rowid,facility_name,facility_id,address,city,state,zip,inspection_date,deficiency_tag,scope_severity,complaint,standard,eventid,inspection_text,filedate
1,GREENBRIAR HEALTHCARE,305005,55 HARRIS ROAD,NASHUA,NH,3062,2018-03-05,550,D,0,1,6C1411,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based upon record review and staff interview the facility failed to protect and promote the rights of 2 of 43 sampled residents (Resident identifiers are #18 and #49). Findings include: Resident #18 was admitted to the facility on [DATE] without having a [DIAGNOSES REDACTED]. However on 7/18/16 Resident #18 was diagnosed with [REDACTED]. The facility from 7/18/16 when the [MEDICAL CONDITION] disorder [MEDICAL CONDITION] type [DIAGNOSES REDACTED].#18. Staff L (Social Services Director) aknowledged during a 3/2/18 interview that the facility has not made a PASARR II referral for Resident #18. Resident #18's new [DIAGNOSES REDACTED]. Resident #49, according to Staff L was an emergency admission who was admitted into the facility on [DATE]. The Consent to Admission and Treatment form was signed by a Family Friend without any documentation being provided to the facility which showed that this individual had been given the legal authroization to sign for Resident #49 on their behalf. Also, this family friend of Resident #49 signed consent forms without having any documentation showing that they had the authority to do so for administering antipsychotic, antidepressant, antianxiety and hypnotic medications to Resident #49. Resident #49's comprehensive care plan states that Resident #49 is able to make her own health care decisions at this time. A Social Service note of 9/26/17 stated that Resident #49 is able to make (his/her) own decisions. Interviews on 3/2/18 and 3/5/18 with respectively Staff L (Social Service Director) and Staff D (Unit Manager) revealed that Resident #49 was not competent to make his/her own health care decisions. This was confirmed by Resident #49's admission MDS assessment of 9/25/17 and 12/18/17 quarterly MDS that indicated Resident #49 is severely cognitively impaired. Also, Resident #49's care plan indicated that their Advance directives are not on file. A Social Service note of 9/26/17 stated that Social Services is attempting to locate DPOA paperwork. A Social Service note of 12/19/17 revealed that Social Services will follow up with Resident #49's son regarding pursuing guardianship. Social Service notes of 1/18/18 and 1/30/18 indicated that Resident #49's son was continuing to look for DPOA documentation. A Social Service note of 3/2/18 stated when communicating with Resident #49's son that the facility needs this paperwork the DPOA documentation and that if we can not locate it we will need to file for guardianship almost six months following Resident #49's admission to the facility.",2020-09-01
2,GREENBRIAR HEALTHCARE,305005,55 HARRIS ROAD,NASHUA,NH,3062,2018-03-05,609,D,0,1,6C1411,"Based on interview and record review, it was determined that the facility failed to ensure that the all alleged violations involving abuse, neglect, exploitation and/or mistreatment are reported to the State Survey Agency within the prescribed time frames (see regulation above for timeframes) for one resident out of a subgoup of one resident, with an allegation of resident to resident abuse, in a survey sample of 43 residents. (Resident identifier is #130). Findings include: Resident #130: 2/27/18 1:37 PM: Interview with Resident #130 revealed a verbal report as follows: (Resident #121) came at me and knocked me down. I thought (he/she) would kill me but two staff saved me. This was a couple of months ago. I will never forget the experience! Social services comes to talk to me and make sure I'm okay. I still watch (him/her) like a hawk whenever (he/she) is nearby. (He/She) hasn't tried anything lately. 2/28/18 1:00 pm: Interview with Staff D, Unit Manager revealed that Staff D felt that the incident was overplayed by Resident #130, and it was most likely that both residents were frightened by each other and that caused Resident #130 to fall. Staff D stated, when asked, that the facility did not report this incident as the residents both have dementia, and would not remember what happened. Staff D went on to say that she was unaware that resident to resident altercations needed to be reported to the State Survey Agency if the residents both had dementia. 03/02/18 07:52 AM: Review of nurses notes from the alleged incident on 2/14/18 confirm that there was a resident to resident altercation in Resident #130's room with Resident #121, who held Resident #130 by the upper arms and knocked him/her down. This was witnessed by a nurse, Staff F, and an LNA (un-named) assisted with separating Resident #121 and redirecting him/her from the room so that Resident #130 could be assessed for injury. On nursing assessment by Staff F, an abrasion to the left elbow was noted to be sustained by Resident #130, and neurological checks were initiated as Resident #130 bumped his/her head on a chair when he/she was knocked down. 3/2/18, 10:30 am: The facility's investigation on this incident was reviewed. Facility Policy & Procedures state that resident to resident altercations are not reported to the State unless there is: .serious injury sustained requiring transfer to a hospital, or transfer for a psychiatric evaluation, and/or prolonged emotional upset.A system for follow up on altercations, with an emphasis to prevent future altercations will be in place, including: .Care plans will be updated to incorporate recommendations from the formal incident review process . This incident was not reported to the State Survey Agency as per interview with Staff D, related to the Facility Policies and Procedures for Resident to Resident Altercation Reporting, and that Staff D did not think it needed to be reported because both residents had dementia.",2020-09-01
3,GREENBRIAR HEALTHCARE,305005,55 HARRIS ROAD,NASHUA,NH,3062,2018-03-05,655,B,0,1,6C1411,**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview the facility failed to develop and implement a baseline care plan for each resident that includes the instructions needed to provide effective and person-centered care of the resident that meet professional standards of quality care within 48 hours of admission for one resident in standard survey sample of 43 (Resident identifier is #194). Findings include: During recertification survey on 3/4/18 and 3/5/18 Resident #194's medical record was reviewed. In this review it was identified that the resident was admitted to the facility on [DATE]. Review of the care plan section of the medical record given to this surveyor for review by Staff M (Assistant Administrator) identified that the first care plan that had been developed for Resident #194 had been developed and initiated on 2/13/18 In addition to being late this initial baseline care plan did not include any reference to dietary orders or social services involvment. Interview with Staff M on 3/5/18 confirmed that the document given to this surveyor was a copy of the initial care plan.,2020-09-01
4,GREENBRIAR HEALTHCARE,305005,55 HARRIS ROAD,NASHUA,NH,3062,2018-03-05,656,D,0,1,6C1411,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interview and review of the facility Comprehensive Person-Centered Care Plan policy and procedure the facility failed to develop and implement a person-centered comprehensive care plan for 5 residents in a survey sample of 43 residents. (Resident identifiers are #15, #49, #80, #93 and #152.) Findings include: Resident #152. Record review on 3/5/18 of the Physical Therapy Plan of Care for Resident #152 dated 1/28/2018 revealed in the section titled Medical History Related to Diagnosis/Condition: . R (right) BKA (below knee amputation) due to osteo[DIAGNOSES REDACTED] 6/2105 . Record review on 3/5/18 of the PT (physical therapy) - Therapist Progress note for Resident #152 dated 2/26/18 revealed The pt (Resident #152) continues to have deficits in ROM (range of motion) in B LE (bilateral lower extremities), which limit pt's ability to stand upright on LLE (left lower extremity) and prepare for ambulation via prosthesis due to limited ROM in R knee .barrier is that the pt. (Resident #152) does not currently have a functional prosthesis, as .socket does not fit despite use of shrinker nearly 24/7. PT has been working with prosthesis to obtain a new socket . Interview and review, on 3/5/18 at approximately 12:30 pm. with Staff [NAME] (Registered Nurse), of the comprehensive care plan for Resident #152 revealed no documented evidence of care plan indicating a below knee amputation with interventions for Resident #152. Staff [NAME] reported that if you read this care plan and had not seen .(Resident #152) you wouldn't know that .had a [MEDICAL CONDITION]. Resident #49 who was admitted to the facility on [DATE] has a comprehensive plan of care initiated on 9/26/17 which states that this resident is able to make (his/her) own health care decisions at this time. Interviews on 3/2/18 and 3/5/18 with respectively Staff L ( Social Services Director) and Staff D (Unit Manager, RN) revealed that Resident #49 was not competent upon their admission to make his/her own health care decisions. In addition both Resident #49's admission MDS assessment of 9/25/17 and quarterly MDS assessment of 12/18/18 coded Resident #49 as being severely cognitively impaired. Record review revealed that Resident #49's care plan states Resident #49's Advance directives are not on file. Staff L stated in a 3/2/18 interview that there wasn't either any guardianship or durable power of attorney documents on file at the facility for Resident #49 since Resident #49's admission on 9/18/17. A 3/5/18 interview with Staff L revealed that a New Hampshire Durable Power of Attorney Form for Resident #49 appointing his/her son as Resident #49's durable power of attorney had been found on 3/5/18 among Resident #49's admission paperwork. A review of this Durable Power of Attorney revealed that it is only for financial matters and states that this document does not authorize the Attorney-in-Fact to make medical decisions for the Principal Resident #49. Resident #93 Review on 03/02/18 of Resident #93's medical record revealed that Resident #93 has dementia. Review of Resident #93's the care plan on 03/05/18 reveals Resident #93 is an extensive assist with a shower. Review of Resident #93's activities of daily living task for showers revealed that during the time frame of 2/3/18-3/5/18 he/she only received one shower since 2/3/18. He/she refused a shower on 2/17/18. Interview on 3/2/18 with Staff N, (Licensed Practical Nurse) revealed that he/she is to be re-approached on another day to receive a shower for the week that he/she missed. There is no documentation that showes that Resident #93 was reapproached and Resident #93 only received a bedbath. Resident #80 Observation of Resident #80 on 3/2/18 at 10:15 a.m. during interview revealed the resident's right foot was not resting on the foot platform of their wheelchair and the resident's slipper was dangling from their foot. There was towel wrapped on the foot platform. Interview with Resident #80 on 3/2/18 at 10:15 am. revealed that when Resident #80 was admitted , the resident had brought an electric wheelchair from home that was no longer taking a charge so was now using a facility manual wheelchair. Resident #80 also revealed that the resident had limited range on motion of the right hip and knee. Review of Resident #80's current care plan on 3/5/18 at 9:09 a.m. revealed there were no interventions for positioning or limited range of motion for the resident's lower right extremity. Interview with Staff M (Assistant Administrator) on 3/5/18 at approximately 10:30 a.m. confirmed there were no care plan interventions for positioning or range of motion. Resident #15 Review of medical record on 3/2/18 at approximatley 10:15 am revealed that Resident #15 had a [DIAGNOSES REDACTED]. Review of Resident #15's care plan revealed that there was no care plan for communication or [MEDICAL CONDITION]. Interview on 3/2/18 at approximatley 11:45 am with Staff G (Unit Manager building 5-3) confirmed that resident has a communication deficit and uses gestures and yes and no answers to communicate with staff and that there is no care plan in place for communication or [MEDICAL CONDITION].",2020-09-01
5,GREENBRIAR HEALTHCARE,305005,55 HARRIS ROAD,NASHUA,NH,3062,2018-03-05,658,D,0,1,6C1411,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview the facility failed to note/validate a medication order for 1 Resident in a sample size of 43 (Resident identifier is #180.) and failed to ensure proper assessments were performed before moving residents after they sustained falls. (Resident identifiers are: #152 and #186.) Findings include: Potter, [NAME] [NAME], and Anne Griffin Perry. Fundamentals of Nursing. 7th Edition, St Louis, Missouri: Mosby Elsevier, 2009. Chapter 16 Nursing Assessment, page 243. Data Documentation Data documentation is the last part of a complete assessment. The timely, thorough and accurate documentation of facts is necessary when recording client data . If you do not record an assessment finding or problem interpretation, it is lost and unavailable to anyone else caring for the client. If there is not specific information, the reader is left with only general impressions. Observation and recording of client status is a legal and professional responsibility. The nurse practice acts in all states and the American Nurses Association Nursing's Social Policy Statement (2003) mandate, or require, accurate data collection and recording as independent functions essential to the role of the professional nurse. Resident #186 This Surveyor requested an Accident /Incident Report and an Investigation Report. Review of an Event Report, written by Staff O, LPN (Licensed Practical Nurse), and provided by Facility Staff for an Event that occurred on 2/25/18 at 0100 hours revealed the following: While standing in the hallway heard a bump heard a resident yelling for help, found resident laying between the beds, on her R (right) side (Resident) stated unsure all (he/she) know (sic) that (he/she) was asleep. ask (sic) resident if (he/she) hit (his/her) head, (stated no) resident assist to bed X3 (times three person assist), while in bed began a head to toe assessment no apparent bruising or open areas noticed at this time, Neuro checks performed as protocol per facility (sic). There was no Investigation Report provided. Review of this residents Progress Notes for 2/25/18 written at 3:49 a.m. reveals at approximately 1:00 a.m.this date, this resident was status [REDACTED]. Assessment: nose bleeding, no sign of open injuries, residents BP (blood pressure) as follows 69/41 (BP) 98 (TEMPERATURE) 70 (HEART RATE) 18 (RESPIRATION RATE) 96% RA (room air)(PULSE OXIMETRY LEVEL) 72/45 97.6 18 100% RA, c/o (complaint of) pain both knees. Background: Resident is paralyzed from the hips down, c/o severe pain frequently (sic). On interview, 3/2/18 at approximately 2:10 p.m. Staff C, RN DON (Director of Nurses) stated that Resident #186 raised the bed to a higher position on his/her own. While this resident is paralyzed from the waist down he/she is quite capable of moving himself/herself around in bed and in using the bed control. Because this resident spends a fair amount of time in her bed he/she is on an air mattress to decrease the chance of developing pressure areas. During this interview Staff C stated that there was no Investigation Report and no report to the State Agency because the Facility did not feel there was any mystery as to how Resident #186 had been able to fall out of bed. Resident #152. Record review on 3/05/18 10:16 of the Nurse Note dated 2/22/18 for Resident #152 revealed This nurse informed by supervisor that resident had an un-witnessed fall w/o injury. Resident found in PT (physical therapy) performing exercises w/ staff, stated he had 0 pain, was assessed for injury by PT and supervisor. Denied hitting his head will continue to monitor. No documented evidence of an assessment could be found for Resident #152 un-witnessed fall on 2/22/18. Review on 3/5/18 of incident report dated 2/21/18 for Resident #152 revealed the following, Slipped from chair to floor, in siting position, while attempting to transfer to bed denied hitting head . Assessed by PT and supervisor, no injury noted, vitals taken neuros initiated . Transferring w/out calling for assistance. Interview on 3/5/18 at approximately 12:30 p.m. with Staff [NAME] (Registered .Nurse) revealed that after review of the medical record and nurse notes, Staff [NAME] confirmed that there was no documented evidence of an assessment done by a nurse or a PT following the fall for Resident #152 on 2/22/18. Resident #180 During review of the use of medications in the insulin and anti-coagulant investigative category, an incidental finding of a non-transcribed [MEDICATION NAME] order was identified. Written on 2/20/18 the order reads [MEDICATION NAME] 50 mg Per Oral at bedtime as needed for [MEDICAL CONDITION] signed by Physician Assistant Certified. Order had no indication that it had been transcribed. Review of MAR (Medication Administration Record) for the month of (MONTH) was conducted. There is no entry on the MAR for [MEDICATION NAME] nor any indication that the resident received any doses. Interview with Staff F Registered Nurse (RN) validated the above findings.",2020-09-01
6,GREENBRIAR HEALTHCARE,305005,55 HARRIS ROAD,NASHUA,NH,3062,2018-03-05,677,D,0,1,6C1411,"Based on medical record and interview it was determined that the facility failed to provide assistance with activities for daily living for 1 resident in a standard survey sample of 43 residents. (Resident identifier is #93.) Findings include: Resident #93 Review on 03/02/18 of Resident #93's medical record revealed that Resident #93 has dementia. Review of Resident #93's the care plan on 03/05/18 reveals Resident #93 is an extensive assist with a shower. Review of Resident #93's activities of daily living task for showers revealed that during the time frame of 2/3/18-3/5/18 he/she only received one shower since 2/3/18. He/She refused a shower on 2/17/18. Interview on 3/2/18 with Staff N, (Licensed Practical Nurse) revealed that he/she is to be re-approached on another day to receive a shower for the week that he missed. There is no documentation that showes that Resident #93 was reapproached and Resident #93 only received a bedbath. Resident Council notes. On 2/28/18 at approximately 11:00 a.m. during a Resident Council meeting with seven (7) residents in attendance it was stated that 2 nurses were known to residents to give showers; most (nurses) do not seem to have the time to do that. Additionally, one of the residents stated that some days they are told that no one is available to give showers on some shifts. As residents are only scheduled for 1 or 2 showers per week, if residents miss a scheduled shower, it could be several days before they receive another shower. It was further stated by Resident Council members that some call lights are being shut off by staff reaching behind curtains and canceling the call lights without acknowledging the residents affected. Interview on 3/1/18 at approximately 7:15 a.m. with Staff U, Licensed Nursing Assistant revealed, Staffing here really impacts the residents a lot here. 2nd shift showers are missed a lot because there is not enough staff. Interview on 3/1/18 at approximately 7:20 a.m. with Staff V, Licensed Nursing Assistant revealed, We are always short staffed, but the weekends are extremely short. I have had a lot of residents soil themselves because we are with others and can't get to them.",2020-09-01
7,GREENBRIAR HEALTHCARE,305005,55 HARRIS ROAD,NASHUA,NH,3062,2018-03-05,684,D,0,1,6C1411,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interview with staff, and interview with resident, it was found that the facility failed to provide care and services to meet 1 of 1 resident's bowel regime by failing to notified the physician to establish a bowel regime in a survey sample of 43 residents. (Resident identifier is #192) Findings include: During the initial tour of the facility on 2/27/18 it was stated by Resident #192 to surveyor during interview that they had not had a bowel movement for over 5 days and had told staff several times but no medications where given to help. Resident #192 did state that they did finally move their bowels but it was very uncomfortable during that period of time. On review of the bowel record for the month of (MONTH) it was found that from 2/20/18 until 2/25/18 Resident #192 did not have a bowel moment as documented on the bowel record, not until 2/26/18 did it show that a bowel movement occurred. On 3/2/18 at 11:35 a.m. Resident #192 record was further reviewed and on 3/1/18 a Bowel and Bladder Evaluation was in progress and under section 13 Bowel Evaluation Summary part (B) it states Does the resident have bowel movements with regularity (every 3 days or more often)? If no please establish bowel regime with Physician. This information was shown to Staff C (DON) at 8:45 a.m. on 3/2/18 who confirmed the finding and notified the physician, getting orders that state Senna Tablet 8.6 mg Give 1 tablet by mouth at bedtime for constipation and [MEDICATION NAME] Suppository 10 mg insert 1 suppository rectally as needed for Constipation if no BM x 2 days.",2020-09-01
8,GREENBRIAR HEALTHCARE,305005,55 HARRIS ROAD,NASHUA,NH,3062,2018-03-05,688,D,0,1,6C1411,"Based on observation and interview, the facility failed to ensure that residents with limited range of motion receive appropriate equipment for 1 of 2 residents with limited range of motion in a sample size of 43 residents. (Resident identifier is #80.) Findings include: Resident #80 Observation of Resident #80 on 3/2/18 at 10:15 a.m. revealed the resident's right foot was not resting on the foot plate of their wheelchair and the resident's slipper was dangling from their foot. There was towel wrapped on the foot plate. Interview with Resident #80 on 3/2/18 at 10:15 am. revealed that when Resident #80 was admitted the resident had brought an electric wheelchair from home that was no longer taking a charge so was now using a facility manual wheelchair. Resident #80 also revealed that the resident had limited range on motion of the right hip and knee. Interview on 3/2/18 at 10:30 a.m. with Staff G (5-2 Unit Manager) revealed the Staff G had not seen Resident #80 using the electric wheelchair in a while because the battery would no longer charge. Interview also revealed that the unit manager believed that Occupational Therapy (OT) was working with Resident #80 on the manual wheelchair currently being used by the resident. Interview with Staff P (Rehabilitation Program Director) revealed the director did not know that Resident #80 was not using the electric wheelchair anymore. Interview further revealed that the rehabilitation department was not aware was that Resident #80 was not positioned properly in the manual wheelchair and did have not referral to work with Resident #80 on the manual wheelchair.",2020-09-01
9,GREENBRIAR HEALTHCARE,305005,55 HARRIS ROAD,NASHUA,NH,3062,2018-03-05,689,E,0,1,6C1411,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure that the resident environment remains as free of accident hazards as is possible for all residents with 2 residents identified as smoking in an initial survey pool of 59 residents in a non-smoking facility. (Resident identifiers are #80 and #138.) Findings include: Observation on 2/28/10 at 8:25 a.m. revealed Resident #80 was outside in front of the main entrance smoking. Observation on 2/28/18 at 9:00 a.m. revealed Resident #80 was outside in front of the main entrance bundled up for weather with a bath blanket over legs in a manual wheelchair. Resident #80 had a cigarette that was put out wrapped in tissue paper. Interview with Staff G (5-2 unit manager) on 2/28/18 9:45 a.m. revealed that staff are aware that Resident #80 goes outside to smoke. Interview further revealed that Staff G did not know where Resident #80 gets or stores their cigarettes and if staff see lighters or cigarettes, they are supposed to take and hold them. Observation on 3/1/18 at 8:05 a.m. revealed Resident #80 outside the main entrance smoking. Observation also revealed three old cigarettes butts on the ground near the main entrance. Review of the facility's smoking policy (not titled or dated) revealed that the facility prohibits the use of tobacco and tobacco products on the facility's premises and there are no designated smoking times or locations. Interview on 3/2/18 at 9:07 a.m. with Staff C (Director of Nursing) revealed that they are a non-smoking facility and have always been a non-smoking facility. Interview also revealed that Staff C did not know where Resident #80 gets cigarettes. Interview confirmed the above smoking policy. Interview with Staff C on 3/2/18 at 9:45 a.m. there was a smoking assessment done on 12/29/17 for Resident #80 that looked at the resident's cognitive ability/vision/and functioning. The assessment did not include any observations of smoking. Interview further revealed that they do not do a complete assessment because they are a non-smoking facility. Review on 3/2/18 at 9:35 a.m. of Resident #80's current care plan showed the following smoking goal: (Resident name omitted) wishes to smoke and is assessed for supervision level: Independent. Interview with Resident #80 on 3/2/18 at 10:15 a.m. revealed the resident goes outside to smoke and the resident hides a lighter and the resident's cigarettes in the resident's room. Interview also revealed that Resident #80 was outside smoking and the wheelchair rolled off the curb and the resident fell out of their wheelchair on 2/26/18. Interview with Staff G on 3/2/18 10:30 a.m. revealed there is a sign-out book that residents are to use when they leave the building but residents do not usually use it. Review of the sign-out book with Staff G revealed that Resident #80 had signed out 4 times, once time a month in September, October, November, and (MONTH) of (YEAR). Review on 3/2/18 at 1:33 p.m. of Resident #80's progress notes revealed the following entries: On 7/7/17 at 2:57 p.m.Pt (patient) wears oxygen during the day. Will frequently take it off and wheel herself outside to smoke . On 8/1/17 at 2:25 p.m. Pt (patient) wears oxygen during the day. Will frequently take it off and wheel .outside to smoke . On 10/19/17 at 8:51 a.m. Last night around midnight, I received a phone call from a concerned individual that there's somebody in (sic) the sidewalk in front of the bld. in a wheelchair with blanket and pillow. I went outside immediately to check and found (Resident #80) smoking in (sic) the sidewalk. I asked (pronoun omitted) to come back inside the building with me because it is not safe for (pronoun omitted) to be out there in the middle of the night. (Pronoun omitted) continued to smoke until (pronoun omitted) was done . I explained to (pronoun omitted) that (pronoun omitted)might get hit or . might fall navigating the wheelchair in the incline . Interview on 2/28/18 1:41 p.m. with Resident #138 revealed that he/she is a smoker and has been for [AGE] years and has no intention on giving it up. He/She acknowledged that the facility is a non-smoking facility. Resident #138 stated he/she has been directed by staff to go out back and smoke near the fence if he/she wants to smoke. Resident #138 stated that because he/she can't get up the ramp to get back in the building that he/she goes out on the platform which is under the awning of the building and smokes out there. Resident #138 explained that since staff are not able to push him/her back up the ramp because they are short staffed most of the time, that he/she has no other option for where he/she smokes. Resident #138 stated that he/she does keep his/her cigarettes and lighter on his/her person. Review of Resident #138's medical record revealed a signed Tobacco Free Policy Acknowledgement form signed by Resident #138 on 3/3/17. Review of the facility's smoking policy revealed that the facility prohibits the use of tobacco and tobacco products on the facility's property and the facility is posted with no smoking signs at the entrances of the facility. Interview with Staff B (LNA) on 2/28/18 at approximately 1:45 p.m. revealed that this is a non-smoking facility and the facility is posted as such.Staff B confirmed that Resident #138 does smoke on the property and there are several other residents in the facility that smoke on the property. Interview with Staff C (RN/DON) on 2/28/18 at approximately 2:15 p.m. revealed there was a smoking assessment done for Resident #138 that only assessed Resident #138's cognitive ability/vision/and physical functioning.",2020-09-01
