CMS-Nursing-Home-Full-Deficiencies

In collaboration with The Seattle Times, Big Local News is providing full-text nursing home deficiencies from Centers for Medicare & Medicaid Services (CMS). These files contain the full narrative details of each nursing home deficiency cited regulators. The files include deficiencies from Standard Surveys (routine inspections) and from Complaint Surveys. Complete data begins January 2011 (although some earlier inspections do show up). Individual states are provides as CSV files. A very large (4.5GB) national file is also provided as a zipped archive. New data will be updated on a monthly basis. For additional documentation, please see the README.

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rowidfacility_namefacility_idaddresscitystatezipinspection_datedeficiency_tagscope_severitycomplaintstandardeventidinspection_textfiledate
10266 CHERAW HEALTHCARE 425005 400 MOFFAT ROAD CHERAW SC 29520 2010-04-14 281 D     THIH11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on record reviews, interviews and review of acceptable standards of practice for licensed staff , the facility failed to assure for 1 of 2 residents reviewed for accurate documentation related to a [MEDICAL TREATMENT] site that the documentation was thorough and accurate as entered. Resident #4 had documentation of thrill and bruit checks after the shunt site was changed and the physician discontinued the order. The findings included: The facility admitted Resident #4 on 6/26/09 with the following Diagnoses: [REDACTED]. The record review on 4/12/10 revealed a physician's orders [REDACTED]. Further review revealed another order written on 11/5/09 for removal of infected [MEDICAL TREATMENT] catheter and replacement of [MEDICAL TREATMENT] catheter- a tummeled catheter due to permanent placement access. During an interview with Registered Nurse (RN) #1 on 4/12/10 he/she stated " a thrill and bruit is not checked because the resident has a catheter in her right chest, the other site was removed." The nurse's notes revealed that Licensed Practical Nurse (LPN) # 2 documented in the notes "thrill felt and bruit heard" on the following dates 3/11/10, 3/13/10, 3/27/10 and 4/10/10. LPN #1 documented in the nurse's notes on 3/13/10 "bruit and thrill felt". LPN #3 documented in the nurse notes on 3/30/10 "thrill felt and bruit heard". During an interview with LPN #1 on 4/12/10 at 4 PM, when asked how he/she checked for a thrill and bruit, he/she stated "I just put the stethoscope above the catheter and hear a "LUB-DUB". During an interview with LPN #2 on 4/12/10 at 4:15 PM when asked how he/she checked for a thrill and bruit, he/she stated " you have to check that in the arm, but hers is in the chest". When ask why he/she documented that the thrill and bruit was checked, the LPN stated "I don't know". 2014-01-01
10267 CHERAW HEALTHCARE 425005 400 MOFFAT ROAD CHERAW SC 29520 2010-04-14 315 D     THIH11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on observation and review of facility policy and procedure, the facility failed to provide appropriate catheter care for one of one catheter treatments observed. The Registered Nurse (RN) failed to properly anchor the catheter tubing during Resident # 3's catheter care. The findings included: The facility admitted Resident #3 on 7/27/09 with the following Diagnoses: [REDACTED]. During the catheter care observation on 4/13/10 at 9:15 AM RN #2 failed to secure the tubing to prevent pressure from tugging of the suprapubic catheter while cleaning, then drying the tube. At 9:20 AM on 4/13/10 during an interview with RN #2 he/she stated when ask about anchoring the tube "I didn't anchor it because its in the stomach." The facility policy titled Catheter Care, Suprapubic, stated under Procedure #11 "Gently grasp the catheter with non-dominant hand and use clean wash cloth to work down the tubing approximately 6 inches" 2014-01-01
10268 CHERAW HEALTHCARE 425005 400 MOFFAT ROAD CHERAW SC 29520 2010-04-14 323 E     THIH11 On the days of the survey, based on observations and interviews, the facility failed to ensure that the resident environment remains as free of accident hazards as is possible. Three bathrooms in the common area observed to be used by residents had no call light system in place. The findings included: A random observation on 4/12/10 revealed a female resident in a wheelchair coming out of the bathroom unsupervised directly across from the main dining room. Another random observation on 4/13/10 revealed a male resident in a wheelchair coming out of the bathroom unsupervised directly across from the main dining room. An inspection of the bathrooms 1. located on the back hall next to the main dining room, 2. the bathroom directly across from the main dining room and 3. the bathroom located between the beauty shop and the activity room, all revealed no call light system in place. During an interview with the Director of Nursing (DON) on 4/13/10 at 11:40 AM, he/she confirmed that "these bathrooms are used by everyone, staff, visitors and residents". The DON stated that "the residents are assisted". When he/she was informed of the observations of residents using the bathroom alone, he/she stated "well we do have some that can go by themselves." 2014-01-01
10269 HEARTLAND OF COLUMBIA REHAB AND NURSING CENTER 425008 2601 FOREST DRIVE COLUMBIA SC 29204 2010-09-14 279 D     916711 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the complaint inspection, based on record review, observations and interviews, the facility failed to develop and implement care plans with interventions to prevent aspiration for Residents #1, #2, #3 and #4 prescribed mechanically altered diets with nectar thick liquids and assessed as at risk for aspiration. The findings included: The facility admitted Resident #1 on 08/20/2008 with [DIAGNOSES REDACTED]. Observation on 09/13/2010 at approximately 3:00 PM of Resident #1's room revealed a white Styrofoam cup dated 09/11/2010 filled with water. In an interview with the surveyor on 09/13/2010 at 3:30 PM Licensed Practical Nurse #1 confirmed the date on the cup and the liquid. LPN #1 stated that a Speech Therapist had been working with Resident #1 and she was to have thickened liquids only. "The cup must have been left by the weekend staff." Record review on 09/13/2010 revealed a hospital transfer summary dated 08/23/2010 with discharge [DIAGNOSES REDACTED]. The physician ordered on [DATE] Speech-Language Pathology 5 days per week daily with precaution listed as aspiration; a pureed diet with nectar thick liquids was prescribed. Review of Resident #1's care plan revised 08/31/2010 listed as a focus area "Alteration in nutritional status r/t (related to) therapeutic mechanically altered diet with thicken liquids. Has severe dysphagia with high aspiration risk, family declines feeding tube." Interventions listed "will provided diet/snacks as ordered, will report hypo/hyper glycemia, will honor food preferences, will provide OHA's (oral hypoglycemic agents) as ordered". The facility admitted Resident #2 on 03/10/2008 with [DIAGNOSES REDACTED]. Record review on 09/14/2010 revealed physician's orders [REDACTED]. Review of Resident #2's care plan revised 09/13/2010 listed as a focus area "History of weight loss r/t receives daily diuretic and has dx (diagnosis) of dysphagia..." Interventions included "will provide honey thick liquids as ordered". The facility admitted Resident #3 on 07/31/2009 with [DIAGNOSES REDACTED]. Record review on 09/14/2010 revealed a telephone order dated 08/26/2010 for a pureed diet with nectar-like thick liquids. Review of Resident #3's care plan revised 08/26/2010 listed as a focus area "Nutrition: potential for weight loss related to dementia is also a diabetic; therapeutic mech (mechanically) alt (altered) diet with nectar thicken liquids..." Interventions included "encourage and assist as needed to consume all foods and/or supplements and fluids offered at and between meals. 8-26-2010 now to receive nectar thick liquids..." The facility admitted Resident #4 on 05/19/2009 with [DIAGNOSES REDACTED]. Record review on 09/14/2010 revealed a physician's orders [REDACTED]. Review of Resident #4 care plan initiated 08/12/2010 listed as a focus area "Feeding tube use with potential for complications also received ordered liquids and PO (by mouth) diet..." Interventions included "elevated head 30-45 degrees at all times... monitor for and report any signs of aspiration or intolerance of feeding..." Review of the Certified Nurse Aide (CNA) Kardex failed to list Resident #1 as at risk for aspiration; Residents #2, #3 and #4 were noted on the CNA Kardex as at risk for aspiration. The PIW (patient intervention worksheet) used by the CNAs did not include aspiration precautions for Residents #1, #2, #3 and #4. In a face-to-face interview with the surveyor on 09/14/2010 at 1:00 PM Speech Therapist #1 stated that any resident receiving nectar thick liquids should be on aspiration precautions, that she taught the CNA individually about aspiration precautions when she worked with the residents. When asked if she taught every shift she stated, "No." The Speech Therapist stated she was concerned about posting information at the bedside due to it being personal information about the resident. In face-to-face interviews with the surveyor on 09/14/2010 CNAs #1, #2 and #3 stated they would position the resident upright and give them small bites. The CNAs could not recall an inservice related to aspiration precautions. In reviewing the CNA Kardex monitor with the surveyor CNA #3 was not sure if the CNA Kardex addressed aspiration precautions, until she saw aspiration precautions on the monitor. 2014-01-01
10270 HEARTLAND OF COLUMBIA REHAB AND NURSING CENTER 425008 2601 FOREST DRIVE COLUMBIA SC 29204 2010-09-14 315 G     916711 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the complaint inspection based on record review and interviews the facility failed to provide appropriate treatment and services to prevent urinary tract infections for 2 of 3 residents reviewed for urinary tract infections. On 08/13/2010 the physician ordered a STAT urinalysis and culture/sensitivity for Resident #1 to be done on 08/14/2010; the urine obtained by an in and out catheterization was left in the refrigerator, the test was not performed and treatment was delayed. Resident #1 was admitted to the hospital on [DATE] with a urinary tract infection. Resident #3's with increased blood sugars and a low grade temperature had a urinalysis and culture/sensitivity done on 08/05/2010, which was carried to the wrong lab, treatment was delayed for 4 days. The findings included: The facility admitted Resident #1 on 08/20/2008 with [DIAGNOSES REDACTED]. Record review on 09/13/2010 revealed the following Nurse's Note: 08/13/2010 at 6:00 PM that stated, "Speech only slightly garbled today. Hx (history) UTI (urinary tract infection) in the past. New order received for UA/CS (urinalysis/culture and sensitivity) Stat in AM.... 08/14/201 at 6:50 AM In and out cath (catheterization) to obtain urine specimen for UA and CS state in AM; pt tolerated procedure well... 08/15/2010 at 2:00 PM Pt with garble speech appears confused unable to coordinate hands to mouth. Placing hands in plate rather than spoon to eat with. Chest congested. BP (blood pressure) 114/63 p (pulse) 68 R (respirations) 18 unlabored. MD notified ordered [MEDICATION NAME] Bid (twice a day) and chest x-ray given. Schedule CT of head at hospital... Late entry for 08/15/2010 12:30 AM MD here to see resident... 08/16/2010 11:40 AM Resident unable to coordinate hand movement. Garbled like speech. Tongue hanging out of mouth. Resident not herself call RP. RP would like for resident to be evaluated. MD notified. Resident sent to hospital..." Record review on 09/13/2010 of the hospital admission history and physical dated 08/16/2010 at 3:33 PM revealed an admission assessment and plan that stated, "Urinary tract infection. We will initiate [MEDICATION NAME]. The last two urine cultures had produced fluoroquinolone resistant species. The patient was given [MEDICATION NAME] in the ER, although these were both acceptable [MEDICATION NAME] given the patient's unspecified [MEDICATION NAME] history, we will refrain cephalosporins and initiate carbapenem therapy pending final culture. 2. Altered mental status secondary to problem 1..." On 09/13/2010 a review of the laboratory studies revealed no results for the UA/CS ordered by the physician STAT in the AM on 08/13/2010. In an interview with the surveyor on 09/14/2010 the Director of Care Delivery for 1 Front stated that she had discovered that the urinalysis had not been done when she came in to work on Monday morning, 08/16/2010; that the urine was left in the refrigerator. The facility admitted Resident #3 on 07/31/2009 with [DIAGNOSES REDACTED]. Record review on 09/14/2010 revealed a physician's orders [REDACTED]. Continued review of the physician's orders [REDACTED]. Review of the Lexington Medical Center urinalysis results dated 08/05/2010 had a note that stated, "wait for C and S". The culture and sensitivity results were available on 08/07/2010 but not obtained by the facility until 08/09/2010, treatment was started 2 days after the test results were available. In an interview with the surveyor on 09/14/2010 the Director of Care Delivery for 1 Front stated that she discovered that the hospice nurse carried the urine to the wrong lab and as soon as this was discovered the resident was treated. 2014-01-01
10271 HEARTLAND OF COLUMBIA REHAB AND NURSING CENTER 425008 2601 FOREST DRIVE COLUMBIA SC 29204 2010-09-14 281 G     916711 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the complaint inspection, based on observations, record review and interviews, the facility failed to provide care that met professional standards of practice for 2 of 3 sampled residents reviewed for standards of practice related to urinary tract infections and for 4 of 4 sampled residents reviewed for standards of practice related to aspiration precautions. The findings included: The facility admitted Resident #1 on 08/20/2008 with [DIAGNOSES REDACTED]. Record review on 09/13/2010 revealed the following Nurse's Note: 08/13/2010 at 6:00 PM that stated, "Speech only slightly garbled today. Hx (history) UTI (urinary tract infection) in the past. New order received for UA/CS (urinalysis/culture and sensitivity) Stat in AM.... 08/14/201 at 6:50 AM In and out cath (catheterization) to obtain urine specimen for UA and CS STAT in AM; pt (patient) tolerated procedure well... 08/15/2010 at 2:00 PM Pt with garble speech appears confused unable to coordinate hands to mouth. Placing hands in plate rather than spoon to eat with. Chest congested. BP (blood pressure) 114/63 p (pulse) 68 R (respirations) 18 unlabored. MD (medical doctor) notified ordered [MEDICATION NAME] Bid (twice a day) and chest x-ray given. Schedule CT (computerized tomography) of head at hospital... Late entry for 08/15/2010 12:30 AM MD here to see resident... 08/16/2010 11:40 AM Resident unable to coordinate hand movement. Garbled like speech. Tongue hanging out of mouth. Resident not herself call RP (responsible party). RP would like for resident to be evaluated. MD notified. Resident sent to hospital..." Record review on 09/13/2010 of the hospital admission history and physical dated 08/16/2010 at 3:33 PM revealed an admission assessment and plan that stated, "Urinary tract infection..." On 09/13/2010 a review of the laboratory studies revealed no results for the STAT UA/CS ordered by the physician for the AM of 08/14/2010. In an interview with the surveyor on 09/14/2010 the Director of Care Delivery (DCD) for 1 Front stated that she had discovered that the urinalysis had not been done when she came in to work on Monday morning, 08/16/2010; that the urine was left in the refrigerator. The nursing staff failed to assure that the lab picked up the urine on 08/14/2010. The facility admitted Resident #3 on 07/31/2009 with [DIAGNOSES REDACTED]. Record review on 09/14/2010 revealed a physician's orders [REDACTED]. Continued review of the physician's orders [REDACTED]. Review of the Lexington Medical Center urinalysis results dated 08/05/2010 had a note that stated, "wait for C and S". The culture and sensitivity results were available on 08/07/2010 but not obtained by the facility until 08/09/2010, treatment was started 2 days after the test results were available. In an interview with the surveyor on 09/14/2010 the DCD for 1 Front stated that she discovered that the hospice nurse carried the urine to the wrong lab and as soon as this was discovered the resident was treated. The DCD stated that the urinalysis results were usually received within 24 hours of the collection date and the culture/sensitivity results was received within 48 hours of the collection date. The nursing staff failed to followup on a urinalysis done on 08/05/2010 until 08/09/2010, four days after the urine was sent to the lab. As stated in paragraph one, the facility admitted Resident #1 on 08/20/2008 with [DIAGNOSES REDACTED]. Observation on 09/13/2010 at approximately 3:00 PM of Resident #1's room revealed a white Styrofoam cup dated 09/11/2010 filled with water. In an interview with the surveyor on 09/13/2010 at 3:30 PM Licensed Practical Nurse #1 confirmed the date on the cup and the liquid. LPN #1 stated that a Speech Therapist had been working with Resident #1 and she was to have thickened liquids only. "The cup must have been left by the weekend staff." Record review on 09/13/2010 revealed a hospital transfer summary dated 08/23/2010 with discharge [DIAGNOSES REDACTED]. The physician ordered on [DATE] Speech-Language Pathology 5 days per week daily with precaution listed as aspiration; a pureed diet with nectar thick liquids was prescribed. Review of Resident #1's care plan revised 08/31/2010 listed as a focus area "Alteration in nutritional status r/t (related to) therapeutic mechanically altered diet with thicken liquids. On 09/14/2010 at 8:15 AM Resident #1 was observed in the dining room independently eating a pureed breakfast and drinking thicken water. The facility admitted Resident #2 on 03/10/2008 with [DIAGNOSES REDACTED]. Record review on 09/14/2010 revealed physician's orders [REDACTED]. Review of Resident #2's care plan revised 09/13/2010 listed as a focus area "History of weight loss r/t receives daily diuretic and has dx (diagnosis) of dysphagia..." On 09/14/2010 at 8:20 AM Resident #2 was observed in the dining room independently drinking thicken juice at breakfast. Additional review revealed the facility admitted Resident #3 on 07/31/2009 with [DIAGNOSES REDACTED]. Record review on 09/14/2010 revealed a telephone order dated 08/26/2010 for a pureed diet with nectar-like thick liquids. Review of Resident #3's care plan revised 08/26/2010 listed as a focus area "Nutrition: potential for weight loss related to dementia is also a diabetic; therapeutic mech (mechanically) alt (altered) diet with nectar thicken liquids..." On 09/13/2010 at approximately 3:15 PM Resident #3's granddaughter stated that her grandmother was unable to drink unassisted. The facility admitted Resident #4 on 05/19/2009 with [DIAGNOSES REDACTED]. Record review on 09/14/2010 revealed a physician's orders [REDACTED]. Review of Resident #4 care plan initiated 08/12/2010 listed as a focus area "Feeding tube use with potential for complications also received ordered liquids and PO (by mouth) diet..." On 09/14/2010 at 10:00 AM Resident #4 stated that he needed help with drinking and eating. Aspiration precautions were not care planned as a focus area for Residents #1, #2, #3 and #4 and observations on 09/13/2010 and 09/14/2010 revealed no system to identify residents who were at risk for aspiration. Review of the Certified Nurse Aide (CNA) Kardex failed to list Resident #1 as at risk for aspiration; Residents #2, #3 and #4 were noted on the CNA Kardex as at risk for aspiration. The PIW (patient intervention worksheet) used by the CNAs did not include aspiration precautions for Residents #1, #2, #3 and #4. In a face-to-face interview with the surveyor on 09/14/2010 at 1:00 PM Speech Therapist #1 stated that any resident receiving nectar thick liquids should be on aspiration precautions, that she taught the CNA individually about aspiration precautions when she worked with the residents. When asked if she taught every shift she stated, "No." The Speech Therapist stated she was concerned about posting information at the bedside due to it being personal information about the resident. In face-to-face interviews with the surveyor on 09/14/2010 CNAs #1, #2 and #3 stated they would position the resident upright and give them small bites. The CNAs could not recall an inservice related to aspiration precautions. In reviewing the CNA Kardex monitor with the surveyor CNA #3 was not sure if the CNA Kardex addressed aspiration precautions, until she saw aspiration precautions on the monitor. 2014-01-01
10272 MAGNOLIA MANOR - INMAN 425032 63 BLACKSTOCK ROAD INMAN SC 29349 2010-09-16 328 D     UGRJ11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the day of the complaint inspection based on observations, interviews and record review the facility failed to ensure residents received timely foot care. The physician saw resident #2 and prescribed an antibiotic and cleaning to the right toenail bed until seen by the podiatrist related to redness of the toenail bed; resident #2 had a history of [REDACTED]. The findings included: The facility admitted Resident #2 on 08/21/2009 with [DIAGNOSES REDACTED]. Resident #2 was sampled as a result of a complaint related to skin care. Review of the current medical record on 09/16/2010 revealed the most recent Podiatry visit as 01/20/2010. A review of the nurse's notes revealed documentation that the podiatrist on 01/10/2010 for routine care saw Resident #2. On 03/10/2010 the physician saw Resident #2 due to pain in the left great toe and ordered triple antibiotic ointment for 7 days and Keflex 250 milligrams for 10 days. Nurse's notes from 03/11, 03/12, and 03/13/2010 documented a purulent yellow discharge from the left great toe. The Nurse's notes on 03/14/2010 at 3:45 PM stated, "CNA (certified nurse aide) reported to me Res (resident) in need of toenail trim. Removed bil (bilateral) bunny boots and both feet extremely dry and cracked no open areas noted. Velcro closure of top of (L) foot has rubbed reddened area to skin but intact. Attempted to trim toenail of (L) great ft (foot) and pus actively comin (sic) out. Toenail fell off. Trimmed all toenails and all came off either whole or crumbled. Skin underneath old nail pink and very healthy in appearance. Cleansed feet multiple times with warm water at bedside... Has had trx (treatment) ongoing to (L) great toes for inf (infection) with TAO. Had foul odor and purulent pus before cleaning. At present no active bleeding. Continued review of the nurse's notes revealed the physician was not notified about the drainage on 03/11, 03/12 and 03/13/2010 or that during care the toenails came off on 03/14/2010. The physician examined Resident #2's toes on 03/16/2010 and continued the previous orders. The antibiotic was completed on 03/19/2010. Review of the nurse's notes from 03/19/2010 thru 08/18/2010 revealed no documentation related to the resident's toenails. A nurse's note dated 08/19/2010 at 2:00 PM stated, "Brought to this nurse's attention; Resident's daughter went to nurse from station 4 to show her resident's (R) great toenail very thick and crusty in some areas. Nurse able to pull back some of crustation (sic) revealing some redness along cuticle line no puss or secretions of any kind noted. Resident denies any discomfort. Resident seen by covering NP (nurse practitioner) orders rcd (received) for Keflex 500 PO (by mouth) TID (three times a day) x 7 days and cleanse (R) great toe nail bed with NSS (normal saline solution) BID (twice a day) until seen by foot MD (medical doctor)...Resident has been added to podiatry list." Review of the Weekly Skin Assessment's from 04/2010 thru 08/13/2010 showed no documentation related to Resident #2's toenails. An observation with the surveyor on 09/16/2010 at 2:10 PM with Licensed Practical Nurse (LPN) #1 revealed Resident #2 wearing bunny boots on both feet; the great toe nails on both feet appeared fragile, rough, thickened and yellow; there was very little nail seen on all toes. Resident #2 stated that she had no pain when asked if the toenails were painful. LPN #1 stated that the resident was on the list to be seen by the podiatrist. In an interview with the surveyor on 09/16/2010 at approximately 4:20 PM the Director of Nurses provided a list of residents who were to been see by the podiatrist at his next visit. When asked when that would be she stated that she did not know, that it was difficult to get the podiatrist to come to the facility. She stated that the RN (registered nurses) cut the toenails for the residents as needed. The DON added that the ward clerk who kept up with the podiatrist appointments was on vacation and she would return next week. The facility was unable to provide a written nail care policy. In an interview with the surveyor on 09/22/2010 at 10:50 AM the Ward Clerk responsible for making the podiatry appointments stated that the podiatrist was in the facility on 01/20/2010, 02/08/2010, 03/25/2010, 04/02/2010, 05/05/2010, 06/23/2010, 07/12/2010 and 08/09/2010. When asked when he would be there again she stated she had not called to ask him to return, that she usually waited two weeks after his visit, then called and schedule him to come to another station; the facility had 4 nursing stations. The Ward Clerk said that she collected the names of the residents who needed to be seen by the podiatrist from each station and then scheduled the residents; she confirmed that Residents #2 was on the list to be seen on the next podiatry visit. When asked if she had been told that Resident #2 had an order for [REDACTED]. 2014-01-01
10273 MAGNOLIA MANOR - INMAN 425032 63 BLACKSTOCK ROAD INMAN SC 29349 2010-09-16 157 D     UGRJ11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the day of the survey, based on record review the facility failed to notify the physician of changes for one of five residents reviewed for foot care. Resident #2 with prescribed antibiotics for an infection of the left great toe developed "a purlent (sic) yellow discharge" that was not reported timely to the physician. The findings included: The facility admitted Resident #2 on 08/21/2009 with [DIAGNOSES REDACTED]. Resident #2 was sampled as a result of a complaint related to foot care. A review of the nurse's notes revealed documentation that the podiatrist on 01/10/2010 for routine care saw Resident #2. On 03/10/2010 the physician saw Resident #2 due to pain in the left great toe and ordered triple antibiotic ointment for 7 days and Keflex 250 milligrams for 10 days. Nurse's notes from 03/11, 03/12, and 03/13/2010 documented a purulent yellow discharge from the left great toe. The Nurse's notes on 03/14/2010 at 3:45 PM stated, "CNA (certified nurse aide) reported to me Res (resident) in need of toenail trim. Removed bil (bilateral) bunny boots and both feet extremely dry and cracked no open areas noted. Velcro closure of top of (L) foot has rubbed reddened area to skin but intact. Attempted to trim toenail of (L) great ft (foot) and pus actively comin (sic) out. Toenail fell off. Trimmed all toenails and all came off either whole or crumbled. Skin underneath old nail pink and very healthy in appearance. Cleansed feet multiple times with warm water at bedside... Has had trx (treatment) ongoing to (L) great toes for inf (infection) with TAO. Had foul odor and purulent pus before cleaning. At present no active bleeding. Continued review of the nurse's notes revealed the physician was not notified about the drainage on 03/11, 03/12 and 03/13/2010 or that during foot care the toenails came off on 03/14/2010. The physician examined Resident #2's toes on 03/16/2010. 2014-01-01
10274 UNIHEALTH POST ACUTE CARE ORANGEBURG, LLC 425085 755 WHITMAN STREET SE ORANGEBURG SC 29115 2010-09-29 225 D     LLC411 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on record review, observations, interviews, and review of facility documents, the facility failed to report an injury of unknown origin within the allowed time frame, failed to promptly begin an investigation into the injury, and failed to thoroughly investigate the resident's injury for a possible explanation of how it occurred for 1 of 1 resident reviewed who had an injury of unknown origin (#3). The findings included: Resident #3 with [DIAGNOSES REDACTED]. Review of the annual Resident Assessment Instruments of 5/14/09 and 4/23/10 showed the resident had short and long term memory problems with moderately impaired decision making ability. Communication was sometimes understood. The resident required total care from the staff for all activities of daily living. Staff transferred the resident by mechanical lift. The resident received nutrition and hydration via feeding tube and maintained a steady weight (206 pounds recorded on the 5/14/09 assessment and 204 pounds on the later assessment.) Resident Assessment Protocol (RAP) notes revealed the resident had left side weakness from the stroke. She could mumble some words and was able to relay simple messages at times. The resident understood simple communication and followed simple commands. Two staff members assisted with bed mobility and transfers with the mechanical lift. Review of the medical record and facility documents showed the resident first showed signs of injury on 7/13/10 when a bruise was discovered after the resident's shower. Review of the Change Of Condition Nurses Notes and Resident Incident Report showed the discoloration was to the left back. There was no inflammation or [MEDICAL CONDITION] noted to the area. The facility did not report this injury of unknown origin or begin any investigation into the injury's possible origin. The facility did report to the State survey and certification agency on 7/15/10 that the resident's weekly skin audit done on 7/15/10 showed purple discoloration on the upper anterior left arm and chest. The resident grimaced when the left arm was manipulated. X-ray and assessment at the hospital showed a fractured left humeral head. The facility began an investigation into the resident's injury at that time. The Five-Day Follow-Up Report dated 7/20/10 stated the area found on 7/13/10 was a discoloration to the left flank. Review of the facility's investigative materials showed on their final report: "Res. was noted to have bruising on back on 7/13/10 which was noted on 7/15/10 to also have new area on arm. No pain noted w/verbalization or movement until 7/15/10. Res. had sling too small for her size on 7/13/10 (sic), which is the date the initial bruising was noted. ..." The facility's investigation revealed interviews were done with direct caregivers and a determination was made that the resident's injury was due to staff using the wrong size mechanical lift sling during transfer. Written statements were taken from the LPN who assessed the bruises, and from Certified Nursing Assistants (CNAs) who provided care to the resident. CNA #1 worked the 3-11 shift on 7/12/10, CNA #2 worked the 7-3 shift on 7/12, 13, 14, and 15/10, and CNA #3 worked the 3-11 shift on 7/13/10. CNA #4 provided a written statement but was not listed on the daily schedule as being assigned to the resident during the same time period. The investigative materials did not show evidence of interviews or written statements from the 11-7 staff, the 7/14/10 3-11 CNA, or any of the staff that assisted the assigned caregivers during transfer of the resident from bed to chair on the days of 7/12-14/10. The investigation did not show what size sling was used for the resident on 7/13/10, which allegedly caused the injury. (The CNA statement alleging the wrong sling size was used was for 7/12/10, not 7/13/10.) Nor did the investigation show any information about which sling size was used for the resident on 7/14/10. The delay in beginning the investigation allowed for the possibility of further injury to the resident. During the survey, discrepancies were noted in the facility's investigative report, statements obtained, and information revealed in staff interviews concerning the sling used, and the location and characteristics of the bruises: CNA #1 stated on 9/28/10 at 12:25 PM that he found the resident on 7/12/10 up in the recliner chair with the wrong type of sling underneath her. He stated the resident needed a full body sling, not the divided leg sling. CNA #1 stated he and another CNA, who he could not recall, removed the sling from under the resident and then applied a full body sling under her before assisting the resident to bed. When asked how the slings were changed, the CNA stated they did it while the resident was still in the recliner by turning her from side to side. CNA #1's written statement said: "... Resident up on (with) sling under her in Geri chair. He states he was nervous to move her (with) smaller sling so he went to get another CNA to help him. The two CNA removed the small sling & replaced (with) a larger sling and she was then transferred to the bed (without) incident." Review of the manufacturer information on mechanical lift slings revealed divided leg slings were designed to allow for application while a resident was seated, full body slings were not. CNA #3 stated in an interview on 9/28/10 at 4:20 PM that the resident was in the recliner chair on 7/13/10 when he started his 3-11 shift. The CNA gave the resident her shower while she remained in the recliner chair, then got assistance from another staff member to transfer the resident to bed. CNA #3 could not recall what type of sling was used for the transfer. While getting the resident ready for bed, CNA #2 noticed a blackish blue area under the resident's left axilla extending under the left breast. The CNA gave an approximate size of 4 centimeters. The resident showed no signs of distress from the area. CNA #3 reported his finding to the nurse. CNA #3's statement for the facility's investigation stated the area was black in color or very dark and it was under her axilla. The information from CNA#3 did not indicate injury to the left flank or left back. LPN #1 was interviewed on 9/29/10 at 10:35 AM. She stated that on 7/13/10, she observed an elongated, approximately 3 inches by 1 inch reddish purple area on the resident's upper back at the axilla level. LPN #1 denied seeing a blackish bruise under the resident's arm, extending under the left breast. On 7/15/10, the LPN witnessed a deep purple bruise on the left breast/chest area. It was approximately 4 inches in size. The back of the resident's upper left arm was also purple in color, about "3 fingers" large. The previously noted area on the resident's upper back was lighter in color and smaller in size. Resident #3's left clavicle appeared different and the physician was notified. LPN #1's written statement said discoloration was noted on the left back on 7/13/10 with improvement noted on 7/14/10. On 7/15/10 "body audit noted discoloration anterior Lt. arm, Lt back same area, same discoloration Lt rib area to under Lt breast. Grimacing when Lt arm moved. Appearance of Lt clavicle area different than Rt. ..." LPN #1 did not reference the resident's left flank in either her interview or in her statement. CNA #2's statement for the facility's investigation revealed she saw on Wednesday (7/14/10) or Thursday (7/15/10) a bruise at the resident's left breast under and toward "(R) back" in axilla line. She also noticed discoloration to the left arm that was a yellow-greenish color from elbow to shoulder. The resident moaned when moved, as if in pain. CNA #2 reported her findings to LPN #1 on 7/15/10. During an interview with the Administrator and DON on 9/29/10 at 12:30 PM, they stated their conclusion that the wrong size sling caused the resident's injury was based on the CNA admitting that the wrong size sling was used. However, the DON continued to say that CNA #2 reported that a too small sling was used on 7/12/10 but CNA #2 reported an appropriate sling size was used with the resident on 7/12/10. When asked why the facility failed to report and begin an investigation on 7/13/10, with the first signs of injury to the resident, the Administrator and DON stated it was because the bruising noted on 7/13/10 was not reported to them until the injuries on 7//15/10 were reported. The Administrator and DON said that prior to the resident's incident, no direction was provided to the CNA staff about which type of lift sling or what size of lift sling was to be used with each resident. 2014-01-01
10275 UNIHEALTH POST ACUTE CARE ORANGEBURG, LLC 425085 755 WHITMAN STREET SE ORANGEBURG SC 29115 2010-09-29 496 D     LLC411 On the days of the survey, based on review of employee information provided, the facility failed to ensure that registry verification was completed before allowing an individual to serve as a Certified Nursing Assistant (CNA) for 2 of 3 employees reviewed who were hired in 2010 as CNAs. The findings included: During the complaint investigation, information concerning the staff on duty around the time of an injury of unknown origin was requested from the facility. The information provided failed to show that two of the CNAs had registry verification checks done prior to hire. The Director of Nurses (DON) was asked for this information on 9/28/10. On 9/29/10, the DON stated she knew the registry verification checks were done before hire, but Human Resources could not produce evidence of this. 2014-01-01
10276 UNIHEALTH POST ACUTE CARE ORANGEBURG, LLC 425085 755 WHITMAN STREET SE ORANGEBURG SC 29115 2010-09-29 514 D     LLC411 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on record reviews, the facility failed to ensure that resident records were complete and accurately documented for 1 of 3 resident records reviewed (#3). Documentation in the medical record concerning Resident #3's injury of unknown origin was incomplete and inaccurate. The findings included: Resident #3 with [DIAGNOSES REDACTED]. Review of the Change Of Condition Nurses Notes showed staff found a discoloration on the resident's left back. The area was without inflammation or [MEDICAL CONDITION]. The nurse's note by LPN #1 did not describe the discoloration's size, shape, color, or specific location on the resident's left back. Certified Nursing Assistant (CNA) #3 found the area on 7/13/10 after the resident's shower and reported it to the nurse for assessment. This CNA was interviewed on 9/28/10 at 4:20 PM and stated what he saw was an area under the resident's left axilla extending to the left breast, it was blackish blue in color, and was approximately 4 by 4 centimeters big. LPN #1 was interviewed on 9/29/10 at 10:35 AM. She stated that on 7/13/10, she observed an elongated; approximately 3 inches by 1 inch, reddish purple area on the resident's upper back at the axilla level. LPN #1 denied seeing a blackish bruise under the resident's arm, extending under the left breast. Documentation in the Change of Condition Nurses Notes on 7/14/10 by LPN #1 described the "left flank discoloration" as not as large as yesterday. The medical record showed no information of any discolored area on the resident's flank. LPN #1 did not reference the resident's left flank in either her interview or in her statement. The information at the top of the page on the 7/15/10 Change of Condition Nurses Notes showed the resident's bruise on the left back was not as large. Purple discoloration was noted on the upper anterior left arm and left chest. Farther down the page, under the Current Care Plan Interventions and physician's orders [REDACTED]." LPN #1 did both entries. The documentation did not show measurements or any other defining characteristics of the new bruising. Review of the skin assessment dated [DATE] showed that an area described as deep purple was outlined on the body form that included the posterior elbow to shoulder and corresponding area on the upper back on the resident's left side. A deep purple area was outlined on the body depiction at the right breast/chest area. LPN #1's statement for the facility's investigation stated that on 7/15/10 "... body audit noted discoloration anterior Lt. arm, Lt back same area, same discoloration Lt rib area to under Lt breast. ..." Documentation in the medical record showed no mention of the rib area or left breast involvement. During the interview with LPN #1, she said that on 7/15/10, she witnessed a deep purple bruise on the resident's left breast/chest area. It was approximately 4 inches in size. The back of the resident's upper left arm was also purple in color, about "3 fingers" large. The previously noted area on the upper back was lighter in color and smaller in size. CNA #2 provided care to the resident on the 7-3 shift on 7/13, 14, and 15/10. Her statement for the facility's investigation revealed she saw on Wednesday (7/14/10) or Thursday (7/15/10) a bruise at the resident's left breast under and toward "(R) back in axilla line." She also noticed discoloration to the left arm that was a yellow-greenish color from elbow to shoulder. 2014-01-01
10277 UNIHEALTH POST ACUTE CARE ORANGEBURG, LLC 425085 755 WHITMAN STREET SE ORANGEBURG SC 29115 2010-09-29 323 D     LLC411 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on record review, observations, interviews, and review of facility documents, the facility failed to ensure each resident received adequate supervision and assistance devices to prevent accidents for 1 of 1 resident reviewed who had an injury of unknown origin (#3). The findings included: Resident #3 with [DIAGNOSES REDACTED]. Review of the annual Resident Assessment Instruments of 5/14/09 and 4/23/10 showed the resident had short and long term memory problems with moderately impaired decision making ability. Communication was sometimes understood. The resident required total care from the staff for all activities of daily living. Staff transferred the resident by mechanical lift. The resident received nutrition and hydration via feeding tube and maintained a steady weight (206 pounds recorded on the 5/14/09 assessment and 204 pounds on the later assessment.) Resident Assessment Protocol (RAP) notes revealed the resident had left side weakness from the stroke. She could mumble some words and was able to relay simple messages at times. The resident understood simple communication and followed simple commands. Two staff members assisted with bed mobility and transfers with the mechanical lift. Review of the medical record and facility documents showed the resident first showed signs of injury on 7/13/10 when a bruise was discovered after the resident's shower in the left axilla area. On 7/15/10, the resident's weekly skin audit on 7/15/10 showed purple discoloration on the upper anterior left arm and chest. The resident grimaced when the left arm was manipulated. X-ray and assessment at the hospital showed a fractured left humeral head. The facility began an investigation into the resident's injury at that time. The Five-Day Follow-Up Report dated 7/20/10 stated the area found on 7/13/10 was a discoloration to the left flank. Review of the facility's investigative materials showed on their final report: "Res. was noted to have bruising on back on 7/13/10 which was noted on 7/15/10 to also have new area on arm. No pain noted w/verbalization or movement until 7/15/10. Res. had sling too small for her size on 7/13/10 (sic) which is the date the initial bruising was noted. ..." The investigation did not show what size sling was used for the resident on 7/13/10, which allegedly caused the injury. (The CNA statement alleging the wrong sling size was used was for 7/12/10, not 7/13/10.) Nor did the investigation show any information about which sling size was used for the resident on 7/14/10. CNA #1 stated on 9/28/10 at 12:25 PM that he found the resident on 7/12/10 up in the recliner chair with the wrong type of sling underneath her. He stated the resident needed a full body sling, not the divided leg sling. CNA #1 stated he and another CNA, who he could not recall, removed the sling from under the resident and then applied a full body sling under her before assisting the resident to bed. When asked how the slings were changed, the CNA stated they did it while the resident was still in the recliner by turning her from side to side. CNA #1's written statement said: "... Resident up on (with) sling under her in Geri chair. He states he was nervous to move her (with) smaller sling so he went to get another CNA to help him. The two CNA removed the small sling & replaced (with) a larger sling and she was then transferred to the bed (without) incident." Review of the manufacturer information on mechanical lift slings revealed divided leg slings were designed to allow for application while a resident was seated, full body slings were not. During an interview with the Administrator and DON on 9/29/10 at 12:30 PM, they stated their conclusion that the wrong size sling caused the resident's injury was based on the CNA admitting that the wrong size sling was used. However, the DON continued to say that CNA #2 reported that a too small sling was used on 7/12/10 but CNA #2 reported an appropriate sling size was used with the resident on 7/12/10. The Administrator and DON said that prior to the resident's incident, no direction was provided to the CNA staff about which type of lift sling or what size of lift sling was to be used with each resident. 2014-01-01
