cms_WV: 8754
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 8754 | PINE LODGE | 515001 | 405 STANAFORD ROAD | BECKLEY | WV | 25801 | 2013-03-13 | 204 | D | 1 | 0 | MS9D11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based upon record review, staff interview, interview of the owner of a receiving facility, and family interview, the facility failed to provide sufficient preparation and orientation to residents to ensure safe and orderly transfer or discharge from the facility to a legally unlicensed adult care home. This was found for one (1) of four (4) records reviewed. Facility census: 115. Findings include: a) Resident #117 The medical record of Resident #117, was begun on 03/11/3 at 3:00 p.m. and continued on 3/12/13 at 8:59 a.m. This fifty-nine (59) year old man, was admitted to the facility on [DATE], and discharged on [DATE]. His [DIAGNOSES REDACTED]. Resident #117 was admitted following hospitalization for a fall resulting in a head injury. The hospital discharged him to the facility on [DATE]. Upon admission to the nursing home, his comprehensive assessment (MDS) of 03/13/12, under section G0110, G0120, and G0300 documented his ability as: Bed Mobility coded: 0,0 indicating 'independent with no help from staff Transfer ability coded: 2,2 indicating 'limited assistance of one staff Walking in room coded: 3,3 indicating 'extensive assistance of two or more staff Walk in corridor coded: 8,8 indicating 'did not occur Locomotion on unit coded: 3,2 indicating 'extensive assistance of one staff Locomotion off unit coded: 3,2 indicating 'extensive assistance of one staff Dressing coded: 3,2 indicating 'extensive assistance of one staff Eating coded: 0,1 indicating 'independent with set up help only Toileting coded: indicating 'limited assistance of one staff Personal Hygiene coded: 0,1 indicating 'set up help only Bathing coded: 3,2 indicating 'extensive assistance of one staff Balance sitting to standing coded: 2 indicating 'not steady, only able to stabilize with staff assistance Balance Walking coded: 2 indicating 'not steady, only able to stabilize with staff assistance Turning around coded: 8 indicating 'activity did not occur Moving on/off toilet coded: 2 indicating 'not steady, only able to stabilize with staff assistance Surface to surface transfer coded: 2 indicating 'not steady, only able to stabilize with staff assistance He was placed on therapy services for strengthening and improvement in his independence with activities of daily living (ADL's). His therapy services were stopped on 04/19/12 because he had met all his goals. He did not resume therapy during his stay. His preadmission screening and eligibility determination form (PAS) was approved for payment by Medicaid for three (3) months, with the physician estimating a stay of approximately twenty-one (21) days. The facility subsequently had to submit a PAS to resume payment on 04/26/12. This application was approved for a recommended period of three (3) to six (6) months on 05/07/12. He improved with therapy, and by 06/11/12, his comprehensive assessment (MDS), under section G0110, G0120, and G0300 documented his ability as: Bed Mobility coded: 0,0 indicating 'independent with no help from staff Transfer ability coded: 0,0 indicating 'independent with no help from staff Walking in room coded: as 'not assessed Walk in corridor coded: 8,8 indicating 'activity did not occur Locomotion on unit coded: 0,0 indicating 'independent with no help from staff Locomotion off unit coded: 0,0 indicating 'independent with no help from staff Dressing coded: 0,0 indicating 'independent with no help from staff Eating coded: 0,0 indicating 'independent with no help from staff Toileting coded: 0,0 indicating 'independent with no help from staff Personal Hygiene coded: 0,0 indicating 'independent with no help from staff Bathing coded: 0,0 indicating 'independent with no help from staff Balance sitting to standing coded: 0 indicating 'steady at all times Balance Walking coded: 0 indicating 'steady at all times Turning around coded: 0 indicating 'steady at all times Moving on/off toilet coded: 0 indicating 'steady at all times Surface to surface transfer coded: 0 indicating 'steady at all times The facility again allowed the PAS approval to expire, and this necessitated another submission for approval for Medicaid coverage for long term care level services. With the improvements in his functional abilities, the reviewer denied the application stating he did not require long term care services on 08/20/12. He had to undergo surgery for [REDACTED]. His MDS of 09/10/12 assessed his functional ability as: Bed Mobility coded: 3,2 indicating 'extensive assistance of one staff Transfer ability coded: 3,2 indicating 'extensive assistance of one staff Walking in room coded: 3,2 indicating 'extensive assistance of one staff Walk in corridor coded: 3,2 indicating 'extensive assistance of one staff Locomotion on unit coded: 0,0 indicating 'independent with no help from staff Locomotion off unit coded: 0,0 indicating 'independent with no help from staff Dressing coded: 3,2 indicating 'extensive assistance of one staff Eating coded: 0,1 indicating 'independent with set up help only Toileting coded: 2,3 indicating 'limited assistance of two or more staff Personal Hygiene coded: 3,2 indicating 'extensive assistance of one staff Bathing coded: 3,2 indicating 'extensive assistance of two or more staff Balance sitting to standing coded: 2 indicating 'not steady, only able to stabilize with staff assistance Balance Walking coded: 2 indicating 'not steady, only able to stabilize with staff assistance Turning around coded: 2 indicating 'not steady, only able to stabilize with staff assistance Moving on/off toilet coded: 2 indicating 'not steady, only able to stabilize with staff assistance Surface to surface transfer coded: 2 indicating 'not steady, only able to stabilize with staff assistance An interview was conducted with the comprehensive assessment (MDS) coordinator, registered nurse (RN), Employee #54 on 03/12/13 at 10:00 a.m. She was asked why a significant change of status comprehensive assessment (MDS) was not considered for Resident #117 upon his return from hernia repair surgery. She agreed that his functional ability had declined markedly following the procedure, but said that the interdisciplinary team was in agreement that they anticipated a fairly rapid return to his baseline, and decided to wait for a time to see what happened. She said that he did improve rapidly, and