| 63 |
MERRY WOOD LODGE |
15019 |
P O BOX 130 |
ELMORE |
AL |
36025 |
2019-03-02 |
725 |
K |
1 |
0 |
KDKT11 |
> Based on interviews, review of the facility's policy titled OPS138 Staffing/Center Plan, the Facility's Assessment Tool, the facility's daily census, staffing and assignment report, the facility failed to ensure sufficient staff was assigned to work during the evening shift on 2/20/2019 on the Homestead Memory Care (Dementia) Unit. The facility had determined the staffing needs for the evening shift was one direct care staff per nine residents. The daily census for the Dementia Unit for 2/20/2019 was 34, which indicated two direct care staff were assigned to care for 11 residents and one direct care staff was assigned to care for 12 residents. During the evening shift on 2/20/2019 around supper time, Resident Identifier (RI) #1, a resident identified as being physically aggressive towards others, was found by staff standing over RI #2, punching RI #2 in the head. RI #1 had previously been identified to physically abuse RI #2 on 2/15/2019. After this physical altercation, RI #1 was to be placed on 1:1 until discharge from the facility. This intervention was not implemented, thus RI #1 was found again physically abusing RI #2, five days later. This deficient practice affected RI #2, one of five sampled residents reviewed for resident to resident altercations; and placed RI #2 in immediate jeopardy for serious injury, harm or death. This failure also had the potential to affect the remaining residents who resided on the facility's Homestead Memory Care (Dementia) Unit. On 3/1/2019 at 3:40 PM, the Administrator, Director of Nursing Service and Director of Clinical Operations were notified of the findings of immediate jeopardy in the area of Nursing Services, F725. Findings include: The facility's policy titled OPS138 Staffing/Center Plan with a revision date of 9/1/2013, documented POLICY Genesis HealthCare Centers will provide qualified and appropriate staffing levels to meet the needs of the patient population. The staffing plan will include all shifts, seven days per week. PURPOSE To assure that appropriate staff levels are scheduled and maintained. PR[NAME]ESS . 4. The Center maintains appropriate staff levels, with qualified personnel, 24 hours/day, seven days/week on each shift to assure that patients are safe and their needs are met. Inquiries concerning nursing staffing should be referred to the Nursing Director . The facility's FACILITY ASSESSMENT TOOL for the Homestead Memory Care Unit dated (MONTH) (YEAR), indicated the direct care staff for the evening shift was one staff per nine residents. On 2/22/2019, anonymous callers reported to the Alabama State Survey Agency that RI #1 had repeatedly physically abused other residents on the Dementia Unit. According to the callers, earlier in the week during the second shift, RI #1 punched RI #2 in the chin. Then during the second shift on 2/20/2019, RI #1 was seen punching RI #2 in the face. The callers stated it was impossible for someone to watch RI #1 1:1 during the second shift because they were understaffed. The Merry [NAME] Lodge Daily Census for 2/20/2019 indicated there were a total of 34 residents who resided on the Homestead Memory Care (Dementia) Unit. The daily staffing sheet for 2/20/2019 indicated there were a total of three Certified Nursing Assistants (CNAs) scheduled to work during the evening shift, 2:00 PM to 10:00 PM; however, one CNA was listed as working 2:30 PM to 8:30 PM. The CNAs were listed as Employee Identifier (EI) #5, EI #6 and EI #7. The Homestead Assignment Sheet for the evening shift on 2/20/2019 revealed EI #5, CNA was assigned to care for 11 residents; EI #6 was assigned to care for 12 residents; and EI #7 was assigned to care for 11 residents. In a telephone interview on 2/27/2019 at 9:31 PM, EI #5, a CNA, said normally three CNAs work the unit. EI #5 said three was not an adequate number of CNAs to work the unit and she had told the person who does scheduling (EI #10, the Staffing Coordinator) that four CNAs were needed. During a telephone interview on 2/27/2019 at 10:36 AM, EI #7, a CNA confirmed there were three CNAs working the Homestead Unit on 2/20/2019. EI #7 stated it was very seldom four CNAs worked the unit. In an interview on 3/1/2019 at 9:34 AM, EI #10, the Staffing Coordinator was asked how the Dementia unit was staffed. EI #10 stated normally there are three CNAs, one male and two female CNAs. EI #10 explained that the male CNA only cared for the eight male residents that resided on the unit, leaving the other two female CNAs to split the other female residents. When asked about the 2/20/2019 incident, EI #10 stated the census on the Homestead Unit was 34 residents. When asked how many staff were scheduled, EI #10 said three females. EI #10 was asked how many residents each staff member had. EI #10 replied that two CNAs had 11 and one CNA had 12. When asked what the facility's assessment indicated the staffing pattern should be for evening shift on the Homestead Unit, EI #10 said one CNA per nine residents. When asked if staffing levels during the evening shift on 2/20/2019 reflected the assessed needs of the unit per the Facility's Assessment, EI #10 said no ma'am. EI #10 was asked if anyone had reported staffing concerns to her related to the facility's Dementia unit. EI #10 said EI #5 had. On 3/1/2019 at 10:25 AM, an interview was conducted with EI #2, the Center Nurse Executive (CNE), also known as the Director of Nursing Service (DNS). EI #2 said she was involved in staffing by helping to make sure the facility had adequate staff for each unit. EI #2 said according to the Daily Staff sheet for the Homestead Unit on 2/20/2019, the census was 34. EI #2 confirmed there were three CNAs scheduled to work and two of the CNAs were assigned to care for 11 residents and one CNA was assigned to care for 12 residents. EI #2 said according to the Facility's Assessment, the ratio was to be one staff to care for nine residents. EI #2 said that staff on that shift did not meet the Facility Assessment's guideline. During an interview with EI #1, the Center Executive Director, also known as the Administrator, on 3/1/2019 at 3:10 PM, he confirmed the facility's Assessment ratio of one staff to care for nine residents was not followed on 2/20/2019, on the Homestead unit for the 2:00 PM to 10:00 PM shift. ************************* On 3/2/2019 at 7:15 PM, the facility submitted an Allegation of Credible Compliance for F725, which documented: F-725 J- Nursing Services; sufficient nursing staff On (MONTH) 20, 2019, on the 2-10 pm shift 3 Certified Nursing Assistants were assigned to the Homestead Unit. Effective (MONTH) 1, 2019, the first and second shifts in the Homestead memory care unit were scheduled with four (4) CNAs. This level of staffing of the Homestead unit will be continued until revised per the Facility Assessment. On (MONTH) 1, 2019, the Nurse Practice Educator validated the employees assigned to the Homestead Unit met the Dementia training education requirements. On (MONTH) 1, 2019, the Center Executive Director (CED) educated the Center Nurse Executive (CNE) and Center Scheduler on ensuring proper direct-care staffing is available on the Homestead unit, per the Facility Assessment. ************************* After reviewing the facility's information provided in their Allegation of Credible Compliance and verifying the immediate actions had been implemented, the scope/severity level of F725 was lowered to a [NAME] level on 3/2/2019, to allow the facility time to monitor and/or revise their corrective actions as necessary to achieve substantial compliance. This deficiency was cited as a result of the investigation of complaint/report number AL 156. |
2020-09-01 |