10278 WHITE OAK MANOR - YORK 425089 111 SOUTH CONGRESS STREET YORK SC 29745 2010-07-28 425 E     1BYP11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on observation, record review and interviews, the pharmacy, supplying medications to the facility, failed to assure the accurate administration of all drugs for 1 of 6 residents observed during medication pass. Resident A with a physician's orders [REDACTED]. The findings included: On 7/27/10 at 8:50 AM during observation of medication pass for Resident A, Licensed Practical Nurse (LPN) #4 was observed to measure Miralax Powder to the 15 milliliter mark in a medication cup used to measure liquid medications. The Miralax Powder was dissolved in 7 ounces of water and administered to the resident along with 8 other medications. Reconciliation of medication pass for Resident A revealed a current physician's orders [REDACTED]. DX (diagnosis) CONSTIPATION". The identical physician's orders [REDACTED]. All of the orders were signed by the physician without clarifying the ambiguous dosage. Further review revealed that the Physician's admission orders [REDACTED]. Dx Constipation". During an interview on 7/28/10 at 8:40 AM, the pharmacist at the pharmacy supplying the medications to the facility, stated that the pharmacy did not have the original order for the Miralax Powers (written 1/20/04) on hand. She/he stated that, on the pharmacy side, they have 17 Gms in 8 ounces of water as the standard (manufacturer's recommended) dose for Miralax and confirmed that the dosage on the monthly orders, printed by the pharmacy, was not clear. She/he further stated that, if there was an error, it was the pharmacy's fault. During an interview on 7/28/10 at 8:47 AM, LPN #4 stated that the pharmacist came to the facility yesterday (7/27/10) at about 5 PM, after the observation of medication by this surveyor the morning of the same day, and changed the dose for the Miralax on the Medication Administration Record [MEDICATION ADMINISTRATION RECORD DETAILS REDACTED]. 2014-01-01
10279 WHITE OAK MANOR - YORK 425089 111 SOUTH CONGRESS STREET YORK SC 29745 2010-07-28 314 D     1BYP11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on observation, record review, interview and review of the product insert sheet for Santyl/facility policy for the application of a [MEDICATION NAME] product, the facility failed to assure that one of two sampled resident's reviewed for pressure ulcer care received appropriate treatment and services. During observation of the pressure ulcer treatment for [REDACTED]. Facility staff was unaware if the pressure relieving mattress in use was appropriately set for the resident's use. The findings included: The facility last admitted Resident # 3 on 7/24/10. The resident's [DIAGNOSES REDACTED]. On 7/27/10 at 9:10am, an observation of the resident's pressure ulcer treatment was conducted. During the the procedure, the wound care nurse was observed to clean the outside raised edge of the pressure ulcer but not clean the wound bed itself. The wound bed was noted to contain slough and tunneling was noted. Following the treatment, the wound care nurse was questioned as to why the wound bed was not cleaned. S/he stated s/he did not want the spray the "collect" where the wound was undermined and did not want to injure the wound bed by having to pat it dry. S/he also stated s/he felt the use of Santyl cleaned the wound bed when the previous dressing was removed. Review of the product insert sheet from Santyl revealed the manufacturers recommendation stated to clean the wound bed prior to the application of Santyl. The instructions stated the wound bed should be cleansed prior to application.. remove as much loose debris as possible, gently cleanse the wound bed with saline or wound cleanser followed by saline each time the dressing is changed. Additionally, the facility policy also stated the wound bed should be cleansed prior to the application of a [MEDICATION NAME] product. Also following the completion of the treatment, the facility wound care nurse was questioned related to the use of the pressure relieving mattress which was in place on the resident's bed. The head, foot and middle areas were all set at the same maximum level - 5. When asked how s/he knew the setting was appropriate for the resident, s/he stated maintenance department set up the bed and s/he did not know. During an interview with the Maintenance Supervisor on 7/28/10, s/he stated Maintenance did set up the bed and s/he could tell by "looking at it" if the setting was appropriate. The Maintenance supervisor confirmed the instructions for determining the appropriate setting for resident use were not used by the maintenance department. 2014-01-01
10280 WHITE OAK MANOR - YORK 425089 111 SOUTH CONGRESS STREET YORK SC 29745 2010-07-28 373 D     1BYP11 On the days of the survey, based on observation, interview and record review, the facility failed to identify the use of a paid feeding assistant program and failed to implement the approved program consistent with State law. The findings included: On 7/26/10, upon entrance to the facility, the Administrator stated the facility did not utilize a paid feeding assistant program. On 7/27/10, at approximately 1:30pm, the Administrator and Nurse Consultant again stated the facility did not have or use a paid feeding assistant program. During random observations during the evening meal on 7/26/10, two activity staff members were observed feeding residents in the "B" building. One resident was being fed in a small alcove in the "B" building and another resident was being fed in his/her room. Both staff members stated they were not Certified Nursing Assistants. During the noon meal on 7/27/10, the activity members were again observed feeding residents either in their rooms (building "B") or dining room (main building). Further investigation revealed the facility did have an state approved feeding assistant program. On 7/27/10 at 2PM, during an interview with the Staff Development Coordinator (SDC) , s/he stated s/he had not taught the feeding assistant program since her return to the facility 12/09 but s/he previously had taught it at the facility. S/he stated an awareness that both activity personnel had previously completed the feeding assistant program. When asked which residents a staff member who had completed the program could feed, the SDC stated they would feed "easier" residents. S/he further stated one particular activity staff member would feed "anyone she felt comfortable with...s/he would not step out of her comfort zone." A review of personnel files revealed both staff members had completed the paid feeding assistant program at the facility (in 2005 and 2007). On 7/28/10, during an interview with the Administrator it was verified that the facility was not cognizant that using trained staff members to feed residents constituted use of a paid feeding program. Additionally, the facility had not been following the stated mandated guideline for the paid feeding program by assuring a record was maintained of all individuals used as feeding assistants; assuring coordination of the program under the general supervision of a nurse; assuring a nurse was readily available for the supervision of feeding assistants while feeding; and identifying and assessing residents who could be fed by feeding assistants based on a charge nurse's assessment. 2014-01-01
10281 WHITE OAK MANOR - YORK 425089 111 SOUTH CONGRESS STREET YORK SC 29745 2010-07-28 441 E     1BYP11 **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 maintain an infection control program to help prevent the development and transmission of disease and infection. Interview and observation of the Laundry Department revealed a lack of knowledge of appropriate infection control practice. Personal Laundry was not being sanitized. Following observation of catheter care for Resident # 3, handwashing concerns were identified. The findings included: On 7/27/10 at 11AM, an observation of the facility laundry department was conducted. Laundry worker # 1 was observed placing soiled laundry into a washing machine. After the soiled laundry was placed, s/he was observed to remove the protective gown by pulling it over his/her head when unable to untie the strings. The same laundry worker was asked to explain the process on how to handle laundry from an infected resident. Both Laundry worker # 1 and # 2 stated they would wear two pair of gloves and put on two gowns for protection. When asked how the two gowns would be applied, they stated one frontward and one backward. A box containing 3 pillows (1 cloth and 2 vinyl covered) was observed in the soiled area. When asked how the pillows would be cleaned, Laundry worker # 1 stated one pillow would be discarded because it was torn. The other two pillows would would be cleaned the same by spraying and wiping off with a disinfectant cleaner and then dried with a towel. Review of the label of the product indicated would be used stated it was to be used for non-porous surfaces. Further interview revealed that no bleach or other disinfecting chemical was used when washing the resident's personal laundry. The facility water temperature for personal laundry was identified as cold/warm. Appropriate chemical sanitization was used for bedding and other linens when washed. On 7/27/10 at 11:25AM, an interview was conducted with the Maintenance Supervisor, identified as in charge of the laundry. S/he also stated that s/he would "guarantee" that s/he would wear two gowns and two pairs of gloves if handling known infectious laundry. During an interview with the Staff Development Coordinator who also was in charge of the facility infection control program, s/he stated laundry staff was in-serviced on hire related to infection control. Thereafter, (annually) staff completed a self study program. Laundry staff was not asked to demonstrate knowledge on how to apply/remove personal protective equipment. The facility last admitted Resident # 3 on 7/24/10. The resident's [DIAGNOSES REDACTED]. On 7/28/10 , an observation of the resident' s catheter care was conducted. After cleaning the residents catheter, the nurse removed his/her gloves, applied the resident's brief, covered the resident, discarded the overbed covering, bagged soiled supplies, raised the resident's head of bed, lowered the bed height, returned an unused brief to the resident's closet, opened the bedside curtain, walked down the hallway and opened the room door prior to discarding used supplies and then sanitized his/her hands. The Facility policy for hand hygiene stated that hands should be washed "after removing gloves." 2014-01-01
10282 WHITE OAK MANOR - YORK 425089 111 SOUTH CONGRESS STREET YORK SC 29745 2010-07-28 156 D     1BYP11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on record review and interview, the facility failed to ensure a Resident's responsible party's stated interest in a Do Not Resuscitate order was acted upon timely. Resident # 11's responsible party expressed interest in formulating an Advanced Directive. After the Resident was determined to lack capacity for healthcare decisions, the facility took no further action. (1 of 13 sampled resident's reviewed for Advanced Directives) The findings included: The facility last admitted Resident # 11 on 7/7/10. The resident's [DIAGNOSES REDACTED]. On 7/26/10 a review of the current medical record revealed a Social progress note dated 7/8/10 which stated: "Res (resident) has POA (Power of Attorney) copy placed on chart and no living will. RP (Responsible party) is interested in DNR (Do not Resuscitate)." On 7/14/10 two physicians documented the resident lacked capacity to make healthcare decisions. Additional Social progress notes were documented on 7/16 and 7/19/10 noting resident behaviors and family visits/contacts. However, there was no further documentation related to the resident's advanced directive status. On 7/26/10 at 4:10pm, during an interview with the nurse consultant, s/he stated the resident was a "full code." On 7/27/10 at 11am, during an interview with social services employee # 1, s/he stated once a resident's capacity has been determined, appropriate action related to the residents/responsible party stated wishes for advanced directives should "happen quickly". S/he verified no action had been taken by the facility after the resident's capacity has been determined. S/he further stated the RP had been contacted and would be coming to the facility "today" to sign the paperwork for the resident's Do Not Resuscitate status. 2014-01-01
10283 HEARTLAND OF LEXINGTON REHAB AND NURSING CENTER 425105 2416 SUNSET BOULEVARD WEST COLUMBIA SC 29169 2010-09-22 281 D     OR4T11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey based on record review and interview the facility failed to clarify and follow a Physicians order related to discontinuing [MEDICATION NAME] for Resident # 12, 1 of 1 resident reviewed on anticoagulant therapy. The findings included: Resident # 12 was admitted by the facility on 3/16/10 with [DIAGNOSES REDACTED]. The record review on 9/21/10 revealed a physician's orders [REDACTED].= 2.0". Further record review revealed an INR drawn on 9/13/10 was 4.05 and on 9/14/10 the INR was 3.03. The Medication Administration Record [MEDICATION ADMINISTRATION RECORD DETAILS REDACTED]. The INR results dated 9/9/10 had an order written [REDACTED].> 2). On 9/21/10 at 1:00 PM Licensed Practical Nurse (LPN) # 2 stated during an interview that "the order should have been clarified, because the orders are not the same. Someone should have called the doctor and asked about it, I think it should be stopped after it is greater than 2.0." The Unit Manager for the 100 hall stated during an interview on 9/21/10 at 2:00 PM " It (the [MEDICATION NAME]) should have been stopped when they got a INR of 2.0 or greater." During a telephone interview with LPN # 3 on 9/22/10 at 10:40 AM she confirmed that she took the order and stated " they were to stop the [MEDICATION NAME] when the INR is 2.0 or greater, I don't know why I would have written equal, that is just a slip of the pen or something, but it should be stopped when the INR is 2.0 or greater.". LPN # 2 called the Physician and received a clear order on 9/21/10 at 1:00 PM which reads "D/C [MEDICATION NAME] when INR greater than or equal to 2.0". 2014-01-01
10284 HEARTLAND OF LEXINGTON REHAB AND NURSING CENTER 425105 2416 SUNSET BOULEVARD WEST COLUMBIA SC 29169 2010-09-22 329 E     OR4T11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey based on record review and interview the facility failed to decrease [MEDICATION NAME] as ordered for Resident # 12. The resident received 30 mg (milligrams) of [MEDICATION NAME] instead of 15 mg as ordered. The findings included: Resident # 12 was admitted by the facility on 3/16/10 with [DIAGNOSES REDACTED]. The record review on 9/21/10 revealed an order written [REDACTED]. The Medication Administration Record [MEDICATION ADMINISTRATION RECORD DETAILS REDACTED]. The MAR indicated [REDACTED]. The MAR indicated [REDACTED]. Licensed Practical Nurse (LPN) # 2 stated during a interview on 9/21/10 that "the nurse who checked the MAR indicated [REDACTED]." The Unit Manager for Hall 100 stated during an interview on 9/21/10 " I checked those MAR's and I missed that, it is a problem." Both nurses stated " we will need to do a medication error report on this." 2014-01-01
10285 HEARTLAND OF LEXINGTON REHAB AND NURSING CENTER 425105 2416 SUNSET BOULEVARD WEST COLUMBIA SC 29169 2010-09-22 502 D     OR4T11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on record review and interview the facility failed to ensure that laboratory services were provided in a timely manner for 1 of 13 residents (Resident #4) reviewed for laboratory services. The findings included: The facility admitted Resident # 4 on 6/18/10 with the following Diagnoses: [REDACTED]. The record review on 9/20/10 revealed an order for [REDACTED]. On the bottom of this report a note/recommendation was made that stated " Mixed culture: 3 or more organisms isolated suggest repeat culture to rule out contamination." No other reports were found on the medical record. During an interview with Licensed Practical Nurse # 2 she stated " we should get another urine sample". This resident does have a Foley catheter and a history of Urinary Tract Infections with the last one documented and treated in July 2010. 2014-01-01
10286 BRIAN CENTER NURSING CARE - ST ANDREWS 425129 3514 SIDNEY ROAD COLUMBIA SC 29210 2010-12-08 441 E     R42P11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on observation, interview and review of facility policies, the facility failed to develop and maintain an infection control program which prevented the spread of infection. During three of four pressure ulcer treatment observations, concerns were identified related to glove use or handwashing. (Resident's # 1, #2, and #5) During observation of three of three gastric tube flushes, the nursing staff failed to clean the stethoscope either before or following the treatment. (Resident's #2, #3, and #8) In two of three medication rooms, supplies were found stored beyond the manufacturer's expiration date. (One hundred and three hundred units) The findings included: The facility last admitted Resident # 1 with [DIAGNOSES REDACTED]. On [DATE] at 10:45AM, Licensed Practical Nurse (LPN) # 5 was observed performing wound care for the resident. LPN # 5 was observed to remove the soiled dressing from the residents left hip area, and without changing gloves proceeded to clean the wound using clean supplies. The facility last admitted Resident # 5 with [DIAGNOSES REDACTED]. On [DATE] at approximately 11AM, Licensed Practical Nurse # 5 was observed performing pressure ulcer care. LPN # 5 removed the soiled dressing from the residents sacrum and without changing gloves proceeded to clean the Stage IV pressure area with clean supplies. After cleaning the area with normal saline and drying the area, LPN #5 removed her gloves, washed her hands and donned clean gloves. The nurse then skin prepped the perimeter of the wound, fanned the area dry, applied Santyl to the areas containing slough, wet a dressing with saline, unfolded it, folded it into a smaller size and placed it directly onto the wound. A cover dressing was applied. LPN #5, continuing to wear the same gloves, reached into her uniform pocket, removed a pen and tape which were used to initial and date the dressing. After moving the bedside table away from the bed, the nurse removed her gloves, placed the tape and pen back into her uniform pocket and then washed her hands. A facility provided QA (Quality Assurance) Worksheet (for) Aseptic Treatment/Dressing Changes stated: "Wear gloves when removing soiled dressings, then discard gloves and dressing." The facility admitted Resident # 2 on [DATE] with [DIAGNOSES REDACTED]. During observation of wound care on [DATE] at approximately 1:30 PM, the Licensed Practical Nurse (LPN # 1) entered the room, pulled the privacy curtain between the beds to the foot of the bed. After cleaning the wound, LPN # 1 discarded the wipes, removed gloves, washed hands, and pulled a pair of gloves from the box on the wall. As LPN # 1 returned to the bedside, his keys fell out of his pocket. He reached over and picked them up with his bare right hand, returned them to his pocket and then put the gloves on without washing his hands again. LPN # 1 then continued to put the clean bandage over the open wound. During an interview with LPN # 1 on [DATE] at approximately 4:00 PM, he confirmed that he had not washed his hands after picking up his keys off the floor during the treatment. The facility admitted Resident # 8 with Anoxic Brain Injury and status Gastrostomy. On [DATE] at 9:55AM, Licensed Practical Nurse # 5 was observed flushing the resident's gastric tube. The nurse walked to the resident's room wearing a stethoscope around her neck. The stethoscope bell was placed directly onto the resident's skin to check placement. The nurse then wrapped the stethoscope around her neck. The bell of the stethoscope was observed to touch the nurses uniform front and also her upper sleeve as the tube flush was administered. The stethoscope remained around the nurses neck. At the completion of the observation, the nurse was asked if she was finished and if she needed to do anything additional. The nurse stated she was "finished." The facility admitted Resident # 2 on [DATE] with [DIAGNOSES REDACTED]. During observation of tube flush on [DATE] at approximately 9:30 AM, Licensed Practical Nurse ( LPN # 1) entered room, explained treatment to Resident # 2, and returned to the hall to get supplies. LPN # 1 picked up a stethoscope from the medication cart and placed it around his neck, then set up the supplies on the over the bed table and proceeded to use the stethoscope to check for placement. At no time did this surveyor observe LPN # 1 cleaning the stethoscope. During an interview with LPN # 1 on [DATE] at approximately 4:00 PM, he stated that he had cleaned the stethoscope after the surveyor left the area, but not before the procedure. The facility admitted Resident # 3 on [DATE] with [DIAGNOSES REDACTED]. During observation of tube flush on [DATE] at approximately 11:30 AM, Licensed Practical Nurse (LPN # 2), entered the room, provided privacy, and set up the supplies on the over the bed table, washed her hands and gloved. She then took the stethoscope from the tube pole and proceeded to check for placement. After using the stethoscope, she returned it to the tube pole and proceeded with the tube flush. She did not clean the stethoscope during or after the procedure. On [DATE] at 3:50 PM, observation of the 300 Hall Medication Room revealed one container of 70 Premoistened Clorox Germicidal Wipes, 6.75 inches by 9 inches, marked "For equipment only", with an expiration date of [DATE]. During an interview on [DATE] at 4:12 PM, Registered Nurse (RN) #1 revealed that the medication nurses were responsible for checking the medication room for expired products. Pharmacy comes once a month and does a total check of the medication rooms. RN #1 stated that the wipes could have been used to clean equipment. On [DATE] at 10:43 AM, observation of the 100 Hall Medication Room revealed a container marked "Disaster Emergency Box", which contained supplies that included two [MEDICATION NAME] Transparent Adhesive Dressings, 6 centimeters by 7 centimeters with an expiration date of ,[DATE]. During an interview on [DATE] at 10:53 AM, Licensed Practical Nurse (LPN) #4 revealed that she (LPN #4) was responsible for checking the medication room for expired products. The medication nurses check the medication room periodically. LPN #3 orders stock medications and monitors stock medication expiration dates. 2014-01-01
10287 BRIAN CENTER NURSING CARE - ST ANDREWS 425129 3514 SIDNEY ROAD COLUMBIA SC 29210 2010-12-08 520 E     R42P11 **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 fully identify quality concerns related to restraints. Resident # 2 with a known restraint, had no quarterly assessment to determine if the restraint was the least restrictive device and whether or not the restraint continued to be necessary. The facility conducted weekly restraint quality assurance reviews and failed to fully identify missing documentation related to the restraint. The findings included: The facility admitted Resident # 20 with a primary [DIAGNOSES REDACTED]. During the initial tour of the facility on 12/6/10 the resident was identified as wearing a hand mitt restraint, "at the families request." The resident was observed with an oven mitt with a splint applied over the mitt on the right hand. On 12/8/10, record review revealed an order was written on 2/2/10 for: "Oven mitt to right hand(with) left hand Spica. Remove for ADL's (Activities of Daily Living) + (and) check skin integrity Q (every) shift d/t (due to) restlessness, Dementia, playing in feces and self scratching." Further review revealed a Quarterly Restraint Review dated 1/8/10 (before the restraint order) which stated: ' Continue current restraint order. ...Look for alternative to mitt that is less restrictive." The quarterly physical restraint review was completed thirteen times, each time recommending the continued use of the restraint. On 12/8/10 from 10AM to approximately 11:15AM, interviews were conducted with the Director of Rehabilitation who stated she was responsible for restraint documentation and the Physical therapist. It was questioned what follow up was done to obtain an alternative which was less restrictive and or whether the resident still required the use the use of the restraint. In reviewing the nurses notes, there was no documentation of the resident scratching or attempting to play in feces when the restraint was released for ADL's. The last note documenting the behavior was 2/2/10 which was stated by the daughter on the day the order was written. The restorative notes did not document any behaviors when the restraint was released for range of motion. There was no documentation that an attempt was made to allow the resident to be either restraint free or attempt made to use a lesser device. The Director of Rehabilitation stated an additional form was used to assess if a resident was a candidate for restraint reduction but verified there was no form in the resident's chart. A search for additional information was also conducted in the thinned record and in the therapy department. On 5/16/10, nursing documented a 2 cm (centimeter) round light purple bruise to the residents right wrist "where glove applied." Safety committee notes for 5/16/10 noted the bruise and stated "glove to be placed loosely"- therapy screening. On 5/17/10 occupational therapy documented a follow up from 5/17/10 concern of a "pressure area "over the right anterior wrist.. The screen stated the therapist had reviewed with the daughter/caregiver to leave strap through loop but not to pull through D ring and tighten over wrist with Velcro. On 7/2/10 the therapist documented reviewed with pts. (patients) splint on, straps correctly placed through d- ring only. no redness, swelling noted. (previous pressure area over wrist). Neither documentation addressed the need for the restraint, whether it was the least restrictive device, resident behaviors or whether the resident had been tried restraint free. At approximately 11AM, the concerns were shared with the Administrator. At 11:15AM, the Director of Rehabilitation provided a form titled report of quality improvement action team. The form was dated 12/6/10 and identified three residents who had not been "tried at a lower rest. (restraint) level for at least 1 year." The possible solution was for trial lower restraint levels this month to see if downgrades are possible with a goal date of 1/1/11. When the Director was asked how she had identified the concern, she stated she had been looking at the chart. When asked if she had also discovered there had been no quarterly assessments documented per policy, she stated "no." At approximately 11:30AM, during an interview with the Administrator, she stated a quality assurance review for restraints was completed every week on Monday. The Administrator verified the weekly quality assurance had not fully identified concerns related to the restraint. 2014-01-01
10288 BRIAN CENTER NURSING CARE - ST ANDREWS 425129 3514 SIDNEY ROAD COLUMBIA SC 29210 2010-12-08 164 D     R42P11 **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 ensure 1 of 3 residents received privacy during wound care. (Resident # 2) The findings included: The facility admitted Resident # 2 on 12-30-08 with [DIAGNOSES REDACTED]. During observation of wound care on 12-7-10 at approximately 1:30 PM, the Licensed Practical Nurse (LPN # 1) entered the room, pulled the privacy curtain between the beds to the foot of the bed, and asked the room mate if she wanted to leave the room while care was being given to Resident # 2. The room mate declined to leave the room, and was moving around her side of the room in her wheelchair. The privacy curtain which could have surrounded Resident # 2's bed was left at the head of her bed and not pulled around her bed. During the treatment LPN # 1 used up all of the supplies and stated to this surveyor, that he needed to leave the room to obtain more supplies to complete the treatment. At that time, Resident # 2 was lying on her side facing the door, with her brief unfastened and her entire backside exposed to view. When LPN # 1 left the room, the door was left ajar and unidentified persons were noted to be walking in the hall past the door. 2014-01-01
10289 BRIAN CENTER NURSING CARE - ST ANDREWS 425129 3514 SIDNEY ROAD COLUMBIA SC 29210 2010-12-08 315 D     R42P11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on observation, interview, review of the South Carolina Nurse Aide Candidate Handbook, and review of the facility policy on catheter care, the facility failed to provide appropriate treatment for 1 of 1 resident observed for catheter care. During observation of catheter care for Resident # 7, the Certified Nursing Assistant failed to secure the catheter close to the meatus to prevent tension or pressure on the bladder wall when cleaning the catheter tubing. The findings included: The facility admitted Resident # 7 on 6-7-10 with [DIAGNOSES REDACTED]. ,During observation of catheter care on 12-7-10 at approximately 10:00 AM, Certified Nursing Assistant (CNA # 1) knocked, entered the room, provided privacy, washed hands and gloved. CNA # 1 then set up the supplies on the over the bed table: 3 separate cups, one containing soapy water and gauze wipes, one containing clear water and gauze wipes, and the third containing dry gauze wipes. After Resident # 7 was positioned for the treatment, CNA # 1 again washed hands and gloved. CNA # 1 then positioned her left hand to separate the labia and secure the catheter. Using her right hand she used a soapy gauze wipe to clean around the left side of the labia, and discarded the gauze wipe, then repeated the procedure on the right side. CNA # 1 then used the third soapy gauze wipe to clean the catheter, beginning at the entry point of the catheter into the body, she wrapped the gauze around the catheter and pulled away from the body to where the fingers of her left hand secured the catheter (about 4 inches from the body). Tension was observed when the catheter was being cleaned. This entire process was repeated with the clear water rinse, and in drying. Review of the facility policy revealed the following: "Female residents: Separate labia with one hand. With the soapy gauze, cleanse from front to back one stroke down one side, discard the used gauze then stroke down the other side with a clean soapy gauze and discard. Anchoring the catheter with the hand holding the labia, complete one wipe down the middle cleaning the catheter and wipe away from the resident. Repeat each step with the rinse gauze and again with the dry gauze." Review of the South Carolina Nurse Aide Candidate Handbook revealed the following; "Provide Catheter Care for Female" #8 While holding catheter near meatus without tugging, cleans at least four inches of catheter nearest meatus, moving in only one direction, away from meatus...#9 While holding catheter near meatus without tugging, rinses at least four inches of catheter nearest meatus, moving only in one direction, away from meatus....#10 While holding catheter near meatus without tugging, dries four inches of catheter moving away from meatus." When these findings were shared with the Administrator and the Assistant Director of Nursing (ADON), on 12-8-10 at approximately 12:30 PM, the ADON stated that the policy would have to be changed to reflect the correct anchoring position. 2014-01-01
10290 UNIHEALTH POST-ACUTE CARE - NORTH AUGUSTA 425296 1200 TALISMAN DRIVE NORTH AUGUSTA SC 29841 2012-02-01 251 C     2C1L11 On the days of the survey, based on interviews and review of the "South Carolina Code of Laws Title 40-Professions and Occupations Chapter 63: Social Workers", the facility, with more than 120 beds, failed to employ a Licensed Social Worker as required by state law. The facility Social Worker had a Bachelor's Degree and had not been licensed. The findings included: During an interview on 02-01-12 with the facility Social Worker, she revealed she had a Bachelor's degree and had not been licensed. During an interview on 02-01-12 with the Administrator, she revealed she did not know a Licensed Social Worker was required. She stated the facility would contract with a Licensed Social Worker as a Consultant to oversee the facility Social Worker at least 20 hours per month. Review of the "South Carolina Code of Laws Unannotated, Current through the end of the 2011 Session, Title 40-Professions and Occupations, Chapter 63: Social Workers" revealed in Section 40-63-30: License as prerequisite to practice or offer to practice; providing social work services through telephone or electronic means. A) No individual shall offer social work services or use the designation "Social Worker", "Licensed Baccalaureate Social Worker", "Licensed Masters Social Worker", "Licensed Independent Social Worker-Clinical Practice", "Licensed Independent Social Worker-Advanced Practice", or the initials "LBSW", "LMSW", or "LISW" or any other designation indicating licensure status or hold themselves out as practicing social work or as a Baccalaureate Social Worker, Masters Social Worker, or Independent Social Worker unless licensed in accordance with this chapter". 2014-01-01
10291 UNIHEALTH POST-ACUTE CARE - NORTH AUGUSTA 425296 1200 TALISMAN DRIVE NORTH AUGUSTA SC 29841 2012-02-01 252 E     2C1L11 On the days of the survey, based on observation and interviews, the facility failed to ensure that the residents' room and care equipment were clean and sanitary for 1 out of 3 units observed for cleanliness. Resident rooms that contained feeding pumps were noted with soiled areas; stains were noted on ceiling tiles; dust was apparent under resident beds and a base board was not intact. The findings included: Observation during the initial tour on 1/30/2012 at 11:00 AM and follow up observation on 1/31/2012 at 9:30 AM on the Ventilator Unit revealed the following concerns. -12-A---tube feeding spills in bathroom; on grab bar; and shower chair. -12-B-- tube feeding noted at the base of the feeding pump. -12-D--wall at the head of the bed had dried spills. -13-C--tube feeding noted on the floor and wall behind the bed. -14-- noted stained ceiling tiles. -14-B---tube feeding noted on feeding pump. -14-D-- tube feeding noted on feeding pump. -15-C-- tube feeding noted on feeding pump and dust under the bed -15-D-- tube feeding noted on feeding pump and dust the under the bed. -16-A-- tube feeding noted on feeding pump and dust under the bed. -17-A-- dust particles noted behind the bed. -17-B-- tube feeding noted on the feeding pump. -18--wall and floor noted with spills. -19--dust noted behind the bed and portion of the base board was not intact. During an interview with the Unit Manager on 1/31/2012 at 3:15 PM, she stated that all staff were responsible for keeping the resident's care equipment and room clean. The Housekeeping and Laundry Supervisor verified all of the following listed above during a walking tour on 1/31/2012 at 4:00 PM. The Housekeeping and Laundry Supervisor stated that is was the responsibility of everyone to ensure all equipment and rooms are kept clean and sanitary. 2014-01-01
10292 L.M.C.- EXTENDED CARE 425321 815 OLD CHEROKEE ROAD LEXINGTON SC 29072 2010-09-30 441 F     IK8X11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on observation, record reviews and interviews, the facility failed to provide Tracheostomy care for one of one resident reviewed for tracheostomy care in a manner that would prevent possible infection on Resident #11. In addition the facility failed to track/trend infectious organisms and failed to adequately notify visitors of contact precautions. The findings included: The facility admitted Resident #11 on 5/12/10 with [DIAGNOSES REDACTED]. Review of the September 2010 cumulative physician's orders [REDACTED]. Observation on 9/28/10 at approximately 4:50 PM revealed Licensed Practical Nurse (LPN) #5 entered the resident's room. After assessing the resident, he put on a pair of clean gloves and suctioned inside and around the tip of the tracheostomy opening with a [MEDICATION NAME] suction catheter. He did not wash his hands prior to putting on the gloves. With the same gloved hands that he had used to suction with the [MEDICATION NAME] catheter, he opened a new inner cannula from a box container, removed the inner cannula from the resident's tracheostomy, and inserted the new inner cannula into the tracheostomy. With the same gloved hands, he then opened the drawer to the bedside table and removed a sterile suction kit. He put one sterile glove on his left hand without removing the other gloves and proceeded to perform endotracheal suctioning to the resident. During an interview on 9/29/10 at 5:13 PM, LPN #5 verified he put on gloves without washing his hands first, put on a sterile glove over a dirty one, and touched the drawer handle and supplies with the same gloved hands used for suctioning. He stated that the reason he put the sterile glove over the dirty one was that the sterile gloves were too small and ripped causing mucus to get on his hands. Review of the policy provided by the facility entitled "Suctioning of Tracheostomy" (dated 11/25/97) on 9/29/10 at 12:58 revealed under Procedure..."3. Assemble equipment at bedside...4. Wash hands...7. Don sterile gloves 8. Open catheter package". Resident #7, admitted [DATE], with [DIAGNOSES REDACTED]. Diff), Stage III Decubitus, Diabetes Mellitus. Record review on 9/28/10 at approximately 10:45am revealed a physician's orders [REDACTED]. Diff. Result of the culture on 9/16/10 reported positive for [DIAGNOSES REDACTED]. A physician's orders [REDACTED]. Interview with Certified Nursing Assistant #2 on 9/28/10 at approximately 1:35pm indicated that nursing notifies staff of when a resident has an infectious disease and when there was a need to glove and/or gown before entering room. Interview with Registered Nurse #5 on 9/29/10 at approximately 9:55am indicated that when determined resident had [DIAGNOSES REDACTED] the facility notified physician, informed Responsible Party, put resident on contact isolation, placed a yellow cart outside door of resident's room, and informed staff. Asked if the facility posted signage asking visitors to see nursing before entering room. She stated that the facility does not post signage. Asked how visitors would know about need for contact precautions. Stated when visitors saw cart they were to come and speak with nursing. On 9/28/10 at approximately 1:30 PM, interview with the infection control nurse and review of the monthly infection control logs revealed that the facility failed to track/trend organisms. Further review of the infection control logs revealed that the facility tracked the number of infections and type of infection by each unit, however did not track/trend infections by room location on the units. When questioned if she had made formal infection control rounds to observe treatments and insure that staff were following infection control practices, she stated no. 2014-01-01
10293 L.M.C.- EXTENDED CARE 425321 815 OLD CHEROKEE ROAD LEXINGTON SC 29072 2010-09-30 225 D     IK8X11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on interview and review of the policy provided by the facility entitled "Alleged Abuse/Incident of Unknown Origin/Accident-Injury Complaint, Complaint Responsibilities" dated 8/7/09, the facility failed to report to the state agency and investigate the alleged verbal abuse of Resident #13, one of 18 residents reviewed for abuse and neglect; the facility failed to complete an incident report related to a skin tear on Resident #30. The findings included: The facility admitted Resident #13 on 6/27/07 with [DIAGNOSES REDACTED]. During an individual interview on 9/29/10 at 11:05 AM, Resident #13 stated that she was lying on her side when a Certified Nursing Assistant (CNA) laughed and made an unprofessional/inappropriate remark related to the resident's size.. Resident #13 stated the CNA pushed her so hard she almost pushed her out of the bed. The resident stated that it had not been long since the incident occurred. She stated she had asked that the CNA not be allowed to take care of her and stated that the CNA had been taken off the floor. During an interview on 9/29/10, the Assistant Director of Nursing (ADON) stated she was unaware of the incident and it had not been reported to her. During an interview on 9/30/10 at approximately 11:00 AM, Nurse A stated she was aware of the incident, but hadn't been on duty at the time the incident occurred. Nurse A stated she had reported the incident to her supervisor, RN #2. Nurse A stated the CNA involved in the incident had requested to be moved off the floor, and had not been moved as a result of any disciplinary action. During an interview on 9/30/10 at approximately 11:30 AM, RN #2 denied any knowledge of the incident and stated that the nurse must have reported the incident to another nursing supervisor. During an interview on 9/30/10 at 12:00 Noon, the Director of Nursing (DON) stated she was unaware of the incident. After reviewing the CNA's personnel record, the DON verified the CNA had been transferred to another unit at the CNA's request. The DON agreed that the incident would need to be investigated had it been reported. Review of the policy provided by the facility entitled "Alleged Abuse/Incident of Unknown Origin/Accident-Injury Complaint, Complaint Responsibilities" dated 8/7/09 revealed under "5. Investigation, A. All suspicious incidents will be thoroughly investigated in a timely fashion, documented via an Alleged Abuse/Incident of Unknown Origin packet, and forwarded to the required state agencies as outlined in policy 02-22, Alleged Abuse/Incident of Unknown Origin/Accident-Injury Complaint Responsibilities". The Policy/Procedure section stated that "DHEC Certification and the facility administrator shall be notified immediately but not to exceed 24 hours after discovery of all alleged violations involving abuse (physical, verbal, sexual, or mental)...". Under Abuse Reporting Procedure the "1. Nurse or Shift Supervisor: a) Receives the complaint from a resident..., b) Assesses the complaint and interviews the complainant, c) Obtains a written statement form included in packet, d) Obtains written statement notarized or signed by two witnesses, e) Contacts shift supervisor, f) Completes incident report." From there, the packet goes to the "2. Shift Supervisor...3. Assistant Director of Nursing or Nurse Supervisor...," and then to "4. Administration". Interview on 9/29/10 with the Assistant Director of Nursing, who performs investigations of abuse, indicated that s/he was not aware of the alleged verbal abuse. The facility admitted Resident #30 on 05/28/2010 with [DIAGNOSES REDACTED]. Resident #30 sampled as a result of a complaint concerning skin tears. Review of Resident #30's closed medical record on 09/27/2010 revealed nursing documentation on 06/07/2010 and 07/21/2010 regarding skin tears. On 06/07/2010 a nurse's note stated, "...F/U (follow-up) to skintear..." Review of the Occurrence Reported dated 06/07/2010 indicated that the resident received the skin tear while participating in physical therapy. Continued review of the nurse's notes revealed a 07/21/2010 note at 2000 that stated, "...Res (resident) has ST (skin tear) on (R) (right) elbow..." The facility was unable to provide an Occurrence Report for the 07/21/2010 skin tear. Review of the skin integrity care plan dated 06/16/2010 did not address the skin tears. 2014-01-01
10294 L.M.C.- EXTENDED CARE 425321 815 OLD CHEROKEE ROAD LEXINGTON SC 29072 2010-09-30 280 D     IK8X11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on record review and interview, the facility failed to review and update the Care Plans for 2 of 18 sampled residents reviewed for comprehensive Care Plans. Resident #13's Care Plan was not updated related to [MEDICAL CONDITION] and drug seeking behaviors; Resident #30's Care plan was not updated related to skin tears. The findings included: The facility admitted Resident #13 on 6/27/07 with [DIAGNOSES REDACTED]. During an interview on 9/30/10 at approximately 12:15 PM, Registered Nurse (RN) #2 stated Resident #13 had been exhibiting drug seeking behavior. According to the nurse, the resident told the physician on 9/20/10 that the [MEDICATION NAME] wasn't working any more and he subsequently discontinued it. Review of the physician's orders [REDACTED]. The nurse stated that the resident kept asking for the [MEDICATION NAME] again, so the nursing staff had to call the on-call physician that same night who gave an order for [REDACTED]. MD (physician) will evaluate in AM". When asked what was being done to address this issue, the nurse stated the resident had been seen by Psychiatry and had a trial of [MEDICATION NAME]. Review of the "Psych Consult and Progress Notes" dated 3/10/10 revealed that Resident #13 had been diagnosed with [REDACTED]. According to the note "Case discussed with staff. Pt. (Patient) had been refusing q (every) hs (Bedtime) [MEDICATION NAME] (Secondary) to "SE" (Side Effects) Upset stomach, [MEDICAL CONDITION] of feet which attributed to (increased) dose. Pt. would like to try another medicine & asks for [MEDICATION NAME]. I explain(ed) to her that this will not help (with) depression & Pt. is already taking [MEDICATION NAME] which is similar. Pt denies SI (Suicidal ideation). She has been cooperating with care. (No) voiced [MEDICAL CONDITION]. Pt is oriented x3. Meds (Medications) [MEDICATION NAME] 1 mg (milligram) PO (By Mouth) Q (every) AM. [MEDICATION NAME] 60 mg PO Q AM, [MEDICATION NAME] 20 mg PO BID (Twice Daily)". The plan was to taper and discontinue the [MEDICATION NAME] and start the resident on [MEDICATION NAME] 20 mg PO Q AM, "Refer pain meds to PCP (Primary Care Physician", and follow up in 3 months. Review of the 6/16/10 Progress Notes revealed resident was seen and "having fewer SE (with) the [MEDICATION NAME] No voiced [MEDICAL CONDITION]/U (follow up) in 6 mos. (months)". When asked if the resident had been care planned for her drug seeking behavior or her delusional disorder, RN #2 said "No". Review of the comprehensive Care Plan on 9/30/10 revealed no mention of drug seeking behavior or delusional disorder. The facility admitted Resident #30 on 05/28/2010 with [DIAGNOSES REDACTED]. Resident #30 was sampled as a result of a complaint regarding skin tears. Review of Resident #30's closed medical record revealed nursing documentation on 06/07/2010 and 07/21/2010 regarding skin tears. Review of the skin integrity care plan dated 06/16/2010 did not address the skin tears. 2014-01-01
