CMS-Nursing-Home-Full-Deficiencies
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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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 4161 | BISHOP GADSDEN EPISCOPAL HEALTH CARE CENTER | 425411 | 1 BISHOP GADSDEN WAY | CHARLESTON | SC | 29412 | 2019-01-31 | 578 | D | 0 | 1 | S24T11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interview, and review of the facility policy entitled Do Not Resuscitate Orders, the facility failed to obtain a Physician's Order for the Do Not Resuscitate (DNR) status of Resident #24 (1 of 4 sampled residents reviewed for Unnecessary Medications). The findings included: The facility admitted Resident #24 with [DIAGNOSES REDACTED]. Review of the electronic health record on 01/29/19 at approximately 2:24 PM revealed the Advance Directive for Resident #24 stated DNR. No Physicians Order related to DNR status was found in the medical record. In an interview on 01/29/19 at approximately 2:42 PM Licensed Practical Nurse (LPN) #1 and the Administrator confirmed no order could be located in the medical record but that staff would be expected to refer to the Physicians Orders to determine Resident #24's DNR status if needed. LPN #1 provided an order dated on this same date of the survey. Review of the facility policy entitled, Do Not Resuscitate Orders, revealed statement 3.3, If the resident decides to have a DNR, the primary physician writes an order that is placed in the resident's health record. The resident information system is updated to reflect the physician's order, and the chart is marked to reflect DNR status. | 2020-09-01 |
| 4162 | BISHOP GADSDEN EPISCOPAL HEALTH CARE CENTER | 425411 | 1 BISHOP GADSDEN WAY | CHARLESTON | SC | 29412 | 2019-01-31 | 607 | D | 1 | 0 | S24T11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on record review, interview, and review of the facility policy titled, Abuse and Neglect Prohibition, the facility failed to implement all criteria necessary during an alleged abuse complaint. The alleged perpetrator for an alleged abuse was allowed to continue to work in the facility during the investigation for Resident #90 (1 of 4 reported incidents reviewed for abuse). The findings included: The facility admitted Resident #90 with [DIAGNOSES REDACTED]. Record review on 1/31/19 at 4:42 PM revealed on 10/16/18 Resident #90 alleged staff members had a bad attitude, s/he was handled roughly, and a staff member intentionally slapped his/her leg. During the investigation, the staff member in question was allowed to continue to work on the unit. S/he was assigned to another group of residents. During an interview with the Director of Nursing on 1/31/19 at approximately 3:30 PM, s/he stated when law enforcement interviewed Resident #90, s/he denied the incident happened. At that time, the investigation was mostly complete and it was felt the allegation was unsubstantiated. S/he continued by stating different caregivers were assigned to Resident #90 and two people were to be in the room while care was rendered. Review of the facility's policy titled, Abuse and Neglect Prohibition, revealed under the Protection section the following: 1.[NAME]Gadsden will protect residents from harm during the investigation. 2.[NAME]Gadsden will make referrals to the appropriate state agencies as necessary, to ensure the protection of the resident or resident's property. | 2020-09-01 |
| 4163 | BISHOP GADSDEN EPISCOPAL HEALTH CARE CENTER | 425411 | 1 BISHOP GADSDEN WAY | CHARLESTON | SC | 29412 | 2019-01-31 | 608 | D | 1 | 0 | S24T11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on record review, interview, and review of the facility policy titled, Abuse and Neglect Prohibition, the facility failed to report an alleged allegation of abuse in a timely manner for Resident #90 (1 of 4 reviewed for abuse). The findings included: The facility admitted Resident #90 with [DIAGNOSES REDACTED]. Record review on 1/31/19 at 4:42 PM revealed on 10/16/18, Resident #90 alleged staff members had a bad attitude, s/he was handled roughly, and a staff member intentionally slapped his/her leg. Review of the 2 hour(hr)/24 hr report submitted to the state, revealed the incident happened on the night shift of 10/15/18. The first report was received per the time and date of the facsimile(fax) report was 10/16/18 at 7:14 PM. During an interview with the Social Services Director on 1/31/19 at 2:00 PM, s/he stated the incident was reported to him/her in the afternoon of 10/16/18, but could not remember the time. After if was reported to him/her, the information was passed on to the Director of Nursing (DON). During an interview with the DON on 1/31/19 at approximately 3:30 PM, s/he stated Resident #90 was waiting on his/her spouse around 4:30 and s/he reported a staff member talked to him/her rough and slapped his/her leg. Security and law enforcement were notified. When law enforcement arrived, Resident #90 was in the dining area and did not want to leave the dining area until s/he had finished his/her wine. When law enforcement interviewed Resident #90, s/he denied anything had ever happened. No other reason was given as to why the incident was not reported within the two hour time frame as required. Review of the facility policy titled, Abuse and Neglect Prohibition, revealed the following under the Reporting & Response section: 1.[NAME]Gadsden will report all allegations and substantiated occurrences of abuse, neglect and misappropriation of resident property to the state agency and law enforcement officials within two hours as designated by state law. | 2020-09-01 |
| 4164 | BISHOP GADSDEN EPISCOPAL HEALTH CARE CENTER | 425411 | 1 BISHOP GADSDEN WAY | CHARLESTON | SC | 29412 | 2019-01-31 | 610 | D | 1 | 0 | S24T11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on record review, interview, and review of the facility policy titled, Abuse and Neglect Prohibition, the facility failed to conduct a thorough investigation for 1 of 4 incidents reviewed (Resident #90). The facility failed to interview all staff working on the shift the alleged incident happened. The findings included: The facility admitted Resident #90 with [DIAGNOSES REDACTED]. Record review on 1/31/19 at 4:42 PM revealed on 10/16/18, Resident #90 alleged staff members had a bad attitude, s/he was handled roughly, and a staff member intentionally slapped his/her leg. Review of the facility work schedule and review of the investigative report revealed all staff working during the time the alleged incident happened were not interviewed. During an interview with the Director of Nursing on 1/31/19 at approximately 3:30 PM, s/he confirmed all staff were not interviewed. Review of the facility policy titled, Abuse and Neglect Prohibition, revealed the following under the Investigation section: 2.[NAME]Gadsden will immediately conduct an investigation of any alleged abuse/neglect or misappropriation of resident property in accordance with state law. | 2020-09-01 |
| 4165 | BISHOP GADSDEN EPISCOPAL HEALTH CARE CENTER | 425411 | 1 BISHOP GADSDEN WAY | CHARLESTON | SC | 29412 | 2019-01-31 | 640 | B | 0 | 1 | S24T11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to transmit required assessments in a timely manner for 2 of 2 residents reviewed for transmission. The Minimum Data Set (MDS) was not transmitted as required for Resident #1 and #2. The findings included: The facility admitted Resident #1 with [DIAGNOSES REDACTED]. Record review on 1/28/19 revealed the last MDS received was dated 8/8/18. The facility admitted Resident #2 with [DIAGNOSES REDACTED]. Record review on 1/28/19 revealed the last MDS received was dated 9/6/18. During an interview on 1/28/19 at approximately 2:00 PM, the MDS Coordinator confirmed the assessments had been completed but not transmitted as required. | 2020-09-01 |
| 4166 | BISHOP GADSDEN EPISCOPAL HEALTH CARE CENTER | 425411 | 1 BISHOP GADSDEN WAY | CHARLESTON | SC | 29412 | 2019-01-31 | 690 | D | 0 | 1 | S24T11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observation, interview, and review of the facility policy titled, Urinary Catheter Care, the facility failed to provide appropriate catheter care for 1 of 1 resident reviewed for catheter care. Resident 13's foreskin was not replaced after providing catheter care. In addition, staff was observed to touch multiple items in the room with soiled gloves. The findings included: The facility admitted Resident #13 with [DIAGNOSES REDACTED]. Record review on 1/29/19 at 2:34 PM of the physician's order revealed an order for [REDACTED]. During observation of catheter care on 1/30/19 at 1:57 PM, Certified Nursing Assistant (CNA) #1 pulled back the foreskin to clean the area. After cleaning, rinsing, and drying the area, the foreskin was not replaced. After cleaning and rinsing the catheter, CNA #1 touched the catheter tubing and leg bag, assisted with the brief, assisted the resident with his/her pants, placed a belt in the belt loops, fastened pants, and lowered the bed. During an interview with CNA #1 on 1/30/19 at approximately 2:30 PM, s/he confirmed items were touched in the room with soiled gloved hands and thought s/he had replaced the foreskin. Review of the facility policy titled, Urinary Catheter Care revealed the following: 12. Steps in the Procedure the following: 16. For a male resident male: .return foreskin to normal position. 20. Discard disposable items into designated containers. Remove gloves and discard in designated container. Wash and dry your hands thoroughly. 21. Reposition the bed covers. Make the resident comfortable | 2020-09-01 |
| 4167 | BISHOP GADSDEN EPISCOPAL HEALTH CARE CENTER | 425411 | 1 BISHOP GADSDEN WAY | CHARLESTON | SC | 29412 | 2019-01-31 | 758 | E | 0 | 1 | S24T11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to provide a determined timeframe for administration of a PRN (as needed) [MEDICAL CONDITION] medication and not attempting nonpharmacological interventions prior to administration of a PRN [MEDICAL CONDITION] for Resident #24 (1 of 4 sampled residents reviewed for unnecessary medications). The findings included: The facility admitted Resident #24 with [DIAGNOSES REDACTED]. Record review on 01/29/19 at approximately 2:24 PM revealed a physician's orders [REDACTED]. Further review of the medical record revealed a pharmacist consultation report dated 10/31/18 stating, per new regulations the order should have a 14-day stop date included and if still indicated, the provider will need to re-evaluate and document continued need every 2 weeks. The doctor's response, dated 11/07/18, stated not to stop yet. Review of the Medication Administration Records (MARs) for Resident #24 revealed the medication was administered on 09/30/18; 10/1, 7, 17,18, 21-23, 25-27, 30-31 (YEAR); 11/2, 5, 9-11, 14-18, 20, 23-26, 28-30 (YEAR); 12/1, 3, 5-7, 9, 11, 13, 16, 17, 19 (YEAR); and 01/6, 15, 18-20, 22, 23, 25-27 2019. No documentation of nonpharmacological interventions attempted prior to administration were found in the medical record. In an interview on 01/31/19 at approximately 1:45 PM, Licensed Practical Nurse #1 confirmed that the PRN order did not have an end date as required and also that nonpharmacological measures should have been attempted prior to administration of the PRN [MEDICAL CONDITION]. | 2020-09-01 |
| 4168 | BISHOP GADSDEN EPISCOPAL HEALTH CARE CENTER | 425411 | 1 BISHOP GADSDEN WAY | CHARLESTON | SC | 29412 | 2019-01-31 | 761 | E | 0 | 1 | S24T11 | Based on observations and interviews, the facility failed to assure that it was free of expired medications in 1 of 1 medication rooms. The findings included: On 1/28/19 at approximately 2:50 PM, inspection of the medication room revealed the following expired medications: [REDACTED]. On 1/28/19 at approximately 2:55 PM Registered Nurse #1 stated that nurses inspect the medication room on a daily basis and on 1/29/19 at approximately 10:13 AM Pharmacy Technician #1 stated that the medication room is inspected during monthly visits. | 2020-09-01 |
| 4169 | BISHOP GADSDEN EPISCOPAL HEALTH CARE CENTER | 425411 | 1 BISHOP GADSDEN WAY | CHARLESTON | SC | 29412 | 2019-01-31 | 880 | D | 0 | 1 | S24T11 | Based on observation, interview, and review of the facility policy titled, Hand Washing/Hand Hygiene, the facility failed to establish and maintain an infection control program designed to provide a safe, sanitary and comfortable environment to help prevent the development and transmission of communicable diseases and infections. During observation of meal delivery, housekeeping carts were observed on the unit. In addition, observation of the laundry revealed staff closed the washer doors with a soiled, gloved hand and no handwashing was observed during the observation of the laundry. During an interview with staff, staff stated personal clothing was not transported covered. The findings included: Observation of the lunch meal on 1/28/19 revealed two housekeeping carts were on the unit during the delivery of lunch trays. During an interview at the time of the observation with Licensed Practical Nurse #1, s/he confirmed the carts were on the unit and the carts should be off the unit during the meal delivery. Observation of the laundry on 1/30/19 at 10:18 AM revealed after loading washers laundry staff closed the washer door with a soiled gloved hand. After removing his/her gloves, no handwashing was observed. During an interview with the Laundry staff on 1/30/19 at 10:00 AM, s/he confirmed handwashing was not done during the observation and s/he did not cover personal laundry when transferred from the laundry to resident rooms. Review of the facility policy titled, Handwashing/Hand Hygiene revealed the following under the Procedure section: 7. Use an alcohol-based hand rub containing at least 62% alcohol; or, alternately, soap (antimicrobial or non-antimicrobial) and water for the following situations: .m. After removing gloves . | 2020-09-01 |
| 4170 | BISHOP GADSDEN EPISCOPAL HEALTH CARE CENTER | 425411 | 1 BISHOP GADSDEN WAY | CHARLESTON | SC | 29412 | 2019-01-31 | 921 | E | 0 | 1 | S24T11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and interview, the facility failed to assure that hazardous substances, labeled by the manufacturers with the cautionary note Do not inhale or ingest, were stored in an area free of cognitively impaired mobile and wandering residents. Ethyl Alcohol 62% (percent) hand sanitizer was found atop 4 of 4 medication carts. The findings included: On 1/28/19 at approximately 3:40 PM inspection of medication carts revealed the following: the Medication Cart outside room [ROOM NUMBER] revealed one opened 30 ounce container (7/8 full) of hand sanitizer (62% ethyl alcohol); the Medication Cart outside room [ROOM NUMBER] revealed one opened 15 ounce container (1/3 full) hand sanitizer (62% ethyl alcohol); the Medication Cart outside room [ROOM NUMBER] revealed one opened 15 ounce container (7/8 full) of hand sanitizer (62% ethyl alcohol); and the Medication Cart outside room [ROOM NUMBER] revealed one opened 15 ounce container (2/3 full) of hand sanitizer (62% ethyl alcohol). On 1/28/19 at approximately 3:57 PM, Licensed Practical Nurse #1 acknowledged these findings. | 2020-09-01 |
| 4171 | BISHOP GADSDEN EPISCOPAL HEALTH CARE CENTER | 425411 | 1 BISHOP GADSDEN WAY | CHARLESTON | SC | 29412 | 2018-02-01 | 758 | D | 0 | 1 | Y9I611 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interview and facility policy, the facility failed to implement nonpharmacological interventions prior to giving a psychoactive medication for 1 of 5 sampled residents reviewed for Unnecessary Medications. Staff administered an as needed (PRN) Antipsychotic Medication to Resident #101 on multiple occasions without attempting other measures before using the drug. The findings included: The facility admitted Resident #101 with [DIAGNOSES REDACTED]. Record review on 02/01/18 at approximately 9:39 AM revealed the Medication Administration Records (MARs) for (MONTH) (YEAR) documented that Resident #101 received PRN [MEDICATION NAME] on (MONTH) 23, 24, 25, 26 and 28, (YEAR) for agitation. The staff did not document any nonpharmacological interventions in the notes section of the MAR. Further review of the Nurses Notes revealed no interventions taken prior to administration on those same dates and there was no documentation of giving the medication on (MONTH) 25th, 26th and 28th. Review of facility policy entitled Documentation for Long Term Care Resident Records revealed, .All pertinent information and/ or exceptions will be documented on a daily basis. In an interview on 02/01/18 at 12:44 PM the Minimum Data Set (MDS) Coordinator stated the nurses had not entered information into the system correctly to activate a prompt which asks what nonpharmacological measures have been attempted prior to administering the [MEDICATION NAME]. In an interview on 02/1/18 at 3:45 PM the Director of Nursing stated more accurate documentation would be expected. The facility documents by exception and giving the medication would be an exception. | 2020-09-01 |
| 4172 | BISHOP GADSDEN EPISCOPAL HEALTH CARE CENTER | 425411 | 1 BISHOP GADSDEN WAY | CHARLESTON | SC | 29412 | 2018-02-01 | 759 | D | 0 | 1 | Y9I611 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, record reviews, interviews and manufacturer package insert the facility failed to ensure a medication error rate of less than 5 % (percent) during medication administration observations. The medication error rate was 14.3% based on 4 of 28 observations. .The findings include: ERROR # 1: On 1/30/17 at approximately 5:14 PM, RN (Registered Nurse) # 2 administered one tablet of [MEDICATION NAME]-D 600/400 to Resident 157. On 1/30/17 at approximately 5:20 PM, RN # 1 stated that the evening meal had not yet been served, but should be served around 5:45 PM. During medication pass reconciliation on 1/30/17 at approximately 6:03 PM, a review of the January, (YEAR) physician orders [REDACTED]. ERROR #s 2, 3 & 4: On 1/31/18 at approximately 8:49 AM, RN # 1 administered one puff of [MEDICATION NAME] HFA (hydrofluoroalkane) 45/21 (45 mcg (microgram)/21 mcg)) to Resident 157 (error 2) and had the resident swallow water instead of swishing mouth with water and then spitting out (error 3). RN # 1 also administered on 2 sprays of [MEDICATION NAME] Nasal Spray to Resident 157 (error 4). During medication pass reconciliation on 1/31/18 at approximately 8:55 AM, a review of the January, (YEAR) physicians orders revealed that Resident 157 should have received 2 puffs of [MEDICATION NAME] HFA 4 mcg - 21 mcg. A review of the the manufacturer package insert states: After inhalation, the patient should rinse his/her mouth with water without swallowing to help reduce the risk of oropharyngeal candidiasis. | 2020-09-01 |
| 4173 | BISHOP GADSDEN EPISCOPAL HEALTH CARE CENTER | 425411 | 1 BISHOP GADSDEN WAY | CHARLESTON | SC | 29412 | 2018-02-01 | 880 | D | 0 | 1 | Y9I611 | Based on observations, interview and Facility Policy and Procedures, the Facility failed to follow standards of practice related to handling of oral medications with bare hands. This occurred during 1 of 28 medication pass observations. The findings include: On 1/30/18 at approximately 1:01 PM, RN (Registered Nurse) # 1 released one capsule of Tamsulosin 0.4 mg ER (extended release) from a punch card into his/her bare hand, then placed the capsule in a medicine cup and administered to Resident 202. On 1/30/18 at approximately 1:09 PM, the nurse acknowledged that he/she had handled the capsule with bare hands and was advised by the Surveyor that this is contrary to nursing standards of practice. Subsequent to the observation on 1/30/18 at approximately 2:07 PM, a review of the[NAME]Gadsden Retirement Community Policy & Procedures revealed under 3. Dose preparation: Staff should not touch the medication when opening a bottle or unit dose package. A review of the Infection Control Manual/ Medication Pass Worksheet revealed under Medication Administration: Does not hold pills with bare hands. | 2020-09-01 |
| 2185 | ROLLING GREEN VILLAGE | 425160 | 1 HOKE SMITH BOULEVARD | GREENVILLE | SC | 29615 | 2017-02-09 | 157 | D | 0 | 1 | NK0T11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, staff interview, and policy review, the facility failed to ensure the Physician and Dietician were notified of Resident (R) 53's significant weight loss and that the Physician was notified of the increase in the size of R91's pressure ulcer. The facility census was 67 and 29 residents were included in the stage 2 survey sample. Findings include: A review of R53's electronic health record (EHR) revealed an admission date of [DATE]. A review of the Activities of Daily Living (ADL) section of the quarterly Minimum Data Set (MDS: a federally mandated comprehensive assessment tool used for care planning) revealed R53 was dependent on staff to eat and had had a significant weight loss of either 5% in the last month or 10% in the last 6 months. A review of R 53's weights recorded in the EHR revealed monthly weights on 11/24/16 of 94 pounds and 12/28/16 of 89 pounds, a >5% weight loss. R53's weight on 1/2/17 was 90 pounds and on 2/2/17 was 91 pounds. A review of the Clinical Notes - Dietary Notes in R53's EHR back to 11/8/16 did not reveal notes authored by the Registered Dietician (RD). The last Nutrition Risk Evaluation in the EHR was on 10/2/16 authored by the Certified Dietary Manager (CDM). revealed the last Registered Dietician note in the EHR was dated 10/28/14. A review of the Clinical Note - Nursing Note dated 1/3/17 in R53's EHR, written by a Licensed Practical Nurse (LPN) 1 at 7:35 a.m., noted .Residents' weight was 99lb on 1/2/17 and 98lb on 12/28/16 She is on a Regular diet, mechanical soft meats with thin liquids. On 1/5/17 at 12:20 p.m., LPN2 charted Staff noticed resident's physical condition is declining and barely weight bearing. Notified NP (Nurse Practitioner) and PT (physical therapy) eval (evaluation) and treatment order given. A note by LPN1 on 1/10/17 at 2:45 a.m. stated .Residents' weight was 99lb on 1/2/17, and 98lb on 12/28/16 She is on Regular diet, Mechanical soft meats with thin liquids. In an interview on 2/9/17 at 8:30 a.m. the CDM stated R53 had not been reviewed since the 1/1/17 MDS assessment and provided the last Registered Dietician Clinical Note - Dietary Note was dated 10/28/14. In an interview on 2/9/17 at 3:55 p.m. the Director of Nursing stated there was no documentation that the physician had been notified of R53's weight loss. When asked about the last RD note date, the DON rhetorically questioned if residents shouldn't be reviewed more often than that. A review of the facility provided policy Nutrition (Impaired)/Unplanned Weight Loss - Clinical Protocol, revised (MONTH) 2012, stated: Assessment and Recognition: 1. The nursing staff will monitor and document the weight and dietary intake of residents in a format which permits readily available comparisons over time. 3. The threshold for significant unplanned and undesired weight loss will be based on the following criteria a. 1 month - 5% weight loss is significant; great than 5% is severe . 4. The Physician will consider whether any assessment including additional diagnostic testing is indicated to help clarify the severity or consequences of weight loss and/or impaired nutrition . The facility provided policy Weight Assessment and Intervention, revised (MONTH) 2008, stated . 3. Any weight change of 5% or more since the last weight assessment will be retaken the next day for confirmation. If the weight is verified, nursing will immediately notify the Dietician in writing. Verbal notification must be confirmed in writing. 4. The Dietician will respond within 24 hours of receipt of written notification. | 2020-09-01 |
| 2186 | ROLLING GREEN VILLAGE | 425160 | 1 HOKE SMITH BOULEVARD | GREENVILLE | SC | 29615 | 2017-02-09 | 282 | D | 0 | 1 | NK0T11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, staff and family interview, the facility failed to ensure the bathing care plan for Resident (R) 91 was followed. The facility census was 67 and 29 residents were included in the stage two survey sample. Findings included: A review of R91's electronic health record (EHR) revealed an admission date of [DATE] with medical [DIAGNOSES REDACTED]. A review of R91's medications revealed a physician's orders [REDACTED]. In an interview on 2/8/17 at 12:25 p.m. Registered Nurse (RN)3 stated R91 has anxiety and agitation with showers as she does not like to be touched. Observation of R91 on 2/6/17 at 2:19 p.m. and 3:56 p.m. revealed she was asleep in bed. Observation of R91 on 2/8/17 at 11:10 a.m. showed the resident asleep in a geriatric chair near the nurses' station. A review of R91's care plan revealed a problem of (R91) has a self-care deficit: bed mobility, dressing, feeding, toileting, transfers, locomotion on/off unit. The care plan goal was (R91) will remain clean, dry, odor free, and maintain a neat appearance daily during the next 90-day review period. The interventions to attain this goal included (R91) prefers no showers or baths and will wash at sink or have bed bath as needed. The intervention was listed as Status: Active (Current). In an interview on 2/9/17 at 3:45 p.m. R91's daughter commented that everyone stays away on the days R91 receives showers because she is so sleepy - that family only visits on non-shower days. In an interview on 2/9/17 at 6:30 p.m. the Director of Nursing stated an expectation that care planned preferences for bathing would be followed. | 2020-09-01 |
| 2187 | ROLLING GREEN VILLAGE | 425160 | 1 HOKE SMITH BOULEVARD | GREENVILLE | SC | 29615 | 2018-04-05 | 578 | D | 0 | 1 | CB2C11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview the facility failed to provide a second/consultant physician's signature for the advance directive of a resident deemed unable to exercise his/her rights and make own health care decisions for 1 of 15 sampled residents reviewed for an advance directive. The findings included: Resident #43 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. According to the comprehensive care plan, reviewed on 04/04/18 at approximately 9:00 AM, Resident #43 had multiple comorbidities and health problems, impaired communication, and established advance directives/do not resuscitate (DNR) order in place. Review of the advance directive on 04/04/18 at 09:45 AM revealed that the attending physician certified that s/he has medically examined Resident #43 and that in his/her opinion the resident is unable to exercise his/her rights and make health care decisions as a result of dementia. However, there is not a second/consultant physician's signature to concur or disagree with the attending physician recommendations. During an interview with the Director of Nursing (DON) stated that s/he was unable to produce farther information regarding resident DNR and s/h confirmed the above findings. | 2020-09-01 |
| 2188 | ROLLING GREEN VILLAGE | 425160 | 1 HOKE SMITH BOULEVARD | GREENVILLE | SC | 29615 | 2018-04-05 | 655 | E | 0 | 1 | CB2C11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews, record reviews and review of the facility's Baseline Care Plan policy, the facility failed to ensure that newly admitted residents and/or their responsible parties were involved in participating/development of the forty-eight (48) hour baseline care plan for 4 of 4 sampled newly admitted residents. Residents #98, #99, #100 and #106 with baseline care plans developed with no documentation to ensure the residents and/or their responsible parties were involved in the development of the baseline care plan. The findings included: The facility admitted Resident #98 on 3/14/18 with [DIAGNOSES REDACTED]. A resident interview on 4/03/18 at approximately 9:30 AM, the resident stated he/she did not remember meeting anyone within forty-eight (48) hours to develop a care plan to address his/her care plan while he/she was in the facility. A review of the paper medical record on 4/04/18 at approximately 11:02 AM revealed there was no documentation to indicate the resident and/or the responsible party was involved in the development of the baseline care plan. A review of electronic medical record on 4/04/18 at approximately 3:12 PM revealed there was no documentation to indicate the resident and/or the responsible party was involved in the development of the baseline care plan. An interview on 4/02/18 at approximately 4:02 PM with Licensed Practical Nurse (LPN)#1, revealed there was a 48 hour bedside meeting with resident and/or responsible party to discuss baseline care plan. LPN #1 stated there was no documentation to confirm the baseline care plan was addressed with the resident and/or the responsible party. The facility admitted Resident #100 on 3/20/18 with [DIAGNOSES REDACTED]. A resident interview on 4/03/18 at approximately 2:17 PM revealed the resident and/or the responsible party were not involved in the development of the baseline (48) hour care plan. The resident stated he/she did not recall having a baseline care plan meeting. A family member who was present stated he/she also did not recall being involved in the development of the baseline care plan. An interview on 4/04/18 at approximately 11:28 AM with Licensed Practical Nurse #1 revealed baseline care was done with the Minimum Data Set nurse with plans to return home. A review of the paper and electronic charting revealed there was no documentation to indicate the resident and/or responsible party was involved in the development of the baseline care plan. An interview on 4/02/18 at approximately 4:02 PM with Licensed Practical Nurse (LPN)#1, revealed there was a 48 hour bedside meeting with resident and/or responsible party to discuss baseline care plan. LPN #1 stated there was no documentation to confirm the baseline care plan was addressed with the resident and/or the responsible party. The facility admitted Resident #99 on 3/27/18 with [DIAGNOSES REDACTED]. A review of the medical record on 4/04/18 at approximately 11:16 AM revealed there was no documentation to indicate the resident and/or the responsible party was involved in the development of the base line care plan. An interview on 4/02/18 at approximately 4:02 PM with Licensed Practical Nurse (LPN)#1, revealed there was a 48 hour bedside meeting with resident and/or responsible party to discuss baseline care plan. LPN #1 stated there was no documentation to confirm the baseline care plan was addressed with the resident and/or the responsible party. The facility admitted Resident #106 on 3/17/18 with [DIAGNOSES REDACTED]. A review of the medical record revealed there was no documentation to indicate the resident and/or the responsible party was involved in the development of the forty eight (48) hour baseline care plan. An interview on 4/04//18 at approximately 11:29 with Licensed Practical Nurse (LPN) #1 reviewed the baseline care was developed but he/she had no knowledge if the resident and/or responsible party was involved in the development of the care plan. An interview on 4/02/18 at approximately 4:02 PM with Licensed Practical Nurse (LPN)#1, revealed there was a 48 hour bedside meeting with resident and/or responsible party to discuss baseline care plan. LPN #1 stated there was no documentation to confirm the baseline care plan was addressed with the resident and/or the responsible party. A review of the facility's baseline care with a revised date of (MONTH) (YEAR) revealed under #4 The resident and their representative will be provided a summary of the baseline care plan that includes but is not limited to: a. The initial goals of the resident; b. A summary of the resident's medications and dietary instructions; c. Any services and treatments to be administered by the facility and personnel acting in behalf of the facility; and d. Any updated information based on the details of the comprehensive care plan, as necessary. | 2020-09-01 |
| 2189 | ROLLING GREEN VILLAGE | 425160 | 1 HOKE SMITH BOULEVARD | GREENVILLE | SC | 29615 | 2018-04-05 | 656 | D | 0 | 1 | CB2C11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and staff interview the facility failed to implement care plan interventions regarding diet accommodations. The findings included: Resident #36 was admitted to the facility with [DIAGNOSES REDACTED]. stent placement During phase one of the survey process 0n 04/04/18 at approximately 3:15 PM, while interviewing resident #36 in his/her room in the presence of his/her daughter, the Licensed Practical Nurse (LPN) #2 came into the resident's room to administer medications. After providing medications s/he gave the resident a cup of water with a straw, the resident precedes to take medication and a few sips of water with the straw. At this point, the daughter gets up, takes the straw from the resident and tells the nurse that s/he has a physician's orders [REDACTED].#2 seems to be confused and apologetic. During an interview with daughter, right after the incident, she states that LPN #2 is not the usual nurse that takes care resident #36. She also points out that the phrase no straw is written on small white boar on the right side of the entrance of the resident's room. The daughter acknowledges that resident did well using the straw and expressed that she did not want to get the LPN in trouble. physician's orders [REDACTED]. Provide beverages in a coffee mug or small plastic tumbler. On 04/05/18 at approximately 8:30 AM review of the clinical note revealed that Resident #36 was admitted to rehab on 10/23/17 with a diet of mechanical soft and no straw. Care plan review on 04/05/18 at approximately 8:45 AM revealed that Resident #36 is at risk for altered nutrition related to variable intake of meals. According to the care plan, the goal is to maintain nutritional status without significant weight loss or gain-goal date 4/30/18. The care plan intervention includes providing diet as ordered, regular bite-sized meats and no straw. On 04/05/18 at 08:58 AM during an interview with the Director of Nursing (DON) s/he stated that LPN #2 works on an as-needed basis and that s/he should have known not to give the resident #36 a straw that s/he was probably nervous. | 2020-09-01 |
| 2190 | ROLLING GREEN VILLAGE | 425160 | 1 HOKE SMITH BOULEVARD | GREENVILLE | SC | 29615 | 2018-04-05 | 657 | D | 0 | 1 | CB2C11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to include the participation of residents, to the extent possible, in the development of the care plan for 1 of 8 residents reviewed for comprehensive care plans. Resident #45 was not invited to attend the last three care plan meetings reviewed. The findings included: Resident #45 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Interview with Resident #45 on 4/3/18 at approximately 9:11 AM revealed he/she did not recall attending care plan meetings nor receiving an invitation to do so. Review of care plan conference attendance sheet on 4/4/18 at approximately 2:09 PM revealed that family was invited to attend care plan meetings and had attended 2 of the previous 3 care plan meetings. The attendance sheet did not state if the resident was invited to the meeting. Interview with Registered Nurse (RN) #1 on 4/4/18 at approximately 2:46 PM revealed the resident was invited to care plan meetings and declined, but s/he stated this was not documented anywhere. RN #1 stated the resident was not his/her own Power of Attorney. Review of resident's chart on 4/5/18 at approximately 9:17 AM revealed signed his/her own Notice of Medicare Non-Coverage, requested a Do Not Resuscitate, and signed the DNR. Review of policy on 4/5/18 at approximately 9:27 AM revealed it was facility policy that Each resident's comprehensive person-centered care plan will be consistent with the resident's rights to participate in the development and implementation of his or her plan of care. | 2020-09-01 |
