cms_AK: 47
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| rowid | facility_name | facility_id | address | city | state | zip | inspection_date | deficiency_tag | scope_severity | complaint | standard | eventid | inspection_text | filedate |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 47 | WRANGELL MEDICAL CENTER LTC | 25015 | P.O. BOX 1081 | WRANGELL | AK | 99929 | 2019-04-24 | 657 | F | 0 | 1 | FNNN11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, record review and observation the facility failed to ensure resident care plans were reviewed and revised based on MDS (Minimum Data Set - A federally required nursing assessment) assessments for 6 residents (#1, 3, 8, 9, 10, 11), out of 8 sampled residents. This failed practice placed the residents at risk for not receiving care/services to maintain the highest practicable mental, physical, and psychosocial well-being. Findings: Care Plan Reviews and Revision Process: During an interview on 4/16/19 at 10:00 am, Registered Nurse (RN) #1 stated the most recent care plans for residents were kept in a binder in the dining room/common area of the unit for staff to review when providing care to the residents During an interview on 4/16/19 at 2:00 pm, RN #1 stated that care plans were reviewed and revised by the MDS Coordinator. During an interview on 4/17/19 at 8:50 am, the MDS Coordinator stated care plans were reviewed during quarterly MDS reviews or when a significant change occured. The start date on the care plan identified problems and interventions indicated the date of the MDS finalization or when the problem was identified. The review date indicated when the next quarterly MDS was due and when the problem, goals, and interventions needed to be evaluated. The MDS Coordinator further stated changes would be made based on that quarterly review, or if any changes had come to light based on the resident's care. He/she stated the review dates for all categories identified in the care plan should move forward, to the next scheduled assessment date of the MDS quarterly review or MDS assessment, to show they remain active and up to date. Observation on 4/17/19 at 3:30 pm revealed Resident care plans were placed in a binder located in the common area of the unit. Sticky notes were placed on the care plans from all staff to share information that should be updated in the care plan. During an interview on 4/17/19 at 3:53pm, RN #1 stated the MDS Nurse used the sticky notes as guidance to update the care plans. During an interview on 4/18/19 at 12:35 pm, RN #2 stated staff were trained to go to the binder to review the care plans for the residents. Resident #1 Record review from 4/15-19/19 revealed Resident #1 was admitted to the facility with [DIAGNOSES REDACTED]. Depression/Psychoactive Drug Use/Behaviors Review of Resident #1's latest annual MDS, dated [DATE] revealed that Resident #1 was coded as having a Total Severity Score (A summary of the frequency scores that indicates the extent of potential depression symptoms) of 3 which indicated minimal depression. Further review revealed the Resident did not exhibit behavior symptoms not specifically toward others. Review of Resident #1's most recent MDS, a quarterly assessment dated [DATE] revealed that Resident #1 was coded as having a Total Severity Score of 7 which indicated mild depression. Further review revealed the Resident did exhibit behavior symptoms not specifically toward others. Record review on 4/17/19 of Resident #1's most current Medication Administration Record [REDACTED]. Record review of a physician's note dated 4/15/19 revealed the physician recommended a further dose reduction because Resident #1 reported no depressive symptoms. Review of Resident #1's care plan, start date of 6/20/18 (with an anticipated review due of 12/12/18), revealed categories of care that included at risk for loneliness/lack of social participation and the use of antidepressant medication. Interventions included a quarterly review of the behavior plan. The care plan had no indications of review or revision since the last MDS. Review of Resident #1's behavior plan revealed the last review date was 12/21/18. Falls Review of Resident #1's latest annual MDS, dated [DATE] revealed that Resident #1 was coded as using a wheelchair as a mobility device. Review of Resident #1's most recent MDS, a quarterly assessment dated [DATE] revealed that Resident #1 was coded as using a wheelchair and walker as a mobility device. In addition, the MDS coded the Resident as not having any falls since admission. During an interview on 4/16/19 at 9:56 am, Resident #1 revealed that he/she had fallen recently. Review of Resident #1's care plan, start date of 6/20/18 (with an anticipated review due of 12/12/18), revealed Resident #1 was at risk for falls. The care plan had no indications of review or revision since the last MDS. Dental During an interview on 4/16/19 at 9:49 am Resident #1 stated he/she