10295 BMC SUBACUTE REHAB CENTER 425340 1330 TAYLOR AT MARION STREET COLUMBIA SC 29203 2011-06-07 371 F     VIJL11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the day of the recertification survey, based on observation, record review, review of the facility's policy entitled HACCP/FOOD SAFETY PROGRAM and interviews, the facility failed to store, prepare, distribute, and serve food under sanitary conditions. The facility failed to dispose of expired foods, failed to label foods in storage to ensure expired foods could be identified and failed to implement policies and procedures to ensure expired items were discarded appropriately. The facility also failed to sanitize the thermometer between foods while testing temperatures on the tray line. In addition, the facility failed to develop and implement a policy for thawing meat to ensure that previously frozen, thawed meats were not refrigerated for extended periods prior to cooking. The findings included: Initial tour of the kitchen was conducted on 6/7/11 beginning at 9:15 AM with the Store Room Manager, the Certified Dietary Manager (CDM) and the Executive Chef. Tour of the dry food storage area revealed a box of [MEDICATION NAME] Extra with an expiration date of 4/11 and a box of muffin mix with an expiration date of 2/16/11. In addition there were 6 boxes of corn muffin mix and 8 boxes of buttermilk biscuit mix with no expiration dates and an opened bag of macaroni with no label. During the tour, the Store Room Manager confirmed there were multiple items without expiration dates and confirmed the items should have been labeled when removed from the case boxes. During an interview at approximately 12:00 PM, the Store Room Manager stated dry goods were rotated with each delivery to ensure "first in, first out." He stated that he doesn't "pay attention" to items already on the shelf if he hasn't ordered any of that item but also stated "I guess I should." He also stated he did not know if there was a policy stating how often the store room should be checked for expired food items. Review of the facility's Operational Standard: Food Storage, dated April, 2002, revealed there was no policy specifying how often food items should be checked for expiration dates and no procedure for checking the dry food storage. Tour of the thawing cooler revealed 2 bags of unlabeled pork chops dated 5/30; fully cooked, vacuum packed bottom round roasts dated 5/9 (1), 5/30 (1) and 6/1 (6); fully cooked vacuum packed hams dated 5/26 (3); unlabeled vacuum packed fully cooked diced ham (13 packages); unlabeled bags of crumbled cooked bacon dated 5/25 (1) and 6/1 (2); 5 pound containers of pulled pork dated 6/1 (7); 2 unlabeled bags of chicken leg quarters dated 5/25 and 4 bags dated 6/1; unlabeled vacuum packed pork roasts dated 5/18 (1), 5/23 (1), 5/26 (8), 6/1 (10) and 2 with no date. During an interview at 11:30 AM, the CDM confirmed the dates on the thawed meats and stated the meats are usually allowed 3 days to thaw in the cooler and then 3 days to be used after being thawed. During an interview at 12:47 PM, the CDM confirmed inconsistences related to dates on the thawed meats; the clerk had informed the CDM the date on the meat package was the date the meats were received (frozen) and the CDM had stated earlier it was the date the meats were placed in the thawing cooler. The Food Service Director (FSD) confirmed there was no consistency in labeling. At 5:25 PM, the FSD confirmed there was no policy for thawing meats related to labeling or maximum amount of time thawed meats could be refrigerated before cooking. ON 6/7/11 at 11:42 PM, Cook #1 was asked to check temperatures on the tray line. The Executive Chef retrieved a new thermometer out of the packaging and Cook #1 began to check the temperatures. She checked the temperatures of spaghetti noodles, marina sauce, green beans, mashed potatoes, white rice, brown gravy, corn bread dressing, macaroni and cheese, chicken gravy, carrots and skillet apples. Cook #1 wiped the thermometer with the same napkin after each item, without turning or folding the napkin to a clean area, and did not sanitize the thermometer. The Executive Chef left the immediate area and returned with clean napkins, he stated that he sanitized the thermometer while he was retrieving the clean napkins. The Executive Chef then checked the temperatures of the cold foods at 11:50 AM: chopped boiled eggs, chicken pieces, sliced roast beef, sliced ham, sliced turkey, tuna salad, chicken salad and cottage cheese using the same napkin to wipe the thermometer between each food but did not sanitize the thermometer and again did not turn of fold the napkin to a clean area. At 11:53 the Executive Chef checked the temperatures of hot foods being kept in the warmer cabinet: ground chicken, new potatoes, marinated baked chicken, butter beans, chopped steak, hamburgers, mashed potatoes, marinara sauce, baked fish, pureed peas and green beans. Again, the thermometer was not sanitized between food items but wiped with a napkin without turning or folding the napkin to a clean area before using. During an interview at approximately 12:15 PM, the FSD stated he would expect the thermometer to be calibrated prior to starting to check food temperatures and further stated that he would expect the thermometer to be sanitized with either alcohol or sanitizer solution between each food item. At 12:21 PM the Executive Chef confirmed that neither he nor the cook had sanitized the thermometer between foods on the tray line. At 5:25 PM on 6/7/11, the FSD provided an in-service that had been conducted from 6/1/11 to 6/3/11 related to thermometers. The in-service stated, under the section titled "Using Thermometers" - "Clean and sanitize thermometers before checking foods." 2014-01-01
10296 AGAPE NURSING & REHAB CENTER 425379 300 AGAPE DRIVE WEST COLUMBIA SC 29169 2010-09-14 328 E     DZ1T11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on record review and interview, the facility failed to ensure that residents received treatments as ordered by the physician for 1 of 2 residents reviewed who had nebulizer treatments ordered (#2). Resident #2 did not receive the nebulizer treatments ordered on [DATE] until 8/17/10. The findings included: Resident #2 with [DIAGNOSES REDACTED]. Review of the Daily Skilled Nurses Notes revealed a note on 8/12/10 at 10:15 PM stating: "Resident noted to have cough (with) congestion. Notified MD." The physician saw the resident on 8/13/10 and wrote in his progress note that the resident was "... quite short of breath and feeling terrible. ..." A treatment plan was documented in the progress note including "Start [MEDICATION NAME] solution 2.5 mg/3mL (2.5 milligrams per 3 milliliters), (0.083%), 3 mL, Q 4 hrs. (every four hours) while awake x (times) 5 days, then prn (as needed for) wheeze. ..." Antibiotics, nasal oxygen, a chest x-ray, and a speech therapy consult were also ordered for suspected aspiration pneumonia. The 8/13/10 Daily Skilled Nurses Note at 6 PM documented that the resident was coughing but had no complaint of pain. He was resting in bed. The nurse's note documented that the physician wrote new orders for oxygen, nebulizer treatments, and a chest x-ray. The chest x-ray was done and no infiltrates were noted. Speech Therapy evaluated the resident and changed his diet. A swallow study was scheduled for 8/16/10. The nurse's note ended with "... No distress when eating supper. Will monitor." Review of the physician's orders [REDACTED]. "Chest x-ray Re: poss (possible) aspiration pneumonia "[MEDICATION NAME] 100 mg PO (by mouth) BID (two times a day) x 10 days, 1st dose STAT "[MEDICATION NAME] 500 mg PO BID x 10 days, 1st dose STAT "[MEDICATION NAME] 2.5mg/3mL via neb q 4 (hours) while awake x 1 week, then PRN "Oxygen 2 L/min (liters per minute) via nasal cannula" This order was signed by the physician and signed by the same nurse who documented the information in the 6 PM nurse's note on 8/13/10. Review of the Medication Administration Record [MEDICATION ADMINISTRATION RECORD DETAILS REDACTED]. The nebulizer treatment was to start on 8/13/10 at 10 PM. Continued review of the MAR indicated [REDACTED]. A notation on the back of the MAR indicated [REDACTED]. Another entry in the resident's MAR for [MEDICATION NAME] showed a date of 8/14/10. It specified the same dose and schedule as the order on 8/13/10. Administration of the [MEDICATION NAME] nebulizer treatments began with the 10 AM dose on 8/17/10 and ended with the 6 AM dose on 8/24/10. Review of a list of nurses assigned to the resident from 8/13/10 to 8/17/10 showed the resident had six different nurses taking care of him on those dates. Review of the medical record showed no evidence the physician was notified of the missed nebulizer treatments. Review of the Daily Skilled Nurses Notes revealed the physician was notified of an elevated temperature of 100.6 degrees on 8/15/10. A urine culture was ordered. The documentation in the nurses' notes did not show evidence of any acute distress suffered by the resident during the period of the missed nebulizer treatments. The physician visited the resident on 8/16/10 and documented in his progress note that the resident's breathing was the same. "... He does not feel clinically improved there. ... " No respiratory distress was assessed. The resident's respiratory rate was regular with normal air movement. Bibasilar crackles were noted. "... His inactivity is the cause of his crackles, based on clinical eval and xray result. Will order an incentive spirometer to the bedside and have him do that Q (every) 2H while awake. ..." There was no new order related to starting the nebulizer treatments on 8/17/10. During an interview with the Director of Nurses (DON)on 9/14/10, she stated there was no reason for the nebulizer treatment omissions. The facility had plenty of nebulizer machines on hand (three machines were observed in the respiratory supply closet) and if one was not available, the facility's supply company was available at all times to obtain needed equipment. The DON said three staff members were counseled related to the omissions and an inservice program was planned for later in the month of September 2010 to review this and other issues. 2014-01-01
10297 WILDEWOOD DOWNS NURSING AND REHABILITATION CENTER 425385 1215 WILDEWOOD DOWNS CIRCLE COLUMBIA SC 29223 2010-09-20 272 D     9EZH11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the day of the survey, based on record reviews, the facility failed to ensure that residents were comprehensively assessed related to a history of falls for 2 of 2 residents reviewed who had repeated falls (#1 and #3). Both residents had a history of [REDACTED]. The findings included: Resident #1 with [DIAGNOSES REDACTED]. No fractures were diagnosed at the hospital. The resident went to the facility for short term rehabilitation. She was discharged home on[DATE]. The admission nursing fall assessment showed a score of 20. A score above 10 indicated risk for falls. Review of the Resident Assessment Instrument (RAI) for 7/12/10 showed the resident had short and long term memory problems with moderately impaired decision making ability. The resident needed extensive assistance of one person for bed mobility, transfer, dressing, and bathing. She required total assistance for toilet use and hygiene. The resident was incontinent of bowel and bladder. A fall in the last 30 days was noted. Review of the Resident Assessment Protocol (RAP) notes revealed the resident was at risk for falls. "She is at risk for falls related to Hx (history of) falls and Dx ([DIAGNOSES REDACTED]. The note failed to provide any history of the resident's falls, and therefore there was no evaluation of any pattern or possible triggers for the falls. The RAP note did not evaluate the resident's internal or external risk factors. The resident fell three times while at the facility, 7/27/10, 7/28/10, and 8/22/10. One fall, the one on 7/28/10, resulted in a fractured distal right clavicle. Review of the medical record revealed the resident was independent and wanted to do for herself. She also participated in therapy with improving functional status. However, the facility failed to use this information to adapt to the resident's changing status in an effort to prevent accidents. There was no evidence of a comprehensive assessment of the resident's falls either on admission or throughout the resident's stay. Resident #3 with [DIAGNOSES REDACTED]. The resident was hospitalized from 7/14 to 7/21/10 for Asthmatic [MEDICAL CONDITION] and Decompensated [MEDICAL CONDITION]. The resident received therapy and was discharged on [DATE]. An admission nursing assessment for falls revealed a score of 22. Scores above 10 indicated a risk for falls. The facility physician's history and physical dated 7/22/10 stated the resident had had multiple falls. Review of the RAI of 7/25/10 showed the resident had short and long term memory problems with moderately impaired decision making ability. The resident needed extensive assistance of one person with bed mobility, transfer, dressing, hygiene, and bathing. He was incontinent of bowel and bladder. The RAI showed no falls. Review of the RAP notes of 7/28/10 showed the resident triggered for falls related to daily use of an antidepressant. The RAP notes showed no further information or assessment of the resident's fall history or risks. Review of the Nurse's Notes showed the resident had 11 falls while at the facility: Review of the medical record showed no evidence that the facility assessed the resident's falls in any attempt to find a pattern and possible triggers for the falls. 2014-01-01
10298 WILDEWOOD DOWNS NURSING AND REHABILITATION CENTER 425385 1215 WILDEWOOD DOWNS CIRCLE COLUMBIA SC 29223 2010-09-20 280 G     9EZH11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the day of the survey, based on record reviews, the facility failed to ensure that residents' care plans were periodically reviewed an updated to reflect changing status for 2 of 2 residents reviewed who had repeated falls (#1 and #3). The findings included: Resident #1 with [DIAGNOSES REDACTED]. The resident was hospitalized after a fall for evaluation of hip pain. No fractures were diagnosed at the hospital. The resident went to the facility for short term rehabilitation after hospitalization . She was discharged home on[DATE]. Review of the Resident Assessment Instrument (RAI) for 7/12/10 showed a fall in the last 30 days. Review of the Resident Assessment Protocol (RAP) noted revealed the resident was at risk for falls related to her history of falls. Review of the plan of care dated 7/15/10 showed a problem of risk for falls with interventions of: gather information about past falls; keep call light in reach; anticipate and meet needs; provide safe environment; physical therapy evaluation and treatment; adaptive equipment as needed; and proper footwear. The resident fell three times while at the facility. One of the falls resulted in a fractured distal right clavicle. Review of the care plan showed it was not updated to show the falls and no new interventions were planned to assist the resident in fall prevention. Resident #3 with [DIAGNOSES REDACTED]. An admission nursing assessment for falls revealed a score of 22, any score above 10 indicated a risk for falls. The facility physician's history and physical dated 7/22/10, the resident had had multiple falls. Review of the RAI of 7/25/10 showed no falls. Review of the RAP notes of 7/28/10 showed the resident triggered for falls related to daily use of an antidepressant. Review of the care plan dated 8/3/10 revealed a problem of "high risk for falls related to Hx (history of) falls, decreased mobility." Interventions included: gather information on past falls; be sure call light is in reach; anticipate and meet needs; provide safe environment; physical therapy evaluation and treatment; adaptive equipment as needed; activities for diversion and strengthening; and appropriate footwear. Review of the medical record showed the resident had 11 falls while at the facility. The care plan showed no changes throughout the resident's stay. 2014-01-01
10299 WILDEWOOD DOWNS NURSING AND REHABILITATION CENTER 425385 1215 WILDEWOOD DOWNS CIRCLE COLUMBIA SC 29223 2010-09-20 323 G     9EZH11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the day of the survey, based on record reviews, the facility failed to ensure that residents received adequate supervision and assistance devices to prevent accidents for 2 of 2 residents reviewed who had repeated falls (#1 and #3). The findings included: Resident #1 with [DIAGNOSES REDACTED]. No fractures were diagnosed at the hospital. Resident #1 went to the facility for short term rehabilitation. Review of the admission nursing assessment showed a fall risk score of 20. A score above 10 indicated risk for falls. Review of the Resident Assessment Instrument (RAI) for 7/12/10 showed the resident had short and long term memory problems with moderately impaired decision making ability. The resident needed extensive assistance of one person for bed mobility, transfer, dressing, and bathing. She required total assistance for toilet use and hygiene. The resident was incontinent of bowel and bladder. A fall in the last 30 days was noted. Review of the Resident Assessment Protocol (RAP) noted revealed the resident was at risk for falls related to her history of falls. The note did not provide any history of the past falls. There was no evaluation of any pattern or triggers for the falls. Review of the plan of care dated 7/15/10 showed a problem of risk for falls with interventions of: gather information about past falls; keep call light in reach; anticipate and meet needs; provide safe environment; physical therapy evaluation and treatment; adaptive equipment as needed; and proper footwear. The resident fell three times while at the facility: 1. A Nurse's Note on 7/27/10 at 7 AM stated the resident was found lying on the floor in her bathroom. The resident could not explain how she got on the floor. A small skin tear on the left elbow resulted from the fall. There was no evidence the facility changed or added interventions to the resident's care plan after this fall. 2. On 7/28/10, at 7 PM, the Nurse ' s Note said her Certified Nursing Assistant (CNA) put the resident on the toilet. The CNA went to get a brief out of the closet. Resident #1 tried to get up alone and fell , hitting her right shoulder. The nurse's assessment showed a red area to the shoulder, and skin tears to the right wrist and left forearm. An orthopedic assessment and x-ray done on 8/6/10 showed a fractured distal right clavicle. There was no evidence the facility changed or added interventions to the resident's care plan after this fall. An interview with the CNA providing care to the resident on 7/28/10 revealed the resident had never tried to get up by herself before when in the CNA's care. The CNA said she found out from the nurse after the fall that the resident had fallen the day before while getting up unassisted. On 8/21/10, a Nurse's Note stated the resident was alert and oriented to herself. She was up at the bedside eating breakfast and took her morning medications. "... Informed pt to call for assistance daughter found up in BR (bathroom) had concerns of safety. ..." A personal safety alarm for the wheelchair was ordered that day. 3. The Nurse's Note on 8/22/10 at 12 PM stated a nursing assistant found the resident on the floor, lying by the bed. Skin tears to the left forearm and elbow were noted. The documentation in the Nurse's Notes, and the incident report, failed to say if the safety alarm was in use at the time of the fall. Review of the medical record revealed the resident was independent and wanted to do for herself. She also participated in therapy with improving functional status. The facility failed to use this information to adapt to the resident's changing status in an effort to prevent accidents. The resident was discharged home on[DATE]. Resident #3 with [DIAGNOSES REDACTED]. An admission nursing assessment for falls revealed a score of 22. Scores above 10 indicated a risk for falls. The facility physician's history and physical dated 7/22/10, the resident had had multiple falls. Review of the RAI of 7/25/10 showed the resident had short and long term memory problems with moderately impaired decision making ability. The resident needed extensive assistance of one person with bed mobility, transfer, dressing, hygiene, and bathing. He was incontinent of bowel and bladder. The RAI showed no falls. Review of the RAP notes of 7/28/10 showed the resident triggered for falls related to daily use of an antidepressant. Review of the care plan dated 8/3/10 revealed a problem of "high risk for falls related to Hx (history of) falls, decreased mobility." Interventions included: gather information on past falls; be sure call light is in reach; anticipate and meet needs; provide safe environment; physical therapy evaluation and treatment; adaptive equipment as needed; activities for diversion and strengthening; and appropriate footwear. The care plan showed no changes throughout the resident's stay. Review of the Nurse's Notes showed the resident had 11 falls without injury while at the facility: On 8/1/10, at 2 AM, the resident tried to get up and slid off the low bed. On 8/3/10, at 7:35 AM, the resident was found on the floor by his low bed. He was yelling for help and told the staff he was "trying to get up to go to therapy." On 8/9/10, at 5:20 AM, the resident was found lying on the floor with his head under the bed and his legs partially extended out on the right side. On 8/10/10 at 11:15 PM, the resident was found lying on the floor beside the bed with his head resting on the bed. On 8/14/10, at 4 AM, the resident was found lying on the floor beside his low bed with a pillow still under his head. On 8/15/10, at 10:45 PM, the resident rolled out of bed. On 8/18/10, at 4:30 AM, the resident was found on scooting on his stomach on the floor by his bed. He told the nurse "he crawled out of bed and couldn't bet back in." On 8/30/10, at 11:45 PM, the resident was found sitting on his buttocks with his back against the low bed. On 9/1/10, the resident was found on the floor in front of his wheelchair. He reported that he was trying to get something off his bedside table, leaned forward and fell . On 9/5/10, at 1:50 PM, the resident was found on the floor by his bed. "I was going to a meeting." On 9/6/10, at 3:40 AM, the resident was found on the floor by the bed. "I have to go to work." He also complained that the "bed is curved in the middle and it messed me up." The resident was discharged on [DATE]. Review of the medical record showed no evidence that the facility assessed the resident's falls in an attempt to find a pattern and possible triggers for the falls. The resident did have a bed in the low position but no other interventions were noted. 2014-01-01
10300 WILDEWOOD DOWNS NURSING AND REHABILITATION CENTER 425385 1215 WILDEWOOD DOWNS CIRCLE COLUMBIA SC 29223 2010-09-20 496 D     9EZH11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the day of the survey, based on review of a Certified Nursing Assistant's employee file and interview, the facility failed to ensure that information was sought from every State registry before allowing an individual to serve as a nurse aide for 1 of 1 employee file reviewed. The findings included: The employee file of a Certified Nursing Assistant (CNA) who was assigned to a resident who fell and was later diagnosed with [REDACTED]. The facility checked the South Carolina CNA Registry for information prior to hire, but failed to check with the Massachusetts CNA Registry. The Assistant Director of Nurses confirmed this after she spoke with Human Resources personnel. 2014-01-01
10240 HEARTLAND OF COLUMBIA REHAB AND NURSING CENTER 425008 2601 FOREST DRIVE COLUMBIA SC 29204 2011-09-21 314 E     MKPP11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on observation, interview and review of a facility provided article from " Primary Intention" which included a reference from Barr J." Principals of Wound Cleansing" and an facility provided article printed from the Internet related to Management of Pressure Ulcers, the facility failed to provide appropriate wound care. The Pressure ulcers for Resident #2 & #3 were not appropriately cleaned. during the observation of wound care. (2 of 3 pressure ulcer care observed). The findings included: The facility readmitted Resident #3 on 08/18/2011 with [DIAGNOSES REDACTED]. On 9/20/11 at !0:05 AM, during observation of wound care for Resident # 3, the Wound Nurse sprayed wound cleanser on the sacral ulcer and wiped the ulcer edges with a four by four gauze four times, using a clean gauze each time, but failed to clean the wound bed. The resident was then turned and repositioned on the left side and wound care to the right hip was observed. The Wound Nurse sprayed the ulcer and wiped the wound bed three times using a separate four by four gauze each time but failed to clean the periwound tissue. The facility admitted Resident # 2 on 3/14/07 with the following Diagnosis: [REDACTED]. On 9/20/11 at 3:30 PM, during observation of wound care for Resident # 2, the Wound Care Nurse (WCN) cleaned the wound from side to side. During a interview with the WCN on 9/20/11 at 2:00 PM when ask about wiping/swabbing the wound from side to side she stated " I was told not to clean it from the center, because you don't know where you started." When ask how she was taught to clean a wound, she stated from the center outward. The wound care nurse was observed during the survey to clean three pressure ulcers. Her methodology varied during all three procedures. The facility Nurse Consultant provided this surveyor with documentation of an article titled "Wound Cleansing: sorely neglected? " ( Primary Intentions Volume 14 Number 4 November 2006, page 160 ) that referenced how to achieve appropriate cleaning while scrubbing a wound by using circular motions, gradually increasing in size, always moving away from the centre. Additionally, an article printed by the facility from the Internet on 9/20/11 at 12:18 PM was given to this surveyor. This article from the National Guideline Clearinghouse related to Management of Pressure Ulcers stated: "1. Cleanse the wound and periwound at each dressing change....." 2014-02-01
10241 HEARTLAND OF COLUMBIA REHAB AND NURSING CENTER 425008 2601 FOREST DRIVE COLUMBIA SC 29204 2011-09-21 315 D     MKPP11 **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 provide appropriate catheter care for Resident # 12. (1 of 2 catheter care observations conducted.) The findings included: The facility admitted Resident # 12 on 9/29/10 with the following Diagnosis: [REDACTED]. During the observation of the catheter care provided by Certified Nursing Assistant (CNA) #1 on 9/19/11 at 1:35 PM, the CNA lifted the penis by raising the catheter tubing. The catheter tubing was held approximately 2 inches from the urinary meatus. While securing the penis in an upright position by holding the catheter tubing, she then cleaned the penis using downward [MEDICAL CONDITION] from tip to the base of the penile shaft. During a interview with the CNA on 9/21/11 at 9:45 AM she did not dispute the observation. 2014-02-01
10242 KERSHAWHEALTH KARESH LONG TERM CARE 425080 1315 ROBERTS STREET CAMDEN SC 29020 2010-10-29 225 D     CXO111 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the day of the survey, based on review of facility files related to an allegation of abuse and misappropriation of resident property, the facility failed to report the allegation to the State survey and certification agency for 1 of 1 allegation reviewed. On 5/5/10, Resident #1's [MEDICATION NAME] ([MEDICATION NAME]) patch was missing. All staff on duty were drug tested that day. Laboratory test results reported to the facility on [DATE] confirmed the presence of the drug in Certified Nursing Assistant (CNA) #1's system. The findings included: Resident #1 arrived at the facility on 1/22/03. His [DIAGNOSES REDACTED]. The resident suffered from chronic pain and received [MEDICATION NAME] 25 micrograms per hour via [MEDICATION NAME]. The patch was changed every 72 hours. Review of the Medication Administration Record [MEDICATION ADMINISTRATION RECORD DETAILS REDACTED]. Review of the investigative materials revealed LPN #1 went to the resident on the morning of 5/5/10 and applied a new [MEDICATION NAME]. She secured the patch with a dated piece of tape. The LPN was unable to find the old patch for removal. LPN #1 tried to find the old patch again at approximately 10 AM and could not. She made another attempt at 12 noon only to discover the 8 AM patch was missing. A search of the resident, his bed, and his room failed to locate the [MEDICATION NAME]. LPN #1 reported her findings to Administration. The facility conducted searches of all employees on duty. The employees were also held for drug testing. Only one employee's drug test returned with positive results for [MEDICATION NAME], CNA #1. The Bureau of Drug Control was called to investigate. CNA #1 was terminated on 5/29/10. The facility could not provide any evidence showing they reported this incident to the State survey and certification agency. 2014-02-01
10243 RIVERSIDE HEALTH AND REHAB 425082 2375 BAKER HOSP BLVD CHARLESTON SC 29405 2010-10-12 225 E     8JQP11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the day of the survey, based on limited record review, interview, and review of the facility's reportable file since 4/9/10, the facility failed to report to the State survey and certification agency 4 of 8 allegations of misappropriation of resident property (Residents A, B, C, D), failed to report timely 3 of 4 allegations of misappropriation (Residents #1, E, F), and failed to thoroughly investigate 4 of 8 allegations of misappropriation (Residents A, B, C, and D). The findings included: Resident #1 reported to the facility on [DATE] that her wallet was missing. The Complaint/Grievance Report stated the resident reported that approximately $30.00 was in the wallet. The facility's initial 24 hour report also noted the resident's debit card was taken and that there had been some activity on the resident's debit card account. The initial report to the State survey and certification agency was dated 9/28/10, which exceeded the 24 hour deadline for reporting allegations of misappropriation. Review of the facility's grievance files revealed three addition allegations of misappropriation around the same time Resident #1 made her complaint. Resident A reported $4.00 missing on 9/24/10. Resident B reported $14.00 missing on 9/27/10. Resident C reported $9.00 missing on 9/28/10. Residents B and C had notations on their grievance stating "resolved by personnel action (secondary to) cluster of similar events on Unit 200." None of these allegations was reported to the State survey and certification agency or thoroughly investigated. Continued review of the facility reportable incidents revealed another cluster of allegations concerning misappropriation of resident property in April 2010. Resident E reported on 4/10/10 that $63.00 was missing. The resident's allegation was not reported until 4/12/10. Resident F reported on 4/16/10 that $20.00 was missing. The allegation was reported to State agency on 4/20/10. Resident D reported "missing $" on 4/16/10. The facility was not able to show evident that this allegation was reported or investigated by the facility. 2014-02-01
10244 WHITE OAK MANOR - ROCK HILL 425088 1915 EBENEZER RD ROCK HILL SC 29732 2010-10-19 225 D     YPDS11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the day of the inspection based on record reviews and interviews the facility failed to ensure that all allegations of abuse/neglect were thoroughly investigate to prevent further abuse to residents #1 and #5. There was no documentation that the facility interviewed all staff on duty at the time of the incident (2 of 5 sample residents reviewed) The findings included: The facility admitted Resident #1 on 06/25/2010 and readmitted the resident on 07/30/2010 with [DIAGNOSES REDACTED]. Review of the facility investigation regarding a facility reported incident involving Resident #1 on 07/23/2010 revealed a statement written by Licensed Practical Nurse #1 that stated, "...I asked her when it started hurting she said yesterday at white guy help me from my bed to my chair he was in white uniform - he was with other workers. He picked me up under my arms and lifted me to the w/c (wheelchair) - felt a little pain not much..." The witness statement indicated the resident informed the facility staff that "he was with other workers". A review of the facility investigation revealed no interviews were done with the staff working at the time of the incident. The Social Services Director (SSD) stated that the facility did not have statements from staff on the unit at the time of the incident with Resident #1. The facility admitted Resident #5 on 12/20/2005 with [DIAGNOSES REDACTED]. Record review revealed a Quarterly MDS (Minimum Data Set) dated 06/17/2010 that indicated the resident had memory problems but had no cognitive problems with daily decision making. Review of the facility grievance log revealed Resident #5 informed the facility on 08/05/2010 that a nurse, in the presence of three CNAs (certified nurse aides), grabbed her wrist and told her to move. There was no documentation the facility investigated the allegation and reported to the State Survey Agency. In an interview on 10/19/2010 at approximately 11:30 PM the DON (Director of Nursing) and the SSD (Social Services Director) confirmed the findings related to Resident #1 and #5. 2014-02-01
10245 SPRINGDALE HEALTHCARE CENTER 425169 146 BATTLESHIP ROAD CAMDEN SC 29020 2010-10-27 157 D     K6DC11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the complaint inspection, based on record review and interview, the facility failed to notify the physician and family promptly of a change in condition which potentially required physician intervention. Resident #4, one of four residents reviewed for notification, had a temperature of 103.2 without timely physician/family notification of a change in condition. The findings included: The facility admitted Resident #4 on 6/18/10 and readmitted the resident on 7/28/10 with [DIAGNOSES REDACTED]. Review of Interdisciplinary Progress Notes on 10/27/10 at 10:20 AM revealed a note dated 7/20/10 at 1:50 PM that stated "130/76, 100.3, 78, 18. Prn (As needed) Tyl(enol) admin(istered) (with) f/u (follow up) temp (temperature) of 98.8. Pt (Patient) total care continues. Up in w/c (wheelchair) daily max assist (with) mech(anical) lift. Skin warm-tx (treatment) to sacral area continues. Moderate drainage noted (with) scant odor. Will cont(inue) to monitor...". The next note was dated 7/21/10 at 3 AM and stated "At 1 AM resident had rapid breathing, skin warm & moist. VS (Vital Signs) as follows 103.2, 98, 24, 136/92. PRN (As Needed) Tylenol given for (increased) temp. Recheck temp @ 3 A(M) (down) to 99.9. Respiration(s) even + nonlabored...". There was no mention that the physician or family had been notified of the change in condition for this resident when her temperature, heart rate, and respiratory rate increased at 1 AM. The next entry was dated 7/21/10 at 10:40 AM and stated "@ 9 am, pt alert, responsive-meds (medications) given per g-(gastrostomy) tube (without) difficulty. g tube patent (with no residual). HOB (Head of Bed) elevated per norm. Tyl(enol) PRN admin(istered) @ this time prior to wound care tx (treatment). @ 9:55 called to pt rm (room) d/t (due to) pt lethargic et facial drooping upon assessment noted pt (with) L(eft) side facial drooping, open mouth breathing-labored respirations @ 26. Lungs full, SpO2 @ 90% RA (Room Air) HR (Heart Rate) 133, B/P (Blood Pressure) 86/58. Pt temp 99.2 Ax(illary). Also noted L(eft) arm [MEDICAL CONDITION]. @ 10:05 notified Dr. Smith of change in pt status. Received order to sent to KCMC (Kershaw Medical Center) ED (Emergency Department)- report given @ 10:20. Pt daughter -- notified of pt's status change @ 10:24. Pt cont(inues) (with) increased resp(irations) et HR. Suctioned x 1 (with) 120 cc (milliliters) white frothy secretions. EMS (Emergency Medical Services) arrived @ 10:30. Pt SpO2 stable @ 90% RA...". Review of the "Notification of Change Nursing Note(s)" revealed a sheet dated 7/21/10 that listed the "Time of Incident: 1 AM, Describe Condition Change/Incident Type: (Increase) in temp 103.2, Tylenol given temp (down) 99.9...Describe the immediate Intervention: Resident had (increase) in temp- relieved (with) Tylenol, Dr. -- was notified on 7/21/10 at 10:05 AM/PM. Responsible Party (RP) --was notified on 7/21/10 at 10:24 AM/PM...Information Documented in the Nurse's Note. Yes/No (Yes was circled)". At the bottom of the sheet was a box that listed Vital Signs as "103.2, 98, 24, 136/92", Skin "Warm, moist", Breathing "Rapid"...and Physician Response "KCMC eval(uate) + tx (treat)". During an interview on 10/27/10, the Director of Nursing (DON) stated that the facility had no specific policy related to notification for changes in condition. She stated that she left it up to nursing judgement. She stated that nurses can contact their supervisor and that the facility utilizes Standing Orders. Review of the "Springdale Health Care Center Standing Orders" on 10/27/10 revealed under 'Medications' for "Fever: Give Tylenol 325 mg (milligrams) 2 tablets PO (By Mouth) q4h (Every 4 hours) for temperature greater than 101. If fever persists for 24 hours, notify physician for further orders". During an interview on 10/27/10 at 3:05 PM, the Unit Manager on the 200 Hall stated she would have called the doctor to let him know about the elevated temperature of 103.2 for Resident #4. When asked about the standing orders regarding "Fevers" that instructed nursing staff to give Tylenol for temperatures greater than 101 and then notify the physician if the fever persists for 24 hours, she stated that since the fever was recurring she would have let him know and would not have waited. 2014-02-01
10246 SPRINGDALE HEALTHCARE CENTER 425169 146 BATTLESHIP ROAD CAMDEN SC 29020 2010-10-27 166 D     K6DC11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the complaint inspection, based on record review, interview, and review of the policy provided by the facility entitled "Grievances & Complaints", the facility failed to actively work towards resolution of a complaint/grievance for one of one sampled residents with a grievance. Family member concerns regarding the care of Resident #4 were not addressed by the facility. The findings included: The facility admitted Resident #4 on 6/18/10 and readmitted the resident on 7/28/10 with [DIAGNOSES REDACTED]. A complaint faxed to DHEC (Department of Health and Environmental Control) Certification was reviewed on 10/26/10 prior to the survey. The complaint included a letter dated 7/29/10 addressed to the Admissions Director and Marketing Director of Springdale Health Care Center. It contained the following: "Gentlemen: (Resident #4) is back at Springdale, as you know, and I'd like to review with you the matters regarding her care that we discussed recently. (Marketing Director) informed us that she would be placed on the "100" wing/hall with different nurses/staff caring for her. (Admissions Director) addressed personally taking care of/supervising her wound care, including the "wound vac". To prevent dehydration, her feeding tube is to be flushed multiple times daily. Insuring that the feeding tube area remains clean. Monitoring excessive therapy (exercise) on her left arm. To make sure that she isn't sitting on the affected area for prolonged periods, and that she is turned on a regular basis. That someone communicates with Dr. --, myself and/or my (other family member) for any change in her condition or care. FYI, her home caregiver --, will continue to make regular visitations with (Resident #4). I am optimistic that the "situation" that occurred last week has been resolved, corrected, and that (Resident #4's) care will be the best that Springdale has to offer. Please contact me immediately if any of the foregoing is incorrect or misunderstood. Thank You..." During an interview on 10/27/10 at 2:20 PM, the Director of Nursing (DON) stated she had received a copy of the above letter but didn't remember the date it had been received. When asked if any of the concerns regarding the resident's care had been investigated, she stated that there was nothing to investigate, that the family wanted the resident moved and she had been moved. When asked if (the Admissions Director) was personally taking care of or supervising the wound care/wound vac for Resident #4, she stated that he was the Admissions Nurse and ordered medical supplies but did not personally take care of or supervise wound care. When asked, she stated that no one in particular is supervising the resident's feeding tube flushes or site care, but that the nursing staff ensures this is done. According to the DON, therapy manages the left arm exercises, and all staff routinely make sure residents are not sitting in one spot for prolonged periods and ensure that residents are turned. The DON stated these concerns were not addressed with particular staff for this resident, and that no inservices or instruction had been given to the staff because of the letter. When asked if the family member's concern regarding notifying the physician, herself, or her (other family member) had been addressed with staff caring for the resident she said no. During an interview on 10/27/10 at 2:35 PM, Social Worker #1 was asked about the above letter. She stated she had not been aware of the letter but had spoken with the family member on 9/21/10 when the family member called. She stated that the family member had concerns with odors and flies in the resident's room and wanted the resident moved to a room without carpet. She stated at the time of the call, the family member had stated that she thought the resident was going to be moved to Hall 100. According to the Social Worker, the resident was moved when a room became available. Review of a note written by the Social Worker on 9/21/10 revealed "...Family requested for patient to be placed in a room that has tile flooring. Family informed that one is not available at this time. However, when one becomes available family will be notified and offered the room change". Review of Interdisciplinary Progress Notes revealed Resident #4 was readmitted on [DATE] to room [ROOM NUMBER]B, and that she was moved to room [ROOM NUMBER]B on 10/12/10. During an interview on 10/27/10 at 1:40 PM, the Rehab (imitation) Director stated no one had said anything to her about Resident #4's therapy on her left arm being excessive. When asked if she had been the person they would have told about the complaint she stated that she was. Review of the policy provided by the facility entitled "Grievances & Complaints" dated April 2005 revealed under 'Policy', "To support each resident's right to voice grievances and to ensure that after a grievance has been received, the facility will actively resolve the issue and communicate the resolution's progress to the resident and/or resident's family in a timely manner". Under 'Fundamental Information', the policy stated that the Administrator was responsible for "Resolving all grievances and/or complaints; and Coordinating compliance at the Facility with this policy..."It went on to state that "Any resident, his or her representative, family member...may file a grievance or complaint...All grievances and complaints are investigated, resolved, and documented". Under 'Procedure', "2. Grievances and complaints may be submitted orally or in writing...(If a grievance is submitted orally, the facility employee taking the grievance must write it up on the report form), 3. The written grievance is to be forwarded to the facility's Administrator within 24 hours of receipt, 4. Upon receipt of a written grievance and/or complaint, the Administrator will refer it to the appropriate department head for investigation, 5. The department head will submit a written report of such findings to the Administrator within 3 working days of receiving the grievance and/or complaint. The investigation and report should be completed using a Grievance/Complaint Report", 6. The Administrator will review the finding with the person investigating the complaint to determine what corrective actions and resolutions need to be made..." 2014-02-01
10247 SPRINGDALE HEALTHCARE CENTER 425169 146 BATTLESHIP ROAD CAMDEN SC 29020 2010-10-27 253 D     K6DC11 On the days of the complaint inspection, based on observation, the facility failed to provide a safe, clean, comfortable and homelike environment for 3 of 6 resident rooms observed. Soiled and malodorous carpets were observed in 3 of 6 resident rooms on Unit 2. The findings included: Observations on 10/26/2010 at 10:10 AM of room 209 revealed 3 large grayish brown spots on the floor under the tube feeding pole and pump; room 213 was noted with a large amount of clothes piled on a chair and a pair of bedroom shoes on the floor; both room had a musty odor throughout. Observations on 10/26/10 at 12:02 PM revealed a fly light position on the floor in room 212B near the window, the ionizer contained approximately 15 dead flies on the base, under the light. There was also a musty odor noted throughout the room. The tan carpet on the floor was worn and had stains along with darker areas that looked like black scuff marks. At 12:24 the Director of Nursing verified the findings but stated she could not smell any odors. She stated that there might be an odor, but that she smoked and didn't have a good sense of smell. 2014-02-01
