| 56 |
BELLA TERRA OF BILLINGS |
275020 |
1807 24TH ST W |
BILLINGS |
MT |
59102 |
2016-12-15 |
279 |
E |
0 |
1 |
PSRD11 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record reviews, interviews, and observations, the facility failed to follow the care plan for a lactose free diet and offering an alternative meal if less than 50% of the original meal was consumed, for one (#1); failed to follow the care plan for straight cathing a resident three times a day, and for a specialized diet for one (#7); and failed to document restorative services on the care plan, and follow a restorative services plan, for a resident with contractures, for one (#10) out of 19 sampled residents. Findings include: 1. Care Plan for Catheter: Review of Resident #7's Physician order [REDACTED]. Review of Resident #7's Care Plan Report, with an effective date of 9/13/16 to present, showed that the resident's intervention was to straight cath, per MD orders, for [DIAGNOSES REDACTED]. Review of Resident #7's Treatment records and Clinical Notes for (MONTH) and (MONTH) (YEAR), showed inconsistencies in the resident being straight cathed three times daily as care planned. During an interview on 12/13/16 at 9:00 a.m., resident #7 stated she should be getting straight cathed three times daily. The resident also stated the staff had not been straight cathing her three times a day. During an interview on 12/13/16 at 3:25 p.m., resident #7 stated she had not been straight cathed yet today. The resident stated the nurse had not came back to cath her. During an interview on 12/13/16 at 3:30 p.m., staff member J stated resident #7 had straight cathed herself at home prior to being admitted to the facility. She also stated the resident had been scheduled to be straight cathed at 5 a.m., 2 p.m., and 10 p.m. Staff member J stated resident #7 had episodes of urinary tract infections. She also stated sometimes the resident had refused to be cathed. 2. Care Plan for Lactose Free Diet: Review of Resident #7's Physician order [REDACTED].>Review of Resident #7's Care Plan Report, with an effective date of 9/13/16 to present, showed the resident was lactose intolerant, the intervention was a lactose free diet. Review of Resident #7's Treatment Record, dated (MONTH) (YEAR), showed the resident was started on a continuous lactose free diet on 10/26/16. Review of Resident #7's Lunch Dining Card, dated 12/13/16, showed the resident was lactose intolerant. Review of the facility's Lactose-Free Diet guideline, showed all lactose products must be eliminated, which would have included foods that would have been prepared with milk. The guideline also showed food groups that would contain lactose such as: -Milk -Cheese -Ice cream -Cream soup, canned, and dehydrated soup mixes containing milk products Review of the facility's tuna and noodles recipe, from the Food for 50 book, showed the recipe contained cheese, canned cream of mushroom or celery soup, and milk. During an observation on 12/13/16 at 11:30 a.m., resident #7 was served tuna casserole, pickled beets with a lettuce garnish, and ice cream for dessert. The resident ate greater than 50 percent of her tuna casserole and 100 percent of her ice cream. The tuna casserole and ice cream contained lactose. During an interview on 12/13/16 at 12:10 p.m., staff member G stated that at the current time, they did not have any residents on a lactose free diet. During an interview on 12/13/16 at 12:25 p.m., staff member H stated the tuna casserole, served to resident #7, contained cream of mushroom soup, milk, and cheese. During an interview on 12/13/16 at 2:45 p.m., staff member I stated resident #7 had always been on a lactose free diet. He had also stated the Registered Dietitian would be the one who would update the interventions on a resident's care plan. During an interview on 12/13/16 at 3:00 p.m., staff member J stated resident #7 had a [DIAGNOSES REDACTED]. She also stated the resident was lactose intolerant and noted the resident had been served ice cream with her lunch. During an interview on 12/13/16 at 3:25 p.m., resident #7 stated she had diarrhea if she ate lactose. The resident stated she had been feeling queasy after lunch. 