10,GREENBRIAR HEALTHCARE,305005,55 HARRIS ROAD,NASHUA,NH,3062,2018-03-05,725,F,0,1,6C1411,"Based on observation, interview (Residents, Family, Staff) and review of staffing records, the facility failed to provide adequate staffing to provide care, safety, and a healthy milieu to all residents at the facility. Findings include: During the recertification survey from 2/27 to 3/5, four members of the facility staff were asked if they had enough staffing to properly care for residents. Based on answers received from direct interviews, two of the four interviewed, Staff D Registered Nurse (RN) and Staff F (RN) replied there was not enough staff to properly care for residents. Staff [NAME] (RN) replied that adequate staffing depended on the shift, the occasion, residents, and acuity. Staff G replied that staffing was tough on the evening, nights, and weekend shifts. Resident #160. Interview on 2/17/18 at approximately 10:20 a.m. with Resident #160 revealed the following information: . not enough staff , especially evening, nights and weekends. . if you ring and they don't answer I expect they are doing something urgent so you fend for yourself. . sometimes you know at the beginning of shift whether your bell will get answered or not depending on whose working or who is not working. . sometimes medications are late and you have to ask for them . as long as two hours. Resident #404. Interview on 2/17/18 at approximately 10:45 a.m. with Resident #404 revealed the following information: . not enough staff, the staff here work hard but just not enough with all the people who need a lot more help then me. . call bells not always answered, we help each other out when they don't come . you can tell when the bells will be answered depending on the staff working that shift. . can be any shift but mostly evening, nights and weekends . you have to wait for medication you are suppose to get at certain times, you end up asking for them. In a 3/5/18 confidential family interview it was revealed that there has been a shortage of nursing staff for building one during the last five months. This family member stated that because of staff being unavailable to provide direct care to residents in building one the resident's families have had to assist residents with their meals and as a safety measure accompany residents ambulating to their rooms. On 3/2/18 Staff D (Unit Manager, RN) who stated during the survey that she manages both building one and building two was observed on one of building one's two units, the Highway Side apparently filling in as a floor nurse throughout the day dispensing medications and assisting resident's with their meals. The following resident and staff interviews were conducted on the east wing: Resident #194 Interview on 2/27/18 at approximately 10:00 a.m. with Resident #194 revealed that the resident had concerns with staffing. Resident #194 stated, I wait over an hour daily for toileting, this place is so short staffed. Resident and family member were present during interview and confirmed Resident #194's staffing concerns. Resident #192 Interview on 2/27/18 at approximately 10:45 a.m. with Resident #192 revealed that Resident #192 stated, I feel that it takes along time for staff to answer my light. Time of day does not matter, there is always a long wait. Resident #55 Interview on 2/27/18 at approximately 11:35 a.m. with Resident #55 revealed, This place is so short staffed, appear to be exhausted. 3-11 is the worst for staff and on 11-7 good luck if anybody comes at all. Resident #55 states, I hear others in the halls yelling out for help, no one comes so I call 0 on the telephone. Resident #196 Interview on 2/27/18 at approximately 12:00 p.m. with Resident #196 revealed, There is not enough staff here, 1 aide and 1 nurse most of the time. Sometimes it takes them so long to come, I have accidents. Resident #161 Interview on 2/27/18 at approximately 12:30 p.m. with Resident #161 revealed, These girls need help here, they are constantly running especially around meal times. It takes forever to get help in this place. Resident #855 Interview on 2/27/18 at approximately 1:30 p.m. with Resident #855 revealed, Sometimes I wait over 2 hours for help here an example, on Sunday I called 911 because I was crying in pain and did not know what else to do. Resident #186 Interview on 2/28/18 at approximately 7:30 a.m. with Resident #186 revealed the following information regarding staffing, I have to wait a long time to get in bed and get out of bed. There are not enough people to help us here. Interview on 2/28/18 at approximately 7:45 a.m. with Staff S, Licensed Practical Nurse revealed, There is not enough staff here, most days there are 1 nurse and 1 Licensed Nursing Assistant. Interview on 2/28/18 at approximately 9:45 a.m. with Staff T, Unit Coordinator revealed there are currently 17 residents on the unit. Four of these residents require a hoyer lift for transfers which requires 2 staff members. Interview on 3/1/18 at approximately 7:15 a.m. with Staff U, Licensed Nursing Assistant revealed, Staffing here really impacts the residents a lot here. 2nd shift showers are missed a lot because there is not enough staff. Interview on 3/1/18 at approximately 7:20 a.m. with Staff V, Licensed Nursing Assistant revealed, We are always short staffed, but the weekends are extremely short. I have had a lot of residents soil themselves because we are with others and can't get to them. Resident #22 Record review of this resident's Quarterly MDS with an Assessment Reference Date of 12/4/17 revealed that the resident's Summary Score for Brief Interview for Mental Status was 15/15. During resident interview on 2/27/18, this resident related that sometimes when staff do not arrive in time when s/he uses the call bell for toileting, s/he is incontinent Resident #80 During interview on 3/2/18, this resident related there are not enough staff, the facility is trying to get more people but haven't, so bedside commodes are not emptied every shift, trays aren't picked up, and beds aren't straightened out. Resident Council notes. 2/28/18 10:58 a.m. Resident Council was held on 2/28/18 at approximately 10:40 a.m. Seven (7) Residents were in attendance, representing 3 of the Facilities Residential Units, all of whom are regular Resident Council members. Staffing was a major concern to these Council members, length of wait times after call bells were activated by residents vary widely. Council members agreed the length of the wait varies directly with the number of LNA's on the floor. They stated they have waited more than a half an hour to an hour to have their needs met. They further stated that coverage is worse on 3 to 11 and 11 to 7 shifts and that on weekends the wait times are atrocious. They mentioned that staff sometimes work through their (personal) lunch time. They also stated that there is a near constant outflow of staff members leaving because of difficult staffing ratios. Some facility staff have actually sought out some residents, including some Resident Council members and tearfully said they do not want to leave but feel they must because they cannot continue to work non-stop. It was stated that 2 nurses were known to residents to give showers; most (nurses) do not seem to have the time to do that. One of the residents stated that some days they are told that no one is available to give showers on some shifts. As residents are only scheduled for 1 or 2 showers per week, if residents miss a scheduled shower, it could be several days before they receive another shower. It was further stated by Resident Council members that some call lights are being shut off by staff reaching behind curtains and canceling the call lights without acknowledging the residents affected. Resident #162 Interview with Resident #162 on 2/27/18 at approximately 10:30 a.m. revealed that she/he often has to stay in bed for the day because the facility does not have enough staff to get her/him out of bed. This resident stated that she/he knows when they are short staffed because the staff will come in and tell her/him that she/he won't be able to get out of bed today because we are short staffed. She/he has not had a negative outcome as a result of having to wait to have her/his call bell answered. Resident #64 Interview with Resident #64 on 2/28/18 at approximately 9:15 a.m. revealed that the resident feels she/he must wait a significantly long time to have her/his call bell answered. She/he stated she/he usually waits a half hour or more and on occasion, an hour or more for her/his call bell to be answered. She/he has not had a negative outcome as a result of having to wait to have her/his call bell answered. Resident #63 Interview with Resident # 93's family member revealed that often times during his/her visit the resident is still in a johnny or in bed when other residents are up and about after 10 a.m. and there are times when this happens after 1 p.m. Resident #124 Interview with Resident #124 on 2/28/18 at 9:48 a.m. revealed that there is not enough staff. She/he has to wait quite a while when she/he rings her/his call bell for assistance, usually a half an hour or more. She/he has not had a negative outcome as a result of having to wait to have her/his call bell answered. A confidential interview on 2/28/18 at approximately 11:30 a.m. with a direct care staff person revealed that staff typically work short staffed and often times cannot meet all the needs of their residents. This staff person stated that staff have convinced their family members to come to work at the facility to try and get enough staff but this option has been exhausted. This person stated that keeping staff is an issue because many staff have left to go to work in Massachusetts where they pay more. This staff person stated that the facility does use agency staff but only for nurses, never LNA's and this is where they are hurting the most.",2020-09-01
11,GREENBRIAR HEALTHCARE,305005,55 HARRIS ROAD,NASHUA,NH,3062,2018-03-05,745,D,0,1,6C1411,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based upon record review and staff interview the facility failed to protect and promote the rights of 2 of 43 sampled residents (Resident identifiers are #18 and #49). Findings include: Resident #18, according to record review was admitted to the facility on [DATE] without having a [DIAGNOSES REDACTED]. Further record review revealed that on 7/18/16 this facility resident was newly diagnosed with [REDACTED]. The facility from 7/18/16 when the [MEDICAL CONDITION] disorder [MEDICAL CONDITION] type [DIAGNOSES REDACTED].#18. Staff L(Social Services Director) aknowledged during a 3/2/18 interview that the facility has not made a PASARR II referral for Resident #18 even though the [DIAGNOSES REDACTED]. Resident #49, according to a 3/5/18 interview with Staff L was an emergency admission who was admitted into the facility on [DATE]. Record review revealed that the Consent to Admission and Treatment form was signed by a Family Friend without any documentation being provided to the facility, according to a 3/5/18 interview with Staff L which showed that this individual had been given the legal authroization to sign for Resident #49 on their behalf. Also record review further revealed this family friend of Resident #49 signed consent forms without having any documentation showing that they had the authority to do so for administering antipsychotic, antidepressant, antianxiety and hypnotic medications to Resident #49. Resident #49's comprehensive care plan states that Resident #49 is able to make her own health care decisions at this time. A Social Service note of 9/26/17 stated that Resident #49 is able to make her own decisions. Interviews on 3/2/18 and 3/5/18 with respectively Staff L(Social Service Director) and Staff D (Unit Manager) revealed that Resident #49 was not competent to make her own health care decisions. This was confirmed by Resident #49's admission MDS assessment of 9/25/17 and her 12/18/17 quarterly MDS that coded Resident #49 as severely cognitively impaired. Also Resident #49's care plan indicated that Resident #49's Advance directives are not on file. A Social Service note of 9/26/17 stated that Social Services is attempting to locate DPOA paperwork. A Social Service note of 12/19/17 revealed that Social Services will follow up with Resident #49's son regarding pursuing guardianship. Social Service notes of 1/18/18 and 1/30/18 indicated that Resident #49's son was continuing to look for DPOA documentation. A Social Service note of 3/2/18 stated when communicating with Resident #49's son that the facility needs this paperwork the DPOA documentation and that if we can not locate it we will need to file for guardianship almost six months following Resident #49's admission to the facility.",2020-09-01
12,GREENBRIAR HEALTHCARE,305005,55 HARRIS ROAD,NASHUA,NH,3062,2018-03-05,761,E,0,1,6C1411,"Based on interview, observation and record review it was determined that the facility failed to follow currently accepted professional principles for labeling and/or storing drugs and biologicals, storing drugs in locked compartments, and/or locking controlled drugs separately, for 3 out of a sample selection of 6 medication carts reviewed. Findings include: Medication Storage and Labeling 02/28/18: 7:18 AM: Observation of Facility Medication carts, medication rooms, and control logs for blood glucose machine quality control was initiated. 6 out of a possible 11 medication carts were reviewed with identified issues found in 3 out of 6 Medication Carts reviewed. Issues are as follows: Bld #2: 3/1/18 Medication cart review with (Staff I, RN) revealed that the narcotic medications were not double locked as required. Observation revealed that the medication cart itself was locked, but the narcotic boxes inside the cart were left ajar. Bldg #5: 3/1/18: 8:15 am Med cart: 3rd floor: Observation of box of blood glucose machine control fluids revealed that the boxes (which don't need to be dated) were dated with an opening date, but the control fluid bottles (which need to be dated) were not dated as to when they were opened. 3/1/18, 8:35: 2nd floor Med cart: Staff J, LPN: Observation of the cart revealed that the cart was not locked. Medications with several resident names and prescriptions were left out on top of medication cart, and the cart was left unattended. In the bottom drawer of the cart, there were empty bags with resident names and prescriptions, and creams and ointments that were not in resident identifiable bag(s). Open insulin vials/pens were not dated as to when they were opened. The nurse, Staff J, was observed to begin pulling out many empty bags and putting creams/ointments back into the labeled bags. The narcotics box inside of the cart was not locked, and cart was also not locked. Observation on 2/28/18 at approximately 6:40 a.m. in Building #3 revealed an unlocked, unattended medication cart in the resident hallway in building 3 with multiple open drawers containing medications in pill packs, bottles, sprays, eye drops and boxes. The top of this medication cart also had multiple containers of individual patient labeled medications. Interview on 2/28/18 at the time of this observation with Staff R (Registered Nurse) revealed that the above listed medication cart was unlocked and unattended with multiple drawers opened and multiple patient labeled medication containers, boxes and pill packs on top of this unlocked medication cart.",2020-09-01
13,GREENBRIAR HEALTHCARE,305005,55 HARRIS ROAD,NASHUA,NH,3062,2018-03-05,812,E,0,1,6C1411,"Based on observation during tour and interview with the director of food services it was found that the facility failed to maintain a sanitary environment along with maintaining kitchen equipment in safe operating conditions. Findings include: During the initial tour of the facility's kitchen on 2/27/18 at 12:17 p.m. it was observed and shown to Staff A (Director of Food Services) during interview that the floors throughout the kitchen areas had broken, chipped and missing tiles creating uneven surfaces throughout the whole kitchen. Also none of the floor surfaces can be cleaned due to deep porous grout lines that are broken and missing grout along with uneven surfaces creating areas that hold water and grease. Also it was observed that the wall behind the cooking equipment (one bay sink, dirty dish rack, double convection oven, main cooking stoves, kettle, and double steamer) had grease and staining along with mold damage as observed from the opposite side of the wall in the dinning room hallway which is under construction due to water damage. There was large amount of dust build up over the cooking area which could inadvertently enter the food, due to the hood suppression system not being cleaned. On review of the inspection tag it was found that the last inspected date was 7/2017 making it one month over due. While touring the units it was found that the delivery food cart doors, while passing trays were mostly left open and staff had trouble latch or close tightly due to gaps. On 3/5/18 all 14 carts were inspected with Staff A and found that all the doors on the carts were either bent, or broken with large splits in the metal doors preventing them from fully closing as designed.",2020-09-01
14,GREENBRIAR HEALTHCARE,305005,55 HARRIS ROAD,NASHUA,NH,3062,2018-03-05,880,E,0,1,6C1411,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations and interviews the facility failed to maintain a safe, sanitary enviroment to prevent the development and transmission of infections. Findings include: Observation on 3/1/18 at approximately 8:45 a.m. of the facility rehabilitation area showed multiple individual cloth gait belts and multiple individual synthetic gait belts. Review of the manufacturer's instructions, at the time of survey, with Staff P (Rehabilitation Director) revealed the following: Gait belts made from woven fibers, either natural or man-made can be laundered recommends washing in lukewarm water (100 degrees F / 38 degrees C) without bleach and low dry in order to maintain color brightness and product longevity. If, however, the woven Gait Belts are contaminated, they may be cleaned per the Centers for Disease Control and Prevention, Guidelines for Environmental Infection Control in Health-care Facilities. Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC) . by washing in hot water (.160 degrees F / 71 degrees C) for a period of 25 minutes or more with, if desirable, the appropriate bleach concentration . Interview on 3/1/18 at approximately 9:00 a.m. with Staff P (Rehabilitation Director) revealed that the facility gait belts, (both the cloth and the synthetic) are wiped down with disinfectant after patient use and are not sent to the laundry to be cleaned. The rehabilitation department failed to ensure that the facility gait belts are cleaned and maintained to prevent the development and transmission of communicable diseases and infections. On 2/27/18 at approximately 1:23 PM Staff K (License Nursing Assistant ) was observed to come out out of room [ROOM NUMBER] without any garb on except for gloves. Staff K then discarded the gloves into room [ROOM NUMBER] and then proceed down the hallway without washing his/her hands. room [ROOM NUMBER] is a precaution room where as Resident #193 is on contact precautions for VRE ([MEDICATION NAME]-resistant [MEDICATION NAME]) in urine and and Resident #79 is on contact precaution for shingles. Staff K had assisted another staff member to get Resident #193 into bed for the afternoon. Medication Cart Observation: 3/1/18 8:00 am: Building #1, Locked Dementia Unit: Observation of medication cart with Staff H, RN revealed one blood glucose meter (BGM) with a dried, brownish red substance smeared on the sides and back. Staff H was able to clean the substance off of the BGM with a bleach wipe during the observation.",2020-09-01
15,GREENBRIAR HEALTHCARE,305005,55 HARRIS ROAD,NASHUA,NH,3062,2018-03-05,881,D,0,1,6C1411,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to ensure that residents who required an antibiotic were prescribed the appropriate antibiotic by obtaining a culture for organism identification. Findings include: Review on 3/5/18 of the infection control line listings, revealed many residents who had infections within the past 5 months and who were placed on antibiotics without obtaining a culture for organism identification. Review on 3/5/18 of the facility's policy and procedure titled, Antibiotic Stewardship - Order for Antibiotics, date established was 11/2017, last revised is documented as 11/2017 and is listed as version 1.0. Section A, third paragraph reveals the following verbiage: Appropriate indications for use of antibiotics include: b. Criteria met for clinical definition of active infection or [MEDICAL CONDITION]; and c. Pathogen susceptibility, based on culture and sensitivity, to antimicrobial (or therapy begun while culture is pending). During review of the facility's Infection Control Logs, the following infections were revealed with no culture obtained but antibiotics were prescribed: Date identified Organism Antibiotic ordered Meets McGeer's Criteria 11/4/17 [MEDICAL CONDITION] - Wound [MEDICATION NAME] No 11/6/17 (blank) - UTI [MEDICATION NAME] No 11/7/17 (blank) - Infection [MEDICATION NAME] No 11/7/17 (blank) - Cyst [MEDICATION NAME] No 11/7/17 (blank) - Cyst [MEDICATION NAME] No 11/14/17 (blank) - Infection [MEDICATION NAME] No 11/14/17 (blank) - PNA (Pneumonia) [MEDICATION NAME] No 11/14/17 (blank) - Infection [MEDICATION NAME] No 11/20/17 (blank) - Wound Infection Keflex No 11/27/17 (blank) - PNA [MEDICATION NAME] No 11/27/17 (blank) - PNA [MEDICATION NAME] No 11/30/17 (blank) - Vaginal Itch [MEDICATION NAME] No 12/4/17 (blank) - PNA (normal flora) [MEDICATION NAME] No 12/11/17 (blank) - [MEDICAL CONDITION] [MEDICATION NAME] No 12/20/17 (blank) - PNA [MEDICATION NAME] No 12/21/17 [MEDICATION NAME] Keflex (Indefinitely) (line drawn through area) 12/25/17 (blank) - PNA Keflex No 12/28/17 (blank) - UTI [MEDICATION NAME][MEDICATION NAME] (line drawn through area) 12/29/17 (blank) - UTI Bactrim - DS No 12/29/18 (blank) - UTI [MEDICATION NAME] No 12/29/17 (blank) - Sinus Infection [MEDICATION NAME] No 1/2/18 (blank) - UTI [MEDICATION NAME] No 1/2/18 (blank) - UTI [MEDICATION NAME] No 1/3/18 (blank) - Increased WBC [MEDICATION NAME] No 1/3/18 (blank) - PNA [MEDICATION NAME] No 1/3/18 (blank) - Increased [MEDICATION NAME] No 1/4/18 (blank) - UTI [MEDICATION NAME] No 1/5/18 (blank) - URI [MEDICATION NAME] No 1/5/18 (blank) UTI [MEDICATION NAME] No 1/7/18 (blank) - PNA [MEDICATION NAME] No 1/7/18 (blank) - PNA [MEDICATION NAME] No 1/8/18 (blank) - [MEDICAL CONDITION] [MEDICATION NAME] No 1/9/18 (blank) - UTI [MEDICATION NAME] No 1/10/18 (blank) - PNA Levoquin No 1/10/18 (blank) - [MEDICAL CONDITION] [MEDICATION NAME] No 1/15/18 (blank) - UTI [MEDICATION NAME] No 1/17/18 (blank) - [MEDICAL CONDITION] Infection [MEDICATION NAME] Yes 1/19/18 (blank) - PNA [MEDICATION NAME] No 1/26/18 (blank) - [MEDICAL CONDITION] Keflex No 1/29/18 (blank) - SOB (shortness of breath) [MEDICATION NAME] No 1/29/18 (blank) - UTI [MEDICATION NAME] No 1/13/18 (blank) -[MEDICAL CONDITION] [MEDICATION NAME] No 1/31/18 (blank) - [MEDICAL CONDITION] Bactrim, [MEDICATION NAME], Vanco No 1/31/18 (blank) - UTI [MEDICATION NAME] No 1/31/18 (blank) - [MEDICAL CONDITION] Cephaloxin No 2/2/18 (blank) - PNA Levoquin No 2/5/18 (blank) - Cough/URI Azithomax No 2/5/18 (blank) - [MEDICAL CONDITION] Keflex No 2/9/18 (blank) - PNA Levoquin No 2/11/18 (blank) - Fever Keflex No 2/11/18 (blank) - Fever [MEDICATION NAME] No 2/17/18 (blank) - Wound Infection Bactrim - DS No 2/20/18 (blank) - [MEDICAL CONDITION] Keflex No 2/20/18 (blank) - UTI [MEDICATION NAME] No ( 2/28/18 (blank) - Wound Infection Bactrim No 2/28/18 (blank) - [MEDICAL CONDITION] Cephalox No Interview on 3/5/18 at approximately 2:15 p.m. with Staff Q (RN Infection Control Program) revealed that cultures were not done to determine the most appropriate antibiotic based on the organism. Interview on 3/5/18 at approximately 2:15 with Staff B (RN Director of Nursing) revealed that cultures were not done to determine the most appropriate antibiotic based on the organism.",2020-09-01
16,GREENBRIAR HEALTHCARE,305005,55 HARRIS ROAD,NASHUA,NH,3062,2018-03-05,883,D,0,1,6C1411,"Based on record review and interview, it was determined that the facility failed to provide influenza vaccination in a timely manner for one resident in a standard survey sample of 43 residents. (Resident identifier is #157.) Findings include: Interview with Staff D, unit manager, on 3/2/18 revealed Resident #157 was transferred to their unit from another unit in the facility in (MONTH) or (MONTH) of (YEAR), and that resident had not received a flu shot in the Fall of (YEAR). Another interview With Staff D on 3/5/18 revealed that there was a standing order for flu vaccine if not allergic to eggs, and Staff D related the resident is not allergic to eggs, and that there is no documentation in the record why the influenza vaccine was not given during the last four months of (YEAR) or documentation that the doctor was notified that the order for influenza vaccine was not administered. Review of the temperature log in the electronic medical record for Resident @157 revealed that for the period from 8/12/17 through 1/9/18 all recorded temperatures were less than 100.0, with the exception of 1/3/18 when the temperature was 103.6 degrees. Review of a nurses not for 1/3/18 reveals that the resident was sent out to the hospital, fever was 103.6, an update from the hospital confirmed flu.",2020-09-01
17,GREENBRIAR HEALTHCARE,305005,55 HARRIS ROAD,NASHUA,NH,3062,2018-03-05,908,E,0,1,6C1411,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on resident interview it was found that the facility failed to maintain patient care equipment in safe operating condition to meet residents needs due to 5 of 6's batteries that failed to hold a charge and left 14 residents who are Hoyer lifts from getting care if needed. Also the facility failed to document temperatures of the hydrocllator on a daily bases to prevent burning during resident treatment. (Resident identifier is #90). Findings include: On 2/27/18 at 10:58 a.m. interview with Resident #90 stated they did not get a shower on 2/23/18 due to the Hoyer lift's not working and being able to get them out of bed. On review of the shower schedule for Resident #90 it was found that the information provided was correct and Resident #90 did not get a shower as documented on 2/23/18. Interview with Staff B (LNA) confirmed that none of the Hoyer lifts work due to the batteries not able to hold a charge. Staff B also confirmed that Resident #90 did not get a shower that day due to the lifts not working and also said other residents also did not always get up for the day due to the battery issues. Staff B when on to say that the Hoyer's would work for about 2 seconds and then they would have to find another battery to continue the task. Staff B also stated that lots of times the resident's would get stuck in the middle of transferring them and they would have to physically remove the resident from the Hoyer lift. On review of the facility's Battery Charging Tracking Tool sheet for 2/26/18 it documents that battery #'s (1, 3, 4, 6, and 7) under Comments no good. Observation on 3/1/18 at approximately 9:00 a.m. of the facility rehabilitation area with Staff P (Rehabilitation Director) revealed that the facility hydrocllator log did not have temperatures taken on the following dates: 1/1/18, 2/18/18, 12/25/17, 11/23/17, 10/6 & 10/7/17, 9/2/17, 9/4/17, 9/9/17, 9/16/17, 9/23/17, 9/30/17, 8/5/17, 8/12/17, 8/19/17, 8/26/17. Temperatures were not done on Sundays for the following dates 1/7/18,1/14/18, 1/21/18 and 2/28/18, 2/4/18, 2/11/18, 2/25/18, 12/3/17, 12/10/17, 12/17/17 and 12/24/17,11/5/17, 11/12/17, 11/19/17, 11/26/17 and 10/1/17, 10/8/17, 10/15/17, 10/22/17 and 10/29/17. Review of the facility policy and procedure titled Clinical Practice Guidelines for the [MEDICATION NAME] dated 9.23.14 revealed the following [MEDICATION NAME] Unit Maintenance . The unit water temperature should be checked and recorded on a daily basis. Review of the INSTRUCTIONS FOR THE USE AND OPERATION OF THE [MEDICATION NAME] M-2 MASTER HEATING UNIT revealed the following: PRECAUTIONARY INSTRUCTIONS 3. REMEMBER. the water temperature in the [MEDICATION NAME] is approximately 160 degrees F (71 degrees C) and the water scalding temperature is approximately 120 degrees F (49 degrees C) . The following steps should be taken when applying the Steam Packs. 1. Know and apply the Precautionary rules. They are for the protection of both the patient and the therapist. Interview on 3/1/18 at approximately 9:00 a.m. with Staff P during this observation confirmed that the [MEDICATION NAME] temperatures were not consistently taken as listed in the above findings. Observation on 03/05/18 at 09:55 AM the tiles, on Unit 2 in rooms 16,19,21.18. 22, 23, 24, 25, and 27 are all cracked and are hard to maintain the integrity to the floor. The wallpaper outside rooms 17, 19, 21 and 22 are peeling and or missing. Interview on 2/28/18 at 1:00 p.m. with Staff C (Director of Nursing) we review the Capital budget which has some improvements for the roof, floor and medication room but not the individual floors or replacing the wallpaper.",2020-09-01
