cms_AK: 44
Data source: Big Local News · About: big-local-datasette
| rowid | facility_name | facility_id | address | city | state | zip | inspection_date | deficiency_tag | scope_severity | complaint | standard | eventid | inspection_text | filedate |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 44 | WRANGELL MEDICAL CENTER LTC | 25015 | P.O. BOX 1081 | WRANGELL | AK | 99929 | 2019-04-24 | 637 | D | 0 | 1 | FNNN11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observation and interview, the facility failed to identify a significant change in condition for 1 resident (#10), out of 8 sampled residents. Specifically, the facility failed to complete a significant change in status assessment for the care areas of mood and ADLs (activities of daily living), within 14 days from the time the significant change should have been identified. This failed practice placed the resident at risk for not receiving interventions and care to maintain the highest practicable level of well-being. Findings: Resident #10 Record review on 4/15-19/19 revealed Resident #10 was admitted to the facility with [DIAGNOSES REDACTED]. Mood: Review of the most recent MDS (Minimum Data Set, a federally required nursing assessment), a quarterly assessment dated [DATE], revealed Resident #10 was coded as having no trouble falling or staying asleep. Review of Resident #10's Physician Notes, dated 2/20/19 at 2:56 pm, revealed Asked to be assessed because of increasing confusion, decreasing mobility, and ongoing [MEDICAL CONDITION] .This is a mild to moderate decrease from (him/her) regular level of functioning. Review of Resident #10's Nurses Notes, dated 2/22/19 at 5:24 am, revealed Resident was restless last night. Up and down multiple times. Further review revealed Resident #10 had restlessness or yelling out on the nights of 2/10-13/19, and [MEDICAL CONDITION] on 2/26/19. Review of Nurses Notes, dated 3/6/19 at 2:49 pm, revealed Resident #10's .behavior last evening was a significant change from normal .(He/She) asked to go to the bathroom [ROOM NUMBER] times in an hour .(He/She) kept calling out that (he/she) was falling out of bed. Review of Physician Notes, dated 3/15/19 at 4:34 pm, revealed Resident #10 .had increasing difficulties with middle of the night [MEDICAL CONDITION] .This has occurred 12 nights this month with increasing frequency. During an observation on 4/15/19 at 2:20 pm, the Physician had asked Registered Nurse (RN) #1 about Resident #10's ability to sleep at night. RN #1 replied to the Physician, It's hit or miss. During an interview on 4/17/19 at 8:08 am, RN #1 stated Resident #10 had a rough night with [MEDICAL CONDITION] last night. Nutrition: Review of the Quarterly MDS assessment, dated 1/11/19, revealed Resident #10 was coded for receiving supervision and encouragement to eat, with set up help only. Review of ADL Assistance and Support, for eating during daytime, revealed Resident #10 required extensive assistance, total dependence or activity did not occur: none for (MONTH) 2019; 4 times for (MONTH) 2019; 4 times for (MONTH) 2019; and 10 times between (MONTH) 1-17/2019. Review of Nurses Notes, dated 2/24/19 at 5:06 pm, revealed Resident #10's .appetite is poor, but seems to do better eating if someone feeds her and encourages her. Review of Nurses Notes, dated 2/27/19 at 6:27 pm, revealed Resident had to be fed .due to confusion. Review of Nurses Notes, dated 2/28/19 at 2:52 pm, revealed Resident has needed increased attention during meals (total feed, direction for eating). Random Observations on 4/15-19/19 revealed Resident #10 had been fed his/her meals. ADLs: Review of ADL Assistance and Support, dated (MONTH) 2019, revealed Resident #10 required extensive assistance, total dependence or activity did not occur: 18 times for transfers; 8 times for locomotion on unit; 16 times for toilet use; and 13 times for personal hygiene. Review of ADL Assistance and Support, dated (MONTH) 2019, revealed Resident #10 required extensive assistance, total dependence or activity did not occur: 33 times for transfers; 24 times for locomotion on unit; 29 times for toilet use; and 24 times for personal hygiene. Review of ADL Assistance and Support, dated (MONTH) 2019, revealed Resident #10 required extensive assistance, total dependence or activity did not occur: 33 times for transfers; 22 times for locomotion on unit; 35 times for toilet use; and 30 times for personal hygiene. During an interview on 4/16/19 at 3:56 pm, CNA #1 stated he/she had noted a decline in Resident #10's activity of daily living since (MONTH) 2019. During an interview on 4/17/19 at 11:34 am, Resident #10's family member stated the Resident had needed more staff assistance with activities of daily living over the last 3 months. Random Observations on 4/15-19/19 revealed Resident #10 had required extensive assistance for toileting and transfers. The Resident required total dependence for locomotion on unit. During an interview on 4/18/19 at 2:00 pm, the MDS Coordinator stated he/she would have conversations with staff members and review notes to learn if a resident had a significant change. Once he/she suspected a significant change, he/she will discuss this with the interdisciplinary team. The MDS RN stated he/she was aware of a significant change with Resident #10's mood last month and wanted to give it a little more time before updating the MDS. He/she had updated the MDS on 4/3/19 due to anxiety, calling out and [MEDICAL CONDITION]. In addition, when the MDS Coordinator was handed the ADL Assistance and Support document, dated (MONTH) 2019, and asked if these numbers would trigger and significant change. The MDS Coordinator stated, Yes, that would prompt me to do a significant change (assessment). The MDS Coordinator further stated the facility had a systemic issue with charting and there needed to be a better system of communication among staff. He/she stated that a significant change assessment done in the MDS more timely would help the residents preserve their functioning. Review of the facility's policy Resident MDS Assessment and Care Planning, last updated on 6/2018, revealed All residents will have Comprehensive Assessment completed .with any Significant changes .All Residents will have an individual Plan of Care .revised as needed with subsequent assessments. | 2020-09-01 |