needed to go to the dentist to have his/her dentures evaluated. He/she further stated he/she had not been using dentures but wants to go to appointment to see how they fit. Review of Resident #1's care plan, start date of 6/20/18 (with an anticipated review due of 12/12/18), revealed a category of dental. The care plan had no indications of review or revision since the last MDS. During an interview on 4/17/19 at 9:15 am, the MDS Nurse stated that he/she had not updated Resident #1's care plan for any of the identified care areas. Resident #3 Record review on 4/15-19/19 revealed Patient #3 was admitted to the facility with [DIAGNOSES REDACTED]. This includes an increased risk of violence, aggressive behavior) and physical deconditioning (a physical and psychological decline in function). A review of the most recent MDS assessment, a quarterly assessment, revealed it was completed on 3/22/19. Review of Resident #3's care plan revealed: - 1 identified problem area with a start date of 10/24/18 and an anticipated review date of 1/24/19; - 17 identified problem areas with a start date of 10/24/18 and an anticipated review date of 3/24/19; - 2 identified problem areas with a start date of 11/9/18 and an anticipated review date of 1/5/19; - 2 identified problem areas with a start date of 11/9/18 and an anticipated review date of 3/24/19; - 2 identified problem areas with a start date of 12/15/18 and an anticipated review date of 3/24/19; - 1 identified problem area with a start date of 12/24/18 and an anticipated review date of 3/24/19; and - 1 identified problem area with a start date of 12/26/18 and an anticipated review date of 3/26/19. During an interview on 4/17/19 at 9:20 am, the MDS Coordinator stated the review dates in Resident #3's care plan were not up to date. He/she further stated the goals and interventions had not been updated to reflect the 3/22/19 MDS quarterly assessment or the current interventions being provided to Resident #3. Resident #8 Record Review on 4/15-19/19 of Resident #8's medical record revealed the Resident had [DIAGNOSES REDACTED]. Care Plan Revision/Review: Review of the most recent MDS comprehensive assessment, an annual assessment dated [DATE], revealed the Resident was triggered for the areas of skin, cognitive loss/dementia, [MEDICAL CONDITION] drug use, pain, falls, visual function and activities of daily living function. Review of Resident #8's care plan revealed the triggered care areas from the most recent MDS comprehensive assessment, dated 3/19/19, were documented to have an anticipated review of 12/29/19. Further review revealed each care area had a goal dated for evaluation in (MONTH) (YEAR). Behaviors: Review of the most recent MDS comprehensive assessment, an annual assessment dated [DATE] revealed the Resident was coded as having verbal behaviors symptoms toward others and other behaviors symptoms not directed toward others. Review of Resident #8's care plan revealed a category of Cognition, with an anticipated review date of 12/29/18. In addition, the care plan goal for cognition stated .will have reduced episodes of agitation and distress through (December) (YEAR). An intervention indicated to monitor the behaviors and use behavior care plan. Further review of the intervention stated to contact the social worker with concerns related to behaviors so he/she may address it in the Resident's behavioral care plan. Review of Resident #8's behavior care plan, attached to the active comprehensive care plan, revealed the behavioral care plan had been last reviewed and/or updated on 12/21/18. During an interview on 4/17/19 at 8:55 am, the MDS Coordinator stated the facility had been without a social worker since (MONTH) 2019. Communication: Review of the most recent MDS assessment, an annual assessment dated [DATE] revealed the Resident was coded as being rarely/never understood with unclear speech. Review of Resident #8's care plan revealed a no category, goals or interventions related to communication. Bowel & Bladder: Review of the most recent MDS comprehensive assessment, an annual assessment dated [DATE], revealed the Resident was coded as always being incontinent of bowel and bladder. Review of Resident #8's care plan revealed no category specific to incontinence. However, review of the category Skin, with a review date of 12/29/18 revealed an intervention that stated the Resident was Usually incontinent of bowel and bladder. Skin: Review of the most recent MDS comprehensive assessment, an annual assessment dated [DATE], revealed the Resident was coded as always being incontinent of bowel and bladder and risk for developing pressure ulcers. Observation on 4/16/19 at 10:28 am revealed linear red irritated areas to both of Resident's inner thighs. During an interview on 4/16/19 at 11:09 am Resident's Family Member stated the Resident's inner thigh skin issue had been ongoing for approximately six months. During an interview on 4/16/19 at 12:51 