18,GREENBRIAR HEALTHCARE,305005,55 HARRIS ROAD,NASHUA,NH,3062,2018-03-05,926,E,0,1,6C1411,"Based on observation, interview, and record review, the facility failed to have smoking policies and procedures that reflect practices at the facility. Findings include: Observation on 2/28/10 at 8:25 a.m. revealed Resident #80 was outside in front of the main entrance smoking. Observation on 2/28/18 at 9:00 a.m. revealed Resident #80 was outside in front of the main entrance bundled up for weather with a bath blanket over legs in a manual wheelchair. Resident #80 had a cigarette that was put out wrapped in tissue paper. Interview with Staff G (5-2 unit manager) on 2/28/18 9:45 a.m. revealed that staff are aware that Resident #80 goes outside to smoke. Interview further revealed that Staff G did not know where Resident #80 gets cigarettes and if staff see lighters or cigarettes, they are supposed to take and hold them. Observation on 3/01/18 at 8:05 a.m. revealed Resident #80 outside the main entrance smoking. Observation also revealed three old cigarettes butts on the ground near the main entrance. Review of the facility's smoking policy (not titled or dated) revealed that the facility prohibits the use of tobacco and tobacco products on the facility's premises and there are no designated smoking times or locations. Interview on 3/02/18 at 9:07 a.m. with Staff C (Director of Nursing) revealed that they are a non-smoking facility and have always been a non-smoking facility. Interview also revealed that the Staff C did not know where Resident # 80 gets cigarettes. Interview confirmed the the above smoking policy. Interview with Staff C on 3/02/18 at 9:45 a.m. there was a smoking assessment done for Resident #80 that looked at the resident's cognitive ability/vision/and physical functioning. The assessment did not include any observations of smoking. Interview further revealed that they do not do a complete assessment to include observation or Interdisciplinary team determination, because they are a non-smoking facility. Review on 3/2/18 at 9:35 a.m. of Resident #80's current care plan showed the following smoking goal: (Resident name omitted) wishes to smoke and is assessed for supervision level: Independent. Interview with Resident #80 on 3/2/18 at 10:15 a.m. revealed the resident goes outside to smoke and the resident hides a lighter and the resident's cigarettes in the resident's room. Interview also revealed that Resident #80 was outside smoking and the wheelchair rolled off the curb and the resident fell out of their wheelchair on 2/26/18. Review on 3/2/18 at 1:33 p.m. of Resident #80's progress notes revealed the following entries: On 7/7/17 at 2:57 p.m.Pt (patient) wears oxygen during the day. Will frequently take it off and wheel herself outside to smoke . On 8/1/17 at 2:25 p.m. Pt (patient) wears oxygen during the day. Will frequently take it off and wheel herself outside to smoke . On 10/19/17 at 8:51 a.m. Last night around midnight, I received a phone call from a concerned individual that there's somebody in (sic) the sidewalk in front of the bld. in a wheelchair with blanket and pillow. I went outside immediately to check and found (Resident #80's name omitted) smoking in (sic) the sidewalk. I asked (pronoun) omitted to come back inside the building with me because it is not safe for (pronoun omitted) to be out there in the middle of the night. (Pronoun omitted) continued to smoke until (pronoun omitted) was done . I explained to (pronoun omitted) that (pronoun omitted) might get hit or (pronoun omitted) might fall navigating the wheelchair in the incline .",2020-09-01
19,GREENBRIAR HEALTHCARE,305005,55 HARRIS ROAD,NASHUA,NH,3062,2017-09-07,157,D,1,0,9SPV11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on medical record review and interview, the facility failed to notify the physician with a change of condition of a resident resulting in a hospitalization , for 1 resident in a survey sample of 1 resident. (Resident identifier is #1.) Findings include: Review on [DATE] of Resident #1's (MONTH) (YEAR) Care Plan revealed DPOA (Durable Power of Attorney) was activated [DATE]. The ADL Self Care Performance . section of this Care Plan revealed that Resident #1 was independent with transfers, toilet use, personal hygiene, oral hygiene and eating. This Care Plan also revealed that Resident #1 was an elopement risk/wanderer . Review on [DATE] of Resident #1's Care Plan revealed further that Resident #1 uses antidepressant medication with the Interventions/Tasks listed as Monitor/document/report to MD (medical doctor) prn (as needed) s/sx (signs/symptoms) of depression .slowed movement .disrupted sleep, fatigue, lethargy .changes in cognition . and in the section for . anti-anxiety medications r/t (related to) anxiety . with the Interventions/Tasks listed as . ANTIANXIETY SIDE EFFECTS: Drowsiness, lack of energy .confusion and disorientation .Implement interventions based on results of behavior assessment. Review on [DATE] of the nursing Progress Notes dated [DATE] at 23:36 revealed the following; Resident (Resident #1) had gone out with daughter today. (Resident #1) came back around ,[DATE]. Shortly after (Resident #1) came back, (Resident#1) started to obsess about .daughter . (Resident#1) couldn't sit still for more than 5 to 10 minutes before (Resident#1) got up and continued with .anxiety . After the LNA (Licensed Nursing Aide) got (Resident #1) in bed, (Resident #1) was quiet for a while, but then came back out into the hallway after 2100 still obsessed . Review on [DATE] of the nursing Progress Notes dated [DATE] for Resident #1 revealed the following three individual entries: when the writer was given off report to the on coming nurse, the friend came to visit and was concern (sic). Both the on coming nurse and the writer checked up on the resident and resident was lethargic and non responsive. Immediate response was taken . At approximately 1630 this writer was paged to unit by Charge nurse. Nurse stated that the resident was unresponsive and had vomited. This writer entered the room and observed the resident lying on L (left) side w/scant amount of emesis and drool next to mouth. Resident had a visitor in the room. Upon initial assessment of pupil dilatation this writer noted that pupils were unreactive and requested that 911 be called. LNA (Licensed Nursing Assistant) was instructed to get O2 (oxygen) tank and place resident on 4 liters r/t (related to) O2 saturation in low 80's. This writer also began sternal rub w/o (without) positive effect. This writer left the resident with another RN (Registered Nurse) on the unit to inquire on the status of emergency transport and paperwork. Upon return to the room, the daughter had arrived .Another attempt to arouse resident was made and O2 saturation once again checked. O2 saturation had increased to 93%. EMTs (Emergency Medical Technician) then arrived on unit and took over. At 16:35, this nurse was called down to the resident's room. Resident was in bed on . left side, snoring, emesis and drool on the sheets around . face, unresponsive. Notified supervisor who came right up. Pupils unreactive, ,[DATE], Pulse 118, 86% O2 (oxygen) RA (room air), resp (respirations) 18, temp (temperature) 99.5. Resident is a Full Code. Called 911 . Review on [DATE] of Staff C's (Licensed Nursing Assistant) written statement dated [DATE] revealed the following: After breakfast I was told by my nurse (Staff D) that the resident was very tired and she put (Resident #1) in .chair because she could not convince the resident to lay down on (Resident #1) bed. I (Staff C) checked on resident twice and reported to nurse (Staff D) that (Resident #1) was still sleeping A few hours after my nurse (Staff D) asked me (Staff C) to help her transfer the resident to . bed because (Resident #1) was hanging over .chairarm and she did not want (Resident#1) falling. The resident did not wake up during the transfer, after we got (Resident#1) on .bed, the visitor that was also in the room tried speaking to the resident at which the resident mumbled an unrecognized word. I (Staff C) checked on the resident two more times before my (Staff C) shift ended and reported to nurse (Staff D) that the resident was snoring. My nurse (Staff D) said let (Resident#1) sleep because (Resident#1) was very tired. Interview on [DATE] at approximately 4:25 p.m. with Staff C (LNA) regarding this incident, revealed that Staff C went to get Resident #1 in the morning after breakfast, went to (Resident #1's) room .(Resident #1) not there. Thought Resident #1 went to get coffee. Later observed Resident #1 sitting in chair beside bed and that the Resident #1 looked like a drunk and acted like a drunk person, limp and leaning on staff . Staff C reported to Staff D what she observed and was told let (Resident #1) sleep because (Resident #1) didn't sleep last night. Staff C reported at this time that this was not like Resident #1 and that Resident #1 usually doesn't sleep that late and is usually up & about. Staff C was told by Staff D to leave Resident #1 alone and let Resident #1 sleep. Staff C further revealed during this interview that Staff D asked Staff C to help transfer Resident #1 back to bed and reported that Resident #1 was leaning on staff for support and that Resident #1 was very limp with Resident #1's upper extremities, like (Resident #1) was zonked and staff had to lift Resident #1 into bed. Staff C revealed that during this transfer Resident #1 didn't say words .mumbled and staff were unable to understand Resident #1. Staff C revealed that Staff C checked Resident #1 and could hear (Resident #1) snoring. Staff C revealed that Resident #1 was not awake for lunch on [DATE]. Staff C was told to let (Resident #1) sleep .(Resident #1) is very tired by Staff D. Staff C revealed during this interview that when Staff C rendered care after lunch at the time of change of shift to check and change (check for urination and change under garment) Resident #1 was rolled on the bed to change undergarment. Staff C revealed that a clean undergarment was applied to Resident #1 and that Resident #1 was not awake, did not stir or verbalize anything during this task. Interview on [DATE] at approximately 2:15 p.m. with Staff A (Administrator) and Staff B (Assistant Director of Nurses) confirmed that Resident #1 had a change in condition on [DATE] when Resident #1 was leaning on staff for support and was limp with upper extremities and mumbling words staff could not understand during transfer from the chair to bed. The facility failed to notify the physician at the time Resident #1 had a change in condition which was confirmed by Staff A and B during interview on [DATE]. Staff A reported that facility staff were educated on the procedure for What is a change in condition and When to Notify on [DATE]. Surveyor:[NAME]B. Review on [DATE] of Resident #1's incident revealed a signed statement dated [DATE] by Staff D (Licensed Practical Nurse/Licensed Vocational Nurse) who documented the following: Morning routine (Resident #1) always up and about. As I went in my morning shift (Resident #1) kept talking to me as usual. (Resident #1) is always up in the morning and comes to talk to me and the LNA's. (Resident #1) looked exhausted but I had been told (Resident #1) usually doesn't get much sleep in the night. Around 9:30 - 10:00 I told (Resident #1) . try (sic) to take a nap (Resident #1) was sitting in (sic) the couch in front of elevators and was ambulating and walked to . room. Sat down in the recliner because (Resident #1) refused to be in bed. (Resident #1) was fine @ (sic) that time and then .friend (name omitted) came to visit .friend said we should come in went to see (Resident #1) and (Resident #1) was sleeping, no hard breathing noted, no high respirations no sweating or excessive sweating noted. The snoring was normal. Not deepen at this time @ (sic) 11:00. Resident was transferred 1200 (sic) from the recliner to bed. Resident usually doesn't eat much through the day. (Resident #1) didn't eat breakfast or lunch. Resident usually can take a nap during the day. The LNA and I checked up on resident throughout the day. The resident did not throw up the times that I rounded . pupils were reactive when I checked upon (Resident #1). After giving report to the on coming nurse (Resident #1's) friend came to us and said something is wrong we went to see (Resident #1) was on (Resident #1's) left side emesis (sic), . was breathing heavily, .was sweating profusely so immediate action was place called 911 supervisor was called and (unreadable writing) and doctor. Interview on [DATE] at approximately 11:20 a.m. with Staff D, Staff D stated the events occurring on [DATE] that lead up to Resident #1 being transported out to the hospital: Staff D stated that she had come in to her shift and was told the Resident #1 had not slept well the previous night. When Staff D left report Resident #1 approached her to talk and then Resident #1 went downstairs as Resident #1 usually does to get breakfast. When Resident #1 came back upstairs Resident #1 sat on the couch in front of the elevators and dozed off. Staff D approached Resident #1 and encouraged Resident #1 to go back to his/her room and take a nap. Resident #1 ambulated back to his/her room and sat in Resident #1's recliner - this was around 10:30 a.m. Around 11:00 a.m. Staff D was approached by Resident #1's family friend who stated she was concerned about Resident #1 as she was sleeping in the recliner chair in the room and was slumped over the side of the chair and was not responsive. Staff D asked Staff C (LNA) to assist Staff D in getting Resident #1 into the bed for a nap. Staff D and Staff C arrived in Resident #1's room and stood and pivoted Resident #1 into bed. Resident #1 did not wake up or respond to this transfer. Once Resident #1 was in bed Resident #1 opened one eye, looked at the family visitor and mumbled something to her that was unintelligible the Resident #1 appeared to be sleeping. Staff D was asked if Staff D had performed an assessment of Resident #1 and Staff D stated that she had performed an assessment that appeared to be normal but that she had another resident that was in crisis and needed to be sent out to the emergency room . Staff D stated that she did not document the assessment because she was too busy with the other resident and had forgotten. Staff D was asked if Staff D notified Resident #1's physician and Staff D stated she had not as she believed Resident #1 was just tired based on the report she had received during morning report. This writer asked if the way Resident #1 had presented during Staff D's shift was the way Resident #1 usually presented and Staff D stated, No, generally (Resident #1) was up and about walking around and socializing. Staff D went on to explain that later in the day the family friend had returned, probably around 4:00 p.m. and asked Staff D to come see Resident #1 because Resident #1 was not responding and had vomited in Resident #1's bed. Staff D performed an assessment at this time of Resident #1 who was found on left side in vomit and drool around face, unresponsive, pupils were not reactive, blood pressure was ,[DATE], pulse was 118 and oxygen saturation on room air was 86% and Resident #1 had a temp of 99.5. On call MD was notified and 911 called for transport. The shift supervisor for the facility was notified of the situation. Staff D stated that the resident was transported to the hospital and died approximately 23 hours later. Interview on [DATE] at approximately 4:25 p.m. with Staff C (Licensed Nursing Assistant) regarding the events of [DATE] with Resident #1, Staff C stated that she was concerned throughout her shift and notified the Staff D a couple of times that the resident was still sleeping. Staff C stated that she was told by Staff D to just let Resident #1 sleep as she did not sleep well the night before and was just tired. When asked Staff C if Resident #1 had lunch and Staff C stated that Resident #1 did not as Staff C had been instructed not to wake Resident #1 because Resident #1 was so tired. Staff C stated that she did assist Staff D with transferring the resident around 11 a.m. from the recliner chair to the bed because Resident #1 was hanging over the side of the recliner. Staff C stated that during this transfer the resident acted like a drunk person, she was limp and leaning on staff as Staff C and Staff D pivoted Resident #1 into bed. Staff C stated that Resident #1 did not wake up during this transfer but did mumble something once Resident #1 had been transferred to bed but Staff C could not understand what Resident #1 had said and then Resident #1 slept.",2020-09-01
20,GREENBRIAR HEALTHCARE,305005,55 HARRIS ROAD,NASHUA,NH,3062,2017-09-07,281,D,1,0,9SPV11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on record review and interview, the facility failed to follow the professional standard of practice for the assessment of a resident, for 1 resident in a survey sample of 1 resident. (Resident identifier is #1.) Findings include: Reference for the professional standard of practice for assessment documentation is: Fundamentals of Nursing, Potter-Perry, Mosby Elsevier, 7th Edition, St. Louis, Missouri, 2009, which revealed the following: Chapter 16 Nursing Assessment page 243. Data Documentation Data documentation is the last part of a complete assessment. The timely, thorough, and accurate documentation of facts is necessary when recording client data. If you do not record an assessment finding or problem interpretation, it is lost and unavailable to anyone caring for the client. If there is not specific information, the reader is left with only general impressions. Observation and recording of a client status is a legal and professional responsibility. The nurse practice acts in all states and the American Nurses Association Nursing's Social Policy Statement (2003) mandate, or require, accurate data collection and recording as independent functions essential to the role of the professional nurse. Review on [DATE] of Staff C's (Licensed Nursing Assistant) written statement dated [DATE] revealed the following: After breakfast I was told by my nurse (Staff D) that the resident was very tired and she put (Resident #1) in .chair because she could not convince the resident to lay down on (Resident #1's) bed. I (Staff C) checked on resident twice and reported to nurse (Staff D) that (Resident #1) was still sleeping A few hours after my nurse (Staff D) asked me (Staff C) to help her transfer the resident to . bed because (Resident #1) was hanging over .chairarm and she did not want (Resident #1) falling. The resident did not wake up during the transfer, after we got (Resident #1) on .bed, the visitor that was also in the room tried speaking to the resident at which the resident mumbled an unrecognized word. I (Staff C) checked on the resident two more times before my (Staff C) shift ended and reported to nurse (Staff D) that the resident was snoring. My nurse (Staff D) said let (Resident #1) sleep because (Resident #1) was very tired. Interview on [DATE] at approximately 4:25 p.m. with Staff C (LNA) regarding this incident, revealed that Staff C went to get Resident #1 in the morning after breakfast, went to (Resident #1's) room . resident not there. Thought resident went to get coffee. Later this LNA (Staff C) observed Resident #1 sitting in chair beside the bed and that the resident looked like a drunk. This LNA (Staff C) reported to the nurse what she observed and was told by Staff D to let (Resident #1) sleep . (because Resident#1) didn't sleep last night. Staff C revealed that this was not like Resident #1 and that Resident #1 usually doesn't sleep that late and is usually up & about. Staff C was told by the Staff D to leave Resident #1 alone and let Residen t#1 sleep. Staff C further revealed at this time that Staff D asked her to help transfer Resident #1 back to bed and reported that Resident #1 was leaning on staff for support and that Resident #1 was very limp with Resident #1's upper extremities, like (Resident #1) was zonked and staff had to lift Resident#1 into bed. During this transfer Staff C reported that the Resident #1 didn't say words . mumbled and staff were unable to understand Resident #1. Staff C checked Resident #1 and could hear (Resident #1) snoring. Resident #1 was not awake for lunch on [DATE]. Staff C was told by Staff D to let (Resident #1) sleep .(Resident #1) is very tired. The facility failed to assess Resident #1 at the time Resident #1 was transferred from the chair to the bed by two staff. Resident #1 was reported as limp, leaning on staff for support and mumblingduring this transfer when Resident #1 was usually independent in walking. Staff C revealed that Resident #1 was not himself/herself and not coherently talking with staff. Interview on [DATE] at approximately 2:15 p.m. with Staff A (Administrator) and Staff B (Assistant Director of Nurses) confirmed that Resident #1 had a change in condition on [DATE]. when Resident #1 was leaning on staff for support and was limp with his/her upper extremities and mumbling words staff could not understand during transfer from the chair to bed. Staff A and Staff B revealed that the facility failed to assess Resident #1 for a change in condition. Review on [DATE] of the incident report revealed a signed statement dated [DATE] by Staff D (Licensed Practical Nurse/Licensed Vocational Nurse) who documented the following: Morning routine (Resident #1) always up and about. As I went in my morning shift (Resident #1) kept talking to me as usual. (Resident #1) is always up in the morning and comes to talk to me and the LNA's. (Resident #1) looked exhausted but I had been told (Resident #1) usually doesn't get much sleep in the night. Around 9:30 - 10:00 I told (Resident #1) . try (sic) to take a nap (Resident #1) was sitting in (sic) the couch in front of elevators and was ambulating and walked to . room. Sat down in the recliner because (Resident #1) refused to be in bed. (Resident #1) was fine @ (sic) that time and then .friend (name omitted) came to visit .friend said we should come in went to see (Resident #1) and (Resident #1) was sleeping, no hard breathing noted, no high respirations no sweating or excessive sweating noted. The snoring was normal. Not deepen at this time @ (sic) 11:00. Resident was transferred 1200 (sic) from the recliner to bed. Resident usually doesn't eat much through the day. (Resident #1) didn't eat breakfast or lunch. Resident usually can take a nap during the day. The LNA and I checked up on resident throughout the day. The resident did not throw up the times that I rounded . pupils were reactive when I checked upon (Resident #1). After giving report to the on coming nurse (Resident #1's) friend came to us and said something is wrong we went to see (Resident #1) was on . left side emesis (sic), . was breathing heavily, .was sweating profusely so immediate action was place called 911 supervisor was called and (unreadable writing) and doctor. Interview on [DATE] at approximately 11:20 a.m. with Staff D, Staff D stated the events occurring on [DATE] that lead up to Resident #1 being transported out to the hospital: Staff D stated that she had come in to her shift and was told that Resident #1 had not slept well the previous night. When Staff D left report Resident #1 approached her to talk and then Resident #1 went downstairs as Resident #1 usually does to get breakfast. When Resident #1 came back upstairs Resident #1 sat on the couch in front of the elevators and dozed off. Staff D approached Resident #1 and encouraged Resident #1 to go back to Resident #1's room and take a nap. Resident #1 ambulated back to room and sat in the recliner - this was around 10:30 a.m. Around 11:00 a.m. Staff D was approached by Resident #1's family friend who stated she was concerned about Resident #1 as he/she was sleeping in the recliner chair in the room and was slumped over the side of the chair and was not responsive. Staff D asked Staff C (LNA) to assist Staff D in getting Resident #1 into bed for a nap. Staff D and Staff C arrived in Resident #1's room and stood and pivoted Resident #1 into bed. Resident #1 did not wake up or respond to this transfer. Once Resident #1 was in bed Resident #1 opened one eye, looked at the family visitor and mumbled something to her that was unintelligible then Resident #1 appeared to be sleeping. Staff D was asked if Staff D had performed an assessment of Resident #1 and Staff D stated that she had performed an assessment that appeared to be normal but that she had another resident that was in crisis and needed to be sent out to the emergency room . Staff D stated that she did not document the assessment because she was too busy with the other resident and had forgotten. Staff D was asked if the way Resident #1 had presented during Staff D's shift was the way Resident #1 usually presented and Staff D stated, No, generally (Resident #1) was up and about walking around and socializing. Staff D went on to explain that later in the day the family friend had returned, probably around 4:00 p.m. and asked Staff D to come see Resident #1 because Resident #1 was not responding and had vomited in the bed. Staff D performed an assessment at this time of Resident #1 who was found on Resident #1's left side in vomit and drool around face, unresponsive, pupils were not reactive, blood pressure was ,[DATE], pulse was 118 and oxygen saturation on room air was 86% and Resident #1 had a temp of 99.5. On call MD was notified and 911 called for transport. The shift supervisor for the facility was notified of the situation. Staff D stated that the resident was transported to the hospital and died approximately 23 hours later. Interview on [DATE] at approximately 4:25 p.m. with Staff C (Licensed Nursing Assistant) regarding the events of [DATE] with Resident #1, Staff C stated that she was concerned throughout her shift and notified Staff D a couple of times that the resident was still sleeping. Staff C stated that she did assist Staff D with transferring the resident around 11:00 a.m. from the recliner chair to the bed because Resident #1 was hanging over the side of the recliner. Staff C stated that during this transfer the resident acted like a drunk person, was limp and leaning on staff as Staff C and Staff D pivoted him/her into bed. Staff C stated that Resident #1 did not wake up during this transfer but did mumble something once he/she had been transferred to bed but Staff C could not understand what Resident #1 had said and then Resident #1 slept.",2020-09-01
