| 56 |
BOYINGTON HEALTH AND REHABILITATION |
255092 |
1530 BROAD AVE |
GULFPORT |
MS |
39501 |
2017-05-18 |
280 |
E |
1 |
0 |
UDH111 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on record review, staff interview and facility policy review, the facility failed to develop/revise Care Plans for Pressure Ulcers for seven (7) of seven (7) residents reviewed for Pressure Ulcers; Residents #7, #8, #9, #10, #11, #12 and #13. The facility also failed to revise Resident #1's Care Plan for continued treatment of [REDACTED].#1, one (1) of 13 sampled resident care plans reviewed; which involved eight (8) of 13 residents. Findings include: Review of the facility policy entitled Care Plan-Comprehensive, dated 11/01, revealed, Policy Interpretation and Implementation 1. An Interdisciplinary Team, in coordination with the resident, his/her family or representative develops and maintains a Comprehensive Care Plan for each resident and 4. Care plans are revised as changes in the resident's condition dictate. Resident #1 Review of Resident #1's Care Plan revealed a Focus, dated 02/25/17, for rash & (and) itching. The approaches included the use of the medication [MEDICATION NAME] Cream (medication for Scabies) 5 % (per cent) Apply from neck down topically one (1) time only for itching initiated 04/04/17, revised 05/10/17, and resolved 05/10/17. Resident #1 continued to have itching at the sites of the scabies, and an order, dated 04/19/17, was added for [MEDICATION NAME] 0.1% Ointment due to itching. The Care Plan was never updated with a Focus of Scabies, nor was there a Focus of history of Scabies. The approach for the [MEDICATION NAME] Cream had not been resolved until 05/10/17, even though it was only to be administered once, and the date it was initiated was 04/04/17. A Focus area of Infection, dated 02/25/17, revealed an Intervention for [MEDICATION NAME] 0.3% ointment, Instill one (1) inch in left eye every eight (8) hours, initiated 03/06/17. Review of the cumulative order summary report for 05/17 revealed the medication order was no longer in effect, since it was not on the cumulative orders. This medication had not been discontinued from the Care Plan. Interview, on 05/10/17 at 3:25 PM, with the Registered Nurse (RN) Risk Manager/Infection Control Nurse revealed Resident #1 no longer had Scabies, but now he had an inflammation rash where the Scabies had been and this was not on the Care Plan. Interview, on 05/10/17 at 2:30 PM, with the Registered Nurse (RN) PPS (Preferred Payer Source) Co-coordinator confirmed the order for the [MEDICATION NAME] was not a current order and should have been removed from the Care Plan. She was unsure of the date the medication had been discontinued. Review of the Admission Record revealed the facility admitted Resident #1 on 02/25/17, with [DIAGNOSES REDACTED]. Review of the 14 day Minimum Data Set (MDS), with an Assessment Reference Date (ARD) of 03/10/17, revealed the Resident scored 13 of 15 on the Brief Interview for Mental Status (BIMS) which indicated he was cognitively intact. Resident #7: Review of Resident #7's current Care Plan revealed the following: 1. A Focus for Resident #7 of High risk for infection R/T (related to) resident has indwelling catheter, Dx (diagnosis) [MEDICAL CONDITION] and GR IV (Grade 4)) to coccyx, Hx (history of) UTI's (Urinary tract infections) [MEDICAL CONDITION]. An Intervention was for Sacral wound: Cleanse with N/S (normal saline), pat dry, pat (pack) with Maxsorb AG (silver) and cover with foam dressing daily and prn (as needed). The Care Plan did not specify the cause or type of the sacrum/coccyx wound, which had been on the 05/12/17 wound report as a stage IV pressure ulcer on the sacrum. The Care Plan also did not include the current treatment, which was a wound vac (vacuum), which was ordered on [DATE]. 2. A Focus of Resident #7 of: impaired skin integrity revealed Interventions, initiated 3/3/17, which included Cleanse left lateral ankle with N/S, pat dry, apply maxsorb extra AG and cover with dry dressing every three (3) days and PRN. Another Intervention was for: Cleanse right lateral ankle N/S N/S (with normal saline), pat dry, apply Maxsorb extra AG, and cover with dry dressing every three (3) days and prn. Review of a hand written order, dated 05/04/17, revealed orders for Wound care to L (left) lateral ankle & (and) R (right) anterior foot, [MEDICATION NAME] q (every) 72 hrs. (hours) & prn, and neither of the current treatments were on the Care Plan. Review of the weekly wound report, dated 05/12/17 revealed the wounds were recorded on the pressure ulcer sheet as pressure ulcers and both were a stage III (3). The stages of the two (2) areas on the ankles were not included on the Care Plan, nor were they documented/identified as pressure ulcers in the Focus of the Care Plan. Review of the Weekly Wound Information Sheet(s) for Resident #7 revealed the following: 1. A Sacrum wound, which was identified as a pressure type wound was documented on 05/10/17. 