cms_DE: 4
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 4 | KENTMERE REHABILITATION AND HEALTHCARE CENTER | 85001 | 1900 LOVERING AVENUE | WILMINGTON | DE | 19806 | 2016-07-18 | 315 | D | 0 | 1 | Z68211 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review, interviews and review of other facility documents as indicated, it was determined that for one (R62) out of 30 Stage 2 sampled residents, the facility failed to ensure that a resident who was incontinent of bladder received appropriate treatment and services to restore as much normal bladder function as possible. The facility failed to re-assess R62 when a decline in bladder continence occurred, and failed to develop an individualized toileting plan. Findings include: The facility nursing policy titled Incontinence (treatment), dated 6/30/06, stated, .PR[NAME]EDURE: Incontinence is assessed on admission. 1. Section H of the MDS in (sic) completed on admission, on re-admission, quarterly and with significant change. Identify those residents who are incontinent, or have experienced a decline in continence. 2. On admission, all residents .should have a voiding diary completed. The diary need only be completed with new incontinence or changes in incontinence patterns (decline) .3. Complete the diary for two days (48) hours, evaluating the resident every 2 hours .4. After 48 hours, review the Voiding Diary to determine if there is a voiding pattern .Complete the Incontinence Assessment .5. If a toileting plan is developed, monitor the planned toileting times and its results for one month. Modify the schedule as needed . A revised nursing policy titled Incontinence Assessment and Management, effective (MONTH) (YEAR), stated, .PR[NAME]EDURE: 1. Upon admission, all residents will be assessed for incontinence using the Bowel and Bladder Diary. 2. Complete the diary for three days (72 hours). 3. After 72 hours, review the Voiding Diary to determine if there is a pattern of incontinence .Complete the Bowel and Bladder Assessment and develop an appropriate plan of care .6. On a quarterly basis and with a decline in continence status, the facility will complete a bowel and bladder assessment. Based on the assessment, a voiding diary will be initiated and the plan of care will be revised if necessary. Review of R62's clinical record revealed the following: R62 had resided at the facility for multiple years and had [DIAGNOSES REDACTED]. 1/10/14 - A care plan, target date 7/18/16, for occasional urinary incontinence r/t altered mobility and inability to always voice need to urinate was developed. Interventions included: Observe for s/sx of UTI, toilet resident on toilet/commode to promote complete emptying of bladder, toilet per toileting schedule and as needed, incontinence care after each incontinent episode. 2/1/15 through 2/28/15 - Review revealed that this was the last time R62 was on a toileting program. 1/1/16 through 1/31/16 - Review of the electronic CNA Documentation History Detail report for bladder continence revealed R62 had 14 episodes of urinary incontinence. 1/6/16 - A quarterly Bowel and Bladder Assessment was completed. This assessment stated: - there were no changes in factors affecting bowel and bladder function; - there was no change in management of bladder function; - R62 was continent of bladder. This assessment was inaccurate, as the electronic CNA Documentation History Detail report revealed R62 was having episodes of urinary incontinence. 1/8/16 - R62's annual MDS assessment stated that during the seven (7) day review period: - daily decision making skills were moderately impaired (decisions poor; cues/supervision required); - required extensive assist of two (2) staff for transfers and toilet use; - had not walked in the room or corridor; - was occasionally incontinent of bladder (four (4) episodes of urinary incontinence during the review time period); - received a diuretic daily during the seven (7) day review period. The CAA portion of the 1/8/16 annual MDS assessment triggered incontinence as a potential problem area and was checked off to proceed with care planning. 2/1/16 through 2/29/16 - Review of the electronic CNA Documentation History Detail report for bladder continence revealed R62 had seven (7) episodes of urinary incontinence. 2/9/16 - A quarterly Bowel and Bladder Assessment was completed after R62 was readmitted to the facility post hospitalization and again erroneously stated R62 was continent of bladder. 3/1/16 through 3/31/16 - Review of the electronic CNA Documentation History Detail report for bladder continence revealed R62 had 16 episodes of urinary incontinence. 4/1/16 through 4/30/16 - Review of the electronic CNA Documentation History Detail report for bladder continence revealed R62 had 24 episodes of urinary incontinence. 