21,GREENBRIAR HEALTHCARE,305005,55 HARRIS ROAD,NASHUA,NH,3062,2018-10-16,658,D,1,0,QTPI11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on record review, interview and facility policy review, it was determined that the facility failed to follow physician orders [REDACTED]. (Resident identifier is #2.) Findings include: Review on 10/16/18 of Resident #2's Order Summary Report revealed that Resident #2 had a physician order [REDACTED]. Review on 10/16/18 of Resident #2's nurses notes, dated 9/20/18, revealed that Resident #2 was .admitted to (Proper Noun) hospital for [MEDICAL CONDITION], without any further notes indicating the signs or symptoms that Resident #2 was experiencing. The last documented nurses note prior to that note was a nurse's note, dated 9/18/18. Review on 10/16/18 of the Facility Policy, titled Charting and Documentation, last revised 4/2018, revealed that All services provided to the resident, progress toward the care plan goals, or any changes in the resident's medical, physical, functional or psychosocial condition, shall be documented in the resident's medical record . Interview on 10/16/18 at approximately 2:00 p.m. with Staff A (Director of Nursing) confirmed that there was no documentation of daily skilled notes.",2020-09-01
22,GREENBRIAR HEALTHCARE,305005,55 HARRIS ROAD,NASHUA,NH,3062,2018-10-16,660,D,1,0,QTPI11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on record review, interview and facility policy and procedure it was determined that the facility failed to implement the discharge planning process to ensure that the needs of 1 resident were met at the time of discharge back to the home setting in a survey sample of 12 discharged residents. (Resident identifier is #1.) Findings include: Review on 10/16/18 of the facility policy and procedure titled Discharge Summary and Plan dated 11/2017 revealed the following: POLICY When a resident's discharge is anticipated, a discharge summary and post-discharge plan will be developed to assist the resident to adjust to his/her new living environment. Guidelines a) When the facility anticipates a resident's discharge to a private residence, another nursing care facility (i.e., skilled, intermediate care, ,,,, etc.), a discharge summary and post-discharge plan will be developed which will assist the resident to adjust to his or her new living environment. b) The discharge summary will include a recapitulation of the resident's stay at this facility and a final summary of the resident's status at the time of the discharge in accordance with established regulations governing release of resident information and as permitted by the resident. The discharge summary shall include a description of the resident's: a. Current diagnosis; b. Medical history .; c. Course of illness, treatment and/or therapy since entering the facility; d. Current laboratory, radiology, consultation, and [DIAGNOSES REDACTED].>e. Physical and mental functional status; f. Ability to perform activities of daily living .; g. Sensory and physical impairments (neurological, or muscular deficits, for example, a decrease in vision and hearing, paralysis, and bladder incontinence); h. Nutritional status and requirements; . i. Special treatments or procedures . j. Mental and psychosocial status (ability to deal with life, interpersonal relationships and goals, make health care decisions, and indications of resident behavior and mood); k. Discharge potential (the expectation of discharging the resident from the facility within the next three months); l. Dental condition . m. Activities potential . n. Rehabilitation potential . o. Cognitive status . p. Medication therapy (all prescription and over-the-counter medications taken by the resident including dosage, frequency of administration and recognition of significant side effects that would be most likely to occur in the resident). c.) As part of the discharge summary, the nurse will reconcile all pre-discharge medication with the resident's post-discharge medications. The medication reconciliation will be documented. d.) Every resident will be evaluated for his or her discharge needs and will have an individualized post-discharge plan. e.) The post-discharge plan will be developed by the Care Planning/Interdisciplinary Team with the assistance of the resident and his or her family and will include; . f.) The discharge plan will be re-evaluated based on changes in the resident's condition or needs prior to discharge. g.) The resiident/representative will be involved in the post-discharge planning process and informed of the final post-discharge plan; h.) Residents will be asked about their interest in returning to the community. If the resident indicates an interest in returning to the community, he or she will be referred to local agencies and support services that can assist in accommodating the resident's post-discharge preferences. i.) If it is determined that returning to the community is not feasible, it will be documented why this is the case and who made the determination. j.) Residents transferring to another skilled nursing facility or who are discharged to a home health agency, long-term care hospital or inpatient rehabilitation will be assisted in selecting a post-acute care provider that is relevant and applicable to the resident's goals and treatment preferences. Data used in helping the resident select an appropriate facility includes the receiving facility's . k.) The resident or representative . should provide the facility with notice of a discharge to assure that an adequate discharge evaluation and post-discharge plan can be developed. l.) A member of the IDT (interdisciplinary team) will review the final post-discharge plan with the resident and family before the discharge is to take place. m.) A copy of the following will be provided to the resident and receiving facility and a copy will be filed in the resident's medical records . k. An evaluation of the resident's discharge needs. l. The post-discharge plan; and m. The discharge summary. Resident #1. Review on 10/16/18 of Resident #1's electronic medical record and the soft paper record revealed that Resident #1 was admitted to the facility on [DATE] with the following Diagnoses: [REDACTED]. Review on 10/16/18 of the Nurse Notes for Resident #1 revealed the following; - 2/19/18 TC (telephone call) to (name and telephone number) re (regarding) Status of getting (Resident#1) home. ML (message left) waiting for (Sentence not completed.) - 4/26/18 S.S. (social service) spoke with (Resident #1) about .over all plan as far as discharging home. S.W. (social worker) has been following up with .in the county where (Resident #1) lives to find assistance for . (Resident #1) when (Resident #1) has an actual discharge date . - 5/10/18 .S.S. working on d/c (discharge) plan for (Resident #1) to get home with equipment and services - 8/28/18 @ 13:58 S.W. spoke with (Resident #1) prior to .discharge tomorrow in the S.S. office. (Resident #1) had this writer buy (Resident #1) a sit to stand lift and have it delivered to (Resident #1's) home. During this time this writer stated that (Resident #1) will need to stay a few more days longer do (sic) to it taking 5-10 days for this lift to even be delivered. There was (sic) witnesses in the office when (Resident #1) stated that is was able (sic) to scoot slide out of . power chair and would like to go home knowing that (Resident #1) will not receive the sit to stand lift on discharge. (Supplier) will be providing the rest of his DME (durable medical equipment) tomorrow. Services were set up through (visiting nursing) and (ambulance) was booked for 2pm pickup to home. S.S. will follow up as needed. - 8/28/18 Resident (#1) had a pulmonologist appointment and new medications were prescribed. (Physician) notified and ordered for the resident (#1) to be given prescripts tomorrow on discharge to home. - 8/29/18 Resident left (discharged ) for home at 1500. Review on 10/16/18 of the physician note for Resident #1 dated 8/17/2018 revealed the following: Pt (patient) is wheelchair dependent, (Resident #1) can use a manual w/c for short distances, due to carpal tunnel syndrome bilateral wrists, (Resident #1) is currently able to use an electric w/c. Needs a stand assist to transfer. Pt is cont (continent) of B&B (bladder & bowel), needs assist to transfer to commode. 1. The patient requires a wide/heavy duty commode chair due to (Resident #1's) weight is over 300lbs (pounds) and pt is confined to a single room. 2. (Resident#1) will require a manual wheelchair for inside .home use as (Resident #1) is a paraplegic and nonambulatory . 3. Pt. requires a hospital, semi electric hospital bed, due to pt. [MEDICAL CONDITION], hx (history) GERD, and persumptive dx (diagnosis) of [MEDICAL CONDITION] with chronic cough. Pt needs .head elevated when .in bed to be more than 30 degrees .requires frequent positioning. 4. Pt needs a Patient Lift, (stand assist) to transfer between .bed, wheel chair and commode. Pt cannot transfer independently due to [MEDICAL CONDITION] without a lift pt would be bed bound. 5. Pt requires a support surface, a mattress overlay due to [MEDICAL CONDITION] and inability to independently reposition Record review on 10/16/18 revealed the Physician Attestation of Face to Face Encounter for Home Health Referral dated 8/23/18 for PT (physical therapy), OT (occupational therapy) therapeutic exercise ROM (range of motion), safety endurance. RN (Registered Nurse) assess & med (medication) management, HHA (home health aide) ass (assist) + ADLs (activities of daily living), SW (social worker) liaison to community resources. Review on 10/16/18 revealed a fax to a home health agency dated 8/29/18 the day of discharge from the facility for PT, OT, HHA, SW services for Resident #1. Review on 10/16/18 of Resident's #1 electronic medical record revealed the following; - 8/30/18 . This writer (social worker) had a home care agency in place as well for them to go out and see (Resident #1) 48 hours after d/c (discharge). This writer received a voicemail from the agency that stated they could not take (Resident #1) on case load due to not having the staff to go to (Resident #1's town). The agency left this writer another agency to call that could better service. This writer called (home health agency) and faxed all .paper work to them for RN and HHA in the home Interview on 10/16/18 at approximately 11:30 a.m. with Staff C (Social Worker) revealed after review of the electronic and paper record for Resident #1that there is no documented evidence that the social worker followed up with discharge plans on 2/19, 4/26, 5/10 and 8/28/18, that there was no documented evidence of a discharge plan with goals and needs to ensure a safe transition from the facility, no documentation prior to discharge that the referral home health agency accepted Resident #1 for the services ordered in the home, no documentation that Resident #1 was given the prescriptions for new medications ordered at the time of discharge and no documentation of a copy of the evaluation of Resident #1's discharge needs, post-discharge plan and discharge summary. Interview on 10/16/18 at approximately 3:00 p.m.with Staff A (Registered Nurse) and Staff B (Registered Nurse) confirmed the findings listed above for Resident #1. The facility failed to fully implement the discharge planning process prior to discharge and Resident #1 was discharged to Resident #1's home with no ordered home health services and adaptive equipment in place to meet Resident #1's needs in the home setting.",2020-09-01
23,GREENBRIAR HEALTHCARE,305005,55 HARRIS ROAD,NASHUA,NH,3062,2019-10-28,580,D,0,1,TYS711,"Based on interview and record review, it was determined that the facility failed to notify a physician for a resident who had a change in an AIMS (Abnormal Involuntary Movement Scale) assessment for 1 resident in a final survey sample of 35 residents. (Resident identifier is #17.) Findings include: Review on 10/28/19 of Resident #17's AIMS revealed the following: 11/9/18 - score 0 (no abnormal movements) 2/9/19 - score 0 (no abnormal movements) 5/9/19 - score 0 (no abnormal movements) 7/31/19 - score 6 (Resident scored a 1 in upper (arms, wrists, hands, fingers) include chronic movements, scored a 1 in lower (legs, knees, ankles, toes), scored a 2 in severity of abnormal movements, scored a 2 in incapacitation due to abnormal movements. Interview on 10/28/19 at approximately 1:00 p.m. with Staff K (Licensed Practical Nurse) revealed that there was no documentation that the physician was notified of the changes in Resident #17's AIMs.",2020-09-01
24,GREENBRIAR HEALTHCARE,305005,55 HARRIS ROAD,NASHUA,NH,3062,2019-10-28,584,B,0,1,TYS711,"Based on observation and interview, it was determined that the facility failed to provided a safe, clean, comfortable and homelike environment for 2 of 5 units. Findings include: Observation on 10/23/19 at 1:12 p.m. during tour of the third floor revealed that the shower room located behind the nurses station had black like tar in 3 inch strips around the outside edges of the shower unit where the walls meet the floor. Also several tiles were broken failing to meet a home like environment. Interview on 10/23/19 at approximately 1:15 p.m. with Staff A (Unit Manager) reviewed the above findings and Staff A stated they are to be remodeling the shower units at some time but was not sure when. Observation on 10/26/19 at approximately 9:30 a.m. of unit one of building one had a strong and pervasive urine like odor which lasted until almost noontime. Observation on 10/23/19 at approximately 11:45 a.m. on the dementia unit revealed a strong urine like odor in the left hallway.",2020-09-01
25,GREENBRIAR HEALTHCARE,305005,55 HARRIS ROAD,NASHUA,NH,3062,2019-10-28,656,B,0,1,TYS711,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, it was determined that the facility failed to develop and implement a comprehensive person-centered care plan that would include measurable objectives and time frames to meet the residents' needs for 3 residents who were smokers and 2 residents with other care needs out of a final survey sample of 35 Residents. (Resident identifiers are #49, #88, #340, #341 and #540). Findings include: Resident # 49 Interview on 10/23/19 at 01:03 p.m. with Resident #49 resulted in Resident #49 stating I get my cigarettes from the nurse. There's a sign out book at the nurse's station. I sign out the book and the nurse gets me my smoking materials. Then I go outside and smoke off the property. We have to smoke off the facility property, out on the sidewalk. When I'm done, I go back to the nurse's station to turn in my smoking materials to the nurse and then I sign back in. If no one is there to take my smoking materials, I keep them on me until I can find a staff member to give them to. This is what they tell me I have to do. Review of the Facility's Tobacco Free Environment Policy on 10/23/19 at 1:35 p.m. revealed that: (Summarized): *The facility will educate prospective admissions on the Tobacco Free Environment Policy. *The prospective resident will agree not to smoke at the facility or on the premises and will be offered smoking cessation information. *On admission, resident or resident representative will sign indicating that there is understanding that the resident will not smoke in the facility or on the premises. *Any residents who were smokers prior to the implementation of this policy will be allowed to smoke in a designated area and will receive a smoking safety assessment to determine the level of supervision to be provided and interventions to mitigate risk of injury. *Residents new to the facility will not receive a smoking assessment. *Policy will be placed in areas that are highly visible. Enforcement of the Tobacco Free Policy will consist of: *Requesting that visitors leave if they fail to comply; *Asking residents to immediately comply, and, * assessing residents for related distress; and, *confiscating tobacco products and lighting materials found in the facility and returning such materials to the resident/owner upon the resident's discharge from the facility. Review on 10/28/19 at approximately 9:00 a.m. of record and Smoking Care Plan for Resident #49 revealed that the Care Plan includes the following (summarized) verbage: *Resident has a history of noncompliance with following the facility's non-smoking policy and chooses to make independent choices to smoke. *Declines smoking cessation programs. There are no individualized interventions in the smoking care plan for Resident #49 that are measurable, include safety goals and ongoing assessments, smoking cessation opportunities, or that meet Resident # 49's needs for smoking safety. Interview on 10/28/19 at approximately 10:48 a.m. with Staff A (Registered Nurse, Unit Manager) confirmed that residents who smoke are to come to the Nurse's Station to sign out, pick up their cigarettes and lighter and leave the facility grounds to smoke. The residents then return to the nurses station, sign back in, and turn in the cigarettes and lighter. If there is no staff covering the nurses station upon return of the resident, then the resident keeps the smoking paraphenalia with them until they can find a staff member they can give them to. Observation on 10/28/19 at 10:56 a.m. revealed that Resident #49 was seen to approach the nurse's station, sign out, obtain smoking materials and then proceed to go outside to smoke. This observation of Resident #49, and interview with Staff A, (as written in above paragraphs), demonstrate that the facility is keeping cigarettes and lighters at the nurse's station for resident use. This process is not reflected in the resident's care plan. Resident #88 Interview on 10/23/19 at 9:30 a.m. with Resident #88 revealed that Resident #88 is a smoker and goes out to the bus stop to smoke. Resident #88 stated that he/she does not smoke in the building, and that smoking materials are kept in Resident #88's drawer. It was observed that resident keeps the cigarettes on his/her person. Resident #88 is alert and oriented and states that the facility is aware of this process for smoking used by Resident #88. Review on 10/28/19 at approximately 1:00 p.m. of care plan for Resident #88 revealed that the care plan has the following items listed for Resident #88: * Discourage resident from providing smoking items to other residents. * Educate and remind resident to check self out on Leave of Absence (LOA) when leaving facility property and inform staff/nurse as needed (PRN). *Offer 1:1 education with Respiratory Therapist (RT) on adverse effects of smoking and support for smoking cessation PRN. * Offer resident a smoking cessation program. *Smoking Policy is reviewed with resident and/or responsible party. Interview on 10/28/19 at approximately 2:00 p.m. with Staff B (Director of Nurses) confirmed the above findings. Resident #340 Review on 10/25/19 at 12:00 p.m. of Resident #340's medical record revealed Resident #340's care plan states under Focus (Resident #340) has a history of non-compliance with the facility's non-Smoking policy, (Resident #340) declines smoking cessation programs offered. Under Intervention Educate (Resident #340) and family/friends regarding center's NON-smoking policy. Designated smoking areas OFF property, and storage of smoking materials. Review on 10/25/19 of Resident #340's nurses notes reveal multiple entries of none compliance with the facility's policy as written. Nurses notes 10/8/19 reveal (Resident #340) continues to be non-compliant with the facility smoking policy. At time of medication administration this nurse could not find patient, (Resident #340) did not sign the LOA book. This nurse observed patient sitting on (his/her) rollator directly outside the sliding glass door on building 4, (Resident #340) was actively smoking. this nurse had (Resident #340) extinguish (his/her) cigarette and explained again the policy. (Resident #340) states (she/he) knows the policy and before this nurse could finish (Resident #340) told this nurse 100% correctly and policy . Nurses notes dated 10/10/19 (Resident #340) was again noted to be non-compliant with facility smoking policy .nurse asked if (he/she) had recently smoked, (he/she) said (he/she) did, and voluntarily gave this nurse (his/her) cigarettes, lighter and clothes pin (which (he/she) uses to hold the cigarette. Nurses notes dated 10/11/19 (Resident#340) continues to smoke outside with out following the facility policy .sitting on ramp outside building 4; .reminding (Resident #340) needed be off property. Nurses notes dated 10/12/19 (Resident #340) again is noted to not be following the smoking policy . Nurses notes dated 10/14/19 (Resident #340) caught outside several times this evening, (Resident #340) was not willing to give up (his/her) cigarettes or lighter, (Resident #340) states its all done now I already smoked it. Nurses notes dated 10/15/19 (Resident #340) is continuing to smoke on premises, despite staff taking (his/her) smoking items and locking them in the med room (he/she) continues to produce cigarettes and a lighter, not sure where (he/she) is getting this from, (he/she) will not answer when asked. Review on 10/25/19 of Resident #340's Nurses notes 10/16/19 .(Resident #340) went out to smoke a couple of times and continues to smoke on the property and not sign the LOA book at the nurse station . Nurses notes dated 10/19/19 .(Resident #340) was not in (his/her) room or on the unit, (he/she) had not signed LOA book. this nurse went to building 4 and there (Resident #340) was noted to be sitting on (Resident #340) rollator smoking at the slider door . Nurses notes dated 10/22/19 .continues to be non-compliant with smoking policy . Interview on 10/28/19 with Staff D (Administrator) the question was asked in regards to a smoking assessment being completed for the safety and change of condition of residents ability to maintain smoking privileges off campus. Staff D stated the facility dose not do smoking assessments due to the fact the facility is a non smoking facility. Resident #341 Review on 10/25/19 of Resident #341's nutrition note, dated 10/2/19, revealed that Staff L (Registered Dietitian) wrote .resident now with sig. (significant) weight loss . Review on 10/25/19 of Resident #341's nutrition note, dated 10/22/19, revealed that Staff L wrote that Weight of 165.5 is down 9.5 pounds in one month . Review on 10/25/19 of Resident #341's Weight and Vitals summary revealed that on 9/20/19, Resident #341 weighed 175 pounds, and on 10/18/19 Resident #341 weighed 165.5 pounds, which was a 5.4% weight loss. Review on 10/25/19 of Resident #341's current care plan revealed that (Resident #341) has nutritional problem or potential nutritional problem r/t (related to) .need for tube feed .overweight . There was nothing documented in the care plan regarding the actual weight loss that Resident #341 had. Interview on 10/28/19 at approximately 11:40 a.m. with Staff M (Licensed Practical Nurse) confirmed that Resident #341 had a significant weight loss and that it was not documented on Resident #341's care plan. Staff M also confirmed that Resident #341's weight loss should have been documented in their care plan Resident #540 Review on 10/24/19 of Resident #540's active physician orders [REDACTED]. Interview on 10/28/19 at approximately 10:45 a.m. with Staff N (Licensed Practical Nurse) revealed that Resident #540 had a pressure ulcer on their coccyx, which resolved on 10/16/19. Review on 10/28/19 of Resident #540's current and resolved care plans revealed that there was no care plan in place for Resident #540's pressure ulcer on their coccyx and no care plan for dressings changes to the coccyx area. Interview on 10/28/19 at approximately 10:45 a.m. with Staff N confirmed that there was no care plan in place for Resident #540's coccyx pressure ulcer. Staff N also confirmed that a care plan should have been in place for the pressure ulcer and for the dressing changes.",2020-09-01
26,GREENBRIAR HEALTHCARE,305005,55 HARRIS ROAD,NASHUA,NH,3062,2019-10-28,658,E,0,1,TYS711,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, record review and policy review, it was determined that the facility failed to meet professional standards for medication administrations via a Gastrostomy tube ([DEVICE]), and checking patency for a Peripherally Inserted Central Catheter (PICC) line prior to medication administrations for 2 out of 37 medication administrations observed; and 2 medication omissions noted on record review for 3 resident out of final sample size of 35 residents. (Resident identifiers are #22, #39, and #46.) Findings include: Resident #46 Wolters Kluwer Health (edited by [NAME] M. Nettina), Manual of Nursing Practice. 9th ed. Ambler, Pennsylvania: Lippincott[NAME] and Wilkins, 2010. Page 86 .Types of I.V. (Intravenous) Administration . .Precaution and Recommendations . .1. Before medication administration . .f. Assess patency of the I.V. line by the presence of blood return . Observation on 10/23/19 at 2:05 p.m. with Staff A (Unit Manager) during medication administration for Resident #46's Meropenem (antibiotic) revealed that Staff A cleaned Resident #46's needleless connector of the PICC line with an alcohol wipe then waited for needless connector to air dry. Staff A used a 10 ml (milliliter) Normal Saline Flush to flush the needless connector. Staff A was not observed to have aspirated the PICC line catheter and no red blood-like substance was observed when Staff A flushed Resident #46's PICC line catheter. Staff A then proceeded to administer Meropenem 1 Gm (gram) I.V. Review on 10/24/19 of facility's procedure titled, Central Vascular Access Device ([MEDICAL CONDITION]) Flushing and Locking, revision dated 5/1/2016, revealed that .[MEDICAL CONDITION] .considerations .1.1 Peripherally Inserted Central Catheter (PICC) .flushing/locking (sic) is performed to ensure and maintain catheter patency .5. Catheter patency must be verified prior to each access. To assess patency, aspirate catheter to obtain a positive blood return. The aspirated blood should be the color and consistency of whole blood .Procedure: .9. Attach syringe with prescribed flushing agent to needleless connector. Aspirate the catheter to obtain blood return to verify vascular access patency . Interview on 10/24/19 at 9:10 a.m. with Staff A confirmed above observation. Staff A stated that when they flush Resident #46's PICC line catheter with 10 ml Normal Saline there was no resistance which indicated that the PICC line was patent. Staff A was unable to state facility's procedure in checking patency of a PICC line. Resident #22 Interview on 10/23/19 at 9:58 a.m. with Resident #22 revealed that the resident had a concern with medication administration. Resident #22 stated; I am very independent. The staff here help me with showers and they give me my medications. There is always a problem with my medications. Often times I get the wrong ones or some meds are missing and I make them take back the meds and get me the right ones. My inhalers have been unavailable for weeks at a time. Review on 10/25/19 at 12:30 p.m. of Resident #22's nursing notes and MAR (Medication Administration Record) revealed that on the following dates, medication that was ordered was not administered: 10/4/19: [MEDICATION NAME] Diskus Aerosol Powder 1 Puff BID (twice per day). Reason Missed: Waiting for Pharmacy to deliver. Signed by Staff H, (licensed Practical Nurse), LPN. 10/5/19: [MEDICATION NAME] Diskus Aerosol Powder 1 Puff BID. Reason Missed: Medication is unavailable. Signed by Staff H. 10/6/19: [MEDICATION NAME] Tablet 40 mg, 4 tabs PO (by mouth) QD (once per day). Reason not given: Unavailable. Signed by Staff [NAME] 10/6/19: [MEDICATION NAME] Diskus Aerosol Powder 1 Puff BID. Reason not given: Medication unavailable. Signed by Staff [NAME] 10/7/19: Note text: [MEDICATION NAME] Tablet 50 mg, give 4 tablets PO QD for tremors. (Not given): Med ordered but has not been delivered by pharmacy, nurse called pharmacy and according to pharmacy, resident is still hospitalized in their computing system but informed patient has been discharged and is in the facility. Signed by Staff G, LPN 10/7/19: [MEDICATION NAME] Diskus Aerosol Powder 1 Puff PO BID. (Not given): Med ordered but has not been delivered by pharmacy, nurse called pharmacy and according to pharmacy, resident is still hospitalized in their computing system but informed patient has been discharged and is in the facility. Signed by Staff [NAME] 10/16/19: [MEDICATION NAME] Diskus Aerosol Powder 1 Puff BID. Reason not given: Awaiting Delivery. Signed by Staff [NAME] 10/20/19: [MEDICATION NAME] Diskus Aerosol Powder 1 Puff BID. Reason not given: Pending delivery from the pharmacy. Signed by Staff F, RN. Review of Resident #22's medical record on 10/28/19 at approximately 12:55 pm revealed that there were no notes to the physician to communicate that these medications were missed, and how to proceed. Interview on 10/28/19 at approximately 1:15 p.m. with Staff B Director of Nursing (DON) confirmed that Resident #22's record did not have documentation to support that the physician had been informed of the missed medications, or how to proceed. Staff B could not provide rationale for the missed medications, for not notifying the physician of the missed medications, or administering staff not inquiring of the physician as to how to proceed. Record review on 10/28/19 at approximately 1:45 p.m. after Staff B provided a printed Order-Search of Omnicare Pharmacy Delivery records dated from 10/1/19 to 10/28/19 revealed the following information for Resident #22's [MEDICATION NAME] and [MEDICATION NAME] medication deliveries: 10/8/19: [MEDICATION NAME] Diskus Delivered on 10/8/19 at 3:09 a.m. 10/8/19: [MEDICATION NAME] 50 mg Delivered on 10/8/19 at 3:09 a.m. 10/18/19: [MEDICATION NAME] Diskus Delivered on 10/18/19 at 7:44 p.m. Resident #39 [NAME] [NAME] Potter and Anne Griffin Perry, Fundamentals of Nursing. 7th ed. St. Louis, Missouri: Mosby Elsevier, 2009. Page 336-Physicians' Orders The physician is responsible for directing medical treatment. Nurses follow physicians' orders unless they believe the orders are in error or harm clients. Therefore you need to assess all orders, and if you find one to be erroneous or harmful, further clarification from the physician is necessary . Page 708 The prescriber often gives specific instructions about when to administer a medication Observation on 10/24/19 at approximately 9:30 a.m. of Resident #39's Gastrostomy tube medication administration with Staff J (Licensed Practical Nurse) revealed that during the administration of 8 medications the tube was not flushed in between medications. Medications administered: Atorvastatin 10 milligrams Calcium with Vitamin D 600-400 milligrams [MEDICATION NAME] 25/100 milligrams Vitamin B12 1000 milligrams [MEDICATION NAME] HCL ([MEDICATION NAME]) 500 milligrams Buproprian HCL 100 milligrams Sodium Chloride 1 gram [MEDICATION NAME] Acid 250 milligrams- 5 milliliters (15 milliliters) Review on 10/24/19 of Resident #39's Medication Administration Record [REDACTED] Flush tube with 5 ml's (milliliters) of water between each medication. Interview on 10/24/19 at at approximately 9:40 a.m. with Staff J confirmed that there were no water flushes administered in between the 8 medications. Review on 10/25/19 of the facility's policy and procedure titled, 6.0 General Dose Preparation and Medication Administration, Revision date; 12/1/07 revealed: .Procedure . 4.1.1 Verify each time a medication is administered that it is the correct medication, at the correct dose, at the correct route, at the correct rate .",2020-09-01