2. A left ankle wound, which was identified as a pressure type wound was documented on 05/10/17. 3. A right ankle wound, which was identified as a pressure type wound was documented on 05/10/17. Interview, on 05/16/17 at 12:30 PM, with the MDS/CP LPN (Minimum Data Set/Care Plan Licensed Practical Nurse) confirmed neither pressure ulcers for the ankles on Resident #7 included the stage of the pressure ulcers. Interview, on 05/16/17 at 12:55 PM, with the MDS/CP LPN confirmed the treatment to the sacrum in the Care Plan for Resident #7 was not the current treatment documented in the Physician's Orders. She confirmed Care Plans should have been initiated/updated with the current treatments. The MDS/CP LPN also stated when a resident returned from the hospital, she tried to update the Care Plan within one (1) to two (2) weeks, but she had not updated this Resident's Care Plan. Review of the Admission Record revealed the facility readmitted Resident #7 on 12/22/16, with [DIAGNOSES REDACTED]. Review of the quarterly MDS, with an Assessment Reference Date (ARD) of 03/18/17, revealed he scored 9 of 15 on the Brief Interview for Mental Status (BIMS), which indicated he had moderate cognitive impairment. Resident #8 Review of the Care Plan for Resident #8 revealed a Focus for Impaired skin integrity AEB (as evidenced by): Area to right side of head (resolved). The Unstageable pressure ulcer on the Resident's right heel was not included in the Focus of the Care Plan. The Interventions included the current pressure ulcer care correctly; but there was no mention of the type of wound or the stage of the wound for the treatment. Review of the Weekly Wound Information Sheet for Resident #8, dated 05/04/17, revealed the type of the wound on the right heel was a pressure ulcer. Interview, on 05/16/17 at 1:45 PM, with the MDS/CP LPN confirmed the Care Plan did not include the current pressure ulcer on Resident #8's right heel, nor did it include the type of ulcer or the stage of the ulcer. Review of the Admission Record revealed the facility readmitted Resident #8 on 03/01/17, with [DIAGNOSES REDACTED]. Review of the admission MDS, with an ARD of 03/07/17, revealed he scored 3 of 15 on the BIMS, which indicated he had severe cognitive impairment. Resident #9 Review of the Care Plan for Resident #9 revealed a Focus for Impaired skin integrity AEB area to right buttocks, right top of hand. Review of the Interventions included Cleanse right buttock with normal saline, pat dry, skin prep per wound, apply [MEDICATION NAME] every three (3) days and prn, which was initiated 5/2/17. Review of the weekly wound report revealed on the pressure ulcer page there was a stage II pressure ulcer documented as acquired in the facility as a stage II on 5/2/17 for Resident #9. Interview, on 05/17/17 at 10:20 AM, with the MDS/CP LPN confirmed the Care Plan did not include the type of wound (pressure ulcer) or the stage of the pressure ulcer for Resident #9 Review of the Admission Record revealed the facility readmitted Resident #9 on 07/03/10, with diagnoses, which included Dementia and Type 2 Diabetes. Review of the quarterly MDS, with an ARD of 04/19/17, revealed the Resident scored zero (0) of 15 on the BIMS, which indicated he had severe cognitive impairment. Resident #10: Review of Resident #10's Care Plan revealed a Focus of Impaired Skin Integrity as evidenced by Stage III pressure ulcer to sacrum. Interventions included Cleanse stage III pressure ulcer to sacrum w/NS (with normal saline), pat dry, apply [MEDICATION NAME] sheet, cover and secure every other day and prn The date of this pressure ulcer order was 12/08/16. Review of the cumulative Order Summary Report for 05/17, revealed Resident #10 had an order, dated 04/09/17 for Wound vac. (vacuum) to sacrum @ (at) 125 mmHg (millimeters of mercury) continuous. The Care Plan was not updated with this current pressure ulcer treatment. Interview, on 05/16/17 at 1:20 PM, with the MDS/CP LPN confirmed Resident #10's Care Plan did not include the current pressure ulcer treatment. The MDS/CP LPN also stated it was her responsibility