cms_ND: 51
Data source: Big Local News · About: big-local-datasette
| rowid | facility_name | facility_id | address | city | state | zip | inspection_date | deficiency_tag | scope_severity | complaint | standard | eventid | inspection_text | filedate |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 51 | MINOT HEALTH AND REHAB, LLC | 355031 | 600 S MAIN ST | MINOT | ND | 58701 | 2019-06-11 | 657 | E | 1 | 0 | HFFF11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > THIS IS A REPEAT DEFICIENCY FROM SURVEY COMPLETED ON 08/16/18. Based on observation, record review, review of facility policy, and staff interview, the facility failed to review and revise the comprehensive care plan to reflect the current status for 4 of 16 sampled residents (Resident #1, #5, #13, #14) and 1 discharged resident (Resident #17). Failure to revise the care plan limited the ability of staff to communicate care needs and ensure continuity of care for each resident. Findings include: Review of the facility policy titled Care Plans - Comprehensive occurred on 06/10/19. This undated policy stated, . develops and maintains a comprehensive care plan for each resident that identifies the highest level of functioning the resident may be expected to attain . Incorporate identified problem areas . Incorporate risk factors associated with identified problems . Identifying problem areas and their causes, and developing interventions that are targeted and meaningful to the resident . care plans are revised as information about the resident and the resident's condition change . - Review of Resident #1's medical record occurred on all days of survey. The current physician order stated, Oxygen at 2 L/M (liters per minute) to maintain O2 (oxygen) saturations > (less than) 90%. Check each shift. Observations on 06/04/19 at 11:05 a.m. and 06/05/19 at 10:08 a.m., showed Resident #1 wearing a nasal cannula attached to an oxygen concentrator set at 1 liter per minute. The facility failed to review/revise the care plan to reflect Resident #1's respiratory status. During an interview on 06/06/19 at 9:05 a.m., an administrative nurse (#5) stated he/she would expect staff to address O2 use/interventions on the careplan. - Review of Resident #5's medical record occurred on all days of the survey. The current care plan stated, ADL (activities of daily living) self care deficit as evidenced by unsteady gait related to lumbar L2 fracture. Transfer with extensive assist of one with gait belt. Observation on 06/04/19 at 11:30 a.m. showed Resident #5 ambulated independently with a front wheeled walker into the bathroom. The facility failed to accurately identify Resident #5's level of assistance and toileting on the care plan. - Review of Resident #13's medical record occurred on all days of survey. The current physician order stated, House supplement three times daily. The current care plan stated, Nutritional status wt (weight) loss . Need for assistance at meals and altered textures . Refuses meals or takes poor . Provide diet as ordered - Pureed small portions per family request. Fortified cereal, pudding, cereal and magic cup . Review of progress notes showed the following: * 02/28/19 at 2:02 p.m. - Doctor started resident on [MEDICATION NAME] to help with weight gain * 02/28/19 at 3:56 p.m. - Resident declining and failing to thrive. Resident has been losing weight and does not have an appetite. * 04/02/19 at 12:05 p.m. - Family is aware of wt loss and does not want comfort measure or tube feeding support * 04/18/19 at 3:15 p.m. - Resident continue with failure to thrive and refusing to eat Resident #13's current physician's order stated, . Clean area to right clavicle . Clean large skin tear to RFA (right forearm) . Clean small skin tear to RFA . The care plan stated, At risk for alteration in skin integrity related to . impaired mobility . Encourage fluids . Float heels . Observe skin condition daily with ADL care daily: report abnormalities . Pressure redistributing device on bed/chair . Provide preventative skin care routinely and PRN (as needed) . Toileting program as indicated . Use pillows/positioning devices as needed . Review of the nursing progress notes showed the following: * 05/20/19 at 10:00 p.m. - Abrasion on right clavicle is small and superficial * 05/23/19 at 3:30 p.m. - Alerted nurse to a large skin tear to right inner elbow area measuring 7 centimeters (cm) x 2 cm (open area bright red wound bed) and another skin tear to right forearm measuring 1 cm x 1 cm. Resident #13's care plan failed to identify current skin issues with treatment and the current weight loss approaches. - Review of Resident #14's medical record occurred on all days of survey. The current physician order stated, [MEDICATION NAME] to open areas on bottom. Change every MWF (Monday, Wednesday, Friday) until healed . [MEDICATION NAME] type bandage change daily . Rt (right) foot wound .Wound to right lower extremity . Change daily. Wound nurse to follow . Review of Resident #14's medical record showed resident has fallen six times in the last six months. A progress note, dated 03/06/19 at 7:44 a.m., stated, . Requesting to place floor mats at bedside . All observations during survey showed Resident #14 with no fall mats in place while in bed. Observation on 06/04/19 at 10:59 a.m. showed two certified nursing assistants (CNAs) (#9 and #10) checked Resident #14's brief and provided incontinent cares for Resident #14 after a bowel movement (BM) while in bed. The current care plan stated, At risk for alteration in skin integrity related to: history of pressure ulcer . Transfer with two assist with gait belt . Resident #14's care plan to failed to identify current skin issues, toileting method, and fall interventions. - Review of Resident #17's medical record occurred on all days of survey, and identified a 37 pound weight loss between 12/03/18-05/05/19. Documentation failed to show staff identified Resident #17's food preferences and/or obtained orders for/implemented other interventions such as fortified foods/supplements. Staff failed to individualize Resident #17's care plan identifying specific preferred foods/supplements. During an interview on 06/04/19 at 3:30 p.m., when asked how the facility addresses residents experiencing weight loss, a managerial dietary staff member (#12) reported monitoring residents for gradual/significant weight loss, and stated, First, I would give the resident fortified foods, and then supplements. I try to do things like cookies, chocolate milk, whole milk, cheese and crackers, cereal, magic cup, sherbet, and peanut butter. If they need help, I ask them to be moved to an assisted table. During an interview on 06/05/19 at 3:00 p.m., a managerial nurse (#5) confirmed the care plan failed to reflect Resident #17's food preferences and/or the fortified foods, supplements, and snacks recommended for her. Resident #17's progress notes identified the following: * 03/10/19 at 9:49 p.m., Resident's daughter approached this recorder and stated, 'my Mom's toe is infected' . On exam 2nd toe on rt foot is light red, no swelling noted, has a dry callous type lesion of DP (sic) joint area, no drainage noted, residents (sic) states it does not hurt . Callous is dry measures 0.9 cm x 1 cm. * 03/12/19 at 4:41 a.m., . received first dose of [MEDICATION NAME] . Toe is [DIAGNOSES REDACTED] and slightly warm to touch. Skin is intact. No drainage noted. She stated only has pain when blanket is laying on the foot. Blanket was pulled back and she stated she had relief. and at 9:11 p.m., . Right 2nd toe is red (and) swollen. Anterior distal tip of toe has a small circular open area with no drainage. Resident denies any pain or discomfort to toe. The care plan failed to address removing pressure from the top of Resident #17's feet. | 2020-09-01 |