| 2191 | ROLLING GREEN VILLAGE | 425160 | 1 HOKE SMITH BOULEVARD | GREENVILLE | SC | 29615 | 2018-04-05 | 684 | D | 0 | 1 | CB2C11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and staff interview the facility failed to execute physician's order regarding the use of straw and beverageware for one of two sampled residents reviewed for nutrition. The findings included: Resident #36 was admitted to the facility with [DIAGNOSES REDACTED]. stent placement During phase one of the survey process 0n 04/04/18 at approximately 3:15 PM, while interviewing resident #36 in his/her room in the present of his/her daughter, the Licensed Practical Nurse (LPN) #2 came into the resident's room to administer medications. After providing medications s/he gave the resident a cup of water with a straw, the resident precedes to take medication and a few sips of water with the straw. At this point, the daughter gets up, takes the straw from the resident and tells the nurse that s/he has a physician's order of no straw. The LPN #2 seems to be confused and apologetic. During an interview with daughter, right after the incident, she states that LPN #2 is not the usual nurse that takes care resident #36. She also points out that the phrase no straw is written on small white boar on the right side of the entrance of the resident's room. The daughter acknowledges that resident did well using the straw and expressed that she did not want to get the LPN in trouble. Physician's order review 04/04/18 at 04:53 PM revealed that on 10/26/18 the physician clarified order to include regular diet, bite-size meats, No straw. Provide beverages in a coffee mug or small plastic tumbler. On 04/05/18 at approximately 8:30 AM review of the clinical note revealed that Resident #36 was admitted to rehab on 10/23/17 with a diet of mechanical soft and no straw. Care plan review on 04/05/18 at approximately 8:45 AM revealed that Resident #36 is at risk for altered nutrition related to variable intake of meals. According to the care plan, the goal is to maintain nutritional status without significant weight loss or gain-goal date 4/30/18. The care plan intervention includes providing diet as ordered, regular bite-sized meats and no straw. On 04/05/18 at 08:58 AM during an interview with the Director of Nursing (DON) s/he stated that LPN #2 works on an as-needed basis and that s/he should have known not to give the resident #36 a straw that s/he was probably nervous. | 2020-09-01 |
| 2192 | ROLLING GREEN VILLAGE | 425160 | 1 HOKE SMITH BOULEVARD | GREENVILLE | SC | 29615 | 2018-04-05 | 745 | D | 0 | 1 | CB2C11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interviews, the facility failed to document whether medically related social services were provided at least quarterly for 1 of 5 sampled residents reviewed for unnecessary medications which included [MEDICAL CONDITION] medications. Resident #18's medical record indicated the last noted social services note was dated 8/24/17. The findings included: The facility admitted Resident #18 on 11/15/16 with [DIAGNOSES REDACTED]. A review of the medical record on 4/04/18 at approximately 9:42 AM revealed a social services note dated 8/24/17 that indicated social services attempted to contact Resident #18's family member for care plan meeting but unable to reach the family a number provided on the face sheet. The social services note further indicated social service will speak with resident, sitter and nursing staff to see if they have a better number. There was no additional information in the paper or electronic medical record of any additional social services notes. A physician's progress report dated 12/27/17 indicated the resident was seen monthly by psychiatric services due to depression with [MEDICAL CONDITION] disorder. The physician's progress report further indicated under family history that family history was unobtainable from any source and the resident was unable to provide the information. The report indicated family was not available and prior charts did not include family history and nursing staff was unable to provide information. An interview on 4/04/18 at approximately 4:17 PM with the Director of Nursing (DON) and Social Services Director (SSD) confirmed the findings that the only documented social services note was dated 8/24/17. The SSD further reviewed the electronic medical record and stated there was no other documented notes in the computer but he/she may have a handwritten note. The SSD on 4/04/18 at approximately 4:45 PM provided a note on a white untitled sheet of paper that indicated 2/10, in room ,glasses/walker Advance Dir?, no hospital ,no children/POA and Sitter Services daily. . | 2020-09-01 |
| 2193 | ROLLING GREEN VILLAGE | 425160 | 1 HOKE SMITH BOULEVARD | GREENVILLE | SC | 29615 | 2019-04-18 | 609 | D | 1 | 0 | N1YN11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on record review and interview, the facility failed to report abuse allegations within 2 hours for 2 of 3 residents reviewed for abuse. Residents #14 and #55 made allegations regarding misappropriation of property and physical abuse respectively, and the facility did not report them to the state agency within 2 hours of becoming aware of the allegations. The findings included: Resident #14 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Review of Initial report on 4/16/19 at approximately 9:10 AM revealed the following: 1. Possible theft occurred on 9/24/18. 2. Resident #14 notified staff and Social Services of possible theft on 9/25/18. 3. Facility sent initial report on 9/27/18. During an interview with the Administrator on 4/18/19 at approximately 10:55 AM s/he confirmed the delayed reporting of possible misappropriation of property. The Administrator stated the room was searched by staff and family to rule out misplacement before being reported as theft, leading to the delayed reporting to the state agency. The facility admitted Resident #55 on 2/22/19 with [DIAGNOSES REDACTED]. Record review of the facility's Initial Report and Five-Day Follow-Up Report on 4/15/19 at 11:16 AM, revealed the facility reported a suspicion of abuse, involving Resident #55, on 3/12/19 at 12:40 PM. The initial Report and Five-Day Follow-Up Report indicated the alleged incident occurred on 3/11/19 at 4:30 PM. The Five-Day Follow-Up Report was not received from the facility until 3/22/19. During an interview with the Director of Nursing (DON) on 4/18/19 at 11:50 AM, the DON confirmed s/he witnessed the alleged violation on 3/11/19 at approximately 4:30 PM. The DON stated s/he was giving Resident #55 medication at the time. The resident's son was present and grabbed the resident's hand and was verbally inappropriate towards the resident. During an interview with the DON and the Administrator on 4/18/19 at 1:15 PM, the DON and Administrator confirmed the alleged violation was not reported within 2 hours, as required. In addition, the Five-Day Follow-Up Report was not received until 11 days after the incident. Review of the facility's Abuse Policy and Procedure revealed the policy did not reflect current regulations related to reporting allegations involving Abuse. Per the policy, alleged violations involving abuse are reported within 2 hours of the violation if there is serious bodily injury or within 24 hours of the violation if there is not serious bodily injury. The results of all investigations must be reported to the Administrator, the Executive Director, and his/her designed representative and to other officials in accordance with the state law (including to the state survey and certification agency) within 5 working days of the incident | 2020-09-01 |
| 2194 | ROLLING GREEN VILLAGE | 425160 | 1 HOKE SMITH BOULEVARD | GREENVILLE | SC | 29615 | 2019-04-18 | 657 | D | 1 | 1 | N1YN11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on record review and interview, the facility failed to revise the Care Plans for Resident's #29 and #55, 1 of 2 sampled residents reviewed for Falls and 1 of 3 sampled residents reviewed for Abuse. Resident #29's Care Plan was not revised after a fracture. Resident #55's care plan was not revised related to visitation restrictions for a family member. The findings included: The facility admitted Resident #55 with [DIAGNOSES REDACTED]. Record review of the facility's Five-Day Follow-Up Report on 4/15/19 at 11:16 AM, revealed an incident involving Resident #55 and a family member on 3/11/19. According to the report, during medication administration, the nurse observed the family member get angry at the resident, grab her/his hand and pull at her/his fingers. The report also revealed the family member was verbally inappropriate towards the resident. Interventions implemented after the incident included visitation with restrictions for the family member. Record review of Resident #55's Care Plan on 4/18/19 at 11:08 AM, revealed no interventions related to the 3/11/19 incident. During an interview with the Director of Nursing (DON) on 4/18/19 at 11:50 AM, the DON confirmed the events on 3/11/19 and stated the facility implemented a visitation plan for the family member after the incident. The DON explained the interventions included in the plan were limiting visitation hours from 5:00-8:00 PM during meal service and until s/he goes to bed. When visiting the resident's room, the family member was to remain visible with the door open or may visit in common areas. In addition, the family member was to step out of the room during care. When asked if these interventions had been added to the care plan, the DON stated they were not. The DON stated the plan was emailed to all of the nurses. The DON provided a copy of the email with the above interventions. The facility admitted Resident #29 on 10/5/17 with [DIAGNOSES REDACTED]. Record review of Resident #29's nursing notes on 04-16-19 at approximately 2:00PM revealed nurses note dated 02-05-19 stated, Resident observed at 3AM kneeling on floor mat in praying position with knees on floor mat; resident stated (s/he) was trying to go to church, resident with no injuries at this time, denies hitting head and denies any pain at this time, resident assisted back to bed; PERRLA (pupils equal round reactive to light); floor mat remains in place, encouraged resident to please use call light and not to get up alone; call light noted in reach by this nurse; MD notified and resident's son, notified at 0700; oncoming nurse notified of fall. Review of Resident #29's Minimum Data Set ((MDS) dated [DATE] revealed a Brief Interview for Mental Status (BIMS) of 3. Review of Resident #29's Nurses note dated 02-12-19 stated the resident had an X-Ray on her/his right knee and it came back positive for fracture to her/his Tibia. Nursing note dated 02-13-19 stated, returned from the hospital at 03:45 [DIAGNOSES REDACTED]. Record review of Resident #29's physician orders [REDACTED]. Record review of Resident #29's care plan effective 10-20-2017 to present on 04-16-19 at approximately 1:28PM revealed under Problems, has history of falling and is at risk for injury related fall with a goal of will have no injury related to falls through the next 90 days. Further review revealed the Care Plan had not been updated to reflect the fall, fracture, non-weight bearing or immobilizer. During an interview on 04-17-19 at 3:13 PM the Minimum Data Set (MDS) Coordinator RN #1 confirmed that Resident #29's Care Plan had not been updated to reflect the fall, fracture and non-weight bearing or immobilizer. | 2020-09-01 |
| 2195 | ROLLING GREEN VILLAGE | 425160 | 1 HOKE SMITH BOULEVARD | GREENVILLE | SC | 29615 | 2019-04-18 | 842 | D | 0 | 1 | N1YN11 | Based on observation, interview and review of the facility policy titled HIPAA Workforce Confidentiality Acknowledgment the facility failed to protect resident identifiable information on 1 of 2 units. Licensed Practical Nurse (LPN) #2 left resident records accessible to unauthorized persons. The findings included: Observation of nursing medicine cart on 4/17/19 at 11:16 AM revealed the electronic medical records on the laptop were accessible to unauthorized persons. The laptop was awake and ajar with the electronic medical records onscreen. Interview with LPN #1 on 4/17/19 at 11:19 AM confirmed the medical record laptop was ajar and awake. LPN #1 stated LPN #2, who was on break, was assigned to the cart. LPN #1 confirmed the laptop should not have been left on the medical record screen. Review of the facility policy titled HIPAA Workforce Confidentiality Acknowledgment revealed workforce is responsible for protecting the use and disclosure of all protected health information that is created, obtained, handled, learned, heard or viewed in the course of his or her work . Review of the facility employee confidentiality acknowledgement revealed Protected health information (PHI) means individually identifiable health information that is transmitted or maintained in any form. Protected health information is not available to the public. Special precautions are necessary to protect this type of information from unauthorized access, use, modification, disclosure, or destruction. | 2020-09-01 |
| 2196 | ROLLING GREEN VILLAGE | 425160 | 1 HOKE SMITH BOULEVARD | GREENVILLE | SC | 29615 | 2019-11-14 | 610 | D | 1 | 0 | NVCX11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on interview, record review, and facility policy review, the facility failed to conduct a thorough investigation for one (1) resident who made an allegation of sexual abuse (Resident #1). The findings included: Review of the facility's undated Abuse Policy: documented the following: Protection Abuse Policy .The progress notes, concerning all residents involved, should include: 6. What was done to prevent further harm to resident or others. Documentation will continue over 72 hours. An acute care plan will be developed that identifies methods for prevention of further occurrence .In House Investigation .Steps taken to protect the alleged victim from further abuse, particularly when an alleged perpetrator has not been identified. Actions taken as a result of the investigation, to include corrective action taken .Abuse Prevention Program, Community Procedures VI. 4. Investigation procedures: The appointed investigator will, at a minimum, attempt to interview the person who reported the incident, anyone likely to have direct knowledge of the incident and the resident, if interviewable. Any written statements that have been submitted will be reviewed, along with any pertinent medical records or other documents .7. Final Abuse Investigation Report .The final investigation report shall contain the following .Facts determined during the process of the investigation, review of medical record and interview of witnesses . Conclusion of the investigation based on known facts .Attach a summary of all interviews conducted .VIII. External Reporting of Potential Abuse. 1 .Steps the community has taken to protect the resident. Resident #1 admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Review of the Admission Minimum Data Set ((MDS) dated [DATE] recorded the resident's Brief Interview for Mental Status (BIMS) score was 13, indicating moderate cognitive impairment. The MDS recorded the resident had minimal hearing difficulty, clear speech, made herself understood, and understood others with clear comprehension. The MDS recorded the resident had no signs or symptoms of [MEDICAL CONDITIONS], hallucinations or delusions, and had rejected care one (1) to three (3) days during the assessment period of seven (7) days. The MDS further recorded the resident required extensive assistance of one (1) staff for toileting and personal hygiene, and the resident had occasional urinary incontinence. The resident was documented as receiving antidepressants seven (7) days during the assessment period. Review of Resident #1's care plan dated 6/26/19 for occasional urinary incontinence directed staff: Check for incontinence; change if wet/soiled. Clean skin with mild soap and water, apply moisture barrier, keep path to bathroom clear and well lit, select clothing that is easily removed for toileting, answer call bed quickly, remind to empty bladder before meals, at bedtime, and before activities. Review of the Clinical Notes from 6/30/19 through 8/1/19 written by Nursing and Social Services (SS) recorded several instances of behaviors by the resident including confusion, disorientation, refusals of care, accusations toward staff, and hallucinations. Dates for the behavior notes in the record were 6/30/19, 7/1/19, 7/6/19, 7/8/19, 7/9/19 (two notes), 7/16/19, and 7/24/19. Staff did not document any additional behaviors in the medical record. On 7/24/19, the Social Worker (SW) documented, SW place (sic) in psychiatrist book to be seen for increase (sic) hallucinations. Review of the Psychiatrist and Psychiatric Nurse Practitioner (NP) notes from 7/10/19 through 8/20/19 recorded the resident was frustrated, irritable, disoriented at times, had cognitive impairment, and expressed having hallucinations. The Psychiatric notes were dated 7/10/19, 7/16/19, 7/23/19, 7/31/19, 8/7/19, and 8/20/19. Review of the initial abuse allegation report dated 8/1/19 revealed the resident's family member reported to the Executive Director that the resident told her on a couple of occasions a staff member came to her room at night and put their finger in her vagina. The facility documented, Investigation initiate (sic). No staff member identified at this time, however the Charge Nurse for 2nd shift and 3rd shift aware and will monitor staff and resident interactions during the investigation and will notify ED/DON (Executive Director/Director of Nursing) of any questionable interactions. Review of the final abuse investigation report dated 8/6/19 recorded, no witnesses, no description of perpetrator, no date given, happened during the night, and list of 3rd shift employees. Interventions by facility to prevent future Injury/Alleged Abuse: Res (resident) to be 'checked' for incont (incontinence) last on 2nd shift, only visual checks when asleep and 1st check on 1st shift. Limit waking up the res (resident) to provide care as long as res (resident) remain (sic) safe and clean. The abuse investigation did not contain any witness statements or written statements by staff, and the facility did not interview any other residents to determine the potential scope of the alleged sexual abuse. The abuse investigation did not consider an increase in the resident's negative behaviors and hallucinations as a potential expression of actual sexual abuse. During interview on 11/14/19 at 10:20 AM, the DON presented a narrative she wrote on 11/14/19 of what transpired on the night shift, the day the allegation was made, 8/1/19. This narrative was not part of the actual sexual abuse investigation. The DON stated Licensed Practical Nurse (LPN) #A was the night time supervisor and the DON asked her to interview the three (3) Certified Nursing Assistants (CNAs) who worked the night shift on 8/1/19. The DON stated that the LPN reported the CNAs were, Turning on the lights, pulling back the covers, doing visual checks of the resident's brief, and it was apparent how the resident could have felt concerned about it; they were waking her up to check her, and she is a very sound sleeper. The DON continued, We did not do any other resident interviews on the unit. We thought it was an isolated event. We did not hear anything from other residents about night time staffing or care concerns, but no we didn't directly ask them (the residents). We did not get individual statements from staff. Statements weren't put on paper, but they occurred on the 3rd shift, with the 3 CNAs, the communication was done, and put in a summary, not individually. The residents on that unit, care issues/concerns are discussed at each care plan meeting. The Social Worker (SW) asks how the care is and how the staff is treating them. We ask the families and the resident. During interview on 11/14/19 at 2:38 PM, LPN #A stated she received an email from the DON who asked LPN #A to do a body audit on the resident and talk to the CNAs on 3rd shift. Then she reported back to the DON. LPN #A stated she asked the CNAs how they toilet and check the resident's brief. LPN #A further stated she did not get any written statements from the three (3) CNAs, she met with them and they talked about care, and she did not interview any other residents. LPN #A determined the resident was a heavy sleeper and misunderstood the staff was providing incontinent care, not sexually abusing her. After discussing it with the DON, they decided to change the way the staff checked and changed the resident, to the last check on the evening shift and the first check on the day shift. LPN #A also stated, The whole investigation process was done in one (1) day. I really did think it was a behavior (the sexual abuse allegation) from transitioning from home to LTC (Long Term Care). The (family member) stopped coming as much so that the resident could adjust and make friends, and I think (the resident) was trying to sort of manipulate her (family member) to go back home. I didn't discount what she was saying about the abuse. The reason I say that's what her problem was (versus potentially acting out with behaviors as a result of abuse) rather than actual abuse; I could tell she missed being at home. During interview on 11/14/19 at 3:24 PM, the MDS nurse stated for an acute problem, such as abuse issues, The SW is the first go-to. They write up the initial report usually. They primarily do the interviews. They would update the care plan. During interview on 11/14/19 at 4:05 PM, SW #1 stated she was informed about Resident #1's sexual abuse allegation, and staff was going in to check if she was incontinent and they put their finger down her brief. SW #1 stated the discussion was about that the resident would be the last check on 2nd shift about 11:00 - 11:30 PM and 3rd shift would not check her, and then she would be the first person on the 1st shift to be checked. SW #1 stated staff did the investigation by interviewing the resident, but did not interview anyone else, I wrote up the initial concern form and gave it to the DON. At 4:45 PM, the SW stated she did not take any actions to protect the resident during the investigation. During interview on 11/14/19 at 4:28 PM, CNA #1 stated she worked both evening and night shifts and provided care for Resident #1 on the night shift and checked the resident every two (2) hours. CNA #1 stated. I pull the covers back to check her brief and look for the line (line on the brief turns blue when wet). I wake her up, she wakes up when you go in unless she's in a deep sleep, she doesn't sleep deeply. Nobody ever interviewed me about (the resident) for anything about sexual abuse. Nobody told me or trained me about any new care interventions or procedures since then. During a follow-up interview on 11/14/19 at 4:47 PM, the DON stated the facility did not protect the resident during the investigation because, It was a quick investigation. We had the family involvement and the staff knew exactly what could have happened. The DON stated they, Should have checked to see if it was unit wide. The DON stated the abuse policy does state the resident should be protected during the investigation, But we didn't feel that there was anyone who was harming her. The DON stated typically they do take into consideration that an increase in behaviors could be a response to sexual abuse, but in this case they didn't because, We felt we knew what happened. During interview on 11/14/19 at 5:17 PM, the Executive Director (ED) stated staff usually looks at the pieces for what is causing behaviors and talk to the physician. I feel that we did a thorough investigation, and We act on the information we think is truthful, and I think we did a thorough investigation .looking back, we should have had other things documented. It may have been a nurse's rush to judgement, but she's a good judge of what has occurred because she knows the resident. | 2020-09-01 |
| 2197 | ROLLING GREEN VILLAGE | 425160 | 1 HOKE SMITH BOULEVARD | GREENVILLE | SC | 29615 | 2019-11-14 | 657 | D | 1 | 0 | NVCX11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on observation, interview, record review and facility policy review, the facility failed to revise the care plan for one (1) resident who alleged staff sexual abuse (Resident #1). The findings included: Review of the facility policy titled, Care Plans, Comprehensive Person-Centered, revised 12/2016 directed, 11. Care plan interventions are chosen only after careful data gathering, proper sequencing of events, careful consideration of the relationship between the resident's problem areas and their causes, and relevant clinical decision making a. When possible, interventions address the underlying source(s) of the problem area(s), not just addressing only symptoms or triggers. 8. The comprehensive, person-centered care plan will: b. Describe the services that are to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being; g. Incorporate identified problem areas. Resident #1 admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Review of the Admission Minimum Data Set ((MDS) dated [DATE] recorded the resident's Brief Interview for Mental Status (BIMS) score was 13, indicating moderate cognitive impairment. The MDS recorded the resident had minimal hearing difficulty, clear speech, made herself understood, and understood others with clear comprehension. The MDS recorded the resident had no signs or symptoms of [MEDICAL CONDITIONS], hallucinations or delusions, and had rejected care one (1) to three (3) days during the assessment period of seven (7) days. The MDS further recorded the resident required extensive assistance of one (1) staff for toileting and personal hygiene, and the resident had occasional urinary incontinence. The resident was assessed to receive antidepressants during the assessment period. Review of Resident #1's care plan for occasional urinary incontinence, dated 6/26/19, directed staff: Check for incontinence; change if wet/soiled. Clean skin with mild soap and water, apply moisture barrier, keep path to bathroom clear and well lit, select clothing that is easily removed for toileting, answer call bed quickly, remind to empty bladder before meals, at bedtime and before activities. The care plan for toileting, dated 6/29/19 directed interventions including: Select clothing that is easily removed. Change incontinence pad/brief. The care plan lacked any direction to staff when to provide an incontinence brief for the resident, or in which circumstances or shifts to provide a brief. Additional review of the care plan failed to reveal any new interventions to address the resident's allegation of sexual abuse. According to the Director of Nursing (DON) on 11/14/19 at 10:20 AM, Resident #1's family member reported the sexual abuse allegation to the Executive Director during a meeting, and an abuse investigation was initiated. Review of the final abuse investigation report dated 8/6/19 recorded, Interventions by facility to prevent future Injury/Alleged Abuse: Res (resident) to be 'checked' for incont (incontinence) last on 2nd shift, only visual checks when asleep and 1st check on 1st shift. Limit waking up the res (resident) to provide care as long as res (resident) remain (sic) safe and clean. During interview on 11/14/19 at 2:38 PM, Licensed Practical Nurse (LPN) #A stated she spoke to the three (3) night shift Certified Nursing Assistants (CNAs) on the night shift as part of the sexual abuse investigation; then she reported back to the DON. LPN #A stated she asked the CNAs how they toilet and check the resident's brief. LPN #A stated she determined the resident was a heavy sleeper and misunderstood the staff was providing incontinent care, not sexually abusing her. After discussing it with the DON, they decided to change the way the staff checked and changed the resident, to the last check on the evening shift and the first check on the day shift. LPN #A stated, I did not update the care plan. The nurses on the unit don't update the care plans. The RNs (Registered Nurses) and (the DON) update the care plans. During interview on 11/14/19 at 3:24 PM, the MDS Nurse stated for an acute problem, such as abuse issues, The SW (Social Worker) is the first go-to person. They write up the initial report usually. They would update the care plan. The MDS Nurse provided a copy of the Resident Summary which was the CNA's copy of the Nursing care plan. The MDS Nurse verified the Summary did not direct the CNAs when to check and change the resident on the first, second and third shifts. During interview on 11/14/19 at 4:05 PM, SW #1 stated she was informed about Resident #1's sexual abuse allegation, and staff was going in to check if the resident was incontinent, and they put their finger down her brief. SW #1 stated the discussion was about the resident would be the last check on evening shift about 11:00 - 11:30 PM and third shift would not check her. And then the resident would be the first person on the day shift to be checked. SW #1 stated, I did not do the care plan addition, just did what I was directed to do. During interview on 11/14/19 at 4:28 PM, CNA #1 stated she worked both evening and night shifts and had provided incontinent care for Resident #1 on the night shift. CNA #1 stated. I pull the covers back to check her brief and look for the line (line on the brief turns blue when wet). I wake her up, she wakes up when you go in unless she's in a deep sleep, she doesn't sleep too deeply. CNA #1 provided the CNA care plan, titled Cart 1 Report Sheet which documented for Resident #1, Cont. (continent) b/b (bowel and bladder). CNA #1 stated the resident did wear a brief at night, but it wasn't on the Report Sheet. CNA #1 stated, Nobody told me or trained me about any new care interventions or procedures since August. During interview on 11/14/19 at 4:47 PM, the DON agreed there was no care plan to communicate to staff that the resident should be checked last on the evening shift and first on day shift, skipping night shift unless the resident was awake. The DON agreed the Cart 1 Report Sheet and the Resident Summary were for directing CNAs about care and did not include these interventions in Resident #1's directives. The DON stated, It's hard to communicate (to the staff) through our computer system. During interview on 11/14/19 at 5:17 PM, the Executive Director stated, I feel that we did a thorough investigation, but I agree there should have been a care plan addition .Agree there could have been more consistency to the policy, and looking backwards, we should have had other things documented. Cross reference F610. | 2020-09-01 |
| 5025 | ROLLING GREEN VILLAGE | 425160 | 1 HOKE SMITH BOULEVARD | GREENVILLE | SC | 29615 | 2016-04-28 | 157 | D | 0 | 1 | 9D8Q11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to notify the physician or Hospice timely of changes in condition for Residents #3 and #160, 2 of 13 residents reviewed for notification of changes. Resident #3 had episodes of vomiting and refusal of meals, supplements and medications beginning 3/4/16 and Hospice was notified on 3/14/16. Resident #160 had a reaction after medications and the physician was not notified. The findings included: The facility admitted Resident #3 with [DIAGNOSES REDACTED]. At 9:12 on 4/27/2016, review of the Clinical Notes revealed episodes of vomiting, multiple refusals of supplements and medications documented beginning 3/4/16. There was no documentation that the physician was notified. Hospice was aware on 3/1/16 that the resident was refusing some meals but was not notified of continued refusal of meals or refusal of meds until 3/13/16. The documentation from Hospice provided by the facility stated no new concerns were voiced on 3/9/16. The DON reviewed the notes with the surveyor and confirmed that the hospice nurse was communicating with the nurse but it looks like they weren't discussing what was going on with the resident. At 1:07 PM on 04/27/2016, review of the Progress Notes revealed a note dated 4/26/16 by the Hospice Physician that stated the resident had a newly developed sacral wound since March. The note further stated the resident's intake was poor and she had continued weight loss in spite of supplements. There was no indication the physician was aware the resident was refusing and/or vomiting after the supplements. The facility admitted Resident #160 with [DIAGNOSES REDACTED]. At 2:48 PM on 04/28/2016, review of the Clinical Notes revealed a note timed and dated 4/6/16 that the resident had a reaction after receiving his IV (intravenous) and PO (by mouth) medications. The resident was noted to have a red itchy rash. There was no documentation the physician was notified. At 2:59 PM on 04/28/2016, review of the Medication Administration Record [REDACTED]. At 3:08 PM on 04/28/2016, the Director of Nursing confirmed the documentation of a reaction after administration of medications. S/he further confirmed there was no documentation the physician was notified. | 2019-06-01 |