to be sure the Care Plans were updated, and stated it was an oversight not to have updated the Care Plan. The MDS/CP LPN also stated she had been employed by the facility since 01/17. Review of the Admission Record revealed the facility readmitted Resident #10 on 03/18/17, with [DIAGNOSES REDACTED]. Review of the quarterly MDS, with an ARD of 04/30/17, revealed the Resident scored 15 of 15 on the BIMS, which indicated he was cognitively intact. Resident #11 Review of Resident #11's Care Plan revealed a Focus of Impaired skin integrity as evidenced by open area to sacrum/left buttocks. The Interventions included treatments for left buttock wound, left horizontal gluteal crease, left stump and right buttocks #1 and #2. There was no identification of what type and/or stages of these wounds. Review of the weekly wound report revealed Resident #11 had stage II wounds to the sacrum, left ishium and right ishium on the sheet for pressure ulcers, and there were no wounds recorded on the sheet for Other Skin Integrity Report. Interview, on 05/16/17 at 1:40 PM, with the MDS/CP LPN confirmed the Care Plan did not include the stage of the pressure ulcers, or the identification of the wounds as pressure ulcers or other skin concerns for Resident #11. Review of the Admission Record revealed the facility admitted Resident #11 on 08/22/16, with [DIAGNOSES REDACTED]. Review of the quarterly MDS, with an ARD of 02/23/1,7 revealed he scored 3 of 15 on the BIMS, which indicated he had severely impaired decision making abilities. Resident #12: Review of the Care Plan for Resident #12 revealed a Focus for Impaired skin integrity as evidenced by: stage IV pressure ulcer to left & (and) right buttocks (ishiums). DTI (deep tissue injury) (now stage II) pressure ulcer to right lateral foot and Right heel pressure ulcer & left ishium. There were no Intervention (s) for the right lateral foot, nor were there any current Physician Orders for treatment to the right lateral foot. There was no documented evidence of a wound to the right lateral foot from 03/03/17 to 05/10/17. The care plan was not revised to include the right lateral foot pressure ulcer was resolved. Review of the physicians orders dated 5/11/17, revealed treatment to the right and left ischium for Santyl, Collagen and Calcium Alginate and cover with dressing daily and prn (as needed). The care plan was not updated to include the right ischium treatment for [REDACTED]. Interview, on 05/17/17 at 10:40 AM, with the MDS/CP Licensed Practical Nurse (LPN) confirmed there was no documentation of a wound to the right lateral foot for Resident #12. The MDS/Care Plan LPN also stated she did not include the stage and cause of the wounds (pressure ulcer or non-pressure wound) in the Care Plan if the information was not included in the Physician's Order. She also stated she did review the weekly wound report, but had not been instructed to include the stage and cause of the wound in the Care Plan. Review of the Admission Record revealed the facility readmitted Resident #12 on 01/21/15, with [DIAGNOSES REDACTED]. Review of the quarterly MDS, with an ARD of 03/14/17, for Resident #12 revealed he scored 15 of 15 on the Brief Interview for Mental Status BIMS, which indicated he was cognitively intact. Resident #13: Observation of Resident #13's wounds/dressings revealed a wound on the right shin, the left lateral leg at the ankle, left ishium and coccyx. Review of Resident #13's Care Plan revealed a Focus for 1/23/17 -actual open area to left lateral leg, wound to coccyc (coccyx); right shin date initiated 01/23/17. Review of the current wound treatments revealed there were also wounds on the right buttock and right posterior thigh, but although these areas were included in the Interventions (s), these wounds were not included in the focus. Review of Resident #13's documentation on the pressure ulcer report, dated 05/12/17, revealed the Resident had a wound on the posterior right thigh, coccyx and two (2) areas on the left lateral leg as well as an area on the right shin. The care plan did not include both areas on the left lateral lower leg. Interview, on 05/17/17 at 10:25 AM, with the MDS/CP LPN, confirmed the wounds were not identified on the Care Plan with the stage or type of ulcers (pressure) for Resident #13. Review of the Admission Record revealed the facility readmitted Resident #13 on 03/07/17, with [DIAGNOSES REDACTED]. Review of the admission MDS revealed the Resident scored 15 of 15 on the BIMS, which indicated he was cognitively intact. |
2020-09-01 |