |