cms_ND: 57
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 57 | MINOT HEALTH AND REHAB, LLC | 355031 | 600 S MAIN ST | MINOT | ND | 58701 | 2019-06-11 | 690 | E | 1 | 0 | HFFF11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > INCONTINENCE 1. Based on information received from the complainants, record review, and review of the facility policy, the facility failed to assess the residents' bowel and bladder patterns to maintain continence for 2 of 16 sampled residents reviewed (Resident #11 and #14) and 2 discharged residents (Resident #17 and #19). Failure to assess bowel and bladder patterns and implement routine toileting consistent with these patterns may result in avoidable incontinence, urinary tract infections (UTIs), and/or falls and does not allow residents to attain/maintain their highest practicable physical and psychosocial well-being. Findings include: Information provided by the complainants indicated nursing staff failed to toilet residents on a frequent basis resulting in residents' observed in soiled clothing/bedding. Review of the facility policy titled Incontinence Prevention Program occurred on 06/11/19. This undated policy stated, . Based upon the results of the Evaluation of Continence . Prompted voiding is a scheduled toileting program . Residents are offered toileting assistance at regular intervals while awake and as needed at night. Habit training is a scheduled bladder management program designed according to the patient's/resident's individual voiding pattern. Routine Toileting . A scheduled bladder management program will be designed to toilet an incontinent patient/resident when a voiding pattern cannot be established or for a patient/resident who is unable to communicate the need to void . - Review of Resident #11's medical record occurred on all days of survey. The current care plan identified, . Urinary incontinence r/t (related to) Disease process (dementia), functional incontinence, [MEDICAL CONDITIONS] . Provide assistance with toileting every two hours at minimum. At risk for falls due to: history of falls, impaired balance/poor coordination. Increased toileting during nighttime hours (every 2-3 hours) . Review of toileting documentation, dated 05/01/19-06/03/19, showed staff toileted Resident #11 one-to-four times per day. The progress notes further identified staff found Resident #11 on the floor incontinent of urine and/or stool on four occasions. - Review of Resident #14 medical record occurred on all days of survey. The current care plan identified, . Urinary incontinence r/t: disease process dementia, impaired mobility . provide incontinent care as needed . At risk for falls due to: impaired balance/poor coordination . anticipate resident needs; assess comfortable for positioning in bed; reposition and provide incontinent cares at routine times . Review of toileting documentation, dated 03/01/19-04/30/19, showed staff toileted Resident #14 one-to-four times per day. The progress notes further identified staff found Resident #14 on the floor incontinent of urine and/or stool on two occasions. - Review of Resident #17's medical record occurred on all days of survey. [DIAGNOSES REDACTED]. The care plan identified, . requires assistance related to physical limitations, visual impairment . CNA (certified nursing assistant) to assist to toilet prior to and following meals. Offer toileting on last rounds for night shift. Review of toileting documentation, dated 04/10/19-05/15/19, showed staff toileted Resident #17 zero-to-seven times per day at random times throughout the day. The facility failed to consistently toilet Resident #17 prior to/following meals as care-planned. The progress notes further identified staff found Resident #17 on the floor of her bathroom on one occasion. - Review of Resident #19's medical record occurred on all days of survey. The care plan identified, . At risk of urinary incontinence r/t Disease process [MEDICAL CONDITIONS] . Remind and assist as needed with toileting at routine times such as upon arising in AM, before/after meals, activities, therapy and at bedtime . Review of toileting documentation, dated 10/01/18-11/19/18, showed staff assisted/toileted Resident #19 two-to-six times per day at random times throughout the day. The facility failed to consistently toilet Resident #19 prior to/following meals as care-planned. Facility staffs' failure to assist/toilet Resident #11, #17, and #19 in a timely manner may have resulted in their experiencing incontinence/avoidable falls. Refer to F585 and F689. URINE CULTURES 2. Based on record review and staff interview, the facility failed to provide services to treat urinary tract infections (UTIs) for 1 of 1 resident discharged from the facility (Resident #17) with a history of UTIs. Failure to contact the physician immediately after being notified of a positive urine culture resulted in Resident #17 receiving delayed treatment for [REDACTED]. Findings include: Upon request, the facility failed to provide a copy of their policy addressing urinary tract infections. Staff indicated they use the McGeers Criteria. - Review of Resident #17 medical record occurred on all days of survey. [DIAGNOSES REDACTED]. The care plan identified, . requires assistance related to physical limitations, visual impairment . CNA (certified nursing assistant) to assist to toilet prior to and following meals. Offer toileting on last rounds for night shift. The progress notes identified the following: * 03/22/19 at 5:43 a.m., . Resident lowered to her knees after resident stated her right knee became weak . * 03/22/19 at 2:42 p.m., Resident returned from appointment with nephrologist . New orders to continue same medications, get a U[NAME] A microbiology report, dated 03/24/19, identified Escherichia coli (E-coli) and Proteus mirabilis (types of bacteria) present in Resident #17's urine. The report further indicated the bacteria as susceptible to [MEDICATION NAME]/Tazobactam, and [MEDICATION NAME]/Sulfa (antibiotics). The chart lacked evidence that staff notified the physician of Resident #17's positive urine culture. The progress notes identified the following: * 03/26/19 at 7:00 p.m., CNA reports that when he was transferring resident from w/c (wheelchair) to toilet with gait belt, resident's legs buckled (and) she had to be lowered to the floor . * 04/01/19 at 5:00 p.m., Resident's hands (and) arms are shaking. Her cheeks are red (and) flushed . Resident had a large food filled emesis . (Physician) paged. New orders to get UA/UC (urinalysis/urine culture). Start resident on [MEDICATION NAME] (antibiotic) . During an interview on the morning of 06/06/19 at 8:00 a.m., the managerial nurse (#5) confirmed staff should have immediately contacted the physician after being notified of her positive urine culture. Facility staff failed to contact Resident #17's physician for eight days after being notified of her positive urine culture, delaying her antibiotic treatment. | 2020-09-01 |