27,GREENBRIAR HEALTHCARE,305005,55 HARRIS ROAD,NASHUA,NH,3062,2019-10-28,676,D,0,1,TYS711,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, it was determined that the facility failed to ensure that a resident received the appropriate monitoring to maintain or improve his or her ability to carry out the activities of daily living for 1 out of 2 residents reviewed for activities of daily living out of a final survey sample of 35 residents . (Resident identifier is #144.) Findings include: Review on 10/28/19 of Resident #144's medical record revealed that Resident #144 had an MBS (Modified [MEDICATION NAME] Swallow) done on 7/31/19 revealed the the following actions are recommended regarding the patient's feeding: .Treatment plan and further recommendations: . The following actions are recommended regarding the patient's feeding: Alternate Solids/Liquids, Positioned Upright, Small Bites/Sips, Upright at 90 degrees during PO (by mouth) and 30 minutes after meal. . Review on 10/28/19 of ST (Speech Therapist) notes revealed the following: Resident was seen by ST from 7/17/19-8/7/19. The following recommendations were noted on the ST progress and discharge summary: . Recommended strategies include alternating bites/sips, upright for all P.O., small bites/sips. . Discharge plans and instructions: . Monitor and report changes of vocal quality or swallow function. Review on 10/28/19 of Resident #144's care plans revealed that these interventions were not in Resident #144's care plan to be monitored. Interview on 10/28/19 at approximately 1:00 p.m. with Staff K (Licensed Practical Nurse) confirmed that the recommendations were not implemented in Resident #144's care plans.",2020-09-01
28,GREENBRIAR HEALTHCARE,305005,55 HARRIS ROAD,NASHUA,NH,3062,2019-10-28,690,D,0,1,TYS711,"Based on record review, and interview, it was determined that the facility failed to provide care and services for 1 resident who is totally incontinent of urine in a final survey sample of 35 residents. (Resident identifier is #590.) Findings included: Interview on 10/24/19 at 8:11 a.m. Resident #590 stated the unit is short staffed. Resident #590 also states that prior to coming to this unit when they were on the skilled unit they were getting checked and changed every 3 hours. Resident #590 states now that they are on this unit they get changed 1-2 times per day. Review on 10/25/19 at 12:54 p.m. of Resident #590's medical record revealed LNA (Licensed Nursing Assistant) documentation showed that from 10/15/19-10/28/19 they are getting toileted only two times a day. Review on 10/25/19 of Resident #590's care plan states skin Actual Alteration in Skin Integrity Related to Rash/fungal infection in groin and abdominal fold . Care Plan states (Resident #590) has frequent bowel and bladder incontinence r/t Impaired Mobility/reconditioning. Review on 10/28/19 of the P[NAME] (Point of Care) Response History under Urinary continence for a 14 day look back period shows Resident #590 being incontinent daily. The times provided by the facility are as follows: 10/15/19 shows Resident #590 being changed only two times in a 24 hour period 10/16/19 shows Resident #590 being changed only two times in a 24 hour period 10/17/19 there is no documentation at all 10/18/19 shows Resident #590 being changed only three times in a 24 hour period 10/19/19 shows Resident #590 being changed only two times in a 24 hour period 10/20/19 shows Resident #590 being changed only two times in a 24 hour period 10/21/19 shows Resident #590 being changed only three times in a 24 hour period 10/22/19 shows Resident #590 being changed only one time in a 24 hour period 10/23/19 shows Resident #590 being changed only one time in a 24 hour period 10/24/19 shows Resident #590 being changed only two times in a 24 hour period 10/25/19 shows Resident #590 being changed four times in a 24 hour period 10/26/19 shows Resident #590 being changed only one time in a 24 hour period 10/27/19 shows Resident #590 being changed only one time in a 24 hour period 10/28/19 shows Resident #590 being changed only one time in a 24 hour period Interview on 10/28/19 with Staff D (Administrator), the findings were reviewed and Staff D confirmed them.",2020-09-01
29,GREENBRIAR HEALTHCARE,305005,55 HARRIS ROAD,NASHUA,NH,3062,2019-10-28,692,D,0,1,TYS711,"Based on interview, record review and facility policy review, it was determined that the facility failed to ensure that weight loss is monitored and weights are obtained for 2 residents in a final survey sample of 35 residents. (Resident identifiers are #135 and #172.) Findings include: Review of the facility policy, titled Weight Measurement, dated 5/23/18, revealed that .Weights will be obtained weekly X 4 (weekly for 4 weeks) after admission. Subsequent weights will be monthly, unless physician's orders or the resident's condition warrants more frequent as determined by Interdisciplinary Team .All residents with significant weight changes will be reweighed to assure accuracy of the weight. Verify re-weigh for accuracy and documentation purposes .Residents with significant unintended weight changes will be added to weekly weights X 4 weeks or until weight stabilizes . Resident #135 Review on 10/24/19 of Resident #135's weights and vitals summary revealed that Resident #135 had a weight of 116.8 pounds on 9/6/19, the date that they were admitted to the facility. The next weight documented was on 9/12/19 which was 113 pounds, which represented a 3.2% weight loss. There were no other weights documented after 9/12/19. Review on 10/25/19 of Resident #135's active physician orders revealed that there was no order to discontinue weights. Review on 10/25/19 of Resident #135's nutrition assessment, dated 9/22/19, revealed that there was no documented evidence that Resident #135 was not being weighed. Interview on 10/28/19 at approximately 11:20 a.m. with Staff J (Licensed Practical Nurse) confirmed that the last weight obtained for Resident #135 was the weight obtained on 9/12/19. Staff J also confirmed that they should have been obtained because there was no physician's order to discontinue them. Resident #172 Review on 10/25/19 of Resident #172's weights and vitals summary revealed that Resident #172 had a weight loss from 222 pounds on 8/9/19 to 178.5 pounds on 9/6/19, which represented a 19.5% weight loss. There was a reweigh obtained on 9/6/19 which was 178 pounds. The next weight obtained for Resident #172 was on 10/10/19. Review of Resident #172's nutrition assessment, dated 10/10/19 revealed that Resident #172 had a significant loss of 17.6% in the last 6 months. Interview on 10/28/19 at approximately 11:15 a.m. with Staff J confirmed that Resident #172 had a significant weight loss and that Resident #172 should have had other weights obtained between 9/6/19 and 10/10/19.",2020-09-01
30,GREENBRIAR HEALTHCARE,305005,55 HARRIS ROAD,NASHUA,NH,3062,2019-10-28,697,D,0,1,TYS711,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, it was determined that the facility has failed to ensure that proper pain management is provided to meet professional standards of care for 1 resident in a final survey sample of 35 residents. (Resident identifier is #47) Findings include: Interview on 10/24/19 at 9:47 a.m. with Resident #47 stated that they were not getting enough pain control. Review on 10/24/19 of the medial record shows Resident #47 is receiving scheduled pain medication along with PRN (as needed), these orders are written as follow: [MEDICATION NAME] Tablet 325 mg Give 2 tablet by mouth every 6 hours as needed for mild to moderate Pain NTE (Not to Exceed) 3 GM(grams)/24 hours . [MEDICATION NAME] HCI Tablet 5 MG (milligrams) Give 1 tablet by mouth as needed for for muscle pain Take one tablet once daily as needed. [MEDICATION NAME] HCI Tablet 50 MG Give 1 tablet by mouth every 6 hours as needed for moderate to severe pain. Pain Monitoring using Verbal/Non-Verbal 0-10 Scale every shift for Monitoring Level of Comfort Interview on 10/28/19 at 12:30 p.m. with Staff B (Director of Nurses) was asked if a resident is cognitively intact and what type of pain scale would be used. Staff B stated the numerical scale because Resident #47 is cognitively intact. Staff B was then shown the orders which are written above and asked if you are using the verbal pain scale and documenting using 1-10 but are administering PRN medication using mild-moderate or moderate to severe. Staff B was then asked what would the numerical pain scale in translation to mild-moderate or moderate to severe be. Staff B was not able to answer the question. Staff B then was asked if these levels are from the Wong backer assessment tool for pain, Staff B said yes. On review of this tool it is rated as 1-3 mild, 4-6 moderate, 7-10 severe. Review on 10/28/19 of the PRN orders for [MEDICATION NAME] 325 mg 2 tablets being given using numerical numbers from 7-10 which when using the mild-severe scale would be coded as sever meaning the wrong pain medication was given for the pain level told 6 times in a row. Review on 10/28/19 of the PRN orders for [MEDICATION NAME] tablet 50 mg given by mouth every 6 hours shows it being given 3 times a day almost every day for the month of (MONTH) with pain levels fluctuating from pain levels of 3-8. On review of the times and doses this medication was being given always at 8:00 a.m., 2:00 p.m., and 8:00 p.m. Review on 10/28/19 of the PRN order for [MEDICATION NAME] 5 mg for muscle pain revealed this medication is again being given every day around 11-12 p.m. Interview on 10/28/19 with Staff B was shown the clinical information regarding substance abuse and Staff B stated it was a long time ago and it was not pills but alcohol. Staff B also stated the resident and physician have agreed to administer medication on a PRN schedule making Resident #47 feel like they have control of their pain.",2020-09-01
31,GREENBRIAR HEALTHCARE,305005,55 HARRIS ROAD,NASHUA,NH,3062,2019-10-28,756,D,0,1,TYS711,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interview and review of the pharmacist reports for irregularities in medications, it was determined that the facility has failed to act upon the reports in a timely manner for 2 residents in a final survey sample of 35 residents. (Resident identifiers are: #17 and #31.) Findings include: Resident #31 Review on 10/25/19 of Resident #31's medical record revealed a pharmacy review report showing a irregularity on 9/6/19. Review on 10/26/19 of Resident #31's pharmacy Consultation Report dated 9/6/19 with a Recommendation Please discontinue Montelukast. Rationale for Recommendation Due to a lack of adequate testing, guidelines do not recommend the use of leukotriene receptor antagonists for [MEDICAL CONDITIONS]. Use may be appropriate in the presence of allergic rhinitis or asthma-[MEDICAL CONDITION] overlap syndrome Physician's Response: I accept the recommendation(s) above, please implement as written: This was dated 10/2019 and signed by the physician. Interview with Staff B (Director of Nurses) on 10/26/19 was asked what day was it signed and Staff B stated just now the 26th. Review on 10/26/19 of the MAR (Medication Administration Record) revealed both (MONTH) and (MONTH) have orders that state Montelukast Sodium Tablet 10 MG Give 1 tablet by mouth at bedtime for [MEDICAL CONDITION] which have been given daily since the pharmacy report stating Please discontinue Montelukast. Resident #17 Review on 10/25/19 of Resident #17's medical record revealed that the pharmacist did an MRR (medication record review) on 9/3/19 with the following recommendation: Please attempt a gradual dose reduction (GDR) to quetiapine 50 mg (milligrams) HS (hour of sleep) while concurrently monitoring for reemergence of target behaviors and/or withdrawal symptoms. Physician's Response: I accept the recommendation(s) above, please implement as written. (signed 9/30/19) Review on 10/25/19 of Resident #17's Medication Administration Record [REDACTED] Quetiapine 12.5 mg by mouth one time a day, dated 11/13/18 and Quetiapine 50 mg by mouth at bedtime, dated 10/21/2018. Interview on 10/25/19 at approximately 1:00 p.m. with Staff K (Licensed Practical Nurse) confirmed that the MRR that was done on 9/3/19, signed by the physician on 9/30/19 but Resident #17 was still receiving the 12.5 mg of Quetiapine that was ordered to be stopped on 9/30/19. Review on 10/28/19 of the MRR dated, 10/11/19 revealed the following: (pronoun omitted)'s prescriber accepted a pharmacy recommendation to decrease dose of quetiapine on 9/30/19, but the order has not yet been processed. Review on 10/28/19 of the facility's policy and procedure titled Medication Regimen Review, effective date 12/1/07 revealed: .Procedure . 6. Facility should ensure that Facility Physicians/Prescribers are provided with copies of the MRRs. 7. Facility should encourage Physician/Prescriber or other Responsible Parties receiving the MRR and the Director of Nursing to act upon the recommendations contained in the MRR. For those issues that require Physician/Prescriber intervention, Facility should encourage Physician/Prescriber to either (a) accept and act upon in the recommendations contained within the MRR, or (b) reject all or some of the recommendations contained in the MRR and provide an explanation as to why the recommendation was rejected. 8. Facility should provide the Medical Director with a copy of MRRs and should alert the Medical Director where MRRs require follow-up. .",2020-09-01
32,GREENBRIAR HEALTHCARE,305005,55 HARRIS ROAD,NASHUA,NH,3062,2019-10-28,757,D,0,1,TYS711,"Based on interview and record review, it was determined that the facility failed to monitor behaviors for 1 resident taking antipsychotic medications, in a final survey sample of 35 residents. (Resident identifier is #25.) Findings include: Review on 10/25/19 of Resident #25's (MONTH) 2019 Medication Administration Record, [REDACTED]. Review on 10/25/19 of Resident #25's (MONTH) 2019 and (MONTH) 2019 nurses notes revealed that there was no documented behavior monitoring for Resident #25. There was also no behavior log found in Resident #25's medical record. Interview on 10/28/19 at approximately 11:00 a.m. with Staff N (Licensed Practical Nurse) confirmed that there was no behavior log for Resident #25 and that there should have been one.",2020-09-01
33,GREENBRIAR HEALTHCARE,305005,55 HARRIS ROAD,NASHUA,NH,3062,2019-10-28,758,D,0,1,TYS711,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, it was determined that the facility failed to ensure that residents who use [MEDICAL CONDITION] medication received a gradual dose reduction for 1 resident, and ensure that PRN (as needed) orders for [MEDICAL CONDITION] medication was limited to 14 days, except, if the attending physician or prescribing practitioner believes that it is appropriate for the PRN order to be extended beyond 14 days, he or she should indicate the duration for the PRN order for 1 resident out of a final sample size of 35 residents. (Resident identifiers are #17 and #42.) Findings include: Resident #42 Review on 10/28/19 of Resident #42's current physician order [REDACTED].#42 had an order for [REDACTED].#42's [MEDICATION NAME] order revealed no indicated duration of use. Review on 10/28/19 of Resident #42's (MONTH) to (MONTH) 2019 EMAR (Electronic Medication Administration Record) revealed that Resident #42's [MEDICATION NAME] 0.5 mg PRN with an order date of 6/5/19 was given on 6/10/19, 6/11/19, 6/16/19, 6/22/19, 6/30/19, 8/15/19, 8/19/19, 8/27/19, 8/28/19, 9/1/19, 9/11/19, 9/12/19, 9/20/19, 9/25/19, 9/29/19, 10/2/19, 10/4/19, 10/6/19, 10/14/19, 10/18/19, and 10/19/19. Review on 10/28/19 of Resident #42's Medication Regimen Review (MRR) dated 7/19/19 revealed .Comments: (Resident #42) has a PRN order for an anxiolytic, which has been in place for greater than 14 days without a stop date: [MEDICATION NAME] 0.5 mg BID PRN since 6/5/19 .Recommendation: Please discontinue PRN [MEDICATION NAME]. If the medication cannot be discontinued at this time, current regulations require that the prescriber document the indication of use, the intended duration therapy and the rationale for the extended time period . Further review of Resident #42's MRR dated 7/19/19 revealed that recommendations were declined by the physician on 7/23/19 and rationale to extend therapy was documented but no documented duration of use. Review on 10/28/19 of Resident #42's MRR dated 10/18/19 revealed .Comment: REPEATED RECOMMENDATION (sic) from 7/19/19: Please respond promptly to assure facility compliance with Federal regulations. (Resident #42) has an order for [REDACTED]. Interview on 10/28/19 at 4:36 p.m. with Staff B (Director of Nursing) confirmed above findings. Staff B stated as Resident #42 had an order for [REDACTED].#42's physician or psychiatrist regarding Resident #42's [MEDICATION NAME] PRN duration of use. Resident #17 Review on 10/25/19 of Resident #17's medical record revealed that Resident #17 was on the Anti-psychotic medication Quetiapine since admission on 10/28/18. There was no documentation of Resident #17 having a GDR (Gradual Dose Reduction). Review on 10/25/19 of Resident #17's MAR (Medication Administration Record) revealed that Quetiapine was being administered for the [DIAGNOSES REDACTED]. Interview on 10/28/19 at approximately 1:00 p.m. with Staff K (Licensed Practical Nurse) confirmed that Resident #17 had not had a GDR of the Anti-psychotic medication Quetiapine since admission. Staff K also confirmed that Resident #17 did not have a supporting [DIAGNOSES REDACTED].",2020-09-01
34,GREENBRIAR HEALTHCARE,305005,55 HARRIS ROAD,NASHUA,NH,3062,2019-10-28,812,E,0,1,TYS711,"Based on observation, record review, and interview, it was determined that the facility failed to properly maintain the dish machine in working order. Findings include: Observation on 10/23/19 while doing the initial inspection of the kitchen with Staff [NAME] (Director of Food Services) revealed that the high temperature dish machine failed to reach its max temperature of 180 degrees. Staff [NAME] ran the dish machine 5 times and the gauge never reached over 165 degrees. On review of the months temperature logs it revealed several days where the dish machine failed to reach its minimum temperature of 180 degrees. Interview on 10/23/19 at approximately 9:30 a.m. with Staff [NAME] confirmed the findings and provided the temperature logs to surveyor. Staff [NAME] contacted the vendor who came to the facility validating that the gauge was broken but the dish machine was running to temperature. The vendor provided a 160 degrees T test strip that tests the dish surface not the water temperature. The test result reflected that the dish machine is running at 180 degrees.",2020-09-01
35,GREENBRIAR HEALTHCARE,305005,55 HARRIS ROAD,NASHUA,NH,3062,2019-10-28,865,B,0,1,TYS711,"Based on record review and interview, it was determined that the facility failed to develop a written Quality Assurance Performance Improvement (QAPI) plan for the facility. Findings: Review on 10/25/19 of the document provided by the facility for the Quality Assurance Performance Improvement (QAPI) plan requested at the time of survey entrance revealed a packet of information titled Quality Assurance and Performance Improvement Program Resource Guide with a revised date of 6/2019. Interview on 10/28/19 at approximately 2:45 P.M. with Staff D (Administrator) and Staff B (Director of Nursing) confirmed that the facility QAPI plan was the packet of information titled Quality Assurance and Performance Improvement Program Resource Guide listed above and that there was no written QAPI plan for the facility.",2020-09-01
36,GREENBRIAR HEALTHCARE,305005,55 HARRIS ROAD,NASHUA,NH,3062,2019-10-28,880,D,0,1,TYS711,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and policy review, it was determined that the facility failed to maintain infection control in regards to hand hygiene during medication administration for 2 out of 37 medication administration observed. (Resident identifiers are #46 and #136.) Findings include: Review on 10/24/19 of facility's policy titled, Handwashing/Hand Hygiene, revision dated 4/2018, revealed that .Use an alcohol-based hand rub .alternatively soap . and water for the following situations: .before and after direct contact with residents .before preparing or handling medications .before and after handling an invasive device (intravenous access sites) .before donning gloves . .Washing hands 1. Vigorously lather hands with soap and rub them together, creating friction to all surfaces, for a minimum of 20 seconds or longer, under a moderate stream of running water, at a comfortable temperature . 2. Rinse hands thoroughly under running water. Hold hands lower than wrist. Do not touch fingertips to inside of sink . 3. Dry hands thoroughly with paper towels and then turn off faucets with a clean, dry paper towel . .Using Alcohol-Based Hand Rub (ABHR) 1. Apply generous amount of product to palm of hand and rub hands together . 2. Cover all surfaces of hands and fingers until hands are dry . Resident #136 Observation on 10/23/19 at 1:30 p.m. with Staff C (Unit Manager) during Resident #136's medication administration of Klonopin (benzodiazapine) revealed that Staff C went into Resident #136 room then left the room with medication cup in hand and headed to the supply closet and obtained a unopened 60 ml (milliliter) syringe and 500 ml basin. Staff C went to Resident #136's bathroom, opened the 60 ml syringe package and washed the 500 ml basin and the 60 ml syringe. Staff C went to Resident #136 without performing hand hygiene and used Resident #136's side table, placed the 500 ml basin and 60 ml syringe on the table and the crushed Klonopin in a medication cup then Staff C donned gloves. Staff C removed gloves and left Resident #136's room with medication cup in hand and went to the nurse's station and answered a doctor's phone call. After the phone call Staff C went back to Resident #136's room with the medication cup, Staff C donned new gloves without performing hand hygiene, and used the 60 ml syringe to push air to the [DEVICE] to check placement then administered the medication the flushed the [DEVICE]. Interview on 10/24/19 at 9:20 a.m. with Staff C confirmed above observation. Staff C was unable to provide explanation for not performing hand hygiene prior to medication administration. Resident #46 Observation on 10/23/19 at 2:00 p.m. with Staff A (Unit Manager) during medication administration of Meropenem for Resident #46 revealed that Staff A went to Resident #46's room, washed their hands with soap and water, dried their hands with paper towel then donned gloves. Staff A then removed gloves went out of Resident #46's room and went to the 5-2 treatment cart and obtain alcohol wipes. Staff A went back to Resident #46's room, donned gloves without performing hand hygiene and continued to flush Resident #46's PICC line catheter, prime the administration set with the Meropenem medication and administered Resident #46's Meropenem. Interview on 10/24/19 at 9:10 a.m. with Staff A confirmed above findings. Staff A stated that they thought that they did hand hygiene prior to medication administration.",2020-09-01
37,GREENBRIAR HEALTHCARE,305005,55 HARRIS ROAD,NASHUA,NH,3062,2018-12-19,550,C,0,1,P2R411,"Based on dining observations made on the West wing of building one during lunch on 12/13/18 and during lunch on 12/18/18 a confidential family interview and a staff interview, the facility failed to serve residents requiring assistance in a dignified manner. Findings include: On 12/13/18 in the West wing dining room of building one during lunch twenty-three residents had been brought into the room for this meal. Staff AA (RN) and Staff BB (LNA) each stood over residents instead of sitting while feeding them. Staff BB stood while helping to feed three residents (#81, #141 and an unidentified resident) at the same time going from resident to resident helping each with a few bites of food or a sip of a beverage before moving on to aid another of these three residents with their meal. Staff AA asssisted one resident with their meal standing the entire time while assisting them. Observation made on 12/18/18 during lunch two unidentified LNA's stood while they assisted one unidentified resident each with eating their meal. Interview with a family member on 12/14/18 confirmed that staff routinely stand in the West Wing dining room of building one while assisting residents with their meals. This family member stated that there's frequently not enough staff available to supervise, encourage or assist residents in theWest Wing dining room of building one which is why staff are standing while assisting residents to eat their meals. Observation on 12/13/18 in the West wing dining room of building one revealed that for the entire lunch Resident #40 remained asleep and at the waist slumped over the right arm of the chair they were sitting in without receiving the supervisory assistance and encouragement that Resident #40's care plan says they require during mealtimes. There was an over the bed table in front of Resident #40's chair with their uncovered lunch tray on the over the bed table. No staff member was observed during lunch attempting to assist Resident #40 with their meal. While Resident #40 slept in the chair their meal tray which had been delivered at approximately 12 noon was removed at 12:50 pm without any food on the tray having been consumned but Staff BB documented in Resident #40's medical record that Resident #40 had eaten more than 75% of this meal. Staff BB confirmed this during a 12/18/18 interview but said she'd made a documentation error. Observations of the twenty-three residents in the West Wing dining room of building one during lunch on 12/13/18 confirmed that several residents needed cueing, supervision and encouragement from staff to assist them in eating their meals but this wasn't observed to be happening. As a result multiple resident's uncovered meal trays remained untouched in front of them for long periods of time during lunch. Some residents barely picked at their food with one unidentified resident asking what should I eat without receiving a response or assistance from staff.",2020-09-01