4/5/16 - A quarterly Bowel and Bladder Assessment was completed and again erroneously stated R62 was continent of bladder. 4/9/16 - A quarterly MDS assessment stated that during the seven (7) day review period R62: - daily decision making skills were moderately impaired (decisions poor; cues/supervision required); - required extensive assist of two (2) staff for transfers and toilet use; - had not walked in the room or corridor; - was frequently incontinent of bladder (nine episodes of urinary incontinence during the review time period); - received a diuretic daily during the seven (7) day review period. After completion of the 4/9/16 MDS assessment, the facility failed to identify R62's decline in urinary continence, they failed to re-assess R62, and failed to develop an individualized toileting plan based on established voiding patterns (voiding diary). Additionally, the facility failed to revise R62's plan of care to address the decline in urinary continence. 5/1/16 through 5/31/16 - Review of the electronic CNA Documentation History Detail report for bladder continence revealed R62 had 13 episodes of urinary incontinence. 6/1/16 through 6/31/16 - Review of the electronic CNA Documentation History Detail report for bladder continence revealed R62 had 19 episodes of urinary incontinence. 7/1/16 through 7/14/16 - Review of the electronic CNA Documentation History Detail report for bladder continence revealed R62 had 13 episodes of urinary incontinence. 7/4/16 - A quarterly Bowel and Bladder Assessment was completed and once again erroneously stated R62 was continent of bladder. 7/13/16 at approximately 2:30 PM - The electronic CNA Assignments Summary, which lists the care CNAs are to provide for R62, was printed. It stated R62 was continent of bladder, used the toilet, wore an incontinence brief, and to SEE TOILETING SCHEDULE. As already stated, the last documented evidence of R62 being on a scheduled toileting plan was back in February, (YEAR). 7/14/16 at 11:19 AM - In an interview with E9 (CNA), R62's assigned aide that day, she stated that when she got the resident up and into the bathroom that despite a slightly wet brief, R62 did also urinate into the toilet. E9 stated that as far as she was aware, R62 does ask to be taken to the bathroom when she needs to go. E9 stated that she was not aware of R62 being on any scheduled toileting plan. This surveyor and E9 then checked the binder on the unit where CNAs document if a resident is on a scheduled toileting plan. There was no scheduled toileting plan found for R62. 7/14/16 at 11:41 AM - During an interview, E8 (RNAC) confirmed that according to the MDS assessments, R62 had a decline from occasionally incontinent (1/8/16 MDS) to frequently incontinent (4/8/16 MDS). E8 stated that when there is a decline the resident should be re-assessed and have a new voiding diary completed. E8 stated that when a decline is noted, she goes to speak with the UM and then the team will decide if a toileting plan would help or not. E8 was not able to state whether this had occurred after completion of R62's 4/8/16 MDS assessment. Additionally, E8 confirmed that the last voiding diary completed for R62 was dated 6/24/14. 7/14/16 at 2:10 PM - During an interview with E2 (DON) the findings were confirmed. E2 stated that the facility felt they had an issue/concern with their incontinence management program and had revised the policy, which went into effect in (MONTH) (YEAR). E2 stated that she personally went through all the resident's bowel and bladder assessments, and those who were incontinent had a new voiding diary completed. E8 stated she reviewed R62's Bowel and Bladder Assessment, but because it stated the resident was continent no further action was taken. 7/14/15 at approximately 4:00 PM - E4 (RN/UM), who completed R62's Bowel and Bladder Assessments from 1/16 through 7/16, was interviewed. When asked how she determined R62's continence status, E4 stated that she calculated percentages and if the resident had a higher percentage of being continent then that was what she documented as the resident's status (e.g. if 92% of the time R62 was continent then she marked continent.). The facility failed to ensure that a resident who is incontinent of bladder received appropriate treatment and services to restore as much normal bladder function as possible. Per the 4/9/16 quarterly MDS assessment, R62 had a decline from occasionally incontinent to frequently incontinent. There was no evidence the resident was re-assessed, no voiding diary completed, no evidence of an individualized toileting plan, and no revision to the resident's plan of care. Although the incontinence care plan stated R62 was on a toileting plan, the last documented evidence of scheduled toileting was back in (MONTH) of (YEAR). 7/18/16 at approximately 5:30 PM - findings were reviewed with E1 (NHA) and E2 during the exit conference. | 2020-09-01 |