10248 SPRINGDALE HEALTHCARE CENTER 425169 146 BATTLESHIP ROAD CAMDEN SC 29020 2010-10-27 279 D     K6DC11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the complaint inspection, based on observation, record review and interview, the facility failed to development comprehensive plans of care, which addressed the needs of 1 of 6 sampled residents. Resident #3 with a [DIAGNOSES REDACTED]. The findings included: The facility admitted Resident #3 on 10/15/2010 with [DIAGNOSES REDACTED]. Review of the current medical record on 10/26/2010 for Resident #3 revealed a Interdisciplinary Progress Note dated 10/23/2010 at 1:00 PM that stated, "Res (resident) noted with nephrostomy valve leaking. Supervisor notified and MD made aware. MD order given to tape around valve to seal and to monitor until Monday and let nephrologist address then. Urine draining in nephrostomy bag without problems..." A care plan dated 10/25/2010, noted the following problem area: "Is at risk for injury related to falls as evidence by...has nephrostomy with drng (drainage) bag and suprapubic cath (catheter)"; "Admits related to weakness from acute hospital stay...suprapubic cath and groin pain"; "Potential for pain related to [DIAGNOSES REDACTED]. staff for ADL's (activities of daily living) related to: suprapubic cath in place..." The care plan identified the left nephrostomy tube as a suprapubic catheter. The plan of care did not document that Resident #3 had a left nephrostomy tube in place or the need to monitor on a routine bases the care of the tube and insertion site. The Director of Nursing verified the resident was not care plan for a left nephrostomy tube. 2014-02-01
10249 SPRINGDALE HEALTHCARE CENTER 425169 146 BATTLESHIP ROAD CAMDEN SC 29020 2010-10-27 309 D     K6DC11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the complaint inspection, based on record review, interviews and observation, the facility failed to assure each resident received care and services in accordance with the plan of care as ordered by the physician. Resident #1 had current physician orders [REDACTED]. Resident #3 with an order documented in the Interdisciplinary Progress Notes for a follow-up with the nephrologist related to a leaking nephrostomy tube that was not transcribed and carried out. (2 of 6 sampled residents reviewed for care and services related to following physician orders.) The findings included: The facility admitted Resident #1 on 10/04/2010 with [DIAGNOSES REDACTED]. As a result of a complaint the closed medical record for Resident #1 was reviewed on 10/26/2010, a physician's orders [REDACTED].#1 complained of loose stools through the night and the standing order for Immodium was initiated, there was no further documentation related to loose stools until 10/10/2010. A late entry dated 10/12/2010 at 8:00 PM for 10/10/2010 4:00 PM stated, "Resident c/o (complains of) loose stool. Medicated with Immodium, ineffective continues to have loose stool. MD aware n/o (new order) received: obtain stool sample, decrease TF (tube feed) 50 cc/hr (centimeters/hour); have dietician assess." On 10/10/2010 the Resident #1 was transferred to the hospital at the request of the family due to their concerns related to her having loose stools. Review of the Activities of Daily Living (ADL) Flow Record showed Resident #1 had extra large stools on all three shifts 10/08/2010; had no stool on the 11-7 shift, an extra large stool on the 7-3 shift and a small stool on the 3-11 on 10/09/2010; had extra large stools on all three shift on 10/10/2010. Review of the 24 hour report from 10/08/2010 thru 10/10/2010 documented on 10/08/2010 for the "Day" shift (7-3) "c/o loose stools, initiated s.o. (standing order) Immodium..."; the 24 hours reports revealed no further documentation related to Resident #1 having loose stools. Review of the Medication Administration Record [MEDICATION ADMINISTRATION RECORD DETAILS REDACTED]> give 2 mg after each loose stool not to exceed 16 mg in 24 hrs." The MAR indicated [REDACTED]'s standing orders were not followed related to the administration of [MEDICATION NAME]. The facility admitted Resident #3 on 10/15/2010 with [DIAGNOSES REDACTED]. Review of the current medical record on 10/26/2010 for Resident #3 revealed a Interdisciplinary Progress Note dated 10/23/2010 at 1:00 PM that stated, "Res (resident) noted with nephrostomy valve leaking. Supervisor notified and MD made aware. MD order given to tape around valve to seal and to monitor until Monday and let nephrologist address then. Urine draining in nephrostomy bag without problems..." Review of the physician's orders [REDACTED]. In an interview with the surveyor on 10/26/2010 at approximately 11:45 AM the Director of Nurses confirmed the ordered had not been written. Resident #3 was sent to the emergency roiagnom on [DATE]; the valve was replaced and a culture was obtained. 2014-02-01
10250 HERITAGE HEALTHCARE OF PICKENS 425306 163 LOVE & CARE ROAD SIX MILE SC 29682 2010-10-26 157 D     M5SK11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on interview, closed record review, and review of facility policy titled Condition Change (9/03) and Documentation (4/06) the facility failed to provide evidence that the resident's physician and legal representative were notified when Resident # 11 experienced a significant change in his condition. The resident's temperature was significantly elevated to 103.9 and the resident was vomiting brown emesis with a foul odor. The findings included: The facility admitted Resident # 11 on 12/1/08. The resident's [DIAGNOSES REDACTED]. On 10/24/10, a review of the closed medical record revealed the resident was documented as having an elevated temperature of 103.9 on 10/1/10 at 2:30PM. The resident vomited twice. The emesis was noted to be brown, watery with a foul odor. There was no documentation that the attending physician was notified but rather standing orders were initiated which included [MEDICATION NAME] and Tylenol. There was no documentation that the responsible party was notified. During an interview with the facility Director of Nursing on 10/24/10 at 8:30PM, she indicated she felt the nurse had initiated the standing orders appropriately. When questioned about the brown emesis with a foul odor, she stated the resident constantly chewed tobacco and felt that was the cause of the foul odor and brown color. The Director of Nurses did not dispute there was no evidence that the family had been notified. On 10/25/10, at 5PM, during an interview with the attending physician, he stated he did not recall being aware of the resident's illness while in the building. He further stated that if he did see him that day it would have been because the resident was seated in the hallway per his usual custom. On 10/25/10 at approximately 5:45PM, during an interview with Licensed Practical Nurse # 1, she stated that the physician was in the building and was informed of the resident's condition and saw the resident. She stated she did not accompany the physician nor visually see the physician examine the resident. LPN # 1 also stated she called the resident's family and left a message. However, there was no documentation either by the nurse or the physician that had occurred. Review of the facility provided policy for condition change stated: "Any staff member who notices a resident/patient status change shall immediately notify the appropriate licensed personnel. After assessing the resident/patient, the licensed personnel shall contact the physician immediately regarding status change. Family members and or guardians...will be notified, except when the change in status regards such routine lab work, diet changes. and/or minor medication changes. ....Notification of the appropriate individuals is to be documented in the medical record. Documentation on the 24 hour report does not replace documentation in the medical record. Facility policy titled Documentation: Charting stated ...all pertinent information will be charted on each individual/patient/resident in accordance with accepted professional standards and practices. The records will be a complete, accurate and functional representation of the actual experience of the patient/resident. ...The chart is a legal document and must be kept up-to-date at all times. ...Pertinent information requiring documentation will include, but not be limited to the following:....A significant change in physical, mental or psychosocial status...clinical complications related to disease status...new behaviors." 2014-02-01
10251 HERITAGE HEALTHCARE OF PICKENS 425306 163 LOVE & CARE ROAD SIX MILE SC 29682 2010-10-26 281 D     M5SK11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey based on record review, interview and review of the facility provided policy for documentation, the facility failed to meets professional standards of quality. Resident # 11 was documented as having a rapid onset of illness with elevated temperature and foul smelling emesis at 2:45PM. At 6PM, a facility staff member documented the effect of medications administered. There was no further documentation of the resident until 355AM, the following morning when the resident was mottled, with unstable vitals signs and transferred to acute care. A History and Physical completed by the attending physician failed to address a complete assessment of the resident. The findings included: The facility admitted Resident # 11 on [DATE]. The resident's [DIAGNOSES REDACTED]. On [DATE], a review of the closed medical record revealed the resident was documented as having an elevated temperature of 103.9 on [DATE] at 2:30PM. The resident vomited twice. The emesis was noted to be brown, watery with a foul odor. Licensed Practical Nurse # 1 documented she administered [MEDICATION NAME] two times that day (at 8:30AM and 2PM) and Tylenol at 2PM for and elevated temperature. The last documented complete physical assessment of the resident was at 2:45PM on [DATE]. Review of the 24 hour report and nursing worksheet contained no additional information. Licensed Practical Nurse # 2 documented on the back side of the Medication Record that Tylenol and [MEDICATION NAME] were repeated at 6PM and were "effective." No further documentation of the resident's condition was found. The next documentation of an assessment of the resident's condition occurred at 3:55AM on [DATE] when the resident was transferred to acute care and admitted to the hospital. The admission History and Physical obtained from the hospital stated the resident was to be admitted with [DIAGNOSES REDACTED]. The resident expired while in the hospital on [DATE]. The Discharge summary stated: "...was noted to have a fever and some vomiting. He had no urinary output and was sent to the emergency room for evaluation. He was evaluated in the ER (emergency room ) and found to have a positive troponin level and elevated D-Dimer He had a urinary tract infection with TNTC (too numerous to count) white cells. ...Patient was admitted to the Critical Care Unit,, He was placed on IV antibiotics....Patient's troponin level continued to rise, as high as 80. He was evaluated by Cardiology, who felt his prognosis was poor due to the size of his MI ([MEDICAL CONDITION] Infarct). On [DATE], at 5PM, during an interview with the attending physician, he stated he had cared for the resident while in the hospital. The physician stated he felt the resident had suffered a [MEDICAL CONDITION] probably secondary to his urinary tract infection. He further stated it was believed that the initial [MEDICAL CONDITION] had occurred ,[DATE] hours prior to admission based on the lab results. When asked if the resident would have exhibited symptoms, he stated "some do and do not". He stated the resident denied having a [MEDICAL CONDITION] and that not all residents experience pain- 50% have no pain. The physician stated at that time he did not recall being called or informed of the resident's initial illness. He acknowledged being in the facility on that day but if he had seen the resident, it would have been because he was" sitting in the hallway" as was his usual habit. During the interview, the physician also concurred with the surveyors concern related to the lack of documentation of nursing assessment from 6PM to 3:55AM. In review of the closed medical record, a History and Physical dated [DATE] lacked recorded vital signs; did not address the residents past history; mental disease; kidney function; rehabilitation potential; the resident's [MEDICAL CONDITION] or use of a Foley catheter. It failed to document a complete list of the resident's known diagnoses. During an interview with attending physician, he stated he agreed the History and Physical was "sparse". The physician stated he had been informed of the surveyors concern prior to the interview. The physician stated he did not like the form, did not know who had developed it, and did not usually answer all the areas addressed on the form. He stated based on the surveyors' concern, it would be a "good time" to change the form. Facility policy titled Documentation: Charting stated ...all pertinent information will be charted on each individual/patient/resident in accordance with accepted professional standards and practices. The records will be a complete, accurate and functional representation of the actual experience of the patient/resident. ...The chart is a legal document and must be kept up-to-date at all times. ...Pertinent information requiring documentation will include, but not be limited to the following:....A significant change in physical, mental or psychosocial status...clinical complications related to disease status...new behaviors." 2014-02-01
10252 HERITAGE HEALTHCARE OF PICKENS 425306 163 LOVE & CARE ROAD SIX MILE SC 29682 2010-10-26 428 D     M5SK11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on record review and interview, the consulting pharmacist failed to identify that Resident # 11 with known bradycardia was not having a pulse taken prior to administration of the medication. The findings included: The facility admitted Resident # 11 on 12/1/08. The resident's [DIAGNOSES REDACTED]. On 10/24/10, a review of the closed medical record revealed the resident was documented as having known Bradycardia. The resident was ordered by the physician to receive Metoprolol 12.5 milligrams daily. Review of the Medication Administration Record [MEDICATION ADMINISTRATION RECORD DETAILS REDACTED]. The pharmacist was questioned as to why there had not been a previous recommendation to take the resident's pulse prior to the administration of the medication, especially since she had acknowledged the resident's known bradycardia. The pharmacist stated that some facilities had policies which required a pulse be obtained prior to the administration of this class of drug, but this facility did not. On 10/25/10 at 5PM, during an interview with the attending physician, he stated he was not aware the resident's pulse was not being taken prior to the administration of the medication. The Nursing Drug Handbook 2011 Edition available as a resource for the nurses on the nursing unit, stated on page 383: "Always check patient's apical pulse rate before giving drug. If it's slower than 60 beats/minute, withhold drug and call prescriber immediately." There was no documentation found that the resident's pulse was being obtained prior to the administration of the Metoprolol or that the consulting pharmacist had reported the irregularity to the physician. 2014-02-01
10253 HERITAGE HEALTHCARE OF PICKENS 425306 163 LOVE & CARE ROAD SIX MILE SC 29682 2010-10-26 156 B     M5SK11 On the days of the survey, based on record review and interview, the facility failed to provide timely Notice of Medicare Provider Non-Coverage notification for 4 of 5 residents reviewed for Change in Pay Source. The findings Included: Review of residents files for change in pay source revealed four of five residents had not received timely notification of Medicare Provider Non-Coverage. Resident A's Notice of Medicare Provider Non-Coverage indicated that effective 1/11/2010 his/her coverage of current skilled nursing services would end. Further review revealed the resident had not received notification of the change in pay source until 1/11/2010. Resident B's Notice of Medicare Provider Non-Coverage indicated that effective 6/11/2010 his/her coverage of current skilled nursing services would end. Further review revealed the resident had not received notification of the change in pay source until the 6/11/10. Resident C's Notice of Medicare Provider Non-Coverage indicated that effective 6/11/2010 his/her coverage of current skilled nursing services would end. Further review revealed the resident had not received notification of the change in pay source until the 6/11/2010. Resident D's Notice of Medicare Provider Non-Coverage indicated that effective 1/14/2010 his/her coverage of current skilled nursing services would end. Further review revealed the resident had not received notification of the change in pay source until the 1/14/2010. During an interview with the Business Office Manager (BOM) on 10/25/10 at approximately 3:30 PM he/she stated " They wanted to go home that day, so we did not have time to give notice". The medical records for residents B and C showed a form titled Notification of Therapy Change which was dated 6/2/10 for resident C. (7 days in advance). and Resident B's form was dated 6/7/10. (4 days in advance). The BOM stated when asked what this form was for, "that is how they let us know the time is ending." 2014-02-01
10254 MARTHA FRANKS BAPTIST RETIREMENT CENTER 425334 ONE MARTHA FRANKS DRIVE LAURENS SC 29360 2010-10-12 157 G     GYKK11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the day of the complaint inspection, based on record review and interview, the facility failed to consult with the resident's physician when there was a significant change in the resident's condition. Resident #6 had clinical record documentation on 07/24/2010 at 0615 as sweaty, which required a linen and clothing change, later in the day he was described as lethargic. The next day (07/25/2010) at 2:00 AM it was documented that he had a temperature of 100 degrees and twitching of his extremities when touched; at 4:00 AM the twitching continued; at 6:00 AM he pulled away when care was provided and would not take fluids. The documentation indicated that the resident was lethargic at 10:50 AM and was sent to the emergency room at his daughter's request. There was no evidence the resident's physician was notified of the change in condition. (One of six sampled residents reviewed for notification) The findings included: The facility admitted Resident #6 with [DIAGNOSES REDACTED]. On 10/12/2010 a review of the resident's closed medical record revealed the following Nurse's Notes from 07/24/2010 thru 07/25/2010: "07/24/2010 0615 Res (resident) has been sweaty this shift requiring linen and night clothing change. Hair damp skin cool and pale, clammy to touch. VS (vital signs) @ present BP (blood pressure) 141/72 p (pulse) 85, resp (respirations) 22 temp (temperature) 97.5 (A) (axillary), BS (blood sugar) 182. Hands to (sic) cool for O2 (oxygen) sat (saturation) to register. No s/s (signs/symptoms) of pain/discomfort. No acute apparent distress. Orderly up and showered. On top of bed resting now. Alert with eyes open. Will pass to next shift to monitor. 1:35 PM Resident was lethargic at breakfast could not wake up enough to eat. Ate 100 % of lunch. Has been holding head down and drooling excessively all day. Afebrile with VS WNL (within normal limits). Will cont. (continue) to monitor. 2300 Remains in bed. Skin cool to touch and dry at this time. No twitching of extremities. No cough or resp distress. 07/25/2010 0100 No change in condition. Opens eyes when spoken to. 0200 Temp. 100 BP (?) P 100, R 18 BS 166. O2 sat 93% on rm (room) air. Twitching extremities when touched. Oral care. Open eyes when spoken to with no awareness of staff. 0400 Eyes closed, resting quietly. Continues to have twitching episodes when touched or spoken to. 0600 Responds to tactile stimuli. T 99.9 BP 110/50 P 180 R 20 O2 93% rm air. Skin moist warm. Pulls away when care given. Unable to get resident to take fluids. 10:50 AM Resident is lethargic and unresponsive. T 97.5, BP 110/80, P 115, R 20. Sent to ... ER (emergency room ) via EMS (emergency medical service) at dgt's (daughters) request..." On 10/12/2010 at approximately 2:15PM, during an interview with the Family Nurse Practitioner she stated that the drooling was usual for the resident but that she would have expected the staff to call the physician when the resident was noted to be sweating and for sure when he first became lethargic. The Family Nurse Practitioner added that the staff was aware that he had just finished treatment for [REDACTED]. In a face-to-face interview on 10/12/2010 at approximately 12:10 PM the Unit 3 Manager stated that she was not sure why the staff failed to call the physician. 2014-02-01
10255 MARTHA FRANKS BAPTIST RETIREMENT CENTER 425334 ONE MARTHA FRANKS DRIVE LAURENS SC 29360 2010-10-12 281 G     GYKK11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the day of the complaint inspection, based on record reviews and interviews, the facility staff failed to meet professional standards of quality for 1 of 6 residents reviewed for an acute change in condition. The physician was not consulted when Resident #6, treated [MEDICATION NAME] for recurrent urinary tract infections and recently treated with a course of antibiotics for a urinary tract infection, showed evidence of a change in condition. On 07/24/2010 at 6:15 AM he was noted with sweating; blood pressure 141/72, temperature 97.5, pulse 85 and respirations 22, he was described as lethargic at breakfast there was no other documentation until 11:00 PM when it was stated that no twitching of extremities was noted. On 07/25/2010 at 2:00 AM his blood pressure was not noted, temperature 100, pulse 100, respirations 18 and twitching of extremities when touched was noted; "opens eyes when spoken to with no awareness of staff. At 4:00 AM twitching when touched was again documented; at 6:00 AM his blood pressure was 110/50, temperature 99.9, pulse 180, fluids not accepted; at 10:50 AM he was lethargic, unresponsive; his BP was 110/80, temperature 97.5, pulse 115, respirations 20. Resident #6 was transferred to the emergency room . The findings included: The facility admitted Resident #6 with [DIAGNOSES REDACTED]. On 10/12/2010 a review of the resident's closed medical record revealed the following Nurse's Notes from 07/24/2010 thru 07/25/2010: "07/24/2010 0615 Res (resident) has been sweaty this shift requiring linen and night clothing change. Hair damp skin cool and pale, clammy to touch. VS (vital signs) @ present BP (blood pressure) 141/72 p (pulse) 85, resp (respirations) 22 temp (temperature) 97.5 (A) (axillary), BS (blood sugar) 182. Hands to cool for O2 (oxygen) sat (saturation) to register. No s/s (signs/symptoms) of pain/discomfort. No acute apparent distress. Orderly up and showered. On top of bed resting now. Alert with eyes open. Will pass to next shift to monitor. 1:35 PM Resident was lethargic at breakfast could not wake up enough to eat. Ate 100 % of lunch. Has been holding head down and drooling excessively all day. Afebrile with VS WNL (within normal limits). Will cont. (continue) to monitor. 2300 Remains in bed. Skin cool to touch and dry at this time. No twitching of extremities. No cough or resp distress. 07/25/2010 0100 No change in condition. Opens eyes when spoken to. 0200 Temp. 100 BP--, P 100, R 18 BS 166. O2 sat 93% on rm (room) air. Twitching extremities when touched. Oral care. Open eyes when spoken to with no awareness of staff. 0400 Eyes closed, resting quietly. Continues to have twitching episodes when touched or spoken to. 0600 Responds to tactile stimuli. T 99.9 BP 110/50 P 180 R 20 O2 93% rm air. Skin moist warm. Pulls away when care given. Unable to get resident to take fluids. 10:50 AM Resident is lethargic and unresponsive. T 97.5, BP 110/80, P 115, R 20. Sent to ...ER (emergency room ) via EMS (emergency medical service) at dgt's (daughters) request..." Review of the physician's orders [REDACTED]. Review of the Medication Administration Record [MEDICATION ADMINISTRATION RECORD DETAILS REDACTED]. On 10/12/2010 at approximately 2:15 PM, during a telephone interview with the surveyor the Family Nurse Practitioner stated that the drooling was usual for the resident but that she would have expected the staff to call the physician when the resident was noted to be sweating and for sure when he first became lethargic. The Family Nurse Practitioner added that the staff was aware that he had just finished treatment for [REDACTED]. In a face-to-face interview on 10/12/2010 at approximately 12:10 PM the Unit 3 Manager stated that she was not sure why the staff failed to call the physician. 2014-02-01
10256 MARTHA FRANKS BAPTIST RETIREMENT CENTER 425334 ONE MARTHA FRANKS DRIVE LAURENS SC 29360 2010-10-12 312 D     GYKK11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the day of the complaint survey based on observations, record review and interviews, the facility failed to ensure that care and services necessary to maintain or attain the highest practical physical well being related to grooming and personal hygiene was provided for Resident #3 observed on 10/12/2010 with blood on the left side of the nose; with long fingernails on both hands and what appeared to be blood under her fingernails. The findings included: The facility admitted Resident #3 with [DIAGNOSES REDACTED]. Resident #3 observed at 11:00 AM seated in the day room on Unit 3 with dried blood on the left side of her nose; her fingernails on both hands, were noted to be long, with what appeared to be blood under the index finger and on the thumb of the right hand. At 11:10 AM Resident #3 was rolled in her Geri-chair to her room and transferred to her bed for incontinent care. CNA #2 stated that the resident preferred her nails long and that nails were done on Tuesday. Review of the Weekly Nursing Assessment from 06/19/2010, 09/11/2010,09/25/2010, and 10/09/2010 documented a scab in the crease of the resident's nose on the left side and stated, "scratches won't leave band aid on." On 10/12/2010 at 11:30 AM Resident #3's fingernails were observed with the Director of Nurses, at that time the nails had been cut and cleaned, but were still uneven and rough. The Director of Nurses confirmed that Resident #3 still needed nail care, which should include filing. 2014-02-01
10257 MARTHA FRANKS BAPTIST RETIREMENT CENTER 425334 ONE MARTHA FRANKS DRIVE LAURENS SC 29360 2010-10-12 280 D     GYKK11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the day of the complaint inspection, based on record review and interview, the facility failed to revise and update the Care Plan for 1 of 6 sampled residents reviewed for Comprehensive Care Plans. Resident #1 had 4 reported incidents where she "slid" out of chairs to the floor without changes to the approaches used to address her falls. The findings included: The facility admitted Resident #1 on 08/16/2010 with [DIAGNOSES REDACTED]. Resident #1 was included in the sample due to an incident reported by the facility which prompted the complaint investigation. Review of the closed medical record on 10/12/2010 revealed an Incident/Accident Report for Resident #1 dated "8-22-10 at 7:45 AM". Under "Describe exactly what happened; why it happened; what the causes were. If an injury, state part of body injured. If property or equipment damaged, describe damage." was a handwritten note. "Resident was in shower chair-it tilted forward + she slid out on the BR (Bathroom) floor...". The "Additional comments and/or steps taken to prevent recurrence:" revealed "Morse Fall Scale". Review of a 2nd Incident/Accident Report dated 09/1/2010 revealed that Resident #1 had been "..sitting in w/c (wheelchair)- nurse went to ck (check) on another res(ident)-this res(ident) sitting on carpet in front of upright w/c. States she "slid out". She was out of site for app(roximately) 2 minutes". The "Additional comments and/or steps taken to prevent recurrence:" revealed "Morse Fall Scale completed, w/c alarm in place but didn't sound-magnet was still in place. Alarm ...". Review of a 3rd Incident/Accident Report dated 09/13/2010 revealed "Resident found sitting on floor in front of chair". The "Additional comments and/or steps taken to prevent recurrence:" revealed "Morse Fall". Review of a 4th Incident/Accident Report dated 09/14/2010 revealed "Sitting in w/c trying to push nurse away, slipped to floor from w/c. Also hitting at nurse". There were no additional comments listed. Review of the Care Plan dated 08/30/2010 revealed that Resident #1 had been identified as being "At risk for falls r/t (related to) a hx (history) of falls, "Morse falls score 75". Under "Last fall date" was handwritten in "9/1/10- slid out of w/c, 9/13/10-slid out of chair, 9/14/10-slid out of w/c". The Approaches used were typed and included "1) Encourage resident to use call light, 2) Encourage resident to ask for assistance with transfers as needed, 3) Observe frequently when up and OOB (Out of bed), 4) 1/2 Siderails up X 2 to assist with mobility, and to define the parameters of the bed, 5) Orient to surroundings as appropriate, 6) Review medications for the continued need, appropriateness dosage, continued effectiveness, 7) Perform ongoing assessment of any physical or mental health status changes, 8) Uses low bed to reduce the risk for falls, 9) Use Morse Falls scale to determine risk for falls, 10) Call light in reach". During an interview on 10/12/2010 at 4:05 PM, the Minimum Data Set (MDS) Coordinator stated that she had handwritten the updates regarding the resident sliding out of the chair onto the Care Plan. She stated she had updated this information for the Director of Nursing (DON) since the Nurse Manager had been out on leave. She stated the Nurse Manager was responsible for updating the approaches used and that the DON had taken over this duty since the Nurse Manager had been out. The MDS Coordinator stated she only updated the Care Plan once a year r/t changes the Nurse Manager had already made. During an interview on 10/12/2010 at 4:15 PM, the DON verified the approaches had not been changed related to Resident #1's repeated "sliding" out of chairs and stated it was probably because there had been nothing to change. 2014-02-01
10258 MARTHA FRANKS BAPTIST RETIREMENT CENTER 425334 ONE MARTHA FRANKS DRIVE LAURENS SC 29360 2010-10-12 272 G     GYKK11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the day of the complaint inspection, based on observations, record review, and interviews, the facility failed to ensure two of four sampled residents were assessed for transfers. Certified Nursing Assistants used a mechanical lift on Residents #1 and #2 without documented assessments as to the appropriateness of the lift device for each resident. Resident #3's CNA Care Plan Guide revealed no mention of the level of assistance required for transfers or the mode of transfer. The findings included: The facility admitted Resident #1 on 08/16/2010 with [DIAGNOSES REDACTED]. Resident #1 was included in the sample due to an incident reported by the facility, which prompted the complaint investigation. Review of the facility investigation revealed that Resident #1 had been sent to the emergency roiagnom on [DATE] for pain, swelling, warmth, decreased range of motion, and a "fading discoloration" around and below the left knee. According to the physician's statement included in those records, the resident had been admitted to the hospital on [DATE] with a [MEDICAL CONDITIONS] and tib-fib (tibia-fibula) [MEDICAL CONDITION] leg. In a letter dated 10/1/2010 from the facility's Director of Nursing (DON), the facility reported that "During the investigation it was noted that on September 25, 2010 (Resident #1's) left foot had slipped forward while being lifted with the "stand-up" lift. The lift procedure was stopped, another Certified Nursing Assistant (CNA) joined the aide caring for (Resident #1). Her left foot was moved approx.(approximately) three inches back into the proper position, and the lift and care proceeded. I had the CNAs demonstrate the procedure for me. I did not observe anything that would cause injury". Review of the closed medical record conducted on 10/12/2010 revealed the following: Review of the cumulative physician's orders [REDACTED]. During an interview at 12:15 PM, Licensed Practical Nurse #1 verified this and stated that the physician deferred the issue of transfers or the use of lifts to nursing. Review of the Admission assessment dated [DATE] revealed no mention of the amount of assistance needed for transfers or any lift devices used. Under "Assistive Aides:" wheelchair alarm and bed alarm had been checked. Review of "Weekly Nursing Assessment(s)" dated 8/22/2010 through 9/19/2010 revealed under "ADL's (Activities of Daily Living), that the resident transfers with extensive assistance with 2 person physical help". There was no documentation that the resident had been assessed for the use of a mechanical lift or that one was being used. Review of the CNA Patient Care Record (PCR) for Resident #1 dated September 2010 revealed no mention of the level of assistance required for transfers or the use of any transfer devices. Review of Nurse's Notes dated 8/16/2010 through 9/26/2010 revealed several entries that stated 2 staff assisted with transfers, but no mention of the use of a mechanical lift. Interviews with nursing staff, however, indicated that the lift had been used many times throughout the resident's stay at the discretion of the nursing staff. The following entries were noted: "8-19-10...Staff x 2 put resident to bed", "8-20-10...Staff x 2 assisted res(ident) to bed", "8-23-10...Staff x 2 assisted to bed...", "8-26-10...Staff x 2 assisted (with) hs (bedtime) care + to bed", "9-26-10...-up to w/c (wheelchair) per 2 CNAs to have haircut". During a phone interview with the surveyor on 10/12/2010 at 11:45 AM, CNA #1 stated that the lift was used for Resident #1 to get her out of bed to the wheelchair. She verified she had used the lift without other staff assistance on several occasions on 9/25/2010 because she didn't have any help. She stated she did get assistance from CNA #2 when she encountered difficulty with Resident #1's foot placement on the lift. During an interview with the surveyor on 10/12/2010 at approximately 12:15 PM, Licensed Practical Nurse #1 stated that she "knew" CNAs had used the lift on Resident #1, but that she had not actually witnessed staff using the lift until 09/25/2010 when CNA #1 had to call CNA #2 for assistance with Resident #1's foot placement. She said that normally 2 CNAs would assist with transfers for Resident #1. LPN #1 verified that the lift had been used to get the resident out of bed on 09/26/2010 and that the resident was placed back into bed with the assistance of 2 CNAs lifting the resident. LPN #1 was asked what she would tell a CNA about the type of assistance Resident #1 required to transfer from the wheelchair to the bed or wheelchair to the toilet. LPN #1 stated that when transferring from the bed to the wheelchair, she would tell them to use the lift and make sure they had someone to help. If they were taking Resident #1 to the toilet, she would tell them to "see if the resident could bear weight with 2 CNAs to assist, and if not, I don't know if they would get the lift into the toilet". During an interview with the surveyor on 10/12/2010 at 1:15 PM, CNA #2 verified she had used the lift on 09/25/10 with CNA #1 and also on 09/26/2010, when she and CNA #3 transferred Resident #1 out of the bed and into the wheelchair. She stated that they had decided to use the lift on 09/26/2010 because the resident had not been able to walk for about a week. She stated that she had used the lift before on Resident #1, due to the residents decline in ability to transfer. During an interview at 1:52 PM, CNA #3 stated that on 09/26/2010, she and CNA #2 were getting Resident #1 up out of bed. When the resident wouldn't help with the transfer, the lift was used to transfer the resident to the wheelchair. A little later when the nurse came to assess Resident #1's leg, the two CNAs transferred the resident back to bed manually using a gait belt. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #1 had been coded under "Transfer" as a "3" requiring extensive assistance with "3" two + persons physical assist. Under "Modes of transfer" she had been coded as "Lifted mechanically". During an interview at 1:48 PM, the MDS Coordinator verified the above MDS coding information. When asked where she had gotten the information for the resident's transfer abilities, she stated she had read the Weekly Nursing Assessment and Nurse's Notes. When asked where she had gotten the information related to the use of a mechanical lift for Resident #1, she looked through the chart and then stated she had spoken with the CNAs about how they transferred the resident. When asked if it was appropriate to obtain this information from a CNA, the MDS Coordinator stated that she thought the CNAs were the best ones to assess whether a lift is needed. When asked what skills CNAs possess in order to determine that a lift is needed, she stated she didn't know- but that "they were certified". Review of the interdisciplinary Care Plan revealed that Resident #1 had the problem of "ADL Deficit, alteration in mobility r/t (related to) recent hospitalization .... transfers-extensive" indicating the amount of assistance needed for transfers. There was no mention of the use of a mechanical lift. During an interview earlier on 10/12/2010 at 9:48 AM, the DON, MDS Coordinator, and ADON were present. When asked about the Care Plan and documentation of the use of a mechanical lift, the MDS Coordinator stated that she did not Care Plan for the use of lifts. She also stated she had never seen staff chart the use of a lift. During a review of Physical Therapy Daily/Weekly Progress Notes for Resident #1 dated 08/16/2010 through 09/24/2010 with the surveyor on 10/12/2010, the Physical Therapist stated that Resident #1's transferring ability varied from day to day and ranged from Total/Maximum assistance of 2-3 staff to minimum/moderate assistance of 1 staff. She verified the following entries related to Resident #1's functional abilities dated 09/21/10 "SPT" (Stand pivot) w/c (wheelchair) toilet max(imum) (assist) x 2" and for 09/22/10 "Bed Chair Max(imum)/Mod(erate) x 2". After reviewing the PT progress notes, she verified there was no mention of a lift and stated she didn't recall that the resident used a mechanical lift device. When asked who determined which residents used a lift device, the Physical Therapist stated that PT and Nursing Staff discuss whether a lift is needed when a resident is admitted , but after that nursing would call PT if they had a concern. When asked if this discussion would be documented somewhere, she stated it would be documented in the PT progress notes. She stated she didn't know who made the decision to use the lift device, but that PT would suggest the lift device if a person was a good candidate. When asked if she thought that a CNA had the knowledge base to determine which resident used a lift, she stated that the CNA knew more about the resident and any changes than PT did. She stated she didn't know about CNA's making the determination. During an interview with the surveyor on 10/12/10 at 4:25 PM, the DON stated that on admission, all residents get a bed alarm and receive 2 person assistance for lifts. Therapy then comes in quickly to give their recommendations on what they think. The nurse and CNAs for that unit then come together and discuss an immediate Care Plan, which the CNA fills out. She was unable to provide a copy of the CNA Care Plan for Resident #1. The DON stated that if there are any changes in the level of assistance needed for transfers, PT is contacted and the CNAs and nurses report to each other. The DON stated Resident #1 responded well to the lift, and that she allowed the CNAs some discretion in the use of the mechanical lift. The facility admitted Resident #2 on 01/14/2009 with [DIAGNOSES REDACTED]. Record review conducted on 10/12/2010 indicated the cumulative physician's orders [REDACTED]. Review of the Weekly Nursing assessment dated [DATE] showed, under ADL's (Activities of Daily Living), the resident's transfer performance as total dependence with 2 person physical support. There was no documentation that the resident had been assessed for the use of a mechanical lift or that one was being used. Review of the CNA Care Plan Guide for Resident #2 revealed that she was a sit/stand lift with no mention of the level of assistance required for transfers. Review of Nurse's Notes dated 07/26/2010 through 10/12/2010 revealed no mention of the use of a mechanical lift. Observation on 10/12/2010 at 10:40 AM revealed CNA #2 and CNA #4 manually transferred Resident #2 from a high-backed chair to a wheelchair and wheeled her to her room for toileting. CNA #3 brought the Sara Lift into Resident #2's room and CNA #2 and CNA #3 transferred her from the wheelchair to the toilet using the lift. Review of the Annual Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #2 had been coded under Transfer as a (3) requiring assistance with (2) one persons physical assist. Under Modes of transfer she had been coded as a manual lift. Review of the interdisciplinary Care Plan dated 07/22/2010 and updated 10/12/2010 revealed that Resident #2 had falls identified as a problem. Interventions included lowest bed position, bed alarm to bed and provide a safe environment; there was no mention of transfer needs. The facility admitted Resident #3 on 04/14/2006 with [DIAGNOSES REDACTED]. Record review conducted on 10/12/2010 indicated the cumulative physician's orders [REDACTED]. Review of the Weekly Nursing assessment dated [DATE] thru 10/09/2010 showed under ADL's (Activities of Daily Living), the resident's transfer performance as total dependence with 2 person physical support. Review of the CNA Care Plan Guide for Resident #3 revealed no mention of the level of assistance required for transfers or a mode of transfer. Review of the Annual Minimum Data Set (MDS) assessment dated [DATE] and Quarterly MDS assessment dated [DATE] revealed Resident #3 coded under Transfer as a (4) total assistance with (3) two persons physical assist. Under Modes of transfer she had been coded as a manual lift. Review of the interdisciplinary Care Plan dated 06/21/2010 and updated 09/14/2010 revealed that Resident #3 required assistance with Activities of Daily Living. Interventions included sits and transports in a Geri-chair daily; there was no mention of transfer needs. 2014-02-01
10259 MARTHA FRANKS BAPTIST RETIREMENT CENTER 425334 ONE MARTHA FRANKS DRIVE LAURENS SC 29360 2010-10-12 225 E     GYKK11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the day of the complaint inspection, based on interviews, observation and record review, the facility failed to thoroughly investigate and/or report two incidents involving Resident #1, two incidents involving Resident #2, one incident involving Resident #3 and one incident involving Resident #5. These residents were 4 of 6 sampled residents reviewed for reportable incidents. The findings included: The facility admitted Resident #1 on 08/16/2010 with [DIAGNOSES REDACTED]. Resident #1 was included in the sample due to an incident reported by the facility which prompted the complaint investigation. Review of the closed medical record on 10/12/2010 revealed an Incident/Accident Report for Resident #1 dated "8-22-2010 at 7:45 AM". Under "Describe exactly what happened; why it happened; what the causes were. If an injury, state part of body injured. If property or equipment damaged, describe damage." was a handwritten note. "Resident was in shower chair-it tilted forward + she slid out on the BR (Bathroom) floor...". During an interview with the surveyor on 10/12/2010 at 4:15 PM, the Director of Nursing (DON) stated there had been no investigation conducted since the incident had been witnessed. When asked if she knew what had happened to cause the shower chair to tilt forward she did not know. Review of a 2nd Incident/Accident Report for Resident #1 dated 09/1/2010 revealed that she had been "..sitting in w/c (wheelchair)- nurse went to ck (check) on another res(ident)-this res(ident) sitting on carpet in front of upright w/c. States she "slid out". She was out of site for app(roximately) 2 minutes". The "Additional comments and/or steps taken to prevent recurrence:" revealed "Morse Fall Scale completed, w/c alarm in place but didn't sound-magnet was still in place. Alarm ...". During an interview with the surveyor on 10/12/2010 at 4:15 PM, the DON verified an investigation had not taken place. She stated the resident had been in the Day Room and staff pretty much knew what had happened. The "Additional comments.." section was brought to her attention which indicated that the alarm was in place but didn't sound. The facility admitted Resident #2 on 01/14/2009 with [DIAGNOSES REDACTED]. Review of the current medical record on 10/12/2010 revealed a Nurse's Note dated 09/01/2010 at 0800 which stated, "Approx (approximately) 5 cm (centimeter) reddish, brown discoloration noted inner side on lt (left) knee. Denies discomfort at site. Noted to cross and uncross legs freq (frequently) when up in chair." On 09/22/2010 at 2100 a Nurse's Note stated, "Staff called to room to observe a purple bruise to (L) (left) upper arm above elbow. Intact with no c/o (complaint) pain or discomfort." There were no incident reports related to the two incidents and they were not investigated and/or reported to the state survey agency. The facility admitted Resident #3 on 04/14/2006 with [DIAGNOSES REDACTED]. Review of the current medical record on 10/12/2010 revealed a Nurse's Note dated 07/11/2010 at 8 AM which stated, "CNA (certified nurse aide) reported large purple bruise on upper outer (R) (right) arm. No s/s (signs/symptoms) of pain noted. Called nephew..." The facility admitted Resident #5 on 07/21/2010 with [DIAGNOSES REDACTED]. Review of the current medical record on 10/12/2010 revealed a Nurse's Note dated 10/05/2010 at 11:30 that stated, "Res. (resident) up in halls with walker without prob (problem) - no limping, denies discom (discomfort) site of bruising top of lt (left) foot." On 10/06/2010 at 0630 a Nurse's Note stated, "...Resident picked up walker and one leg of walker was placed on top of foot (L) (left) foot and was ready to place her weight down on it. May have been cause of bruising and swelling on top of foot seen yesterday..." The incident was not investigated and/or reported to the state survey agency. During an interview with the surveyor on 10/12/2010 at approximately 11:45 AM, the Assistant Director of Nursing (ADON) stated she was not aware of the incidents related to resident #2 on 09/01 and 09/22/2010, no incident reports were made. When asked about Resident #3 she provided an investigation. The incident was not reported to the state survey agency. During an interview with the surveyor on 10/12/2010 at approximately 12:15 PM the Unit 3 Unit Manager confirmed the only observation documented concerning Resident #5 placing her walker on top of her left foot occurred on 10/06/2010 after the initial injury. The Unit Manager confirmed the incident had not been investigated and/or reported to the state survey agency. 2014-02-01