| 5026 | ROLLING GREEN VILLAGE | 425160 | 1 HOKE SMITH BOULEVARD | GREENVILLE | SC | 29615 | 2016-04-28 | 309 | D | 0 | 1 | 9D8Q11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview the facility failed to administer medication as ordered for Resident #164, 1 of 5 residents reviewed for unnecessary medications. Resident #164 received 6 days of a medication that was ordered to be given for 7 days. In addition, the facility failed to communicate changes in status to Hospice and failed to administer treatments as ordered for Resident #3, 1 of 3 residents reviewed for pressure ulcers. The findings included: The facility admitted Resident #164 with [DIAGNOSES REDACTED]. At 10:45 AM on 04/28/2016, review of the Medication Administration Record [REDACTED]. Review of the MAR indicated [REDACTED]. The documentation indicated the medication was not available on 4/8/16. On 04/28/2016 at 3:07 PM, the Director of Nursing confirmed the resident only received 6 days of the [MEDICATION NAME] nebulizer treatment, not 7 as ordered. The facility admitted Resident #3 with [DIAGNOSES REDACTED]. At 8:46 AM on 04/27/2016, review of the Physician order [REDACTED]. At 4:15 PM on 4/27/16, review of the Treatment Administration Record revealed one dose of [MEDICATION NAME] was not administered. Further review revealed the treatment was changed 3/20/16 when the [MEDICATION NAME] was supposed to be completed but no treatment was administered on 3/20/16. During an interview at 8:54 AM on 04/28/2016, the Director of Nursing (DON) confirmed one treatment with the [MEDICATION NAME] was not administered. At 9:12 AM on 4/28/16, the DON also confirmed there was no treatment done on 3/20/16. At 8:49 AM on 04/27/2016, review of the Wound Reviews revealed the resident had a Stage III pressure ulcer to the coccyx. The date of onset was noted as (MONTH) 29, (YEAR) as a Stage III measuring 7.0 x 5.5 cm with no depth. At 9:12 AM on 04/27/2016, review of the Clinical Notes revealed Body Audits dated 1/23, 1/25, 1/31, 2/8, 2/13 (pink heels and buttocks, on air mattress, treatment started with [MEDICATION NAME]), and 3/3/16. No documented skin audits were found between 2/13 and 3/3/16. During an interview at 3:48 PM on 04/27/2016, the MDS (Minimal Data Set) Coordinator/ Wound Nurse/ QA (Quality Assurance) confirmed the date of onset of the sacral wound was 2/29/16. S/he also confirmed no body audits were documented after 2/13 until the Pressure ulcer was discovered on 2/29/16 at Stage III. At 9:12 AM on 04/27/2016, review of the Clinical Notes revealed episodes of vomiting, multiple refusals of supplements and medications documented beginning 3/4/16. There was no documentation that the physician or Hospice were notified until 3/13/16. At 9:12 AM on 4/28/16, the DON provided documentation that the hospice nurse visited the resident on 3/9/16, 3/10/16 and 3/13/16. There was no documentation in the hospice notes that the hospice nurse was notified of the episodes of vomiting or refusals of supplements and medications until 3/13/16. The documentation provided stated no new concerns were voiced on 3/9/16. The DON reviewed the notes with the surveyor and confirmed that the hospice nurse was communicating with the nurse but it looks like they weren't discussing what was going on with the resident. | 2019-06-01 |
| 5027 | ROLLING GREEN VILLAGE | 425160 | 1 HOKE SMITH BOULEVARD | GREENVILLE | SC | 29615 | 2016-04-28 | 502 | D | 0 | 1 | 9D8Q11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to obtain weekly hemoglobin and hematocrit laboratory tests as ordered for Resident #3, 1 of 3 residents reviewed for lab results completed. The findings included: The facility admitted Resident #3 with [DIAGNOSES REDACTED]. At 8:46 AM on 4/27/16, review of the (MONTH) (YEAR) Physician order [REDACTED]. At 1:15 PM on 04/27/2016, review of the laboratory studies in the record revealed an H&H was done 4/23, 4/2, 3/11, 3/4, 2/26, and 2/19/16. At 10:21 AM on 04/28/2016, the Director of Nursing stated that s/he was unable to locate any other H&H results and confirmed the test was not done every 7 days as ordered. | 2019-06-01 |
| 6132 | ROLLING GREEN VILLAGE | 425160 | 1 HOKE SMITH BOULEVARD | GREENVILLE | SC | 29615 | 2014-12-31 | 156 | C | 0 | 1 | D2FB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to provide the appropriate Medicare non-coverage letters to 3 of 3 residents reviewed for liability notices upon termination of Medicare coverage. In addition, the facility failed to provide a CMS (Centers for Medicare and Medicaid Services) Form or one of 5 other approved denial letters to 1 of 1 resident reviewed for termination of Medicare coverage who remained in the facility. The findings included: On [DATE] at 5:05 PM, review of Liability Notices and Beneficiary Appeal Rights revealed 3 residents were provided CMS Form NOMNC (Notice of Medicare Non-Coverage) when their Medicare Coverage was terminated instead of the required CMS NOMNC. The CMS Form NOMNC stated on the bottom of the form (Exp. (Expired) [DATE]). Further review revealed that 1 of the 3 residents had Medicare days remaining and stayed in the facility. The CMS Form or 1 of 5 approved Denial letters was not provided to that resident as required. During an interview on [DATE] at 5:15 PM, the Social Worker confirmed the facility was not providing the CMS or one of the five approved letters when residents' Medicare coverage was terminated with days remaining. S/he further confirmed the facility was providing the CMS NOMNC which had expired [DATE]. | 2018-05-01 |
| 6133 | ROLLING GREEN VILLAGE | 425160 | 1 HOKE SMITH BOULEVARD | GREENVILLE | SC | 29615 | 2014-12-31 | 274 | D | 0 | 1 | D2FB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record reviews, interviews, and review of the CMS (Centers for Medicare and Medicaid Services) RAI (Resident Assessment Instrument) Version 3.0 Manual the facility failed to conduct a Significant Change in Status Assessment (SCSA) following a decline in function for Residents #2 and #7, 2 of 4 residents reviewed with significant changes. The findings included: The facility admitted Resident #2 with [DIAGNOSES REDACTED]. On 12/31/14 at 3:43 PM, comparison of the Annual Minimal Data Set ((MDS) dated [DATE] to the quarterly assessment dated [DATE] revealed a decline in 5 areas of Activities of Daily Living (ADLs). The resident received limited assistance with bed mobility, transfers dressing, toileting, and supervision with hygiene on the 5/27/14 annual assessment and was newly coded as requiring extensive assistance in all 5 of the areas on the 8/26/14 assessment. In addition, review of the quarterly assessment dated [DATE] revealed the resident was coded as 8, activity did not occur, during the 7 days ending 11/25/14 for ambulation, locomotion, dressing, eating, hygiene and bathing. During an interview on 12/31/14 at 5:15, MDS Coordinators #1 and #2 confirmed the areas of decline and confirmed that a SCSA should have been completed. MDS Coordinator #2 stated that Section G, Activities of Daily Living, had not been completed on the 11/25/14 assessment before it was locked and transmitted. The facility admitted Resident #7 with [DIAGNOSES REDACTED]. On 12/31/14 at 11:15 AM, comparison of the 2/24/14 Admission to the 11/25/14 Quarterly MDS revealed a decline in locomotion and in bowel and bladder incontinence. Further review of the 8/26/14 and 5/27/14 Quarterly assessments was conducted to determine when the declines had occurred. Review of the 5/27/14 MDS revealed Resident #7 had improved in ambulation and locomotion since the admission assessment and was newly coded as limited assistance. Comparison of the 8/26/14 Quarterly MDS to the 11/25/14 Quarterly assessment revealed Resident #7 had declined in ambulation and hygiene and was newly coded as requiring extensive assistance. Further review revealed the resident also had a change in bladder continence from occasionally to frequently incontinent and from continent to occasionally incontinent of bowel. During an interview on 12/1/14 at 4:45 PM, the Director of Nursing confirmed the 3 areas of decline from 8/26/14 to 11/25/14 and that a SCSA should have been completed. At 5:15 PM, MDS Coordinators #1 and #2 stated that Resident #7 had an acute episode of Pneumonia in November and that was why a SCSA had not been done. The MDS Coordinators provided documentation of the resident's current continence status indicating the resident was again continent of bowel and bladder. The MDS Coordinators also confirmed the documented decline in ambulation and hygiene and stated they would have to review the ADL documentation for that time period to confirm the information. No further information or documentation was provided at the time of exit. There was no documentation in the record to indicate that the facility had monitored the resident's function for return to baseline. A review of the CMS (Centers for Medicare and Medicaid Services) RAI (Resident Assessment Instrument) Version 3.0 Manual, Chapter 2, page 2-20 revealed The SCSA (Significant Change in Status Assessment) is a comprehensive assessment for a resident that must be completed when the IDT (Interdisciplinary Team) has determined that a resident meets the significant change guidelines for either improvement or decline. The manual further stated A SCSA is appropriate when: There is a determination that a significant change (either improvement or decline) in a resident's condition from his/her baseline has occurred as indicated by comparison of the resident's current status to the most recent comprehensive assessment and any subsequent Quarterly assessments . The Guidelines for Determining a Significant Change in a Resident's Status further state A SCSA is also appropriate if there is a consistent pattern of changes, with either two or more areas of decline or two or more areas of improvement. This may include two changes within a particular domain (e.g., two areas of ADL decline or improvement). Listed in the areas of decline was Any decline in an ADL physical functioning area where a resident is newly coded as Extensive assistance, Total dependence, or Activity did not occur since last assessment. In addition, the manual stated MDS assessments are not required for minor or temporary variations in resident status - in these cases, the resident's condition is expected to return to baseline within 2 weeks. However, staff must note these transient changes in the resident's status in the resident's record and implement necessary assessment, care planning, and clinical interventions, even though an MDS assessment is not required. The RAI manual also stated If the condition has not resolved within 2 weeks, staff should begin a SCSA and that This situation should be documented in the resident's clinical record along with the plan for subsequent monitoring and, if the problem persists or worsens, a SCSA may be warranted. | 2018-05-01 |
| 6134 | ROLLING GREEN VILLAGE | 425160 | 1 HOKE SMITH BOULEVARD | GREENVILLE | SC | 29615 | 2014-12-31 | 281 | E | 0 | 1 | D2FB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interviews, review of manufacturer's information, and review of the facility policy entitled Administering Medications, nursing staff failed to rotate [MEDICATION NAME] medication patch application sites for 1 of 1 resident reviewed with orders for [MEDICATION NAME] Patches (Resident #1). In addition 1 of 4 nurses observed during the medication pass failed to follow a process to prevent transmission of disease and infection. Registered Nurse (RN) #4 did not wash/sanitize hands between residents and touched medications with her/his hands. The findings included: The facility admitted Resident #1 with [DIAGNOSES REDACTED]. Record review on 12/30/14 revealed a 9/30/2014 Physician's Order for [MEDICATION NAME] 4.6 mg (milligrams)/24 hr (hour) Patch, [MEDICATION NAME] 24 hours. Rotate placement site daily. Remove old patch prior to applying new patch. Review of Medication Administration Records (MAR) revealed where nurses initialed when the old patch was removed, when the new patch was applied, and the patch application site. In another location, the nurses documented the date, time, and application site. Only four sites (Upper Back L(ef)t, Upper Back R(ight)t, Upper Chest Lt, and Lower Back) were documented throughout the three month period (10/14 through 12/14) reviewed. During an interview on 12/31/14 at 9:30 AM, Licensed Practical Nurse (LPN) #1 was asked about documentation of sites for applying the [MEDICATION NAME] Patches. The nurse showed the surveyor a diagram of a body back with 14 areas numbered which was kept on the medication cart. The nurse stated, We use the diagram to document the numbered area where we place the patch. The patch should not be placed in the same place for 14 days. S/he stated that the nurses were not documenting these numbers because the computer program would not allow them to do so. S/he also confirmed that the information was not documented elsewhere. An interview with Registered Nurse (RN) #1 at the same time also confirmed this information. Both nurses were aware of the manufacturer's recommendations to rotate the application site so as to not place it in the same area for 14 days. The nurse reviewed the computer documentation and stated that the nurses should have been entering the numbered area from the diagram to show placement of the patches. RN #1 stated, I see the problem. When the order was put into the computer, under location, it should have noted Back. Then the program would prompt the nurse to place a number. Review of manufacturer's information revealed: Change .application site every day to avoid skin irritation .do not use the exact same spot for at least 14 days after .last application. During medication pass observation on 12/29/14 at 3:14 PM, RN #4 administered medications to a resident, left the room, and proceeded to the med(ication) cart without cleansing her/his hands. S/he immediately pulled 3 individual medication cards from the cart, punched the medications from the bubble packaging into her/his hand, and placed them in the medication cup for the next resident. During an interview on 12/30/14 at 5:00 PM, the Director of Nursing stated that the nurse should not have touched the pills prior to administration. The facility policy, Administering Medications stated: Staff shall follow established facility infection control procedures (e.g. handwashing, antiseptic technique, gloves, isolation precautions, etc) when these apply to the administration of medications. | 2018-05-01 |
| 6135 | ROLLING GREEN VILLAGE | 425160 | 1 HOKE SMITH BOULEVARD | GREENVILLE | SC | 29615 | 2014-12-31 | 332 | D | 0 | 1 | D2FB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, interview, review of pharmacy policies entitled [MEDICATION NAME] Sulf(ate) HFA 90 MCG (microgram) INH(aler) (8.5) and [MEDICATION NAME] 160-4.5 MCG Inhaler (10.2) , and review of the facility policy entitled Administering Medications Through a Metered Dose Inhaler, the facility failed to ensure it was free of medication error rates of five percent or greater for 2 of 4 nurses observed during the medication pass. There were 3 errors in 27 opportunities, resulting in a medication administration error rate of 11.11%. The findings included: Observation of Registered Nurse (RN) #2 on 12/29/14 at 3:52 PM revealed Resident A was given [MEDICATION NAME] and [MEDICATION NAME] 160-4.5 mcg inhalers without waiting between puffs. RN #2 instructed the resident to breathe in the first inhalation of one inhaler and immediately followed with administration of the second inhalation. S/he repeated the same process with administration of the second inhaler. Observation of Licensed Practical Nurse (LPN) #4 on 12/30/14 at 8:35 AM revealed Resident B received 11 medications. Review of the physician's most current orders for December, 2014, revealed an order for [REDACTED].#4 was unsure about the omission as the medication did not show up on the resident's electronic medication record. She/he contacted the Nurse Practitioner (NP) who was present on the unit and reported to this surveyor that the NP had given a verbal order for that medication to be discontinued. LPN #4 wrote the phone order for 12/30/14 to DC (Discontinue)[MEDICATION NAME]. Upon review, the pharmacy policy, [MEDICATION NAME] Sulf HFA 90MCG INH (8.5) stated, If two inhalations are prescribed, wait at least 1 minute between them. The Omnicare Pharmacy policy, [MEDICATION NAME] 160-4.5 MCG Inhaler (10.2) stated, If your prescribed dose is 2 puffs, wait at least one minute between them. The facility's policy, Administering Medications Through a Metered Dose Inhaler stated, Allow at least one minute between inhalations of the same medication . During an interview on 12/30/14 at approximately 2:30 PM, the Director of Nursing (DON) stated that the nurse should have waited at least one minute between puffs during inhaler administration. | 2018-05-01 |
| 6136 | ROLLING GREEN VILLAGE | 425160 | 1 HOKE SMITH BOULEVARD | GREENVILLE | SC | 29615 | 2014-12-31 | 369 | D | 0 | 1 | D2FB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, and interview, the facility failed to provide assistive eating devices as ordered for Resident #2 and Resident #4, 2 of 4 residents reviewed with orders for assistive eating devices. The findings included : The facility admitted Resident #2 with [DIAGNOSES REDACTED]. On 12/30/14 at 12:40 PM, observation of Resident #2 at the noon meal revealed the resident had regular utensils. Review of the physician's monthly orders revealed an order for [REDACTED]. At 12:45 PM on 12/31/14, observation again revealed the resident had regular utensils at lunch. During an interview at 12:46 PM, the Dining Room Manager confirmed the resident did not have the built-up utensils and that they were not listed on the resident's meal card to be provided. The Dining Room Manager confirmed there was an order for [REDACTED]. Review of the telephone orders with the Dining Room Manager revealed no order to discontinue the built-up utensils. The facility admitted Resident #4 with [DIAGNOSES REDACTED]. At 3:03 PM on 12/29/14, review of the telephone orders revealed an order dated 12/2/14 for built-up utensils and a divided plate. On 12/30/14 at approximately 12:35 PM, observation of the resident eating lunch revealed the resident had the divided plate but did not have built-up utensils. Resident #4 was again observed eating lunch on 12/31/14 at 12:25 PM without built up utensils. On 12/31/14 at 12:25 PM, the Kitchen Manager confirmed the resident did not have the adaptive equipment. S/he verified the physician's orders [REDACTED]. The Kitchen Manager confirmed the kitchen had the utensils but did not know why they weren't provided. | 2018-05-01 |
| 6137 | ROLLING GREEN VILLAGE | 425160 | 1 HOKE SMITH BOULEVARD | GREENVILLE | SC | 29615 | 2014-12-31 | 371 | F | 0 | 1 | D2FB11 | Based on observation and interview, and review of the Food Code, 2013, the facility failed to ensure meals were served under sanitary conditions. A large fan was in use in the kitchen area and a dietary employee failed to wear a beard and hair restraint. These practices had the potential to affect all residents served meals from the kitchen. The findings included: During the kitchen tour on 12/29/14 at 10:50 AM, there was a tall, commercial fan blowing on the shelving in the kitchen area by the 3-compartment sink. The shelving contained multiple damp food preparation pans. Also, a dietary employee toured with the surveyor and checked food temperatures in the food preparation area without donning a hair or beard restraint. The Food Code, 2013, Chapter 4, Protection of Clean Items, 4-901.11 - Drying - Equipment and Utensils, Air-Drying Required (Page 148), reads, After cleaning and sanitizing, equipment and utensils: (A) Shall be air-dried . The Food Code, 2013, Chapter 2, 2-401.11 - Hair Restraints (Page 51) reads, (A) Except as provided in (B) of this section, Food Employees shall wear hair restraints such as hats, hair coverings or nets, beard restraints, and clothing that covers body hair, that are designed and worn to effectively keep their hair from contacting exposed food, clean equipment, utensils, and lines; an unwrapped single-service and single-use articles. During an interview on 12/30/14 at approximately 4:30 PM, the Director of Food and Beverage stated that it took so long, especially in the summer, for the pans to dry. S/he stated that the fan helped to dry the pans quickly. S/he also stated that a hair restraint was not required as long as the hair was cut close to the skin. | 2018-05-01 |
| 6138 | ROLLING GREEN VILLAGE | 425160 | 1 HOKE SMITH BOULEVARD | GREENVILLE | SC | 29615 | 2014-12-31 | 431 | E | 0 | 1 | D2FB11 | On the days of the survey, based on observation, interview and review of the pharmacy policies entitled Recommended Minimum Medication Storage Parameters and Insulin Storage Recommendations, the facility failed to follow a procedure to ensure expired medications were not stored for resident use in 1 of 2 medication rooms and 2 of 3 medication carts. The findings included: Observation of the 100/200 Unit Medication Room on 12/30/14 at 10:00 AM revealed 2 opened vials of Tuberculin Purified Protein Derivative (PPD) and one opened vial of Novolog R insulin that were not labeled with puncture dates. Registered Nurse (RN) #3 stated the vials should have been dated and initialed when opened. Observation of the Medication Cart for Rooms 316-332 on 12/30/14 at 10:40 AM revealed Glucocard Card Control 2.5 ml (milliliter) - 1 box containing 2 bottles with an expiration date of 11/14. Licensed Practical Nurse (LPN) #4 confirmed the findings and removed the items from the cart. Observation of Medication Cart 3 for Rooms 233-248 & 215, excluding 242, on 12/30/14 at 11:00 AM revealed one vial of Lantus 100 U(nits)/ml insulin was dated as opened on 11/10/14. The label stated, Discard unused med(ication) after 28 days. A vial of Novolin R(egular) 10 ml, 100 U/ml insulin was dated as opened 11/6/14. A vial of Novolog insulin was dated as opened 11/25/14. RN #3 was unsure of the policy and stated s/he would find out. S/he returned at approximately 11:20 AM and stated that the Novolin expired in 28 days. When asked about the other two vials of insulin, RN #3 stated, All 3 expire in 28 days. The pharmacy policy, Recommended Minimum Medication Storage Parameters, last revised March 31, 2014, stated: Aplisol Injection (tuberculin test) - Date when opened and discard unused portion after 30 days. The manufacturer's package insert for the PPD read: Vials in use for more than 30 days should be discarded. The pharmacy policy, Insulin Storage Recommendations, last revised March 31, 2014, stated: Lantus-Room Temperature 28 days . Novolin R-Room temperature 42 days . Novolog-Room temperature 28 days. | 2018-05-01 |
| 6139 | ROLLING GREEN VILLAGE | 425160 | 1 HOKE SMITH BOULEVARD | GREENVILLE | SC | 29615 | 2014-12-31 | 502 | E | 0 | 1 | D2FB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and review of Glucocard manufacturer's information, the facility failed to follow a procedure to ensure that testing materials in current stock for use were suitable for purposes of assuring the quality of laboratory testing in 1 of 2 medication rooms and 1 of 3 medication carts. Hemoccult slides and Glucocard Controls were found to be expired. The findings included: Observation of the ,[DATE] Unit Medication Room on [DATE] at 10:00 AM revealed 26 Hemoccult slides with the expiration date of ,[DATE]. Registered Nurse #3 confirmed the expiration date and removed Hemoccult slides from the medication room. Observation of the Medication Cart for Rooms ,[DATE] on [DATE] at 10:40 AM revealed a box containing 2 bottles of Glucocard Control 2.5 ml (milliliters) with an expiration date of ,[DATE]. Licensed Practical Nurse #4 confirmed the findings and removed the items from the cart. The Glucocard manufacturer's information stated: It is recommended to use Control Solution: Before performing a control solution test, always check the expiration date of the control solution. Do not use control solution if it is past the expiration date. | 2018-05-01 |
| 7254 | ROLLING GREEN VILLAGE | 425160 | 1 HOKE SMITH BOULEVARD | GREENVILLE | SC | 29615 | 2013-04-18 | 309 | E | 0 | 1 | P9WS11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on closed record review and interview, the facility faialed to follow physcian orders related to providing a nutritional supplement for Resident A. an order for [REDACTED]. The findings included: Resident A was admitted to the facility with a known history of weight loss and poor appetite. A closed record review conducted on 4/15/13 revealled a order written on 4/2/13 stating: Recommend 2cal/ml 120 (2 calories per milliliter) ml 6 times daily as a nutritional supplement per Dietician. There was no documentation that the order was noted or initiated. The April 2013 Physician order [REDACTED]. During an interview with the Unit Manager on 4/15/13 ar 11:50AM, s/he verified the order was originally written on 4/2/13 for the resident to recieve the nutritional supplement. S/he was unable to explain why the order was not initiated or why the computer generated order indicated an order date of 2/5/13. The admission dietary note (undated) also documented the resident should recieve chocolate ensure with all meals. During an interview with the CDM on 4/15/13, at 1:30pm, s/he stated Ensure was the initial choice, however, after discussion with the RD (Registered Dietician) it was decided that the 2 Cal product was the most appropriate intervention. The CDM also could not explain why the order was not implemented. The CDM verified the resident never recieved the chocolate ensure nor the 2 cal supplement despite his documented poor appetite. | 2017-04-01 |
| 7255 | ROLLING GREEN VILLAGE | 425160 | 1 HOKE SMITH BOULEVARD | GREENVILLE | SC | 29615 | 2013-04-18 | 312 | D | 0 | 1 | P9WS11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on record review, review of facility policy for Skin Assessment Guidelines and interview, the facility failed to provide evidence that Resident A received the necessary services and assistance to maintain good nutrition. (1 of 2 sampled residents reviewed for assistance with Activities of Daily Living.) The facility failed to assure a resident was fully assessed for actual and potential skin disorders and appropriate treatment imitated on admission. Cross refer to F 309 as it relates to the failure of the facility to provide nutritional supplements as ordered. The findings included: Resident A was admitted to the facility with a known history of poor appetite. A closed record review on 4/15/13 revealed the resident was 71 inches tall and weighed 139 pounds on admission. The Dietary Assessment stated the resident's Ideal Body Weight was 155-189 pounds and noted the resident consumed 25% or less at meals. The initial careplan started on 4/1/13 identified the resident at risk for dehydration with a goal to consume adequate fluids, offer fluids between meals, An Occupational Therapy plan of care dated 4/2/13 stated the patient is able to manage a cup using no assistive feeding equipment requiring total assistance (100% assist) with initiation cue and 100% verbal instructions/cues. The patient is able to feed self after set-up utilizing regular utensils for 25% of meal requiring total assistance (100% assist) with initiation cue and 100% verbal instruction cues. A Speech Therapy Plan of Care dated 4/2/13 identified the resident as able to safely consume a regular diet with moderate impairment .requires thickened liquids; difficulty masticating foods and given 75% verbal instructions/cues. On 4/2/13 the speech therapist documented the resident had poor po (by mouth) intake with max(imum) cues. 4/3/13 .Resident refused all po intake .NP (Nurse Practitioner)notified of poor to no intake. 4/4/13 Patient required maximum cues to increase intake.Question impact of medications and or lack of nutrition as cause for decline in swallow function. Information on the assistance a resident requires (used by the nursing assistants) as a guide for care and titled: All About Me, stated the resident was a total assist at times for feeding. with verbal cues. Review of the clinical Notes Report revealed ongoing documentation of the residents poor appetite. On 4/2/13 at 3:46pm and 9:54pm the notes stated the Resident can feed self with set up- poor appetite . 4/3/13 Appetite is poor. today . appears to be weak. 4/4/13 Refused meal this shift. 4/4/13 Resident not eating/drinking well. Spoke with MD- new order for [MEDICATION NAME]. 4/4/13 10:44pm Resident did not eat any of his/her meal. 4/5/13 .is not eating or drinking well . Transferred to hospital. During an interview with the Unit Manager on 4/15/13 at 11:50 AM, s/he verified after reviewing the record, the ongoing documentation of the residents poor appetite. S/he did not dispute there was no documentation of alternative choices being offered, supplements or assistance being provided. There was no documented evidence the resident was receiving the assistance required as noted by the both the speech and occupational therapy assessments to consume sufficient nutrition. Additionally. on admission, nursing noted the presence of a Duoderm on the resident's buttock. There were no additional open areas documented. The dressing was not removed on admission and the area was not assessed, measured or evaluated for the proper treatment. On 4/15/13, during an interview with the Director of Nursing, s/he stated s/he would have expected the dressing to be removed, the area assessed and the physician contacted for orders for treatment. Post survey, the facility provided information that stated the dressing was not removed because it had been applied on the day of discharge and the area was going to be assessed by the wound nurse the following day. The resident was admitted on [DATE] at 6PM and the wound was assessed the following day at 11:51PM at which time the resident was noted to have two open areas. (An open area to the right buttock and an additional area to the left buttock) . Orders for treatment were documented as being written on 4/2/13 at 11:40 and 11:52pm. A copy of the facility provided Skin Assessment Guidelines states: Document on chart on the assessment, Describe (approx(imate) measure, color, shape open/closed). Chart location. Do not stage. Notify MD and Power of Attorney (POA) . Get an order for [REDACTED]. This is the written communication referral to the wound nurse. Implement treatment. Transcribe order. Order med(ication)/or treatment. Start treatment. Record. | 2017-04-01 |
| 9587 | ROLLING GREEN VILLAGE | 425160 | 1 HOKE SMITH BOULEVARD | GREENVILLE | SC | 29615 | 2011-08-03 | 333 | D | 0 | 1 | LVKY11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on observation, record review and interview, the facility failed to ensure that a resident observed during medication pass (Resident A) was free of a significant medication error. The findings included: On 8/2/11 at approximately 4:04 PM, during observation of medication pass, Licensed Practical Nurse (LPN) #1 was observed to administer [MEDICATION NAME] 6.25 milligram (mg) tablet and five other medications to Resident A. After administering the medications LPN #1 returned to the medication cart and began to record the medications on the Medication Administration Record [REDACTED] On 8/2/11 at approximately 4:22 PM, through interview LPN #1 verified that the [MEDICATION NAME] 6.25 mg tablet was not administered according to the physcian's order. "I did not take pulse, normally medical nurses have it before we get on the floor." On 8/2/11 at approximately 4:30 PM review of the current physician's orders [REDACTED]. | 2015-03-01 |
| 9588 | ROLLING GREEN VILLAGE | 425160 | 1 HOKE SMITH BOULEVARD | GREENVILLE | SC | 29615 | 2011-08-03 | 425 | D | 0 | 1 | LVKY11 | On the days of the survey, based on observation and interview, the facility failed to discard one expired 5 milliliter (ml) Heparin Lock Flush Solution 10 units/ml which was stored in the medication room. The findings included: On 8/2/11 at approximately 2 PM, inspection of the medication storage room revealed a 5 ml Heparin Lock Flush Solution 10 units/ml with an expiration date of June 2011 available for use. Interview with Registered Nurse #1 at approximately 2:30 PM, confirmed the Heparin Lock Flush Solution was expired.. | 2015-03-01 |
| 9589 | ROLLING GREEN VILLAGE | 425160 | 1 HOKE SMITH BOULEVARD | GREENVILLE | SC | 29615 | 2011-08-03 | 441 | D | 0 | 1 | LVKY11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on observation and interview, the facility failed to discard one box of expired Exuderm Odor Shield with Hydropolymer dressings and one Med Mark Inc. dressing change tray that were stored and available for use in the Medication Room. The findings included: On [DATE] at approximately 2 PM while in the medication room the following observations were made: 1. A box of ten Exuderm Odor Shield with Hydropolymer Dressings 2 inch x 2 inch with the expiration date of [DATE]. 2. One Med Mark Inc. Dressing Change Tray with the following contents: mask, measuring tape, waste bag, 2 x 2 inch gauze sponge, 4 x 4 inch gauze sponge, chlora prep 1 step applicator, chlora prep 1 step insert, non adherent dressing, transparent dressing, and one label. The expiration date was [DATE]. The expired items were in unopened and undamaged packaging and were for single use only. During an interview on [DATE] at approximately 2:30 PM, Registered Nurse (RN) #1 confirmed the expired items in the medication room. RN #1 stated, "Nurses take turns every week checking the med room and pharmacy comes one a month to check for expired meds." | 2015-03-01 |
| 9590 | ROLLING GREEN VILLAGE | 425160 | 1 HOKE SMITH BOULEVARD | GREENVILLE | SC | 29615 | 2011-08-03 | 225 | D | 0 | 1 | LVKY11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on record review and interviews, the facility failed to report and investigate an allegation of misappropriation of a resident's property to the State Survey and Certification Agency. ( 1 of 7 sampled resident reviewed) Resident #3 informed the facility that "someone stole his money". There was no report or investigation submitted to the State Survey and Certification Agency. The findings included: The facility admitted Resident #3 on 5/31/11 with [DIAGNOSES REDACTED]. Record review revealed a nurse note dated 6/04/11 that indicated the resident was alert with no confusion and was able to make his needs known. The nurse note further indicated the resident came to the nurse station with his wallet in his hand and stated "he had almost $100.00 in his wallet yesterday and now there is only $4 in his wallet states he think someone stole his money". An interview on 8/02/11 at approximately 1:32 PM with the resident revealed he felt someone stole money from his wallet and he had reported the incident to the facility staff. The resident further stated "I still have not heard any about the stolen money and I wish they would let me know something." An interview on 8/02/11 at approximately 2 PM with the Social Services Director revealed the facility was aware of the report and the report was taken a grievance and the facility staff spoke with the "boyfriend" of the resident's daughter and not the resident. An interview on 8/03/11 at approximately 8:30 AM with the DON (Director of Nursing) confirmed the report was taken as a grievance. The DON further stated the facility did not report the allegation to the State Survey and Certification agency as a misappropriation of property. | 2015-03-01 |
