cms_ID: 14
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 14 | ST LUKE'S ELMORE LONG TERM CARE | 135006 | 895 NORTH 6TH EAST | MOUNTAIN HOME | ID | 83647 | 2017-07-27 | 526 | D | 0 | 1 | V9TA11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, and resident, hospice staff and facility staff interview, it was determined the facility failed to ensure coordination of care, including development of a coordinated plan of care, between the hospice provider and the facility. This was true for 3 of 3 residents (#s 5, #6, #7) sampled for hospice care. This failure had the potential for harm if the residents received inadequate care from the facility and/or hospice agency due to a lack of care coordination. Findings include: Resident #'s 5 and 7 local hospice agency contract, dated 3/6/12, documented, The plan of care will identify which provider is responsible for performing the respective functions that have been agreed upon and included in the plan of care. Resident #6's local hospice agency contract, dated 5/13/14, documented, .hospice and facility shall jointly develop and agree upon the hospice patient's plan of care. 1. Resident #5 was readmitted to the facility on [DATE] with multiple diagnoses, including [MEDICAL CONDITION]. Resident #5's physician orders, dated 5/11/17, documented an order for [REDACTED].>Resident #5's Significant Change Minimum Data Set (MDS) assessment, dated 5/15/17, documented the resident was severely impaired, required extensive assistance from staff for all cares, and received hospice services. Resident #5's current facility Comfort Care (End of Life) care plan, dated 5/18/17, documented an intervention, (Hospice Agency) hospice to help maintain comfort for (Resident #5). No other information regarding hospice was documented in the care plan. Resident #5's record did not contain a delineation of duties between the hospice agency and the facility. On 7/26/17 at 9:25 am, Resident #5 was observed in his bed in his room. Hospice Nurse #1 was observed in the room who said she had just finished her assessment. Hospice Nurse #1 said she or another hospice nurse came into the facility at least once a week or as needed to assess the resident and a CNA (Certified Nurse Assistant) came in twice a week to bathe the resident and provide other ADLs (Activities of Daily Living) as needed. Hospice Nurse #1 said when she or another hospice staff member came into the facility they contacted the charge nurse before and after their visits and left a note in the hospice book which was located at the nurse's station. She said the facility staff was supposed to provide all cares and the hospice only provided additional support. On 7/26/17 at 9:35 am, CNA #1 said the hospice provided the resident showers and the facility provided all other ADL cares. She said if the hospice staff were unable to provide the resident a shower, the facility staff were to provide showers for Resident #5. On 7/26/17 at 9:45 and 10:15 am, RN #1 said hospice provided the resident showers and the facility provided all other ADL cares. She said if the hospice staff were unable to provide the resident a shower, the facility staff were to provide showers. RN #1 said this information should be in Resident #5's facility care plan, including frequency of visits by hospice staff. She said the hospice agency care plan for hospice staff, along with notes were located in a book at the nurses station. On 7/27/17 at 2:45 pm, the DNS (Director of Nursing Services) said Resident #5's facility hospice care plan lacked direction for facility staff regarding what services the hospice provided versus what facility provided and lacked information regarding frequency of hospice visits. The DNS said there was no delineation of duties for the resident. 2. Resident #6 was admitted to the facility on [DATE] with multiple diagnoses, including terminal [MEDICAL CONDITION]. Resident #6's physician orders, dated 6/27/17, documented an order for [REDACTED].>Resident #6's Admission MDS, dated [DATE], documented the resident was cognitively intact, required limited assistance of one staff member for toileting, had an ostomy (a surgical opening in the body to discharge waste) and received hospice services. Resident #6's current facility Comfort Care (End of Life) care plan, dated 6/23/17, documented an intervention, Staff will collaborate with (Hospice Agency) on end of life cares. She will be encouraged to participate in activities that she enjoys. She will be able to attend spiritual services as she wishes. No other information regarding hospice was documented in the care plan. The resident's bowel care plan, dated 6/23/17, documented how facility staff were to assist the resident with her ostomy care. Resident #6's record did not contain a delineation of duties between the hospice agency and the facility. Resident #6's ADL flow sheet, dated 7/26/17, documented a Hospice CNA assisted the resident in changing her ostomy bag and wafer. On 7/26/17 at 4:00 pm, Resident #6 was observed in her bed in her room. Hospice CNA #3 was observed to offer the resident a mug of ice water and asked the resident if she needed anything else. On 7/26/17 at 4:05 pm, Hospice CNA #3 said hospice CNA staff came to the facility for Resident #6 at least once a week and as needed and provided various ADL cares and services for the resident. On 7/27/17 at 8:50 am, Resident #6 said she had just requested for hospice to come and give her a bath. She said when she requested a bath, the hospice or facility staff would provide a bath for her. On 7/27/17 at 8:55 am, CNA #2 said the CNA who was providing showers for that day was aware of the resident's request and would offer the resident a bath. CNA #2 said the facility provided all of the resident's ADL cares, including showers and hospice provided extra showers and cares. On 7/27/17 at 9:50 am, CNA #4 was observed to provide Resident #6 with a bed bath in the resident's room. On 7/27/17 at 9:55 am, LPN #1 said she had only been working in the facility for a few days. She said the resident's facility care plan should document which services the facility provided and which services the hospice provided. LPN #1 said hospice staff checked in with her when they visited the resident. On 7/27/17 at 11:05 am, CNA #3 said she had assisted Resident #6 and Hospice CNA #3 the day before with the ostomy bag change and said the hospice agency supplied the resident's ostomy supplies, which were kept in the resident's room. On 7/27/17 at 3:00 pm, the DNS said there was no delineation of duties for the resident. She said Resident #6's facility's hospice care plan lacked direction for facility staff regarding what services the hospice provided versus what facility provided, lacked information regarding frequency of hospice visits, and did not address who would provide the resident's ostomy supplies. 3. Resident # 7 admitted to the facility on [DATE] with the [DIAGNOSES REDACTED]. Resident #7's physician orders, dated 3/24/17 included hospice care. Resident #7's Admission MDS assessment, dated 3/31/17, documented the resident was severely cognitively impaired, required extensive assist of 2 or more staff for bed mobility, transfers, dressing, toileting, and personal hygiene with hospice care provided. Resident #7's facility care plan, dated 3/24/17, documented comfort care for end of life care. The goal documented for Resident #7 was to be free from pain. The care plan documented the facility and hospice staff would work together to manage the Resident's end of life care. Resident #7's hospice care plan documented weekly visits from the licensed nurse and the CNA and monthly visits from the social worker. A binder was located at the nurse's station which was entitled Hospice contained weekly notes that documented the care provided by the hospice Licensed Nurse and CN[NAME] On 7/27/17 at 2:45 pm, the DNS (Director of Nursing Services) said Resident #7's facility's hospice care plan lacked direction for facility staff regarding what services the hospice provided versus what facility provided and lacked information regarding frequency of hospice visits. The DNS said there was no delineation of duties for the resident. | 2020-09-01 |