10260 MARTHA FRANKS BAPTIST RETIREMENT CENTER 425334 ONE MARTHA FRANKS DRIVE LAURENS SC 29360 2010-10-12 253 D     GYKK11 On the day of the complaint inspection, based on observations and interviews the facility failed to provide housekeeping and maintenance services to maintain a sanitary, orderly, and comfortable interior for 1 of 1 Unit reviewed. There were 2 blue wheelchair with cracked, rough and peeling arm supports; 2 black wheelchairs with soiled seats and frames with food particles; 1 Geri-chair with a cracked arm support frame and torn upholstery on the back of the back support at the top. The findings included: Observations on 10/12/2010 at approximately 10:40 AM revealed maintenance issues on Unit 3. The Director of Nurses confirmed the following at 11:30 AM: One Geri-chair with a crack approximately 10 inches long on Resident #3's Geri-chair, right arm support frame; back support, top right back with exposed foam. Resident #2 seated in a blue wheelchair with both armrests torn and cracked. A blue wheelchair with both arm rests torn and cracked; 2 black wheelchairs with soiled seats and frames with food particles. Review of Schedule of Events/Activities revealed that Gerri Chairs and Wheelchairs were to be cleaned once a week and as needed; there was no cleaning log maintained. 2014-02-01
10261 MARTHA FRANKS BAPTIST RETIREMENT CENTER 425334 ONE MARTHA FRANKS DRIVE LAURENS SC 29360 2010-10-12 323 G     GYKK11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the day of the complaint inspection, based on observations, record review, and interviews, 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. Certified Nursing Assistants used a mechanical lift on Residents #1 and #2 without documented assessments as to the appropriateness of the lift device. The findings included: The facility admitted Resident #1 on 08/16/2010 with [DIAGNOSES REDACTED]. Resident #1 was included in the sample due to an incident reported by the facility, which prompted the complaint investigation. Review of the facility investigation revealed that Resident #1 had been sent to the emergency roiagnom on [DATE] for pain, swelling, warmth, decreased range of motion, and a "fading discoloration" around and below the left knee. According to the physician's statement included in those records, the resident had been admitted to the hospital on [DATE] with a Deep Vein Thromboses (DVT) and tib-fib (tibia-fibula) fracture of the left leg. In a letter dated 10/1/10 from the facility's Director of Nursing (DON), the facility reported, "During the investigation it was noted that on September 25, 2010 (Resident #1's) left foot had slipped forward while being lifted with the "stand-up" lift. The lift procedure was stopped, another Certified Nursing Assistant (CNA) joined the aid caring for (Resident #1). Her left foot was moved approx. (approximately) three inches back into the proper position, and the lift and care proceeded. I had the CNAs demonstrate the procedure for me. I did not observe anything that would cause injury". Review of the closed medical record on 10/12/2010 revealed the following: Review of the cumulative physician's orders [REDACTED]. During an interview at 12:15 PM, Licensed Practical Nurse #1 verified this and stated that the physician deferred the issue of transfers or the use of lifts to nursing. Review of the Admission assessment dated [DATE] revealed no mention of the amount of assistance needed for transfers or any lift devices used. Under "Assistive Aides:" wheelchair alarm and bed alarm had been checked. Review of "Weekly Nursing Assessment(s)" dated 08/22/2010 through 09/19/2010 revealed under "ADL's (Activities of Daily Living), that the resident transfers with extensive assistance with 2 person physical help. There was no documentation that the resident had been assessed for the use of a mechanical lift or that one was being used. Review of the CNA Patient Care Record (PCR) for Resident #1 dated September 2010 revealed no mention of the level of assistance required for transfers or the use of any transfer devices. Review of Nurse's Notes dated 08/16/2010 through 09/26/2010 revealed several entries that stated 2 staff assisted with transfers, but no mention of the use of a mechanical lift. Interviews with nursing staff, however, indicated that the lift had been used many times throughout the resident's stay at the discretion of the nursing staff. The following entries were noted: "8-19-10...Staff x 2 put resident to bed", "8-20-10...Staff x 2 assisted res(ident) to bed", "8-23-10...Staff x 2 assisted to bed...", "8-26-10...Staff x 2 assisted (with) hs (bedtime) care + to bed", "9-26-10...-up to w/c (wheelchair) per 2 CNAs to have haircut". During a phone interview on 10/21/2010 at 11:45 AM, CNA #1 stated that the lift was used for Resident #1 to get her out of bed to the wheelchair. She verified she had used the lift without other staff assistance on several occasions on 09/25/2010 because she didn't have any help. She stated she did get assistance from CNA #2 when she encountered difficulty with Resident #1's foot placement on the lift. During an interview on 10/12/2010 at approximately 12:15 PM, Licensed Practical Nurse #1 stated that she "knew" CNAs had used the lift on Resident #1, but that she had not actually witnessed staff using the lift until 09/25/2010 when CNA #1 had to call CNA #2 for assistance with Resident #1's foot placement. She said that normally 2 CNAs would assist with transfers for Resident #1. LPN #1 verified that the lift had been used to get the resident out of bed on 09/26/2010 and that the resident was placed back into bed with the assistance of 2 CNAs lifting the resident. LPN #1 was asked what she would tell a CNA about the type of assistance Resident #1 required to transfer from the wheelchair to the bed or wheelchair to the toilet. LPN #1 stated that when transferring from the bed to the wheelchair, she would tell them to use the lift and make sure they had someone to help. If they were taking Resident #1 to the toilet, she would tell them to "see if the resident could bear weight with 2 CNAs to assist, and if not, I don't know if they would get the lift into the toilet". During an interview on 10/12/2010 at 1:15 PM, CNA #2 verified she had used the lift on 09/25/2010 with CNA #1 and also on 09/26/2010, when she and CNA #3 transferred Resident #1 out of the bed and into the wheelchair. She stated that they had decided to use the lift on 09/26/2010 because the resident had not been able to walk for about a week. She stated that she had used the lift before on Resident #1, due to the residents decline in ability to transfer. During an interview at 1:52 PM, CNA #3 stated that on 09/26/2010, she and CNA #2 were getting Resident #1 up out of bed. When the resident wouldn't help with the transfer, the lift was used to transfer the resident to the wheelchair. A little later when the nurse came to assess Resident #1's leg, the two CNAs transferred the resident back to bed manually using a gait belt. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #1 had been coded under "Transfer" as a "3" requiring extensive assistance with "3" two + persons physical assist. Under "Modes of transfer" she had been coded as "Lifted mechanically". During an interview at 1:48 PM, the MDS Coordinator verified the above MDS coding information. When asked where she had gotten the information for the resident's transfer abilities, she stated she had read the Weekly Nursing Assessment and Nurse's Notes. When asked where she had gotten the information related to the use of a mechanical lift for Resident #1, she looked through the chart and then stated she had spoken with the CNAs about how they transferred the resident. When asked if it was appropriate to obtain this information from a CNA, the MDS Coordinator stated that she thought the CNAs were the best ones to assess whether a lift is needed. When asked what skills CNAs possess in order to determine that a lift is needed, she stated she didn't know- but that "they were certified". Review of the interdisciplinary Care Plan dated 08/30/2010 revealed that Resident #1 had the problem of "ADL Deficit, alteration in mobility r/t (related to) recent hospitalization .... transfers-extensive" indicating the amount of assistance needed for transfers. There was no mention of the use of a mechanical lift. During an interview earlier on 10/12/2010 at 9:48 AM, the DON, MDS Coordinator, and ADON were present. When asked about the Care Plan and documentation of the use of a mechanical lift, the MDS Coordinator stated that she did not Care Plan for the use of lifts. She also stated she had never seen staff chart the use of a lift. During a review of Physical Therapy Daily/Weekly Progress Notes for Resident #1 dated 08/16/2010 through 09/24/2010, the Physical Therapist #1 stated that Resident #1's transferring ability varied from day to day and ranged from Total/Maximum assistance of 2-3 staff to minimum/moderate assistance of 1 staff. She verified the following entries related to Resident #1's functional abilities dated 09/21/2010 "SPT" (Stand pivot) w/c (wheelchair) toilet max(imum) (assist) x 2" and for 09/22/2010 "Bed Chair Max(imum)/Mod(erate) x 2". After reviewing the PT progress notes, she verified there was no mention of a lift and stated she didn't recall that the resident used a mechanical lift device. When asked who determined which residents used a lift device, the Physical Therapist stated that PT and Nursing Staff discuss whether a lift is needed when a resident is admitted , but after that nursing would call PT if they had a concern. When asked if this discussion would be documented somewhere, she stated it would be documented in the PT progress notes. She stated she didn't know who made the decision to use the lift device, but that PT would suggest the lift device if a person was a good candidate. When asked if she thought that a CNA had the knowledge base to determine which resident used a lift, she stated that the CNA knew more about the resident and any changes than PT did. She stated she didn't know about CNA's making the determination. During the interview, the Physical Therapist was asked if PT provided any training on the use of the lifts. She stated that there had been an inservice done on 09/2/2010 by PT. She stated the training was in response to a resident that was supposed to be non-weight bearing. She stated PT spoke mostly about how to transfer residents with different weight bearing statuses, body mechanics, and hip precautions (what type of care a person with a total hip replacement requires). She stated there were no demonstrations on the use of the lift, but that it was mentioned -"If they needed to use the lift, go ahead". When asked if she had received any training on the use of the lift, she stated she had not received training in this facility, but that she had in other facilities she's worked in. She stated she had not trained any staff in the use of the lift. During interviews with the nursing staff, CNAs were asked about training received on the use of the mechanical lift and how they determined the amount of transfer assistance needed for a resident. Two CNAs indicated that they had not been provided with written instructions on how to use a mechanical lift and that CNAs that trained newly orienting CNAs did not use any set check list to instruct them on lift procedures. During a phone interview on 10/12/2010 at 11:45 AM, CNA #1 was asked if she had received any training on how to use a mechanical lift. She replied that when she did clinicals at the facility, she was taught how to use them. She stated once employed by the facility, she received training in orientation where she was shown how to use the lift by another CNA. When asked how she determined which residents needed to use the lift, she replied that you could tell the ones with more weight than the others. She stated that there was no paper documentation to tell her which residents needed to use a lift, that this was common sense. During an interview on 10/12/2010 at 1:15 PM, CNA #2 stated that she had been working at the facility for [AGE] years. She stated that staff receives inservices on the use of the mechanical lift whenever they get a new one. She stated that CNAs train other CNAs in the use of the lift but that no check off sheets or written instructions are used. When asked what she would do if she didn't know how to transfer a resident, she stated she would first ask the nurse, then ask PT. When asked if she would refer to the CNA Care Plan she said she would. During an interview on 10/12/2010 at 1:52 PM, CNA #3 stated that she had been employed at the facility for approximately 2 years. She stated she had been trained on the use of mechanical lifts during orientation. She stated she did not remember the CNA who trained her, but that she had been told how to use the lift, showed how to use the lift, and had to demonstrate the lift procedure back to her trainer. She was not aware of any check off sheet related to the lift procedure that had been used or turned in. When asked how she determined what type of assistance is required with resident transfers and if a lift is used, CNA #3 stated that she would first ask the nurse or other staff. Then she would look at the CNA Care Plan, which is located in the PCR book at the nursing station. During an interview on 10/12/2010 at 4:25 PM, the DON stated that on admission, all residents get a bed alarm and receive 2 person assistance for lift. Therapy then comes in quickly to give their recommendations on what they think. The nurse and CNAs for that unit then come together and discuss an immediate Care Plan, which the CNA fills out. She was unable to provide a copy of the CNA Care Plan for Resident #1. The DON stated that if there are any changes in the level of assistance needed for transfers, PT is contacted and the CNAs and nurses report to each other. The DON stated Resident #1 responded well to the lift, and that she allowed the CNAs some discretion in the use of the mechanical lift. She verified there were no formal assessments in place for the use of mechanical lifts. When asked how CNAs were trained in the use of the mechanical lift, she stated mentor CNAs checked them off during orientation. She was unable to provide any check off sheets or policies/procedures related to the use of the mechanical lift. She was asked to provide documentation of training for the mentor CNAs but did not provide any. When asked if there was a facility designated inservice trainer, she stated that there was not one, but that the Secretary and ADON kept up with staff training. When asked if any inservices or training had been provided related to using mechanical lifts since the incident with Resident #1's broken leg, she stated that there was an inservice scheduled for October 21st. She stated the inservice was being done in response to the incident with Resident #1 and was going to address the use of lifts and fire safety. Prior to the exit conference, the DON stated she had forgotten about an inservice regarding the proper use and function of the Sara Lift and the Marissa Lift that had been done in July 2010 and provided a copy. The inservice report stated that a demonstration had been done by therapy in which "The actual lifts were brought into the room and several employees acted as residents to properly demonstrate the use and function of these lifts". The inservice sheet did not contain any checklist or written procedures that had been communicated to the staff during the inservice. The signature sheet included CNAs #1, #2, and #3. During an interview on 10/12/2010 at approximately 5:00 PM, the Assistant Director of Nurse's (ADON) stated that inservices related to the mechanical lift devices were done periodically by therapy. She stated that CNAs who have been here a long time and who were very knowledgeable about lifts train new CNAs during orientation. She stated that the licensed nursing staff does not train the CNAs on the use of the mechanical lifts. The ADON stated that "mentor" CNAs use a "Nurse's Aide Checklist For Orientation" and provided a copy for review. She stated that CNAs get checked off on the use of mechanical lifts under the heading "Safety devices" and "Comfort of patients". Review of the checklist under those headings revealed no mention of the use of a lift. When asked how the CNAs were supposed to know this information pertained to the use of a mechanical lift (since there was no mention of a mechanical lift), the ADON stated she guessed they wouldn't. She was unable to provide a check off sheet or any other documentation to show what information the mentor CNAs were using to train new CNAs regarding how the mechanical lift should be operated. Review of the PCR book, which included all the PCR's for Unit 3 revealed a communication in the front of the book dated 3/28/2006 that stated "Residents are to be lifted using one of the lifts or a gait belt. No exceptions. This is to protect the staff as well as the residents. Corrective action will be taken if this is not followed. Thank you for your cooperation!" During an interview at 5:35 PM, the DON, when asked relative to the above communication if the philosophy of the facility had been and now was to use the lift as much as possible to prevent injury, answered "yes". The facility admitted Resident #2 on 01/14/2009 with [DIAGNOSES REDACTED]. Record review conducted on 10/12/2010 indicated the cumulative physician's orders [REDACTED]. Review of the Weekly Nursing assessment dated [DATE] showed under ADL's (Activities of Daily Living), that the resident transfer performance as total dependence with 2 person physical support. There was no documentation that the resident had been assessed for the use of a mechanical lift or that one was being used. Review of the CNA Care Plan Guide for Resident #2 dated September 2010 revealed that she was a sit/stand lift with no mention of the level of assistance required for transfers. Review of Nurse's Notes dated 07/26/2010 through 10/12/2010 revealed no mention of the use of a mechanical lift. Observation on 10/12/2010 at 10:40 AM revealed CNA #2 and CNA #4 manually transferred Resident #2 from a high-backed chair to a wheelchair and wheeled her to her room for toileting. CNA #3 brought the Sara Lift into Resident #2's room and CNA #2 and CNA #3 transferred her from the wheelchair to the toilet using the lift. Review of the Annual Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #2 had been coded under Transfer as a (3) requiring assistance with (2) one persons physical assist. Under Modes of transfer she had been coded as a manual lift. Review of the interdisciplinary Care Plan dated 07/22/2010 and updated 10/12/2010 revealed that Resident #2 had falls identified as a problem. Interventions included lowest bed position, bed alarm to bed and provide a safe environment; there was no mention of transfer needs. 2014-02-01
10262 MAGNOLIA PLACE - GREENVILLE 425361 35 SOUTHPOINT DRIVE GREENVILLE SC 29607 2010-10-18 280 D     DFY111 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the complaint survey, based on record review and interview, the facility failed to revise and update the Care Plan for 1 of 4 sampled residents reviewed for Comprehensive Care Plans. Resident #1's Care Plan had not been updated regarding approaches used for proper positioning and to prevent and/or care for Pressure Ulcers. The findings included: The facility admitted Resident #1 on 09/06/2002 and readmitted her on 12/10/2004 with [DIAGNOSES REDACTED]. Observation on 10/18/2010 at 12:35 PM revealed the resident lying on a specialty mattress with the head of bed elevated. Review of the cumulative Physician order [REDACTED]. Review of the Physician/Nurse Practitioner Progress Notes on 10/18/2010 at 1:15 PM revealed the following: 06/16/2010- "S(ubjective): Resident had an area of skin compromise noted to her sacrum. Initial treatment was the use of [MEDICATION NAME] although wound treatment nurse reports the skin was intact at that time. However, we were called to see the resident today due to changes in the sacral wound...P(lan): ...Also, initiate a specialty mattress surface for the resident to minimize skin breakdown and to offload this area". 07/12/2010- "Patient is an elderly white female with a known history of advanced dementia, ... and essentially total care for activities of daily living (ADLs) and instrumental activities of daily living (IADLs)...". 07/14/2010- "Chief Complaint: Pressure Area. S(ubjective): Resident is frail and debilitated, cachectic, with wound on her sacrum...O(bjective): The wound is open...Heels are intact... P(lan): ...Keep resident turned and positioned...". 07/28/2010- "P(lan): She is on double shot protein q.i.d. (4 Times daily)...Heels are intact...Encourage turning and repositioning". 08/09/2010- "P(lan): ...Keep resident turned and repositioned". 08/30/2010- "P(lan):...Encourage turning and repositioning, although due to her frailty and debility would contribute greatly to poor wound healing. She is also very thin...". 09/29/2010- "Chief complaint: Pressure areas. S(ubjective): Resident was seen by this provider for follow up of a pressure area on her sacrum. She has developed other areas of skin compromise. O(bjective): ... On the left outer heel is a smaller wound that measures approximately .1 cm (centimeters) The wound is dark brown, purple coloration, with peeling edges. No open areas at this time...P(lan): Encourage turning and repositioning....She is already on double shot protein...". Review of the Care Plan for Resident #1 on 10/18/2010 at approximately 1:40 PM revealed page 13 of the Care Plan folded over. Written on the fold was "7/7/10 New Skin Integrity Care Plan Printed". On the folded page were approaches listed for the problem of being at risk for impaired skin integrity with the "Date(s)" listed as 10/13/2009, 01/04/2010, and 04/06/2010. The "Goal" was that "Resident's skin will be free from irritation and breakdown" with an evaluation date of 07/06/2010. The approaches listed included "Turn and reposition every 2 HRS (hours), Assess nutritional status, Keep skin dry and clean, Assess skin condition PER POLICY, float heels as ordered, ...". Further review of the Care Plan for Resident #1 revealed there was an entry dated 07/14/2010 that addressed the problem of being at risk for impaired skin integrity related to skin tears, but it did not include approaches to prevent or care for pressure ulcers. Continued review revealed "Problem Start Date: 07/07/10, Resident has a pressure ulcer Stage III to sacrum". The goal was listed as "Resident's ulcer will decrease in size and ulcer will not exhibit signs of infection...". The approaches listed included the following: "Use pads or briefs to maintain personal hygiene and dignity, Keep clean and dry as possible. Minimize skin exposure to moisture, Keep linens clean, dry, and wrinkle free. Conduct a skin inspection weekly, and daily per policy. Report any signs of any further skin breakdown. Assess pressure ulcer for location, stage, size (length, width, and depth), presence/absence of granulation tissue and epithelization, and condition of surrounding skin. Follow wound care nurse and provider's recommendations and orders related to dressing changes. Provide incontinence care after each incontinent episode." There was no mention of the Nurse Practitioner's recommendation to keep the resident turned and repositioned, that the resident used a specialty mattress, that Resident #1's heels were to be floated, or that the resident should be in her geri-chair with foam cushion for proper positioning while out of bed. During an interview on 10/18/2010 at 1:48 PM, one of the Minimum Data Set (MDS) Coordinators (Registered Nurse #1) reviewed the Care Plan and verified that the folded page was not included in the current Care Plan. She verified that there was not a "7/7/10 New Skin Integrity Care Plan" and that the current Care Plan did not address turning and repositioning the resident or floating the resident's heels. She stated that another MDS Coordinator had been responsible for updating Resident #1's Care Plan and that this nurse had just started in July. She stated she would look to see if there were any more pages that should have been included in Resident #1's Care Plan. Upon return, she did have some pages to add, but none related to skin breakdown or pressure ulcer care. 2014-02-01
10263 MAGNOLIA PLACE - GREENVILLE 425361 35 SOUTHPOINT DRIVE GREENVILLE SC 29607 2010-10-18 157 D     DFY111 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the complaint inspection, based on observation, record review, interview, and review of the policy provided by the facility entitled "Physician Communication Grid", the facility failed to notify the physician with changes related to pressure ulcers for 2 of 4 sampled residents reviewed with pressure ulcers. Residents #3 and #4 had pressure ulcers worsen without physician notification. The findings included: The facility admitted Resident #3 on 07/06/2010 with [DIAGNOSES REDACTED]. Record Review on 10/18/2010 revealed a Wound Treatment & Progress Record dated for September 2010. On the front was an order dated "9-15-10" that stated "Cleanse sacral area (with) wound cleanser, pack (with) calcium alginate & cover (with) adhesive foam dsg.(dressing), (Change) qd (daily) & PRN (When needed)". Under this was written "crush [MEDICATION NAME] 500 mg (milligrams) (1) tab(let) into wound on coccyx qd". On the back of the sheet were 3 entries. One of the entries, dated 09/22/2010 revealed that the wound had measured "Length 5.0, Width 8.0, depth 1.0, Undermining 3.9". On 9/29/10 the wound had increased in size to "Length 5.9, Width 8.0, Depth 1.6, and Undermining 4.1". Another Wound Treatment and Progress Record dated October 2010 revealed two entries, one dated for 10/07/2010 that stated the wound measured "Length 6.1, Width 8.0, Depth 1.5, Undermining 3.8"; and one dated 10/14/2010 that stated "Length 6.5, Width 8.0, Depth 1.5, Undermining 4.1". Review of the Physician/Nurse Practitioner Progress Notes revealed the last note in the chart was dated 09/06/2010 and did not mention the sacral wound. Review of Physician order [REDACTED]. Review of the Nurse's Notes for September and October 2010 revealed no mention that the Physician or Nurse Practitioner had been notified that the Pressure Ulcer had gotten bigger. During an interview on 10/18/2010 at 8:42 AM, the Wound Care Nurse (LPN #1) stated that the facility used a Nurse Practitioner (NP) as their wound consultant and that she looked at the wounds and changed the dressing orders. When asked how often the NP looked at the wounds, she stated that it depended on how long the resident had the wound, and it was usually once a month. She stated that if the wound had been acquired here at the facility, the NP looked at those more frequently and it was usually every other week. When asked where to find documentation of pressure ulcers, LPN #1 stated that the NP dictated a progress note and that she (the Wound Care Nurse) would document measurements on the treatment sheet. She stated she would also document anything going on or any changes in the Nurse's Notes. She stated that if she were off, the floor nurses document on the wounds. During an interview on 10/18/2010 at approximately 12:00 Noon, the Director of Nursing (DON) reviewed the wound measurements for September and October 2010 and verified the wound had increased in size from 09/22 to 09/29/2010. After reviewing the chart, she verified there were not any Physician/Nurse Practitioner Progress Notes that addressed the wound for the above referenced time periods. When asked about any other progress notes that may not have been in the chart, the DON asked another staff member to check, but was unable to provide any additional progress notes that indicated the Physician/Nurse Practitioner was aware of the worsening pressure ulcer. She stated that the nursing staff talks with the Nurse Practitioner/Physician when they come in twice a week, but they weren't aggressively treating the resident because she was on hospice. During an interview on 10/18/2010 at 4:15 PM, the Nurse Practitioner was asked about the resident's worsening pressure ulcer. She was given the measurements for the following dates and was told that the pressure ulcer had increased in size on 09/29/2010 and had continued to increase in size according to the documentation for 10/07/2010 and 10/14/2010. She was told that there had been no documentation of physician notification and when asked if she would have expected the nursing staff to call and notify her or the physician, she stated "yes". Review of the policy provided by the facility on 10/22/2010 entitled "Physician Communication Grid" revealed an entry for "Pressure Ulcers". Under the heading "Treatment Required within 4 Hours (If no response within 4 hours call medical director)" was listed "New Stage III or higher, any break in skin associated with fever or signs of infection". Under the heading "Routine Physician Notification" was "New Stage II or less". There was no mention of notification for enlargement of existing Pressure Ulcers. The facility initially admitted Resident #4 on 08/11/09 and readmitted him on 03/07/2010 with [DIAGNOSES REDACTED]. Record review on 10/18/2010 at 9:23 AM revealed a Nurse's Note dated 09/19/2010 that stated "Aide doing AM (Morning) care noticed open area to L(eft) heel. Came + got me. Open area bleeding slightly. No drainage noted. Cleansed (with) NS (Normal Saline) + dressed (with) safe gel foam pad + Kerlix. No C/O (complaints) of pain/discomfort voiced". Review of the Wound Treatment and Progress Record dated October 2010 revealed an order dated 09/19/2010. Under "Treatment" was written "Cleanse L(eft) heel (with) NS (Normal Saline) or wound cleanser, apply sm (all) amt (amount) wound gel (with) dry dsg (dressing). Secure (with) tape. May cover loosely (with) gauze, (Change) qd (daily) & PRN (When needed). On the back of the Wound Treatment and Progress Record were two entries. One entry dated 10/07/2010 documented the wound as being "Length 1.8, Width 2.4". The other entry was dated 10/14/2010 and documented "Length 4.6, Width 7.0". There were no other entries on the sheet. Observation of the dressing change to the left heel on 10/18/2010 revealed that the ulcer was located on the left lateral side of the left foot and went up the backside of the heel. The ulcer had some depth in the center of the wound along with a black discoloration along the top edge of the wound. According to the Treatment Nurse (LPN #1), she usually measured wounds once a week. When asked, she stated that she would normally measure any new areas of depth, but verified that she had not done so for the area on the resident's left heel. According to LPN #1, the Nurse Practitioner (NP) had not been informed about the new area of depth on the left heel. She stated that the NP would be there today and she would have the NP look at the wound. Review of the Physician/Prescriber Telephone Orders for October 2010 at approximately 9:00 AM revealed no orders related to the left heel ulcer. Further review of October's Nurse's Notes revealed no mention that the physician or Nurse Practitioner (NP) had been notified that the left heel ulcer had gotten worse. Review of the Physician/Nurse Practitioner Progress notes revealed a note dated 10/05/2010 that stated "...His areas have opened back up on both heels" and "Both heels have darkened skin with blisters and drainage, serous. Right seems larger than the left". There were no other Physician/Nurse Practitioner progress notes for October 2010 provided by the facility. During an interview on 10/18/2010 at 8:42 AM, the Wound Care Nurse (LPN #1) stated that the facility used a Nurse Practitioner (NP) as their wound consultant and that she looked at the wounds and changed the dressing orders. When asked how often the NP looked at the wounds, she stated that it depended on how long the resident had the wound, and it was usually once a month. She stated that if the wound had been acquired here at the facility, the NP looked at those more frequently and it was usually every other week. When asked where to find documentation of pressure ulcers, LPN #1 stated that the NP dictated a progress note and that she (the Wound Care Nurse) would document measurements on the treatment sheet. She stated she would also document anything going on or any changes in the Nurse's Notes. She stated that if she were off, the floor nurses document on the wounds. Review of the policy provided by the facility on 10/22/2010 entitled "Physician Communication Grid" revealed an entry for "Pressure Ulcers". Under the heading "Treatment Required within 4 Hours (If no response within 4 hours call medical director)" was listed "New Stage III or higher, any break in skin associated with fever or signs of infection". Under the heading "Routine Physician Notification" was "New Stage II or less". There was no mention of notification for enlargement of existing Pressure Ulcers. 2014-02-01
10264 MAGNOLIA PLACE - GREENVILLE 425361 35 SOUTHPOINT DRIVE GREENVILLE SC 29607 2010-10-18 514 E     DFY111 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the complaint inspection, based on record reviews, the facility failed to ensure that nursing staff initialed treatments when completed for 2 of 4 sampled residents reviewed for completeness and accuracy of clinical records. Residents #3 and #4 had blanks on their treatment record where the nurse failed to initial the treatment as having been completed. Review of the Narcotics Log and Medication Administration Records for the Blue Wing revealed inaccuracies in documentation of narcotic/hypnotic medication administration for Residents A, B, C, D, E, and F. The findings included: The facility initially admitted Resident #4 on 08/11/2009 and readmitted him on 03/07/2010 with [DIAGNOSES REDACTED]. Review of Wound Treatment and Progress Records for July, August, September, and October 2010 revealed the following blanks indicating that the nurse had not initialed the treatment as having been completed: -physician's orders [REDACTED]. (Change) qd (daily) & PRN (As needed)". Blank spaces were noted for 10/2, 10/3, 10/6, 10/8, 9/4, 9/6, 9/12, 9/13, 9/21, 8/1, 8/24, 8/25, 8/30, 8/31, 7/9, and 7/11/2010. -physician's orders [REDACTED]. Secure (with) tape. May cover loosely (with) gauze. (Change) qd and PRN". Blank spaces were noted for 10/6 and 9/21/2010. -physician's orders [REDACTED]. Wrap (with) Kerlix. (Change) qd & PRN". A blank space was noted for 10/01/2010. The Treatment Nurse on 10/18/2010 verified the blanks for September and October 2010. The facility admitted Resident #3 on 07/06/2010 with [DIAGNOSES REDACTED]. Review of Wound Treatment and Progress Records for August and October 2010 revealed the following blanks indicating that the nurse had not initialed the treatment as having been completed: -physician's orders [REDACTED]. (Change) qd & PRN". A blank space was noted for 10/06/2010. -physician's orders [REDACTED]. (Change) qd & PRN". Blank spaces were noted for 8/24 and 8/29/2010. The Director of Nursing on 10/18/2010 verified these blanks. Review of multiple Medication Flowsheets revealed that narcotic medications had been initialed as having been given when there was no documentation to corroborate this in the Narcotic and Hypnotic Record. There were also instances of medications being signed out on the Narcotic and Hypnotic Record, which were not documented on the Medication Flowsheet as having been given to the resident. The following documentation was reviewed and verified by Registered Nurse (RN) #2 on 10/17/2010. Review of Resident A's October 2010 Medication Flowsheet revealed an order dated 09/11/2010 that stated "[MEDICATION NAME] ([MEDICATION NAME])- Schedule IV Tablet; 0.5 mg; Amount to Administer: 1 tab; Oral PRN-As Needed (Q 4hrs PRN)". This was initialed on the front of the Medication Flowsheet as having been given on 10/10/2010 at 6:30 PM. On the back of the flowsheet, was an entry dated 10/10/10 that stated that [MEDICATION NAME] 0.5 mg had been given at 6:30 PM for agitation. However, the narcotic log documented that [MEDICATION NAME] 0.5 mg had only been signed out at 2 PM on 10/10/2010. There was nothing on the Medication Flowsheet to indicate the resident received any [MEDICATION NAME] at 2 PM. There was another separate entry that revealed that [MEDICATION NAME] 0.5 mg had been initialed as having been given on the Medication Flowsheet for 10/03/2010 at 9 PM, however, the Narcotic and Hypnotic Record did not have an entry for that date and time. Review of the Narcotic and Hypnotic Log for Resident A revealed "[MEDICATION NAME] 0.5 mg, Take 1 Tab by mouth every 4 hours as needed". Further review revealed that [MEDICATION NAME] 0.5 mg had been signed out on the log on 10/07/2010 at 9 AM and 10/15/2010 at 4:45 PM, however, there was no documentation on the Medication Flowsheet to show that the medication had been given at these times. Another order for Resident A, dated 09/21/2010, was listed on the Medication Flowsheet as "[MEDICATION NAME]-[MEDICATION NAME]- Schedule III, Tablet; 2.5-500 mg (milligrams) Amount to Administer: 1 tab (tablet); Oral TID- Three Times A Day". The scheduled times were listed as 9 AM, 1 PM, and 9 PM. Review of the Medication Flowsheet revealed initials in the 10/06/2010, 9 PM square. However, review of the Narcotic and Hypnotic Record revealed that the medication had not been signed out for that date and time. There was another order dated 9/13/10 that stated "[MEDICATION NAME]-[MEDICATION NAME]- Schedule III, Tablet; 2.5-500 mg (milligrams) Amount to Administer: 1 tab; Oral PRN-As Needed". Review of the Narcotic and Hypnotic Record revealed that the medication had been signed out on 10/03/2010 at 1700 but this had not been documented as having been given on the Medication Flowsheet. Review of Resident B's October 2010 Medication Flowsheet revealed an order for [REDACTED]. Review of the Narcotic and Hypnotic Record revealed that [MEDICATION NAME] 1 mg had been signed out on 10/11/2010 at 10 AM, 10/13/2010 at 9:30 AM, and on 10/16/2010 at 9 PM. However, there was no documentation on the Medication Flowsheet to show that the medication had been given at these times. Review of Resident C's October 2010 Medication Flowsheet revealed an order for [REDACTED]. Review of the Narcotic and Hypnotic Record for "[MEDICATION NAME] 10 mg Tablet SUB (Substitute) FOR: AMBIEN" revealed that the medication had been signed out on 10/16/2010 at 9 PM, however, the Medication Flowsheet was blank for that date and time. Review of Resident D's October 2010 Medication Flowsheet revealed an order for [REDACTED]. Review of the Narcotic and Hypnotic Record for the medication revealed [MEDICATION NAME] 0.5 mg had been signed out on 10/3/2010 at 9 PM, however, there was no documentation on the Medication Flowsheet to show that the medication had been given at this time. Review of Resident E's October 2010 Medication Flowsheet revealed an order for [REDACTED]. Review of the resident's Narcotic and Hypnotic Record for "[MEDICATION NAME](one) W(ith) APAP 7.5-500 mg Tablet, Take 1 Tab by mouth every 4-6 hours as needed" revealed that the medication had been signed out on 10/9/2010 at 9 PM and on 10/11/2010 at 9 PM. The Medication Flowsheet, however, was blank and did not document any [MEDICATION NAME] as having been given for these dates. Review of Resident F's October 2010 Medication Flowsheet revealed an order for [REDACTED]. Further review revealed another entry for "[MEDICATION NAME]-[MEDICATION NAME]- Schedule III Tablet; 10-500 mg; Amount to Administer: 1 tab; Oral PRN-As Needed (Q 6hrs PRN)". Review of the Narcotic and Hypnotic Record for the medication revealed that the medication had been signed out on 10/09/2010 at 8 AM, 1:30 PM, and 5 PM only. The Medication Flowsheet for the PRN Hydocodone-[MEDICATION NAME] was blank and did not indicate a 5 PM dose had been given on this date. The nurse had initialed the medication as having been given on the routine (Three Times Daily) entry for 10/09/2010 at 9 AM, 1 PM, and 9 PM; however, there was no 9 PM entry on the narcotic log. Further review revealed this same medication had been signed out on the narcotic log on 10/11/2010 at 9AM, 1 PM, 5 PM, and 9 PM; however, there was no documentation on the Medication Flowsheet that a PRN dose had been given at 5 PM. 2014-02-01
10265 MAGNOLIA PLACE - GREENVILLE 425361 35 SOUTHPOINT DRIVE GREENVILLE SC 29607 2010-10-18 314 D     DFY111 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the complaint inspection, based on observation, record review, interview, and review of the policy provided by the facility entitled "Physician Communication Grid", the facility failed to assess and address with the physician changes related to pressure ulcers for 2 of 4 sampled residents reviewed with pressure ulcers. Residents #3 and #4 had pressure ulcers worsen without physician notification. The findings included: The facility admitted Resident #3 on 07/06/2010 with [DIAGNOSES REDACTED]. Record Review on 10/18/2010 revealed a Wound Treatment & Progress Record dated for September 2010. On the front was an order dated "9-15-10" that stated "Cleanse sacral area (with) wound cleanser, pack (with) calcium alginate & cover (with) adhesive foam dsg.(dressing), (Change) qd (daily) & PRN (When needed)". Under this was written "crush [MEDICATION NAME] 500 mg (milligrams) (1) tab(let) into wound on coccyx qd". On the back of the sheet were 3 entries. One of the entries, dated 09/22/2010 revealed that the wound had measured "Length 5.0, Width 8.0, depth 1.0, Undermining 3.9". On 9/29/10 the wound had increased in size to "Length 5.9, Width 8.0, Depth 1.6, and Undermining 4.1". Another Wound Treatment and Progress Record dated October 2010 revealed two entries, one dated for 10/07/2010 that stated the wound measured "Length 6.1, Width 8.0, Depth 1.5, Undermining 3.8"; and one dated 10/14/2010 that stated "Length 6.5, Width 8.0, Depth 1.5, Undermining 4.1". Review of the Physician/Nurse Practitioner Progress Notes revealed the last note in the chart was dated 09/06/2010 and did not mention the sacral wound. Review of Physician order [REDACTED]. Review of the Nurse's Notes for September and October 2010 revealed no mention that the Physician or Nurse Practitioner had been notified that the Pressure Ulcer had gotten bigger. During an interview on 10/18/2010 at 8:42 AM, the Wound Care Nurse (LPN #1) stated that the facility used a Nurse Practitioner (NP) as their wound consultant and that she looked at the wounds and changed the dressing orders. When asked how often the NP looked at the wounds, she stated that it depended on how long the resident had the wound, and it was usually once a month. She stated that if the wound had been acquired here at the facility, the NP looked at those more frequently and it was usually every other week. When asked where to find documentation of pressure ulcers, LPN #1 stated that the NP dictated a progress note and that she (the Wound Care Nurse) would document measurements on the treatment sheet. She stated she would also document anything going on or any changes in the Nurse's Notes. She stated that if she were off, the floor nurses document on the wounds. During an interview on 10/18/2010 at approximately 12:00 Noon, the Director of Nursing (DON) reviewed the wound measurements for September and October 2010 and verified the wound had increased in size from 09/22 to 09/29/2010. After reviewing the chart, she verified there were not any Physician/Nurse Practitioner Progress Notes that addressed the wound for the above referenced time periods. When asked about any other progress notes that may not have been in the chart, the DON asked another staff member to check, but was unable to provide any additional progress notes that indicated the Physician/Nurse Practitioner was aware of the worsening pressure ulcer. She stated that the nursing staff talks with the Nurse Practitioner/Physician when they come in twice a week, but they weren't aggressively treating the resident because she was on hospice. During an interview on 10/18/2010 at 4:15 PM, the Nurse Practitioner was asked about the resident's worsening pressure ulcer. She was given the measurements for the following dates and was told that the pressure ulcer had increased in size on 09/29/2010 and had continued to increase in size according to the documentation for 10/07/2010 and 10/14/2010. She was told that there had been no documentation of physician notification and when asked if she would have expected the nursing staff to call and notify her or the physician, she stated "yes". Review of the policy provided by the facility on 10/22/2010 entitled "Physician Communication Grid" revealed an entry for "Pressure Ulcers". Under the heading "Treatment Required within 4 Hours (If no response within 4 hours call medical director)" was listed "New Stage III or higher, any break in skin associated with fever or signs of infection". Under the heading "Routine Physician Notification" was "New Stage II or less". There was no mention of notification for enlargement of existing Pressure Ulcers. The facility initially admitted Resident #4 on 08/11/09 and readmitted him on 03/07/2010 with [DIAGNOSES REDACTED]. Record review on 10/18/2010 at 9:23 AM revealed a Nurse's Note dated 09/19/2010 that stated "Aide doing AM (Morning) care noticed open area to L(eft) heel. Came + got me. Open area bleeding slightly. No drainage noted. Cleansed (with) NS (Normal Saline) + dressed (with) safe gel foam pad + Kerlix. No C/O (complaints) of pain/discomfort voiced". Review of the Wound Treatment and Progress Record dated October 2010 revealed an order dated 09/19/2010. Under "Treatment" was written "Cleanse L(eft) heel (with) NS (Normal Saline) or wound cleanser, apply sm (all) amt (amount) wound gel (with) dry dsg (dressing). Secure (with) tape. May cover loosely (with) gauze, (Change) qd (daily) & PRN (When needed). On the back of the Wound Treatment and Progress Record were two entries. One entry dated 10/07/2010 documented the wound as being "Length 1.8, Width 2.4". The other entry was dated 10/14/2010 and documented "Length 4.6, Width 7.0". There were no other entries on the sheet. Observation of the dressing change to the left heel on 10/18/2010 revealed that the ulcer was located on the left lateral side of the left foot and went up the backside of the heel. The ulcer had some depth in the center of the wound along with a black discoloration along the top edge of the wound. According to the Treatment Nurse (LPN #1), she usually measured wounds once a week. When asked, she stated that she would normally measure any new areas of depth, but verified that she had not done so for the area on the resident's left heel. According to LPN #1, the Nurse Practitioner (NP) had not been informed about the new area of depth on the left heel. She stated that the NP would be there today and she would have the NP look at the wound. Review of the Physician/Prescriber Telephone Orders for October 2010 at approximately 9:00 AM revealed no orders related to the left heel ulcer. Further review of October's Nurse's Notes revealed no mention that the physician or Nurse Practitioner (NP) had been notified that the left heel ulcer had gotten worse. Review of the Physician/Nurse Practitioner Progress notes revealed a note dated 10/05/2010 that stated "...His areas have opened back up on both heels" and "Both heels have darkened skin with blisters and drainage, serous. Right seems larger than the left". There were no other Physician/Nurse Practitioner progress notes for October 2010 provided by the facility. During an interview on 10/18/2010 at 8:42 AM, the Wound Care Nurse (LPN #1) stated that the facility used a Nurse Practitioner (NP) as their wound consultant and that she looked at the wounds and changed the dressing orders. When asked how often the NP looked at the wounds, she stated that it depended on how long the resident had the wound, and it was usually once a month. She stated that if the wound had been acquired here at the facility, the NP looked at those more frequently and it was usually every other week. When asked where to find documentation of pressure ulcers, LPN #1 stated that the NP dictated a progress note and that she (the Wound Care Nurse) would document measurements on the treatment sheet. She stated she would also document anything going on or any changes in the Nurse's Notes. She stated that if she were off, the floor nurses document on the wounds. Review of the policy provided by the facility on 10/22/2010 entitled "Physician Communication Grid" revealed an entry for "Pressure Ulcers". Under the heading "Treatment Required within 4 Hours (If no response within 4 hours call medical director)" was listed "New Stage III or higher, any break in skin associated with fever or signs of infection". Under the heading "Routine Physician Notification" was "New Stage II or less". There was no mention of notification for enlargement of existing Pressure Ulcers. 2014-02-01