38,GREENBRIAR HEALTHCARE,305005,55 HARRIS ROAD,NASHUA,NH,3062,2018-12-19,561,B,0,1,P2R411,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, it was determined that the facility failed to put procedures in place for self administration of medications for 1 resident in a final survey sample of 40 residents. (Resident identifier is #196.) Findings include: Observation on 12/13/18 at approximately 1:00 p.m. of Resident #196's bedside table revealed an opened bottle of nasal spray and an opened bottle of [MEDICATION NAME] oral rinse on top of the bedside table that was right next to Resident #196's bed. Observation on 12/14/18 at approximately 8:50 a.m. of Resident #196's bedside table again revealed an opened bottle of nasal spray and an opened bottle of [MEDICATION NAME] oral rinse on top of the bedside table. Interview on 12/14/18 at approximately 8:50 a.m. with Resident #196 revealed that Resident #196 stated that they self administer the spray and the rinse whenever they need them. Resident #196 also revealed that they did not notify any staff members of when they had used them. Review on 12/17/18 of Resident #196's current Physician Orders revealed that there were no physician orders for the nasal spray or the [MEDICATION NAME] oral rinse. Review on 12/17/18 of Resident #196's current care plan revealed that there was no care plan for Resident #196's self administration of medications. Review on 12/17/18 of Resident #196's list of assessments revealed that there was no assessment done for Resident #196's ability to self administer medications. Interview on 12/18/18 at approximately 8:30 a.m. with Staff J (Unit Manager) revealed that they were unaware that Resident #196 was self administering any medications. Staff J also confirmed that there should have been physician orders and a self medication assessment done.",2020-09-01
39,GREENBRIAR HEALTHCARE,305005,55 HARRIS ROAD,NASHUA,NH,3062,2018-12-19,580,D,0,1,P2R411,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, it was determined that the facility failed to notify the physician of significant change for 1 resident out of a final sample size of 40 residents. (Resident identifier is #207.) Findings include: Review on 12/18/18 of Resident #207's EMAR (Electronic Medication Administration Record) for the month of (MONTH) revealed that on 11/9, 16, 19, 21, 26, 28, and 30/2018 there were medications scheduled for 9:00 a.m. that were coded as 1 Out of the Facility which were [MEDICATION NAME] Acid 500 mg (milligram), Aspirin 325 mg, [MEDICATION NAME] 1000 units,[MEDICATION NAME] mg, [MEDICATION NAME] 6 units, [MEDICATION NAME] 1 mg, [MEDICATION NAME] 75 mg, [MEDICATION NAME] 300 mg, [MEDICATION NAME] 250 mg, Acidophilus 2 capsules, [MEDICATION NAME] 500 mg, [MEDICATION NAME] 800 mg, and Sodium [MEDICATION NAME] 650 mg. Review on 12/18/18 of Resident #207's EMAR for the month of (MONTH) (YEAR) revealed that on 12/3, 5, 7, 10, 12, 14, and 17/ (YEAR) there were medications scheduled for 9:00 a.m. that were coded as 1 Out of the Facility which were [MEDICATION NAME] Acid 500 mg, Aspirin 325 mg, [MEDICATION NAME] 1000 unit,[MEDICATION NAME] mg, [MEDICATION NAME] 6 units, [MEDICATION NAME] 1 mg, [MEDICATION NAME] 75 mg, [MEDICATION NAME] 300 mg, [MEDICATION NAME] 250 mg, Acidophilus 2 capsules, [MEDICATION NAME] 500 mg, [MEDICATION NAME] 800 mg, and Sodium [MEDICATION NAME] 650 mg. Interview on 12/18/18 at 2:08 p.m. with Staff J (Unit Manager) confirmed the above findings and that Resident #207 was out of the facility on the said dates listed above. Staff J also confirmed that on the EMAR for 12/14/18 it was their initials on the 9:00 a.m. medications, which were listed above, and that they did not administer as Resident #207 was at [MEDICAL TREATMENT]. Staff J revealed that Resident #207 goes to the [MEDICAL TREATMENT] center on Monday, Wednesday and Friday and that Resident #207 leaves that facility around 7:30 a.m. and comes back from [MEDICAL TREATMENT] around 11:30 a.m. Staff J also revealed that 11/9, 16, 19, 21, 26, 28, and 30/2018 and 12/3, 5, 7, 10, 12, 14, and 17/ (YEAR) were [MEDICAL TREATMENT] days. Staff J was unable to provide more information and explanation if the physician was notified for the 9:00 a.m. medications that was not given on dates listed above. Review on 12/18/18 of Resident #207's nurses notes for the month of (MONTH) and (MONTH) (YEAR) revealed that there were no nurses notes regarding physician notification of 9:00 a.m. medications, as listed above, not being administered on dates listed above. Review on 12/18/18 of Resident #207's physician, nephrologist, and nurse practitioner notes for the month of (MONTH) and (MONTH) (YEAR) revealed that there were no physician or nurse practitioner notes regarding being notified of medications, as listed above, not being administered on dates listed above. Interview on 12/19/18 at 8:59 a.m. with Staff W (License Practical Nurse) confirmed that it was their initials on 11/16, 26, 28, and 30/2018 and 12/ 3, 5, 7, 10, 12, and 17/2018 on the 9:00 a.m. medications, as listed above. Staff W revealed that Resident #207 was at the [MEDICAL TREATMENT] center and that they did not administer the 9:00 a.m. medications or send medications with Resident #207. Staff W was unable to provide more information or explanation if physician was notified.",2020-09-01
40,GREENBRIAR HEALTHCARE,305005,55 HARRIS ROAD,NASHUA,NH,3062,2018-12-19,584,B,0,1,P2R411,"Based on observation, and interview, it was determined that the facility failed to provide a homelike dining environment for 3 out of 5 buildings. (Resident identifiers #87,#187 and #191.) Findings include: Observation on 12/13/18 of Building 2 dining area at 12:56 p.m. revealed a white erasable board that stated that lunch would be at 12:00. Several residents were at various tables waiting for lunch to be delivered complaining to each other that lunch is always late and wondering how long today. Interview at 12:15 p.m. with Resident #87, #187 and #191, revealed that lunch is always late. Observation at 12:56 p.m. revealed that the lunch cart arrived and that lunch trays were being distributed to different tables by two staff members. At 1:03 p.m. Resident #87 did not like the meal serve and pushed the tray away. The staff members did not stop and ask Resident #87 if Resident #87 wanted an alternate. At 1:14 p.m. this resident got up to leave the room and the staff asked if Resident #87 was done and which time an affirmative answer was stated. Further observations revealed that all meals stay on the trays whether in the dining area or in the rooms in Building 2. Interview with Resident #87 at 1:45 p.m. revealed that the lunch trays are always late and if you do not like the main meal you can ask for an alternate but it will take up to an hour to get it so why bother. It would be nice to have some music while we eat; it is so quiet it and so institutional on the lunch trays. Interview on 12/19/18 at 1:45 p.m. with Staff C, (Administrator) revealed that they have tried everything with dining. With trays and without trays but can not seem to keep boundaries from other residents; so it is easier with the trays. Observation on 12/13/18 in the West Wing dining room of building one, a dementia unit, revealed the absence of a homelike environment as all twenty-three residents there for lunch received their meals on trays which remained left in front of them for the entire meal.",2020-09-01
41,GREENBRIAR HEALTHCARE,305005,55 HARRIS ROAD,NASHUA,NH,3062,2018-12-19,641,C,0,1,P2R411,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, it was determined that the facility failed to ensure that assessments accurately reflect the resident's status for 25 residents out of the sample size of 40 residents. (Resident identifiers are #7, #13, #18, #19, #22, #25, #27, #74, #80, #84, #88, #89, #91, #94, #109, #112, #118, #135, #140, #177, #190, #204, #210, #212, and #226.) Findings include: Review on 12/19/18 of Resident #7, #18, #22 #25, #74, #80, #84, #88, #89, #91, #94, #109, #112, #118, #135, #140, #177, #190, #204, #210, #212, and #226 MDS (Minimum Data Set) for the month of (MONTH) to (MONTH) (YEAR) revealed that section C0100-C0500 (BIMS (Brief Interview of Mental Status)) was coded not assessed and with no BIMS score. Review on 12/19/18 of Resident #7, #18, #22, #25, #74, #80, #84, #88, #89, #91, #94, #109, #112, #118, #135, #140, #177, #190, #204, #210, #212, and #226 previous MDS dated between (MONTH) to (MONTH) (YEAR) revealed that Section C0100-0500 was coded with BIMS scores. Interview on 12/19/18 at 9:00 a.m. with Staff X (Social Worker) confirmed that above findings. Staff X revealed that they evaluate and document residents BIMS.Staff X states that they started working at the facility the last week of (MONTH) (YEAR) and that many of the BIMS for the month of (MONTH) to (MONTH) (YEAR) were not done and that they are trying to catch up with the BIMS assessments. Review on 12/19/18 of Resident #18, #22, and #88 BIMS assessment revealed that their last documented assessment were 727/18, 9/13/18, and 7/13/18, respectively. Interview on 12/19/18 at 10:47 a.m. with Staff U (MDS Head Coordinator) confirmed that Resident #18, #22, and #88's BIMS were not completed. Staff U states that the BIMS should have been completed. Staff U stated that the social worker evaluates residents BIMS and completed Section C of the MDS and the MDS coordinators electronically signs for the completion of the MDS. Resident #13 Review on 12/18/18 of Resident #13's Minimum Data Set ((MDS) dated [DATE] revealed Section C0100 Should Brief Interview for Mental Status (C0200-C0500) be Conducted? dashes though sections C0100-C0500 with no BIMS score. Review on 12/18/18 of Resident #13's medical record revealed that Resident #13 had a previous Brief Interview for Mental Status (BIMS) score of 15 in previous MDS dated [DATE]. Interview on 12/18/18 at approximately 10:40 a.m. with Staff H (MDS Coordinator) confirmed the above findings and revealed the 9/28/18 MDS sections were completed in error due to no social service worker available to do the work and that Resident #13 should still have a BIMS score. Resident #27 Review on 12/18/18 of Resident #27's MDS dated [DATE] revealed Section J0100 Pain Management revealed that Resident #27 had received no scheduled pain medication in the past 5 days. Review on 12/18/18 of Resident #27's physician orders [REDACTED]. Interview on 12/18/18 at approximately 10:40 a.m. with Staff H confirmed the above findings and revealed the above MDS sections were completed in error. Resident #19 Review on 12/18/18 at 9:34 a.m. Resident #19's medical record shows a 14 day MDS Medicare review completed on 8/9/18 coding section C Cognitive Pattern Section C0500. BIMS with a summary score of 12. Then on 10/31/18 a Quarterly MDS was competed and section C0500 was not completed with prior sections coded as Not assessed . Interview on 12/18/18 at 10:00 a.m. with Staff N (MDS coordinator) confirmed that there was no Social Services personal employed during this time and this area was not completed.",2020-09-01
42,GREENBRIAR HEALTHCARE,305005,55 HARRIS ROAD,NASHUA,NH,3062,2018-12-19,656,D,0,1,P2R411,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview it was determined the facility failed to develop and implement a person-centered comprehensive care plan for 2 resident out of a final survey sample of 40 residents. (Resident identifiers are #149, and #226.) Findings include: Resident #226 Review on 12/19/18 of Resident #226's medical record revealed that Resident #226 has Dow[DIAGNOSES REDACTED], Alzheimer and Dementia and was remitted on 10/5/18. Review of Resident #226's the care plan on 10/5/18 reveals Resident #226 is an extensive assist with Activities of daily living. Review on 12/19/18 of Resident 226's nurses notes revealed that Resident #226 had a fall on 10/9/18, 10/14/18, and 10/20/18 and a behavior where Resident #226 sat oneself onto the floor on 10/10/18. All falls had no injuries. Interview on 12/19/18 at 11:27 a.m. with Staff F, (Building 2 Unit Manager) confirmed that Resident #226 did not have a fall care plan since Resident #226 readmission. It had been created in the previous admission and resolved and Staff F did not know why the fall care plan would have been resolved. Resident #149 Review on 12/17/18 of Resident #149's medical record has a note dated 7/23/18 at 16:54 from social service stating When speaking with (Resident #149) this afternoon (Resident #149) said that (Resident #149) wanted to commit suicide earlier in the day. (Resident #149) stated that (Resident #149) had a plan of hanging himself with a cord. After speaking with (Resident #149) about this (Resident #149) stated (Resident #149) no longer wanted to hurt (self) . On 7/24/18 at 14:13 nurses note states (Resident #149) sent out via ambulance to (hospital) for Evaluation for SI (Suicidal Ideation). (Resident #149) states (Resident #149) wants to hurt (self) and verbalizes a plan. (Resident #149) was seen by our psych services and have stated that (Resident #149) should be evaluated at the hospital . On 7/27/18 at 16:00 an Evaluation Summary was complete and within the note is states . (Resident #149) has a history of suicidal ideation . On 12/17/18 Resident #149 care plan was updated with a description area of (Resident #149) has mood problem r/t [MEDICAL CONDITION] disorder, [MEDICAL CONDITION]. (Resident #149) has a history of Suicidal ideation, but no recent verbalization. Observation on 12/13/18 at 11:00 a.m. revealed Resident #149's call bell was ringing. When entering the room Resident #149 gestured to say they were choking lightly spoke with a gurgled voice, and pointed to the suction machine at Resident #149's bed side. Review on 12/13/18 Resident #149's medical record revealed there was not a physicians order for the use of [REDACTED]. Once the above findings were shown to Staff [NAME] (Director of Nurses) a care plan was crated dated 12/17/18 with a Focus stating potential for alteration in respiratory status r/t Tube Feeding, increased secretions, need for oral suctioning PRN.",2020-09-01
43,GREENBRIAR HEALTHCARE,305005,55 HARRIS ROAD,NASHUA,NH,3062,2018-12-19,689,E,0,1,P2R411,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, and interview, it was determined that the facility failed to ensure that the non-smoking facility is free from accident hazards of smoking by allowing residents to have cigarettes and lighters on their person and not supervising residents when necessary who smoke on the facility's property for 5 of 5 residents in a final sample of 40 residents. (Resident identifiers are #227, #15, #105, #214 and #27.) Findings include: Review on 12/14/18 of the facility's policy titled Tobacco-Free Environment Policy, dated 11/2017, revealed the following: 3. Upon admission the patient/family sign the acknowledgment herein to demonstrate their understanding the patient will not smoke anywhere in the facility or on the premises . 11. The CEO/CCO (Chief Executive Officer/Chief Compliance Officer), ED/DNS (Director of Nursing Services), management and security personnel designate by the CEO/CCO and ED/DNS will enforce the Tobacco -Free policy by: .2) Confiscating tobacco products and light materials found in the facility (and returning such materials to the resident -owner upon the resident's discharge) . Resident #227 Interview on 12/14/18 at 9:31 a.m. with Resident #227 revealed the resident keeps cigarettes and lighter on their person or in their room. Resident #227 also revealed that they were told yesterday by staff (12/13/18) that they needed to smoke up by the street to smoke instead of on the facility property. Resident #227 stated It is dangerous up there and some of the smokers here should not be up there by the traffic. Review on 12/19/18 at 8:14 a.m. of Resident #227's admission packet revealed that on 11/20/2018 Resident #227 signed the following acknowledgment The Resident acknowledges that he/she received, reviewed, and understands the facility's Tobacco-Free Environment Policy and agrees not to use tobacco produces (sic) on the premises of the Center. Resident #15 Interview on 12/13/18 at approximately 10:45 a.m. with Resident #15 revealed that Resident #15 stated that they smoke outside the building, on the buliding premises, and that they keep their own cigarettes and lighter with them at all times. Observation on 12/13/18 at approximately 12:30 p.m. with Resident #15 revealed that the gloves that they wore outside when smoking had multiple burn marks on them. Review on 12/18/18 of Resident #15's Smoking Evaluation, dated 8/9/18, revealed that the question of .Does the resident have any evidence of burn holes on clothing or wheelchair, etc? . was answered Yes. The evaluation also revealed that the sentence .Resident is safe to light own cigarettes with staff supervision . was checked off. Review on 12/18/18 of Resident #15's current care plan revealed that there was no intervention for supervision with lighting cigarettes, no mention of the burn marks in Resident #15's gloves and no intervention regarding Resident #15 keeping their own cigarette and lighter with them. Interview on 12/18/18 at approximately 8:30 a.m. with Staff J (Unit Manager) revealed that Resident #15 was non compliant with returning their cigarettes and lighter to staff. Staff J revealed that staff were supposed to be encouraging Resident #15 to return these items and that they should have been documenting Resident #15's refusal to give them to staff. Staff J confirmed that Resident #15 did not receive supervision with lighting cigarettes and that Staff J was not aware that there were burn marks on Resident #15's gloves. Resident #105 Interview on 12/14/18 at approximately 8:30 a.m. with Resident #105 revealed that Resident #105 stated that they smoke outside the building and that they keep their own cigarettes and lighter with them at all times. Review on 12/18/18 of Resident #105's current care plan revealed that there was no intervention regarding Resident #105 keeping their own cigarette and lighter with them or for staff reminding or encouraging Resident #105 to return cigarettes and lighter to staff after smoking. Interview on 12/18/18 at approximately 8:30 a.m. with Staff J revealed that Resident #105 was non compliant with returning their cigarettes and lighter to staff. Staff J revealed that staff were supposed to be encouraging Resident #105 to return these items and that they should have been documenting Resident #105's refusal to give them to staff. Resident #27 Interview on 12/14/18 at 9:05 a.m. with Resident #27 revealed that Resident #27 was a smoker and the they kept their own cigarettes and lighter on their person and in their room. Resident #27 also revealed that they independently smoke and go outside the facility premises. Observation on 12/14/18 at 9:05 a.m. at Resident #27's room revealed that Resident #27 had an oxygen concentrator turned on and the nasal cannula tubing was at their bedside. Interview on 12/14/18 at 9:06 a.m. with Resident #27 revealed that Resident #27 was using oxygen every night. Resident #27 also revealed that their roommate rummages on their side of the room to look for food and that they constantly have to hide their important belongings including their smoking materials (e.g. cigarettes and lighter). Interview on 12/14/18 at 9:10 a.m. with Staff A (Unit Manager) confirmed that Resident #27 was a smoker. Staff A revealed that the facility was a smoke-free facility and Resident #27 was required to sign out on the LOA (Leave of Absence) book and go out of the facility premises to smoke and that residents that smoke were not allowed to keep their smoking materials (e.g. cigarettes and lighters) with them in the facility. Review on 12/18/18 of Resident #27's current physician orders [REDACTED].#27 has an order for [REDACTED]. Review on 12/18/18 of Resident #27's smoking evaluation revealed that the last documented smoking evaluation was on 7/18/18 which revealed that Resident #27 was a independent smoker and a safe smoker under current facility policy. Interview on 12/18/18 at 9:15 a.m. with Staff A revealed that smoking evaluation was to be done quarterly and then stated that it was not required to be done anymore as the facility has a smoke-free policy. Staff A also revealed that smoking materials were to be kept in the medication room. Observation on 12/18/18 at 9:30 a.m. with Staff S (Licensed Practical Nurse) at the 5-2 unit medication room revealed that smoking materials were kept in the medication room but no smoking materials were found for Resident #27. Interview on 12/18/18 at 9:30 a.m. with Staff S revealed that they do not always get the smoking materials back from the residents who smokes and that Staff S does not document the refusal in the resident records. Staff S also revealed that they should be following up with the residents, who smoke, on their smoking materials to be locked in the medication room and document any refusals. Interview on 12/18/18 at 10:39 a.m. with Staff R (Licensed Nursing Assistant) confirmed that Resident #27 kept their smoking materials on their person and in their rooms and that Resident #27's roommate does rummage on Resident #27 side of the room and other resident rooms as well. Staff R revealed that the residents, who smoke, kept their smoking materials on their person and in their rooms. Interview on 12/18/18 at 11:00 a.m. with Resident #27 revealed that the nurses was asking for their smoking materials to be locked in the medication room and it was their first time hearing about it on 12/18/18. Resident #214 Interview on 12/14/18 at 8:30 a.m. with Resident #214 revealed that Resident #214 was a independent smoker. Review on 12/18/18 of Resident #214's smoking evaluation revealed that the last documented smoking evaluation was on 8/30/18 which revealed that Resident #214 was an independent smoker. Review on 12/18/18 of Resident #214's smoking care plan revealed that smoking policy was reviewed with resident. Interview on 12/18/18 at 10:00 a.m. with Staff R revealed that Resident #214 kept their own cigarettes and lighter on their person and in their room. Interview on 12/18/18 at 10:05 a.m. with Staff A and Resident #214 revealed that Resident #214 kept their own cigarette materials on their person. Staff A had asked Resident #214 about their smoking materials to be handed over but Resident #214 declined and states that it was their first time hearing about handing over their smoking materials. Resident #214 states they have always kept their cigarette materials with them. Staff A was unable to explain what to do when the resident does not follow smoking policy.",2020-09-01
44,GREENBRIAR HEALTHCARE,305005,55 HARRIS ROAD,NASHUA,NH,3062,2018-12-19,692,E,0,1,P2R411,"Based on interview, record review, and facility policy review, it was determined that the facility failed to monitor significant weight loss for 4 residents in a final survey sample of 40 residents. (Resident identifiers are #15, #105, #118, and #196.) Findings include: Review on 12/18/18 of the Facility Policy titled, Weight Measurement, dated 5/23/18 revealed that .All residents with significant weight changes will be rewighed to assure accuracy of the weight. Verify re-weigh for accuracy and documentation purposes .Residents with significant unintended weight changes will be added to weekly weight X (times) 4 weeks or until weight stabilizes . Resident #15 Interview on 12/13/18 at approximately 12:00 p.m. with Resident #15 revealed that Resident #15 stated that they had a weight loss. Review on 12/14/18 of Resident #15's weight documentation log revealed that Resident #15 had a weight loss from 105 pounds on 6/4/18 to 92 pounds on 11/5/18. This was a 12.3% loss in approximately 5 months. Resident #15's weight on 10/8/18 had been 98 pounds, which indicated a 6 pound or 6.1% weight loss in 1 month The review also revealed that after the weight that was documented on 11/5/18 indicating the 6 pound weight loss, there was not another documented weight until 12/9/18. The review also revealed that the Resident #15's weight was documented approximately once a month and that the last documented weight was the one taken on 12/9/18. Resident #118 Review on 12/14/18 of Resident #118's weight documentation log revealed that Resident #118 had an unintended weight loss from 200 pounds on 7/20/18 to 186 pounds on 8/6/18. This represented a 7% weight loss in 17 days. There was no documentation of a reweight to confirm this weight loss in one month and the next documented weight for Resident #118 was on 9/4/18, which was 187 pounds. Resident #118's weight on 12/5/18 was 171.5 pounds which represents a 14.2% loss in less than 5 months. There were no documented weights since the one obtained on 12/5/18. The review of weights documented for Resident #118, since their admission on 7/20/18, revealed that Resident #118's weight is documented approximately once a month and that the last documented weight was the one taken on 12/5/18. Resident #196 Interview on 12/14/18 at approximately 8:40 a.m. with Resident #196 revealed that Resident #196 stated that they had a weight loss. Review on 12/14/18 of Resident #196's weight documentation log revealed that Resident #196 had a weight loss from 141.5 pounds on 6/5/18 to 126 pounds on 9/1/18. This was a 10.9% weight loss in less than 3 months. After the documented weight on 9/1/18, another weight was not documented on Resident #196 until 10/1/18, which was 126.2 pounds. The next weight documented after the 10/1/18 weight on Resident #196 was not until 11/16/18, which was 128 pounds. Review on 12/18/18 of Resident #196's .Medical Nutrition Therapy Assessment . dated 11/15/18, revealed that the Dietitian documented that Resident #196 had a weight loss and when documenting the Most Recent Weight the dietitian indicated that the most recent weight was taken on 10/1/18. Resident #105 Interview on 12/14/18 at approximately 8:34 a.m. with Resident #105 revealed that Resident #105 stated that they had a weight loss. Review on 12/14/18 of Resident #105's weight documentation log revealed that Resident #105 had a documented weight on 8/6/18 of 138 pounds. The next weight documented for Resident #105 was on 9/4/18, which was 127 pounds. This was a 7.9% weight loss in approximately a month. There were no documented reweights to confirm this loss and the next documented weight for Resident #105 was on 10/26/18. Interview on 12/18/18 at approximately 9:05 a.m. with Staff J (Unit Manager) regarding the weights for each of the above referenced residents confirmed that when there was a significant weight change a reweight should have been obtained either that day or the next day.",2020-09-01