am, the Director of Nursing (DON) stated the issue had been going on for several months with various interventions attempted. Review of Resident #8's care plan revealed a category of skin, with an anticipated review date of 12/29/18. Further review of care plan revealed no interventions documented for the on-going issue of skin irritation on the inner thighs of Resident #8. Resident #9 Record review from 4/15-19/19 revealed Resident #9 was admitted to the facility with [DIAGNOSES REDACTED]. Review of Resident #9's care plan, start date of 7/11/18 (with an anticipated review due of 1/2/19), revealed the Resident was at risk for impaired physical mobility, self-care deficit, alteration to skin integrity, ineffective coping skills, weight issues due to diabetes, pain, and communication deficits. Review of Resident #9's annual MDS dated [DATE] revealed Resident #9 should be care planned for ADL functional/rehabilitation potential, behavioral symptoms, nutritional status, [MEDICAL CONDITION] drug use, and pain. Behaviors (Anxiety) Record review on 4/17/19 of Resident #9's MDS, a quarterly assessment dated [DATE], revealed that Resident #9 was coded as not exhibiting behavior symptoms not specifically directed toward others. Record review on 4/17/19 of Resident #9's most recent MDS, a quarterly assessment dated [DATE], revealed that Resident #9 was coded as exhibiting behavior symptoms not specifically directed toward others During an interview on 4/19/19 at 8:42 am, the DON stated that Resident #9 has a number of challenging behaviors and multiple non-pharmacological interventions have been tried to meet the Resident's needs. Review of Resident #9's behavior plan revealed the last revision/review date was 12/18/19. Review of Resident #9's care plan, start date of 7/11/18 (with an anticipated review due of 1/2/19), revealed a category of anxiety. The care plan had no indications of review or revision since the last MDS. Pain Record review on 4/17/19 of Resident #9's MDS, a quarterly assessment dated [DATE], revealed that Resident #9 was coded as experiencing pain frequently. Record review on 4/17/19 of Resident #9's most recent MDS, a quarterly assessment dated [DATE], revealed that Resident #9 was coded as experiencing pain almost constantly. During an interview on 4/15/19 at 3:12 pm, Resident #9 stated that he/she had chronic pain and takes Tylenol #3 (Tylenol with a narcotic combination) or Tylenol for pain. Record review on 4/18/19 at 10:47 am of the physician's orders [REDACTED].#9 is on [MEDICATION NAME] for neuralgia (nerve pain) and Tylenol #3 for pain. Review of Resident #9's care plan, start date of 7/11/18 (with an anticipated review due of 1/2/19), revealed a category of pain. The care plan had no indications of review or revision since the last MDS. During an interview on 4/17/19, the MDS Coordinator stated he/she had not updated Resident #9's care plan for any of the identified care areas. Resident #10 Record review on 4/15-19/19 revealed Resident #10 was admitted to the facility with [DIAGNOSES REDACTED]. Record review revealed Quarterly MDS assessments were completed on 10/18/18 and 1/11/19; and a significant change MDS assessment was completed on 4/3/19. Review of Resident #10's current care plan revealed a start date of 8/8/18 with an anticipated review date of 11/8/18. During an interview on 4/17/19 at 3:53pm, RN #1 stated Resident #10's care plan, dated 8/8/18, was the most recent care plan that staff used to guide Resident #10's care. Falls/Activities of Daily Living/Bed alarm: Review of the most recent quarterly MDS, dated [DATE], revealed Resident used bed alarm daily, required limited assistance with ambulation, transfer, and locomotion on the unit. Review of the most recent MDS, a significant change assessment, dated 4/3/19, revealed Resident used bed alarm daily, required extensive assistance with ambulation, transfer, and locomotion on the unit. Random observations from 4/15-19/19 revealed a bed alarm (an alarm to alert staff of Resident movement) was located on Resident #10's bed. Staff responded to the Resident when the alarm sounded. During an interview on 4/16/19 at 9:00 am, CNA #1 stated he/she was not sure if the bed alarm was effective to prevent falls and the Resident gets up on (his/her) own and is wobbly. During an interview on 4/19/19 at 12:38 pm, the MDS Coordinator stated the bed alarm interventions had not been updated on the paper copy that was used by direct care staff. Review of Resident #10's current care plan, with a start date of 8/8/18 (and an anticipated review date of 11/8/18, revealed categories of activities of daily living, mobility and falls. The care plan had no indication of revision or review since the previous two MDS assessments. Diet: Review of the most recent quarterly MDS, dated [DATE], revealed Resident was coded as having weight gain that was not a result of a physician-prescribed weight-gain regimen. Review of the most