| 499 | MUSC HEALTH CHESTER NURSING CENTER | 425061 | 1 MEDICAL PARK DRIVE | CHESTER | SC | 29706 | 2017-02-23 | 248 | D | 0 | 1 | 4GPQ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews and record reviews, the facility failed to provide an on-going activity program for 3 of 31 sampled residents (Residents #75, #56, & #26), that supported their choices of activities, met their interests, and supported their physical, mental and psychological well-being. Findings include: 1. Resident (R) 75 was admitted on [DATE] with a [DIAGNOSES REDACTED]. Observations of R75 on 2/20/17 at 11:30 a.m., 2:40 p.m. and 2:50 p.m., revealed she was not engaged in activities. Record review of Activity Progress notes on the Point Click Care electronic medical record revealed R75 was provided group or one to one activities on only one occasion since admission. On 2/21/17, a gospel tape was played in her room, to which R75 responded I like that. During an interview with the Activities Therapist (AT) on 2/22/17 at 4:57 p.m., she reviewed the daily activity resident records contained in her activity book and stated R75 came to 3 activities during the past 6 months: 2/14/17 Valentine's Party for 10 to 15 minutes; 1/30/17 horse shoes and 1/13/17 church. Additionally, during the interview on 2/22/2017 at 4:57 p.m., the AT stated she considered placing R75 on one to one activities in her room because she was disruptive during group activities, but did not. 2. Resident (R) 56 was admitted on [DATE] with the primary [DIAGNOSES REDACTED]. During an interview with R56 on 2/21/17 at 11:02 a.m., the resident was noted to be bedridden responded to survey questions about activities, that staff did not encourage her to attend activities or provide assistance to attend them. During an interview with the AT on 2/22/17 at 5:40 p.m., she stated there are no evening activities and that the last activity of the day ends at 3:30 p.m. She stated activities are provided Monday through Saturday. Additionally, the AT stated R56 does not come to activities because she stays in her room and is on one to one activities in her room. During the interview with the AD reviewed the daily activity resident records contained in her activity book and stated R56 had been provided one to one activity on only 3 occasions during the past 6 months: 11/22/16, 2/6/17 and 2/16/17. 3. According to the Admission record dated 2/22/17 Resident (R) R26 had the following pertinent diagnosis; dementia without behavioral disturbances, anxiety and major [MEDICAL CONDITION]. Review of the 5/20/16 annual Minimum Data Set (MDS) section C Cognition identified that R26 has short and long-term memory problems and is severely impaired for decision regarding tasks of daily life. Section J1400 Prognosis identified that R26 had a condition or chronic disease that may result in a life expectancy of less than 6 months. Section F Preferences for Routine & Activities revealed that R26's was not assessed for daily preferences, activity preferences, interview with primary respondent (resident, family/significant or interview could not be completed), and staff assessment of daily activity and preferences was not completed. Review of the focus title Activities care plan last revised on 7/28/16 identified that R26 was dependent on staff for meeting emotional, intellectual, physical, and social needs related to physical limitations and cognitive deficits. The goal was that the resident would respond to 1:1 visits or activity verbally or with facial expressions. Observations 2/20/17 at 1:00 p.m. R26 was observed lying in bed in the fetal position. He had nothing in his room that would provide any stimulation. He was not observed to attend any activities. On 2/21/17 at 10:20 a.m. R26 was observed lying in bed in the fetal position, he had no radio or TV in his room. On 2/22/17 at 8:20 a.m. R26 was observed lying in bed on his left side, he was awake and alert. He had no TV or radio in the room. On 2/22/17 at 10:30 a.m. R26 remained in bed on his left side, he was alert but had a difficult time communicating as he is very hard of hearing and unable to see. He stated help me, and I love you, he was unable to elaborate any more than that. On 2/23/17 at 8:15 a.m. the resident was observed lying in bed, sleeping. On 2/23/17 at 9:00 a.m. the resident was observed sleeping. A certified nursing assistant (CNA) was setting up to give resident a bed bath. On 2/23/17 at 1:44 p.m. resident on his left side in the fetal position. His eyes were open, he responded to verbal stimuli. He had no TV or radio the room was dark. Record Review Review of the activity sheets for on 2/22/17 for 11/16 through 2/23/17 revealed that R26 was only seen by the activity staff three times in November, once in December, six times in (MONTH) and three times in February. There was no documentation regarding what the 1:1 consisted of, duration of visit or the resident participation/response to the activity. Review of the quarterly activity progress notes for R26 dated 10/17/16, 6/17/16, 4/25/16, and 2/4/16. The quarterly notes only addressed the visit being conducted during the quarterly note visit. There was no summary of the resident's participation, response, or frequency of the visits conducted during the quarter. There were no notes regarding how the activity staff incorporated the resident's activity preferences and needs. Review of the task documents in Point Click Care (PCC) for R26 on 2/20/17 at 3:10 p.m. revealed that there was no activity documentation found under the following tasks, 1:1 program, arts/crafts, barber, cards, cooking baking, games/exercise, kids visit, nail care, newspaper, self-directed activity, outings, puzzles, religious, social activity, special needs activity or TV/Movies. Staff Interviews: On 2/21/2017 at 3:00 p.m. spoke with the Activity Coordinator (AC) and the Activity Therapist (AT) they stated that they had documented in PCC and they may have some paper activity records. Neither record indicated that they had provided 1:1 visits with R26. On 2/21/2017 at 3:50 p.m. the AT stated that she had been the only one in the department and she had been struggling to get the documentation done as she has an AC whom staff pull to work the floor. She discussed that she does a quarterly activity note only and has not been documenting what activity she did for R26's 1:1 visits. She was unable to verbalize what activities she has done other than referencing her last quarterly note where she visited with him in his room. She stated she was not aware of the activities listed under tasks in PCC and was not aware that she needed to document time, activity, and R26's response to the activity. She was unable to remember what 1:1 activity was done with R26 yesterday. 2/21/17 at 4:13 p.m. the Administrator stated that it was his expectation that the activity staff find out and be aware of what the resident's activity preferences were and build a program around those interest. He would expect that they were trying to encourage them to come out for socialization. If the resident were bed bound by physician's orders [REDACTED]. He discussed that he would prefer to have activities staff see bed bound residents daily if possible but at minimum a few times a week. He discussed that activity staff could encourage other departments to visit with the resident and report to activity so they could capture those visits. He stated that he expected that any activity that was being provided or the resident participated in would be documented on the activity sheet and if receiving 1:1 visits there be detailed documentation of the activity. | 2020-09-01 |
| 500 | MUSC HEALTH CHESTER NURSING CENTER | 425061 | 1 MEDICAL PARK DRIVE | CHESTER | SC | 29706 | 2017-02-23 | 278 | D | 0 | 1 | 4GPQ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure each Resident (R) had an accurate comprehensive assessment for dental status for 1 of 31 sampled residents (R37) and an accurate comprehensive assessment for nutritional status for 1 of 31 sampled residents (R32). Findings include: 1. During an observation of R37 on 2/21/17 at 9:15 a.m., R37 was observed to be edentulous except for one broken tooth in the lower front of her mouth. A review of her annual Minimum Data Set (MDS) assessment, dated 8/1/16, in the Dental section of the assessment, it indicated unable to examine. A review of her quarterly MDS assessment dated [DATE] indicated there were no dental concerns and did not identify her dental status as being edentulous or having one broken tooth in her mouth. A review of R37's quarterly assessment dated [DATE] also indicated there were no dental concerns. During an interview with the MDS Coordinator, on 2/22/17 at 9:16 a.m., she confirmed the MDS assessments for dental status were incorrect for R37and she would modify the current MDS dated [DATE]. Cross reference to F325. A review of the quarterly MDS assessment, dated 1/28/17, indicated R32 had no weight loss. A review of facility weights for R32 revealed she weighed 169 pounds (lbs.) 11/28/16, 130 lbs. 12/19/16, and 125 lbs. on 1/20/17. During an interview with the MDS Coordinator reference to F32 on 2/22/17 at 9:16 a.m., she confirmed the MDS assessment for weight loss was inaccurate. | 2020-09-01 |
| 501 | MUSC HEALTH CHESTER NURSING CENTER | 425061 | 1 MEDICAL PARK DRIVE | CHESTER | SC | 29706 | 2017-02-23 | 279 | D | 0 | 1 | 4GPQ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview the facility failed to develop a comprehensive care plan for one resident (R26) out of 31 sample residents. Specifically, the facility failed to ensure R26 had a person-center and measurable care plan for activities. Findings include: According to the Admission record dated 2/22/17 Resident (R) R26 had the following pertinent diagnosis; dementia without behavioral disturbances, anxiety and major [MEDICAL CONDITION]. Review of the 5/20/16 annual Minimum Data Set (MDS) section C Cognition identified that R26 has short and long-term memory problems and is severely impaired for decision regarding tasks of daily life. Section J1400 Prognosis identified that R26 had a condition or chronic disease that may result in a life expectancy of less than 6 months. Section F Preferences for Routine & Activities revealed that R26's was not assessed for daily preferences, activity preferences, interview with primary respondent (resident, family/significant or interview could not be completed), and staff assessment of daily activity and preferences was not completed. Record Review Review of the focus title Activities care plan last revised on 7/28/16 identified that R26 was dependent on staff for meeting emotional, intellectual, physical, and social needs related to physical limitations and cognitive deficits. The goal was that resident would respond to 1:1 visits or activity verbally or with facial expressions. There was no documentation on the activity sheets regarding what the 1:1 visits consisted of, the duration of visit or what the resident's participation and response was to the activity. Review of the activity sheets provided on 2/22/17 for 11/16 through 2/23/17 revealed that R26 was only seen by the activity staff thirteen times. There was no documentation on the activity sheets regarding what the 1:1 visits consisted of, the duration of visit or what the resident's participation and response was to the activity. Review of the quarterly activity progress notes for R26 revealed one note for (YEAR) dated 2/4/16. There was no documentation regarding how many 1:1 visits R26 received in the quarter. Staff Interviews: On 2/21/2017 at 3:50 p.m. the Activity Therapist stated that she was not aware that she needed to document time, activity performed, resident's participation or response to the activity for R26. On 2/23/17 at 3:00 p.m. the MDS Coordinator stated that Activity Therapist does her own care plan for R26. She stated that if during a care conference the family or resident bring up things they would like to do or did in the past she will update the care plan to reflect those interests. She was unaware that the care plan needed to have measurable goals. | 2020-09-01 |
| 502 | MUSC HEALTH CHESTER NURSING CENTER | 425061 | 1 MEDICAL PARK DRIVE | CHESTER | SC | 29706 | 2017-02-23 | 280 | D | 0 | 1 | 4GPQ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observation and interview, the facility failed to revise the Care Plan for the nutritional status for 1 of 31 sampled Residents (R37) and for activities for 1 of 31 sampled Residents (R75). Findings include: 1. A review of facility weights for R37 revealed the Resident weighed 177 pounds (lbs.) on 2/15/17, and on 11/10/16 weighed 200 lbs. The weights indicated a 13% weigh loss. A review of the care plan for R37 revealed a concern indicating R37 has potential nutritional problem r/t (due to) [MEDICAL CONDITION], poor dentition diabetes. The care plan was last revised on 8/16/16 for weight gain. Further review of the care plan revealed no evidence the care plan was revised after R37 experienced unexpected weight loss from 11/6/16 through 2/23/17. During an interview with the facility Registered Dietician, on 2/21/17 at 4:25 p.m., she stated R37 should have been put on Nutritional Alert in (MONTH) (YEAR), and her care plan revised for the unexpected weight loss. She further stated neither was done. 2. Record review of R75 behavior care plan indicated The resident has behavior problem shouting out, combative, grabbing, slapping, cursing, pulling clothes off, hitting staff with fists related to dementia. The interventions included: Administer medications as ordered. Monitor / document for side effects and effectiveness. Anticipate and meet the resident needs. Explain all procedures to the resident before starting and allow the resident a few minutes to adjust to the changes. Intervene as necessary to protect the rights and safety of others. Approach and speak in a calm manner. Divert attention. Remove from situation and take to alternate location as needed. Praise any indication of the resident's progress/improvement in behavior. Observations on 2/20/17 revealed no activities for R75. During an interview with the Activity Therapist on 2/22/17 at 4:57 p.m., she stated, I know (R75) didn't come to many activities. (R75) is up cussing by the nursing station, because she can't stay down here with us. What does she do? Tell you off as you walk by . The Activity Therapist confirmed that no revisions were made to the behavior care plan to include diversional activities that were individualized and person centered. | 2020-09-01 |
| 503 | MUSC HEALTH CHESTER NURSING CENTER | 425061 | 1 MEDICAL PARK DRIVE | CHESTER | SC | 29706 | 2017-02-23 | 282 | E | 0 | 1 | 4GPQ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, facility policy review and staff interviews the facility failed to demonstrate implementation of side effect monitoring as written in the [MEDICAL CONDITION] medication care plan for 4 out of 31 Residents (R) (R4, R17, R37 and R75) as evidenced by lack of abnormal involuntary movement scale (AIMS) assessments scheduled to be performed every 6 months per facility policy. Cross Refer to F329 Findings include: 1. Review of the record for Resident (R4) revealed [DIAGNOSES REDACTED]. R4's current list of medications included [MEDICATION NAME] 12.5 milligrams (mg) 1 tablet daily, and [MEDICATION NAME] 25 mg 1 tablet daily. Per record review for R4 the care plan for [MEDICAL CONDITION] medications initiated on 6/12/14 indicated: Administer medications as ordered. Monitor/document for side effects and effectiveness. The care plan was last revised on 11/16/16 with no changes to the above intervention. 2. Resident (R17) was admitted from the hospital due to patient exhibiting bizarre behaviors at the assisted living facility. Record review revealed R17's list of [DIAGNOSES REDACTED]. R17's current list of medications included [MEDICATION NAME] 12.5 mg 1 tablet daily, and [MEDICATION NAME] 10 mg 1 tablet daily Per record review the care plan for [MEDICAL CONDITION] medications initiated on 9/02/14 indicated: Administer medications as ordered. Monitor/document for side effects and effectiveness, [MEDICATION NAME] and [MEDICATION NAME]. The care plan was last revised on 02/17/17 with no changes to the above intervention. A query of R4 and R17's AIMS assessments documented in Point Click Care (PCC) revealed no AIMS assessments were completed and entered for either resident since the PCC electronic software was initiated in on 11/13/15. Review of the nurse's notes of both residents (R4, R17) in PCC and hard chart from 2/19/16 to 2/23/17 revealed no documentation reported [MEDICAL CONDITION] side effects identified and or assessments of side effects performed. An interview conducted with Licensed Practical Nurse (LPN3) on 2/22/17 at 3:06 p.m. acknowledged based on her review of R4 and R17 hard charts and PCC no AIMs assessments were found for the past year on either resident. She further stated review of the nurses notes over the past year did not reflect reports of or absence of [MEDICAL CONDITION] side effects and or nursing assessments of [MEDICAL CONDITION] assessments completed. An interview conducted with the Director of Nursing (DON) on 2/22/17 at 3:12 p.m. stated it is her expectation that the nurses comply with our policies and general standards for nursing practice. We expect our nurses to perform AIMS assessment on all resident receiving [MEDICAL CONDITION] medications. Review of the facility policy titled, Nursing Staff Reports - Medication Monitoring and Management dated (MONTH) 2009 states: For Antipsychotics: The continued monitoring of AIMS. 3. The facility failed to implement the Abnormal Involuntary Movement Scale (AIMS) for Resident (R) 75 as care planned. Record review of the Point Click Care electronic medical record revealed the AIMS report was not completed. During an interview with LPN1 on 2/23/17 at 1:54 p.m., she checked R75's Point Click Care electronic record and stated the AIMS report was 173 days overdue. During an interview with the Case Manager Assistant on 2/23/17 at 2:05 p.m., she reviewed the AIMS report on the Point Click Care electronic medical record and stated the Social Worker does the AIMS monitoring and some were done on paper. During an interview with the Social Worker on 2/23/17 at 2:20 p.m., he stated he had no AIMS monitoring for R75. 4. A review of the Physician's orders for R37 for (MONTH) (YEAR) revealed R37 had orders for [MEDICATION NAME] (anti-anxiety medication) 0.25 milligrams (mg) to be given twice a day and [MEDICATION NAME] 0.25 mg to be given as needed, for anxiety. A review of the care plan for R37 indicated resident uses anti-anxiety medications [MEDICATION NAME], R/T (due to) Anxiety disorder last revised 3/10/16, revealed an intervention stating Administer anti-anxiety medications as ordered by physician. Monitor for side effects and effectiveness Q-shift. A review of R37's clinical record including electronic and paper documents revealed no evidence [MEDICATION NAME] was being monitored for effectiveness. During an interview with the Unit Manager, Licensed Practical Nurse (LPN1) on 2/22/17 at 2:00 p.m., she stated she could find no evidence of [MEDICATION NAME] being monitored for effectiveness in R37's clinical record. | 2020-09-01 |
| 504 | MUSC HEALTH CHESTER NURSING CENTER | 425061 | 1 MEDICAL PARK DRIVE | CHESTER | SC | 29706 | 2017-02-23 | 325 | E | 0 | 1 | 4GPQ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and interview, the facility failed to provide nutritional care and services to prevent or treat avoidable weight loss for 2 of 31 sampled Residents (R) (R37, R51). Findings include: 1. A review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed R37 was assessed as having a weight loss of 5% or more in last month or loss of 10% or more in the last 6 months. It further indicated R37 was not on a prescribed weight loss regimen and received a mechanically altered diet. A review of facility weights for R37 revealed the Resident weighed 177 pounds (lbs.) on 2/15/17, and on 11/10/16 weighed 200 lbs. The weights indicated a 13% weigh loss. A review of the care plan for R37 revealed a concern indicating R37 has potential nutritional problem r/t (due to) [MEDICAL CONDITION], poor dentition diabetes. The care plan was last revised on 8/16/16 for weight gain. Further review of the care plan revealed no evidence the care plan was revised after R37 experienced unexpected weight loss from 11/6/16 through 2/23/17. A review of R37's document for Total Fluid Meal Intake Reports for 2/8/17 through 2/22/17 revealed R37 ate 25%-50% of her breakfast meal 7of 15 documented opportunities and none of her breakfast on one day. R37 ate 25%-50% of her lunch meal 4 of 9 documented opportunities. R37 ate none of her supper meals on 2 of 8 documented opportunities and 25%-50% for 2 of 8 documented opportunities. A review of all physicians' notes from 11/2017 through 2/21/17 revealed no mention of R37's weight loss. A review of Physicians' order for R37 for (MONTH) (YEAR), included Mech(sic) (mechanical) soft w/pureed meats and vegs thin liquids. During an observation and interview with R37 on 2/22/17 at 8:13 a.m., it was observed that she was served pureed pork sausage, cheese grits, and scrambled eggs. The resident was observed to eat 1/2 of her eggs, 1/2 of her cheese grits and none of her pureed sausage. R37 stated she does not like pureed food and will not eat it. She further stated she had told the facility multiple times she will not eat pureed food. During an interview with the facility Registered Dietician, on 2/21/17 at 4:25 p.m., she stated R37 should have been put on Nutritional Alert in (MONTH) (YEAR), and her care plan revised for the unexpected weight loss. She further stated neither was done. She continued she was unaware of why R37 had such a dramatic weight loss. During a second interview with the Registered Dietician on 2/22/17 at 9:30 a.m. she stated she was unaware R37 was refusing her pureed foods. 2. Review of the record for R51 indicated the resident had a past medical history of [REDACTED]. On 11/29/16 an x-ray was completed of R51's left hand due to persistent complaints of pain and swelling. Findings revealed severe [MEDICAL CONDITION] arthritis noted at the first carpometacarpal and second carpometacarpal joint. Severe [MEDICAL CONDITION] arthritis at the first metacarpophalangeal joint, second through fifth proximal interphalangeal joints, and first through fifth distal interphalangeal joints. She was screened and treated by occupational therapy from 1/18/17 - 2/17/17 with underlying impairments assessed as follows: Strength in left upper extremity (UE) 2+/5, strength in right UE 3/5, strength of left hand grip was 5, and strength of right hand grip was 22. Resident requires set up for meals with assist as needed. Record review for R51 from 10/17/16 to 2/07/17, the resident demonstrated a 44 pound (lb.) weight loss at 20%. Further review of the RD records of weekly IDT meeting minutes' summary reports for residents on nutritional alert from 12/15/16 - 2/23/17 reflected R51 had not been included in the list of residents for review each week. Record review of R51's activities of daily living (ADL) care plan initiated on 9/30/15 indicated: For eating the resident requires assistance by (1) staff to set up. Last updated on 2/20/17 with no changes to the aforementioned intervention. Record review of R51's daily percentage of meal intake from 2/07/17 to 2/21/17 revealed 14 out of the 22 entries revealed R51 ate at a consumption rate of 0 - 25% for 63.6% of his/her meals documented during this time frame. On 2/20/17 records revealed R51 ate 0 - 25% of her breakfast with 250cc of fluid. On 2/20/17 records revealed R51 ate 0 - 25% of her lunch with 250cc of fluid. On 2/20/17 records revealed CNA did not record meal intake percentage, not applicable was entered. Multiple observations were made from 2/20/17 - 2/23/17 revealing R51 failed to receive assistance from staff for meal set up. Observation on 2/20/17 at 12:15 p.m. R51's lunch tray was brought to her room by a Certified Nursing Assistant (CNA) who pleasantly greeted resident and placed the lunch tray on the residents over bed table and left the room. No set up or repositioning was provided. The resident was positioned poorly in bed, head of bed elevated 45 - 60 degrees with R51 leaning to left side. R51's lunch tray remained covered with green plate lid, all liquids remained covered with plastic lids, milk carton not opened, and dessert remained covered with cellophane. An observation on 2/20/17 at 12:25 p.m. spoke with R51 who stated she usually gets help from her family with meals they are on their way. The food tray and drinks remained covered. R51 stated due to her severe arthritis she cannot feed herself. The resident indicated her hands hurt really bad and she can barely move them. The head of bed (HOB) was elevated 45 - 60 degrees, and the resident was slumped toward her left side. Observation on 2/20/17 at 12:40 p.m. R51 still lying in bed with tray untouched. Remains in same position. R51 was observed attempting to remove a plastic lid from her drink, but was unable to do so. An observation on 2/20/17 at 12:58 p.m. R51 remains in bed and awake. The food tray remains untouched. CNA6 enters the room and prepares to sit and feed R51's roommate R4. Observation on 2/20/17 at 1:17 p.m. spoke with R51 at her bedside. The food tray remained untouched. The resident position was unchanged, remained slumped to the left side in bed. CNA6 is still in room feeding roommate. Upon completing feeding R4 CNA6, asked R51 if she was finished eating and removed her tray with 0% consumed by resident. Observation on 2/22/17 at 8:06 a.m. R51 lying in bed. HOB elevated 45 - 60%, R51 sitting in bed with eyes closed. The breakfast tray was on the bedside table and the plate was uncovered. Liquids with lids remaining, milk carton unopened, the Danish covered with cellophane. The food was untouched. Observation at 8:22 a.m. R51 resting in bed with eyes closed. Food tray remains untouched Interview conducted with CNA7 on 2/22/17 at 8:37 a.m. who stated R51 is confused. She usually will say her family is coming to feed her. We will bring her tray and set her up. She can eat well by herself without assistance. Lately she only eats about 25 - 50% of her meals. We try to encourage her to eat more. Observation on 2/22/2017 8:40 a.m. CNA1 enters R51 room and takes her tray. Ask CNA1 in hallway prior to placing tray back on cart if I can see how much R51 consumed. 0% eaten. Asked CNA1 to take tray back to the room and ask R51 if she wanted something on her tray. R51 stated she wanted to eat the cheese grits however, due to her hands hurting she was unable to do so. CNA1 reheated the cheese grits and fed them to R51 who at 100% of the cheese grits and drank 60cc of juice. Interview conducted with Licensed Practical Nurse (LPN1) on 2/22/17 at 8:57 a.m. who stated R51 sometimes can do for herself in feeding and sometimes she can't and the staff will assist her. Our CNAs know to inform us if the resident is not eating. She was in our nutritional alert meetings due to weight loss some time ago. She was placed on weekly weights. We spoke with the family (daughter and son in-law) they were aware of her not eating and tried to bring in foods but she still would not eat. Therapy has reassessed her several times. An interview conducted with the Registered Dietician (RD) on 2/22/17 at 9:18 a.m. who acknowledged she had seen R51 for the first time on 2/14/17 to talk to her about her food preferences and to complete her next nutritional quarterly review. She acknowledged she was not aware of R51 severe arthritic left hand. The RD indicated when residents are noted to have weight loss they are placed on our weight monitor program and weekly weights. She further stated R51 was placed on the Nutritional Alert program due to weight loss by her predecessor on 12/15/16 with recommendations for weekly weight assessments and interdisciplinary team (IDT) monitoring. R51 was added to weekly weight list however she failed to add her to the weekly list of residents for IDT to review. She stated she would discuss further with Interdisciplinary Team (IDT) and the physician as resident is now on nutritional alert list as of 2/22/17. An interview conducted with the Occupational Therapist, (OT) on 2/22/17 at 1:59 p.m. who stated based on his last review which ended on 1/18/17, R51 could lift a cup, and feed herself. She required assistance with set up only. He stated R51 has had problems with her left hand primarily due to [MEDICAL CONDITION] arthritis. She doesn't do anything with her left hand and doesn't want anyone touch it. We've had her on skilled care multiple times however she has declined in the past few months demonstrating increasing confusion. There were additional recommendations in the past such as restorative care but now she had reached her max potential. She used to get up back in September, October, and maybe in (MONTH) by the PT staff. When out of bed her posture is better and facilitates her ability to eat. But now she refuses to get out of bed. When she does eat she is often in poor positioning as the staff do not pull her up in bed. The CNA's are supposed to assist her with set up by removing lids, removing tray cover, placing the straw if drink. The OT therapist was accompanied to R51's room and resident was found well positioned in bed. She was asked to pick up her cup of water with her right hand, R51 was unable to do so, she was asked to hold a butter knife with her right hand, again R51 was unable to do so. 02/22/2017 4:49:32 PM Interview conducted with the RD who stated R51 was placed on Nutritional Alert List back in (MONTH) (YEAR). Per record review she was added to weekly weights on 12/15/16 and at this time she would have been placed on the Nutritional Alert. Based on our process this resident should have had weekly interdisciplinary team (IDT) meetings to address interventions implemented to address identified weight loss concerns. The IDT team consist of the nurses, administrator, MDS Coordinator, social worker, rehab, and activities. I always tell the CNAs to inform me if a resident is eating at 25% or less of meal intake. No one reported any meal intake concerns regarding R51. She will be placed on the weekly weights as today 2/22/17. The physician is notified of all residents who are placed on weekly weights for nutrition alerts, as our Nutritional Alert summary reports are forwarded to the physician for review each week. She did not get placed on the report like she should have. She further acknowledged by not placing her on the nutritional alert list the facility failed to include her in their weekly IDT meetings held on Friday mornings Interview conducted with LPN3 on 2/23/17/ at 8:23 a.m. who stated she participated in the weekly Friday morning interdisciplinary meetings for residents placed on nutritional alert, restraints, falls, and wounds. The team members included the Administrator, DON, registered dietician, MDS, Social Worker, Infection Control and the Rehab Manager. She acknowledged she did not recall R51 being discussed in the weekly IDT meetings. She further stated R51 was not on the list to assist with feeding she was on the list to assist with set up meaning bring tray, remove lids, positioning for meals, open straws, ensure items are within reach, make sure food is seasoned as desired, and for CNA staff to ask if they can assist the resident further prior to leaving the room. Interview conducted with DON on 2/23/27 at 9:54 a.m. who stated it was her expectation that all residents who require set up with meals receive the assistance needed. I expect our staff to monitor the percentage of food intake, and report poor intake and weight loss. A review of the facility's undated Weight Management Protocol revealed a section entitled For residents identified with weight loss trend. This section indicated the following was to be done: dietician will add residents to Nutrition Alert list and have interdisciplinary team discussion/approach at Nutrition Alert Meeting to identify the etiology/cause of weight loss and begin monitoring resident's nutritional status in a frequently and intensive (weekly) manner. | 2020-09-01 |
| 505 | MUSC HEALTH CHESTER NURSING CENTER | 425061 | 1 MEDICAL PARK DRIVE | CHESTER | SC | 29706 | 2017-02-23 | 329 | E | 0 | 1 | 4GPQ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interviews, the facility failed to ensure each Resident (R) was free from unnecessary drugs such as an anti-anxiety medication for R37 and anti-psychotic medications for R4 and R17. This affected 3 of 6 sampled Residents for unnecessary medications. Findings include: 1. A review of the clinical record for R37 revealed she was admitted to the facility on [DATE] with the following Diagnosis: [REDACTED]. A review of R37's quarterly Minimum Data Set (MDS) assessment dated [DATE] coded the resident as having received an anti-anxiety medication. A review of her care plan for R37 revealed a concern Uses anti-anxiety medications [MEDICATION NAME], R/t (due to) anxiety disorder. The interventions included: Administer anti-anxiety medications as ordered by physician. Monitor for side effects and effectiveness Q (every)-shift initiated 8/7/15 and last revised 8/10/16. A review of physician's orders [REDACTED]. A review of the clinical for record for R37 including nurses notes, progress notes, assessments and Medication Administration Record [REDACTED]. During an interview with the Director of Nursing (DON), on 2/23/1 at 12:26 p.m. she stated she could find no evidence in R37's clinical record of the effectiveness of the anti-anxiety medication for R37. She further stated there should be documentation of the medications effectiveness on each shift, each day. Further review of R37's MAR indicated [REDACTED]. During a review of the Consultant Pharmacist's medication review for R37, a document entitled Note to Attending Physician/Prescriber indicated a pharmacist recommendation to reduce the anti-anxiety medication from .25 mg twice a day to .25 mg once a day. The physician had signed the note but did not date when he signed it, wrote no change to the medication, but did not give a rationale for not following the pharmacist's recommendation. During an interview with the facility Medical Director on 2/22/17 at 2:20 p.m., he stated he was not aware of the necessity of documenting a rationale for not following a pharmacist recommendation to reduce medication for R37. 2. The record review for R4 revealed a list of [DIAGNOSES REDACTED]. R4's current list of medications included [MEDICATION NAME] 12.5 milligrams (mg) 1 tablet daily, and [MEDICATION NAME] 25 mg 1 tablet daily. Per record review of R4 the care plan for [MEDICAL CONDITION] medications initiated on 6/12/14 states: Administer medications as ordered. Monitor/document for side effects and effectiveness. Care plan last revised on 11/16/16 with no changes to the above intervention. 3. Resident (R17) was admitted to the facility from the hospital due to patient exhibiting bizarre behaviors at the assisted living facility. Record review revealed R17's list of [DIAGNOSES REDACTED]. Per R17's review of her care plan for [MEDICAL CONDITION] medications initiated on 9/02/14 indicated: Administer medications as ordered. Monitor/document for side effects and effectiveness, [MEDICATION NAME] and [MEDICATION NAME]. The care plan was last revised on 02/17/17 with no changes to the above intervention. A query of R4 and R17's AIMS assessments documented in Point Click Care (PCC) revealed no AIMS assessments were completed and entered for either resident since the PCC electronic software was initiated in on 11/13/15. Review of the nurse's notes of both residents (R4, R17) in PCC and hard chart from 2/19/16 to 2/23/17 revealed no documentation reported [MEDICAL CONDITION] side effects identified and or assessments of side effects performed. Interview conducted with Licensed Practical Nurse (LPN3) on 2/22/17 at 3:06 p.m. acknowledged based her review of R4 and R17 hard charts and PCC no AIMs assessments were found for the past year on either resident. She further stated review of the nurses notes over the past year did not reflect reports of or absence of [MEDICAL CONDITION] side effects and or nursing assessments of [MEDICAL CONDITION] assessments completed. Interview conducted with Director of Nursing (DON) on 2/22/17 at 3:12 p.m. who stated it is her expectation that the nurses comply with our policies and general standards for nursing practice. We expect our nurses to perform AIMS assessment on all resident receiving [MEDICAL CONDITION] medications. This is an area we can reeducate the nursing staff on. Facility policy titled, Nursing Staff Reports - Medication Monitoring and Management dated (MONTH) 2009 states: For Antipsychotics: The continued monitoring of AIMS is also evaluated with antipsychotic medications, as well as [MEDICATION NAME]. AIMs testing is performed every 6 months by the facility and stored on the resident's chart. | 2020-09-01 |
