cms_WV: 9033
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 9033 | DUNBAR CENTER | 515066 | 501 CALDWELL LANE | DUNBAR | WV | 25064 | 2013-03-14 | 155 | D | 0 | 1 | RKHC12 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, staff interview, resident interview, and policy review, the facility failed to assist two (2) of three (3) residents, reviewed for decision making, to formulate an advance directive, stating their desire to receive or not to receive cardiopulmonary resuscitation (CPR). Resident #193's wishes were to receive CPR if she was found to have no pulse, respirations and/or blood pressure. This was not assessed by the facility. She had a physician's orders [REDACTED]. Resident #217 had a Physician order [REDACTED].#217. The form was signed by her medical power of attorney (MPOA); however the resident still maintained capacity to make medical decisions. Resident identifiers: #193 and #217. Facility Census: 113 Findings Include: a) Resident #193 A medical record review was completed at 9:20 a.m. on [DATE]. This review revealed the resident had an order for [REDACTED]. The resident was readmitted to the facility from an acute care hospital on [DATE]. A care plan conference summary sheet was reviewed. It noted the resident wanted to be a Full Code. This indicated the resident wanted to have CPR initiated should it be needed. This summary was signed by Employee #36, a Registered Nurse (RN), minimum data set (MDS) Coordinator, Employee #51, Social Worker, a Licensed Physical Therapy Assistant, a Certified Occupational Therapy Assistant, and Resident #193. The resident's care plan was also reviewed. The care plan contained the following problem, The resident desires to be a DNR. The goal contained on the care plan was, DNR will be honored upon absence of pulse, respirations, and/or blood pressure. The care plan contained the following interventions. 1. Verify the absence of apical pulse, respirations, and/or blood pressure. 2. Notify Physician. 3. Notify Family. Additional review of the medical record revealed a hospital discharge summary, dated [DATE], which contained the following statements: It was questioned whether or not the son would request comfort care. He did make her a do not resuscitate, do not intubate. The medical record contained a Physician's Determination of Capacity, dated [DATE], which identified the resident demonstrated the capacity to make healthcare decisions. Finally, the medical record did not contain any evidence to suggest Resident #193 ever told facility staff she had a desire to have a DNR order. At 9:45 a.m. on [DATE], a resident interview was conducted with Resident #193. The resident was alert and orientated to time, place, and person. She was able to answer questions appropriately. She was asked if she had told the facility what her wishes were in regards to CPR. She stated, I have never really thought about whether or not I would want CPR. She further stated, I have never told anyone here that I did not want CPR. She stated, No one has ever asked me that before. At 9:52 a.m. on [DATE], Employee #108, Licensed Practical Nurse (LPN) and Employee #90, Registered Nurse (RN) were interviewed. They were asked how they determined whether or not to initiate CPR on a resident. They both confirmed they looked at the resident's Condition Alert sheet in the front of the chart for a DNR sticker. They stated if there was no sticker, they then looked at the resident's POST form. If there was no POST form, they reported they would look at the physician's orders [REDACTED].>At 10:00 a.m. on [DATE], Employee #51, the social worker, was interviewed. She stated the resident was a Full Code. She referred to the care plan conference summary sheet dated [DATE]. She confirmed she had not discussed this with the resident since her return from the hospital. She confirmed the resident had a physician's orders [REDACTED]. Employee #51 confirmed the resident had not signed any paperwork at the facility to indicate she would want to be a DNR. Employee #51 also confirmed the resident had a DNR care plan. At 10:22 a.m. on [DATE], Employee #108, an LPN, was asked to review the medical record of Resident #193 and to indicate if he would perform CPR on the resident should she have an absence of pulse, respirations and/or blood pressure. The LPN reviewed the medical record and indicated he would not perform CPR on this resident because she had a physician's orders [REDACTED]. At 10:25 a.m. on [DATE], Employee #46, an RN, was asked to review the medical record of Resident #193 and to indicate if she would perform CPR on this resident should she have an absence of pulse, respirations and/or blood pressure. The RN reviewed the medical record and stated she would not perform CPR on this resident because she had a physician's orders [REDACTED]. Employee #72, RN, Director of Nursing (DON), was interviewed at 10:30 a.m. on [DATE]. She was asked to review the medical record of Resident #193 and to indicate if she would perform CPR on this resident if there