3. Review of the physician recapitulation orders, dated (MONTH) (YEAR), showed resident #1 had an order, dated 6/30/16, for a mechanical soft diet. The diet was documented in the order that the resident should be receiving mechanical soft, but also staff should send a pureed diet plate, and offer the puree if she refused to eat mechanical soft textures. Review of the Residents Care Plan, with an effective date of 3/31/16-current, showed the resident had the following nutritional interventions: - Provide max to total assist with eating. - Allow adequate time to eat; provide assistance, cueing, and encouragement as indicated. Feed the resident. - Offer alternates if - Provide diet as ordered: Mechanical Soft. Provide pureed foods as alternative. Review of the resident's diet card for 12/13/16, showed the following orders: - may need assistance - dysphagia level 3 (advanced) and dysphagia level 1 (pureed) During an observation on 12/13/16 at 7:28 a.m., resident #1 was sitting in the Mountain View dining room, waiting for her breakfast. She was served scrambled eggs and hot cereal. Staff left her sitting at the table, waiting for assistance, for a period of time after she appeared to be finished eating. No continued prompting or cuing was offered to her. The facility failed to allow adequate time for the resident to eat, and encourage her as the care plan showed. The resident ate less than 10% of her eggs or cereal at the meal. The staff members failed to offer her pureed eggs as an alternate as the doctor had ordered, and for what the care plan showed. During an observation on 12/13/16 at 11:46 a.m., resident #1 was sitting in the Mountain View dining room waiting for her lunch. Staff served her pureed carrots and mashed potatoes with gravy. The facility failed to offer her the mechanical soft diet prior to serving her the pureed carrots. During an interview on 12/13/16 at 12:00 p.m., staff member Z stated the resident had been receiving pureed meals, and recognized the resident was only given one option for breakfast. The staff member explained the resident's diet card showed the resident was to receive a pureed diet. The facility failed to follow the care plan by not offering her a mechanical soft diet menu item, prior to giving her a pureed meal. During an observation and interview on 12/14/16 at 9:00 a.m., a family member stated resident #1 ate well, and that the resident would not eat pureed food. The family member stated the resident ate the mechanical soft diet well. The family member also stated they had requested mashed potatoes and ice cream to be offered at meal. The resident would always eat those two foods items, because they were some of her favorites. The family member stated the diets had been a problem at the facility because there was a staff change over and sometimes she just doesn't get the assistance she needs. During the interview, the resident was observed eating a cookie that was broken into small pieces. The resident didn't appear to be having any struggles with eating the cookie, she just needed a bit more time to eat her snack. She was able to eat well with cueing and adequate time. 4. During an observation and interview on 12/13/16 at 8:30 a.m., in the dining room, resident #10's daughter assisted her with eating breakfast. The daughter stated she had a concern with her mother's hand, which was contracted. The daughter wanted a rolled up wash cloth in the hand which would keep the resident's fingers from curling inward. During an observation on 12/13/16 at 12:20 p.m. in the dining room, Resident #10 sat at the table with her right hand in her lap. Her fingers were curled into her palm. Review of resident #10's Physician order [REDACTED]. During an interview on 12/14/16 at 10:30 a.m., with staff members AA, BB, and R, staff member AA stated the PT department tried to work closely with resident #10 to meet her needs. Staff member BB stated she assessed Resident #10 quarterly for any changes the resident needed. Staff member R stated she did ask the resident to participate in restorative, but the resident usually refused. Review of the restorative care sheet showed the resident was to receive a TENS unit 2-3 times a week to her shoulder. There was no information on the care sheet for the splinting or bracing of the resident's hand. Review of resident #10's Care Plan showed a lack of restorative service, used as an intervention for the treatment of [REDACTED].#10's hand. During an interview on 12/15/16 at 9:00 a.m., staff member CC stated she missed putting restorative services on the resident's care plan. She thought resident #10 was no longer receiving restorative. |
2020-09-01 |