cms_WV: 5393
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 5393 | ANSTED CENTER | 515133 | PO BOX 400 | ANSTED | WV | 25812 | 2015-09-02 | 309 | D | 0 | 1 | ZG3O11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, medical record review, resident interview, and staff interview, the facility failed to provide care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being for two (2) of twenty-three (23) Stage 2 sampled residents. Resident #36 did not receive medicated rectal suppositories as ordered by the physician. Resident #9 did not receive vital signs assessment timely upon her return to the facility following a [MEDICAL TREATMENT] treatment. Resident identifiers: #36 and #9. Facility census: 53. Findings include: a) Resident #36 Review of the medical record, on 08/25/15 at 4:00 p.m., found [DIAGNOSES REDACTED]. A signed physician's orders [REDACTED]. Nursing staff documented family notification of this new physician's orders [REDACTED].>The Medication Administration Record [REDACTED]. Review of the medical record and the activities of daily living (ADL) record, found the resident did not receive a rectal suppository, or have a documented refusal, following any of the twenty-five (25) documented bowel movements between 08/07/15 and 08/25/15. During an interview with the director of nursing (DON) on 08/25/15 at 5:00 p.m., she acknowledged that the signed physician's orders [REDACTED]. She agreed that it appeared the resident received only one (1) rectal suppository and had only two (2) documented refusals of the rectal suppository between 08/07/15 and 08/24/15. The DON acknowledged that the order was written in a confusing manner on the MAR, which caused the resident not to receive the prescribed medication. On 08/26/15 at 8:30 a.m., the DON said she spoke with the nurse who wrote the original order for the [MEDICATION NAME] suppositories. The DON said the nurse did not mean to write it that way. The DON said nursing staff contacted the physician this morning, and received a clarification for the [MEDICATION NAME] order. The physician's orders [REDACTED]. b) Resident #9 Review of the medical record, on 08/26/15 at 12:00 p.m., revealed this [AGE] year old resident came to the facility on [DATE]. While residing at the facility, she received [MEDICAL TREATMENT] treatments at a [MEDICAL TREATMENT] center three (3) times per week. An interview, conducted with Licensed Practical Nurse #14 on 08/26/15 at 12:50 p.m., revealed this resident goes out to [MEDICAL TREATMENT] on the night shift three (3) times weekly. Upon return to the facility from [MEDICAL TREATMENT], the day shift nurse immediately assessed the resident. This assessment includes checking the fistula site for redness, drainage, bleeding or pain, checking for thrill and bruit, and obtaining vital signs. Observation, on 08/27/15 at 1:10 p.m., found Resident #9 had returned from the [MEDICAL TREATMENT] center via ambulance transport. Observation, on 08/27/15 at 1:33 p.m., found the resident eating lunch in her room. Upon inquiry, she said no one had checked her blood pressure since she returned from the [MEDICAL TREATMENT] center today. During an interview with Registered Nurse #55 on 08/27/15 at 1:35 p.m., he said the aides obtain the vital signs upon the resident's return from [MEDICAL TREATMENT], and he did not know if the aide had obtained Resident #9's vital signs yet. He said he assessed the access site after her return to the facility today. During an interview with Nursing Assistant #35 on 08/27/15 at 1:37 p.m., she spoke her belief that the nurse is supposed to check the blood pressure when the resident first returns from [MEDICAL TREATMENT]. She said she would check it now if needed. She said she usually does not work this hall. Observation on 08/27/15 at 1:43 p.m. found Nursing Assistant (NA) #30 in Resident #9's room as she obtained the resident's vital signs. Upon inquiry, she said Registered Nurse #55 directed her about a minute ago to obtain the resident's vital signs. NA#30 said she was new to day shift, and was unaware of the need to get vital signs upon the resident's return to the facility from [MEDICAL TREATMENT]. She said the aide who was permanently assigned to this hall was off today. At 2:00 p.m. on 08/27/15, Registered Nurse #55 said he should have obtained the vital signs when the resident returned to the facility from [MEDICAL TREATMENT]. He said he does not typically work day shift, and the nurse who is usually assigned to this hall is off today. During an interview with the director of nursing (DON) on 08/27/15 at 3:00 p.m., she said it was her expectation that nurses obtain vital signs prior to sending the resident out for [MEDICAL TREATMENT], and immediately upon the resident's return from [MEDICAL TREATMENT] treatments. She said it was the nurse's responsibility to take the vital signs, assess the resident, and assess the access site upon return to the facility from [MEDICAL TREATMENT]. | 2019-01-01 |