was an absence of pulse, respirations, and/or blood pressure. She stated she would perform CPR on this resident because she did not have a DNR sticker on her condition alert page in the front of her chart. The DON then reviewed the chart with the surveyor and confirmed the resident had a physician's orders [REDACTED]. She also confirmed the absence of a POST form and of a DNR sticker on the condition alert form at the front of the resident's medical record. At 10:35 a.m. on [DATE], Employee #37, the social worker, reported the facility contacted the acute care hospital and now had a form which the resident had signed while in the hospital. Employee #37 also reported, Employee #51 had spoken with Resident #193 and completed a POST form. The resident indicated to Employee #51 she wanted CPR should it be needed. The POST form was completed to reflect the resident's wishes regarding end of life care. Later in the afternoon of [DATE], Employee #37 provided a copy of a Do not Resuscitate and Limited Resuscitation orders (DNR) form. This form was completed at the acute care hospital on [DATE]. The form was faxed to the facility at 12:31 p.m. on [DATE]. This form was not signed by Resident #193. It was instead signed by her MPOA. The form was also not signed by a physician which meant it was not a valid physician's orders [REDACTED].>The facility's Advance Directives policy was reviewed at 8:00 a.m. on [DATE]. The policy states, The Social Services Director/Designee assists the resident or legal representative with any questions regarding Advanced Directives at the time of admission by providing them the Advance Directive booklet as applicable. The policy further stated, The Social Services Director/designee periodically provides education related to Advance Directives. At any time the resident who wishes to initiate or change an advance directive, the Social Service Director/designee directs the resident or legal representative to the appropriate resource(s). Upon further review of the Advance Directives policy the following procedure was identified if the resident or legal representative chooses to request a DNR. Documented discussion between the resident or legal representative regarding the request for DNR, which may include signed Request for Do Not Initiate CPR or state specific DNR Consent completed by the resident or legal representative This information was not contained on Resident #193's medical record. The policy also stated, An advanced directive label is placed on the Condition alert tab within the medical record reflecting the resident's choice. This information was not contained on the resident's medical record. b) Resident #217 A review of Resident #217's medical record was completed at 8:30 a.m. on [DATE]. This review revealed the resident had a Physician's Determination of Capacity dated [DATE]. This form indicated Resident #217 demonstrated the capacity to make health care decisions. Further review revealed a POST form which indicated the resident desired to be a DNR. This form indicated this was discussed with the resident's medical power of attorney (MPOA). The form was also signed by the resident's MPOA and not the resident. This form was signed by the MPOA on [DATE] and by the physician [DATE]. The form indicated Employee #51 assisted the MPOA in completing this form. An interview with Employee #51, the social worker, was completed at 9:20 a.m. on [DATE]. Employee #51 stated the resident could not see at all and this was why the resident did not sign the POST form. The social worker reported she did talk to the resident about the POST form, but that the MPOA had signed the form. She reported the resident understood what the POST form was and the resident wanted to be a DNR. The social worker wrote a note, on [DATE], which contained the following information in regards to Resident #217: Resident is alert and orientated, but she has her niece (nieces name) as her MPOA to make all decisions for her. The note further states, . She does not have many hobbies as she can not see and/or hear. Completed post form with MPOA, she is a DNR nurse notified . At 9:36 a.m. on [DATE], Resident #217 was interviewed. Resident #217 confirmed she wanted to be a DNR. She stated she did not want to have CPR. She stated she did not recall anyone ever discussing this with her. The resident confirmed she did not see well, but she stated she could see well enough to sign a paper if someone will show her where to sign. She reported she signed some paperwork when she first came to the facility and they just showed her where to sign and read her the information. An additional medical record review was completed at 10:00 a.m. on [DATE]. This review revealed an Admission Agreement which was signed by Resident #217 on [DATE]. This form was also signed by Employee #60, an admissions employee. There was also a Representative Designation form contained on the medical record which indicated, Resident/Patient completing admission paperwork. No Representative Designated. . | 2016-02-01 |