| 85 |
THE PILLARS OF BILOXI |
255093 |
2279 ATKINSON ROAD |
BILOXI |
MS |
39531 |
2019-05-15 |
550 |
D |
0 |
1 |
0E0S11 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, facility policy review, and interviews, the facility failed to ensure the residents' dignity was not compromised for two (2) of 24 sampled residents, Residents #21 and #37. Specifically, staff posted signage visible to others regarding a resident's personal care (Resident #21), and the facility staff failed to provide privacy for one (1) resident (Resident #37), leaving the resident's skin and/or body exposed. Findings include: Review of an undated facility policy tilted, Dignity and Respect, revealed, It is the policy of this facility to treat each resident with respect and dignity and care for each resident in a manner and environment that promotes maintenance or enhancement of his or her quality of life. 1. The staff shall display respect for residents when speaking with, caring for, or talking about them, as constant affirmation of their individuality and dignity as human beings .3. Residents shall be examined and treated in a manner that maintains the privacy of their bodies. A closed door or drawn curtains shields the residents from passer-by. People not involved in the care of the resident shall not be present without the resident's consent while they are being examined or treated. Staff members shall knock before entering the resident's room. 4. Privacy of a resident's body shall be maintained during toileting, bathing, and other activities of personal hygiene, except when staff assistance is needed for the resident's safety . Resident #21 Review of Resident #21's Minimum Data Set (MDS), Significant Change Assessment, dated 03/05/19, revealed the facility admitted the resident on 04/19/17. Both of Resident #21's legs were amputated above the knee, with the most recent amputation (right leg) occurring on 02/25/19. The resident also had [DIAGNOSES REDACTED]. According to the MDS assessment, the resident had impairment on both sides of his body; had an indwelling urinary catheter; was always incontinent of bowel; and required extensive assistance with bed mobility, transferring, dressing, personal hygiene, and bathing. Observation, on 05/14/19 at 10:07 AM, of Resident #21's room, revealed the resident was in the bed nearest the entry door from the hallway. The resident's eyes were closed, and he was covered with a bedspread. There was a sign posted on the wall over the resident's bed which read, Do not fasten brief. Keep brief loose under buttocks and peri area to prevent kinking of tubing. The sign was hand written on an 8 x 11 inch piece of paper. During an observation on 05/14/19 at 11:10 AM, of Resident #21's daily wound care, revealed the sign remained posted over the resident's bed. On 05/14/19 at 2:28 PM, observation of Resident #21's room, revealed the sign remained posted on the wall above his bed. Observation on 05/15/19 at 9:03 AM, of Resident #21's room, revealed the sign remained posted over the resident's bed. Interview on 05/15/19 at 09:10 AM, with Resident #21 revealed the sign had been on the wall over his bed for about two (2) months, since he returned from the hospital following the amputation of his right leg. Resident #21 stated he did not request placement of the sign, but staff let him know they were posting it on the wall. He could not remember which staff member talked to him about the sign. The resident said that due to the condition of his lower body, and the indwelling catheter tubing, he had discomfort at the genital area if the brief was fastened. Review of Resident #21's physician's orders did not reveal placement of the sign was ordered. The care plan for Resident #21 included interventions for monitoring the resident's catheter tubing for kinks, and for observing the resident for any pain or discomfort related to the catheter. Interview, on 05/15/19 11:55 AM, with Certified Nursing Assistant (CNA) #1, revealed she thought the wound care nurse suggested the resident's brief should remain loose due to the resident's physical status, the recent amputation, the ongoing care of the resident's pressure ulcers, and the overall status of the resident's skin. CNA #1 stated she did not think the sign should be posted over the resident's bed. Instead, she said the information about the resident's brief could be communicated to nurses and CNAs at the change of each shift. CNA #1 said the information on the sign should remain confidential and should not become common knowledge for everyone who might enter the resident's room. Observation, on 05/15/19 at 12:30 PM, revealed the sign had been removed from the resident's wall. Interview on 05/15/19 at 12:40 PM, with Licensed Practical Nurse (LPN) #1, revealed the sign had just been taken down. The LPN stated she thought it was inappropriate for the sign to be posted over Resident #21's bed. She said it would alert staff to keep the resident's brief open, but visitors were also able to see the sign. She said staff should communicate resident care needs at shift change. LPN #1 further stated the sign did not enhance the resident's dignity because while posted on the wall, it informed anyone who came into the room that the resident wore a diaper. LPN #1 said the entire message on the sign was not appropriate, but she did not know when the sign was posted over the resident's bed, or who posted it. During an interview on 05/15/19 at 01:45 PM, with the Director of Nursing (DON), the DON revealed the sign should not have been posted over Resident #21's bed, and confirmed it was a dignity issue. She said the sign would inform anyone who came into the resident's room, such as visitors or non-clinical employees like maintenance staff, about the resident's personal care. The DON said she did not know who posted the sign. She said staff had other methods for communicating a resident's care needs which included; the Care Tracker system used by CNAs for updating and documenting care; another option was to communicate information about resident care during the verbal report between nursing staff that should occur at every shift change. Interview on 05/16/19 at 10:12 AM, with the facility's Administrator, revealed Departmental Staff were supposed to conduct daily rounds in assigned areas of the building, including the residents' rooms or living spaces. She said if staff persons identified concerns, they could report them at the morning meeting, so the issue(s) could be addressed as soon as possible. She said the staff who made the morning rounds had not reported any concerns with signage in residents' rooms. Resident #37 Review of Resident #37's undated Face Sheet (a document that contains demographic and [DIAGNOSES REDACTED]. Resident #37's [DIAGNOSES REDACTED]. Review of an admission MDS assessment, with the assessment reference date of 5/07/19, indicated Resident #37 scored a 15 (of 15) on the Brief Interview for Mental Status, indicating the resident was cognitively intact. Further review of the MDS assessment indicated the resident required two (2) staff assist for bed mobility, extensive two (2) staff assistance for transfers, dressing, toilet use and bathing and extensive one (1) staff assistance for personal hygiene. Review of Resident #37's current care plan for activities of daily living revealed the resident required staff assistance for eating, personal hygiene, toilet use, dressing and urinary incontinence. During an observation on 5/12/19 at 2:28 PM, Resident #37 was up in a wheelchair, sitting in the dining room. Her hospital gown was open in the back and pushed to the left side revealing the resident's back, left hip, thigh and part of her torso area. Interview with the RN/TCU (Transitional Care Unit) Unit Manager on 5/12/19 at 2:43 PM, following the observation of Resident #37 in the dining area, indicated she thought she was the resident was covered. Observation on 5/13/19 at 12:06 PM, Resident #37 was up in a wheelchair and was being pushed down the hallway by the Respiratory Therapist. The resident's shirt was pulled up to her breast and was exposing her stomach area and her back. When asked, CNA #3 stated the resident's shirt should be pulled down. |
2020-09-01 |