10194 ELLEN SAGAR NURSING HOME 425012 1817 JONESVILLE HIGHWAY UNION SC 29379 2010-09-15 441 E     A4CW11 On the days of the survey, based on observation and interview, the facility failed to sanitize residents' personal laundry. The findings included: During observation on 9/14/10 at approximately 1:36 PM, Laundry Aid #1 loaded multiple residents' personal laundry into the washer and set the cleaning solution pump on "F1." The sign posted on the wall stated F1 solution was without bleach. During an interview at that time, the laundry aid stated she always used setting 1 for residents' personal clothes so they wouldn't be damaged. At 1:46 PM, during an interview, the Area Mechanic stated the water in the washer was between 115 and 120 degrees. He further stated the water used to be at 180 degrees but, after changing chemicals, they had been told the water temperature didn't need to be that high. At approximately 3:08 PM on 9/14/10, the Director of Environmental Services confirmed that the F1 setting did not include bleach and stated the (solution) pump should have been set on the F2 setting which added bleach after five minutes. Review of the detergent container did not reveal that the detergent contained any sanitizer. The Director of Environmental Services did not provide any additional information that the detergent had any bateriocidal properties. 2014-03-01
10195 ELLEN SAGAR NURSING HOME 425012 1817 JONESVILLE HIGHWAY UNION SC 29379 2010-09-15 333 D     A4CW11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on record review and interview, the facility failed to ensure that one of 20 residents reviewed for medication assessment was free of significant medication errors. Potassium was not administered as ordered to Resident #6 for a period of 5 days. The findings included: The facility admitted Resident #6 with [DIAGNOSES REDACTED]. Prognosis was "nil" at the time of admission. Record review on 9-14-10 at 1:55 PM revealed 7-19-10 physician's orders [REDACTED]. Review of the 7-19-10 Basic Metabolic Profile revealed the following results: Sodium = 130 LOW (reference 135-145 mmol/L); Potassium = 4.9 (reference 3.6-5.0 mmol/L); Chloride = 95 LOW (reference 101-111 mmol/L); Blood Urea Nitrogen = 52 HIGH (reference 6-20 mg/dl); Creatinine = 1.8 HIGH (reference 0.5-1.2 mg/dl). Review of the 7-10 Documentation Record (Medication Administration Record/MAR) revealed that the medication was held as ordered and that the [MEDICATION NAME] was resumed on 7-27-10. The Potassium (20 milliEquivalents daily) was not initialed on the MAR indicated [REDACTED]. During an interview on 9-15-10 at 9:40 AM, the Director of Nurses verified that the medication had not been initialed as given for the five day period as noted. She stated she had been unaware of the omissions, no medication error report had been completed, and the physician had not been notified. She reviewed the record and verified that no recent Potassium level had been drawn. 2014-03-01
10196 ELLEN SAGAR NURSING HOME 425012 1817 JONESVILLE HIGHWAY UNION SC 29379 2010-09-15 315 E     A4CW11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on observation, record review, interview, and review of the policy provided by the facility entitled "Skills Checklist for Suprapubic Catheter Care", the facility failed to ensure appropriate treatment and services for residents with catheters. The Certified Nursing Assistant (CNA) failed to properly anchor the suprapubic catheter tubing during catheter care for Resident #2, one of three residents observed with catheter care. Also, the facility failed to assess oral intake and urinary output as indicated by residents' medical condition for one of two sampled residents reviewed with an indwelling Foley catheter and Care Plan for intake and output monitoring. Resident #6, with a history of fluid imbalance and [MEDICAL CONDITION], had incomplete intake and output documentation. The findings included: The facility admitted Resident #2 on 10/22/09 with [DIAGNOSES REDACTED]. Observation of catheter care on 9/14/10 at 12:23 PM revealed CNA(Certified Nursing Assistant) #2 cleaning, rinsing, and drying the catheter tubing. She held the tubing between her index finger and thumb, approximately 4 inches from the insertion site, and anchored it to the resident's thigh while wiping down the tubing. The CNA cleansed from the insertion site distally toward where she held the catheter, causing undo tension on the catheter tubing. During an interview on 9/15/10 at 11:25 AM, CNA #2 verified she had anchored the catheter tubing at the resident's thigh instead of at the insertion site while performing catheter care. She stated she thought she was supposed to anchor the tubing to the thigh. Review of the policy entitled "Skills Checklist for Suprapubic Catheter Care" on 9/15/10 revealed "...6. Apply soap to one wet cloth, 7. Hold tubing (Without pulling) in other hand, 8. Wash around one side of tubing with soapy cloth-, 9. Using a different, clean part of cloth- wash around the other side of the Tubing, 10. Hold the tubing closest to the body to anchor it and prevent it from being pulled, 11. Using a different, clean part of cloth- wrap cloth around tubing (while holding with other hand) and wash tubing at least 4 inches away from body...14. Rinse one side of the insertion site ___/other side of tubing ___/the tube at least 4 inches___(while anchoring the tubing)___...16. Dry with clean cloth- one side of insertion site ___/other side of insertion site __/ around tubing and out 4 inches ___/ while anchoring tubing___." The facility admitted Resident #6 with [DIAGNOSES REDACTED]. Prognosis was "nil" at the time of admission. Record review on 9-14-10 at 1:55 PM revealed significant weight loss noted on both the 11-16-09 Admission and 7-22-10 Quarterly Minimum Data Set Assessments. Weight records revealed an admission weight of 242 pounds and a 7-10 weight of 129.3 pounds. Further review revealed stabilization after the most recent assessment. The resident was admitted with and continued to have an indwelling Foley catheter. During an interview on 9-15-10 at 9:40 AM, the Director of Nurses (DON) attributed the majority of the weight loss to a dramatic decrease in [MEDICAL CONDITION] after admission (related to the [DIAGNOSES REDACTED]. Review of the current Care Plan revealed approaches including monitoring for [MEDICAL CONDITION] and recording intake and output every shift. Review of Intake and Output (I&O) Records revealed that urinary output was inconsistently monitored. For the month of 7-10, 31 of 31 days had omissions of recorded output. For 8-10, 30 of 31 days were incomplete. 13 of 13 days were incomplete in 9-10, through the dates of the survey. There was no output recorded for 7-31-10 7AM-3PM shift through 8-1-10 11PM-7AM shift (6 consecutive shifts), from 8-28-10 7AM-3PM shift through 8-31-10 7AM-3PM shift (10 consecutive shifts), and from 8-31-10 11PM-7AM shift through 9-3-10 7AM-3PM shift (8 consecutive shifts). Review of the diet card on 9-14-10 at 12:05 PM indicated that the resident was on a 1500 ml (milliliter) fluid restriction. As the tray was delivered, Certified Nursing Assistant (CNA) #4 stated she would "go get the coffee" as per the resident's request. During an interview at this time, CNA #4 reviewed the diet card and stated that she thought the resident was on a fluid restriction. The CNA verified that the diet card noted and that the resident received only 5 ounces of soup and 1/2 cup of iced tea as fluids for that meal. CNA #4 also verified that the resident had a water-filled pitcher at the bedside. A water pitcher had also been observed at the residents bedside on 9-13-10 at 9:35 PM and on 9-14-10 at 10:15 AM. At 12:30 PM on 9-14-10, Licensed Practical Nurse (LPN) #2 verified that a resident on fluid restriction should not have a water pitcher at the bedside and that intake and output should be monitored. I&O records were reviewed and 23 of 31 days in 7-10, 27 of 31 days in 8-10, and 11 of 13 days in 9-10, through the dates of the survey, were recorded with intakes of greater than 1500 ml. No current physician's orders [REDACTED]. During an interview on 9-15-10 at 9:35 AM, LPN #5 verified that Resident #6 should have had her intake and output monitored every shift. She stated that nurses wrote this information on the daily assignment sheet. CNAs were to record the intake and output at the end of their shifts. The Ward Secretary was responsible to "get the I&O and record it" on the Intake and Output Records. During the interview on 9-15-10 at 9:40 AM, the DON confirmed that Resident #6 had not been on a fluid restriction "for quite some time...She was on a restriction when first admitted due to [MEDICAL CONDITION] (skin) all over her body..." The DON stated that the diet card had been corrected. She verified the Care Plan to monitor the intake and output and confirmed that the reports were incomplete. 2014-03-01
10197 ELLEN SAGAR NURSING HOME 425012 1817 JONESVILLE HIGHWAY UNION SC 29379 2010-09-15 332 D     A4CW11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on observations, record reviews, interviews and the Drug Facts and Comparisons book (updated monthly), the facility failed to ensure that it was free of medication error rates of five percent or greater. The medication error rate was 6.5 %. There were 3 errors out of 46 opportunities for error. The findings included: Error #1: On 9/13/10 at 8:36 PM, during observation of medication pass, Registered Nurse (RN) #5 was observed to administer two Klor-Con 10 (Potassium Chloride Extended Release) tablets and 7 other medications to Resident #10. During an interview on 9/13/10 at 8:48 PM, RN #5 revealed that supper trays arrived on the unit at about 6 PM and that Resident #10 had eaten in his room (approximately 2 and one-half hours before the potassium was administered). The Drug Facts and Comparisons book, page 49 (Potassium Replacement Products), states (under "Patient Information"): "May cause GI (gastro-intestinal) upset; take after meals or with food and with a full glass of water." Error #2: On 9/13/10 at 9 PM, during observation of medication pass, RN #2 was observed to administer one drop of [MEDICATION NAME] Ophthalmic Solution and one drop of [MEDICATION NAME] Ophthalmic Solution to the right eye of Resident A with one minute and 56 seconds between the two drops. RN #2 then administered one drop of the same two eye drops to the resident's left eye with 2 minutes and 4 seconds between the 2 drops. The Drug Facts and Comparisons book, page 1725, states (under "General Considerations in Topical Ophthalmic Drug Therapy"): "Because of rapid lacrimal drainage and limited eye capacity, if multiple drop therapy is indicated, the best interval between drops is 5 minutes. This ensures that the first drop is not flushed away by the second or that the second drop is not diluted by the first.". Error #3: On 9/14/10 at 7:47 AM, during observation of medication pass, RN #1 was observed to instill one drop of [MEDICATION NAME] Ophthalmic Suspension into each eye of Resident B without shaking the bottle before instillation. The Drug Facts and Comparisons book, page 1725, states (under "General Considerations in Topical Ophthalmic Drug Therapy"): "Resuspend suspensions (notably, many ocular steroids) by shaking to provide an accurate dosage of drug.". During an interview on 9/14/10 at 9:53 AM, RN #1 confirmed she did not shake the [MEDICATION NAME] Ophthalmic Suspension before instillation into the resident's eyes. Observation of the [MEDICATION NAME] Ophthalmic Suspension bottle revealed that there was no auxiliary "Shake Well" label attached to the bottle. During an interview on 9/14/10 at 10:43 AM, the facility's Consultant Pharmacist stated that she doesn't supply medications to the facility but agreed that there should be a "Shake Well" auxiliary label attached to the [MEDICATION NAME] bottle. 2014-03-01
10198 ELLEN SAGAR NURSING HOME 425012 1817 JONESVILLE HIGHWAY UNION SC 29379 2010-09-15 225 D     A4CW11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on record review, interview, and review of the policy provided by the facility entitled "Alleged Violations of Mistreatment, Neglect and Abuse Including Injuries of Unknown Origin and Misappropriation of Property" dated 2/09, the facility failed to complete a thorough investigation for one of one reportable incidents reviewed for misappropriation of funds. The findings included: One of three reportable incidents reviewed on 9/15/10 revealed that a resident reported $44.00 missing from his room on 9/7/10. According to the DHEC (Department of Health and Environmental Control) Five-Day Follow-Up Report dated 9/13/10, "He had noticed this the week prior to the report". Under "Witnesses and other Staff on duty at time of/or prior to Reportable Incident:", there was nothing written. According to the report, the missing money had been reported by the facility to the Union County Sheriff's Office on 9/8/10. The "Summary Report of Facility Investigation:" stated "(Resident) keeps various items in the basket where he reported the money had been stored. (Numerous pieces of mail, straws, playing cards, and various other items). He has been reminded again to lock up any large amounts of money." Attached to the Five-Day Follow-Up Report was a letter dated May 4, 2010 from the Administrator addressed to residents and their families reminding them that the facility could store valuables and that residents are encouraged to not keep any items of personal or monetary value in their room. The letter went on to state that "The facility will take every precaution to protect belongings but cannot be accountable for valuables left in resident rooms". There were no resident or staff statements attached or evidence of a thorough investigation being completed. During an interview on 9/15/10 at approximately 12:30 PM, the Social Services Director (SSD) stated the resident had a history of [REDACTED]. After reviewing the Five-Day Follow-Up Report, she verified there were no resident or staff statements included. When asked if she had asked any of the staff about the missing money, she said "We felt like, they know to report. We thought it would be ineffective to ask each one." She went on to state that they had thought it best if the Sheriff's Department handled it. The SSD stated staff receive inservices on misappropriation. She then stated they did ask staff present at the time of the report if anyone knew about missing money, however, they did not get any statements and did not check to see which staff may have been on duty at the time of the alleged incident. The SSD had questions about where to draw the line as far as who to interview during an investigation. Review of the policy entitled "Alleged Violations of Mistreatment, Neglect and Abuse Including Injuries of Unknown Origin and Misappropriation of Property" on 9/15/10 revealed "Investigation procedures for allegations of misappropriation of resident property are as follows: ...The individual assigned to conduct the investigation will conduct a thorough investigation of the allegation. Areas/items that may be included as appropriate in the investigation include: a. An interview with the person reporting the missing items, b. A search of the resident's room for the missing items, c. an interview with the resident, as medically appropriate, e. An interview with the alleged individual accused of taking the residents' property, if known, f. Interviews with staff members, g. Interviews with the resident's roommate, family members, and visitors as appropriate...". 2014-03-01
10199 ELLEN SAGAR NURSING HOME 425012 1817 JONESVILLE HIGHWAY UNION SC 29379 2010-09-15 323 D     A4CW11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey based on observations, record reviews, and interviews, the facility failed to ensure that the resident environment remained free of accident hazards as was possible and that each resident received assistance devices to prevent accidents. Random observations were made of unattended paint thinner accessible to cognitively impaired, mobile residents and of bottles of Hydrogen Peroxide (H2O2) stored unsecured in Resident #3's bathroom. The facility also failed to provide interventions as required to minimize injury for one (1 )of 6 sampled residents reviewed for falls. Resident # 6 who was assessed at high risk for falls did not have a low bed and mats provided as per the plan of care. The findings included: On 9/14/10 at 10:50 AM a random observation was made by two surveyors on Unit 1 Maple Lane in the patient shower area of an unattended 1 gallon container of Paint Thinner on the window sill and 2 paint cans without covers containing paint thinner, soaked brushes, and rags soaked in paint thinner. There was a strong odor of the chemical in the shower area and in the Maple Lane Hall. The label on the Paint Thinner read, "DANGER: COMBUSTIBLE LIQUID, FLAMMABLE--HARMFUL OR FATAL IF SWALLOWED". The Material Safety Data Sheet (MSDS) provided by the Administrator on 9/14/10 read : "RISK STATEMENTS-Irritating to eyes, respiratory system, and skin. Harmful by inhalation, may cause lung damage if swallowed. Harmful in contact with skin. Vapors may cause drowsiness and dizziness". SAFETY STATEMENTS on the MSDS read: "Avoid contact with skin and eyes, Keep container tightly closed. Do not breathe gas, fumes, vapor, or spray, Keep away from sources of ignition. Take precautionary measures against static discharges." HANDLING AND STORAGE SECTIONS of the MSDS stated, "STORAGE : Vapors may ignite explosively and spread long distances. Prevent vapor build up. Keep cool and keep in the dark. Do not store above 49 C/120 F(Fahrenheit). Keep container lightly closed and upright when not in use to prevent leakage." "HANDLING: Use only with adequate ventilation. Avoid breathing of vapor of spray mist. Avoid contact with skin and eyes. Wear OSHA standard goggle or face shield. Wear gloves, apron, and footwear impervious to this material. Wash clothing before reuse. Avoid free fall of liquid. Empty container very hazardous!" Residents in nearby rooms #17 and #15 were using oxygen at the time of the random observation and a fan was blowing in the hall by the shower room with the observed Paint Thinner. In an interview on 9/14/10 at 11:00 AM with the Administrator and Environmental Services Manager they recognized the paint thinner as a hazardous chemical and removed if from the premises promptly. The Administrator stated they had contracted painters to repaint the facility halls and the Paint Thinner was left by the painters who were currently using the product. He stated that he had informed them prior to the start of the painting of the halls to remove unattended hazardous chemicals while painting the facility. He did not have a formal, written contract with the paint company, or evidence of this instruction. Following completion of tracheal suctioning and care on 9-14-10, Registered Nurse (RN) #1 removed the two-tiered wired basket cart containing all tracheostomy suctioning and care supplies from Resident #3's room. She stated that it was routinely stored in the resident's bathroom. The cart contained two 16 ounce bottles of Hydrogen Peroxide which were labeled, "Harmful if swallowed. Keep out of the reach of children." On 9-15-10 at 10:45 AM, Licensed Practical Nurse (LPN) #4, while preparing to perform tracheostomy care for Resident #3, stated that she had obtained the cart containing the H2O2 and other supplies from the unlocked resident bathroom. The facility admitted Resident #6 with [DIAGNOSES REDACTED]. Record review on 9-14-10 at 1:55 PM revealed that resident was assessed at high risk for falls on the most recent Fall Risk Assessment completed on 7-20-10. The 7-22-10 Care Plan noted that the resident was to have a "Low bed with mats". The 7-22-10 Quarterly Minimum Data Set Assessment noted the resident with both short- and long-term memory problems and varying mental function. On 9-13-10 at 9:35 PM, the resident was observed in a low bed, but without mats in place. The resident was observed in a regular height bed without mats on 9-14-10 at 9 AM, 10:15 AM, 12:05 PM, 1:30 PM, and 3:50 PM. During an interview on 9-14-10 at 4 PM, Certified Nursing Assistant (CNA) #1 stated that she did not know how long the resident had not had the low bed/mats. She was aware that the resident was supposed to have them "because it's on the Basic Care Sheet (CNA Care Plan)." During an interview on 9-14-10 at 3:50 PM, RN #2 checked the Documentation Record and verified that it indicated that the resident was to have a low bed with mats. The form noted "FYI" next to the intervention which RN #2 stated meant that the nurse was to check to assure the item was in place. She went to the resident's room and verified that the resident was in a regular height bed without mats. The nurse was unable to lower the bed and was unable to locate mats in the room for the resident. 2014-03-01
10200 ELLEN SAGAR NURSING HOME 425012 1817 JONESVILLE HIGHWAY UNION SC 29379 2010-09-15 309 E     A4CW11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on observations, interviews and record review, the facility failed to follow physician's orders for application of Knee High TED (antiembolism stockings) Hose for Resident # 11, 1 of 4 residents reviewed with orders for TED Hose. The facility also failed to include provision of Services from a Chaplain and Social Services in the care plan and no documentation of visits from these disciplines were found in the record for Resident #18, 1 of 2 resident's reviewed receiving Hospice Services . The findings included: The facility admitted Resident #11 on 4/26/04 with [DIAGNOSES REDACTED]. Record Review on 9/14/10 at approximately 6:15 PM revealed a Physician's Order for "Knee high TED hose on in the morning before getting out of bed & (and) remove at bedtime ([MEDICAL CONDITION])" with a start date of 9/16/08. Observation of the resident at 6:25 PM on 9/14/10 revealed the resident was not wearing TED Hose. During an interview on 9/15/10 at 1:15 PM, the resident stated she had never had any stockings and that she did have swelling in her feet "sometimes." Review of the resident's Minimal Data Set revealed the resident was coded as not having any short or long term memory problems. The resident was named on the list provided by the facility of Interviewable Residents and she was a member of the Resident Council. Record Review on 9/15/10 at approximately 1:30 PM revealed that the TED Hose had been signed off daily for August and September, including being signed off for being applied the morning of 9/15/10. During an interview on 9/15/10 at approximately 2:15 PM, Registered Nurse (RN) #4 stated she had just received a new pair of TED Hose for the resident the previous week. Upon observation of the resident, RN #4 confirmed the resident was not wearing TED Hose. RN #4 was unable to locate any TED Hose in the resident's drawers. When informed of the resident's statement that she had never had any stockings, RN #4 stated: "She's usually pretty with it." During an interview on 9/15/10 at approximately 2:45 PM, Physical Therapy Assistant #1 stated Resident #11 was being seen 3 times per week by Physical Therapy and the treatment included leg exercises. She further stated that she had not observed the resident wearing TED Hose for at least the last month. The facility admitted Resident #18 on 7/6/10 with [DIAGNOSES REDACTED]. She was placed on Hospice Services on 7/30/10 for [DIAGNOSES REDACTED]. Review of Resident #18's record on 9/15/10, revealed no documentation of Chaplain or Social Service visits since the resident was admitted to Hospice. Review of the resident's facility and Hospice care plans revealed no care plan for Chaplain or Social Services. During an interview with RN #4 at approximately 12:00 PM, she stated she knew of no other place there would be any documentation from the Hospice staff other than in the chart. At approximately 12:30 PM on 9/15/10, the Director of Nursing stated she had spoken to the Hospice provider in the past regarding keeping information in the residents' charts in the facility and not just in the Hospice office. She stated the Director of Social Services might know if there was any documentation located anywhere else. During an interview on 9/15/10 at 1:22 PM, the Social Services Director stated she did not know of any documentation other than what was located in the chart and confirmed there was no documentation in the record of Chaplain or Social Service visits. Review of the Hospice Contract revealed the Hospice Provider was responsible for providing medical social services and counseling services (including bereavement,...and spiritual counseling.) It further stated that "Hospice shall furnish Nursing Facility with a copy of the Hospice Plan of Care" and any modifications to the plan of care. 2014-03-01
10201 ELLEN SAGAR NURSING HOME 425012 1817 JONESVILLE HIGHWAY UNION SC 29379 2010-09-15 322 D     A4CW11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on observation, interviews, and review of the facility's policies entitled "Gastrostomy Tube Check List" and "Procedure for Cleaning 60 cc (cubic centimeters) Syringes Used for Resident Feeding", the facility failed to utilize universal precautions and clean technique when flushing the Gastrostomy (G-) Tube and when cleaning and storing the piston syringes and gravity set for 2 of 3 residents observed for Gastrostomy Tube flushes. The findings included: The facility admitted Resident #5 on 7/17/09 with [DIAGNOSES REDACTED]. On 9/14/10 at approximately 12:33 PM, Licensed Practical Nurse (LPN) #6 was observed by two surveyors providing a Gastrostomy Tube flush before and after medication administration without washing her hands prior to initiating the procedure. LPN #6 opened the Medication cart, retrieved a bottle of liquid Tylenol from the drawer and poured 20 milliliters (ml) of Tylenol into a medication cup. LPN #6 proceeded to the resident's room, knocked, entered the room and filled the 2 empty medicine cups with 30 ml of water from the sink and placed all 3 medicine cups on the over-bed table. She then closed the door, opened a plastic bag and placed it on the foot of the bed and donned a pair of non-sterile gloves. LPN #6 proceeded to check for and replace residual, checked for placement of the [DEVICE], and administered the 30 ml flush, the medication and ended with another 30 ml flush. Upon completion of the procedure, the piston syringe was rinsed and placed wet, back into the bag. Review of the "Gastrostomy Tube Check List" provided by the facility on 9-14-10 revealed "2. Placement check: Check placement before flushes,...Gather supplies..., Explain procedure to Resident, Provide Privacy, Wash Hands, (apply) Non-sterile gloves, ..." The facility admitted Resident #3 on 4-8-01 with [DIAGNOSES REDACTED]. Prior to observation of a Gastrostomy (G-) feeding and flush on 9-14-10 beginning at 9:55 AM, two Certified Nursing Assistants exited the resident's room after completing AM care, including incontinent care. Registered Nurse (RN) #1 proceeded to prepare the resident for a gravity feeding. She checked placement using a 60 cc (cubic centimeter) piston syringe and then infused 30 cc of water via gravity through the barrel of the syringe. The RN then connected the gravity feeding tubing to the [DEVICE] and set the clamp so as to infuse it slowly. She then took apart the piston syringe and placed it in the sink. She removed the gloves she had used during the procedure, rinsed the syringe with water, placed the piston in the barrel of the syringe, and stored it together, wet, in its original packaging. At 10:30 AM, RN #1 disconnected the gravity feeding set and hung the capped tubing on the feeding pole. She neglected to rinse out the feeding set, allowing feeding to remain in the tubing and bottom of the bag. When asked if this was how the set was stored until the next feeding, the RN replied, "Yes." The nurse completed the water flush via gravity using the barrel of the feeding syringe. After completing the procedure, RN #1 again placed the piston and barrel of the feeding syringe into the sink. She removed the gloves she had used during the procedure, rinsed the syringe with water, placed the piston in the barrel of the syringe, and stored it together, wet, in its original packaging. RN #1 verified that this was the procedure she always followed. During an interview on 9-15-10 at 10 AM, the Director of Nurses stated that the facility policy did not address handling of the piston syringe or gravity feeding set. She stated that the syringe should not have been placed in the sink and that the feeding should have been rinsed out of the gravity set and not allowed to remain until the next feeding time. On 9-15-10 at 1 PM, RN #1 verified the procedure as above noted. During an interview on 9-15-10 at 12:05 PM, the Administrator stated there was no evidence on file that RN #1 had been trained on the proper procedure for [DEVICE] feeding/flush. Review of the facility's policy entitled "Gastrostomy Tube Checklist" on 9-15-10 revealed no reference to cleansing or storage of the piston syringe or gravity feeding set. Review of the Infection Control Manual on 9-15-10 revealed a policy entitled "Procedure for Cleaning 60 cc Syringes Used for Resident Feeding" which stated: "...3. The syringe is washed and cleaned thoroughly with dispenser soap and water and rinsed well in hot water subsequent to use. Be sure not to place the syringe in the sink. 4. The syringe is stored separate (barrel and syringe) on a clean paper towel and covered with a clean towel and allowed to air dry...7. Syringes used for tube feeding are cared for in the same manner as described above..." 2014-03-01
10202 ELLEN SAGAR NURSING HOME 425012 1817 JONESVILLE HIGHWAY UNION SC 29379 2010-09-15 328 D     A4CW11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on observation, record review and interviews, the facility failed to follow the Physician's Orders for the administration of oxygen for 1 of 4 sampled residents reviewed with oxygen. Resident # 18 oxygen rate was observed above the stated physician's order. The findings included: The facility admitted Resident #18 on 7/6/10 with [DIAGNOSES REDACTED]. She was placed on Hospice Services on 7/30/10 for [DIAGNOSES REDACTED]. Review of the record on 9/15/10 at approximately 11:00 AM revealed a Physician's order for O2 (oxygen) at 2 liter per minute (lpm) via NC (nasal cannula.) Review of the Hospice Nursing Visit Note revealed the Hospice nurse had documented the oxygen at 3 lpm via NC on 9/15/10, 9/8/10 and on 8/23/10. Review of the Documentation Record (MAR) revealed facility nursing staff was signing off the O2 at 2 lpm via NC each shift including the days of the survey. Observation on 9/15/10 at approximately 11:30 revealed the oxygen was flowing at approximately 3 1/2 lpm via NC. At approximately 1:00 PM on 9/15/10, Registered Nurse (RN) # 4, verified the oxygen was flowing at 3 1/2 lpm via NC. Upon questioning, she stated "I'd have to check the MAR (Documentation Record) but I'm pretty sure it's supposed to be at 2 (lpm)." RN #4 also reviewed the record and confirmed the Physician's Orders and the MAR indicated and could not locate any new order to increase the flow rate. During an interview on 9/15/10 at 2:28 PM, the Hospice Nurse stated the oxygen was supposed to be at 2 lpm and had been since admission to Hospice. She stated she thought the oxygen flow rate had inadvertently been changed on 9/15/10 when the Certified Nursing Assistant had reached to turn the oxygen back on after the resident's AM care had been completed. She stated the 3 lpm documented on the Nursing Visit Note for 9/15/10 had been a documentation error only. The Hospice Nurse later changed the documentation on the 9/8/10 Nursing Visit Note from 3 lpm to 2 lpm and did not date the change. 2014-03-01
10203 ELLEN SAGAR NURSING HOME 425012 1817 JONESVILLE HIGHWAY UNION SC 29379 2010-09-15 468 E     A4CW11 On the days of the survey, based on observation and interview, the facility failed to equip multiples areas in the corridors with handrails. The findings included: On 9/15/10 at approximately 1:55 PM, multiple areas leading into or on corridors were observed without handrails affixed to the walls. Areas included, but were not limited to: -an area approximately 3 1/2 feet at the entrance to Rocky Road Hall on the left and right sides of the hall -an area approximately 3 1/2 feet at the entrance to Rainbow Row Hall on the right side of the hall -approximately 5 feet across from the Unit I Nurses Station -a section approximately 8 feet long in a corridor behind the Unit I Nurses Station -the entire length of the corridor connecting Unit I and Unit II on both sides of the hallway -two 5 foot sections and two 3 1/2 foot sections on Unit II at the Nurses Station and several other areas leading into the 3 halls from the nurses station. During an interview on 9/14/10 at approximately 4:15 PM, the Maintenance Director verified multiple areas were without handrails and stated that the corridor between Units I and II had never had handrails as far as he knew. He also stated that the area behind the Unit I Nurses Station "looks like there used to be one there." 2014-03-01
10204 FELLOWSHIP HEALTH & REHAB OF ANDERSON, LLC 425016 208 JAMES STREET ANDERSON SC 29625 2010-11-08 323 G     CCT011 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the day of the inspection based on record review, interviews, review of the facility's policy on Falls, and review of the facility's inservices, the facility failed to assure each resident was free of accidents as was possible for 1 of 6 sampled residents. Resident #1 sustained 3 falls in 3 days without new interventions implemented. Resident #1 fell on ,[DATE], 7/30 (sustained injuries to the face and mouth) and on 8/1/2010, no interventions were implemented until 8/2/2010. The findings included: The facility admitted Resident #1 on 6/29/2010. [DIAGNOSES REDACTED]. Review of the medical record revealed the Initial Minimum Data Set ((MDS) dated [DATE] coded Resident #1 as having a short-term and long-term memory problem with moderately impaired cognitive skills for daily decision-making. The MDS coded the resident as needing extensive 1 person assistance with transfers and bed mobility and completely dependent for locomotion on and off the unit. Resident #1 was also coded as dependent for eating, dressing, hygiene, and bathing with no behaviors coded as occurring during the assessment period. The resident was coded as receiving Hospice services. Resident #1 was not coded as having any accidents within 180 days. Review of the Nurses' Progress Notes dated 7/29/2010 at 12:30 PM indicated Resident #1 "fell forward out of wheelchair and hit his R(ight) forehead. He reports no pain and no sign of injury." A Nurses' Note dated 7/30/2010 at 5 PM documented that Resident #1 was "observed on floor laying on L(eft) side of body with blood on floor (small amount) from nose and mouth. Resident helped off the floor and into bed and pressure to nose applied. Writer took out bottom and top dentures and noted a small piece of the palate of the denture was broke off and a few small cuts on top of gums..." Further review revealed an entry dated 8/1/2010 at 6 AM, "slid off of the bed on to floor, Resident observed sitting on floor with back against bed." On 8/2/2010 at 11 AM, the nurses' note indicated an order was obtained for a bed alarm and 1/2 lap tray. Review of the care plan revealed a risk for injury (falls) related to weakness, history of syncope, dementia and seizures was identified as a problem area. Interventions and approaches to this problem area were documented on the care plan and included "observe frequently, call light within reach..., provide assistive devices for mobility, provide assistance with mobility, review circumstances of how falls occur to try to eliminate further falls, keep floor/pathway free of debris, notify MD/hospice PRN (as needed)." The care plan was updated on 7/29/2010 with a handwritten note to "observe res(ident) frequently when up." The care plan was not updated with the 7/30/2010 fall nor the 8/1/2010 fall. On 8/2/2010 the bed alarm was written on the care plan, however the lap tray was not added. The care plan did not include new or appropriate interventions to prevent Resident #1 from falling after he sustained several falls on 7/29/2010, 7/30/2010 and 8/1/2010. Review of the MD Progress Notes dated 8/2/2010 indicated that Resident #1 was assessed by the physician, however there was no documentation relevant to the falls on 7/29, 7/30 or 8/1/2010. Review of the physician's orders [REDACTED]. No other orders were written related to the falls on 7/29, 7/30 or 8/1/2010. Review of the Medication Administration Record (MAR) revealed that the bed alarm and lap tray were added on 8/2/2010 and then signed for each shift. Review of the Nursing Admission Screen dated 6/29/2010 revealed that Resident #1 scored a "12" on the Fall Risk Screen, indicating he was at "high risk" for falls. Resident #1 had another Fall Risk Screen completed on 7/7/2010 scoring a "12", indicating he was still at high risk for falls. The interventions listed were "staff observes freq(uently), no hx (history) of falls." Review of the incident reports related to each fall revealed: On 7/29/2010 at 12:00 PM, Resident #1 was in the hallway with he "tipped forward out of wheelchair, caught himself with his arms and his R(ight) forehead the floor. No injuries or report of pain. Hospice nurse notified." "Steps taken to prevent recurrence: 1/2 lap tray for w/c (wheelchair) on 8/2/2010." An incident report dated 7/30/2010 at 5 PM, indicated the "resident was observed lying on L(eft) side of body with blood on floor (small amount) from nose and mouth. Resident helped off the floor and into bed and pressure to nose applied. Writer took out bottom and top dentures and noted a small piece of the palate of the denture was broke off and a few small cuts on top of gums..." "Steps taken to prevent recurrence: bed alarm ordered on [DATE]." An incident report dated 8/1/2010 at 6 AM revealed Resident #1 was "trying to get up and slid off of the bed. Resident observed sitting on floor with back resting against bed...no injury observed." "Steps taken to prevent recurrence: bed alarm ordered on [DATE]." During an interview on 11/8/2010 at 10:00 AM, CNA (Certified Nursing Assistant) stated #1 that she routinely cared for Resident #1. CNA #1 stated that she witnessed the resident fall on 7/29/2010. She further stated that she knew he had a bed alarm and 1/2 lap tray put in place but was unsure as to when they were placed. During an interview on 11/8/2010 at 10:15 AM, LPN Supervisor (Licensed Practical Nurse) #1 stated she was present for Resident #1's fall on 7/30/2010. She stated that she assessed the resident after the fall and filled out the incident report. She stated that Resident #1's dentures were broken and he was bleeding from his gums. She stated that she did not implement an intervention to prevent further falls and stated that she thought it "was ok to wait on the DHS." She stated that it was routine practice to wait for the DHS to implement a new fall prevention intervention. LPN #1 confirmed there was a delay in implementing appropriate fall prevention devices. During an interview on 11/8/2010 at 10:30 AM, LPN #2 stated that she was present for Resident #1's fall on 8/1/2010. She stated that she was aware of his previous two falls and stated that the resident did not have any fall prevention devices in place. LPN #2 stated that she found the resident on the floor in his room. She further revealed that the intervention she implemented was to "observe frequently." LPN #2 confirmed that this was not a new intervention. LPN #2 confirmed that there was a delay in implementing appropriate fall prevention devices. During an interview on 11/8/2010 at 11:30 AM, RN (Registered Nurse) #1 stated that she was present for Resident #1's fall on 7/29/2010. RN #1 stated that he was in orientation at the time of the fall. She further stated that she did not know that she was supposed to implement intervention after each fall to prevent further falls from occurring. RN #1 confirmed there were no interventions put in place after the fall and confirmed that there was a delay in implementing appropriate interventions. During an interview on 11/8/2010 at 12 PM, the Medical Director stated that when a resident falls he would expect the staff to assess the resident, notify him via phone or fax, execute routine procedure (i.e. vital signs, incident reports etc.). The Medical Director then stated that Resident #1 should have had an intervention put in place after he sustained the fall on 7/30/2010 that resulted in injuries to the face. The Medical Director also stated that the intervention should have been implemented immediately and not waited. During an interview on 11/8/2010 at 8:50 AM, the DHS stated that nursing should have implemented an intervention immediately after Resident #1's falls on 7/29, 7/30 and 8/1/2010. The DHS further stated that staff was waiting on her to implement interventions and she stated that she was aware that this practice was not appropriate. The DHS also indicated that the care plan coordinator was to update the care plans with each fall and add interventions. The DHS stated that she was first made aware of the concern related to untimely interventions related to falls when she reviewed Resident #1's record at the end of September 2010. The DHS confirmed there was a delay in implementing Resident #1's fall prevention interventions. . 2014-03-01
