cms_ME: 84
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 84 | ORONO COMMONS | 205031 | 117 BENNOCH RD | ORONO | ME | 4473 | 2018-04-05 | 689 | J | 1 | 0 | G71711 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on observations, interviews and record review, the facility failed to adequately secure windows in the residents' environment for 1 of 3 residents reviewed with a history of elopement risk. This failure resulted in a resident eloping from a window onto a side deck and wander to the front of the building (Resident #1). Findings: On 3/22/18 at 5:00 p.m., The Division of Licensing and Certification received a facility Reportable Incident Form indicating that on 3/22/18 at 2:35 p.m. Resident #1 was seen standing outside at the front door trying to get into the facility. Facility investigations indicated one of the dining room windows had been removed and there were footprints in the snow on the deck outside the dining room. The facility Reportable Incident Form indicated the Maintenance director is currently securing the windows so they cannot be tilted out/removed by residents. During a review of the medical record, Resident #1 was admitted on [DATE] to the Memory unit and a wander guard placed on resident at this time. A progress note dated 3/19/18 at 12:28 p.m., indicated that Resident #1 had been very agitated and anxious this shift, searching for his/her family and trying to get out of the building. Resident #1 had opened several windows and one in room [ROOM NUMBER] (second story room). Resident #1 had opened the window and was able to tip the window inward. Resident #1 stated it fell all the way out and landed on his/her leg. The note reflects that the window never actually fell and was not low enough to actually have fallen on residents leg. A progress note dated, 3/22/18 at 11:44 a.m. indicated that Resident #1 was very anxious and had gotten dressed in his/her coat and gloves several times that day. Each time the resident stating, was looking to go home even if he/she had to walk. At this time, outdoor clothing was removed and placed in the nursing office. A progress note dated, 3/22/18 at 3:15 p.m. indicated that the nurse was alerted at 2:35 p.m. that Resident #1 was standing outside at the front door trying to get into the facility. Resident #1 had been seen by the Clinical Reimbursement Coordinator walking past the office window, and was found attempting to come in the front door but the door would not open immediately as resident had a wander guard on. Resident #1 was assisted by the Administrator back into the facility and back to the unit. Resident #1 reported a sore hand/palm showing slight bruising. Upon return to the unit the charge nurse noted one of the dining room windows had been removed and footprints in the snow were seen on the deck outside the dining room. Resident #1 then stated he/she was going to a family members house thought to lived nearby. On 3/26/18 at 3:10 p.m., during an interview with a surveyor, the Medical Director stated that she was not aware of the elopement out the window on the 3/22/18, however, was aware that resident had gotten his/her head/shoulders out of the window yesterday (3/25/18). This was confirmed when a surveyor reviewed the following progress note dated 3/25/18 at 4:09 p.m. indicating Resident #1 was found in dining room with the window and screen up with his/her head/neck out the window. Resident stating I just wanted to get out on the deck On 3/26/18 at 1:30 p.m. during an interview with a surveyor the charge nurse stated that on the day of admission for Resident #1, the family member had revealed that when the resident was at home he/she climbed out the window and fell and fractured his/her ankle. On 3/27/18 during an interview with the surveyor the Maintenance director stated the windows on the Homestead unit (memory unit) were secured to prevent them from tilting outward on 3/22/18, and that on 3/26/18 the wedges used to prevent the windows from opening up more than 6 inches were observed. A few wedges were observed not to be at the correct height to prevent the windows from opening more than the 6 inches and were corrected immediately. A surveyor confirmed these findings with the Director of Nursing on 3/26/18 at 4:50 p.m. and on 3/27/18 at 4:00 p.m. | 2020-09-01 |