45,GREENBRIAR HEALTHCARE,305005,55 HARRIS ROAD,NASHUA,NH,3062,2018-12-19,695,D,0,1,P2R411,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, medical record review and interview it was determined that the facility failed to ensure that a resident who needs respiratory care, is provided such care, consistent with professional standards of practice, with a comprehensive person-centered care plan, to meet resident's goals for 1 resident out of a final survey sample of 40 residents. (Resident identifier is #149.) Findings include: Observation on 12/13/18 at 11:00 a.m. revealed Resident #149's call bell was ringing. When entering the room Resident #149 gestured to say she/he was choking, lightly spoke with a gurgled voice, and pointed to the suction machine at Resident #149's bed side. Review on 12/13/18 of the medical record there failed to be a physicians order for the use of [REDACTED]. Interview on 12/14/18 at approximately 2:30 p.m. with Staff [NAME] (Director of Nurses) revealed there were only two residents are needing suction and that Resident #149 was not one of those residents. Interview on 12/18/18 at 09:19 a.m. with Staff I (Nurse) on the phone revealed that Staff I provides suction to Resident #149 every morning and sometime in the afternoon pending on how much secretions form in Resident #149 throat. Staff I also stated when suctioning Resident #149's Staff I always removes clear/yellow discharge. Staff I stated Resident #149 needs the services but also feels it's a comfort measure that provides Resident #149 relief. Review on 12/18/18 at 11:52 a.m. of Resident #149 medical record revealed that new order were written for Resident #149, the orders written are: 1) Oral suctioning of increased secretion using [MEDICATION NAME]--every shift for maintain airway 2) (speech) Eval &(treat)/swallowing Also on 12/17/18 a care plan was written with a Focus stating potential for alteration in respiratory status (related to) Tube Feeding, increased secretions, need for oral suctioning PRN.",2020-09-01
46,GREENBRIAR HEALTHCARE,305005,55 HARRIS ROAD,NASHUA,NH,3062,2018-12-19,725,E,0,1,P2R411,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, observation and record review, it was determined that the facility failed to ensure sufficient staffing to provide nursing care for 16 residents out of a facility census of 234 residents. (Resident identifiers are #15, #18, #27, #30, #78, #79, #89, #91, #140, #164, #165, #177, #190, #196, #203, and #535.) Findings include: Resident #165 Interview on 12/13/18 at 9:53 a.m. with Resident #165 revealed that there were not enough staff and that at times it took hours for nursing staff to answer call lights. Resident #91 Interview on 12/13/18 at 10:06 a.m. with Resident #91 revealed that on early mornings between 5:00 a.m. to 6:00 a.m. the call lights took up to 2 hours to be answered. Resident #140 Interview on 12/13/18 at 10:27 a.m. with Resident #140 revealed that weekend nursing staff are short, 3-11 shift would have 3 nursing staff on the floor (5-2 unit) and most times they do not get showers. Resident #30 Interview on 12/13/18 at 10:40 a.m. with Resident #30 revealed that most nights, it took 3 hours to get Resident #30 to be assisted back to bed because of short nursing staff. Resident #30 stated that they need the assistance to go back to bed. Resident #30 stated that there were 2 LNA's (Licensed Nursing Assistant) most nights. Resident #89 Interview on 12/13/18 at 11:53 a.m. with Resident #89 revealed that Resident #89 states that there were not enough nursing staff. Resident #18 Interview on 12/13/18 at 1:13 p.m. with Resident #18 revealed that the facility needs more nursing staff and that nursing staff were worst at night as they had one LN[NAME] Interview on 12/14/18 at 6:30 a.m. with Staff L (LNA) confirmed that there was one LNA scheduled most 11-7 (Night) shifts. Staff L states that the 5-3 unit residents need more assistance, staffing was unsafe and call lights were going to be answered when they were available to do so and residents had to wait. Resident #27 Interview on 12/14/18 at 8:11 a.m. with Resident #27 revealed that the facility was short of nursing staff. Resident #27 stated that they had to wait for 1-2 hours on 3-11(Evening) and 11-7 (Night) shifts. Resident #27 stated that there were 2 LNA's on 3-11 and 11-7 shifts on 5-2 unit. Resident #78 Interview on 12/14/18 at 8:44 a.m. with Resident #78 revealed that the facility were short staff and it took an hour to answer the call light on all shifts. Resident #535 Interview on 12/14/18 at 9:06 a.m. with Resident #535 revealed that Resident #535 had to spend nights in their day clothes as no one got them ready for bed between 8:00 p.m. to 10:00 p.m. Resident #164 Interview on 12/14/18 at 10:09 a.m. with Resident #164 revealed that it took a long time for nursing staff to answer call lights and that Resident #164 felt that there were not enough staff on the unit (5-2 unit). Resident #190 Interview on 12/14/18 at 1:16 p.m. with Resident #190's family member revealed that there main concern was staff shortage. Family member stated that they had to do care for Resident #190 because the unit (Building #1 unit) was short staffed. Interview on 12/19/18 at 12:54 p.m. with Staff K (Staff Development Coordinator) revealed that the 5-3 unit residents were more acute and needed more assistance. Staff K was unable to provide more information on how the facility assess's the level of assistance that the residents need and how to appropriately staff in regards to the resident needs. Interview on 12/14/18 at 10:35 a.m.with Resident Council had 11 Residents present representing 3 different units in the building. When asked if Facility staff listened about grievances, Resident #140 responded with: The staff will listen and respond back, but not always timely. Resident #72 added: but the next step is actions, and those seem to be rarely taken. Resident #138 stated: when waiting for a call bell to be answered you can wait a half hour or more without anyone to even check to see if you are safe; Activities staff has been doing more and more to help other staff members in the building; i.e. (A greater) percent of the transporting of people to meetings. Resident #72 stated: There seems to be a shortage of people working in the Kitchen. They always seem to be 2 or 3 people short in the kitchen. Resident #72 also said there seems to be a lack of supervision in the kitchen, why else would we get such poor (food) service. There is a lot of turnover in the Kitchen. The turnover is incredible, in my lifetime of working, I've never seen turnover this bad. Resident #140 stated: that Monday through Friday (staffing) is bad, the weekends are brutal. The question was raised by a Resident as to who is managing the kitchen. Resident #72 said: They should have a person in the kitchen that knows the business inside and out so that they can tell staff what they should be doing. Resident #72 has also observed desserts to be uncovered during transport and was worried that dust or crumbs from carts or trays could get into those uncovered desserts. Resident #72 also stated: There are people in management throughout the entire organization who seem to lack experience. Resident #72 stated that on Thanksgiving Day there were 6 LNA's on the one floor because there were so many families on the unit. This resident further stated that ordinarily there were one or two aides on the unit. Interview on 12/18/19 at 1:09 p.m. with the Family Council revealed the family members present all said they need to provide activities of daily living such as feeding, grooming, and toileting to their family member residents when they visit. Interview on 12/14/18 with a family member revealed that there's a staffing shortage on the West Wing in building one. This family member stated that residents go for long periods of time without being changed after they've deficated or urinated in their disposable diapers. This family member said that the lack of sufficient staff is particularly apparent on weekends. In addition this family member reported having had to change their own spouse because of a shortage of available staff. In addition this family member reported that there's a lack of available staff to provide assistance to residents who need help during meals. Some residents, according to this family member, have missed eating altogether during a meal because of a lack of staff asssistance. Review of the minutes of a 11/27/18 meeting of the Resident's Food Committee noted cold food being served on unit 5-3. The Resident's Food Committee notes of the 11/27/18 meeting further stated that on unit 5-3 there's not enough nursing staff available to serve trays no one is there to pass out trays resulting in residents receiving cold food. Resident #203 Observation on 12/13/18 from approximately 12:30 p.m. to 12:45 p.m. of room [ROOM NUMBER]'s call light was on for assitance. During this observation, the light was visibly flashing and the sound was heard. It was observed that 5 different staff members walked past this room without entering. Interview on 12/13/18 at approximately 12:45 p.m. with Staff A (Unit Manager) stated that, Everybody answers lights. Resident #64 Interview on 12/14/18 at approximately 9:50 a.m with Resident #64 revealed the following statement, It takes too long for people to answer my call light, sometimes up to an hour. The food is always cold and it takes too long for anybody to warm it up. Resident #165 Interview on 12/14/18 at approximately 10:00 a.m. with Resident #165's family member revealed that sometimes when visiting the call light goes off for an hour without staff entering the room. Resident #165 also stated that at 6:00 a.m. on a regular basis staff can take up to an hour to answer call light. Resident #15 Interview on 12/13/18 at approximately 10:50 a.m. with Resident #15 revealed that Resident #15 stated that the facility was very short staffed. Resident #15 stated that food was frequently served cold and that if asked the nursing staff would heat it up but that Resident #15 did not ask the staff to heat up food because they were already so busy and that would take them away from their work. Resident #61 Interview on 12/13/18 at approximately 10:10 a.m. with Resident #61 stated that the facility was very short staffed. Resident #61 stated that their roommate, who was non interviewable, had to wait long periods of time for help. Resident #61 stated that they felt bad for their roommate and tried to help them but that the staff got upset when they tried to help their roommate. Resident #61 stated that it was for that reason that they were looking to transfer to another facility. Resident #79 Interview on 12/13/18 at approximately 11:45 a.m. with Resident #79 revealed that Resident #79 stated that the facility was very short staffed and that the residents had to wait for long periods of time for assistance. Resident #177 Interview on 12/13/18 at approximately 11:40 a.m. with Resident #177 revealed that Resident #177 stated that the facility was very short staffed and that residents had to wait long periods of time for assistance. Resident #196 Interview on 12/14/18 at approximately 8:45 am with Resident #196 revealed that Resident #196 stated that the facility was very short staffed. Resident #196 stated that the 11-7 shift was extremely short staffed and that they have had to wait over an hour for assistance.",2020-09-01
47,GREENBRIAR HEALTHCARE,305005,55 HARRIS ROAD,NASHUA,NH,3062,2018-12-19,726,D,0,1,P2R411,"Based on observation record review and interview, it was determined that the facility failed to ensure that licensed nurses have the specific competencies and skill sets necessary to care for residents' needs for 1 resident in a final survey sample of 40 residents. (Resident identifier is #149.) Findings include: Observation on 12/13/18 at approximately 10:00 a.m. revealed Resident #149's call bell was ringing. When entering the room, Resident #149 gestured to say they were choking, lightly spoke with a gurgled voice, and pointed to the suction machine at Resident #149's bed side. Staff member was looked for to care for Resident #149 and no aide's could be found on the floor. Walking the length of the floor did not locate a staff member. Finally Staff G (Nurse) who was distrubuting medications, was told of the event , asking that they come to Resident #149 needs. Staff G walked down the hall and entered Resident #149's room. At this time Staff G told Resident #149 to clear their mouth themselves and use tissues, but Resident #149 was not able to clear their throat. The nurse then went to use the suction machine that was at Resident #149's bedside, but the canister was full and had to emptied. When doing this, the nurse removed the suction lines to the equipment, emptied the canister and cleaned it in the bathroom and returned to the suction machine at Resident #149 bedside. Then the nurse tried to hook up the suction machine but appered to not know where the suction lines hooked to. At this time surveyor showed Staff G where the suction lines go so the equipment could be used to help provide care to Resident #149. Once the tubing was properly connected to the suction machine Staff G said they did not have a piece of equipment for suction even though they had the yanko suction tube hooked to the machine. Staff G left the room again at 10:25 a.m. and returned with suction tubing trying to attach it to the end of the yanko then stopped. Staff G then said they will just use this (yanko tube) turning the suction machine on and off to extended the yanko further to clear Resident #149 throat. Staff G did this several times hitting Resident #149 gag reflex causing them to gag and cough. At the end of this process Resident # 149 had relief and was able to speak by 10:30. Resident #149 was asked if this nurse does this for them all the time and Resident #149 said not always. Resident #149 said, Staff I (Nurse) usually does it for me, they really know how to do it. Staff G after suctioning Resident #149 left the yanko uncovered and the suction tubing filled with mucus. Resident #149 told surveyor that Resident #149 was scared during the event but feels much better now that there throat was cleared. Resview on 12/17/18 Staff G personal file with education and training revealed that they had not completed their competencies for how to use a suction machine. Following this incident, the facility had Staff G complete the competencies needed on how to use and care for residents needing suction. Interview on 12/18/18 09:19 AM with Staff I confirmed that they provides suction to Resident #149 every morning and sometime in the afternoon depending on how much secretions form in Resident #149 throat. Staff I also stated when they suction Resident #149 they always removes clear/yellow discharge. Staff I stated Resident #149 needs the services but also feels it's a comfort measure that provides Resident #149 relief.",2020-09-01
48,GREENBRIAR HEALTHCARE,305005,55 HARRIS ROAD,NASHUA,NH,3062,2018-12-19,755,D,1,1,P2R411,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on observation, record review, interview and facility policy and procedure the facility failed to ensure accurate reconciliation of controlled narcotic medications for two residents resulting in the actual loss of the prescribed narcotic medications. (Resident identifiers are #30 and #48.) Findings include: Review on 12/14/18 of the facility policy and procedure titled Inventory Control of Controlled Substances with revision date of 1/1/13 revealed the following: Applicability: This Policy 5.4 sets forth the procedures for inventory control of controlled substances. Procedure: 1. With respect to Schedule II controlled substances . 1.2 Facility should ensure that the incoming and outgoing nurses count all Schedule II controlled substances and other medications with a risk of abuse or diversion at the change of each shift or at least once daily and document the results in the 'Controlled Substance Count Verification/Shift Count Sheet' set forth . 1.2.1 Reconcile the total number of controlled medications on hand , add newly received medications to the inventory and remove medications that are completed or discontinued from the inventory, pursuant to the Controlled Substance Verification Count Sheet and 1.2.2 Reconcile the number of doses remaining in the package to the number of remaining doses recorded on the Controlled Substance Verification Count Sheet. 1.2.3 The Facility should routinely reconcile the number of doses remaining in the package to the number of remaining doses recorded in the Controlled Substance Verification/Shift Count Sheet, to the medication administration record. Observation on 12/14/18 at approximately 7:30 a.m. showed Staff Y (Licensed Practical Nurse) and Staff Z (Registered Nurse) doing a shift change narcotic count. Observation showed Staff Y. oncoming nurse, holding individual resident narcotic packaged medications and verbally confirming the number of doses left in the medication package. Staff Z, outgoing nurse, verbally confirmed the number of doses left from the narcotic count sheet. Staff Y and Staff Z failed to visualize each of the individual residents' medication packages with the number listed in the narcotic count log to confirm the correct count. Interview on 12/14/18 at approximately 7:50 a.m. with Staff Z revealed that Staff Z verbally reports the number of narcotic doses left from the narcotic record for each individual resident to Staff Y. Staff Y verbally confirms the number of doses left in each individual resident narcotic package. Staff Z reported that visualization of the each individual resident narcotic packaged medication was not done. Staff Z reported confirmation of number of medication doses left were verbally confirmed by Staff Y and Staff Z. Review on 12/14/18 of a Narcotic Book at approximately 2:00 p.m. for Resident #48 on page #3 dated 10/28/18 revealed [MEDICATION NAME] 5 mg. (1/2 tab) 19 tablets as amount left. This medication was documented as MEDICATION TRANSFERRED to Page 26 Review on 12/14/18 of the Narcotic Book at approximately 3:00 p.m. for Resident #48 on page #26 dated 10/28/18 transferred from page #3 revealed 18 tablets of [MEDICATION NAME] not 19 tablets as indicated on page #3. Further review of page #26 for Resident #48 showed three entries on 10/29/18, three entries on 10/30/18 and two entries on 10/31/18 indicating [MEDICATION NAME] being dispensed to Resident #48 with the incorrect [MEDICATION NAME] count from 10/29/18 through 10/31/18. Interview on 12/14/18 at approximately 2:00 p.m. with Staff [NAME] (Director of Nursing) confirmed after review of the Narcotic Book listed above that the [MEDICATION NAME] narcotic count for Resident #48 was incorrect. Staff [NAME] reported that this discrepancy of the incorrect count was missed when audit was done. Review on 12/14/18 at approximately 1:30 p.m. of the facility reported missing narcotic medication on 10/31/18 for Resident #30 and Resident #48 revealed 11 missing [MEDICATION NAME] pills for Resident #48 and 24 missing [MEDICATION NAME] pills for Resident #30. Interview on 12/14/18 at approximately 2:30 p.m. with Staff C (Administrator) and Staff [NAME] (Director of Nursing) confirmed that the reported 11 missing [MEDICATION NAME] medications for Resident #48 and the 24 missing [MEDICATION NAME] medications for Resident #30 were investigated and never found. Staff [NAME] reported that the above listed incorrect [MEDICATION NAME] count for Resident #48 was missed when audit was done during the investigation for the missing [MEDICATION NAME] medications for Resident #48 and Resident #30.",2020-09-01
49,GREENBRIAR HEALTHCARE,305005,55 HARRIS ROAD,NASHUA,NH,3062,2018-12-19,756,D,0,1,P2R411,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and interview, it was determined that the facility failed to receive and follow pharmacist report of irregularities to the attending physician for 1 resident in a final survey sample of 40 residents. (Resident identifier is #19.) Findings include: Resident #19 Review on 12/18/18 of Resident # 19's record had three pharmacist reviews checked off stating see recommendations. Review of the medication tab section of the record revealed that these recommendations were not within the chart with dates of service, 10/18/18, 11/14/18 and 12/10/18 Review on 12/18/18 of Resident #19 Consultation Report for 10/18/18, 11/14/18 and 12/10/18, reveled they were forwarded to the facility by the pharmacist. Review on 12/18/18 of an evaluation that was within the record dated 8/27/18 states Rationale for Recommendation: Evidence for the efficacy and safety of combined use of 2 or more antidepressant medications is limited. The risk for drug interactions, adverse events, noncompliance, and mediation errors are increased. The medication are: [MEDICATION NAME] and [MEDICATION NAME]. Review on 9/13/18 of the medical recorded revealed that the APRN wrote D/C [MEDICATION NAME] (sic-[MEDICATION NAME]), D/C [MEDICATION NAME], and [MEDICATION NAME] decreased to QHS. Both [MEDICATION NAME] and [MEDICATION NAME] are PRN medication and [MEDICATION NAME] was decreased from TID (three times a day) to QD (One time a day). Review on 12/18/18 of the The first Consulation Report dated 10/18/18 which was not in the cart was sent to the facility on [DATE] which states under comment REPEATED RECOMMENDATION from 8/27/18: Please respond promptly to assure facility compliance with Federal regulations Once the facility recived the report called the physican on 12/18/18 and wrote TORB (Telephone order read back) already addressed 9/13/18. Review on 12/18/18 of the second Consultation Report dated 11/14/18 that was sent to the facility on [DATE] with a Recommendation: Please attempt a gradual dose reduction of [MEDICATION NAME], with the end goal of discontinuation, while monitoring for re-emergence of target behaviors and /or withdrawal symptoms. This recommendation was not addressed since facility did not have the report. Review on 12/18/18 of the third Consultation Report dated 12/10/18 that was not within the chart and was sent to the facility on [DATE] with a Comment (Resident #19) has received an antidepressant [MEDICATION NAME] 60 mg po BID . with Recommendation stating Please consider a gradual dose reduction (GDR) attempt . This was addressed on 12/18/18 through interview with Staff F (Unit Manger) once facility was told of the missing documentation and had it forward to the facility from pharmacy.",2020-09-01
50,GREENBRIAR HEALTHCARE,305005,55 HARRIS ROAD,NASHUA,NH,3062,2018-12-19,758,D,0,1,P2R411,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, it was determined that the facility failed to ensure PRN (As Needed) orders for [MEDICAL CONDITION] drugs are limited to 14 days except, if the attending physician or prescribing practitioner believes that it is appropriate for the PRN order to be extended beyond 14 days, he or she should document their rationale in the resident's medical record and indicate the duration for the PRN order for 1 resident out of a final sample size of 40 residents. (Resident identifier is #212.) Findings include: Review on 12/18/18 of Resident #212 current physician orders [REDACTED].#212 had an order for [REDACTED]. Review on 12/18/18 of Resident #212 physician orders [REDACTED]. Review on 12/18/18 of Resident #212 EMAR (Electronic Medication Administration Record) for the month of (MONTH) (YEAR) revealed that [MEDICATION NAME] 1 mg by mouth every 6 hours PRN for anxiety with start date of 9/20/18 and with no end date was given on 9/21, 23, 24, 25, 26, 27, 28, and 30/2018. Review on 12/18/18 of Resident #212 EMAR for the month of (MONTH) (YEAR) revealed that [MEDICATION NAME] 1 mg by mouth every 6 hours PRN for anxiety with start date of 9/20/18 and with no end date was given on 10/1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11,12, 14, 15, 17, 18,19, 20, 21, 22, 23, 24, 25, 26, 27, 29 and 30/2018. Review on 12/18/18 of Resident #212 EMAR for the month of (MONTH) (YEAR) revealed that [MEDICATION NAME] 1 mg by mouth every 6 hours PRN for anxiety with start date of 9/20/18 and with no end date was given on 11/1, 2, 3, 4, 5, 6, 7, 8, 10, 11, 12, 13, 14, 15, 16, 17, 18, 22, 23, 25, 26, 27 and 29/2018. Review on 12/18/18 of Resident #212 EMAR for the month of (MONTH) (YEAR) revealed that [MEDICATION NAME] 1 mg by mouth every 6 hours PRN for anxiety with start date of 9/20/18 and with no end date was given on 12/ 5-6, 9-12, and 14-17/2018. Review on 12/18/18 of Resident #212 physician and nurse practitioner notes dated 9/24/18, 10/1/18, 10/3/18, 10/12/18, 10/26/18, 11/19/18, and 11/27/18 revealed that there were no notes regarding rationale for the PRN [MEDICATION NAME] use and indication of the duration for the PRN [MEDICATION NAME] order. Review on 12/18/18 of Resident #212 consult notes revealed that there were no psychiatry consult notes from (MONTH) to (MONTH) (YEAR) regarding rationale for the PRN [MEDICATION NAME] use and indication of the duration for the PRN [MEDICATION NAME] order. The last psychiatry notes documented was dated 8/28/18. Interview on 12/18/18 at 9:30 a.m. with Staff A (Unit Manager) confirmed the above findings. Staff A revealed that Resident #212 was transferred to their unit (5-2) since (MONTH) (YEAR) and had been using the [MEDICATION NAME] PRN order. Staff A was unable to give explanation of Resident #212's [MEDICATION NAME] PRN order not having a documented rationale for use and duration.",2020-09-01
51,GREENBRIAR HEALTHCARE,305005,55 HARRIS ROAD,NASHUA,NH,3062,2018-12-19,761,D,0,1,P2R411,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and facility policy review, it was determined that the facility failed to ensure that all medications are labeled, stored in locked compartments and discarded when expired for 3 residents in a final survey sample of 40 residents. (Resident identifiers are #109, #165 and #29) Resident #109 Observation on [DATE] at approximately 9:45 a.m. in Resident #109's room revealed the following treatment items: Wound packing strip container without a cover and open to air, and sterile water (single use container) opened and on Resident #109's dresser. Interview on [DATE] at approximately 9:46 a.m. with Staff A (Unit Manager) confirmed that the items did not have a date of opening, Staff A put the items in the garbage. Resident #165 Observation on [DATE] at approximately 10:00 a.m. in Resident #109's room revealed the following treatment item: lac-hydrin five lotion expiration date of ,[DATE]. Interview on [DATE] at approximately 10:30 a.m. with Staff B (Licensed Practical Nurse) confirmed that the items on the dresser were expired and the items were thrown in the garbage. Resident #29 Observation on [DATE] at approximately 12:30 p.m. in Resident #29's room revealed on the dresser was an opened, undated (single container) of sterile water. The sterile water container had several floating black substances in it. Interview on [DATE] at approximately 12:35 p.m. with Staff A (Unit Manager) was not able to identify the floating substances in the container of sterile water. Staff A confirmed that the container was opened and not dated. Review on [DATE] of the facility policy and procedure titled, Storage of Medications, Revision date ,[DATE] revealed: Policy: The facility shall store all drugs and biologicals in a safe, secure, and orderly manner. Guidelines: . 2. The nursing staff shall be responsible for maintaining medication storage and preparation areas in a clean, safe, and sanitary manner. . 4. The facility shall not use discontinued, outdated, or deteriorated drugs or biologicals. All such drugs shall be returned to the dispensing pharmacy or destroyed.",2020-09-01
