| 45 |
BOYINGTON HEALTH AND REHABILITATION |
255092 |
1530 BROAD AVE |
GULFPORT |
MS |
39501 |
2017-01-13 |
282 |
E |
0 |
1 |
QXQE11 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, staff interview, and policy review, the facility failed to follow Resident #8 and Resident #13's Care Plan for the risk of impaired skin integrity for one (2) of five (5) incontinent care observations, and Resident #18's Care Plan for risk of altered nutrition related to (r/t) a feeding tube, for three (3) of 21 care plans reviewed. Findings include: Review of the facility's policy titled, Care Plan-Comprehensive, dated (MONTH) 2001, revealed the facility would develop a Comprehensive Care Plan that includes measurable objectives and timetables to meet the resident's medical, nursing, mental, and psychological needs for each resident. The comprehensive care plan had been designed to incorporate identified problem areas, incorporate risk factors associated with identified problems, reflect treatment goals and objectives in measurable outcomes, and identify the professional services that are responsible for each element of care. Resident #8 Review of Resident #8's Care Plan initiated on 8/16/16, revealed the Focus for high risk for impaired skin integrity with the included intervention for prompt pericare after each incontinent episode. Observation of Resident #8's incontinent care provided by Certified Nursing Assistant (CNA) #1 and CNA #6 on 1/12/17 at 2:05 PM, revealed CNA #1 wiped down the middle of the vagina with an area of the washcloth that was previously used to wipe with. CNA #1 also wiped the anal area and left buttock upwards five (5) times with the same area of the washcloth. An interview on 1/12/17 at 2:20 PM, revealed CNA #1 stated she was not aware she had used the contaminated area of the cloth more than once. CNA #1 said she wiped the buttocks and the anal area multiple times with the same area of the cloth. Review of the facility's Face Sheet revealed the facility admitted Resident #8 on 9/14/15 with the [DIAGNOSES REDACTED]. Review of Resident #8's Quarterly Minimum Data Set (MDS) with an Assessment Reference Date (ARD) of 10/31/16, revealed a Brief Interview for Mental Status (BIMS) score of fifteen (15), which indicated Resident #8 was cognitively intact. Further review of the MDS revealed Resident #8 was able to make herself understood, and able to understand others. Resident #8 was independent, or required limited assistance with set up, or one person physical assist with bed mobility, transfers, dressing, toilet use, and bathing. Resident #8 was occasionally incontinent of bowels, and frequently incontinent of bladder. Resident #13 Review of resident #13's Care Plan initiated on 7/22/2014 for High Risk for Impaired Skin Integrity related to bowel and bladder incontinence listed the intervention for prompt pericare after each incontinent episode. An observation on 1/12/17 at 11 AM, revealed Certified Nursing Assistant (CNA) #2 and #4 provided Resident #13's incontinent care. CNA #2 cleaned each side, and the middle of the resident's labia, and the buttocks, but did not clean any other areas of the perineum, or the rectum. In an interview with CNA #2 on 01/12/17 at 3:00 PM, CNA #2 confirmed she cleaned only the labia in the perineal area. CNA #2 stated she had been checked off on incontinent care about four (4) months ago. CNA #2 stated the resident could get an infection of the bladder, or Urinary Tract Infection [MEDICAL CONDITION] if proper technique was not used. Interview on 01/13/17 at 10:15 AM, with Licensed Practical Nurse (LPN) #3, and Registered Nurse (RN) #1 revealed LPN #3 stated the care plans should be followed. RN #1 stated the CNAs are taught to look at, and follow care plans. Review of the facility's Face Sheet revealed the facility admitted Resident #13 on 06/14/07. Resident #13's [DIAGNOSES REDACTED]. Review of Resident #13's MDS with an ARD of 12/14/16, revealed a Brief Interview of Mental Status (BIMS) score 14, indicating the resident was cognitively intact. Further review of the MDS revealed Resident #13 required extensive assistance with one to two (1 to 2) person physical assist with bed mobility, transfers, toilet use, dressing, and bathing. Resident #13 was always incontinent of bowel and bladder. Resident #18 Review of Resident #18's Care Plan initiated on 3/27/14 for high risk for altered nutrition r/t a feeding tube revealed the included intervention to check placement by auscultation and aspiration before administration of medications. On 1/13/17 at 11:12 AM, an observation during the medication administration revealed Licensed Practical Nurse (LPN) #5 prepared to administer [MEDICATION NAME] 20 milligrams (mgs) and [MEDICATION NAME] 10 mgs. via Resident #18's PEG tube. LPN #5 checked the PEG tube placement, and pushed 10 millimeters (ml)s of water instead of air into the PEG Tube, and auscultated with a stethoscope below the Xyphoid Process (lower part of the sternum). An interview on 1/13/17 at 11:30 AM, revealed LPN #5 confirmed she used water instead of air to check placement of Resident #18's PEG tube. LPN #5 stated, I was nervous. Record review of the Face Sheet revealed the facility admitted Resident #18 on 4/3/12 with the [DIAGNOSES REDACTED]. Review of Resident #18's Quarterly Minimum Data Set (MDS) with the Assessment Reference Date (ARD) of (MONTH) 17, (YEAR), revealed the Brief Interview for Mental Status (BIMS) score was not completed due to the resident was not able to complete the interview. Resident #18's Cognitive Skills for Daily Decision Making was coded a three (3), which indicated severe impairment, and rarely or never made decisions. Further reveiw of the MDS revealed Resient #18 had a feeding tube while a resident at the facility. Resident #18 received a proportion of her total calories of 51% (percent) or more through parentaral or tube feedings, and an average of 501 cc (cubic-centimeters) or more of fluid per day by IV (intravenous) or tube feeding. Resident #18 required extensive to total assistance with one to two (1 to 2) person physical assist with bed mobility, transfers, dressing, toilet use, and bathing. |
2020-09-01 |