10205 FELLOWSHIP HEALTH & REHAB OF ANDERSON, LLC 425016 208 JAMES STREET ANDERSON SC 29625 2010-11-08 280 G     CCT011 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the day of the inspection based on record reviews and interviews, the facility failed to assure 1 of 6 resident's care plans were reviewed and revised appropriately. Resident #1's care plan was not reviewed and revised with each fall. The findings included: The facility admitted Resident #1 on 6/29/2010. [DIAGNOSES REDACTED]. Review of the Nurses' Progress Notes dated 7/29/2010 at 12:30 PM indicated Resident #1 "fell forward out of wheelchair and hit his R(ight) forehead. He reports no pain and no sign of injury." A Nurses' Note dated 7/30/2010 at 5 PM documented that Resident #1 was "observed on floor laying on L(eft) side of body with blood on floor (small amount) from nose and mouth. Resident helped off the floor and into bed and pressure to nose applied. Writer took out bottom and top dentures and noted a small piece of the palate of the denture was broke off and a few small cuts on top of gums..." Further review revealed an entry dated 8/1/2010 at 6 AM, "slid off of the bed on to floor, Resident observed sitting on floor with back against bed." On 8/2/2010 at 11 AM, the nurses' note indicated an order was obtained for a bed alarm and 1/2 lap tray. Review of the care plan revealed a risk for injury (falls) related to weakness, history of [MEDICAL CONDITION], dementia and [MEDICAL CONDITION] was identified as a problem area. Interventions and approaches to this problem area were documented on the care plan and included "observe frequently, call light within reach..., provide assistive devices for mobility, provide assistance with mobility, review circumstances of how falls occur to try to eliminate further falls, keep floor/pathway free of debris, notify MD/hospice PRN (as needed)." The care plan was updated on 7/29/2010 with a handwritten note to "observe res(ident) frequently when up." The care plan was not updated with the 7/30/2010 fall or the 8/1/2010 fall. On 8/2/2010 the bed alarm was written on the care plan, however the lap tray was not added. The care plan did not include new or appropriate interventions to prevent Resident #1 from falling after he sustained several falls on 7/29/2010, 7/30/2010 and 8/1/2010. Review of the incident reports related to each fall revealed: On 7/29/2010 at 12:00 PM, Resident #1 was in the hallway with he "tipped forward out of wheelchair, caught himself with his arms and his R(ight) forehead the floor. No injuries or report of pain. Hospice nurse notified." "Steps taken to prevent recurrence: 1/2 lap tray for w/c (wheelchair) on 8/2/2010." An incident report dated 7/30/2010 at 5 PM, indicated the "resident was observed lying on L(eft) side of body with blood on floor (small amount) from nose and mouth. Resident helped off the floor and into bed and pressure to nose applied. Writer took out bottom and top dentures and noted a small piece of the palate of the denture was broke off and a few small cuts on top of gums..." "Steps taken to prevent recurrence: bed alarm ordered on [DATE]." An incident report dated 8/1/2010 at 6 AM revealed Resident #1 was "trying to get up and slid off of the bed. Resident observed sitting on floor with back resting against bed...no injury observed." "Steps taken to prevent recurrence: bed alarm ordered on [DATE]." During an interview on 11/8/2010 at 8:50 AM, the DHS stated that nursing should have implemented an intervention immediately after Resident #1's falls on 7/29, 7/30 and 8/1/2010. The DHS further stated that staff was waiting on her to implement interventions and she stated that she was aware that this practice was not appropriate. The DHS also indicated that the care plan coordinator was to update the care plans with each fall and add new interventions. The DHS stated that the care plans were only updated on the weekdays when the care plan coordinators were working. No other staff members updated the care plans. There was not a system in place to update the care plans on the weekends or off hours. 2014-03-01
10206 MAJESTY HEALTH & REHAB OF EASLEY, LLC 425018 200 ANNE DRIVE EASLEY SC 29640 2010-11-04 323 G     GK1G11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on limited record reviews, interviews, observations, and review of facility files, the facility failed to provide residents and staff with adequate supervision to ensure it's system for safe transfer of residents was followed by Hospice and facility staff members for 1 of 1 resident reviewed who sustained injury from an inappropriate transfer (Resident #1). Resident #1 was transferred from bed to chair on [DATE] by manual lift instead of by mechanical lift by his Hospice Certified Nursing Assistant (CNA) and two facility CNAs resulting in bruising to the left axilla and chest. The findings included: Resident #1 with [DIAGNOSES REDACTED]. The resident was hospitalized from [DATE] to [DATE] because of acute renal failure and congestive heart failure exacerbation. Several medications were discontinued on his return to the facility including the Prednisone the resident had taken for years. The resident was admitted to Hospice on [DATE]. Review of the resident assessments of [DATE] and [DATE] showed the resident had short and long term memory problems with moderately impaired decision making ability. The resident was dependent on staff for all activities of daily living. The Significant Change Assessment of [DATE] noted mechanical lift was needed for transfers. According to the Resident Assessment Protocol (RAP) notes of [DATE], the resident required mechanical lift for transfers. Review of the care plan, dated [DATE] and reviewed by the facility and the resident's Hospice nurse, showed no direction to the staff to use a mechanical lift for transfers. The care plan noted problems with fragile skin due to steroid use, risk for pathological fractures related to osteoporosis, risk for falls, risk for complications due to CVA with left side weakness, and impaired mobility. Approaches to these problems included: handle resident cautiously; handle gently during care; transfer resident with care; assist with mobility as needed; provide assistive devises for transfer as needed; and evaluate the use of assistive devices for transferring from bed to chair. review of the resident's medical record revealed [REDACTED]. Review of the Resident Care Plan used by CNAs showed a sling lift was needed for transfers. The form was completed in pencil and showed no date of completion. Observations of resident rooms for three residents on Unit #3 who required mechanical lift transfers showed each resident had a sign at the head of the bed noting how the resident needed to be transferred. Resident #1's sign stated he needed a sling lift. Review of the Nurses' Notes revealed that on [DATE], the resident's daughter notified staff of new discolored areas on her father's left arm, axillary area, and left upper chest. Although the resident had a history of [REDACTED].#1 revealed the areas she saw on the axillary area and left chest on [DATE] were new. The facility's investigation revealed the resident was given care on the morning of [DATE] by his Hospice CNA (CNA #1). After bathing and dressing the resident, CNA #1 requested help to transfer him to the recliner. CNA #1 and a facility CNA (CNA #2) manually transferred the resident to the chair. According to CNA #2's statement, a third CNA (CNA #3) was present in the room and steadied the recliner during the transfer. According to the information in the facility's investigation, the facility CNAs assisted in the inappropriate transfer. There was no evidence to show either of the facility CNAs requested that the mechanical lift be used for the resident. 2014-03-01
10207 MAJESTY HEALTH & REHAB OF EASLEY, LLC 425018 200 ANNE DRIVE EASLEY SC 29640 2010-11-04 282 G     GK1G11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on observation, record review, and interviews the facility failed to ensure that care plans were followed for Resident #1, 1 of 3 sampled residents care planned for a mechanical lift with transfers, was transferred from bed to chair on [DATE] by manual lift by his Hospice Certified Nursing Assistant (CNA) and two facility CNAs resulting in bruising to the left axilla and chest. The findings included: Resident #1 with [DIAGNOSES REDACTED]. The resident was admitted to Hospice on [DATE]. Review of the resident assessments of [DATE] and [DATE] showed the resident had short and long term memory problems with moderately impaired decision making ability. The resident was dependent on staff for all activities of daily living. The Significant Change Assessment of [DATE] noted mechanical lift was needed for transfers. According to the Resident Assessment Protocol (RAP) notes of [DATE], the resident required mechanical lift for transfers. Review of the care plan, dated [DATE] and reviewed by the facility and the resident's Hospice nurse, showed no direction to the staff to use a mechanical lift for transfers. The care plan noted problems with fragile skin due to steroid use, risk for pathological fractures related to [MEDICAL CONDITION], risk for falls, risk for complications due [MEDICAL CONDITION] left side weakness, and impaired mobility. Approaches to these problems included: handle resident cautiously; handle gently during care; transfer resident with care; assist with mobility as needed; provide assistive devises for transfer as needed; and evaluate the use of assistive devices for transferring from bed to chair. review of the resident's medical record revealed [REDACTED]. Review of the Resident Care Plan used by CNAs showed a sling lift was needed for transfers. The form was completed in pencil and showed no date of completion. Observations of resident rooms for three residents on Unit #3 who required mechanical lift transfers showed each resident had a sign at the head of the bed noting how the resident needed to be transferred. Resident #1's sign stated he needed a sling lift. Review of the Nurses' Notes revealed that on [DATE], the resident's daughter notified staff of new discolored areas on her father's left arm, axillary area, and left upper chest. Although the resident had a history of [REDACTED].#1 revealed the areas she saw on the axillary area and left chest on [DATE] were new. The facility's investigation revealed the resident was given care on the morning of [DATE] by his Hospice CNA (CNA #1). After bathing and dressing the resident, CNA #1 requested help to transfer him to the recliner. CNA #1 and a facility CNA (CNA #2) manually transferred the resident to the chair. According to CNA #2's statement, a third CNA (CNA #3) was present in the room and steadied the recliner during the transfer. Cross Refers to F323 as it relates to the failure of the facility to follow an established care plan to prevent harm and ensure the safety of Resident #1 when moving the resident in bed or transferring the resident to allow for care. 2014-03-01
10208 MAJESTY HEALTH & REHAB OF EASLEY, LLC 425018 200 ANNE DRIVE EASLEY SC 29640 2010-11-04 225 D     GK1G11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on limited record reviews, interviews, observations, and review of facility files, 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). Resident #1, 1 of 1 sampled resident that sustained an injury during a transfer, was transferred from bed to chair on [DATE] by manual lift instead of by mechanical lift, as care planned, by his Hospice Certified Nursing Assistant (CNA) and two facility CNAs resulting in bruising to the left axilla and chest. The findings included: Resident #1 with [DIAGNOSES REDACTED]. The resident was admitted to Hospice on [DATE]. Review of the resident assessments of [DATE] and [DATE] showed the resident had short and long term memory problems with moderately impaired decision making ability. The resident was dependent on staff for all activities of daily living. The Significant Change Assessment of [DATE] noted mechanical lift was needed for transfers. According to the Resident Assessment Protocol (RAP) notes of [DATE], the resident required mechanical lift for transfers. Review of the Resident Care Plan used by CNAs showed a sling lift was needed for transfers. The form was completed in pencil and showed no date of completion. Observations of resident rooms for three residents on Unit #3 who required mechanical lift transfers showed each resident had a sign at the head of the bed noting how the resident needed to be transferred. Resident #1's sign stated he needed a sling lift. Review of the Nurses' Notes revealed that on [DATE], the resident's daughter notified staff of new discolored areas on her father's left arm, axillary area, and left upper chest. Although the resident had a history of [REDACTED].#1 revealed the areas she saw on the axillary area and left chest on [DATE] were new. The facility's investigation revealed the resident was given care on the morning of [DATE] by his Hospice CNA (CNA #1). After bathing and dressing the resident, CNA #1 requested help to transfer him to the recliner. CNA #1 and a facility CNA (CNA #2) manually transferred the resident to the chair. According to CNA #2's statement, a third CNA (CNA #3) was present in the room and steadied the recliner during the transfer. According to the information in the facility's investigation, the facility CNAs assisted in the inappropriate transfer. There was no evidence to show either of the facility CNAs requested that the mechanical lift be used for the resident. 2014-03-01
10209 MOUNTAINVIEW NURSING HOME 425027 340 CEDAR SPRINGS ROAD SPARTANBURG SC 29302 2010-11-10 280 D     0LRQ11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the compliant inspection, based on observations, interviews and record reviews, the facility failed to ensure that Resident #4's care planned was review and revised regarding one-to-one supervision by the staff (1 of 4 sampled reviewed with behaviors). The findings included: The facility admitted Resident #4 on 10/23/09 with [DIAGNOSES REDACTED]. Review the of Nurse's Progress Notes dated 10/03/10 at 1250 documented at 1145 the staff was paged to the facility's canteen and that Resident #4 was in the canteen area and he threw a chair at a snack machine, hit a visiting family member of another resident and slammed a nurse's finger in a cabinet. The Nurse's Note further indicated that once the resident calmed down he requested to call law enforcement. At 1245 physician's orders [REDACTED].#4 returned to the facility from the hospital; at 1930 Resident #4 was noted running his wheelchair into people and things. The resident later calmed down and went to bed. A Nurse's Note dated 10/04/10 at 2330 indicated the staff was at the bedside with no behaviors noted. A Nurse's Note dated 10/05/10 at 0830 indicated the staff was at the bedside with no behaviors noted; at 2145 the resident became agitated and talked about hitting the vending machine on 10/03/10. Nurse's Note date 10/06/10 indicated that a staff member was at the bedside and in attendance when family and friends visited the resident. A Nurse's Note dated 10/07/10 at 1340 indicated Resident #4 was in the facility lobby with a staff member when he knocked over a table in the front lobby and tried to hit a staff member with a chair. The resident was return to the unit and given 5 mg (milligrams) of [MEDICATION NAME] IM for combativeness. An observation on 11/03/10 at 11:10 AM, 1:30 PM and 2:10 PM revealed staff seated in the room with the resident. There was nothing in the chart to indicate why a staff was seated in the room with the resident. There was no care plan to indicate why staff was present in the room with the resident at all times. An interview on 11/03/10 at 2:45 PM with the SSD (Social Service Director) revealed the care plan did not address one-to-one supervision with the resident as a result of his behaviors. The SSD further stated the resident was put on one-to-one supervision on 10/04/10. The Assistant Administrator confirmed the resident's care plan did not address one-to-one supervision. 2014-03-01
10210 MAGNOLIA MANOR - INMAN 425032 63 BLACKSTOCK ROAD INMAN SC 29349 2010-11-17 241 E     JNTL11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on record review and observation of meal service, the facility failed to provide services that respected resident's dignity during a random observation of a meal. Resident # 5 and 2 other unidentified residents were not served their meal in a timely manner. The findings included: The facility admitted Resident # 5 on 10/30/06 with [DIAGNOSES REDACTED]. On 11/16/10, at 12:20 PM, the lunch trays were delivered to the dining room. Resident # 5 was observed along with two other residents sitting in the dining room facing the other residents. Meal trays were served and the other residents ate or were assisted with their meals. Resident # 5's meal tray was noted to be on the cart. Resident # 5 and the other two residents were not assisted to a table or served the meal until 1:00 PM. This observation was shared with the DON during sharing. The facility admitted Resident # 3 on 6/23/10 with [DIAGNOSES REDACTED]. Prior to observation of wound care on 11-16-10 at 1:35 PM, Licensed Practical Nurse (LPN) #3 and Registered Nurse (RN) #5 entered the room without knocking. During the course of the treatment from 1:35 PM until 2:55 PM, the LPN left the room two times to obtain needed supplies and reentered without knocking. The nurse entered the shared bathroom to wash her hands four times without knocking to ensure that residents from the adjoining room were not using the commode. At 2:30 PM, when the nurse entered the bathroom for the fifth time (without knocking) to wash her hands, she walked in on a resident who was using the commode. After this incident, the nurse continued to enter the bathroom door three more times without knocking while completing the wound care. The privacy curtain was not closed at the foot of the resident's bed during the entire treatment. During an interview with LPN # 3 on 11-17-10 at 12:40 PM, the nurse verified that she had failed to knock when entering the room and each time she entered the bathroom to wash her hands. On 11-17-10 at 1:05 PM, the Staff Development Coordinator (SDC) provided a document entitled "Survey Readiness" which stated: "Remember Privacy: Knock on each door, close the door, pull the privacy curtain, and close the blinds." The SDC stated that she goes over this information with new hires and periodically as needed. During a discussion with the Director of Nursing (DON) related to privacy issues identified during treatments on 11-17-10 at 1:00 PM, the DON said she had in-serviced the staff on closing blinds, pulling curtains around the bed, and closing and knocking on doors. She stated she did not recall specifically addressing bathroom doors. 2014-03-01
10211 MAGNOLIA MANOR - INMAN 425032 63 BLACKSTOCK ROAD INMAN SC 29349 2010-11-17 250 E     JNTL11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on record review and interview, no medically related social services were provided for Residents #21 and #26 related to behaviors. ( 2 of 6 residents reviewed for specific medically related social services.) The findings included: The facility admitted Resident # 26 on 3/23/10 with [DIAGNOSES REDACTED]. Record review on 11/16/10 revealed numerous nurse's notes documenting sexually inappropriate behaviors towards staff and residents and wandering into other resident rooms. This was also confirmed on 11/16/10 at 1:30 PM by 4 of 4 residents who attended group meeting. These residents stated they had been touched on the arms, toe, and asked "give me some sugar." Nurse's note on 5/18/10 documents " CNA (Certified Nursing Assistant) - resident touching and rubbing her leg - won't quit." On 5/25/10 " MD (Medical Doctor) in today for touching staff inappropriately. CNA reported resident asked for a kiss." On 5/26/10 note documents " CNA makes resident hold to side rails to keep him from reaching for her." Nurses notes continue: 6/12/10- touches staff inappropriately at times; 6/14/10 - started on Lexapro 10 mg (milligrams) r/t (related to) inappropriate sexual disinhibition; 6/16/10 - continues to enter resident rooms, continues to attempt to touch staff and residents- redirect as necessary; 9/1/10 CNA and PT (Physical Therapist) reported resident made inappropriate gestures and sexual comments. Resident attempted to enter other resident's rooms without permission; 9/4/10 - inappropriate sexual remarks at staff at times; 10/17/10 - staff and residents reported resident has been making inappropriate comments "give me some sugar and I want a lick." staff will continue to monitor behavior. On 11/16/10 resident approached a surveyor and asked "when can we meet" and made an explicit sexual gesture. Only two physician progress notes [REDACTED]. Review of Social Service Notes revealed a note on 4/22/10 -Resident has been noted wandering into other peoples rooms. He is confused. Easily re-directed. Next note on 6/18/10 - Has periods of wandering t/o (through out) facility, in others rooms. Has inappropriate conduct, tries to touch staff and peers. Does not appear to remember what you tell him. Note of 9/10/10 "Flirts with staff and visitors." There was no documentation of any interventions tried by social services. During an interview with Social Services on 10/17/10 at 11:00 AM, she stated "it was put into the hot box and in the doctors book." When asked if she did the analysis per the care plan, she stated "no." Nursing should have done that. Interview with 100 Unit Manager on 11/17/10 at 12 NOON revealed someone put in hot box charting (to observe and chart every shift for 72 hours ) 10/17/10; however, the Unit Manager stated staff did not do that. They only charted one shift and stopped. It was placed in the doctor's book (nurse did not remember when) but doctor didn't check resident. Did not check with doctor until 11/16/10 after brought to attention by surveyors. On 11/16/10 Nurse Practitioner increased Lexapro to 20 mg and ordered a Psych Consult. No analysis of key times, places, circumstances, triggers, or what de-escalates behavior per care plan had been done by any discipline listed on the care plan. The facility admitted Resident # 27 on 10/20/09 with [DIAGNOSES REDACTED]. Nurses Assistant) responded to the resident's room and intervened d/t (due to) this resident hitting another resident from another station, with a metal/aluminum grabber stick. Yelling at the resident while hitting resident in the back of the resident's head. CN removed the injured resident and checked resident, where she (CNA) found a knot on his head.." Resident # 27 was encouraged to ask for assistance. Further review of the record revealed no additional follow-up or intervention from Social Services. On 11/16/10 at approximately 11:00 AM, revealed that the DON (Director of Nurses') was unaware of the incident. She stated that the nurse working should have filled out an occurrence report and passed reported this on the twenty-four hour report. She stated that she did not find any incident report related to this incident. The surveyor requested the twenty-four hour report sheet for that date. By the end of the survey no twenty-four hour report was provided to the team. On 11/16/10 at approximately 11:26 during an interview with Social Service Worker # 1, she stated that she was not aware of the incident, however she was not the primary social worker for the unit. When questioned about follow-up by social services, she confirmed that there were no social service notes related to the incident. She confirmed that there should have been an intervention by social services. 2014-03-01
10212 MAGNOLIA MANOR - INMAN 425032 63 BLACKSTOCK ROAD INMAN SC 29349 2010-11-17 281 E     JNTL11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on record review and interview, the facility failed to provide nursing services that met professional standards of practice. The facility nurse failed to transcribe Resident # 7's medication order correctly and multiple nurses administering medications to the resident failed to clarify the entry on the MAR (Medication Administration Record) for [MEDICATION NAME] as needed on Monday, Wednesday and Friday, resulting in a medication errors. The findings included: The facility admitted Resident # 7 on 11/10/10 with [DIAGNOSES REDACTED]. On 11/16/10, review of the resident's medical revealed a physician's orders [REDACTED]. Review of the MAR (Medication Administration Record) revealed that the order had been transcribed incorrectly to the MAR indicated [REDACTED]. Further review of the MAR indicated [REDACTED]. On 11/16/10 at approximately 4:00 PM interview with RN (Registered Nurse) # 4 revealed that she had transcribed the order incorrectly. She stated that the computer system being used will not recognize Monday, Wednesday, Friday orders unless entered as a prn order. She stated that she had failed to mark out the PRN as needed when the MAR indicated [REDACTED]. 2014-03-01
10213 MAGNOLIA MANOR - INMAN 425032 63 BLACKSTOCK ROAD INMAN SC 29349 2010-11-17 279 D     JNTL11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on record reviews and interviews, the facility failed to develop a plan of care which addressed the non compliance of Resident # 21 with safety regulations within the facility and failed to address the resident's non compliance with fluid restrictions. (One of one sampled resident known to be noncompliant with smoking regulations and one of one sampled resident reviewed with a fluid restriction reviewed for the development of care plans) The findings included: Resident # 21 was recently readmitted with a [DIAGNOSES REDACTED]. On 11/14/10, at 6:50PM, the resident was observed to be out of bed sitting near the nurses station and in the dining room. The resident was observed to obtain glass(es) of water from a drinking cooler three times during the observation which lasted approximately one hour. No staff intervened or spoke with the resident about his fluid consumption. During an interview with the unit manager, when asked if the resident was compliant with the fluid restriction, she stated "no." The unit manager further verified that the resident's plan of care did not address his non-compliance or the facility plan to address the concern. Further record review revealed the resident had been noncompliant with the facility smoking regulations which had been addressed by the facility Administrator. On August 21, 2009 and on September 10, 2010, the resident had received a letter from the facility addressing his non-compliance. Nursing notes also revealed that on 9/16/10, two cigarette lighters had been removed from the resident's room. When the Administrator was questioned if he was aware of the 9/16/10 occurrence, he did not respond. Further review of the resident's comprehensive plan of care did not reveal any concern/plan related to the residents non-compliance with the facility safety/non-smoking regulations. A copy of the smoking policy (7/06) stated; "All residents are prohibited from keeping any type of smoking materials (lighter, matches, cigarettes, etc.) in their rooms or on their person." 2014-03-01
10214 MAGNOLIA MANOR - INMAN 425032 63 BLACKSTOCK ROAD INMAN SC 29349 2010-11-17 309 E     JNTL11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on observations, record reviews, and interviews, the facility failed to provide physician-ordered care and services for one of two residents reviewed with orders for Hospice services and one of one residents reviewed for provision of [MEDICAL TREATMENT]. There was no evidence of implementation of a 10-6-10 hospital transfer order for Hospice for Resident #17. Intake and output was not monitored to ensure compliance with a fluid restriction order for Resident #21. The findings included: The facility initially admitted Resident #17 on 10-5-09 and readmitted him following a hospitalization from [DATE] to 10-6-10. Record review on 11-15-10 at 12:45 PM revealed a hospital Patient Transfer Form dated 10-6-10 which was noted as faxed to the facility on the same date. Instructions on the cover page of the form included to "Arrange hospice". Additionally, the same Discharge Instruction was listed as a line item on an attached Order Confirmation Report. There was no evidence in the medical record that the order had been implemented. During an interview on 11-15-10 at 3:30 PM, the Director of Nurses reviewed the transfer document and confirmed the order for Hospice. She stated she "did not see" and had not been aware of the order until 10-26-10, the date of the resident's death. During an interview on 11-16-10 at 11:35 AM, Registered Nurse (RN) #6 also confirmed the Hospice order and stated that she had been unaware of the Hospice order until after the resident's death when she "found the Hospice note". The RN stated that the transfer information usually came from the hospital in a packet and that the nurse who received the resident should have written the order for the referral. She stated that, when she became aware of the order, she questioned the nursing staff and they "said they never saw the order". The nurse further stated that the admitting nurse "should have made the referral". Resident # 21 was recently readmitted with a [DIAGNOSES REDACTED]. The resident's Comprehensive Plan of Care was updated and stated: "I & 0 record" (record intake and output). Further record review revealed consistent missing documentation that the resident's intake and output were monitored. On 11/15/10 at 10:15AM, during an interview with the Unit Manager, she confirmed the resident's intake and output were not consistently/accurately recorded. The Unit Manager stated it was the responsibility of the nurse on each shift to enter the total fluids the resident received per shift and then it was the responsibility of the 11-7 shift to total the amounts for the day. 2014-03-01
10215 MAGNOLIA MANOR - INMAN 425032 63 BLACKSTOCK ROAD INMAN SC 29349 2010-11-17 314 G     JNTL11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on record reviews, facility policy on care and assessment of Pressure Ulcers, and interview, the facility failed to ensure that a resident having pressure sores receives necessary treatment and services to promote healing, prevent infection and prevent new sores from developing for four of seven sampled residents reviewed for pressure ulcers. Resident # 23 was admitted [DATE] with a known pressure ulcer. treatment for [REDACTED]. Resident # 22 with a known red area to the back, receiving treatment, was not assessed weekly for changes in the area and effectiveness of treatment. Resident #1 failed to have ongoing documentation available of a pressure ulcer as it was treated to allow staff to accurately determine response to the treatment and the need for possible changes in treatment. During a pressure ulcer treatment observed on Resident #3 the licensed staff failed to implement infection control techniques to ensure healing. The findings included: The facility admitted Resident # 23 on 3/6/10 with [DIAGNOSES REDACTED]. On the weekly skin documentation form dated 3/6/10 the resident was documented by nursing to have a black area to the right heel with no further description/measurement noted. On 3/15/10 the area was documented as "soft and black." There was no physician order for [REDACTED]. ... He has a large decubitus over the right heel. It is covered by skin" . He previously had a blister and nursing staff reported that this has drained and there is some serosanguineous type drainage....Small area in the plantar surface of the right foot that is measuring approximately .5cm (centimeter) in diameter Wound bed in this area is pink, moist. This again is a very superficial area ..." The NP at this time ordered vitamin C, Prosource and Vitamin with Minerals, treatments to both areas, continued use of Podus boots, and floating of the heels while in bed. The physician saw the resident on 3/23/10 and made no changes. A care plan for the pressure ulcer to the heel was not developed until 3/18/10 During an interview with the current Unit Manager and the Unit Manager for the unit on which the resident originally resided, revealed that neither nurse could provide evidence the wound(s) noted on admission had been measured or assessed as pressure areas. There was no documentation found that the facility was providing any treatment to the heel wound from 3/6 until 3/18/10. During the interview, the unit manager stated- "It should have been skin prepped. Anything black we always skin prep to off with." On 3/22/10 a "dark area" to the bottom of the right foot was documented on the weekly assessment form. However, an order was written previously on 3/9/10 to apply skin prep to the ball of the right foot bid until healed (stage I decubitus) . There was no documentation per facility provided policy to include: " location, measurement, appearance, drainage, odor, color, presence of undermining/tunneling, healing, stage if a pressure ulcer, pain and [MEDICAL CONDITION].The resident's admission care plan noted on 3/8/10 the presence of a stage I - "ball of RH foot (?right heel) -skin prep ball of rh foot as ordered." Resident # 22 was admitted to the facility with Arthritis and Bullous Lung Disease. On 6/12/10 a weekly skin assessment noted the resident had a "pink" area to the bony prominence of the mid back and sacral area. On 6/27/10 an order was obtained for Optofoam pad, cover with [MEDICATION NAME] every three days for protection to mid back bony prominence area. On 11/15/10 at 11AM, during an interview with the Unit Manager, she stated although weekly skin assessments were completed, they were done by the weekend nurse who would be unable to see thru the Optofoam pad to visualize the area. There was no documentation that the area was measured. On 11/17/10, during an interview with the Director of Nursing, she verified that a red/pink area over a bony prominence would meet the definition of a Stage I pressure area. She stated she would have expected the area to be measured weekly and to have been included in the pressure ulcer reports submitted to her office. After checking the pressure ulcer records on file in her office, the Director of Nursing stated the resident was not and had not been included in the pressure ulcer reports. Further review of the treatment flow sheet for October 2010 revealed there were no signatures present for the application of the treatment to the back from from 10/17 to 10/29/10. On 11/15/10 at 11AM, during an interview, the Unit Manager and the nurse responsible for the application of the treatment verified there was no documentation that the dressing had been applied per the order. Resident #22 was seen by the Nurse Practitioner (NP) on 11/8/10 who commented: ..."The family was somewhat concerned.... The buttocks area and gluteal cleft are inspected. There is some pinkness in the superior aspect of the gluteal cleft. She has a very prominent coccyx, and some pinkness over these and open areas. ...Upper back approximately T8 through T 12 is pink. She has a foam dressing on, which was removed, and there is some mild what appears to be fungal -type changes to the skin, redness and pinkness, which again blanched, while there are no open areas....." The resident was diagnosed by the NP with a stage I decubitus to the Sacrococcygeal area and started on Vitamin C. The treatment to the mid back was changed at that time. The Facility provided policy for Staging pressure ulcers (Revised 6/08) stated: A stage I pressure ulcer was defined as "intact skin" and a Stage II pressure ulcer was a "partial loss of dermis..." The policy also stated that wounds will be evaluated/documented to include: " location, measurement, appearance, drainage, odor, color, presence of undermining/tunneling, healing, stage if a pressure ulcer, pain and [MEDICAL CONDITION].Treatments should be re-evaluated every 2-3 weeks. If no wound progression noted treatment change should be considered. If no change in treatment done documentation should occur as to why current treatment maintained." The facility admitted Resident #1 on 7/07/10 with [DIAGNOSES REDACTED]. Record review on 11/16/10 revealed the resident to be receiving treatments of Santyl ointment to right heel and wrap for a pressure ulcer. The last documentation found in the record was dated 9/03/10 showing a measurement of 4 cm ( centimeters) by 6 cm 1/2 sealed off pink brown lower area- 1/2 dark purple with surrounding skin normal. On 9/17/10 the wound measured .3 by .8 had scant amount of yellow drainage. An interview with RN #1 (Registered Nurse) revealed she did not do the daily dressings but measured all the wounds weekly. She stated, "I have a sheet I document all the information on and give a copy to the DON (Director of Nursing). I am supposed to transfer the information to each resident's individual Wound Treatment & Progress Record weekly. I goofed. I have not always documented weekly on the individual sheets." The nurses doing the dressings had nothing to compare with in order to make recommendations about continuing or changing treatments. The nurses assigned to do the treatments were the staff nurses on duty each day and not the same nurse each day. There was no continuity of care in treating the wound. The facility admitted Resident #3 on 6/23/10 with a [DIAGNOSES REDACTED]. During an observation of wound treatment for [REDACTED].#3 failed to wash or sanitize her hands between removal of the soiled dressing from the Stage III wound on the top of the left foot and placement of the clean dressing. LPN #3 stated that the dressing was saturated with "yellow, bloody drainage". Prior to placement of the clean dressing, the nurse removed scissors from her pocket and cut a foam dressing for use on the wound without disinfecting or cleaning the scissors prior to use. The dressing was then applied to the Stage III wound. Prior to the wound treatment to the Stage II wound on the left buttock, when the resident was positioned onto her right side, the underpad was noted to be soiled with a red tinged drainage. LPN # 3 stated, "This could be a vaginal drainage". After removal of the soiled dressing, the resident was allowed to turn back onto her back on the underpad without a dressing to the open wound on the left buttock. When the resident was turned back for placement of the clean dressing, an area of red tinged drainage the size and shape of the wound was noted on the soiled underpad. On 11-17-10 at 1:05 PM the Staff Development Coordinator (SDC) provided a facility policy entitled, "Dressing-Absorption Dressing, Application of". Step #10 stated: "Disposes of soiled dressings appropriately. Removes gloves and disposes. Washes hands." The policy then continued with the preparation and application of the clean dressing. An interview was conducted with LPN #3 on 11-17-10 at 12:40 PM. The nurse verified all the above observations and stated, "I messed up with glove changing and handwashing." The nurse stated that she cleaned the scissors prior to placing them in her pocket and she was unaware that the scissors should be cleaned prior to each use. 2014-03-01
10216 MAGNOLIA MANOR - INMAN 425032 63 BLACKSTOCK ROAD INMAN SC 29349 2010-11-17 367 E     JNTL11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on observations, record reviews, and interviews, the facility failed to provide the diets as ordered by the physician for two of seven sampled residents reviewed for therapeutic diets. Resident #17 was provided solid foods on a mechanically-altered (pureed) diet and an order for [REDACTED]. The findings included: The facility initially admitted Resident #17 on 10-5-09 and readmitted him following hospitalization from [DATE] to 10-6-10 for Aspiration Pneumonia, Dehydration, and [MEDICAL CONDITION]. Additional/chronic [DIAGNOSES REDACTED]. Record review on 11-15-10 at 12:45 PM revealed that Resident #17 was on a "Puree diet with nectar thick liquids for pleasure" prior to hospitalization and received an "egg salad sandwich c (with) ea(ch) meal" per a physician's orders [REDACTED]. The hospital Patient Transfer Form dated 10-6-10 noted "Instructions" for a Discharge Diet of "TF (tube feeding)". The hospital Discharge Summary noted that the resident was to receive "[MEDICATION NAME] 1.5 at 80 ml (milliliters)/hour for 18 hours, start at 3 PM, off at 9 AM." physician's orders [REDACTED]. There was no evidence in the record that the sandwiches had been reordered. A copy of a Diet Order & Communication form dated 10-7-10 was found in the medical record. Pureed Texture and Nectar-Like Thickened Liquids were checked to indicate the type of diet to be provided. During an interview on 11-15-10 at 4 PM, the Speech Language Pathologist (SLP) reviewed the Rehabilitation Screen form she had completed on 10-8-10. She stated that the resident had been on caseload prior to the 9-26-10 hospitalization , but had reached a plateau. He had received the sandwich with meals prior to hospitalization and was "safe" with it. Upon readmission, she stated that the resident was uncooperative with the screening process for oral motor assessment and noted that the resident was "WFL (within functional limits) for puree". She did not request an upgrade in the diet because of her inability to perform an assessment. The SLP was aware that Resident #17 had received the sandwich without an order and thought that dietary had written an order or provided it without a current order or evaluation/recommendation from the SLP. During an interview on 11-15-10 at 4:15 PM, the Certified Dietary Manager (CDM) stated that Resident #17 had been provided a pureed diet with nectar thick liquids and an egg salad sandwich three times daily from the date of his readmission on 10-6-10 to the date of his death. The CDM stated that she had received verbal notification from nursing staff upon readmission to continue the resident's diet as prior to hospitalization . She reviewed and verified receipt of the diet communication form dated 10-7-10 and that the order failed to include the sandwich. When questioned as to the reason the resident had continued to receive the sandwich after receipt of the order on 10-7-10, the CDM stated that there was "no order to discontinue it". During an interview on 11-16-10 at 11:05 AM, the Director of Nurses (DON) reviewed and verified the Speech Language Pathologist's documented screen. During interviews with the DON on 11-16-10 at 11:05 AM and Registered Nurse (RN) #6 on 11-16-10 at 11:35 AM, each stated that the sandwich should have been cancelled if not reordered after hospitalization . Interviews with Licensed Practical Nurse (LPN) #4 on 11-15-10 at 3:45 PM, with CNA #2 on 11-16-10 at 12 PM, with CNA #1 on 11-16-10 at 12:05 PM, and with the Unit 4 Manager on 11-16-10 at 11:35 AM revealed that Resident #17 had received egg salad sandwiches with each meal daily prior to his death and had tolerated them well with no choking episodes noted. During an interview on 11-15-10 at 5 PM, the attending physician stated that he would expect physician's orders [REDACTED]. Resident # 21 was recently readmitted with a [DIAGNOSES REDACTED]. During observation of the breakfast meal on 11/15/10, the resident was observed to receive fluids in excess of what the planned dietary plan had established. When the resident was interviewed as to what the facility had sent in his bagged lunch to eat while at [MEDICAL TREATMENT], it was stated that less fluids were sent than established in his dietary plan. During an interview with the Dietary department on 11/16/10 at 9AM, it was verified that a plan had been developed which established how much dietary would send the resident with each meal and how much nursing would provide. However, it was confirmed that the Dietary Department had not followed the established plan for breakfast nor lunch on the day of the observation. 2014-03-01
10217 MAGNOLIA MANOR - INMAN 425032 63 BLACKSTOCK ROAD INMAN SC 29349 2010-11-17 156 C     JNTL11 On the days of the survey, based on record review and interview, the facility failed to provide Liability Notices to 3 of 3 residents reviewed for notification of Medicare Provider Non- Coverage. The facility did not utilize form or any of the 5 denial letters to inform residents or their responsible party of the items and services expected to be denied under Medicare Part A. The findings included: On 11/17/10 at 10:20 AM, a review of 3 random Medicare Non-Coverage Notices revealed that there were no Liability Notices included in the information given to the resident or responsible party. An interview with the Admission Coordinator revealed that she had not been aware until yesterday that Liability Notices were required. According to information provided by the Admission Coordinator, Resident A had used 50 days and his last covered day was 10/27/10 due to therapy being discontinued. Resident B had used 64 days and no longer required skilled services. His last covered day had been 9/2/10. Resident #8 had used 36 days and her last covered day had been 8/20/10 due to her therapy having been discontinued. 2014-03-01