| 506 | MUSC HEALTH CHESTER NURSING CENTER | 425061 | 1 MEDICAL PARK DRIVE | CHESTER | SC | 29706 | 2017-02-23 | 371 | F | 0 | 1 | 4GPQ11 | Based on observation and interview, the facility failed to ensure a sanitary kitchen, sanitary food preparation, and sanitary food service for 31 of 31 sampled Residents (R) (R51, R64, R90, R2, R11, R60, R4, R34, R26, R59, R58, R17, R37, R38, R53, R8, R29, R69, R86, R84, R12, R23, R19, R16, R40, R71, R75, R32, R56, R33, and R30.) Findings include: 1. During an observation in the kitchen, on 2/20/17 at 9:30 a.m., the walk-in freezer was observed to have paper trash and French fries littering the freezer floor. An observation of the walk-in refrigerator, on 2/20/17 at 9:33 a.m., revealed a tray of chicken sitting in a liquid that was not covered. An interview with the Dietary Manager, on 2/20/17 at 9:33 a.m. confirmed the observation in the walk-in freezer and the tray of uncovered chicken in the refrigerator. The dietary Manager stated neither was acceptable. Further observation in the kitchen on 2/20/17 at 9:36 a.m., revealed an oven with baked on food debris on the front face of the oven, a food preparation table that had built up grease and food debris on it, and metal shelves that held clean dishes had built up greasy debris on them. An interview with the Dietary Manager on 2/20/17 at 9:40 a.m. confirmed the observations. During an observation in the kitchen on 2/22/17 at 11:20 a.m., a Dietary Aide (DA1) was observed to open and enter the walk-in refrigerator with gloved hands and exit the refrigerator holding an unopened package of sliced ham. With the same gloved hands, she was observed to open the package of ham and hold slices of ham in her same gloved hands to slice the ham. An interview with DA1, on 2/22/17 at 11:25 a.m., confirmed she had contaminated her gloves in touching the walk-in refrigerator's door handle and handling the unopened package of ham prior to handling the ham with the same gloves. During an observation on 2/22/17 at 12:07 p.m., the Cook was observed to bring a box of disposable plates to a counter with gloved hands. He was then observed to open the card board box with his gloved hands and reach in and handle the food holding sections of the disposable plates with the same gloved hands. During an interview with the Cook on 2/22/17 at 12:07 p.m., he stated he should have removed the gloves after handling the card board box, wash his hands then don new gloves before handling the food surface of the disposable plates. During an observation in the 3 Hall, on 2/20/17 at 12:43 p.m., a Certified Nursing Assistant (CNA4) was observed to enter room 56 with a meal tray for the Resident. She was observed to set the meal tray down on the Resident's bed table, and then pick the Resident's cell phone off the floor. After picking the phone up off the floor, she proceeded to serve the Resident his meal handling his silver ware with her hand that handled the cell phone. During an interview with CNA4, on 2/20/17 at 12:44 p.m. she states she should have washed her hands after picking up the cell phone from the floor and before she served the resident his meal. 2. On 2/20/17 at 12:38 p.m. during the tray delivery Certified Nursing Assistant (CNA) CNA1 and the Activity Coordinator (AC) were observed touching the tips of the straws while opening them and putting them in the resident's drinks. On 2/20/17 at 12:43 p.m. CNA1 was observed opening a pack of crackers, she removed the crackers from the wrapper and put them on the resident plates using her hands. She was not observed sanitizing her hands before or after the tray delivery. On 2/20/17 at 12:43 p.m. the AC was observed removing items from the meal tray, removing the lids that covered the drinks and soup bowl. She then picked the glasses and the bowl up by the rim and placed them in front of the resident. She also touched the tip of the straw while placing it into the milk carton. On 2/22/17 at 1:00 p.m. the AC was observed pulling the paper off the resident's straw, she then touched the top of the straw bending it over after inserting it into the resident's drink. She was observed delivering and setting up others trays and did not sanitize her hands prior to touching the straw. On 2/22/17 at 1:00 p.m. and again at 1:05 p.m. CNA2 was observed removing corn bread from the bag with her bare hands and putting it on the resident's plate, she also pulled the paper off the straw and handled the tip as she put it in the residents' drink. She was not observed sanitizing her hands during the tray pass and meal set-up. Observations on Hall #1 rooms 18-31: On 2/22/17 at 12:35 p.m. CNA4 was observed picking up R75's fried chicken and shredding piece of chicken off with her bare hands. Prior to handling the chicken she had moved the tray, moved and set-up a chair and set up the resident's meal she was not observed sanitizing her hands. On 2/22/17 at 12:43 p.m. CNA5 was observed dropping Resident 26's tray off, she raised the head of the bed, got a folding chair, and set it next to the bed. She returned to the hall and retrieved a towel and touched the tip of the resident's straw while putting it in his drink. She was not observed sanitizing her hands. Staff Interview: On 2/22/17 at 1:05 p.m. the Director of Nursing (DON) stated that staff are to keep the top part of the straw encapsulated so the resident if able can remove the paper without touching the tip of the straw and if the resident could not remove the tip on their own she would expect staff to place the straw in the glass and then pull the paper off without touching the straw. She discussed that staff should not be handling any food bare handed, the should use a napkin or utensils to cut food up. Staff were also to be sanitizing/washing their hands frequently. On 2/22/17 at 1:10 p.m. Register Nurse (RN) RN1 who was the nurse assigned to the dining room stated that staff should not touch the straws with their bare hands, they should be sanitizing their hands in between tray delivery/setup, and they are never to touch any food with their bare hands. On 2/23/17 at 8:58 a.m. CNA4 stated that you are not to handle food with your bare hands ever. When asked if she was aware that she had picked up R75's chicken and started to pull the chicken apart. CNA4 stated that she did not realize she had done that. On 2/23/17 at 11:00 a.m. the Dietary Manger (DM) stated that he was not aware that he needed to do or coordinate training with nursing staff regarding how to handle foods and he was not sure when they last received training. He stated that staff were not to handle bowls or glasses by the rims, they were to tear the straw and leave the top part covered and either they could remove the paper by the tip or the resident could remove. The staff should never touch the top of the straw with their hands. He further discussed that staff were never to handle food with their bare hands and they should be sanitizing their hands in between meal deliver/set up and prior to assisting the resident. | 2020-09-01 |
| 507 | MUSC HEALTH CHESTER NURSING CENTER | 425061 | 1 MEDICAL PARK DRIVE | CHESTER | SC | 29706 | 2017-02-23 | 428 | D | 0 | 1 | 4GPQ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, facility policy review and staff interviews the facility failed to demonstrate an adequate physician written response to pharmacist' medication regimen review (MRR) recommendations as evidenced by lack of documented clinical rationale for 3 out of 31 sampled Residents (R4, R17, and R37.) Findings include: 1. Review of the record for Resident (R4) revealed [DIAGNOSES REDACTED]. The MRR for R4 dated 6/27/16 revealed the Pharmacist wrote a recommendation for a gradual dose reduction (GDR) to decrease/discontinue both Seroquel 25 mg 1 tablet daily for psychosis since (MONTH) 2014 and Zoloft 25 mg daily for depression since (MONTH) 2014. The Physician responded, Disagree - No Changes. The date of physician entry was not recorded. Documentation of the physician clinical rationale was not found in the record. Review of the MRR for R4 dated 12/20/16 the Pharmacist wrote a recommendation for a GDR for both Sertraline 25 mg daily and Seroquel 25 mg daily documented: There are no reported behaviors documented at this time. Please consider if appropriate decreasing both medications to 1/2 tab daily or to lowest effective dose. The Physician responded: Agree to decreasing Seroquel to 12.5 mg daily however, failed to provide documented clinical rational for not agreeing to decrease Sertraline. The date of physician entry not recorded. 2. Resident (R17 was admitted from the hospital due to patient exhibiting bizarre behaviors at the assisted living facility. Record review revealed R17's list of [DIAGNOSES REDACTED]. R17's current list of medications included Seroquel 12.5 mg 1 tablet daily, and Celexa 10 mg 1 tablet daily. The MRR for R17 dated 6/12/16 revealed the Pharmacist wrote a recommendation to decrease both Seroquel 12.5 mg 1 tablet daily for psychosis since (MONTH) 2010 and Celexa 10 mg daily for depression since (MONTH) 2010. Physician responded, No Changes. The date of physician entry was not recorded. Documentation of the physician rationale could not be found in the record. An interview conducted with the Consulting Pharmacist on 2/21/17 at 3:12 p.m. who stated, the prescribing physician has been reminded more than once on the importance of documenting a clinical rationale when he/she disagrees with a pharmacy GDR recommendation. An interview conducted with the Medical Director on 2/22/17 at 2:19 p.m., who upon review of the GDR request forms signed by the prescribing physician who disagreed with the GDR recommendation with no clinical rationale documented, stated he would reeducate the physician to comply with the regulatory standard as written. 3. A review of physician's orders [REDACTED]. During a review of the Consultant Pharmacist's medication review for R37, a document entitled Note to Attending Physician/Prescriber indicated a pharmacist recommendation to reduce the anti-anxiety medication from .25 mg twice a day to .25 mg once a day. The physician had signed the note related to R37 but did not date when he signed it, wrote no change to the medication, but did not give a rationale for not following the pharmacist's recommendation. During an interview with the Registered Pharmacy Consultant, on 2/22/17 at 1:38 p.m., she stated she had spoken with the physician multiple times about R37 informing him he must document a rationale for not following her recommendations, but he continued to disregard her instructions. During an interview with the facility Medical Director on 2/22/17 at 2:20 p.m. a review of his response to pharmacy recommendations about R37's medications was discussed. He stated he was not aware of the necessity of documenting a rationale for not following a pharmacist recommendation to reduce a resident medication. The facility undated policy titled, Consultant Pharmacy Reports - Medication Monitoring and Management indicated: For Antipsychotics: If a resident is admitted on an antipsychotic medication or the facility initiates antipsychotic therapy, the facility must attempt a gradual dose reduction (GDR) in two separate quarters (with at least one month between the attempts) within the first year, unless clinically contraindicated. After the first year, a GDR must be attempted annually, unless clinically contraindicated. B. If a medication seems unnecessary or harmful to the resident, the (Director of Nursing, consultant pharmacist) requests the prescriber to evaluate the resident for the continued need for the medication and/or to consider tapering the medication. If the prescriber deems the medication necessary, a documented clinical rationale for the benefit of, or necessity for, the medication is documented in the resident's (active record). | 2020-09-01 |
| 508 | MUSC HEALTH CHESTER NURSING CENTER | 425061 | 1 MEDICAL PARK DRIVE | CHESTER | SC | 29706 | 2017-02-23 | 456 | F | 0 | 1 | 4GPQ11 | Based on observation, reviewing dishwasher manufacturer's instruction sheet, and interview, the facility failed to ensure the kitchen dishwashing machine was operating at the appropriate temperatures to ensure all items washed in the machine were properly cleaned and sanitized. This had the potential to affect 31 of 31 sampled residents, Residents (R) (R51, R64, R90, R2, R11, R60, R4, R34, R26, R59, R58, R17, R37, R38, R53, R8, R29, R69, R86, R84, R12, R23, R19, R16, R40, R71, R75, R32, R56, R33, and R30.) Findings include: During an observation in the kitchen on 2/22/17 at 10:10 a.m., the dishwashing machine was observed to run multiple cycles with the maximum wash water temperature of 145 degrees Fahrenheit (F) and a maximum water rinse temperature at 159 degrees F. A review of posted manufacturer's instructions revealed the wash temperature should be 150 degrees F and the rinse should be 180 degrees F to ensure clean, sanitized dining and cooking utensils and plates. An interview with the Dietary Manager on 2/22/17 at 10:13 a.m. confirmed the temperatures of the wash and rinse cycle and confirmed the dish washing machine was not performing at the necessary temperatures. | 2020-09-01 |
| 509 | MUSC HEALTH CHESTER NURSING CENTER | 425061 | 1 MEDICAL PARK DRIVE | CHESTER | SC | 29706 | 2019-06-12 | 550 | E | 0 | 1 | C9E011 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations and interviews, the facility failed to provided dignity during the dining experience on 1 of 3 halls observed and 1 of 1 main dining room observed. Residents that depended on staff to feed them were not served and eating while their roommate was served and eating in full view of the resident not served or eating on the hall with room numbers 33 through 46. Staff was observed placing clothing protectors on residents in the main dining without asking. The finding included: During a random meal observation on 6/10/19 at approximately 12:45 PM revealed a resident served and eating independently in rooms [ROOM NUMBERS] while their roommate was in the room not served or eating in full view of the resident that was eating. During an interview and observation with the Director of Nursing (DON) on 6/10/19 at approximately 12:55 PM s/he confirmed that residents that can feed themselves independently are served first and the residents that require staff assistance are served and fed last when staff are available. The DON further acknowledged the privacy curtains were not pulled and the resident that was eating was in full view of the resident waiting to be served. During a dining room observation on 06/10/19 at approximately 12:00 PM, CNA #1 was in the main dining room assisting residents. CNA #1 applied clothing protectors to residents #57, #40 and #7 without asking permission. During an interview with CNA #1 on 06/10/19 at approximately 12:40 PM CNA #1 stated I just know they want one and they do (want one) when I ask. | 2020-09-01 |
| 510 | MUSC HEALTH CHESTER NURSING CENTER | 425061 | 1 MEDICAL PARK DRIVE | CHESTER | SC | 29706 | 2019-06-12 | 584 | D | 0 | 1 | C9E011 | Based on observations and interview, the facility failed to ensure that privacy curtains in rooms near the window provided full privacy. The privacy curtains in rooms 34-B, 35-B, 36-B, 45-B and 46-B did not extend from wall to wall to ensure full privacy, had stains or tears. 1 or 3 halls reviewed. The findings included: Random room observations on 6/10/19 at approximately 10:41 AM revealed the privacy curtain near the window in rooms 34-B, 35-B, 36-B, 45-B and 46-B did not extend from wall to wall to provide full privacy, had stains or in poor repair (tears). During an interview and observation with the Housekeeping Manager on 6/10/19 at approximately 11:05 AM s/he confirmed there were privacy curtains that did not extend from wall to wall near the window. The Housekeeping Manager stated the facility was in the process of replacing worn and stained privacy curtains. When asked if there was documentation to indicate the facility had identified the concerns with the privacy curtains; the Housekeeping Manager stated no. At approximately 11:20 AM on 6/10/19, the housekeeping department provided a list of rooms #26, #27, #34, #35, #36, #37, #38, #41, #45, #46, #48, #51 and #54 with a note that indicated need to order. No further information was noted. | 2020-09-01 |
| 511 | MUSC HEALTH CHESTER NURSING CENTER | 425061 | 1 MEDICAL PARK DRIVE | CHESTER | SC | 29706 | 2019-06-12 | 636 | D | 0 | 1 | C9E011 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview Resident #29 had no resident assessment done after readmission to the facility related to pressure ulcer developed in the hospital. 1 of 4 residents reviewed for pressure area. The findings included: The facility admitted Resident #29 on 4/26/19 with [DIAGNOSES REDACTED]. Review of Resident #29's Physicians orders revealed an order to clean wound to right hip with wound cleanser and prep area with skin prep, apply therahoney gel and cover with dry dressing daily and PRN(as necessary). Review of Resident #29's Nurses note dated 5/23/19 documented skin condition fair with redness on buttocks, open pressure area on right hip, standing orders applied (therahoney to right hip.) Record review of Resident #29's record revealed that a MDS (Minimum Data Set) had not been completed since re-admission. Review of Resident #29's Care Plan on 6/12/19 revealed no care plan addressing the pressure ulcer. During an interview with the Director of Nursing (DON) on 6/12/19 the DON stated that s/he had not assessed Resident #29 for pressure ulcers when the resident returned from the hospital. Therefore, the pressure area had not been staged or measured, and no documentation had been done on the wound since 5/23/19. | 2020-09-01 |
| 512 | MUSC HEALTH CHESTER NURSING CENTER | 425061 | 1 MEDICAL PARK DRIVE | CHESTER | SC | 29706 | 2019-06-12 | 655 | D | 0 | 1 | C9E011 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview an initial care plan problem for pressure area was never added to the care plan when Resident #29 returned from the hospital. 1 of 4 care plans reviewed for pressure areas. The findings included: The facility admitted Resident #29 on 4/26/19 with [DIAGNOSES REDACTED]. Review of Resident #29's Physicians orders revealed an order to clean wound to right hip with wound cleanser and prep area with skin prep, apply therahoney gel and cover with dry dressing daily and PRN(as necessary). Review of Resident #29's Nurses note dated 5/23/19 documented skin condition fair with redness on buttocks, open pressure area on right hip, standing orders applied (therahoney to right hip.) Record review of Resident #29's record revealed that a MDS (Minimum Data Set) had not been completed since re-admission. Review of Resident #29's Care Plan on 6/12/19 revealed no care plan addressing the pressure ulcer. During an interview with the Director of Nursing (DON) on 6/12/19 the DON stated that s/he had not assessed Resident #29 for pressure ulcers when the resident returned from the hospital. Therefore, the pressure area had not been staged or measured, and no documentation had been done on the wound since 5/23/19. During an interview with the Care Plan Co-coordinator on 6/12/19 s/he stated that the care plan was not updated to reflect the pressure area because it had not been assessed as a wound. The Care Plan Co-coordinator stated that s/he usually picks up in daily meetings or wound assessments. S/he also stated the physicians order for treatment was missed. Review of Resident #29's Medication Administration and Treatment Administration Sheets were reviewed, and treatments were documented as done daily to the pressure area on the right hip. Observation of wound care on 6/12/19 at 3:30 PM showed the wound to be clean, no drainage, and healing. | 2020-09-01 |
| 513 | MUSC HEALTH CHESTER NURSING CENTER | 425061 | 1 MEDICAL PARK DRIVE | CHESTER | SC | 29706 | 2019-06-12 | 761 | D | 0 | 1 | C9E011 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and interview the facility failed to ensure medications were not expired. 2 of 2 medication storage rooms reviewed. The findings included: On 06/11/19 at approximately 09:28 AM surveyor was performing medication storage and discovered expired [MEDICATION NAME] (5 mls/300 mg). The expired [MEDICATION NAME] sulfate was packaged in individual doses of 5 milliliters. 50 individual dosages of the expired medication was dated as expiration date (MONTH) 2019. In addition, 20 individual dosages of the expired medication was dated as expiration date (MONTH) (YEAR). On 06/11/19 at approximately 09:28 AM the Unit Manager and Pharmacist were present during the medication storage checking for expired medications and confirmed the expired medications and removed the expired medications. | 2020-09-01 |
| 514 | MUSC HEALTH CHESTER NURSING CENTER | 425061 | 1 MEDICAL PARK DRIVE | CHESTER | SC | 29706 | 2019-06-12 | 812 | F | 0 | 1 | C9E011 | Based on observation and interview the oven and back splash of range were not cleaned per schedule and a kitchen staff member was observed not wearing a beard protector while in the kitchen preparing food. 1 of 1 main kitchen reviewed. The findings included: During initial observation of the main kitchen on 6/10/10 at 9:30 AM with the Dietary Manager, the ovens had dark brown splatters built up on the inside of the ovens. When the Dietary Manager was asked for the cleaning schedule it was revealed that the ovens were supposed to have been cleaned on 6/5/19; however, that employee had been on leave of absence and no one had taken that assignment. The back splash behind the range top also had build-up of dark brown splatters. On 6/12/19 at 11:45 AM the Chef was observed working over food with no beard protector in place. This was confirmed by the Dietary Manager. | 2020-09-01 |
| 515 | MUSC HEALTH CHESTER NURSING CENTER | 425061 | 1 MEDICAL PARK DRIVE | CHESTER | SC | 29706 | 2019-06-12 | 880 | E | 0 | 1 | C9E011 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations and interviews, the facility failed to ensure that residents' personal laundry was processed to an appropriate manner. The laundry room large overhead vent near the front of the washer was noted with a heavy build of gray matter. There was large section of plastic peeling from the ceiling near the rear of the washer with a hole in the area. Staff did not use a sanitation process of wiping the washer when doing individual residents' laundry. There was no policy in place regarding the handling on resident's personal laundry while at the facility. 1 of 1 laundry rooms reviewed. The findings included: A random observation of the laundry process on 6/11/19 at approximately 7:48 AM with the Linen Service worker revealed a single stainless-steel washer with multiple streaks on the outside of the washer. A large overhead vent near the front of the washer was noted with a heavy buildup of gray matter. There was a large section plastic peeling from the ceiling behind the washer with a hole in the area. The laundry staff did not wipe the washer with a sanitation process after washing individual residents clothing. All the residents clothing was transported in a clear thin plastic bag. Residents identified as being on contact precaution laundry was transported in a clear thin plastic bag. During an interview on 6/11/19 at approximately 8:08 AM with the Linen Service Worker s/he confirmed the observation related to the multiple streaks on the outside of the washer, the hole in ceiling with peeling plastic and heavy lint build up. The Linen Service Worker further stated s/he would wipe down the inside and outside of the washer after every two loads of laundry but did not have an training on how often to clean the washer. During an interview on 6/11/19 at approximately 9:27 AM with the Director of Nursing revealed the facility did not have a policy in place regarding washing resident's personal laundry. The facility reportedly uses the universal precaution doctrine but there was no formal guidance in place for laundry staff to follow. During an interview on 6/12/19 at approximately 12:26 PM with the Housekeeping Manager revealed there was no documentation of training provided to laundry staff on how to maintain the laundry area when handling resident's personal laundry. And no documentation of training when handling resident's laundry who were identified as being on contact precautions such as C.diff ([MEDICAL CONDITION]) or MSRA (Methionine Sulfoxide Reductase A). The Housekeeping Manager further stated that all residents' clothes are transported to the laundry in clear plastic bag. There was no distinction between a resident on contact precautions or the other residents clothing process. | 2020-09-01 |
| 516 | MUSC HEALTH CHESTER NURSING CENTER | 425061 | 1 MEDICAL PARK DRIVE | CHESTER | SC | 29706 | 2018-06-27 | 550 | D | 0 | 1 | 11DB11 | Based on observation and interview the facility failed to maintain the environment in a way that promoted Resident's #6's rights and dignity, 1 of 2 sampled residents reviewed for Dignity. The facility posted confidential clinical information above Resident #6's bed. The findings included: The facility admitted Resident #6 with diagnoses, including, but not limited to, Dementia. Resident #6 was observed in bed on 6/25/2018 at 3:47 PM. A sign, dated 8/29/2017, with swallowing guidelines instructions was posted above his/her bed. The sign was in view of anyone who entered the room. Clinical information posted on the sign included the resident's diet type (puree) and the resident required a low stimulation environment. In addition, the sign indicated the resident required one to one assistance for meals, to sit up for an hour after meals, to crush medications, small bites/sips, one bite at a time, alternate liquids/solids and to remain upright at 90 degrees for all intake. The resident was also observed on 6/26/2018 at 10:39 AM and 12:38 PM with the sign posted above his/her bed. Resident #6 was observed on 6/26/2018 at 12:42 PM with the Director of Nursing (DON) present. The DON confirmed the sign displayed confidential clinical information and removed the sign. The DON also stated the sign should not have been posted for public viewing. | 2020-09-01 |
| 517 | MUSC HEALTH CHESTER NURSING CENTER | 425061 | 1 MEDICAL PARK DRIVE | CHESTER | SC | 29706 | 2018-06-27 | 565 | E | 0 | 1 | 11DB11 | Based on interview and record review the facility failed to act on grievances of the resident council for 3 to 5 months of concerns. The resident council filed concerns of call lights and response times that the facility failed to address in a timely manner. The findings included: Review of resident council minutes on 6/25/18 at approximately 1:22 PM revealed concerns of call light response times and staff taking call lights from residents for (MONTH) and (MONTH) of (YEAR). Interview with resident council on 6/25/18 at approximately 2 PM revealed staffing issues are ongoing and that it can still take time for staff to respond to call lights. Some of the residents expressed having wet themselves because staff were taking too long to respond to call lights. They expressed this issue had been going on for approximately 5 months. Review of grievance logs on 6/27/18 at approximately 10:50 AM revealed concerns with call bell response times going back since (MONTH) (YEAR). | 2020-09-01 |
| 518 | MUSC HEALTH CHESTER NURSING CENTER | 425061 | 1 MEDICAL PARK DRIVE | CHESTER | SC | 29706 | 2018-06-27 | 580 | D | 0 | 1 | 11DB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interviews, the facility failed to ensure that the physician was notified as ordered when Resident #36's finger stick blood sugars went above 400 for 1 of 3 sampled residents reviewed for hospitalization s. Resident #36 had finger stick blood sugars above 400 on 5/28/18 and 6/02/18 with no physician notification as ordered. The findings included: The facility admitted Resident #36 on 5/02/18 with [DIAGNOSES REDACTED]. A review of the medical record on 6/26/18 at approximately 12:20 PM revealed a physician's orders [REDACTED].=2 units, 201-250=4 units, 251-300=6 units, 301-350=8 units, 351-400=10 units, above 400=12 units and call medical doctor. Further review of the medical record revealed a nurse's note dated 5/28/18 that indicated resident had a FSBS of 438 at 16:30 (4:30 PM) with insulin given and rechecked in 30 minutes. There was no documentation to indicate the physician had been called/notified as ordered. A nurses noted dated 6/02/18 indicated the resident had a FSBS of 452 at 11:30 (11:30 AM) with 12 units of insulin given per physician orders. There was no documentation to indicate the physician had been called/notified as ordered. An interview on 6/26/18 at approximately 2:50 PM with Licensed Practical Nurse (LPN) #1 revealed the electronic medical record and 24 hour reporting and confirmed the findings that the physician was not notified of the FSBS over 400 as ordered. An interview on 6/27/18 at approximately 10:17 AM with the Director of Nursing (DON) reviewed the electronic record and confirmed there was no documentation to indicate the physician was notified of the FSBS over 400 on 5/28/18 and 6/02/18. | 2020-09-01 |
| 519 | MUSC HEALTH CHESTER NURSING CENTER | 425061 | 1 MEDICAL PARK DRIVE | CHESTER | SC | 29706 | 2018-06-27 | 585 | C | 0 | 1 | 11DB11 | Based on interview and record review the facility failed to inform residents of their right to file a grievance in 4 of 4 units reviewed. Grievance procedure was not posted in public view as specified by the facility's grievance policy. The findings included: Resident council interview on 6/25/18 at approximately 2 PM revealed several residents did not know how to file a grievance. Review of grievance policy on 6/26/18 at approximately 3:29 PM revealed a copy of grievance / complaint procedure was to be posted on the resident bulletin board. Observation of resident bulletin boards on 6/26/18 at approximately 3:40 PM revealed it was not posted on either resident bulletin board. Interview with social services director on 6/26/18 at approximately 3:50 PM confirmed it was not posted. | 2020-09-01 |
| 520 | MUSC HEALTH CHESTER NURSING CENTER | 425061 | 1 MEDICAL PARK DRIVE | CHESTER | SC | 29706 | 2018-06-27 | 655 | D | 0 | 1 | 11DB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview the facility failed to develop a baseline care plan within 48 hours of admission for Resident #33, 1 of 1 sampled resident reviewed for [MEDICAL TREATMENT]. In addition, the facility had no documentation to show the Resident Representative (RR) was provided a written summary of the baseline care plan by completion of the comprehensive care plan. The findings included: The facility admitted Resident #33 with [DIAGNOSES REDACTED]. Record review of the baseline care plan on 6/27/2018 at 10:01 AM, revealed instructions to date top of each problem section upon initiation. 5 problem sections of the baseline care plan were initiated and were not dated. The section to show who initially completed the baseline care plan was blank. The date for when the baseline care plan was initially completed was blank. The baseline care plan was signed by the RR, but there was no date to indicate when it was signed. Further review of the medical record revealed no documentation of when the baseline care plan was initiated or when the RR was given the written summary. During an interview with the Director of Nursing (DON) on 6/27/2018 at 10:54 AM, the DON confirmed the baseline care plan was not dated on initiation nor dated when the RR signed the baseline care plan. The DON stated there was no documentation to show when the baseline care plan was created or when the RR was given a written summary. | 2020-09-01 |
| 521 | MUSC HEALTH CHESTER NURSING CENTER | 425061 | 1 MEDICAL PARK DRIVE | CHESTER | SC | 29706 | 2018-06-27 | 656 | D | 0 | 1 | 11DB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and interview, the facility failed to follow the care plan related to contractures for 1 of 2 residents reviewed for positioning/mobility. The findings included: Resident #12 was admitted to the facility with [DIAGNOSES REDACTED]. Initial observation of Resident #12 on 6/25/2018 at approximately 10AM revealed that the Resident had severe contractures of the left (L) and Right (R) hand, however, there were no splints or interventions applied. Random observations throughout the day on 6/26/2018 and 6/27/2018 revealed that there were no interventions in place for Resident #12's contractures. On 6/26/2018 at approximately 10AM, Resident #12's medical record was reviewed and provided that on 5/17/2018, a physician (MD) order was written for a L hand splint; 4-6 hours a day; 5 times a week. On 6/1/2018, a telephone order was given for bilateral hand splints; 4 hours; 7 days a week for 12 weeks. Resident #12's care plan was reviewed on 6/26/2018 at 1018AM revealed that the Resident was care planned to have splints applied. Review of the Restorative Care Flow Record on 6/26/2018 at 1050AM revealed that the splints had not been applied since the original order was written on 5/17/2018. In an interview with the Director of Nursing (DON) on 6/26/2018 at 11AM, the DON stated For 6/25/2018 and 6/26/2018, the restorative aide was pulled to a floor assignment at the hospital and couldn't place the splint on the Resident and we didn't have anyone else to do it. The DON also stated the splints haven't been applied because we probably had staffing issues on those days and didn't have anyone to place them. | 2020-09-01 |
