| 68 |
HAVEN OF SCOTTSDALE |
35059 |
3293 NORTH DRINKWATER BOULEVARD |
SCOTTSDALE |
AZ |
85251 |
2016-09-22 |
250 |
D |
0 |
1 |
BZVV11 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review, staff interviews, facility documents and policy review, the facility failed to provide medically-related social services to maintain the highest practicable physical, mental, and psychosocial well-being of one resident (#144). Findings include: Resident #144 was admitted to the facility on (MONTH) 31, (YEAR), with [DIAGNOSES REDACTED]. Physician admission orders [REDACTED]. A care plan initiated on (MONTH) 1, (YEAR) included for the use of antianxiety medications related to an anxiety disorder. Interventions included to administer anxiety medications as ordered and to monitor and document side effects and effectiveness. A social service intervention included to educate the resident/family regarding the risks/benefits and side effects and/or toxic symptoms of antianxiety medication. Another care plan included the resident exhibited behavior problems related to hitting staff, throwing food, and poor safety awareness. Interventions included to administer medication as ordered after non pharmacological interventions are tried and ineffective, monitor side effects, approach resident calmly and provide activities. Review of the admission Minimum Data Set (MDS) assessment dated (MONTH) 7, (YEAR) revealed the resident had a Basic Interview for Mental Status score of 13, which indicated the resident was cognitively intact. The mood section indicated the resident had not exhibited any symptoms of depression since arrival. Review of the behavior section revealed the resident had not exhibited any behaviors since admission. Nursing progress notes for (MONTH) 6 and 7, (YEAR) documented the resident complained of increased anxiety and requested the Alprazolam. Review of the Daily Skilled Notes from (MONTH) 8, 9 and 10, (YEAR) included the resident was experiencing confusion and anxiety, and received Alprazolam as ordered. A MAR note dated (MONTH) 10, (YEAR) documented the resident was trying to stand and remove her clothing and was yelling. The resident was medicated with Alprazolam for behaviors. A MAR note dated (MONTH) 11, (YEAR) at 1:08 a.m. included the resident stated that she was trying to leave and find her husband and was nervous, and was medicated with Alprazolam. Review of a fall report dated (MONTH) 11, (YEAR) at 7:34 a.m., the resident had been yelling and trying to get out of her chair. The report indicated the resident got away from the Licensed Practical Nurse, took off the tab alarm and jumped out of her chair onto the floor. The report also included the resident commented about not wanting to live anymore. A physician's orders [REDACTED]. Review of the MAR and a MAR note revealed the resident received the increased one time dose of Alprazolam. Further review of the MAR note dated (MONTH) 11, (YEAR) at 8:59 a.m. revealed the one time dose of Alprazolam was not effective. No additional interventions were documented. Review of the Alert Charting note dated (MONTH) 12, (YEAR) at 1:57 a.m. revealed the resident continuously attempted to get up unassisted during waking hours, was occasionally combative, and self propelled herself in her wheelchair into the medication cart, treatment cart, snack cart and attempted to open them. The note also indicated the resident self propelled herself into other resident's rooms and the resident remained intermittently argumentative. Despite the resident's behaviors, there was no clinical record documentation from social services regarding any services that were provided or interventions which were implemented to address the social service needs of the resident. A physician's orders [REDACTED]. A care plan was developed on (MONTH) 12, (YEAR) for feelings of loss of control and not wanting to live anymore. Interventions included to administer psychotropic medications as ordered, monitor for ineffective coping ability (e.g. verbalization of inability to cope, decreased problem solving, increased confusion, social withdrawal, insomnia, destructive behaviors toward self or others), psychiatrist to evaluate, and social service to visit and offer support as needed. Review of the MAR notes for (MONTH) 13 and 14 revealed the administered doses of Alprazolam were not effective. Review of physician progress notes [REDACTED]. Further review of the physician's orders [REDACTED]. Additional orders included to monitor the resident for target symptoms/behaviors every shift, which included yelling out and to monitor for side effects associated with the use of antianxiety medication. According to the Medication Administration Record (MAR), the resident received the Alprazolam for increased anxiety from one to four times each day between (MONTH) 1, and (MONTH) 20, (YEAR), with the exception of (MONTH) 12, when she did not receive any Alprazolam. Further review of the clinical record revealed that as of (MONTH) 20, (YEAR), the resident had not yet been evaluated by a psychiatrist as ordered on (MONTH) 12, (YEAR). In addition, there were still no social services notes addressing the resident's needs. In an interview conducted with the Director of Nursing (DON/staff #6) on (MONTH) 20, (YEAR), the DON stated that depending on what type of consult and the circumstances, the Social Worker will contact the physician to come out and see the resident. She further stated that the delay in getting this consult is not within the expected time frame and the consult should have been completed sooner. In an interview conducted with the Social Worker (staff #21) on (MONTH) 20, (YEAR) at 2:25 p.m., staff #21 stated that he called and requested for the psychiatrist to see the resident, but he won't see her until tomorrow. He stated that he did not know about her comment (of not wanting to live) and did not see any immediacy in getting the consult any faster. He stated that usually our psychiatrist comes once each month to see residents and if a consult is ordered, then it is requested. He stated he initially emailed the doctor and then talked with him by phone and they did not see any reason for him to see her any faster. He stated he does not have any social services notes regarding this resident. Shortly after the above interview the clinical record was reviewed. A social services progress note dated (MONTH) 20, (YEAR) at 2:51 p.m. now included that the social worker met with the resident regarding her previous statements of not wanting to live anymore and the resident indicated that she felt trapped in her body, due to Parkinson's disease. The note included the resident had been seeing a psychiatrist in the community prior to admission to the facility, and agreed to social services involvement. The note also included that the resident did not currently have any suicidal ideations. Review of a physician progress notes [REDACTED]. The resident states that the worst her suicidality becomes is when she has random thoughts to wheel herself in her wheelchair into traffic, but states she would never do that. Per the note, the resident also described feeling down, due to being away from home, family and her dogs, and due to having insomnia, Parkinson's disease, chronic pain and anxiety. The physician initiated treatment included for Remeron at bedtime for sleep, depression and anxiety. Review of a policy titled, Social Services revealed that the facility provides medically related social services to assure that each resident can attain or maintain his/her highest practicable physical, mental, or psychosocial well-being. The policy identified factors that have a potentially negative affect on the resident's dignity and sense of control that included disability or loss of function, the presence of a progressive, chronic, or disabling condition and behavioral problems (anxiety, confusion, depressed mood, anger, fear, wandering, psychotic episodes). The responsibilities of the social services department included obtaining pertinent social data, identifying social and emotional needs, assisting in providing corrective actions by developing and maintaining care plans, maintaining regular progress and follow-up notes, maintaining appropriate documentation of referrals and providing social services data summaries and making supportive visits to the resident. |
2020-09-01 |