10218 MAGNOLIA MANOR - INMAN 425032 63 BLACKSTOCK ROAD INMAN SC 29349 2010-11-17 159 D     JNTL11 On the days of the survey, based on record review and interview, the facility co-mingled personal funds with facility funds for 2 of 5 residents reviewed with Resident Trust Fund Accounts. Resident D had personal funds withdrawn from her Trust Fund Account and deposited into the facility account. Resident E had retirement checks deposited into the facility account instead of being deposited into her Trust Fund Account first. In addition, there was no evidence of notification of balances that would jeopardize Medicaid eligibility for Resident D. The findings included: Review of Resident D's Trust Fund Account record on 11/17/10 at 1:42 PM revealed a Care Cost Payment dated 9/17/10 of $3.04, a second Care Cost Payment dated 10/7/10 for $11.28, and a third Care Cost Payment dated 11/5/10 for $30.06. When asked about what these payments were for, the Business Office Manager stated that she withdrew these amounts from the resident's Trust Fund Account and deposited the monies into the facility account since the resident had reached her $1800.00 limit in which she would need to start spending down her account since she was a Medicaid recipient. According to the Business Office Manager, the monies deposited into the facility account would go towards payment of any remaining balances the resident might have. When asked if the resident owed a balance, she stated "no". She stated the facility account was not interest bearing. When asked if she had contacted the family of the resident to try to see if they could spend down her account she stated she had never seen the family and hadn't recently tried to get ahold of them, but she would try now. Review of the Resident Fund Management Service reports revealed that these funds had been withdrawn from the resident's Trust Fund Account and had been deposited into the facility account. During the funds interview on 11/17/10 at approximately 9:30 AM, the Business Office Manager stated that when a Medicaid resident's account reached #1800.00, she told the resident or responsible party that they needed to spend down the account. She stated she did not document this notification any where. According to the Administrator, the facility used letters to notify residents that their Trust Fund Account balances were within $200.00 of exceeding what is allowable under Medicaid. However, he was unable to provide a copy of any letters notifying Resident D or her responsible party with this information. Review of Resident E's Trust Fund Account Record on 11/17/10 at 12:25 PM revealed a Care Cost Payment of $31.00 on 6/8/10 and another Care Cost Payment of $1077.33 dated 11/5/10. When asked what these payments were for, the Business Office Manager stated they were payments for balances owed since the resident's room and board were more than her Social Security check. She provided documentation of these balances owed and revealed a Resident Statement dated 5/21/10 which listed a balance of $31.00 on 6/8/10. It also had a "receipt copy" included on the statement dated 5/26/10 for a check from the "State Budget" for $461.85. The amount of the check received from the State Budget had been handwritten onto the statement and deducted from the resident's balance on 5/26/10. According to the Business Office Manager, the "State Budget" check had been deposited into the facility account, and had not been deposited into the Resident's Trust Fund. When asked if the "State Budget" checks were made out to the resident, she said that they were. When asked why it had not been deposited into the resident's Trust Fund Account, she did not answer. Review of a letter dated October 23, 2007 from the resident to the Insurance Operations Department revealed the resident had requested her "WestPoint Stevens" retirement check to go to the nursing home, and that she only wished to change her check mailing address. Review of the Resident statement dated 5/21/10 revealed an entry for a check from "West Point Stevens" for $63.11 that had been deducted from the resident's balance on 6/1/10. According to the Resident Trust Fund Account Statement dated 6/1/10 through 11/16/10, there had not been a deduction of $63.11 from that account on 6/1/10. The Business Office Manager also provided a Resident Statement dated 10/21/10 that listed a balance of $1077.33 on 11/5/10. On the statement were 2 payments that were both dated 10/8/10, one for $461.85 and one for $63.11, both of which had been deducted from the resident's balance and were not included in the Resident Trust Account statement dated 6/1/10 through 11/16/10. This indicated these funds had not been first deposited into the Trust Fund Account for the resident before being used to pay balances owed. Further review of the Trust Fund Account record dated 6/1/10 through 11/16/10 revealed the resident had been receiving "miscellaneous income" of $63.11 on 8/4/10, 9/1/10, and 11/8/10. According to the statement, she also had a "State/Cnty/City CK" for $461.85 that had been deposited into her Trust Fund Account on 11/8/10. There was no indication of any deposits matching these amounts in October. 2014-03-01
10219 MAGNOLIA MANOR - INMAN 425032 63 BLACKSTOCK ROAD INMAN SC 29349 2010-11-17 160 D     JNTL11 On the days of the survey, based on record review and interview, one of five resident records reviewed for conveyance of funds revealed disbursement of funds without written authorization. The findings included: On 11/17/10 at approximately 9:30 AM, the Business Office Manager stated that Resident #19 had $30.00 in the Resident Trust Fund Account that had been sent to the funeral home at the family's request after her death. According to the Business Office Manager, the family wanted the cash money, however, she told them she could send it to the funeral home or the estate. The family requested the money sent to the funeral home. According to the Business Office Manager, there was no Power of Attorney in effect over the resident's financial matters. Review of the Admission Agreement revealed a "Beneficiary Designation:" section that was not filled out and did not designate a person to receive the resident's personal funds. 2014-03-01
10220 MAGNOLIA MANOR - INMAN 425032 63 BLACKSTOCK ROAD INMAN SC 29349 2010-11-17 167 C     JNTL11 On the days of the survey, based on observations, the facility failed to post the most recent survey report within the facility. The facility failed to post the most recent complaint survey with citations from 9/16/10 and failed to post a complaint survey with citations from February 2010. The findings included: Observation on 11/15/10 at approximately 5:00 PM revealed a plastic holder mounted on the wall in the hallway near the front lobby. Observation of the contents of the holder revealed a labeled notebook containing the annual recertification survey report from September 2009. The complaint surveys with citations from 9/16/10 and February 2010 were not posted as required. On 11/17/10 at approximately 4:30 PM, the surveyor reviewed the contents of the notebook with the Administrator. The Administrator confirmed that the complaint surveys were not posted at that time. 2014-03-01
10221 MAGNOLIA MANOR - INMAN 425032 63 BLACKSTOCK ROAD INMAN SC 29349 2010-11-17 282 D     JNTL11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on record review and interview, the care plan was not followed related to pacemaker checks for Resident #9 and analysis of causative factors of behavior for Resident # 26. ( 1 of 2 residents reviewed with pacemakers and 1 of 1 resident reviewed for socially inappropriate behaviors.) The findings included: The facility admitted Resident #9 on 5/13/09 with [DIAGNOSES REDACTED]. Record review on 11/15/10 revealed the resident to have a pacemaker. The Physician's History and Physical listed a [DIAGNOSES REDACTED]. Dates of 5/14/09, 9/3/09, 12/17/09 and 3/4/10 were listed on the sheet as to when checks should be done. The only documentation of testing in the medical record was dated 9/03/09. No other documentation could be found. There was no physician order to do pacemaker checks. The care plan for pacemaker also documented pacemaker check as ordered q 3 months ( every 3 months). An interview with RN # 1 (Registered Nurse) and the Unit Manager revealed that the nurse did not know the resident had a pacemaker. She was unable to find any information in the record related to the checks other than the one report of 9/03/09. RN #1 placed a call to the Clinic and found that a check had been done on 9/03/10. There were no other reports sent at this time. The facility admitted Resident # 26 on 3/23/10 with [DIAGNOSES REDACTED]. Review of the resident's care plan revealed a problem which stated, "Resident exhibits socially inappropriate behaviors IE: wandering into others room, touching peers and staff inappropriately, pulling fire alarm. Under approaches were listed: assess resident's understanding of the situation, monitor resident frequently, analyze key times, places, circumstances, triggers, and what de-escalates behavior, and Psychiatric evaluation as indicated. An interview with the Unit Manager of 100 unit and Social Services on 11/17/10 revealed that no one had done an analysis, and no psychiatric evaluation had been done. The Unit Manager was not even aware of the care plan approach, and although Social Services was listed also, she stated, "Nursing should do that, not me." None of the disciplines listed for the approach had done an analysis. 2014-03-01
10222 MAGNOLIA MANOR - INMAN 425032 63 BLACKSTOCK ROAD INMAN SC 29349 2010-11-17 441 E     JNTL11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on observation and interviews, the facility failed to provide evidence that all personal laundry was effectively cleansed/sanitized to destroy microorganisms. Also, based on observations and interviews, the facility failed to follow a procedure whereby expired topical agents, irrigation trays, and wound care supplies were removed from current stock and were available for daily use in two of four medication rooms reviewed. The findings included: During observation of the laundry on [DATE] at 10:15 AM, two home-type washers were noted (in use) not to be connected (via the chemical dispensing system) to any type of sanitizing agent. Bleach was set up to be dispensed on an automatic dispensing system to a third commercial-type washer. A sign was noted on the wall above a dryer indicating "no bleach" formula to be used on given wash cycles. When asked at this time, the Laundry Aide confirmed that bleach was not used for some personal laundry. She stated that the water temperature ranged from 120 to 160 degrees and was monitored by maintenance. She was unaware if any type of sanitizer was used and deferred to the Housekeeping Supervisor. During an interview on [DATE] at 2 PM, the Maintenance Supervisor provided laundry water temperature logs for review. Water temperatures ranged from 129 to 141 degrees Fahrenheit over the previous six month period. When informed that personal laundry was being washed without bleach, or water temperatures over 160 degrees, the Housekeeping Supervisor stated that he could provide no information to verify use of any other type of sanitizing agent. During an interview at 2:35 PM on [DATE], a second maintenance employee stated that he had checked the dispensing mechanism on the two home-type washers and that the commercial bleach product had not been connected. At that time, the Housekeeping Supervisor verified that he could provide no information on use of any type of sanitizing agent, other than the bleach product used on one of the three machines in use, to enable the facility to provide hygienically cleansed laundry. On [DATE] at 7:43 AM, observation of the Station 2 Medication Room revealed 2 Medline Piston Irrigation Trays with Sterile Sodium Chloride expired ,[DATE]. During an interview on [DATE] at 8:01 AM, Licensed Practical Nurse (LPN) #4 revealed that the medication nurses and the stock supply person from Central Supply checked the medication room for expired products. Central Supply comes to restock the cabinets about once a week. There is no set schedule for the medication nurses to check the medication room. On [DATE] at 8:04 AM, observation of the Station 3 Medication Room revealed the following: - two one ounce (28.35 gram) White [MEDICATION NAME] USP (United States Pharmacopoeia), expired ,[DATE] - two Piston Irrigation Trays with Sterile Sodium Chloride, expired ,[DATE] - 14 Medline Sterile Bordered Gause, 4 inch by 14 inch dressings, expired [DATE] During an interview on [DATE] at 8:32 AM, Registered Nurse (RN) #5 revealed that the medication nurses checked the medication room for expired products and that it should be checked every day. The Nurse Manager could also check the medication room. 2014-03-01
10223 MAGNOLIA MANOR - INMAN 425032 63 BLACKSTOCK ROAD INMAN SC 29349 2010-11-17 164 D     JNTL11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on observation, interview, and review of facility protocol entitled "Survey Readiness", the facility failed to provide privacy to 1 of 3 residents observed for wound care and 1 resident randomly observed in the bathroom during the same wound care procedure. Resident # 3 was exposed during wound care to the buttock when a Certified Nursing Assistant (CNA) entered the room without knocking. The Licensed Practical Nurse (LPN) entered an occupied bathroom without knocking during this same treatment. The findings included: The facility admitted Resident #3 on 6/23/10 with a [DIAGNOSES REDACTED]. During observation of wound treatment for [REDACTED].#3 entered the room through the closed bathroom door without knocking, left the bathroom door open while she got the lift and then left the room through the same bathroom door. The wound care treatment was in progress with Resident #3's buttock exposed and the privacy curtain was not pulled at the foot of the bed. During observation of the same wound treatment for [REDACTED].#3 entered the bathroom to wash her hands and did not knock. A resident was using the bathroom at the time when the nurse entered without knocking. During an interview with LPN #3 on 11-17-10 at 12:40 PM, the nurse verified that she did enter the occupied bathroom without knocking. She also verified that CNA #3 entered the room without knocking while Resident #3 was exposed. On 11-17-10 at 1:05 PM, the Staff Development Coordinator (SDC) provided a document entitled "Survey Readiness" which stated: "Remember Privacy: Knock on each door, close the door, pull the privacy curtain, and close the blinds." The SDC stated that she goes over this information with new hires and periodically as needed. During a discussion with the Director of Nursing (DON) related to privacy issues identified during treatments on 11-17-10 at 1:00 PM, the DON said she had in-serviced the staff on closing blinds, pulling curtains around the bed, and closing and knocking on doors. She stated she did not recall specifically addressing bathroom doors. 2014-03-01
10224 MAGNOLIA MANOR - INMAN 425032 63 BLACKSTOCK ROAD INMAN SC 29349 2010-11-17 315 D     JNTL11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on observation, interview, record review, review of the facility policy entitled "Suprapubic Catheter Care", and review of the training manual "Assisting in Long Term Care, Second Edition", the facility failed to provide appropriate treatment and services to prevent Urinary Tract Infections for 2 of 4 sampled residents reviewed with indwelling catheters. Resident #3 had the catheter anchored inappropriately during catheter care causing a potential for trauma. Resident # 14's catheter tubing was on the floor throughout catheter care observation. The findings included: The facility admitted Resident #3 on 6/23/10 with a [DIAGNOSES REDACTED]. On 11-17-10 at 10:45 AM during observation of suprapubic catheter care for Resident # 3, Licensed Practical Nurse (LPN) #3 anchored the catheter tubing approximately 4 inches away from the insertion site and cleansed the tubing from the insertion site in an outward motion causing potential trauma. Review of the facility policy entitled "Suprapubic Catheter Care" step # 12 stated: 'With the third wipe, clean the catheter tubing about 4 inches, while holding the catheter securely." The facility admitted Resident # 14 on 6/12/09 with [DIAGNOSES REDACTED]. During observation of suprapubic catheter care by Registered Nurse (RN) # 5 on 11-17-10 at 10:30 AM, the catheter tubing was noted to be lying on the floor upon entering the room and remained there during the entire procedure. After completion of the procedure, RN #5 was questioned about the cloudy character of the urine. The nurse stated that the resident was currently being treated for [REDACTED]. Record review revealed a Physician's Telephone Order dated 11/14/10 which stated: "Keflex 250 mg. (milligrams) po (by mouth) TID (three times daily) X 10 days for positive urinalysis." RN # 5 confirmed that the tubing was on the floor during an interview held on 11-17-10 at 12:30 PM. The nurse verified that she was aware that the tubing should be positioned off the floor to prevent infection. Review of "Assisting in Long Term Care, second edition", page 390 stated "The drainage bag or tubing must never touch the floor." 2014-03-01
10225 J F HAWKINS NURSING HOME 425035 1330 KINARD STREET NEWBERRY SC 29108 2010-11-18 225 D     PITJ11 On the day of the inspection, based on record review and review of facility files, the facility failed to ensure that all allegations of neglect were reported within twenty-four hours to the State survey and certification agency for 1 of 1 allegation of neglect reported (Resident #1). The findings included: On 10/22/10, after Resident #1 complained of pain in her right ankle, the physician found a dressing dated 9/27/10 on her ankle. The dressing had originally covered a callus. When the physician removed the dressing, he found the resident's ankle red and swollen with an open and infected ulcer. Review of the medical record revealed the resident was to have a DuoDerm dressing to the site, changed every three days. The facility reported this allegation of neglect to the State survey and certification agency on 10/25/10, which exceeded the twenty-four hours allowed. 2014-03-01
10226 J F HAWKINS NURSING HOME 425035 1330 KINARD STREET NEWBERRY SC 29108 2010-11-18 281 G     PITJ11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the day of the inspection, based on record review, interviews, and review of facility files, the facility failed to ensure that services provided by the facility met professional standards of quality for 1 of 1 resident who developed redness, swelling, pain, and an open area under a [MEDICATION NAME] dressing that was not changed for 23 days (Resident #1). Facility staff failed to ensure the resident's treatment order was carried forward to the new month, and failed to thoroughly assess and accurately document the resident's changing skin condition. The findings included: Resident #1 with [DIAGNOSES REDACTED]. The physician found an occlusive dressing on the right lateral ankle dated 09/27/10. There was pus underlying the dressing and an infected open area measuring 1 X 1 cm (centimeter) surrounded by a 3 by 3 cm area of [MEDICAL CONDITION]. The physician ordered wet to dry dressings, and antibiotic treatment with [MEDICATION NAME] 250 milligrams three times a day for ten days. Review of the medical record and the facility's investigative materials revealed none of the staff providing care to the resident (five nurses and thirteen nursing assistants), from 9/27/10 to 10/22/10, noticed the unchanged dressing and the developing decline in the resident's skin condition. CNAs (Certified Nursing Assistants) doing daily skin inspections noted the resident's skin was "clear." Licensed staff documented on the weekly body audits that the resident had a callus on her right ankle. The licensed staff failed to update the monthly cumulative orders for October 2010 to show the dressing change order for DuoDerm to the right ankle every three days. This order was initiated on 6/30/10. Licensed staff failed to realize the omission of the order and therefore, failed to provide the resident with the treatment. The staff also failed to provide the appropriate care and ongoing assessment required to manage the resident's skin care. Cross refer to F-314 related to the facility's failure to assess the resident and failure to provide care and services to prevent development of an open area and infection of the site. 2014-03-01
10227 J F HAWKINS NURSING HOME 425035 1330 KINARD STREET NEWBERRY SC 29108 2010-11-18 314 G     PITJ11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the day of the inspection, based on record review and interview, the facility failed to ensure that a resident received treatment to promote healing, prevent infection, and prevent new sores from developing for 1 of 1 resident reviewed who developed an infected sore when facility staff left a protective dressing in place from 9/27/10 to 10/22/10 (Resident #1). The resident did not have her dressing changed because the treatment order was omitted from the October 2010 orders and treatment record. Facility staff failed to recognize the omission. As the resident's ankle declined in condition, the staff failed to thoroughly assess and accurately document her condition in the medical record. The daily skin inspection and weekly body audit documentation showed no changes in the condition of the resident's ankle. These failures lead to a lack of appropriate interventions. The findings included: Resident #1 with [DIAGNOSES REDACTED]. The physician's progress note, dated 10/22/10 and signed on 11/18/10, stated he found an occlusive dressing on the right lateral ankle "which was dated 09/27 and had pus underlying the dressing." Under the dressing was "a 3 X 3 cm (centimeter) stage 2 ulceration and a 1 X 1 cm stage 3 ulceration with surrounding [MEDICAL CONDITION]." The physician ordered wet to dry dressings, and antibiotic treatment with [MEDICATION NAME] 250 milligrams three times a day for ten days. According to the physician's progress note, it was his understanding the Wound Care team was assessing this wound at least weekly. The physician wanted to know why the dressing had "apparently not been changed for 23 days." He showed the wound to the Unit Manager and wanted to know why the dressing had not been changed. The facility began an investigation to answer the physician's questions. Review of the medical record revealed the resident had an ulcer on her right lateral ankle in February 2010. The pressure ulcer was treated with antibiotics for two weeks and wet to dry dressings for one month. The ulcer healed. Review of the medical record revealed the resident had [MEDICATION NAME] cream applied to her knees twice a day by the licensed staff. Review of the Nurse's Notes showed the resident complained of pain in the right outer ankle on 5/8/10 while receiving her treatment to her knees. The nurse observed a raw area on the ankle and applied barrier ointment. The resident continued to sporadically complain of pain in her ankle. On 5/23/10, a hard callus was observed on the right outer ankle with no open area or redness. On 6/30/10, the physician ordered "Duoderm patch applied to (R) lateral ankle every 3 days" for treatment. He also ordered padded boots. Review of the physician's progress note of 9/25/10 showed no evidence of a pressure ulcer on the resident's right lateral ankle. Review of the C.N.A. (Certified Nursing Assistant) Daily Skin Inspection Record showed "clear" results for September 1 - 31, and for 10/1 - 22/10. Review of the Body & Skin Audits done by the licensed staff showed results of "callus to R ankle " on 9/1/10, 9/8/10, 9/15/10, and 9/22/10. The body audit on 9/29/10 revealed a checkmark next to "Red/Broken Areas" under the heading ANKLES. The word Red was circled and a handwritten note "(R) ankle Tx (treatment) in progress" was to the side. The body audit on 10/6/10 showed "callus to (R) ankle." On 10/13/10, the audit showed a checkmark by "normal" under the heading ANKLES with a noted under "Abnormal Explanation:" stating "callus to (R) ankle - tx in process." The body audit of 10/20/10 showed "normal" ANKLES with "callus to (R) ankle" written next to that finding. Review of the Nurse's Notes revealed no documentation of the discovery of the ankle ulcer on 10/22/10. The nurse's entry stated the physician made rounds and ordered new treatment. There was no description of the area or notation of the old dressing found on the resident's ankle. Review of the Skin Condition Report showed documentation beginning on 10/22/10 for a right outer ankle ulcer measuring 1.2 cm by 2 cm with a light amount of serous foul smelling drainage. The surrounding area was red, warm, swollen, and tender to touch. Documentation on 10/27/10 showed the resident was in less pain. The ulcer measured 1 by 0.8 cm. No swelling was noted but a slight amount of serous drainage continued. On 11/5/10, the ulcer measured 1 by 1 cm. Treatment was changed to using Santyl daily. The Skin Condition Report for 11/10/10 showed the resident's ulcer was 1.5 by 1.5 cm with a central area measuring 0.8 by 0.8 cm. Review of the Weekly Wound Tracking Worksheet showed the resident's wound was designated an open callus. The physician's progress note of 10/22/10 designated the wound a pressure ulcer. An interview with LPN #1 on 11/18/10 at 12:15 PM revealed she was on duty but was not the resident's assigned caregiver on 10/22/10 when the physician saw the resident. The physician called her over to the resident and asked what type of dressing was on the ankle and what date was on the dressing. The LPN went to the Documentation Record for treatments and did not see any treatment corresponding to the dressing on the resident's ankle. She observed that the dressing had bubbled. The dressing was dated 9/27 and had initials written on it. The resident's foot was swollen and red. After the physician removed the dressing, she saw an open ulcer measuring approximately 1 cm in diameter. An observation of the resident's pressure ulcer on 11/18/10 revealed a sore measuring approximately 1.5 by 1.5 cm with a central area of approximately 0.8 by 0.8 cm. covered with slough. The surrounding skin was darkened in an area approximately 4 centimeters round. There was no swelling, redness, or drainage noted. The resident briefly complained of pain when her ankle was touched and then lay quietly in between manipulations. The facility's investigation found that the resident's direct caregivers failed to accurately document her skin condition on the nursing assistant daily skin inspection and on the weekly body audits. An LPN had signed for the [MEDICATION NAME] treatment as being done on 9/30/10. During the investigation the LPN revealed the resident had refused it and she failed to circle her initials indicating the treatment was not done. The facility's investigation also showed that the treatment order was not carried forward to the October 2010 cumulative orders. Three nurses did body audits, one nurse checked the monthly orders, one nurse signed for a treatment that was not done, and thirteen nursing assistants provided direct care to the resident in the time span of 9/27/10 to 10/22/10. The nurses were terminated and the nursing assistants were all given final warnings. An interview with the Director of Nurses (DON) on 11/18/10 at 11:45 AM revealed night shift nurses were assigned to do resident body audits. The verification of monthly orders in preparation for a new month was assigned to different nurses for completion. When the DON interviewed her staff for the investigation, the nurses said they did the body audits but "didn't see" the dated dressing on the resident's ankle. The nurses also stated they did the treatments listed on the Documentation Record and did not recall the resident had a treatment to her ankle. CNAs told the DON that they "didn't see it" when she asked them about the resident's ankle. Some of the CNAs said the resident's foot was red and she complained of pain. They would tell the nurse and assumed the nurse provided medication for the pain. The DON was asked about the Wound Team. She stated the Unit Managers assessed wounds on a weekly basis and then met with the DON to report. When asked how the Unit Manager missed Resident #1's dressing, the DON stated that the resident's area was not a pressure ulcer but a callus, so the Unit Manager would not have assessed it. 2014-03-01
10228 J F HAWKINS NURSING HOME 425035 1330 KINARD STREET NEWBERRY SC 29108 2010-11-18 514 G     PITJ11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the day of the inspection, based on record review, the facility failed to ensure medical records were complete and accurately documented for 1 of 1 resident who developed an infected open area under a [MEDICATION NAME] dressing that was not changed for 23 days (Resident #1). On 11/18/10, the physician's progress note of 10/22/10 was not on the record. Facility staff failed to ensure monthly cumulative orders were complete related to treatments ordered, and failed to accurately document the resident's changing skin condition. The findings included: Resident #1 with [DIAGNOSES REDACTED]. On 10/22/10, the resident complained to the physician of pain in her ankle. While examining the resident, the physician found a DuoDerm dressing on the ankle 9/27/10. Under the dressing was an open and infected ulcer. Review of the resident's medical record on the morning of 11/18/10 failed to show a physician progress notes [REDACTED]. The physician signed and sent his progress note for 10/22/10 via facsimile on the afternoon of 11/18/10. Review of the Nurse's Notes for 10/22/10 showed no descriptive documentation of the resident's right ankle. The redness, swelling, and open area found by the physician was not included in the nurse's note. The pressure ulcer's characteristics were documented in the Skin Condition Report, but other than the physician's progress note, the medical record did not show that a dressing dated 9/27/10 was found on the resident on 10/22/10. Facility staff failed to note the omission of the DuoDerm treatment order on the printed cumulative orders for October 2010. Therefore, the order was not listed on the Documentation Sheet for treatments and the resident did not receive the DuoDerm treatment 10/1-22/10. Review of the CNA Daily Skin Inspection Record and the Body & Skin Audits done by the nurses on a weekly basis revealed documentation for September 2010 and up to October 22, 2010 showing no changes in the resident's condition although she was developed swelling, redness, pain, and an open area under the [MEDICATION NAME] dressing on her outer right ankle. 2014-03-01
10229 C M TUCKER NURSING CARE CENTER / STONE & FEWELL 425074 2200 HARDEN STREET COLUMBIA SC 29203 2010-11-30 225 D     5NE411 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the complaint inspection based on record review, interviews, and review of the facility's policy on Abuse and Neglect, the facility failed to provide evidence that an incident involving the care of Resident #1 was thoroughly investigate. The facility failed to interview and obtain witness statements from the Certified Nursing Aide (CNA) assigned to Resident #1 at the time of the incident and the Registered Nurse (RN) on duty at the time of the incident; Resident #2's family's concern about his eye was not investigated and reported to the state agency. (2 of 5 sampled residents reviewed). The findings included: The facility admitted Resident #1 on 5/12/2010 with [DIAGNOSES REDACTED]. Review of the Nurses' Note dated 11/08/2010 at 10:40 AM stated, "Called to room Resident on floor matt with laceration to right forehead measuring 1.5 cm (centimeters)..." Review of the facility investigation file revealed a facility accident/incident report dated 11/08/2010 at 11:22 AM Section One: To be completed by person reporting/witnessing the incident. CNA #1 described the incident as follows: "staff turn back and res (resident) rolled over and hit head on closet. Section Two: To be completed by a licensed nurse dated 11/08/2010 at 1500 under Corrective/preventive measures RN #1 stated, "Resident receiving AM care staff turned and resident rolled OOB (out of bed) struck head on closet. Orders written to pad closet and nightstand to prevent this type of injury. Matts were on floor..." The facility investigation included incident witness statements from three staff members who stated they were unaware of the incident; there were no credentials/job titles to identify the three witnesses. The facility failed to obtain interview statements from CNA #1 and RN #1. In an interview on 11/17/2010 at 10:40 AM the Director of Nurses confirmed there were no witness statements completed by CNA #1 and RN #1. The facility admitted Resident #2 on 11/29/2004 with [DIAGNOSES REDACTED]. Record review revealed a Quarterly MDS (Minimum Data Set) dated 9/21/2010 that indicated the resident had memory problems and impaired cognitive daily decision making skills. A nurse's note dated 7/03/2010 at 11:50 PM Late entry for 5:15 P (M) stated, "Summoned to resident ' s room by resident's daughter who stated that her father's (R) (right) eye was stuck in the corner and that it looks as though some one had struck him in the eye. Resident's daughter preceded to say that her aunt, resident's sister had called her and told her that someone had struck resident in the eye..." A nurses' note dated 7/04/2010 at 1:10 PM stated, "Resident's wife called this afternoon regarding Resident's (R) eye. She said that her sister-n-law told her that Mr. --- eye appeared to be stuck in the (R) corner and that it appeared red and swollen. She wanted to know if resident had fallen or if he was hit in the eye..." The facility was unable to show that the family's concern about Resident #2's eye was investigated and reported to the state agency. 2014-03-01
10230 C M TUCKER NURSING CARE CENTER / STONE & FEWELL 425074 2200 HARDEN STREET COLUMBIA SC 29203 2010-11-30 282 G     5NE411 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the complaint inspection, based on record review and interviews the facility failed to ensure that care plans were followed for 1 of 5 sampled residents reviewed. Resident #1 care planned as a total assist with two care givers with bathing, dressing and grooming, was injured on 11/08/2010 when Certified Nurse Aide #1 provided care unassisted. The findings included: The facility admitted Resident #1 on 5/12/2010 with [DIAGNOSES REDACTED]. Review of the Quarterly Minimum Data Set ((MDS) dated [DATE] and 11/04/2010 coded the resident as having short and long-term memory problems with moderately impaired cognitive skills for daily decision-making. The MDS coded the resident as being totally dependent on staff for transfer, hygiene and dressing. Review of the Nurses' Note dated 11/08/2010 at 10:40 AM stated, "Called to room Resident on floor matt (sic) with laceration to right forehead measuring 1.5 cm (centimeters)..." Review of the care plan with a start dated of 05/31/2010 identified as Problem #6 "Self care deficit r/t (related to) Alzheimer's dementia with inability to follow directions, impaired mobility..." Interventions included, "1. Requires total assistance of two care givers with bathing, dressing and grooming needs..." In an interview with the surveyor on 11/17/2010 at 10:05 AM Certified Nurse Aide (CNA) #1 stated that on 11/08/2010 Resident #1 rolled over and fell from the bed when she turned around "to grab things" while providing care. CNA #1 stated, "I turned away for a few seconds and the resident rolled out of bed." CNA #1 stated she was the only CNA providing care. In an interview with the surveyor on 11/17/2010 at 10:20 AM Registered Nurse (RN) #1 stated that when he entered the room the resident was lying in bed on he back and he noted an injury to the right side of the resident's forehead. RN #1 stated that CNA #1 told him she went to the closet and the resident fell . RN #1 stated that CNA #1 was the only CNA providing care for the resident at the time of the incident. 2014-03-01
10231 C M TUCKER NURSING CARE CENTER / STONE & FEWELL 425074 2200 HARDEN STREET COLUMBIA SC 29203 2010-11-30 323 G     5NE411 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the complaint inspection, based on observations, record review and interviews the facility failed to ensure that Resident #1's environment remains as free of accident hazards as possible. Resident #1 injured on 11/08/2010 when a Certified Nurse Aide (CNA) bathed him alone, was care planned to have two people with bathing. The review of the Nursing Guide To Care sheet, the CNA care guide, dated 10/01/2010 did not include the number of caregivers required for care. Following the injury the care plan was updated on 11/09/2010 to include padded edges to the nightstand and closet, observation on 11/17/2010 revealed no padded edges. The findings included: The facility admitted Resident #1 on 5/12/2010 with [DIAGNOSES REDACTED]. Review of the Quarterly Minimum Data Set ((MDS) dated [DATE] and 11/04/2010 coded the resident as having short and long-term memory problems with moderately impaired cognitive skills for daily decision-making. The MDS coded the resident as being totally dependent on staff for transfer, hygiene and dressing. Review of the Nurses' Note dated 11/08/2010 at 10:40 AM stated, "Called to room Resident on floor matt (sic) with laceration to right forehead measuring 1.5 cm (centimeters)..." Review of the care plan with a start dated of 05/31/2010 identified as Problem #6 "Self care deficit r/t (related to) Alzheimer's dementia with inability to follow directions, impaired mobility..." Interventions included, "1. Requires total assistance of two care givers with bathing, dressing and grooming needs..." On 11/09/2010 the care plan was updated with an intervention to include "Pad night stand and closet." Review of the Nursing Guide To Care sheet, the CNA care guide, dated 10/01/2010 did not include the number of caregivers required for care. In an interview with the surveyor on 11/17/2010 at 10:05 AM Certified Nurse Aide (CNA) #1 stated that on 11/08/2010 Resident #1 rolled over and fell from the bed when she turned around "to grab things" while providing care. CNA #1 stated, "I turned away for a few seconds and the resident rolled out of bed. CNA #1 stated she was the only CNA providing care. In an interview with the surveyor on 11/30/2010 CNA #1 stated that she was not aware that two people were needed when providing care. She stated that she used the Nursing Guide to Care sheet, which did not address how many people were needed to provide care. In an interview with the surveyor on 11/17/2010 at 10:20 AM Registered Nurse (RN) #1 stated that when he entered the room the resident was lying in bed on he back and he noted an injury to the right side of the resident's forehead. RN #1 stated that CNA #1 told him she went to the closet and the resident fell . RN #1 stated that CNA #1 was the only CNA providing care for the resident at the time of the incident. RN #1 stated he was not aware that the resident was a two-person assist. An observation on 11/17/2010 at 10:00 AM revealed the closet edges were not padded as ordered; at 10:40 AM the Director of Nurses confirmed that the closet edges were not padded appropriately. 2014-03-01
10232 UNIHEALTH POST ACUTE CARE - AIKEN, LLC 425145 830 LAURENS STREET NORTH AIKEN SC 29801 2010-11-22 153 G     6LCC11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the inspection, based on record review and interviews, the facility failed to provide access to all medical records for 1 of 4 residents sampled for the request of medical records (Resident #1). A written request made by the wife (personal representative) of Resident #1 made initially to the facility on [DATE] and then again on [DATE] was denied. The Regional Ombudsman, after numerous attempts to assist the resident's wife in obtaining the medical records of Resident #1, filed a complaint with the State Survey Agency on [DATE]. Nurses' Notes documented that the facility notified Resident #1's wife with any change in condition and acknowledged her as his personal representative. The facility failed to acknowledge the Health Care Consent Act (SC Code [DATE] et. esq.) and failed to recognize Resident #1's wife as his personal representative when she requested copies of his medical record. The findings included: On [DATE] the facility admitted Resident #1 with [DIAGNOSES REDACTED]. Review of the Admission Minimum Data Set (MDS) assessment dated [DATE] and Quarterly MDS assessment dated [DATE] coded the resident as having short-term and long-term memory problems with severely impaired cognitive skills for daily decision-making. Resident #1 required extensive to total assistance for all activities of daily living on the Admission and Quarterly MDS. Review of the current medical record revealed a Do Not Resuscitate (DNR) Authorization for Patient/Resident Without Decision-Making Capacity for Resident #1 signed [DATE] by two physicians and by the resident's wife ([DATE]). During an onsite visit to the facility on [DATE], Resident #1 was sampled as a result of a complaint received by the State Agency on [DATE]/2010, which alleged that the resident's wife failed to receive requested medical records. The allegation stated that the Ombudsman had worked since [DATE] to resolve a complaint filed against the facility related to the denial of requested copies of the medical record. Review of the current medical record indicated that on [DATE] the resident's wife signed a facility provided Authorization for Use & Disclosure of Information form requesting records for her husband (Resident #1) from "[DATE] - Present for personal purposes". On [DATE] Resident #1's wife received a letter from a representative of the facility, which stated, "...regarding your request for the above mentioned patients' medical records. As you are aware, the Health Insurance Portability and Accountability Act and the privacy regulations promulgated there under (collectively, "HIPPAA") has imposed strict requirements on health care providers regarding the release of protected health information ("PHI"). Under HIPPAA, a provider may disclose an individual's PHI to a personal representative who under state law has authority to act on behalf of the individual. See 45 CFR 164.502(g)(1), 164.514(h)(1)(i). Further, HIPPAA requires that the provider verify the identity of the personal representative and that person's authority to access PHI as a personal representative. See 45 CFR... Such a personal representative may be a durable power of attorney for health care or guardian of the person if the individual is living, or the permanent administrator or executor of the state if the individual is deceased . The Advance Directive provided to the facility does not provide the proper authority. The center will not be able to release these records until it receives verification of the applicable representation..." Information provided by the Ombudsman revealed a letter to Resident #1's wife dated [DATE] in which she was advised of her rights under the Health Care Consent Act (SC Code [DATE] et. esq.). A letter to the facility dated [DATE] from the Ombudsman was also provided, which included the following statement, "...I will meet with Resident #1's wife in the morning to visually inspect the medical record and from there will assist as needed in identifying the records she wants copied for her personal use." On [DATE] Resident #1's wife signed another Authorization for Use & Disclosure of Information form requesting records "from date of admission to present: nurses notes, skin asst. (assessments)/body audits, Soc (social) Services notes, all physical therapy, speech therapy, care plans" for personal use. Review of the Health Care Consent Act (SC Code [DATE] et. esq.) Section [DATE] states, "Persons who may make health care decisions for patient who is unable to consent; order of priority; exceptions. (A) Where a patient is unable to consent, decisions concerning his health care may be made by the following persons in the following order of priority: (1) a guardian appointed by the court pursuant to Article 5, Part 3 of the South Carolina Probate Code, it the decision is within the scope of the guardianship; (2) an attorney-in-fact appointed by the patient in a durable power of attorney executed pursuant to Section [DATE], if the decision is within the scope of his authority; (3) a person given priority to make health care decisions for the patient by another statutory provision; (4) a spouse of the patient..." Resident #1's spouse is his personal representative and per the Health Care Consent Act is the person who makes health care decisions for him. In a telephone interview with the facility on [DATE] the facility stated that this was a HIPPA concern and they would not release information to Resident #1's wife for "personal use" and that the wife would have to complete the request to list specific information and the purpose of the use of the information. In an interview with the surveyor on [DATE] the Ombudsman stated that she met with Resident #1's wife at the facility on [DATE] in order to review Resident #1's medical record during a care plan meeting. A verbal review was conducted of the medical record with the Administrator, Social Worker, Director of Health Services, Senior Care Partner and Speech Therapist present along with Resident #1's wife and the Ombudsman. Following the verbal review Resident #1's wife and the Ombudsman looked at the record page by page to determine what she wanted copied. When asked if the resident's wife filled out the authorization form, the Ombudsman stated that the facility staff completed the Authorization for Use & Disclosure of Information form and the resident's wife initialed and signed where needed. At no time did the facility staff give any instructions to the resident's wife regarding how to fill out the form. At the time of the survey Resident #1's wife had not received the requested copies of her husband's medical record. 2014-03-01
10233 MAGNOLIA MANOR - ROCK HILL 425165 127 MURRAH DR ROCK HILL SC 29732 2010-11-23 225 D     FIPL11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the day of the complaint inspection based on record review, interview, the facility's "Patient/Resident Incident/Accident Investigation Worksheet" and review of the facility's policy on Abuse and Neglect, the facility failed to report injuries of unknown origin to the State survey and certification agency related to Resident #1. Resident #1 with injuries of unknown origin; a bruise to her right lower jaw on 10/27/2010 and a bruise to her left knee/leg on 11/04/2010 that were not reported to the state agency. (1 of 3 sampled residents reviewed) The findings included: The facility admitted Resident #1 on 5/09/1907 with [DIAGNOSES REDACTED]. Review of the medical record revealed a Quarterly Minimum Data Set ((MDS) dated [DATE] that indicated the resident had short and long-term memory problems with severely impaired cognitive skills for daily decision-making. Range of motion showed limitation on both side for neck, arm, hands and leg with partial voluntary movement. Review of a 10/27/2010 "Patient/Resident Incident/Accident Investigation Worksheet" indicated "2 cm (centimeter) bruise noted to RT (right) v (lower) jaw. doesn't flinch when touch. Unable to communicate to tell what happened D/T (due to) mentality." Review of an 11/04/10 "Patient/Resident Incident/Accident Investigation Worksheet" indicated "8 AM called to Room CNA (Certified Nurse Aide) states every time I move her left leg she hollers. In to exam Resident noted to have light purple bruise appx (approximately) 3x (times) 3 in (inches) area (just above left outer knee)..." In an interview with the surveyor on 11/23/2010 at 11:50 AM the Director of Nursing (DON) revealed she did not report the 10/27/2010 or the 11/04/2010 incidents to State survey and certification agency. An interview on 11/23/10 at 12: 20 PM with the Interim Administrator revealed the unwitnessed incidents were not reported because he believed the facility had within 24 hours to determine the cause of the incident. 2014-03-01