| 522 | MUSC HEALTH CHESTER NURSING CENTER | 425061 | 1 MEDICAL PARK DRIVE | CHESTER | SC | 29706 | 2018-06-27 | 657 | D | 0 | 1 | 11DB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and interview the facility failed to revise the care plan for Resident #35, 1 of 2 sampled residents reviewed for Range of Motion. In addition, the facility failed to implement interventions on the care plan to maintain or prevent a decline in Range of Motion. The findings included: The facility admitted Resident #35 with [DIAGNOSES REDACTED]. Resident #35 was observed at lunch on 6/26/2018 at 11:52 AM. The resident was in a wheel chair with her/his right arm resting on a pillow to her/his right side. The right arm appeared flaccid, but not contracted. The resident did not move her/his right arm. Record review of the care plan on 6/26/2018 at 2:23 PM, revealed a focus area for Activities of Daily Living (ADLs) indicating the resident had limited physical mobility related to Stroke with right sided [MEDICAL CONDITION]. The were no interventions to promote Range of Motion. In addition, a focus area for Musculoskeletal indicated the resident had a alteration in musculoskeletal status [MEDICAL CONDITION], contractures. A goal listed for the focus area was to remain free of contractures. There were no interventions listed for this focus area to promote Range of Motion or prevent contractures. During an interview with the Director of Nursing (DON) on 6/27/2018 at 11:01 AM, the DON confirmed the care plan addressed the resident's impaired Range of Motion and risk for contractures. The DON stated there were no interventions on the care plan to prevent contractures or to prevent a decline in Range of Motion. | 2020-09-01 |
| 523 | MUSC HEALTH CHESTER NURSING CENTER | 425061 | 1 MEDICAL PARK DRIVE | CHESTER | SC | 29706 | 2018-06-27 | 698 | D | 0 | 1 | 11DB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interview and review of facility policy the facility failed to provide appropriate services to Resident #33, 1 of 1 sampled resident reviewed for [MEDICAL TREATMENT]. The resident's [MEDICAL TREATMENT], weight and vital signs were not monitored. In addition, there were no orders to receive [MEDICAL TREATMENT] or how often. The findings included: The facility admitted Resident #33 with [DIAGNOSES REDACTED]. Record review of the physician's orders [REDACTED]. In addition, there were no orders related to monitoring the residents [MEDICAL TREATMENT] for bleeding or infection. There were no orders to check the thrill and bruitt of the access site. Record review of the Medication Administration Record [REDACTED]. Record review of the [MEDICAL TREATMENT] Communication Record (DCR) on 6/27/2018 at 9:45 AM, revealed the resident attended [MEDICAL TREATMENT] 3 days a week and the DCR was sent to [MEDICAL TREATMENT] with the resident. The DCR revealed that vital signs and weights were to be checked before and after [MEDICAL TREATMENT]. In addition the thrill and bruitt was to be checked prior to [MEDICAL TREATMENT]. From 4/17/18-6/26/18 the thrill and bruitt was not checked 13 times. Pre-[MEDICAL TREATMENT] vital signs were not checked 6 times. Pre-[MEDICAL TREATMENT] weights were not checked 18 times. Post-[MEDICAL TREATMENT] weights were not checked 7 times. Review of the facility's [MEDICAL TREATMENT] policy on 6/27/2018 at 10:15 AM revealed The facility staff will provide immediate monitoring and documentation of the status of the resident's access site (s) upon return from the [MEDICAL TREATMENT] treatment to observe for bleeding or other complications. During an interview with the Director of Nursing (DON) on 6/27/2018 at 10:20 AM, the DON confirmed the thrill and bruitt checks, weights and vital signs were not documented as done. During an interview with the DON on 6/27/2018 at 10:54 AM, the DON confirmed the facility policy for monitoring the access site was not done. The DON also confirmed there was no order for [MEDICAL TREATMENT]. The DON stated there was no additional documentation to show thrill and bruitt, vital signs and weights were done pre and post [MEDICAL TREATMENT]. The DON stated the [MEDICAL TREATMENT] center should have been checking the pre and post weights. In addition, the DON stated there should have been orders for checking the thrill and bruitt and monitoring of the access site every shift. The DON stated this should have been on the TAR to ensure it was done. | 2020-09-01 |
| 524 | MUSC HEALTH CHESTER NURSING CENTER | 425061 | 1 MEDICAL PARK DRIVE | CHESTER | SC | 29706 | 2018-06-27 | 725 | E | 0 | 1 | 11DB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to maintain sufficient staffing to provide care and services to the residents for 4 of 4 units reviewed during the survey. The findings included: Resident #19 was admitted to the facility with [DIAGNOSES REDACTED]. Review of the facility's grievance log from January-June (YEAR) on 6/26/2018 at approximately 930AM revealed that there was an ongoing issue with call-light response time since (MONTH) (YEAR). The Resident Council minutes for the same period were also reviewed and proved that call light response was an ongoing issue since (MONTH) (YEAR). In a telephone interview with Resident 19's Responsible Party (RP), RP stated that it could take up 30 minutes for the facility staff to answer the call light. The RP also stated that when staff did respond after waiting, staff would verbalize to him/her that it took so long to respond because the facility was short staffed. In an interview with the Director of Nursing (DON) regarding a different resident on 6/26/2018 at 11AM, the DON stated, the splints haven't been applied because we probably had staffing issues on those days and didn't have anyone to place them. Review of resident council minutes on 6/25/18 at approximately 1:22 PM revealed concerns of call light response times and staff taking call lights from residents for (MONTH) and (MONTH) of (YEAR). Interview with resident council on 6/25/18 at approximately 2 PM revealed staffing issues are ongoing and that it can still take time for staff to respond to call lights. Some of the residents expressed having wet themselves because staff were taking too long to respond to call lights. They expressed this issue had been going on for approximately 5 months. Review of grievance logs on 6/27/18 at approximately 10:50 AM revealed concerns with call bell response times going back since (MONTH) (YEAR). Interview with Licensed [MEDICATION NAME] Nurse (LPN) #2 on 6/27/18 at approximately 9:20 AM revealed s/he watches over 30 residents and does not have enough time in a shift to finish tasks without sacrificing breaks or staying late. S/he also stated that the facility is aware with staffing problems and short staffing, and they try to get people to work overtime and are trying to hire new staff. Interview with Certified Nursing Assistant (CNA) #1 on 9:30 AM confirmed concerns with staffing. S/he stated that nurses, restorative, and activities staff are often pulled onto units to help out. Interview with Director of Nursing (DON) on 6/27/18 at approximately 9:55 AM confirmed that staff from activities and restorative staff are pulled a couple times a week to work as a CN[NAME] Interview with Staffing Coordinator on 6/27/18 at approximately 10 AM revealed turnover rate was high. Review of Turnover Report on 6/27/18 at approximately 10:30 AM revealed a 20% turnover rate for skilled nursing care over the period of a year. | 2020-09-01 |
| 525 | MUSC HEALTH CHESTER NURSING CENTER | 425061 | 1 MEDICAL PARK DRIVE | CHESTER | SC | 29706 | 2018-06-27 | 756 | D | 0 | 1 | 11DB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to identify medication irregularities in 1 of 5 residents reviewed for unnecessary medications. Resident #17 was ordered PRN [MEDICATION NAME] for over 14 days and the pharmacist did not identify this irregularity in the medication regimen review. The findings included: Resident #17 was admitted to to the facility on [DATE] with [DIAGNOSES REDACTED]. Review of orders on 6/26/18 at approximately 9:50 AM revealed an order for [REDACTED]. Review of medication reviews on 6/26/18 at approximately 10:20 AM revealed the pharmacist did not identify the extended use of PRN [MEDICATION NAME] as an irregularity. Interview with the pharmacist on 6/26/18 at approximately 12:17 PM confirmed that the extended use of PRN [MEDICATION NAME] was not identified as an irregularity. | 2020-09-01 |
| 526 | MUSC HEALTH CHESTER NURSING CENTER | 425061 | 1 MEDICAL PARK DRIVE | CHESTER | SC | 29706 | 2018-06-27 | 758 | E | 0 | 1 | 11DB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interviews, the facility failed to provide a documented rationale for continued use of as needed (PRN) [MEDICAL CONDITION] medication ([MEDICATION NAME]) beyond 14 days for Resident #9 and continued to use PRN [MEDICATION NAME] for Resident #17 beyond 14 days for 2 of 5 sampled residents reviewed for unnecessary medications. The findings included: The facility admitted Resident #9 on 12/25/12 with [DIAGNOSES REDACTED]. A review of the medical record on 6/26/18 at approximately 11:18 AM revealed a pharmacy consultant with a printed date of 3/01/18 that indicated this was the third request from 11/2017 to indicate why the PRN (as needed) [MEDICATION NAME] 0.25 milligrams was given. The pharmacy consultant document further indicated Residents do not receive PRN [MEDICAL CONDITION] drugs unless med is necessary to treat a diagnosed specific condition that is documented in the clinical record. PRN orders for [MEDICAL CONDITION] drugs are limited to 14 days. If order needs to be extended, physician should document their rationale in the medical record and indicate the duration PRN orders for antipsychotic drugs are limited to 14 days. Orders cannot be renewed unless physician evaluates the resident for continued appropriateness of the med and document in the resident's chart. Review of the (MONTH) (YEAR) Medication Administration Record [REDACTED]. Further review of the medical record revealed a new physician's orders [REDACTED]. There was no documentation in the medical record to indicate the reason for the continued use of the as needed [MEDICAL CONDITION] medication [MEDICATION NAME]. An interview on 6/26/18 at approximately 11:35 AM with the facility's pharmacy consultant who reviewed the medical record confirmed there was no documentation to address the reason for the continued use of the PRN medication [MEDICATION NAME] beyond 14 days. An interview on 6/27/18 at approximately 10:17 AM with the Director of Nursing (DON) revealed he/she spoke with the facility's pharmacy consultant and was informed that there was no documentation in the medical record to justify the continued use of the PRN [MEDICATION NAME] beyond 14 days. Resident #17 was admitted to to the facility on [DATE] with [DIAGNOSES REDACTED]. Review of orders on 6/26/18 at approximately 9:50 AM revealed an order for [REDACTED]. Interview with the pharmacist on 6/26/18 at approximately 12:17 PM confirmed extended order for PRN [MEDICATION NAME] as well as the lack of documentation regarding justification for extended use of PRN [MEDICATION NAME] or intended duration. | 2020-09-01 |
| 527 | MUSC HEALTH CHESTER NURSING CENTER | 425061 | 1 MEDICAL PARK DRIVE | CHESTER | SC | 29706 | 2018-06-27 | 812 | D | 0 | 1 | 11DB11 | Based on observation, interview and record review, the facility failed to ensure that all staff members working in the kitchen had proper hair restraints in place for 1 of 1 main kitchen. The findings included: A random observation of the kitchen on 6/26/2018 at about 11:45AM revealed that a food service staff member was in the food preparation area without a hair restraint. An interview with the Food Services Director revealed that he/she would expect food services members to wear the proper hair restraints when in the kitchen area. A review of the food services policy on hair restraints on 6/27/18 at approximately 930AM stated Food employees shall wear hair restraints such as hats, hair coverings or nets, beard restraints, and clothing covers body hair, that are designed and worn to effectively keep their hair from contacting exposed food. The policy also states, Facial hair must be effectively restrained as per local and state regulations. | 2020-09-01 |
| 4737 | MUSC HEALTH CHESTER NURSING CENTER | 425061 | 1 MEDICAL PARK DRIVE | CHESTER | SC | 29706 | 2016-05-11 | 156 | C | 0 | 1 | 1UJ011 | Based on record review and interviews, the facility failed to provided the required Centers for Medicare and Medicaid (CMS) Advance Beneficiary Notice (ABN) form for 3 of 3 sampled residents reviewed for notification of medicare liability notices. The findings included: During a review of the medicare liability notices on 5/11/16 at approximately 8:59 AM with the Business Office Manager (BOM) revealed the facility did not provide the Advance Beneficiary Notice (ABN) form for 3 of 3 sampled residents. The BOM stated he/she was not aware that the CMS ABN form was required During an interview with the BOM and Social Services Director at approximately 9:30 AM revealed the facility had been completing the Notice of Medicare Non-Coverage (NOMNC) Centers for Medicare and Medicaid Services (CMS) form but not the Advance Beneficiary Notice (CMS) which does address the resident's right to request a demand bill. | 2019-08-01 |
| 4738 | MUSC HEALTH CHESTER NURSING CENTER | 425061 | 1 MEDICAL PARK DRIVE | CHESTER | SC | 29706 | 2016-05-11 | 241 | E | 0 | 1 | 1UJ011 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations and interviews, the facility failed to ensure the staff knocked on residents' doors during meal delivery on 2 of 4 halls observed for dignity. Staff was observed entering residents' room during lunch without knocking on 2 days of the survey. The findings included: During the lunch meal observation on the Gaston Wing on 5/09/16 at approximately 1 PM, staff was observed entering multiple residents' rooms to deliver lunch without knocking. During the lunch meal observation on the Gaston Wing on 5/10/16 at approximately 1 PM staff was observed delivering the meals to residents' rooms without knocking. An interview on 5/10/16 at approximately 1:08 PM with Certified Nursing Aide (CNA) #1 confirmed he/she did not knock on residents' doors that were opened during the meal delivery. CNA #1 further stated they generally did not knock on the residents' door when they are opened because the resident can see them delivering the meal. The CNA stated they knock on the resident's door when it was closed. During an interview on 5/10/16 at approximately 1:11 PM with Licensed Practical Nurse (LPN) #1 revealed staff should acknowledge their presence by saying knock, knock then enter the resident's room during meal delivery when the door was opened. On 05/10/2016 during the lunch meal, an observation was made of CNA #2(Certified Nursing Assistant) taking a meal tray into resident room [ROOM NUMBER] on Stone Wing without knocking. CNA #2 was interviewed on 05/11/2016 at approximately 12:30 PM and confirmed that he/she did not knock prior to entering the room. CNA #2 stated I know I did forget to knock, resident is very hard of hearing. I went to sink to get paper towels to wipe something spilled on her tray, then told the resident that I had her lunch | 2019-08-01 |
| 4739 | MUSC HEALTH CHESTER NURSING CENTER | 425061 | 1 MEDICAL PARK DRIVE | CHESTER | SC | 29706 | 2016-05-11 | 242 | D | 0 | 1 | 1UJ011 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interviews, the facility failed to honor a resident's choices/rights to get the number of showers preferred for 1 of 3 sampled residents reviewed for choices. Resident #59 was not afforded the right to make choices related to the shower frequency. The findings included: The facility admitted Resident #59 with [DIAGNOSES REDACTED]. A record review on 5/10/16 at approximately 2:26 PM revealed a Quarterly Minimum Data Set ((MDS) dated [DATE] that indicated the resident had a Brief Interview Mental Status (BIMS) of 13, which indicated the resident was alert and interview-able. During an interview on 5/09/16 at approximately 1:10 PM, Resident #59 stated, No when asked, Do you choose how many times a week you take a bath or shower? Resident #59 stated he/she would like to have showers more than 2 times a week because he/she feels cleaner when he/she takes showers. Review of the CNA (Certified Nursing Assistant) Nursing Center Resident Bath List on 2nd and 3rd shift, revealed that Resident #59 received 2 showers a week. Review of the 2/01/16 MDS revealed Resident #59 was totally dependent on staff for Activities of Daily Living (ADL) care. An interview on 5/10/16 at approximately 2:33 PM with Licensed Practical Nurse #4 revealed Resident #59 gets showers Wednesday and Saturday. LPN #4 stated the residents can have more showers and they can reportedly ask a nurse on the unit. LPN #4 stated after being asked, if the resident has requested more showers, the LPN stated nurses rotate units every two weeks. An interview on 5/10/16 at approximately 2:43 PM with the Director of Nursing revealed Resident #59 had showers twice a week. When asked if a resident wanted showers more than twice a week, how do they get them? The DON stated he/she would have to find that out and get back with surveyor. An interview on 5/11/16 at approximately 9:27 PM with the DON revealed there was no form related to the number of showers a resident can choose to have while in the facility. | 2019-08-01 |
| 4740 | MUSC HEALTH CHESTER NURSING CENTER | 425061 | 1 MEDICAL PARK DRIVE | CHESTER | SC | 29706 | 2016-05-11 | 250 | D | 0 | 1 | 1UJ011 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interviews, the facility failed to provide medically related social services for 1 of 2 sampled residents reviewed for social services. Resident #48 was documented with an episode of agitation and crying that resulted in a dose increase of a psychotropic medication with no social services interventions. The findings included: The facility admitted Resident #48 with [DIAGNOSES REDACTED]. A review of the medical record on 5/10/16 at approximately 12:21 PM revealed Resident #48 was admitted on [DATE] receiving the medication Seroquel at 25 milligrams everyday. A nurse's note dated 3/14/16 at 1 PM revealed the resident was restless and talking loudly. A nurse reportedly tried to provide one on one but the resident became increasingly agitated, yelling at staff and trying to get out of bed. The resident was reportedly pounding his/her fist on the bed stating he/she was tired of not being home and he/she was going home now. The family was notified. The family arrived at approximately 1:45 PM and the resident continued to be agitated, crying and expressing desire to go home. A review of a nurse's note dated 3/21/16 indicated new orders received to increase Seroquel to 50 milligrams everyday. There was no documentation in the nurse's notes or social services notes to indicate the facility attempted to address the resident's psychosocial issues of agitation, crying and wanting to go home. During an interview on 5/10/16 at approximately 12:55 PM with the Assistant Director of Nursing (ADON) confirmed there was no documentation to indicate referral was made to social services. The ADON further confirmed the medication was increased due to 3/14/16 nurse note and there was no other documentation of behaviors in the medical/electronic record. During an interview on 5/10/16 at approximately 1:54 PM with the Social Services Director (SSD) revealed he/she was aware of a crying episode last week. The SSD stated he/she was not aware of a crying episode/incident in (MONTH) (YEAR) which resulted in an increase of medication. The SSD stated the resident would cry when expressing thanks for the care and services he/she would receive in the facility. The SSD further stated he/she was not aware of any behaviors and he/she only had an admission social note dated 3/10/16 in the medical/electronic record that did not address behaviors. An interview on 5/11/16 at approximately 9:28 AM with the Director of Nursing (DON) revealed there was no documentation in the medical record to indicate medically related social services were provided for Resident #48 based on the 3/14/16 nurse's note that indicated the resident was agitated and crying which resulted in an increase in medication on 3/21/16. | 2019-08-01 |
| 4741 | MUSC HEALTH CHESTER NURSING CENTER | 425061 | 1 MEDICAL PARK DRIVE | CHESTER | SC | 29706 | 2016-05-11 | 279 | D | 0 | 1 | 1UJ011 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to develop a comprehensive plan of care for 1 of 5 sampled residents reviewed for unnecessary medications. Resident #48 was not care planned for receiving [MEDICAL CONDITION] medications. The findings included: The facility admitted Resident #48 with [DIAGNOSES REDACTED]. A review of the medical record on 5/10/16 at approximately 12:21 PM revealed Resident #48 was receiving two (2) [MEDICAL CONDITION] medications ([MEDICATION NAME] 10 milligrams everyday and [MEDICATION NAME] 25 mg everyday) since admission on 3/10/16 and was not care planned. Further review of the care plan revealed Resident #48 was not care planned for behaviors. During an interview on 5/11/16 at approximately 10:49 AM with Registered Nurse/Care Plan Coordinator (RN/CPC) confirmed the findings and stated he/she was not aware of the resident's [DIAGNOSES REDACTED]. | 2019-08-01 |
| 4742 | MUSC HEALTH CHESTER NURSING CENTER | 425061 | 1 MEDICAL PARK DRIVE | CHESTER | SC | 29706 | 2016-05-11 | 280 | D | 0 | 1 | 1UJ011 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interviews, the facility failed to update the care plan after initiation of antipsychotic medication for resident #6. 1 of 5 residents reviewed for unnecessary medications. The findings included: Resident #6 with [DIAGNOSES REDACTED]. Record review of the physicians orders on 05/10/2016 revealed focus areas including anxiety disorder, physical behavior symptoms and agitation. The care plan also included focus areas related to antidepressant medication use and antianxiety medication use. The care plan was not revised to show that antipsychotic medication was initiated for the resident. Record review of the Minimum Data Set (MDS) 3.0 on 05/10/2016 revealed that the resident had a BIMS (Brief Interview for Mental Status) score of 2, indicating severe cognitive impairment. During an interview with the Director of Nursing (DON) and Registered Nurse (RN) #1 on 05/11/2016 the DON and RN # 1 confirmed that the resident was started on [MEDICATION NAME] on 2/3/2016. In addition the DON and RN #1 confirmed that the residents care plan had not been revised to include antipsychotic medication use. | 2019-08-01 |
| 4743 | MUSC HEALTH CHESTER NURSING CENTER | 425061 | 1 MEDICAL PARK DRIVE | CHESTER | SC | 29706 | 2016-05-11 | 315 | D | 0 | 1 | 1UJ011 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview the facility failed to obtain a physician's order for catheter care for resident #8, 1 of 3 sampled residents reviewed with Urinary Catheters. Resident #8 was receiving catheter care, but there was no order to do catheter care and no orders identifying when or how frequently catheter care should be done. The findings included: The facility admitted Resident #8 with [DIAGNOSES REDACTED]. Record review of the Physician's Orders on 5/10/2016 at 12:24 PM revealed an order to apply a drain sponge to the resident's Suprapubic (SP) catheter after catheter care to prevent irritation. This treatment was scheduled to be done daily on the night shift. There was no order specifically for catheter care. Record review of the Treatment Administration Records (TARs) for the past 3 months on 5/10/2016 at 1:00 PM, revealed documentation that the drain sponge was being applied as ordered daily on the night shift. Record review of the Care Plan on 5/10/2016 at 1:32 PM revealed the following interventions for the resident's Suprapubic Catheter: Cath (catheter) care daily by licensed nurse daily. Apply drain sponge to SP cath site after cath care to prevent skin irritation q (every) shift. During an interview with Licensed Practical Nurse (LPN) #3 on 5/10/2016 at 1:43 PM, LPN #3 stated that the resident received cath care every day shift and wasn't sure if the resident received catheter care on the night shift or not (Nursing at the facility works 12 hour shifts). During an additional interview at 2:46 PM, the orders were reviewed with LPN #3. LPN #3 stated she/he followed the drain sponge order as the order for cath care. LPN #3 stated the drain sponge order was not clearly an order for [REDACTED]. The DON also confirmed that the drain sponge order was being done on the night shift. The DON stated the facility went to an electronic record in (MONTH) and the order for catheter care must not have been picked up on the electronic record. The DON also stated it was her/his and the Unit Manager's job to ensure accuracy and clarification of orders. The DON also confirmed that the Care Plan interventions indicated that cath care should be done daily and every shift. The orders prior to the electronic orders were reviewed with the DON and an order to do catheter care daily was on the TAR for January, (YEAR). During an interview with Registered Nurse (RN) #1 on 5/10/2016 at 2:32 PM, RN #1 confirmed that cath care was care planned to be done daily. RN #1 also confirmed that the same Care Plan indicated cath care should be done every shift, as well. RN #1 stated she would check the Physician's Orders to determine how often catheter care should be done. After checking the orders RN #1 confirmed there was not an order for [REDACTED].>Review of the Nurse's Notes, Physician's Orders and Lab Reports revealed that the resident did not suffer from any Urinary Tract Infections since switching to the electronic orders. | 2019-08-01 |
| 4744 | MUSC HEALTH CHESTER NURSING CENTER | 425061 | 1 MEDICAL PARK DRIVE | CHESTER | SC | 29706 | 2016-05-11 | 329 | D | 0 | 1 | 1UJ011 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interviews, the facility failed to ensure that a resident on a [MEDICAL CONDITION] medication was adequately monitored for its use for 1 of 5 sampled residents reviewed of unnecessary medications. Resident #48 was documented with an episode of agitation and crying episode which resulted in a dose increase of a [MEDICAL CONDITION] medication with no non medication interventions in place prior to dose increase. There was on-going behavioral documentation to indicate the need for a dose increase. The findings included: The facility admitted Resident #48 with [DIAGNOSES REDACTED]. A review of the medical record on 5/10/16 at approximately 12:21 PM revealed Resident #48 was admitted on [DATE] receiving the medication [MEDICATION NAME] at 25 milligrams everyday. A nurse's note dated 3/14/16 at 1 PM revealed the resident was restless and talking loudly. A nurse reported tried to provide one on one but the resident became increasing agitated, yelling at staff and trying to get out of bed. The resident was reportedly pounding his/her fist on the bed stating he/she was tired of not being home and he/she was going home now. The family was notified. The family arrived at approximately 1:45 PM and the resident continued to be agitated, crying and expressing desire to go home. A review of a nurse's note dated 3/21/16 indicated new orders received to increase [MEDICATION NAME] to 50 milligrams everyday from the 25 milligrams received on admission. There was no behavioral monitoring/documentation in the medical record to indicate the use of the of the [MEDICATION NAME] on admission to present. The was no documentation in the nurse's notes to indicate the reason for the increase in the [MEDICATION NAME]. There was no documentation in the nurse's notes or social services notes to indicate the facility attempted to address the resident's psychosocial issues of agitation, crying and wanting to go home other than increasing the medication. During an interview on 5/10/16 at approximately 12:55 PM with the Assistant Director of Nursing (ADON) confirmed the medication was increased due to a 3/14/16 nurse note and there was no other documentation of behaviors in the medical/electronic record. During an interview on 5/10/16 at approximately 1:54 PM with the Social Services Director (SSD) revealed he/she was aware of a crying episode last week. The SSD stated he/she was not aware of a crying episode/incident in (MONTH) (YEAR) which resulted in an increase of medication. The SSD stated the resident would cry when expressing thanks for the care and services he/she would receive in the facility. The SSD further stated he/she was not aware of any behaviors and he/she only had an admission social note dated 3/10/16 in the medical/electronic record that did not address behaviors. An interview on 5/11/16 at approximately 9:28 AM with the Director of Nursing (DON) revealed there was no documentation in the medical record to indicate medically related social services were provided for Resident #48 based on the 3/14/16 nurse's note that indicate the resident was agitated and crying which resulted in an increased in medication on 3/21/16. The DON further stated there was no assessment in the medication record to address the use of [MEDICATION NAME]. During an interview on 5/11/16 at approximately 10:49 AM with Registered Nurse/Care Plan Coordinator (RN/CPC) confirmed the findings and stated he/she was not aware of the resident's [DIAGNOSES REDACTED]. The RN/CPC further stated agitation and crying was not a reason to increase medication. | 2019-08-01 |
| 4745 | MUSC HEALTH CHESTER NURSING CENTER | 425061 | 1 MEDICAL PARK DRIVE | CHESTER | SC | 29706 | 2016-05-11 | 371 | F | 0 | 1 | 1UJ011 | Based on observations, interviews and review of the facility's Resident Food Service policy, the facility failed to ensure foods were properly covered during meal delivery on 2 days of the survey on 4 of 4 halls observed sanitary food delivery. Food trays had bread on a saucer and fruit in a small clear colored bowl that were uncovered during meal delivery. The findings included: During meal observation on 5/09/16 at approximately 12:15 PM on the Brice Wing revealed bread on a saucer that was not covered when staff removed a food tray from the food cart and delivered the tray down the hall. Staff was observed pressing the food tray closed to his/her mid section to balance the food tray while the bread was uncovered. Staff was observed delivering other trays to the(NAME)Wing from the food cart with uncovered bread on the food tray. During the meal observation on 5/09/16 at approximately 12:50 PM on the Gaston Wing staff was observed delivering food trays with uncovered bread on a saucer from the food cart. During meal observation on 5/10/16 at approximately 1 PM, staff was observed delivering food trays down the hall from a food cart with fruit in a bowl that was uncovered. An interview on 5/10/16 at approximately 1:06 PM with Certified Nursing Aide #1 confirmed the fruit in the bowl was not covered and that sometimes other food items are covered and sometimes they are not. During an interview with the Director of Food and Nutrition Services on 5/11/16 at approximately 10 AM confirmed the bread on the saucers and fruit in bowls were not covered on the food tray because they were delivered from the main kitchen to the unit inside a food cart. A review of the facility's Resident Food Services policy reviewed under Dining Services Department under bullet #2 Assembles meals in the kitchen and delivers them in an enclosed cart or delivers food pans to serving area in closed cart. When served on ancillary open carts, ensures all food items not under cover or served in individual packaging are protected with plastic wrap or other covering. | 2019-08-01 |
| 4746 | MUSC HEALTH CHESTER NURSING CENTER | 425061 | 1 MEDICAL PARK DRIVE | CHESTER | SC | 29706 | 2016-05-11 | 431 | D | 0 | 1 | 1UJ011 | Based on observations, record reviews, interview and manufacturer labeling the facility failed to ensure that a sterile medication was properly stored in 1 of 4 medication carts observed. The findings included: On 05/09/2016 at approximately 3:02 PM inspection of the Gaston Wing Medication Cart revealed one opened and 3/4 full bottle of Sterile 0.9% (percent) Normal Saline, USP (United States Pharmacopoeia) 100 ml (milliliters) by Medline. The label on the opened and partially used bottle was labeled by the manufacturer: Caution: No antimicrobial or other substance added. and Contents sterile unless container is opened or damaged. This finding was verified on 5/9/16 at approximately 3:06 PM by Licensed Practical Nurse #2 who stated that the bottle should have been discarded after use. | 2019-08-01 |
| 5819 | CHESTER NURSING CENTER | 425061 | 1 MEDICAL PARK DRIVE | CHESTER | SC | 29706 | 2015-01-14 | 157 | D | 0 | 1 | 0ILK11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to notify the physician and family/responsible party (RP) of significant changes in the resident's medical condition potentially requiring physician intervention for 1 of 4 sampled residents reviewed for Finger Stick Blood Sugars (FSBS). There was no evidence that the physician and family were notified when Resident #33's blood sugars were over 400 mg%. The findings included: The facility admitted Resident #33 with [DIAGNOSES REDACTED]. Record review on 1/14/15 at approximately 9:48 AM revealed physician's orders [REDACTED]. Call MD if greater than 400. Review of Nurses Notes on 1/14/15 at approximately 10:30 AM revealed that Resident #33 had significantly elevated blood sugars with no evidence of notification of the physician or the resident's family/RP: 9/24/14 1730 (5:30 PM) FSBS at 1717 was 422. Rechecked with different glucometer, FSBS at 1726 was 416. Called lab to come and verify blood glucose. Will continue to monitor. 9/24/14 1755 (5:55 PM) Received report from lab that blood glucose was 412. On-call MD paged. 9/24/14 1805 (6:05 PM) Doctor paged again. Awaiting response. 9/24/14 (YEAR) (8:15 PM) Page not returned by doctor. Resident received scheduled 35 units of [MEDICATION NAME] as ordered. Continued review of Nurses Notes revealed the following: 1/7/15 6:00 PM FSBS 442. Rechecked 459. Lab verified Blood Glucose via venous puncture as 410. On-call MD paged. 1/7/15 9:30 PM On-call MD paged x 3. No return call received. Resident received 35 units [MEDICATION NAME] at 9:00 PM per (routine) order will continue to monitor. During an interview on 1/13/15 at approximately 3:00 PM, the Assistant Director of Nursing (ADON) stated that when a resident's blood sugar was high, the nurse would get the lab to recheck it. The nurse should notify the physician for an order and then notify the resident's responsible party. The ADON stated that the physician should be notified in a timely manner and, if the physician and/or on-call physician could not be reached, the resident should be sent to the emergency room (ER) for evaluation. After reviewing the Nurses Notes, the ADON confirmed that the physician never returned the facility's calls and that the nurses should have sent the resident to the ER. | 2018-08-01 |