within a couple of weeks, he had returned to near his functional level as assessed on 06/11/12. The facility once again submitted another PAS form for a change in condition, to attempt to get Medicaid payments resumed. This form was submitted on 10/01/12, following his improvement following surgery in September, and was again denied on 10/02/12. The facility was still receiving no reimbursement for Resident #117's stay. There was documentation that numerous attempts were being made to find a location that would accept Resident #117 to allow the facility to discharge him. Social services notes documented that beginning on 09/11/12, assisted living facilities were contacted. The note stated that all were private pay, which Resident #117 could not afford on his approximately $432.00 per month disability benefits. The note said that legally unlicensed adult care homes would be contacted. The record showed that from 09/17/12 until 09/28/12, attempts were made to arrange placement at twenty-seven (27) legally unlicensed adult care homes all over the region. They all had concerns over the care required, they did not accept smokers, or only accepted private pay residents. The record indicated that on 09/28/12, the unlicensed care home to which Resident #117 was ultimately discharged , called to let the social worker know that she would accept him, but needed time to prepare his room. Earlier efforts to obtain placement in another state where Resident #117's sister lived were unsuccessful as the facility there also refused to accept him. The record documents that she was contacted on 09/28/12 and notified of Resident #117's upcoming placement. Transportation problems with two (2) different ambulance services, complications from hernia surgery, and an unspecified emergency at the unlicensed care home delayed the discharge until 11/08/12, when the record shows he was taken to the unlicensed home in the facility van, with a wheelchair and a cane. The social worker for Resident #117, Employee #37, was interviewed on 03/12/13 at 2:40 p.m. He confirmed that Resident #117 had improved following his hernia surgery and within a couple of weeks was back walking with his cane, although he always used his wheelchair to go any appreciable distance. He said that when the preadmission screening was denied, the facility stopped getting paid, and he began to pursue locations for discharge. He said it was very difficult due to Resident #117 having [MEDICAL CONDITION] C, being a smoker, exhibiting inappropriate and aggressive behaviors at times, and not being covered by Medicaid. He said that finally an unlicensed adult care home agreed to take Resident #117 on 09/28/12. Following several logistical problems with the provider and the ambulance services, the facility activities director and a nursing assistant drove Resident #117 to the unlicensed care home in the facility van. He was asked if he had visited the home prior to the discharge to see if it was a safe appropriate location for the discharge. He replied that he had not. He said he spoke with the owner on the phone. He said that she had told him there were seven (7) or eight (8) steps that Resident #117 would have to negotiate. He was asked if he made any effort to determine if Resident #117 could safely negotiate steps. He said he asked the resident, who told him it would be no problem. He was asked if physical therapy was consulted for an assessment of the resident's ability to climb stairs. He stated he thought he had asked them about it, but no formal assessment was requested or completed. None of the goals met when resident #117 was discharged from therapy on 04/19/12 addressed stairs. There was a goal that stated he should be able to negotiate ramps, grass, and gravel. There was no documentation in the record regarding any stairs or any attempts to determine if the location was appropriate for discharge. He was asked if the staff that transported the resident to the home had gone inside to make any assessment of the suitability. He replied that he did not know. He offered that the regional ombudsman had visited the facility later following the discharge and had told him that there were eighteen (18) steps to Resident #117's room, and that he was in a bad situation. The activities director, Employee #87, was interviewed on 03/12/13 at 3:34 p.m. She confirmed that she and a nursing assistant had transported Resident #117 to the unlicensed care home on 11/08/12 in the facility van. She said that they had a TV, three (3) boxes of clothing and personal items, a cane, and a wheelchair. She said she had a bag with his medications. She took it to the front room. The owner was not there, but her son signed for the medications. She said that Resident #117 walked around the front yard, and talked with another resident. She said they left his belongings there, the resident hugged her, and we dropped him off and left. The owner of the legally unlicensed home was interviewed on the telephone on 03/11/13 at 3:23 p.m. She was asked if Resident #117 was still living in her home. S he replied that he was still there. She asked if there was someone who could get him placed somewhere else. She said that he needed to stay over there (the facility). She said he can't get around here, he is not doing good. She said they are trying to find someplace for him to go. He wants to go back to the facility or somewhere closer to his sister (out of state). She said they were having trouble with his medications and that he needed nursing home care. She was asked if she had spoken with the facility about this. She said that she had talked with that man (Employee #37). She stated she told him that Resident #117 needed to stay over there. The health care surrogate was interviewed by telephone on 03/12/13 at 1:59 p.m. She related that she had no problems with the facility, that they treated him very well there. She said that he was in a wheelchair, that it was still sitting on the front porch. She said there were fifteen (15) steps up to his room and he could not get up or down by himself. He just sat up there and smoked. She said the ombudsman was working with him on finding a new place. She stated that the facility did not assess the place, they did not check it to see if it was safe, they just took him there in the van and dropped him off. The administrator was interviewed on 03/12/13 at 3:47 p.m. She confirmed there was no documented effort to ensure a safe and orderly discharge for Resident #117. | 2016-03-01 |