recent MDS, a significant change assessment, dated 4/3/19, revealed Resident was coded as not having any weight gain. Review of LTC/SB Physician Orders, dated 4/9/19 at 1:00 pm, revealed Diet Change: Mechanical Soft, thin liquids with dysphagia (difficulty swallowing). Review of Resident #10's current care plan, dated 8/8/2018, revealed no documentation regarding a dysphagia problem or an intervention for a mechanical soft diet. Review of Resident #10's current care plan, with a start date of 8/8/18 (and an anticipated review date of 11/8/18, revealed a category of nutrition. Further review revealed no documentation regarding a dysphagia problem or an intervention for a mechanical soft diet. The care plan had no indication of revision or review since the previous two MDS assessments. Wound: Review of the most recent quarterly MDS, dated [DATE], revealed Resident was coded having no unhealed pressure ulcers. Review of the most recent MDS, a significant change assessment, dated 4/3/19, revealed Resident was coded as having one unhealed stage II pressure ulcer (pressure injury to the skin that involves partial-thickness skin loss with exposed under skin layers. Wound is pink or red, moist, and may be intact or a ruptured serum-filled blister) that was to be addressed in the care plan. Review of LTC/SB Physician Orders, dated 1/28/19 at 9:45 am, revealed Daily dressing change with localized to left foot wound . Review of LTC/SB Physician Orders, dated 3/19/19 at 11:00 am, revealed Wound care consult- Decubitus (pressure) ulcer Rt (Right) foot. Observation of Resident #10's wound care on 4/15/19, at 2:20 pm, revealed decubitus ulcers (a wound caused by pressure) to the right great toe and the left foot. Review of Resident #10's current care plan, with a start date of 8/8/18 (and an anticipated review date of 11/8/18), revealed no documentation regarding wounds or ulcerations to feet. Further review revealed no interventions for dressing changes or pain management related to the foot wounds. The care plan had no indication of revision or review since the previous two MDS assessments. Behavior/Mood: Review of most recent MDS assessment, a significant change assessment dated [DATE], revealed Resident #10's care area assessment was coded as having behavior symptoms that was to be addressed in the care plan. 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]. (He/She) is been agitated, crying, frightened, and unconsolable. This has occurred 12 nights this month with increasing frequency. Review of LTC/SB Physician Orders, dated 3/23/19 at 8:55 pm, revealed order Strict Sleep hygiene as follows .should be exposed to sunlight as much as possible .naps should be strongly discourage during the day .(naps) should be limited to 45 minutes or less . 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. Review of Resident #10's most recent care plan, with a start date of 8/8/18 (and an anticipated review date of 11/8/18), revealed no documentation of a night time [MEDICAL CONDITION] problem or any interventions pertaining to sleep hygiene. The care plan had no indication of revision or review since the previous two MDS assessments. During an interview on 4/19/19 at 12:38, the MDS Coordinator stated the care plan dated 8/8/18 was the most recent care plan used by the staff to guide Resident #10's care. He/she further stated that care plans should be updated with significant change and quarterly MDS assessments. The MDS Coordinator also stated better care is received when the care plan was up to date. Resident #11 Record Review on 4/15-19/19 of Resident #11's medical record revealed the Resident had [DIAGNOSES REDACTED]. Review of the most recent MDS assessment, an admission assessment dated [DATE], revealed the Resident had constipation. Review of Resident #11's physician's orders [REDACTED]. Review of the Resident's Bowel Movement Details Rosters, dated 4/1-13/19 revealed a time span of 4/2/19 at 7:17 pm to 4/6/19 at 3:15 pm with no bowel movement. Review of the medication administration recorded, dated 4/1-6/19, revealed MOM was administered on 4/3/19 at 10:11 am with no result until 4/6/19 at 3:15 pm (3 days and 5 hours post administration of MOM). Review of the Resident's Bowel Movement Details Rosters, dated 4/1-13/19 revealed a time span of 4/9/19 at 9:26 am to 4/13/19 at 3:52 am with no bowel movement. Review of the medication administration recorded, dated 4/9-13/19, revealed no medication intervention was provided. During an interview on 4/17/19 at 11:24 am Resident #11's Family Member stated the resident had a history of [REDACTED]. During an interview on 4/18/19 the Pharmacy Nurse stated the two episodes of multi-day constipation were not addressed in accordance with Resident #11's physician's orders [REDACTED]. Review of Resident #11's current comprehensive care plan, with a start date of 3/14/19, revealed no category, goal or interventions pertaining to constipation. | 2020-09-01 |