| 5820 | CHESTER NURSING CENTER | 425061 | 1 MEDICAL PARK DRIVE | CHESTER | SC | 29706 | 2015-01-14 | 253 | D | 0 | 1 | 0ILK11 | Based on observations and interview, the facility failed to provide services necessary to maintain the interior of the facility in good repair on 2 of 3 units. Multiple residents had torn/cracked padding on wheelchairs. Closets and walls were damaged and there were missing pieces of baseboard. The findings included: During the days of the survey, random observations were made of residents with cracked/torn padding on the arms of their wheelchairs. The residents in Rooms 41-A, 42-A and 34-B had wheelchairs with cracks and tears which caused the foam cushioning to be exposed. During an environmental tour with the Maintenance Director on 1/14/15 at approximately 8:48 AM, the following concerns were observed and confirmed: -Room 20: The ceiling vent in the bathroom had dirt and rust build-up. The resident's bathroom had an accumulation of dead bugs in the light fixture. -Room 27: Baseboard was missing beneath the resident's sink. -Room 34: The closet door had multiple scratches. -Room 35: There were multiple scraped areas on the bottom of the closet door and stains on the wall under the paper towel dispenser. -Room 42- There was missing plaster on the walls in front of A bed and on the side of B bed. Baseboard was missing along the wall. During an interview on 1/14/15 at approximately 9:20 AM, the Maintenance Director stated that there was no system in place to monitor the condition of residents' wheelchairs. The nurses or CNAs (Certified Nursing Assistants) will inform us if it needs to be repaired. During an interview on 1/14/15 at approximately 8:48 AM, Licensed Practical Nurse #1 stated that housekeeping cleaned the residents' wheelchairs weekly and should notify staff if the arm pads are torn. If we see anything wrong with the wheelchair we put work orders in. No work orders were provided for review. | 2018-08-01 |
| 5821 | CHESTER NURSING CENTER | 425061 | 1 MEDICAL PARK DRIVE | CHESTER | SC | 29706 | 2015-01-14 | 279 | D | 0 | 1 | 0ILK11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview the facility failed to develop a care plan with specific individualized interventions to prevent further decline in Range of Motion (ROM) for Resident #2, 1 of 1 sampled resident reviewed for ROM. ROM is defined as the extent of movement of a joint. The findings included: The facility admitted Resident #2 with [DIAGNOSES REDACTED]. Record review of a Physician Consultation, dated 8/17/2012, on 1/14/2015 at 9:00 AM, revealed that the resident is bedridden because of congenital [DIAGNOSES REDACTED] and [MEDICAL CONDITION] with severe hip and knee flexion contractures. Review of the resident's care plan on 1/13/2015 at 3:20 PM revealed no interventions to prevent further decline in ROM. During an interview on 1/14/2015 at 8:48 AM, the Director of Nursing (DON) confirmed the care plan did not list interventions that specifically addressed the resident's contractures and limited ROM. The DON confirmed there were no interventions on the care plan to prevent further decline in ROM. The DON also stated the resident was not currently receiving any ROM services or other preventive care. The DON stated the last time the resident had a therapy evaluation of her/his contractures and ROM was in 2012. | 2018-08-01 |
| 5822 | CHESTER NURSING CENTER | 425061 | 1 MEDICAL PARK DRIVE | CHESTER | SC | 29706 | 2015-01-14 | 309 | D | 0 | 1 | 0ILK11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and interview, the facility failed to monitor weights as per the plan of care for one of one resident reviewed for [MEDICAL TREATMENT]. The facility failed to weigh Resident #48, who was non-compliant with dietary restrictions, three times per week as per the plan of care. The findings included: The facility admitted Resident #48 with [DIAGNOSES REDACTED]. Review of the 10-17-14 Annual Minimum Data Set Assessment revealed the resident had a Brief Interview for Mental Status Score of 12, indicating moderate cognitive impairment. Review of the physician's orders [REDACTED]. In addition, the resident had a 32 ounce fluid restriction ordered. Review of the resident's care plan on 1/14/2015 at 9:58 AM revealed an intervention, initiated on 10/28/2014, to weigh the resident after [MEDICAL TREATMENT] on Tuesday, Thursday and Saturday (3 times per week). The care plan also noted that the resident was non-compliant with his/her dietary restrictions and had signed a waiver on 2/20/2014 for pleasure foods so resident can eat what he wants. Review of the resident's weight record on 1/14/2015 at 11:11 AM, revealed that 8 of approximately 26 weights were not obtained as ordered during the months of 11/14 and 12/14. The resident was not weighed on Saturday, 11/22/2014. The week of 11/23/2014, which was also Thanksgiving week, the weight record revealed that the resident was weighed 2 of the 3 times planned. The resident's weight was not obtained on Saturday, 12/6/14 and Saturday, 12/13/14. The weight record revealed the resident's weight was obtained once the week of 12/21/2014 (Christmas week) and once the week of 12/28/2014. Observation of the resident's room on 1/14/2015 at 10:49 AM, revealed 1 opened and 3 unopened 12 packs of Sprite Zero soda, 20 bottles of water, a bag containing a box of microwave buttered popcorn, another bag containing potato chips and other snack items, and a bag of Goldfish snacks on the night stand. During an interview on 1/14/2015 at 11:25 AM, the Director of Nursing (DON) confirmed that the resident's weight was not obtained 3 times a week after [MEDICAL TREATMENT] per the care plan. The DON also confirmed that on the holiday weeks, the resident did continue [MEDICAL TREATMENT] 3 times per week. | 2018-08-01 |
| 5823 | CHESTER NURSING CENTER | 425061 | 1 MEDICAL PARK DRIVE | CHESTER | SC | 29706 | 2015-01-14 | 318 | D | 0 | 1 | 0ILK11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview the facility failed to provide treatment and services to prevent further decrease in Range of Motion (ROM) for Resident #2, 1 of 1 sampled resident reviewed for ROM. ROM is defined as the extent of movement of a joint. The findings included: The facility admitted Resident #2 with [DIAGNOSES REDACTED]. Record review of a Physician Consultation, dated 8/17/2012, on 1/14/2015 at 9:00 AM, revealed that the resident is bedridden because of congenital [DIAGNOSES REDACTED] and [MEDICAL CONDITION] with severe hip and knee flexion contractures. Review of the resident's care plan on 1/13/2015 at 3:20 PM revealed a goal that read: The resident will remain free of complications related to immobility, including contractures, thrombus formation, skin-breakdown, fall related injury through the next review date. The interventions listed for this goal were Transfers independently, The resident is NON-WEIGHT BEARING and L[NAME]OMOTION: The resident self propels wheelchair for locomotion. Clean as scheduled. There were no interventions listed on the care plan that addressed the resident's existing contractures or limited ROM. There were no interventions to prevent decline in ROM. During an interview on 1/14/2015 at 8:48 AM, the Director of Nursing (DON) confirmed the care plan did not list interventions that specifically addressed the resident's contractures and limited ROM. The DON confirmed there were no interventions to prevent further decline in ROM. The DON also stated the resident was not currently receiving any ROM services or other preventive care. S/he stated the resident's contractures and ROM were not being routinely evaluated or assessed on a monthly, quarterly or annual schedule. The DON stated that there are Therapy referral forms for the Certified Nursing Assistants and nursing staff to fill out if they notice any decline in the resident's contractures and ROM. The DON stated the last time the resident had a therapy evaluation of her/his contractures and ROM was in 2012. | 2018-08-01 |
| 5824 | CHESTER NURSING CENTER | 425061 | 1 MEDICAL PARK DRIVE | CHESTER | SC | 29706 | 2015-01-14 | 371 | E | 0 | 1 | 0ILK11 | Based on observations and interview, the facility failed to store, prepare, distribute and serve food under sanitary conditions as evidenced by a heavy accumulation of dust build-up on the vent and filter of the ice machine, food stored in the refrigerator not labeled and dated after opening, and improper hand washing between kitchen tasks. This had the potential to affect all residents who utilized dining services in the facility. The findings included: While conducting the initial tour of the facility kitchen on 1/12/15 at approximately 11:05 AM, the ice machine was noted with a heavy accumulation of dust build-up on the filter and vent cover. Further observation of the kitchen revealed refrigerator #2 with a package of biscuits, removed from its original packaging, which was not labeled and dated after opening. During observation of the tray line service for lunch on 1/13/15 at approximately 11:17 AM, the Dietary Aide was observed putting on gloves before washing his/her hands. After completion of taking the food temperatures, the Dietary Aide left the tray line to get a cloth from the sanitizer bucket. The Dietary Aide proceeded to wipe down the surface of the tray line and placed the cloth back into the sanitizer bucket. The Dietary Aide did not wash hands or change his/her gloves prior to opening the cooler to get the brownies which were being served for lunch. The Dietary Aide was observed taking the temperature of the brownies with the same gloved hands s/he used to clean the tray line. During an interview on 1/13/15 at approximately 11:45 AM, the Food Service Supervisor (FSS) verified s/he had observed the Dietary Aide's failure to wash hands in between kitchen tasks. The FSS stated that the dietary staff had received training on hand washing and that the gloves should have been changed and hands washed after completing each task. | 2018-08-01 |
| 5825 | CHESTER NURSING CENTER | 425061 | 1 MEDICAL PARK DRIVE | CHESTER | SC | 29706 | 2015-01-14 | 385 | E | 0 | 1 | 0ILK11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to ensure that physician services were provided as needed for Resident #33, 1 of 4 sampled residents reviewed for Finger Stick Blood Sugars (FSBS). The attending or on-call physician failed to respond to multiple documented attempts at contact/notification and the facility failed to seek an alternate source of physician services when Resident #33 had validated blood sugars of greater than 400 mg%. The findings included: The facility admitted Resident #33 with [DIAGNOSES REDACTED]. Record review on 1/14/15 at approximately 9:48 AM revealed physician's orders [REDACTED]. and for [MEDICATION NAME] 100 units Inject 35 units subcutaneously daily. Call MD if greater than 400. Record review on 1/14/15 at approximately 10:30 AM revealed that when Resident #33 had significantly elevated blood sugars, the physician failed to respond to attempts to contact him/her. Review of Nurses Notes revealed the following: 9/24/14 1730 (5:30 PM) FSBS at 1717 was 422. Rechecked with different glucometer, FSBS at 1726 was 416. Called lab to come and verify blood glucose. Will continue to monitor. 9/24/14 1755 (5:55 PM) Received report from lab that blood glucose was 412. On-call MD paged. 9/24/14 1805 (6:05 PM) Doctor paged again. Awaiting response. 9/24/14 (YEAR) (8:15 PM) Page not returned by doctor. Resident received scheduled 35 units of [MEDICATION NAME] as ordered. Continued review of Nurses Notes revealed the following: 1/7/15 6:00 PM FSBS 442. Rechecked 459. Lab verified Blood Glucose via venous puncture as 410. On-call MD paged. 1/7/15 9:30 PM On-call MD paged x 3. No return call received. Resident received 35 units [MEDICATION NAME] at 9:00 PM per (routine) order will continue to monitor. During an interview on 1/13/15 at approximately 3:00 PM, the Assistant Director of Nursing (ADON) stated that when a resident's blood sugar was high, the nurse would get the lab to recheck it. The nurse should then notify the physician for an order. The ADON stated that the physician should be notified in a timely manner and, if the physician and/or on-call physician could not be reached, the resident should be sent to the emergency room (ER) for evaluation. After reviewing the Nurses Notes, the ADON confirmed that the physician never returned the facility's calls and that the nurses should have sent the resident to the ER. | 2018-08-01 |
| 7323 | CHESTER NURSING CENTER | 425061 | 1 MEDICAL PARK DRIVE | CHESTER | SC | 29706 | 2013-08-02 | 323 | D | 0 | 1 | QN9211 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on record review, observation, and interview the staff failed to reassess and put new interventions into place for Resident # 72 after falls occurring on 1/9/13, 6/6/13, 4/13/13, and 7/27/13. ( 1 of 2 residents reviewed for accidents) The findings included: The facility admitted Resident # 72 on 7/4/12 with [DIAGNOSES REDACTED]. Record review on 7/31/13 revealed Fall Risk Assessments dated 3/15/12 and 3/29/12 that indicated the resident was at high risk for falls with a score of 17. Assessments completed on 12/10/12 and 5/8/13 scored the resident a 9 although the resident was noted to have an increase in falls. Although the care plan had been updated with the dates of falls (excluding one); no interventions were changed or new interventions put into place by the facility to prevent future falls. Incident reports were reviewed for 1/9/13, 4/13,13, and 6/6/13. No incident report had been completed for the 7/27/13 fall. None of the incident reports documented the resident had been reassessed by the staff or that any new interventions had been recommended to help reduce future falls. The ADON (Assistant Director of Nursing) confirmed no new interventions nor assessments had been done after each of the falls. | 2017-03-01 |
| 7324 | CHESTER NURSING CENTER | 425061 | 1 MEDICAL PARK DRIVE | CHESTER | SC | 29706 | 2013-08-02 | 371 | E | 0 | 1 | QN9211 | On the days of the survey, based on observations, interviews and review of the facility's policy, the facility failed to store, label and date foods in the freezer and refrigerators properly and to maintain equipment in the kitchen in a safe operating condition. The findings included: On 7/30/13 at approximately 7:50 AM, during an observation of the facility's kitchen, the microwave had spots/splatters of food inside on the walls and ceiling of the microwave. A freestanding warmer beside refrigerator #3 was noted to have spills and splatters of baked- on food debris on the walls, racks and doors. Freezer #1 contained an opened box of partially wrapped rope sausage with the plastic wrap not covering the sausage, exposing the product to air. There was also one package of an unknown item wrapped in brown paper, partially covered in plastic wrap with no label or date and one package of onion rings in the original plastic bag which was opened at one end exposing the product to air. A walk in refrigerator contained one dish of greens, partially wrapped, one dish of macaroni and cheese, partially wrapped; one bowl partially wrapped pineapple chunks and one bowl of chicken, partially wrapped. The plastic wrap on the items did not securely cover the food allowing air to enter the containers. There were also 3 packages food with no label/date lying on a shelf in walk in freezer #2, out of it's original packaging. The bin containing bread crumbs was open during the kitchen observation but was closed by the CDM (Certified Dietary Manager) as the surveyor walked by the bin. During observation of the equipment in the kitchen, two ovens contained a heavy build up of grease on the doors, the ledge under the doors and handles. Burnt on grease and food debris were observed inside the ovens on the walls, racks and inner door area. The bowl area of one of the gas burners on the stove top was full of uncooked macaroni noodles and the opening in the center of the bowl revealed noodles under the burner. The stove top was in use with an active pilot light. The surveyor asked the CDM if the plates around the burners could be removed for cleaning. The CDM stated yes and lifted the plate, exposing a heavy build up of burnt debris and noodles under the burner. The pilot lights were lit under the burners when the CDM lifted the plate. When asked by the surveyor if the debris under the burners with active pilot lights could be a problem, the CDM stated the debris could be a fire hazard. When asked by the surveyor when the equipment in the kitchen was last cleaned and if they had a cleaning schedule, the CDM stated it was cleaned on a as needed basis and that they had no formal cleaning schedule. When the CDM was asked again by surveyor if noodles in gas burner bowl and debris under gas burners and grease on and in ovens were issues to be concerned about, the CDM stated that they were fire hazards. The CDM also stated that the macaroni had been cooked the day before when asked by the surveyor when it was cooked. The Plant Operations Manager and the Certified Dietary Manager (CDM) both verified findings. In an interview with the CDM, he/she verified the food storage observations and stated that the items should have been wrapped to prevent air from entering the containers and that all items should have been labeled and dated. Review of the facility's policy entitled B. Production, Purchasing,Storage revealed .Policies: All food, non-food items, and supplies used in food preparation shall be stored in such a manner as to maintain the wholesomeness of the food for human consumption .Refrigerated Storage .cover tightly. Label and date container The facility's policy entitled F. Sanitization And Infection Control ,Subject: Area And Equipment Cleaning Frequency/Schedule indicated that the facility did have a cleaning schedule which was not implemented and in use. The policy also indicated .Method B: Use of Daily Work Activities Schedules Daily Cleaning: .Monthly/Special Cleaning .Wipe Down all cooking equipment was listed as a daily activity .Area And Equipment Cleaning Frequency Kitchen/Prep Area .Ovens - .outside-daily; inside-daily; racks-weekly; inside-weekly . | 2017-03-01 |
| 8211 | CHESTER NURSING CENTER | 425061 | 1 MEDICAL PARK DRIVE | CHESTER | SC | 29706 | 2012-05-03 | 223 | L | 0 | 1 | WII411 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** July 17, 2012 - Ammended to reflect change of original Scope and Severity Lowered to K and lowered Scope and Severity to E On the days of the Recertification and Extended Survey, based on observations, record review, and interviews, the facility failed to ensure the staff monitored visitors/sitters interactions with residents to ensure the safety and well being of residents in the facility. Resident #18 was allegedly verbally abused by Resident #11's visitor/sitter. The findings included: Cross refers to F-226 as it relates to the failure of the facility to follow policy to identify abuse and neglect, report allegations of abuse/neglect as well as protect residents from further abuse/neglect once an allegation was reported. Cross refers to F-490 as it related to the failure of the facility Administration to provide the necessary oversight to ensure policies and procedures related to protecting residents from abuse/neglect by reporting and intervening to prevent further abuse/neglect was implemented properly. The Administration was not aware paid sitters were operating in the building and the facility had no policies in place to ensure sitters were aware of facility policies and procedures and met regulatory requirements. Cross refers to F-520 as it relates to the failure of the facility to be aware that paid sitters were operating in the building and the facility had no policies in place to ensure sitters were aware of facility policies and procedures. The facility admitted Resident #18 with [DIAGNOSES REDACTED]. Record review revealed an Annual MDS (Minimum Data Set) dated 6/17/11 that indicated the resident had a BIMS (Brief Interview for Mental Status) of 3 indicating she was cognitively impaired. Review of the MDS dated [DATE] indicated Resident #18 had long and short-term memory with severe cognitive impairment in daily living skills. The MDS further indicated the resident had the ability to respond adequately to simple direction; no behavior problems were noted. On 5/01/12 at approximately 4 PM this surveyor heard loud yelling on the Gaston Unit. At least four staff members were observed on the unit at the time of yelling. As the surveyor approached the room from which the yelling was coming, she observed a tall, large male, believed to be a family member of Resident #11, standing over, yelling and pointing his finger at Resident #18 who was seated in a Geri chair. The male looked directly at Resident #18 and stated, You don't talk to her. You don't say anything to her. You all better move her. Prior to the surveyor approaching the room a hospice nurse was observed standing outside the door while the family member yelled at Resident #18. The surveyor in the hallway observed four facility staff members, fail to respond to the family member yelling at Resident #18. The surveyor approached the staff in the hallway and asked, Can anyone hear the yelling going on down the hall? What are you going to do about the family member yelling at the resident? The staff looked at the surveyor and hesitated. CNA (Certified Nursing Assistant) #3 entered the room and the family member and Resident #11 exited the room. The nurse at the medication cart did not attempt to protect Resident #18 from the angry family member. At approximately 4:08 PM the surveyor overheard Licensed Practical Nurse (LPN) #1 asking Registered Nurse (RN) #1 What should I do? Should I write a report? The State Agency surveyor reported to the Administrator at 4:35 PM on 5/01/12 the staff 's failure to respond immediately to protect Resident #18 from the alleged family member. In addition, the family member/sitter that was observed verbally abusing Resident #18 was allowed by staff to remove Resident #11 from the room via wheelchair and go to an unsupervised area of the skilled nursing facility without intervention by staff. In an interview with the surveyor on 5/02/12 at approximately 3:35 PM CNA #1 stated Resident #18 was confused and always made statements like This is my house. The CNA stated the visitor had been observed having conversations with himself but that 5/01/12 was the first time I have seen him in this rage. CNA #1 stated the visitor was loud and had been observed fussing with the staff last week. She stated that she did not respond to the yelling because the visitor was generally loud. The surveyor interviewed CNA #3 at approximately 3:50 PM on 5/02/12; she stated that she did not pay attention to the visitor's loud talking because he generally spoke loudly. In an interview with the surveyor on 5/02/12 at approximately 4:05 PM RN #1 stated the visitor was generally loud and sometimes he would get upset about clothes. In an interview with the surveyor on 5/02/12 at 8:30 AM the Administrator stated he was not aware of the Elder Justice Act (Affordable Care Act 2012), which requires long-term care facilities to report any reasonable suspicion of crimes. On 5/2/12 at 5:05 PM the Administrator stated the visitor was not a family member but a private sitter. The Administrator stated he was unaware the visitor was not a relative until today. The facility had no policy and procedures in place related to paid sitters and their role in the facility. On 5/2/12 at 1:55 PM, the Administrator and the Director Of Nursing were notified of a second Substandard Quality of Care and/or Immediate Jeopardy existing in the facility when an observation was made of a visitor verbally abusing a resident with no staff intervention to protect the resident. Documentation of inservices, observations, and interviews revealed the Allegation of Compliance submitted by the facility on 5/3/2012 had been implemented by the facility and was in practice removing the immediacy of the deficient practice. Facility nursing staff had been educated and were knowledgeable of abuse policies and facility procedures. The Administrator was informed of this on 5/3/12. The citation at F-223 remained at a lower scope and severity of E. | 2016-06-01 |
| 8212 | CHESTER NURSING CENTER | 425061 | 1 MEDICAL PARK DRIVE | CHESTER | SC | 29706 | 2012-05-03 | 225 | L | 0 | 1 | WII411 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** July 17, 2012 - Ammended to reflect change to original Scope and Severity to J and lowered Scope and Severity to D On the days of the Recertification and Extended survey, based on record reviews, interviews and incident logs, the facility failed to ensure that all alleged violations involving mistreatment, neglect, or abuse, were reported immediately to the administrator of the facility and to other officials in accordance with State law through established procedures (including to the State survey and certification agency). Application of heat by a licensed staff member to the leg of Resident #11, 1 of 3 residents reviewed for heat treatments, was applied improperly and not monitored resulting in a second degree burn to the resident. The incident was not reported as possible neglect to the State Agency. The findings included: Cross refers to F-226 as it relates to the failure of the facility to follow policy to identify neglect, report allegations of neglect as well as protect residents from further neglect once an allegation was reported. Cross Refers to F-281 as it relates to the failure of the facility Nursing staff to verify the physician's orders [REDACTED]. The failure placed Resident #11 at risk of serious harm. Cross Refers to F-323 as it relates to the failure of the facility to provide necessary care for Resident #11 when a licensed staff member used a microwave to heat a compress and placed the heated compress directly on the resident's leg without using a barrier between the resident's leg and the compress. This action resulted in a second degree burn to the resident's leg. Cross Refers to F-490 as it relates to the failure of the Administrator to ensure the facility was administered in a manner that enabled it to use its resources effectively and efficiently to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident. The administrator was aware that a licensed nurse used a microwave to heat a compress and apply it directly to a resident's leg that resulted in a second degree burn and failed to implement corrective action to ensure resident safety. Cross Refers to F-520 as it relates to the failure of the facility to ensure that the Quality Assurance process was utilized to identify, monitor and implement a plan of correction related to an injury that was the result of applying heat to a resident incorrectly. The facility admitted Resident #11 on 11/18/2011 with [DIAGNOSES REDACTED]. Review of the Physician's Telephone Orders (TO) revealed that Resident #11 had a TO (telephone order) dated 3/11/12 for Heat to knee and a clarification order on 3/11/12 for heat to knee q (every) shift. On 3/27/12 a new TO was written to D/C (discontinue) heat to left knee and orders were given for a treatment to the knee. Review of the facility's Event Report indicated that on 3/27/12 at 10:30 AM the nurse was called to resident's room by (CNA), observed red area with two intact blisters to lt (left) knee. Also on mattress beside resident was a biohazard bag with two washclothes (sic) inside and a pillowcase covering it. Resident currently has tx (treatment) of heat to lt knee q (every) shift. Called 11p-7a nurse on duty last night, ask her how she did heat tx. to resident's knee. She stated 'I wet two washclothes (sic), put them in microwave for 2 minutes then put inside a biohazard bag and wrapped a pillowcase around it and laid it on resident's knee'. On 5/2/2012 at 9:05 AM, during an interview with the Assistant Director of Nursing (ADON), she stated the incident had not been reported because the injury was not of unknown origin and the facility did not feel like the nurse intended to cause harm to the resident. On 5/3/2012 at 10:30 AM, the Administrator, Director of Nursing and the Assistant Director of Nursing were notified that Substandard Quality of Care and/or Immediate Jeopardy were identified. The Substandard Quality of Care and/or Immediate Jeopardy existed in the facility on 3/27/2012 when Resident #11 received a burn from a heat treatment, which was executed and applied incorrectly. Documentation of inservices, observations, and interviews revealed the Allegation of Compliance submitted by the facility on 5/3/2012 had been implemented by the facility and was in practice removing the immediacy of the deficient practice. Facility nursing staff had been educated and was knowledgeable of abuse policies and procedures and the proper use of heat treatments. The Administrator was informed of this on 5/3/12. The citation at F-225 remained at a lower scope and severity of D. | 2016-06-01 |
| 8213 | CHESTER NURSING CENTER | 425061 | 1 MEDICAL PARK DRIVE | CHESTER | SC | 29706 | 2012-05-03 | 226 | L | 0 | 1 | WII411 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** July 17, 2012 - Ammended to reflect change to original Scope and Severity to K and lowered Scope and Severity to E On the days of the Recertification and Extended survey, based on interviews, record reviews, and review of the facility Abuse and Neglect Policy the facility failed to follow its policies and procedures that prohibit mistreatment, neglect, and abuse of residents. The facility staff failed to report neglect involving Resident #11 who suffered a burn related to a heat treatment which was applied incorrectly. The incident was not investigated and reported to the State Agency. The facility staff failed to respond when a sitter for Resident #11 yelled at her roommate Resident #18; multiple staff members were observed by the surveyor standing by when the incident occurred. The findings included: Cross Refers to F-223 as it relates to the failure of the facility to ensure that staff monitored visitors/sitters interactions with residents to ensure the residents safety and well being in the facility. Resident #18 was allegedly verbally abused by Resident #11's visitor/sitter. Cross Refers to F-225 as it relates to the failure of the facility to report and thoroughly investigate an incident in the facility as possible neglect due to a nurse's inappropriate approach to applying heat to Resident #11's leg that resulted in a burn. Cross Refers to F-281 as it relates to the failure of the facility Nursing staff to verify the physician's orders [REDACTED]. The failure placed Resident #11 at risk of serious harm. Cross Refers to F-323 as it relates to the failure of the facility to provide necessary care for Resident #11. The resident was burned when a nurse used a microwave to heat a compress and placed it directly on the resident's leg without using an appropriate barrier between the resident's leg and the heated compress. This action resulted in a second degree burn to the resident's leg. Cross Refers to F-490 as it relates to the failure of the Administrator to ensure the facility was administered in a manner that enabled it to use its resources effectively and efficiently to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident. The administrator was aware that a licensed nurse used a microwave to heat a compress and apply it to a resident's leg that resulted in a second degree burn and failed to implement corrective action to ensure resident safety. In addition, the Administration was not aware paid sitters were operating in the building and the facility had no policies in place to ensure sitters were aware of facility policies and procedures. Cross Refers to F-520 as it relates to the failure of the facility to ensure that the Quality Assurance process was utilized to identify, monitor and implement a plan of correction related to an injury that was the result of applying heat to a resident incorrectly. In addition, the Administration was not aware paid sitters were operating in the building and the facility had no policies in place to ensure sitters were aware of facility policies and procedures and met regulation. The facility admitted Resident #11with [DIAGNOSES REDACTED]. Review of the Physician's Telephone Orders (TO) reveled that Resident #11 had a TO (telephone order) dated 3/11/12 for Heat to knee and a clarification order on 3/11/12 for heat to knee q (every) shift. On 3/27/12 a new TO was written to D/C (discontinue) heat to left knee and orders were given for a treatment to the knee. Review of the facility's Event Report indicated that on 3/27/12 at 10:30 AM the nurse was called to resident's room by (CNA), observed red area with two intact blisters to lt (left) knee. Also on mattress beside resident was a biohazard bag with two washclothes (sic) inside and a pillowcase covering it. Resident currently has tx (treatment) of heat to lt knee q (every) shift. Called 11p-7a nurse on duty last night, ask her how she did heat tx. to resident's knee. She stated 'I wet two washclothes (sic), put them in microwave for 2 minutes then put inside a biohazard bag and wrapped a pillowcase around it and laid it on resident's knee'. On 5/2/2012 at 9:05 AM, during an interview with the Assistant Director of Nursing (ADON), she stated the incident was not reported because the injury was not of unknown origin and the facility did not feel like the nurse intended to cause harm to the resident. No further investigation was done by the facility. The facility admitted Resident #18 on 6/10/11 with [DIAGNOSES REDACTED]. On 5/01/12 at approximately 4 PM the surveyor heard loud yelling on the Gaston Unit. At least four staff members were observed on the unit at the time of yelling. As the State Agency surveyor approached the room from which the yelling was coming, she observed a tall, large male, believed to be a family member of Resident #11, standing over, yelling and pointing his finger at Resident #18 who was seated in a Geri chair. The male looked directly at Resident #18 and stated, You don't talk to her. You don't say anything to her. You all better move her. Prior to the surveyor approaching the room a hospice nurse was observed standing outside the door while the family member yelled at Resident #18. The surveyor in the hallway observed four facility staff members who failed to respond to the family member yelling at Resident #18. The surveyor approached the staff in the hallway and asked, Can anyone hear the yelling going on down the hall? What are you going to do about the family member yelling at the resident? The staff looked at the surveyor and hesitated. CNA (Certified Nursing Assistant) #3 entered the room and the family member and Resident #11 exited the room. The nurse at the medication cart did not attempt to protect Resident #18 from the angry family member. Review of the facility's Policy & Procedure Manual Subject: Abuse and Neglect last revised on July 2010 stated, Policy: .Failure to report shall be cause of disciplinary action . All allegations will be reported to appropriate agencies and services as required by applicable state and federal regulations. The DHEC Certification Division shall be notified within 24 hours of the allegation . Procedure: . 1. Any person having information, either by direct observation or by report, or any act or suspected act that he/she considers may be abuse, neglect or mistreatment of [REDACTED]. Initial reports are to be completed verbally and in a written form on an Incident Report. This Incident Report should be given immediately or as soon as practically possible to the Health Facility Administrator, the Director of Nursing, or his/her designee. The Health Facility Administrator . will initiate an Investigation. 2. Any employee who reports or who receives a report of abuse or neglect must take whatever actions are appropriate to protect the resident from further alleged abuse or neglect. 3. The resident's physician and agent will be notified . A resident who is a victim of alleged abuse or neglect must be immediately assessed by a Licensed Nurse . The clinical record of the resident for whom a suspected abuse/neglect report is completed must contain objective information, facts NOT speculation. 4. The investigation Report is considered a confidential facility report and should include: a. The date, time, location of the alleged incident; b. A complete description of the event . e. A description of any injuries sustained and/or any changes in resident's mental state . h. Action taken . 6. If a family member or other visitor is suspected of abuse, they may not be allowed to visit the resident, or may be required to visit only if a staff member is present . 8. The results of all investigations of substantiated incidents of abuse or neglect will be reported to the Department of Health Licensing and Certification and to all other agencies in accordance with state law within five (5) working days . DEFINITIONS 1. Abuse means the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain or mental anguish, or the deprivation by care custodian of goods or services that are necessary to avoid physical harm or mental suffering . 3. Verbal refers to any use of oral, written or gestured language that includes disparaging and derogatory term to residents or their families, or within their hearing distance, to describe residents, regardless of their age, ability to comprehend, or disability . 15. Neglect means failure to exercise that degree of care which a reasonable person in a like position would exercise. It includes failure to assist in personal hygiene or the provision of food and clothing, failure to provided medical care for physical and mental health needs, failure to protect from health and safety hazards . Reporting/Response: .All substantiated incidents of abuse or neglect will be reported to the Quality Assurance Committee . On 5/3/12 at 10:30 AM, the Administrator, Director of Nursing, and the Assistant Director of Nursing were notified that Substandard Quality of Care and/or Immediate Jeopardy was identified. The Substandard Quality of Care and/or Immediate Jeopardy existed in the facility on 3/27/2012 when Resident #11 received a burn from a heat treatment which was executed and applied incorrectly. On 5/2/12 at 1:55 PM, the Administrator and the Director Of Nursing were notified of a second Substandard Quality of Care and/or Immediate Jeopardy existing in the facility when an observation was made of a visitor verbally abusing a resident with no staff intervention to protect the resident. Documentation of inservices, observations, and interviews revealed the Allegation of Compliance submitted by the facility on 5/3/2012 had been implemented by the facility and was in practice removing the immediacy of the deficient practice. Facility nursing staff had been educated and were knowledgeable of abuse policies and facility procedures. The Administrator was informed of this on 5/3/12. The citation at F-226 remained at a lower scope and severity of E. | 2016-06-01 |
