| 49 |
BELLA TERRA OF BILLINGS |
275020 |
1807 24TH ST W |
BILLINGS |
MT |
59102 |
2018-06-14 |
698 |
D |
0 |
1 |
JJY911 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to obtain and document vital signs when the resident returned to the facility after having [MEDICAL TREATMENT], failed to send medication to the [MEDICAL TREATMENT] clinic to be given as prescribed during [MEDICAL TREATMENT], and failed to plan individualized interventions for [MEDICAL TREATMENT] care for 1 (#s 48) of 3 sampled and supplemental residents on [MEDICAL TREATMENT]. Findings include: 1. During an interview on 6/13/18 at 8:50 a.m., staff member U said to prepare resident #48 for her scheduled [MEDICAL TREATMENT] treatment, she planned to get her FSBS and to administer her with sliding scale insulin if needed. She said she normally did not take the resident's vital signs and weight before sending the resident to the [MEDICAL TREATMENT] clinic. She said after residents returned from [MEDICAL TREATMENT], she usually checked their arteriovenous shunt sites for bleeding, and depending on how the resident looked, she might take the resident's vital signs. When shown a copy of the facility's [MEDICAL TREATMENT] Communication Record, staff member U said she had not previously seen the form and had never used it. A review of resident #48's TARS for (MONTH) and (MONTH) of (YEAR), did not show documentation of the resident's vital signs upon returning to the facility after [MEDICAL TREATMENT] treatments. A review of resident #48's Care Plan showed, Resident is at risk for End Stage [MEDICAL CONDITION] r/t Chronic Kidney Failure AEB weekly [MEDICAL TREATMENT]. Date Initiated 4/25/18. The interventions showed, Resident will be compliant with [MEDICAL TREATMENT] Appointments. The care plan did not mention the need for nursing assessments to include measurements of the resident's vital signs upon return to the facility, following [MEDICAL TREATMENT] treatment. 2. A review of resident #48's MARS for (MONTH) and (MONTH) (YEAR), showed the resident was ordered on [DATE] to receive [MEDICATION NAME] HCL 10 mg tablet, one tablet by mouth as needed for [MEDICAL CONDITION]. The order showed, Take at the beginning of [MEDICAL TREATMENT] and may repeat dose 1 hour before the end of treatment if needed. The MARS did not reflect resident #48 had received [MEDICATION NAME] during (MONTH) or June. A review of resident #48's [MEDICAL TREATMENT] Communication Records for (MONTH) and (MONTH) (YEAR), showed resident #48 received [MEDICATION NAME] on 5/4/18 and 5/14/18 as administered by the staff at the [MEDICAL TREATMENT] clinic. [MEDICATION NAME] had been sent by the facility with the resident went to the [MEDICAL TREATMENT] clinic on 5/4/18. The notes did not reflect the [MEDICATION NAME] had been sent with the resident on 5/14/18. During an interview on 6/13/18 at 8:57 a.m., staff member U said she had not sent [MEDICATION NAME] to the [MEDICAL TREATMENT] clinic for resident #48's use in the past. She said she did not know if the [MEDICAL TREATMENT] clinic had a stock of [MEDICATION NAME] to give to the resident if needed. During an interview on 6/13/18 at 9:00 a.m., NF1, at the ([MEDICAL TREATMENT] clinic) said, the clinic's renal doctor had ordered the [MEDICATION NAME] for resident #48 to be given as needed for [MEDICAL CONDITION] during [MEDICAL TREATMENT] treatment. She said the [MEDICAL TREATMENT] center did not keep stock medications. She said the facility had been called in the past and had sent [MEDICATION NAME] with the facility's driver to the [MEDICAL TREATMENT] clinic so resident #48 could be treated for [REDACTED]. When the [MEDICATION NAME] had been administered, the [MEDICAL TREATMENT] clinic had documented it on the resident's [MEDICAL TREATMENT] Communication Order. The resident had been scheduled for [MEDICAL TREATMENT] at the [MEDICAL TREATMENT] clinic twice a week for the months of (MONTH) and (MONTH) in (YEAR). Resident #48's prescription for [MEDICATION NAME] was to have been given at the beginning of each [MEDICAL TREATMENT] treatment and then it could have been repeated if needed. It had been given twice during the month of (MONTH) and had not been given in (MONTH) of (YEAR). 3. A review of resident #48's Order Review Report, dated (MONTH) 3, (YEAR), showed the resident was ordered to be monitored for thrill and bruit of her [MEDICAL TREATMENT] shunt/fistula daily, monitored for s/s of shunt/fistula for infection every shift, and not to have blood draws or her blood pressure taken on the arm with her shunt/fistula. The resident was also ordered a renal diet without potatoes, tomatoes, oranges and bananas. In an interview on 6/13/18 at 8:57 a.m., staff member U said resident #48 took all of her medications except for her insulin after she returned to the facility from her [MEDICAL TREATMENT] treatment. A review of resident #48's Care Plan showed only one intervention: Resident is at risk for End Stage [MEDICAL CONDITION] r/t Chronic Kidney Failure AEB weekly [MEDICAL TREATMENT]. Date Initiated 4/25/18. The care plan did not show specific information regarding the resident and her needs related to [MEDICAL TREATMENT]. It did not show how often, when, or where the resident was scheduled to receive [MEDICAL TREATMENT] treatments. It did not show how the resident was to be transferred to and from the facility for [MEDICAL TREATMENT] care. It did not show the residents need for the assessments of vital signs before and after [MEDICAL TREATMENT], shunt/fistula assessments for bruit, thrill or s/s of infection, weight measurements for potential fluid imbalance, or lab follow-ups for abnormal electrolyte concerns. The care plan failed to reflect the resident's medications were to be held until after her return from [MEDICAL TREATMENT] on the days she was scheduled to receive [MEDICAL TREATMENT]. The care plan did not show that the [MEDICAL TREATMENT] clinic had been notified of the resident's end of life wishes in case of emergency at the [MEDICAL TREATMENT] clinic. The care plan did not show the resident had been educated about her renal diet and to avoid potatoes, tomatoes, oranges and bananas. ` |
2020-09-01 |