cms_GU: 26
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 26 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2016-09-29 | 248 | E | 0 | 1 | H7FJ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility did not provide an ongoing program of activities designed to meet the interests and the physical, mental and psychosocial well-being of each resident for four (4) of 10 sampled residents. (Residents 3, 4, 5 and 9). Findings include: 1. Resident 4 was admitted to the facility on [DATE] with the following Diagnoses: [REDACTED]. Review of the initial assessment dated [DATE] revealed that Resident 4's activity preferences included having books, newspapers and magazines to read; keeping up with the news; listening to music he liked; doing things with groups of people; going outside to get fresh air when the weather was good; being around animals as pets, and participating in religious activities. Resident care plan dated 1/12/16 revealed a problem of activity deficit - little or no involvement in activities. Comments documented include for the patient to have at least one enjoyable activity to participate in throughout stay, and also to participate in socialization with staff or friends/family members when demonstrating appropriate behavior at least once a week. The care plan outcome noted: Will participate in activities ___ times per ___. Interventions documented: Review level of activity prior to change in health status by talking with Family/Representative/Resident; Explain importance of social or relaxation or leisure activities; Advise daily of activities available and invite to participate; Offer a variety of both in and out of room activities; also allow resident to make choices; Ask family or representatives to encourage activities and to accompany resident in activity. From 9/26/16 to 9/29/16 during the days of the survey, Resident 4 was observed staying in the room most of the time and occasionally going to the dining/activity room to have lunch. On 9/26/16 at 10:45 a.m. to 12:00 p.m., the resident was observed to remain in his bed taking naps at intervals. Review of the activity calendar for September, (YEAR) revealed current events occurred at 10:00 a.m., and at 1:00 p.m. visits/social hour was scheduled. Interview with Resident 4 on 9/26/16 at 2:15 p.m. revealed that he did not participate in those activities. In another interview on 9/28/16 at 12:10 p.m., the resident stated that he didn't have any family members to visit him and that he wanted to talk to his ex-wife to ask her opinion about the surgery. On 9/29/16 at 10:45 a.m. during an interview with activity staff (AS)2, she stated that Resident 4 refused to join the activities and stayed in his room most of the time depending on his mood. AS2 added that activity staff provided room visits and try to engage him in conversations. Review of recreational therapy notes however, revealed the lack of documented evidence that a variety of activities were offered to the resident to meet his activities preference. 2. Resident 5 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Review of the latest assessment dated [DATE] revealed the resident had a BIMS of 15 indicating that he was cognitively intact, was totally dependent, and required one person physical assist with bed mobility, dressing, eating, toilet use, personal hygiene, and bathing. The last annual assessment dated [DATE] revealed the following activity preferences as very important to the resident: having books, newspapers and magazines to read; keeping up with the news; listening to music he liked; doing things with groups of people; going outside to get fresh air when the weather was good, and participating in religious activities. Review of the resident's care plan dated 6/09/15 revealed a problem of activity deficit - little or no involvement in activities. The comments documented: Patient (Pt.) always active texting on his phone. Incorporate card games, exercise and sunshine into 1:1 visits. On 9/26/16 at 10:50 a.m., during the initial tour, the resident was observed in bed inside a dark resident room with all window curtains drawn. The resident was awake and communicated by text messages using his personal cell phone. The resident was observed with right upper extremity contracture and able to move his left hand. On the days of the survey from 9/26/16 to 9/29/16, Resident 5 was observed in bed inside his room with the radio on at times and/or texting on his phone. On 9/29/16 at 10:30 a.m., AS2 stated that they take Resident 5 outside of his room by bed to enjoy good weather at least once a month. AS2 added that he did not join group activities in the dining/activities room but that 1:1 room visits were done on regular visits. 