| 8214 | CHESTER NURSING CENTER | 425061 | 1 MEDICAL PARK DRIVE | CHESTER | SC | 29706 | 2012-05-03 | 242 | E | 0 | 1 | WII411 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on group interview and review of the facility's menus, the facility failed to plan a menu that residents did not feel was repetitive. (i.e. tomato soup and green beans served frequently). Five of 5 group members stated food preferences are not honored. Resident #8's food choices were not honored during two meal observations The findings included: Based on concerns expressed during the group interview of repeatedly receiving tomato soup and green beans, the facility's menus were reviewed for repetitiveness. On 5/1/12, review of the 3 week CMRC (Chester Regional Medical Center) Menus revealed the Sunday evening meal for weeks #1, 2 and 3 was tomato soup, saltine crackers, grilled cheese, banana foster bread pudding. The Wednesday evening meal for weeks #1, 2, and 3 was fried chicken, macaroni and cheese, seasoned greens, cornbread, carmelicious brownies. The Friday lunch meal for weeks #1, 2, and 3 was chicken wings, baked fries, walking salad, wheat dinner roll. The Friday evening meal for weeks 1, 2, and 3 was crusted/breaded fish with tartar sauce, half baked potato, cole slaw, hush puppies, cornbread, lemon coconut cake. For week # 3, supper on Wednesday, Thursday, and Saturday and the week 1 Sunday lunch, (which follows week 3 Saturday) green beans were served. An interview was conducted on 5/2/12, at approximately 10:00am, with the Food Service Director (FSD) and the Registered Dietitian (RD). The surveyor reviewed the above information with the FSD and RD. The FSD and RD acknowledged that the menus were written in such a way that single food items (tomato soup, green beans) and entire meals were being duplicated repeatedly throughout the menu. The facility admitted Resident #8 on 4/20/10 and readmitted the resident on 2/06/12 with [DIAGNOSES REDACTED]. Record review revealed a Quarterly MDS (Minimum Data Set) dated 4/10/12 which indicated the resident had a Brief Interview Mental Status (BIMS) score of 15 (cognitively intact). A random meal observation on 4/30/12 at approximately 12:20 PM revealed the resident was served a pimento cheese sandwich A meal observation on 4/30/12 at approximately 5 PM revealed revealed the resident was served a large roll, mashed potatoes, pork chop and broccoli. Review of the meal card revealed documentation that the resident disliked sandwiches and bread. In a group interview on 5/01/12 at approximately 10:15 AM 5 of 5 group members identified by the facility as interviewable, stated they consistently received food on their food tray that they do not like. The group members further stated at times they just leave the food on the tray and did not ask for anything else Five of 5 group members stated they receive green beans and tomato soup too often. The group members further staff they had shared their concerns related to food during Resident Council Meeting. Review of Resident council meeting notes revealed the residents had shared dietary concerns during the months of April 2012, March 2012, and February 2012. | 2016-06-01 |
| 8215 | CHESTER NURSING CENTER | 425061 | 1 MEDICAL PARK DRIVE | CHESTER | SC | 29706 | 2012-05-03 | 281 | J | 0 | 1 | WII411 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the Recertification and Extended survey, based on observations, interviews, record reviews and review of the facility's policies entitled Applying A Warm Compress Or Soak and Standing Orders for Chester Regional Nursing Center, and the facility Event Report, the facility failed to provide services that met professional standards of quality for 3 of 16 sampled residents reviewed for professional standards of care. Resident #11 received a burn due to improper application by a licensed staff member, failure to monitor the heat treatment, and failure to consistently assess and monitor healing of the burn, Resident #16 with a low body temperature reading had no recheck of temperature delaying treatment, and the facility allowed untrained Licensed Practical Nurses (LPN) to administer medications through a Peripherally Inserted Central Catheter (PICC) or did not have a Registered Nurse present in the facility during the medication administration via the PICC line for Resident #1. The findings included: Cross Refer to F323 as it relates to a licensed staff member applying heat improperly to Resident #11 resulting in a second degree burn to the resident's leg. The facility admitted Resident #11 with [DIAGNOSES REDACTED]. On 5/1/2012 at 3:40 PM, during review of the medical chart for Resident #11, a telephone order dated 3/11/12 indicated that the resident had an order for [REDACTED]. The Nurse's Notes (NN) dated 3/8/12 indicated that the resident had complained of left knee pain and a pain medication was given. On 3/11/12 the NN again indicated that the resident had left knee pain and the physician was in the facility and ordered heat to the knee every shift. The NN contained no documentation related to clarifying the order for moist or dry heat. The Treatment Record indicated that heat was applied to the resident's knee every shift as ordered until it was discontinued on 3/27/11. The NN for 3/27/12 at 11:00 AM revealed that the facility received new orders to discontinue the heat to the resident's left knee and an order for [REDACTED]. On 3/28/12 at 10:00 AM, the NN stated that blisters and redness were noted. On 3/29/12 at 2:30 PM the NN indicated that an increase in the size of the blisters was noted and that the blisters were intact. On 3/29 at 5:00 PM the nurses documented continue to monitor. dressing dry and intact and on 3/30 12 at 1:45 AM, dry and intact. On 4/1/12, 4/3/12, 4/4/12 and 4/7/12 the Nurse's Notes indicated that the dressing was dry and intact. On 4/14/12 at 1:00 PM a new order was received to change the treatment to Resident #11's left knee. On 4/15/12 at 10:00 AM the nurses documented that the physician was in to see Resident #11. No other NN related to the left knee were noted. The Nurse's Notes contained no measurement of the blisters or how many blisters were present. During the survey on 5/1/12 at 3:50 PM, LPN #1 removed the resident's knee dressing. The area of the resident's knee cap was discolored and purple. Three areas were noted on the knee, 1 area was approximately 1 inch long by 1/2 inch wide, 1 was approximately 1/2 by 1/2 inches and 1 was approximately 1/4 by 1/4 inches. There were no intact blisters observed on the knee. All 3 areas contained sloth in the wound bed and all 3 were bright red in color around the sloth. No odors were noted. Further review of the resident's record revealed no documentation in the Physician's Progress Notes related to the burn. The facility's skin sheets were also reviewed. The skin sheet had documentation on 3/31/12 that blisters were present-treatment in progress, on 4/14/12: left knee blisters, treatment in progress bandage intact, on 4/21/12- left knee in progress and a skin sheet with no date stated that left knee wound treatment was in progress. The skin notes contained no entries related to Resident #11's knee wound. In an interview with Registered Nurse (RN) #1, she verified that there were no other places where wound/skin notes were documented and that there was no documentation of measuring the knee wounds. Review of the facility's Event Report indicated that on 3/27/12 at 10:30 AM the nurse was called to resident's room by (CNA), observed red area with two intact blisters to lt (left) knee. Also on mattress beside resident was a biohazard bag with two washclothes (sic) inside and a pillowcase covering it. Resident currently has tx (treatment) of heat to lt knee q (every) shift. Called 11p-7a nurse on duty last night, ask her how she did heat tx. to resident's knee. She stated 'I wet two washclothes (sic), put them in microwave for 2 minutes then put inside a biohazard bag and wrapped a pillowcase around it and laid it on resident's knee'. In an interview on 5/2/12 at 9:05 AM with the Assistant Director of Nursing (ADON), the ADON stated that the facility uses moist heat unless the physician orders heat packs but the order should have been clarified as to which type of heat to use. When asked if the treatment should have been checked and documented every 5 minutes as written in the policy for moist heat, the ADON stated that the facility does not have check sheets but if the policy indicates every 5 minute checks they should have been done and documented. When asked if it was normal practice at the facility to heat moist cloths in the microwave for heat treatments, the ADON stated that it was not the normal practice to use a microwave. On 5/2/12 from 9:30 AM to 9:42 AM, 4 nurses were interviewed related to how to use heat for a treatment. RN #2 stated that she would use a heat pack wrapped in a towel. LPN #4 stated she would call the physician to verify the type of heat source to use. LPN #5 stated she would use a heat pack and LPN #6 stated that she would warm moist cloths in the microwave. In an interview on 5/2/12 at 12:35 PM, the physician stated that he was informed of the incident stating it was a burn 2nd degree. The physician stated that he would expect the nurses to use moist heat when he ordered heat. He stated that he would expect the wound nurse to monitor, measure and document the progression of blisters, pressure ulcers and surgical sites. He also stated that he would expect the facility to in-service the staff after any incident. Review of the facility's policy entitled Applying A Warm Compress Or Soak indicated .Preparation 1. Verify that there is a physician's order for this procedure .2. Check the resident's skin often. Look for: a. Too much redness b. Skin discoloration .Equipment and Supplies .4. If applying a warm compress: . c. Pitcher of warm water (115 degrees F) .k. Unless otherwise instructed, check the skin of the limb being soaked every five (5) minutes . Resident #1 was admitted with [DIAGNOSES REDACTED]. Record review on 4/30/12, at approximately 12:15PM, revealed an admitting Physician's order for Flush PICC (Peripherally Inserted Central Catheter) line with NS (Normal Saline) 5 ml (milliliters) prior to and after med (medication) administration. Further review revealed a Physician's order dated 4/17/12 to D/C (Discontinue) PICC line. Review of the April Medication Administration Record [REDACTED]. Interview on 4/30/12 with the Gaston Unit Manager indicated that all the nurses who signed off as doing the PICC line flushes were Licensed Practical Nurses (LPN). Review of The South Carolina State Board of Nursing Advisory Opinion #28 Revision revealed that the Board of Nursing for South Carolina acknowledges it is within the extended role practice of the selected LPN to perform procedures and to administer ordered treatments via peripheral and central venous access devices and lines according to the following stipulations: 2. LPN's must complete specialized education and training relative to arterial and central access lines. A registered nurse must be immediately available for supervision. Review of the Facility's Policy# B-261 titled Picc (Peripherally Inserted Central Catheter) states under III. RESPONSIBILITY, A. Nursing:, 2. The special selected LPN must complete an intravenous therapy course relative to the administration of fluids and medications via peripheral and central venous access devices and perform the necessary skills checklist. These skills will be performed under the immediate availability and supervision of a Registered Nurse. Interview on 5/1/12, at approximately 3:00pm, with the Director of Nursing (DON) and the Assistant Director of Nursing (ADON) revealed three of the LPNs who signed off as doing the PICC line flushes did not have the required specialized education and training. In addition, during review of the daily nursing staffing sheets for 4/6/12 through 4/17/12 when the PICC line was discontinued, the DON and ADON confirmed that for eleven of thirty-three shifts reviewed there was no registered nurse immediately available for supervision. The facility admitted Resident #16 with [DIAGNOSES REDACTED]. Record review on 5/01/12 revealed nurse's notes dated 4/12/12 at 1:45 PM that stated: resident alert and verbal with respiratory even and unlabored no distress noted. A nurse note dated 4/13/12 at 4 AM vital sign 97 Temperature, 98 Pulse, 20 Respiration with 104/76 Blood Pressure. Nurse note (NN) dated 4/13/12 at 7 PM indicated resident alert with nasal cannula. Assisted with all activities of daily living (ADLs), no sign and symptom of pain or distress. NN dated 4/14/12 at 1:30 AM indicated vital signs 125/68 Blood Pressure, 81 Pulse, 98.8 Temperature, 20 Respiration. No sign and symptom of distress with breathing even and unlabored. Resting quietly with continue to monitor. NN dated 4/14/12 at 10 AM indicated noted increased foul smelling drainage from left hip wound. Medical Doctor on call with new orders for C&S (culture and sensitivity) [MEDICATION NAME] 500 mg every day for 7 days. NN dated 4/14/12 at 5:15 PM vital sign 92 Temperature, 60 Pulse, 20 Respiration, 90/62 Blood Pressure with resident resting quietly in bed at present. Noted to be alert with confusion. No complaints voiced and requires total care with ADLs. NN dated 4/15/12 at 12 Noon indicated resident was alert, non verbal and denies pain with Respiration up 28, no Blood Pressure reading, 64 Pulse, Temperature of 90 with no oxygen statistics. Finger nails noted to be purple and hands very cold to touch with Medical Doctor called. NN dated 4/15/12 at 12:40 PM Resident transported to emergency room . An interview on 5/03/12 at approximately 1:30 PM with the Assistant Director of Nursing (ADON), after reading the nurses' notes dated 4/12/12 to 4/15/12 the ADON stated 02 should have been started and that the facility has standing orders as to when to provide oxygen and notify the physician. On 5/2/12 at 10:30 AM, the Administrator and the Director Of Nursing were notified that Substandard Quality of Care and/or Immediate Jeopardy was identified. The Substandard Quality of Care and/or Immediate Jeopardy existed in the facility on 3/27/2012 when Resident #11 received a burn from a heat treatment which was executed and applied incorrectly. Documentation of inservices, observations, and interviews revealed the Allegation of Compliance submitted by the facility on 5/3/2012 had been implemented by the facility and was in practice removing the immediacy of the deficient practice. Facility nursing staff had been educated and were knowledgeable of abuse policies and procedures and the proper use of heat treatments The Administrator was informed of this on 5/3/12. The citation at F-281 remained at a lower scope and severity of D. | 2016-06-01 |
| 8216 | CHESTER NURSING CENTER | 425061 | 1 MEDICAL PARK DRIVE | CHESTER | SC | 29706 | 2012-05-03 | 314 | D | 0 | 1 | WII411 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the Recertification and Extended survey, based on observations, interviews and review of the facility's policy entitled Aseptic Technique For Changing Dressings, the facility failed to provide necessary treatment and services to promote healing and prevent infection for 1 of 2 residents observed for Pressure Ulcer Treatment. Licensed Practical Nurse (LPN) #1 failed to properly cleanse the pressure area for Resident #2. The findings included: The facility admitted Resident #2 with [DIAGNOSES REDACTED]. On 5/1/2012 at 11:50 AM, during observation of a Pressure Ulcer treatment for [REDACTED].#1 used a saline soaked 4X4 to cleanse the wound. The LPN patted the wound bed and the peri-wound area multiple times using the same 4X4 and the same area of the 4X4. LPN #1 then, using a new 4X4, patted the wound bed and peri-wound area multiple times with the same side of the 4X4 to dry the wound before applying the new dressing. On 5/15/12 at 5:15 PM, during an interview with LPN #1, the surveyor reviewed her observations on the wound care. The LPN did not disagree with the surveyors observations. Review of the facility's police entitled Aseptic Technique For Changing Dressings revealed .Work from center outward in small [MEDICAL CONDITION], using a clean gauze for each stroke . | 2016-06-01 |
| 8217 | CHESTER NURSING CENTER | 425061 | 1 MEDICAL PARK DRIVE | CHESTER | SC | 29706 | 2012-05-03 | 315 | D | 0 | 1 | WII411 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the Recertification and Extended survey, based on observation, interviews and review of the facility's policy entitled Catheter Care, the facility failed to ensure that a resident who is incontinent of bladder receives appropriate treatment and services to prevent urinary tract infections and to restore as much normal bladder function as possible for 1 of 1 resident reviewed with a Foley Catheter. Licensed Practical Nurse (LPN) #3 failed to properly cleanse Resident #8's labia, meatus and tubing during catheter care. LPN #3 also failed to wash her hands and change gloves properly during and after the procedure. The findings included: The facility admitted Resident #8 on 4/20/2011 and readmitted her on 2/6/12 with [DIAGNOSES REDACTED]. On 5/1/2012 at 3:05 PM, during observation of catheter care for Resident #8, LPN #3 assembled supplies on the resident's bedside table, washed her hands and gloved. She removed the resident's brief, then LPN #3 removed her gloves, washed her hands and put on clean gloves. LPN #3 placed a towel under the resident and assisted her into position. LPN #3 then removed her gloves and put on new gloves without washing her hands. After wetting a wash cloth, LPN #3 spread the resident's labia slightly without exposing the urinary meatus. LPN #3 wiped the edge of each side of the resident's labia and down the center, not reaching the meatus, using a new cloth for each wipe. LPN #3 then grasp the catheter tubing at the point where it met the labia and wiped the tubing one time. The LPN wiped the resident front to back on the exterior center of the labia three times and again grasp the tubing at the exterior of the labia and wiped it one time with the same area of the cloth. She then used a towel to pat the area dry. Without removing her gloves or washing her hands, LPN #3 assisted the resident to her right side, removed the towel, opened the resident's closet, took a new brief from the closet and assisted a Certified Nursing Assistant with placing the brief on the resident. She then assisted with repositioning the resident, pulling her up in the bed and repositioning her linens. After repositioning the resident, LPN #3 rinsed and dried the basin and placed it in a drawer in the residents night stand. At that time LPN #3 removed her gloves and washed her hands. During the procedure Resident #8 stated that they don't do catheter care here, we used to spread the labia and clean around the tube at the meatus, they don't do that here. On 5/1/2012 at 4:40 PM, during an interview with LPN #3, the surveyor reviewed her observations with LPN #3. LPN #3 did not disagree with the surveyors observations. LPN #3 stated that it is hard to wash your hands in that room because the resident has too much stuff in it and it's hard to spread her labia because she is a large person. Review of the facility's policy entitled Catheter Care, revealed .Procedure .5 .b) Separate labia and inspect meatus for redness, swelling and/or drainage. c) With other hand, use washcloth, soap and water to gently cleanse meatus around catheter: Wipe downward over left side, right side, and middle, refolding to a clean area of the cloth after each stroke. d) .Hold the catheter near the insertion point .e) Using a clean washcloth, rinse by wiping down the left side, right side, and middle, refolding the washcloth after each stroke. Rinse the catheter tubing as above . | 2016-06-01 |
| 8218 | CHESTER NURSING CENTER | 425061 | 1 MEDICAL PARK DRIVE | CHESTER | SC | 29706 | 2012-05-03 | 323 | J | 0 | 1 | WII411 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the Recertification and Extended survey, based on observations, interviews, record reviews and review of the facility's policy's entitled Applying A Warm Compress or Soak, Event Report, and Abuse and Neglect, the facility failed to ensure that the resident environment remains as free of accident hazards as is possible; and each resident receives adequate supervision and assistance devices to prevent accidents for 1 of 1 resident reviewed for burns. Resident #11 received a burn when a heat treatment was administered incorrectly and not monitored during the treatment. In addition 3 of 4 units were noted to have high hot water temperatures and one of 4 units was noted to have low cool water temperatures. The findings included: Cross Refer to F281 as it relates to the facility failure to ensure resident treatments were performed safely and failure to consistently assess and monitor progress should any harm occur. The facility admitted Resident #11 on 11/18/2011 with [DIAGNOSES REDACTED]. Review of Resident #11's medical record revealed a facility's Event Report that indicated on 3/27/12 at 10:30 AM the nurse was called to resident's room by (CNA), observed red area with two intact blisters to lt (left) knee. Also on mattress beside resident was a biohazard bag with two washclothes (sic) inside and a pillowcase covering it. Resident currently has tx (treatment) of heat to lt knee q (every) shift. Called 11p-7a nurse on duty last night, ask her how she did heat tx. to resident's knee. She stated 'I wet two washclothes (sic), put them in microwave for 2 minutes then put inside a biohazard bag and wrapped a pillowcase around it and laid it on resident's knee'. Further documentation reviewed at the facility did indicate the LPN did not check the progress of the treatment after she became busy with other tasks. In an interview on 5/2/12 at 9:05 AM with the Assistant Director of Nursing (ADON), she stated that the facility uses moist heat unless the physician orders heat packs but the order should have been clarified as to which type of heat to use. When asked if the treatment should have been checked and documented every 5 minutes as written in the policy for moist heat, the ADON stated that the facility does not have check sheets but if the policy says every 5 minute checks they should have been done and documented. When asked if it was normal practice at the facility to heat moist cloths in the microwave for heat treatments, the ADON stated that it was not the normal practice to use a microwave. On 5/2/12 from 9:30 AM to 9:42 AM, 4 nurses were interviewed related to how to use heat for a treatment. RN #2 stated that she would use a heat pack wrapped in a towel. LPN #4 stated she would call the physician to verify the type of heat source to use. LPN #5 stated she would use a heat pack and LPN #6 stated that she would warm moist cloths in the microwave. In an interview on 5/2/12 at 12:35 PM, the physician stated that he had been informed of the incident stating it was a burn 2nd degree. The physician stated that he would expect the nurses to use moist heat when he ordered heat. He stated that he would expect the wound nurse to monitor, measure and document the progression of blisters, pressure ulcers and surgical sites. He also stated that he would expect the facility to re-train/in-service the staff after any incident. Review of the facility's policy entitled Applying A Warm Compress Or Soak indicated .Preparation 1. Verify that there is a physician's order for this procedure .2. Check the resident's skin often. Look for: a. Too much redness b. Skin discoloration .Equipment and Supplies .4. If applying a warm compress: . c. Pitcher of warm water (115 degrees F) .k. Unless otherwise instructed, check the skin of the limb being soaked every five (5) minutes . During the initial tour of the facility on 4/30/12 at approximately 10:45 AM, it was noted the hot water temperature in rooms #22 and #31 on Hall 1 were excessively hot to the touch. The surveyor checked random rooms at approximately 12:20 PM on 4/30/12 with a digital thermometer and the following temperatures were revealed: Room # 29: 122.0 degrees Fahrenheit Room #58: 127.5 degrees Fahrenheit Room #54: 122.4 degrees Fahrenheit Room #20: 122.5 degrees Fahrenheit Room #33: 123.5 degrees Fahrenheit Room #43: 124.3 degrees Fahrenheit On 4/30/12 at approximately 1:50 PM, the surveyor toured with Maintenance Technician #1, the following areas and temperature results were noted as: Hall #1 Shower room sink: 123.0 degrees Fahrenheit Room #26 124.5 degrees Fahrenheit Room #20 125.6 degrees Fahrenheit Room #30 123.0 degrees Fahrenheit Hall #2 Shower room sink: 124.3 degrees Fahrenheit Room #45 123.2 degrees Fahrenheit Room #36 125.7 degrees Fahrenheit Room #38 126.1 degrees Fahrenheit Hall #3 Room #55 128.1 degrees Fahrenheit Room #52 120.0 degrees Fahrenheit Room #59 127.9 degrees Fahrenheit Room #54 122.9 degrees Fahrenheit During an interview with Maintenance Technician #1 on 4/30/12 at approximately 1:50 PM, the Maintenance Technician #1 confirmed he did not know if water temperature checks were routinely performed in residents rooms. On the same day at approximately 2:48 PM, an interview with the Maintenance Director revealed that no one in the maintenance department had checked the main domestic supply temperature that morning. He also stated the facility had not been recording random resident room temperatures since December, 2011 and the facility policy was to have the hot water temperatures be at 115 degrees Fahrenheit or less. He confirmed that the temperature at the main domestic supply was 126.3 degrees per computerized recording early this morning. The Maintenance Director stated he had already turned the steam valve down and will recheck the temperature at the valve and also in the resident rooms throughout the rest of the evening. On 4/30/12 at approximately 3:50 PM, the Maintenance Director stated he checked the actual temperature at the main boiler, recorded at 140 degrees Fahrenheit, and he had reduced the temperature setting to 115 degrees Fahrenheit. Interview with a facility CNA and a resident was held on 4/30/12 at 3:45PM related to the water temperatures. Both stated that whenever the water was used they mixed the cold with the hot to ensure that the temperature was not at a level that a resident would receive a burn. On 4/30/12 at approximately 1:30 PM, during random resident room water temperature checks, the surveyor noted in the Gaston Wing, Room #64, the hot water temperature was 85.1 degrees Fahrenheit. On the same day at approximately 2:27 PM, the resident in this private room stated, It's always too cold in the shower and my sink. Random hot water temperature checks continued in the Gaston Wing at approximately 2:30 PM and revealed the following temperatures: Room #61 89.0 degrees Fahrenheit Room #64 88.3 degrees Fahrenheit Room #72 93.3 degrees Fahrenheit Room #77 92.8 degrees Fahrenheit On 4/30/12 at approximately 4:30 PM, the surveyor toured the Gaston Wing with Maintenance Technician #1, and revealed the following hot water temperatures: Room #61 88.1 degrees Fahrenheit Room #72 97.1 degrees Fahrenheit Room #77 104.1 degrees Fahrenheit While observing the Maintenance Director checking the hot water temperature in Room #77, the resident of this room questioned, Is it warm enough to shave now?. The Maintenance Director revealed on 5/1/12 at approximately 8:50 AM that he did not have a policy in place to perform routine water temperatures in resident room to ensure safe and/or comfortable water temperatures. On 5/2/12 at 10:30 AM, the Administrator and the Director of Nursing were notified that Substandard Quality of Care and/or Immediate Jeopardy was identified. The Substandard Quality of Care and/or Immediate Jeopardy existed in the facility on 3/27/2012 when Resident #11 received a burn from a heat treatment which was applied incorrectly. Documentation of inservices, observations, and interviews revealed the Allegation of Compliance submitted by the facility on 5/3/2012 had been implemented by the facility and was in practice removing the immediacy of the deficient practice. Facility nursing staff had been educated and were knowledgeable of abuse policies and procedures and the proper use of heat treatments. The Administrator was informed of this on 5/3/2012. The citation at F-323 remained at a lower scope and severity of D. | 2016-06-01 |
| 8219 | CHESTER NURSING CENTER | 425061 | 1 MEDICAL PARK DRIVE | CHESTER | SC | 29706 | 2012-05-03 | 363 | F | 0 | 1 | WII411 | On the days of the survey, based on observation, interview, and review of the menus, the facility failed to serve the menu as written. The menu stated 6 ounces (oz) of chili and 3 oz or 4 oz of mashed potatoes was to be served. The staff served 4 oz of chili and 2 and 2/3 oz of mashed potatoes. The findings included: Observation on 5/1/12, at approximately 11:40am revealed Cook #1 serving 4 oz of chili and 2 2/3 oz of mashed potatoes for all diet types. The State Agency surveyor and Cook #1 checked the ladle and scoops sizes together and confirmed that a 4 oz ladle was being used to portion the chili and a #12 (2 2/3 oz) scoop was being used to portion the mashed potatoes. This surveyor then asked the Registered Dietitian (RD) to provide the surveyor with the menu the staff was using to determine the portion sizes to be served. The RD and surveyor reviewed the menu together and verified that all diet types were to receive 6 oz of chili, Pureed diets were to receive 4 oz of mashed potatoes, and all other diet types were to receive 3 oz of mashed potatoes. The RD and Cook #1 confirmed that the required amount of chili and mashed potatoes were not being served at that time. | 2016-06-01 |
| 8220 | CHESTER NURSING CENTER | 425061 | 1 MEDICAL PARK DRIVE | CHESTER | SC | 29706 | 2012-05-03 | 367 | D | 0 | 1 | WII411 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on observation, interview, and record review, the facility failed to provide a mechanical soft diet as prescribed by the physician for 1 of 3 residents with physician ordered mechanically altered diets. (Resident #1) The findings included: Resident #1 was admitted on [DATE] with [DIAGNOSES REDACTED]. Record review on 4/30/12, at approximately 12:15pm revealed a physician's orders [REDACTED]. Observations on 4/30/12 at approximately 12:30pm revealed Resident #1 eating a lunch of pureed pimento cheese, pureed cottage cheese, pureed fruit, soup, ice cream, and tea. Observation on 4/30/12 at approximately 5:00pm revealed the resident eating a supper of pureed meatloaf, mashed potatoes, pureed broccoli, pureed pineapple upside down cake, and tea. Observations on 5/1/12 at approximately 12:15pm revealed the resident eating a lunch of pureed chili, mashed potatoes, and tea. Review of the tray card for each meal indicated that the resident should receive a pureed diet. Interview with the Registered Dietitian on 5/1/12 at approximately 3:15pm confirmed that the physician's orders [REDACTED]. The RD confirmed that a pureed diet was not the same texture as a Soft diet and the resident was not receiving the appropriate textured diet. | 2016-06-01 |