cms_AK: 90
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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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 90 | PROVIDENCE TRANSITIONAL CARE CENTER | 25018 | 910 COMPASSION CIRCLE | ANCHORAGE | AK | 99504 | 2017-06-22 | 315 | D | 0 | 1 | NLCD11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observation, interview and policy review the facility failed to ensure 1 resident (#1), out of 7 sampled residents, urinary incontinence was assessed for participation in an individualized toileting program to improve urinary function. This failed practice placed the resident at risk for diminished feelings of self-worth, reduced quality of life, and for a potentially unsuccessful discharge. Findings: Record review on 6/20-22/17 revealed Resident #1 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. The Resident was at the facility to receive rehabilitation for an anticipated discharge home. Continuous Observation: Observation on 6/20/17 from 7:20 am until 2:00 pm (6 hours and 40 minutes), revealed the Resident was awake, ate breakfast, went to occupational and physical therapy, returned to the unit and ate lunch. The Resident was not offered toileting or checked for incontinence during the observation. At 2:00 pm, Certified Nursing Assistant (CNA) #4 and Licensed Nurse (LN) #4 transferred the Resident to bed. After the Resident was assisted to bed the CNA checked his/her adult incontinence brief. The brief was heavily saturated with dark foul smelling urine. During an interview on 6/20/17 at 2:10 pm, when asked if he/she was able to feel the urge to void Resident #1 stated I'm not sure. Review of the Nursing Physical Examination for Resident #1, dated 4/26/17, revealed under the GU ([MEDICAL CONDITION]) section Incontinent was circled; the section where the assessing nurse was to mark the type of incontinence was not filled out. Review of the Resident's Daily Care Plan (RDCP), updated 4/26/17, revealed Toileting: Incontinent of bladder. Continent of bowel. Offer toileting in am, before and after meals, prior to rehab, and HS (bedtime) and prn (as needed) . Review of the most recent Minimum Data Set (MDS-a federally required assessment) admission assessment, dated 5/3/17, revealed the Resident required extensive assistance with transfers and was frequently incontinent of bowel and bladder. Review of the Care Area Assessment, dated 5/9/17, revealed under type of incontinence was Frequently incontinent of bladder and bowel. During an interview on 6/21/17 at 10:00 am, when asked about the facility's prompted voiding program, Nursing Supervisor (NS) #1 stated the bladder continence program was initiated by the nurse. The CNAs then documented the Resident's intake and times of voiding, after which the nurse would determine if the resident had improved or the program needed to be discontinued. The NS was asked to provide a copy of Resident #1's assessment. During a second interview on 6/21/17 at 10:25 am, the NS stated he/she was unable to find the toileting program assessment for the Resident and stated the program fell apart after the 3 days. During an interview on 6/22/17 at 4:10 pm, MDS Nurse #1 stated the CNAs were to collect 3 consecutive days of voiding data (called the CACTUS program). The Resident's primary care nurse was to assess the data and determine if the Resident was a candidate for the toileting program. During the interview, the MDS Nurse stated Resident #1's assessment for bowel and bladder continence may not have been done. Review of the documentation provided by the MDS Nurse on 6/22/17, revealed urinary voiding data from 4/26-28/17 revealed there was no assessment of the data by a nurse. In addition, the intake and voiding information from the electronic medical record CACTUS record, documented by the CNA's was missing information and did not always indicate if the Resident was offered toileting and/or a bed pan throughout the 3 day assessment period. Review of the facility policy, Bladder Continence (Prompted Voiding) Program, dated 4/11/16, revealed Patient is candidate for bladder training Admission or Clinical Supervisor/ MDS nurse initiates assessment of prompted voiding for 3 days utilizing cactus worksheet .1. Monitor that CNA is doing prompted voiding program while patient (resident) awake. 2. pass on information to Clinical Supervisor/MDS Nurse .after 3 days of consistent CACTUS assessment, pass on the information and forms to MDS Nurse/Clinical supervisor .Patient is excluded from bladder training . 1. writes check and change on the RDCP (resident daily care plan) 2. If the patient has refused bladder training documents that the risk and benefits of this action has been reviewed with the patient. Care planning decision: After the initial screening for 3 days of successfully utilizing the CACTUS form, PCN (primary care nurse) to refer the form to MDS Nurse/Clinical Supervisor to assess and care plan on one of the two: [NAME] Care plan to toilet on schedule that has been indicated by the prompted voiding .B. check and change program. | 2020-09-01 |