3. Resident 9 was admitted to the facility on [DATE] with several [DIAGNOSES REDACTED]. The most current MDS dated [DATE] described the resident as having short or long-term memory problems and that she was dependent on staff for most activities of daily living (ADLs). While the same MDS noted that the resident had severely impaired cognitive skills for daily decision making, recreational therapy notes dated 9/17/16, however, described Resident 9 as awake and alert, able to follow simple commands, and can understand word but having (a) hard time to constructing words. Review of the medical record revealed that while there was lack of indication that Resident 9 was bedbound, Resident 9 during the survey was always observed in bed sleeping or looking out to the hallway when repositioned on her right side. During an interview on 9/28/16, a licensed staff (LN7) stated that the resident did not want to get out of bed but received 1:1 visits in her room (at the bedside) with recreational therapy staff. Further record review revealed that while the resident refused to get out of bed, and engaged in isolative behavior, there was no indication that attempts to determine the reasons for the refusal (to get out of bed) were made. In the same interview on 9/28/16, LN7 added that when the resident was brought to the nursing station in her wheelchair where she stayed for several minutes, the resident had tears in her eyes. She was then, according to LN7 returned to her bed. While recreational therapy notes described room visits and activities provided such as read newspaper for current event, socialization for self awareness on day, time, and the weather for today, assisting in grooming, setting up meal tray, and providing range of motion exercises, there was no documentation whether the activities were meaningful to the resident and met the resident's psychosocial needs as well as needs for recreation and diversion. Review of the admission MDS dated [DATE] for example, revealed the lack documentation that an assessment of the resident's customary routine and preferred activities was conducted, or that the resident's family members were involved in eliciting information to determine past or present preferences. In addition there was no evidence that an activity care plan was developed to identifying goals and objectives to be achieved. Without the assessment and care plan, any interaction or activity provided could not be determined whether it was meaningful or effective. 4. Resident 3 was admitted to the facility on [DATE] with several [DIAGNOSES REDACTED]. The most current quarterly MDS (minimum data set) assessment dated [DATE] described the resident as having no short or long term memory problems, had intact cognitive skills for daily decision making, and had no mood, [MEDICAL CONDITION], or behavioral problems. During the initial tour on 9/26/16, a licensed facility staff (LN6) described the resident as alert and oriented but non-verbal as a result of the stroke, but was able to communicate or make his needs known mostly by gestures. Review of the annual MDS assessment dated [DATE] revealed that while an interview was not conducted, an assessment by staff noted the resident's daily and activity preferences included listening to music and doing things with groups of people. In addition, a care plan developed (initially dated 6/09/15) for activity deficit noted that the resident had little or no involvement in activities. During the survey, the resident was often observed alone and engaged in solitary activities, On 9/27/16 for example, after Resident 3 was observed in the day room in front of the television set for about 20 minutes, he was found wheeling himself up and down the hallways several times from the day room to the dining room stopping only to briefly look outside into the courtyard. When asked how he was doing and whether he was doing exercises, the resident was unable to verbally respond but shook his head to indicate no. During meal observations, the resident was also observed eating in the dining room by himself separate from other residents. Review of recreational notes revealed that while observations were being documented regarding the resident eating meals in the dining room, going out for sunshine, and watching television (on 9/26/16); performed conditioning exercises, observed in the courtyard, observed singing and praying, and watching TV (on 9/17/16); and observed wheeling himself around unit in outdoor sunshine, spending most of his time in the day room watching television, and going in and out of the recreation room (on 9/03/16); the documentation did not always include any group or organized activity attended, the length of time, whether the resident was an active participant or a bystander, and whether it met the resident's needs for psychosocial stimulation, recreation, or diversion. Further record review revealed that while the same care plan (dated 6/09/15; revised 8/10/16) identified an outcome that the resident will participate in activity or activities 2 times per week, it did not, however, address whether the activities provided were designed to meet, in accordance with the comprehensive assessment, the interests and the physical, mental, and psychosocial well-being of the resident. | 2020-09-01 |