52,GREENBRIAR HEALTHCARE,305005,55 HARRIS ROAD,NASHUA,NH,3062,2018-12-19,802,C,0,1,P2R411,"Based on observation, interview, and record review, it was determined that the facility failed to employ sufficient staff to effectively carry out food functions for 5 of 5 nursing units (Building 2, 5-2, 5-3). Findings include: Observation on 12/13/18 1:15 p.m. on unit 3 East revealed lunch meal trays being delivered to residents in their rooms. Review on 12/18/18 of meal delivery times revealed that 3 East is scheduled to have food delivered for lunch at 11:14 a.m. Observation on 12/13/18 approximately at 10:00 a.m. on Building 2 revealed Resident #191 eating breakfast in the bedroom. Resident #191 complained that the breakfast always has toast but today was different because it had peanut butter on the tray; usually the toast does not even have butter on it it is always burnt. Observation on 12/13/18 of Building 2 dining area at 12:56 p.m. revealed a white erasable board that stated that lunch would be at 12:00. Several residents were at various tables waiting for lunch to be delivered complaining to each other that lunch is always late and wondering how long today. Interview at 12:15 p.m. with Residents #87, #187 and #191 revealed that lunch is always late. Observation at 12:56 p.m. revealed that the lunch cart arrived and that lunch trays were being distributed to different tables by two staff members. At 1:03 p.m. Resident #87 did not like the meal served and pushed the tray away. The staff members did not stop and ask Resident #87 if Resident #87 wanted an alternate. At 1:14 p.m. this resident got up to leave the room and the staff asked if Resident #87 was done and which time an affirmative answer was stated. Further observations revealed that all meals stay on the trays whether in the dining area or in the rooms in Building 2. Interview with Resident #87 at 1:45 p.m. revealed that the lunch trays are always late and if you do not like the main meal you can ask for an alternate but it will take up to an hour to get it so why bother. It would be nice to have some music while we eat; it is so quiet it and so institutional on the lunch trays. Interview on 12/19/18 at 1:45 p.m. with Staff C, (Administrator) revealed that they have tried everything with dining. With trays and without trays but can not seem to keep boundaries from other residents; so it is easier with the trays. Interview on 12/13/18 with Staff T (Food service manager) revealed that Staff T's department is operating short staffed and in need of filling six dietary positions including a cook, two full-time dietary aides and three part-time dietary aides. This staffing shortage is causing tray carts containing the resident's meals to be delivered late to the facility units. Interview on 12/19/18 with Staff T revealed that on 12/19/18 the dietary department only had four of seven needed staff available to help prepare the food carts in the kitchen. As a result on 12/19/18 the food carts for every unit left the kitchen late and Staff T's documentation revealed that the food carts were late leaving the kitchen on all days of the survey. A test tray on 12/19/18 done by Staff P (Dietician) on unit 5-3 documented the meal temperatures at a unaccpetable low level temperatures according to the dieticians form with the entree temperature recorded at 107 degrees and the vegetables at 115 degrees. Interview on 12/14/18 at 9:44 AM with Staff C (Administrator) confirmed that they are short staffed in the kitchen by 5 dietary aide's and one cook. The Staff C states they are doing the best they can trying to hire staff for the department but it has been very difficult. Observation on 12/13/18 at approximately 9:20 a.m. of the dining room on Unit 5-2 revealed the food truck arrived to the unit at 9:20 a.m. Observation on 12/14/18 at approximately 9:15 a.m. of the dining room on Unit 5-2 revealed the food truck arrived to the unit at 9:15 a.m. Interview on 12/14/18 at approximately 9:15 a.m. with Resident #226 and Resident #5 revealed that Resident #226 had been waiting about an hour to an hour and a half for breakfast. It's ridiculous, we wait like this everyday for all of our meals. Resident #5 confirmed Resident #226's statement that meals are always about an hour to an hour and a half late. Review on 12/13/18 of the facilitys Cart delivery sheet revealed that breakfast leaves the kitchen at 8:23 a.m. Interview on 12/14/18 at approximately 10:00 a.m. with Resident #164 revealed that meals are always cold. I don't ask for it to be warmed up anymore because it takes so long. Observation on 12/19/18 at approximately 9:00 a.m. of the dining room on Unit 5-2 revealed the food truck arrived to the unit at 9:05 a.m. Interview on 12/13/18 at approximately 10:45 a.m. with Resident #15 revealed that the meals arriving from the kitchen were frequently late and were frequently cold. When asked if the facility staff would heat the food up, Resident #15 stated that they would heat it up, but that Resident #15 didn't ask because they felt that it would have taken staff away from their work and they were already short staffed. Observation on 12/13/18 of the dining room on Floor 5-3 revealed that the lunch food carts arrived on the unit from the kitchen at 1:35 p.m. Interview on 12/13/18 at approximately 1:15 p.m. with Staff J (Unit Manager) revealed that the lunch carts were late and that they should have arrived earlier. Observation on 12/14/18 of the dining room on Floor 5-3 revealed that the lunch food carts arrived on the unit from the kitchen at 1:15 p.m. Review on 12/19/18 of the facility form, titled Cart delivery . time . revised 12/11, revealed that the lunch carts that went to Floor 5-3 were supposed to leave the kitchen at 12:18 p.m. Interview on 12/13/18 at 11:00 a.m. with Staff J (Unit Manager) revealed that lunch is served at 12:30 p.m. Observation on 12/13/18 at 12:38 p.m. of the 5-3 unit revealed that there were no meal trays for lunch delivered on the unit. Interview on 12/13/18 at 12:38 p.m. with Staff J revealed that the meal trays for lunch will be delivered in 5-10 minutes. Interview on 12/13/18 at 1:00 p.m. with Resident #62 and Resident #18 revealed that their lunch was often served late around 1:30 p.m. Observation on 12/14/18 at 12:30 p.m. of the 5-3 unit revealed that the meal trays for lunch were not on the unit. Interview on 12/14/18 at 12:30 p.m. with Staff M (Licensed Nursing Assistant) confirmed that meal trays have not been delivered to the 5-3 unit. Observation on 12/14/18 at 1:00 p.m. of the 5-3 unit revealed that the meal trays for lunch were not on the unit. Interview on 12/14/18 at 1:00 p.m. with Staff M (Licensed Nursing Assistant) confirmed that meal trays have not been up in the 5-3 unit. Observation on 12/14/18 at 1:20 p.m. of the 5-3 unit revealed that meal trays for lunch were just delivered on the unit.",2020-09-01
53,GREENBRIAR HEALTHCARE,305005,55 HARRIS ROAD,NASHUA,NH,3062,2018-12-19,804,E,0,1,P2R411,"Based on a resident complaint, resident record review, interview and observation it was determined the facilty failed to ensure that food is served at appetizing temperatures and not served cold. (Resident identifiers are #72 and #138) Findings include: Review on 12/19/18 Staff P's (Dietician) of documentation of the results of a test tray conducted on unit 5-3 recorded the food temperatures at unacceptably low levels according to the facility form the entree was recorded at 107 degrees and the vegetables recorded at 115 degrees. Staff T (Dietary manager) documented on 12/19/18 and on the other days of survey when the food carts were actually going out to the units next to the times they were supposed to be dispensed to each unit. This documentation showed that on all days of survey the food carts were being dispensed late to all units during all three meals daily because of a shortage of dietary staff. Interview on 12/19/18 with Staff T revealed that on 12/19/18 dietary had only four of the seven needed staff available to help prepare the food carts for dispensing lunch to the facility units. Staff T also revealed that the dietary department needed another cook, two full-time dietary aides and three part-time dietary aides. Review of a resident complaint regarding cold food noted in the minutes of the 11/27/18 meeting of the Resident's food committee revealed that this came from a resident on unit 5-3. The complaint stated that there's not enough staff to serve trays no one is there to pass out trays. Staff T confirmed that this information was verbally passed on to Staff P (Dietician). Interview with Staff P acknowledged receiving this complaint of cold food from Staff T but stated that there was no test tray or other follow up done in response to this resident's complaint of cold food on unit 5-3. Interview on 12/14/18 at 10:35 a.m.with Resident Council had 11 Residents present representing 3 different units in the building. All of the 11 residents in attendance felt like meals were always late getting to the floor and Resident 72 said: the meals are getting colder & colder. Resident #72 also said: In some cases residents are not getting specialized diets or are not always getting what they ordered. Resident #72 also stated that it (meal service) is getting really bad. One resident (Resident number was not identified) has pictures of the meals as presented. One picture showed a hamburger patty, dried out, overcooked (resident said blackened) and curled up. Resident #72 stated: There seems to be a shortage of people working in the Kitchen. They always seem to be 2 or 3 people short in the kitchen. Resident #72 also said there seems to be a lack of supervision in the kitchen, why else would we get such poor (food) service. There is a lot of turnover in the Kitchen. The turnover is incredible, in my lifetime of working, I've never seen turnover this bad. Resident #138 stated: I am about ready to deduct money from my monthly payments for every meal I can't eat. The question was raised by a Resident as to who is managing the kitchen. Resident #72 said: They should have a person in the kitchen that knows the business inside and out so that they can tell staff what they should be doing. Resident #72 has also observed desserts to be uncovered during transport and was worried that dust or crumbs from carts or trays could get into those uncovered desserts. Resident #72 also stated: There are people in management throughout the entire organization who seem to lack experience.",2020-09-01
54,GREENBRIAR HEALTHCARE,305005,55 HARRIS ROAD,NASHUA,NH,3062,2018-12-19,806,E,0,1,P2R411,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, it was determined that the facility failed to provide food that was appealing, and to ensure that the food offered took into consideration resident allergies and preferences for 4 out of 6 nursing units. Findings include: Resident #196 Interview on 12/14/18 at approximately 8:40 a.m. with Resident #196 revealed that Resident #196 stated that the food was not good. They stated that they have a [MEDICAL CONDITION] and are bothered by gassy foods. They stated that they met with the dietitian and that the dietitian listened and wrote down what their preferences were, but that it did not seem as though that information had been communicated with the kitchen, as they frequently got served the foods that they could not tolerate. Review on 12/19/18 of Resident #196's Diet History/Food Preferences form, that was not dated, revealed that Resident #196 indicated that they did not want to be served spicy foods, fish, broccoli, cabbage, cauliflower, spinach, yellow squash or zucchini. Review on 12/19/18 of Resident #196's Diet Order and Communication form, dated 9/17/18, revealed that Resident #196 was allergic to mushrooms. Review on 12/19/18 of Resident #196's diet slips from the kitchen revealed that it read that Resident #196 was allergic to mushrooms. There was nothing documented on the diet slip about Resident #196's preference not to be served spicy foods, cabbage, spinach, yellow squash or zucchini. Interview on 12/19/18 at approximately 11:10 a.m. with Resident #196 and Staff P (Registered Dietitian) confirmed that Resident #196 had an allergy to mushrooms and that they did not want to be served spicy foods. Resident #196 stated that they were served clam chowder for supper on 12/18/18, that they were served mushrooms very frequently and that they are served brussel sprouts, broccoli and cauliflower. Resident #536 Interview on 12/14/18 at 1:45 p.m. revealed that Resident #536 was not eating lunch because Resident #536 got fish for a meal even though Resident #536 has a fish allergy. Observation on 12/14/19 at 1:50 p.m. of Resident #536's meal tray and meal ticket revealed a plate with a fish meal and a meal ticket for Resident #526 that had Allergies: FISH bolded in red printed across the top. Interview on 12/14/18 at 1:55 p.m. with Staff V (Licensed Nursing Assistant) confirmed there was fish on Resident #536's meal tray. Review on 12/18/18 of Resident #526's medical record revealed a list of Resident #536's allergies that listed fish as an allergy. Interview on 12/14/18 at 9:44 AM with Staff C (Administrator) stated that they are short staffed in the kitchen by 5 dietary aides and one cook. The Staff C states they are doing the best they can trying to hire staff for the department but it has been very difficult. Resident #92 Interview on 12/13/18 at 10:55 a.m. with Resident # 92 revealed their meal ticket, is the same meal ticket I get every meal since I've been here. But every time my meal tray comes up it is always something different then what the meal ticket says. Resident #152 Interview on 12/13/18 at 9:49 a.m. Resident #152's husband stated his wife has been waiting for her cereal for over a hour which was not on her food tray. Resident #152's meal ticket was observed on their tray, review of the meal ticket reveals 3/4 cup Cereal-cold. The husband stated this happens all the time, I'm just glad I'm here to make sure my wife gets what she needs. Resident #41 Interview on 12/14/18 at approximately 10:00 a.m. with Resident #164 revealed that items are missing from the food menu on a daily basis. At least 1 thing is missing off of the menu every day. The other day it was brussel sprouts, another day was potato chips.",2020-09-01
55,GREENBRIAR HEALTHCARE,305005,55 HARRIS ROAD,NASHUA,NH,3062,2018-12-19,880,D,0,1,P2R411,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and policy review, it was determined that the facility failed to provide a safe and sanitary environment for infection control in regards to following transmission-based precautions and a unsanitary suction machine for 2 residents out of the facility census of 234 residents. (Resident identifiers are #84, and #118.) Findings include: Policy review Review on 12/14/18 of the facility's policy titled, Isolation- Categories of Transmission-Based Precaution, last revised date of 4/2018, revealed that .Droplet Precautions .when a private room is not available and cohorting is not achievable, use a curtain and maintain at least 3 feet of space between the infected resident and other residents and visitors .put on a mask when entering the room .the facility will implement a system to alert staff and visitors to the type of precaution the resident requires . Resident #84 Observation on 12/14/18 at approximately 8:10 a.m. in Resident #84's room revealed a mouth suction machine on the night stand next to Resident #84's bed. The suction machine canister was 1/2 filled with what appeared to be yellow/white remnants of mouth suctioning. The tubing connected to the canister had a film noted on the inside that was consistent with what was in the canister. Interview on 8/14/18 at approximately 8:15 a.m. with Staff B (Licensed Practical Nurse) confirmed that the canister was 1/2 filled with remnants of mouth suctioning and the tubing also. Staff B revealed that mouth suctioning had not been done on Staff B's shift, the night nurse may have done mouth suctioning on (pronoun omitted). Interview on 8/14/18 at approximately 8:20 a.m. with Staff D (Registered Nurse) who worked the night shift revealed that Staff D did not do any mouth suctioning with Resident #84. Review on 12/14/18 of Resident #84's physician orders [REDACTED]. Oral suctioning PRN (as needed) for increased secretions, start date 2/9/16. Review on 12/14/18 of Resident #84's Medication Administration Record [REDACTED]. Interview on 12/14/18 at approximately 2:30 p.m. with Staff [NAME] (Director of Nurses) revealed that Resident #84 had not been suctioned recently, and stated that It could be up to 3 months without cleaning the suctioning system. It is a closed system. Review on 12/17/18 of the facility policy and procedure titled, Suctioning the Upper Airway (Oral Pharyngeal Suctioning), Revision date 4/2018 revealed the following: . Steps in the Procedure . 22. Discard water or saline in commode. Dispose cup in designated receptacle. 23. Empty and rinse collection container if necessary or as indicated by facility policy. . Resident #118 Interview on 12/13/18 at approximately 9:30 a.m. with Staff J (Unit Manager) revealed that Resident #118 was on contact precautions for [MEDICAL CONDITION]. When asked what personal protective equipment needed to be worn when entering Resident #118's room, Staff J stated that gowns, gloves and masks needed to be worn. Observation on 12/14/18 at approximately 8:15 a.m. of Resident #118 being fed by Staff Q (Licensed Nursing Assistant) who was standing right next to Resident #118's bed while feeding them, revealed that Staff Q was wearing gloves, but was not wearing a gown. Interview on 12/14/18 at approximately 9:00 a.m. with Staff Q revealed that Staff Q stated that they only needed to wear a gown when washing Resident #118, not when they are feeding them. Interview on 12/19/18 at approximately 1:15 p.m. with Staff K (Infection Control Nurse) confirmed that, for residents on contact precautions, gowns and gloves are to be worn when in the room. Staff K also confirmed that masks did not have to be worn, that when feeding a resident in their room who is on contact precautions a gown was to be worn, and that the signs alerting visitors needed to be visible where they could be easily seen.",2020-09-01
56,HANOVER HILL HEALTH CARE CENTER,305009,700 HANOVER STREET,MANCHESTER,NH,3104,2020-01-31,585,B,0,1,0IIF11,"Based on interview and record review the facility failed to maintain a complaint/grievance log. Findings include: Review on 1/31/20 of the facility policy and procedure titled Grievances revealed the following: Policy Interpretation and Implementation: 7. The patient/resident, or person filing the grievance on behalf of the patient/resident, will be informed of the findings of the investigation and the actions that will be taken to correct any identified problems. Such report will be made orally by the administrator, or her designee, within ten working days of the completion of initial investigation of the grievance. A written summary of the report will also be provided to the patient/resident upon request, and a copy will be filed in the Social Services Office. Review on 1/31/20 of the facility policy and procedure titled Investigating Grievances revealed the following: 3. The Grievance Investigation Report must be filed with the administrator within five (5) working days of the receipt of the grievance. 4. The patient/resident, or person acting on behalf of the patient/resident, will be informed of the findings of the investigation, as well as any corrective actions recommended, within ten (10) working days of the filing of the grievance. 5. A copy of the Grievance Investigation Report must be filed in the social services office. 6. Copies of all reports must be signed and a written summary of the report will be provided upon request to patient/resident or person acting on behalf of the patient/resident. Interview on 1/30/20 at approximately 11:30 a.m. with Staff [NAME] (Director of Social Services) revealed that grievances/complaints are addressed at the time of the grievance/complaint is reported to the facility. Staff [NAME] confirmed that there was no documented complaint/grievance log to track and/or trend complaints/grievances investigated by the facility within 3 years from the date of a complaint/grievance resolution.",2020-09-01
57,HANOVER HILL HEALTH CARE CENTER,305009,700 HANOVER STREET,MANCHESTER,NH,3104,2020-01-31,658,D,0,1,0IIF11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and interview, it was determined the facility failed to follow physician orders [REDACTED]. (Resident identifier is #47.) Findings include: Review of [NAME] [NAME] Potter and Anne Griffin Perry, Fundamentals of Nursing. 7th ed. St. Louis, Missouri: Mosby Elsevier, 2009. Page 336-Physicians' Orders revealed the following: The physician is responsible for directing medical treatment. Nurses follow physicians' orders unless they believe the orders are in error or harm clients. Therefore you need to assess all orders, and if you find one to be erroneous or harmful, further clarification from the physician is necessary . Review on 1/31/2020 of Resident #47's medical record revealed a physician's orders [REDACTED].#47 would have weekly skin assessment. Review on 1/31/2020 of Resident #47's weekly skin condition record revealed that Resident #47 did not receive timely weekly skin assessment. Resident #47 received one on 1/4/2020, which stated wounds to buttocks treated as ordered in MAR (Medication Administration Record) No s/s (signs/symptoms) of infections; the following week 1/11/2020 it revealed that it Continues with multiple open areas to coccyx/buttocks. Dressing and ointments applied as ordered. No changes noted. No s/s infection. This was the last note/input to the skin condition record. Review on 1/31/2020 of Resident #47's care plan revealed that Resident #47 has an alteration in skin integrity r/t (related /to) the pressure of Deep Tissue Injury (DTI). The care plan inventions include dressings as ordered. assesses placement and integrity of the dressing every shift and change if compromised. Interview on 1/31/2020 at approximately 2:00 p.m. with Staff D (Unit Manager) confirmed that Resident #47 developed a DTI on the heel. Staff D confirmed the heels started to be offloaded at this time. Review on 1/31/2020 of physician orders [REDACTED]. Heel foam cups BL (bilateral) heels- change weekly off-loading boot while in bed at all times. Staff D confirmed this was started after the DTI was discovered. Review on 1/31/2020 of Resident #47's medical record revealed no documentation that the heels had been looked at prior to the DTI developing.",2020-09-01
58,HAVENWOOD-HERITAGE HEIGHTS,305016,33 CHRISTIAN AVENUE,CONCORD,NH,3301,2019-05-23,926,D,0,1,XFUZ11,"Based on observation, interview, record review and policy review, it was determined that the facility failed to follow facility smoking policy for 1 out of 1 resident who smoked. (Resident identifier is #11.) Findings include: Review on 5/22/19 of facility's policy titled, Resident Smoking while in the Health Service Center, dated 10/07/16, revealed .complete a smoking evaluation .review status of resident's smoking privileges at least quarterly and more often as needed .update the resident's care plan to indicate the current status of smoking privileges/restrictions Review on 5/22/19 of facility's smoking evaluation, revision date 10/7/16, revealed .for resident who wishes to smoke, perform evaluation on admission, quarterly, at a significant change, or if there has been an incident of unsafe smoking observed or reported Interview on 5/21/19 at 11:42 a.m. with Resident #11 revealed that Resident #11 smoked once a day at the parking lot with staff supervision. Resident #11 stated that they kept their cigarettes in their bedside drawer and that the nurses kept their lighter. Observation on 5/21/19 at 11:42 am in Resident #11's room revealed that Resident #11 had a box of cigarette in their bedside table. Review on 5/23/19 of Resident #11's current smoking care plan revealed that Resident #11 wanted to continue to smoke and that Resident #11 will not smoke without someone present, Resident #11 will smoke 1 cigarette per outing, and Resident #11's friend will accompany resident outside of sliding glass doors, down the ramp, and outside the fence to smoke. Review on 5/23/19 of Resident #11's chart and EHR (Electronic Health Record) revealed that Resident #11's smoking evaluation was completed on 10/7/16. Further review of Resident #11's chart and EHR revealed no other smoking evaluation after 10/7/16. Interview on 5/23/19 at 8:45 a.m. with Staff B (Registered Nurse) confirmed that Resident #11 was the only resident who smoked. Staff B revealed that there was no smoking evaluation done. Staff B stated that they do not do smoking evaluation. Staff B was unable to provide more information regarding smoking evaluation. Interview on 5/23/19 at 8:45 a.m. with Staff D (Unit Coordinator) revealed that Resident #11 was supervised when smoking and that Resident #11 utilized a smoking apron. Interview on 5/23/19 at 9:00 a.m. with Staff A (Unit Manager) revealed that there was no smoking evaluation done after 10/7/16. Staff A stated that they did not know about the smoking policy and smoking evaluations. Staff B also stated that the care plan was not updated as Resident #11 needed a smoking apron and that Resident #11's lighter would be kept at the nurse's medication cart when not used by Resident #11.",2020-09-01
59,HAVENWOOD-HERITAGE HEIGHTS,305016,33 CHRISTIAN AVENUE,CONCORD,NH,3301,2017-09-22,226,D,0,1,NEVL11,"Based on interview and review of the facility policy, it was determined that the facility failed to include two of the seven required components that assure the facility is doing all that is within its control to prevent occurrences of abuse and neglect. Findings include: Review on 9/21/17 of the facility policy for abuse and neglect titled Resident Abuse, Neglect, & Exploitation dated 5/31/2017 revealed that of the seven required components that must be included in the facilities abuse policy two were not included. The components are: Screening, training, protection, prevention, identification, investigation, and reporting/response. The two components that were not included in the facility's policy are screening and identification. Interview on 9/21/17 at approximately 2:10 p.m. with Staff B (Director of Nursing) confirmed that the two components had been left out of the current policy when it was put into effect on 5/31/17.",2020-09-01
60,HAVENWOOD-HERITAGE HEIGHTS,305016,33 CHRISTIAN AVENUE,CONCORD,NH,3301,2017-09-22,279,D,0,1,NEVL11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, it was determined that the facility failed to develop comprehensive care plans for 2 residents out of a sample size of 18 residents. (Resident Identifiers are #3 and #9.) Findings include: Resident #9 Review on 9/21/17 of Resident #9's medical record in the nursing note dated 6/15/17 02:28 p.m. revealed that Resident #9 had a pacemaker. Review on 9/21/17 of Resident #9's care plans revealed that there was not a care plan for the pacemaker. Interview on 9/21/17 at approximately 2:00 p.m. with Staff A (Registered Nurse) confirmed that there was not a care plan for Resident #9's pacemaker. Resident #7 Review on 9/18/17 of Resident #7's comprehensive care plan indicates Resident #7 is receiving a regular diet. Interview on 9/22/17 with Staff H (Registered Dietician) revealed that Resident #7 since 8/28/17 Resident #7 has been receiving a mechanical soft diet with ground meat. The Facility failed to ensure that Resident #7's comprehensive care plan reflected the actual diet Resident #7 was receiving. Resident #3 Review on 9/21/17 of Resident #3's [DIAGNOSES REDACTED].#3 had a pacemaker in place. Review on 9/21/17 of Resident #3's current Care Plan, dated 7/13/17, revealed that there was no care plan for Resident #3's use of a pacemaker. Interview on 9/22/17 at approximately 11:00 a.m. with Staff [NAME] (Registered Nurse) confirmed that Resident #3 had a pacemaker and that there was no care plan in place for the pacemaker.",2020-09-01
61,HAVENWOOD-HERITAGE HEIGHTS,305016,33 CHRISTIAN AVENUE,CONCORD,NH,3301,2017-09-22,431,D,0,1,NEVL11,"Based on observation and interview, it was determined that the facility failed to discard expired medications found in the medication room on Lighthouse Lane and medication cart on[NAME]Lane medication cart. Findings include: Observation on 9/22/17 at approximately 7:15 a.m. of the[NAME]Lane medication storage room refrigerator revealed the following expired medications: [REDACTED] Prochloroperazine 25 mg (milligram) suppositories expiration date 6/17. (House Stock) Glycerin suppositories expiration date 1/17. (House Stock) Interview on 9/22/17 at approximately 7:15 a.m. with Staff D (Licensed Practical Nurse) confirmed that the above medications were expired. Observation on 9/22/17 at approximately 8:10 a.m. of the medication cart on[NAME]Lane revealed the following expired medications: [REDACTED] Melatonin 3 mg (milligram) expiration date 3/16. (Resident # 10) Nitrostat 0.4 mg expiration date 5/25/17. (Resident #19) Nitrostat 0.4 mg expiration date 6/29/17. (Resident #20) Nitrostat 0.4 mg expiration date 6/28/17. (Resident #21) Risperdal 0.25 mg expiration date 7/19/17. (Resident #22) Tylenol 325 mg expiration date 9/6/17. (Resident #23) Sennokot S 8.6/50 mg expiration date 9/6/17. (Resident #23) Tylenol 325 mg expiration date 6/28/17. (Resident #24) Acidophilus with Pectin expiration 6/14/17. (Resident #24) Preservision Areds expiration date 5/30/17. (Resident #25) Sennokot S 8.6/50 mg expiration date 9/16/17. (Resident #26) Siltussin 100 mg/5 ml (milliliter) expiration date 9/3/17. (Resident #27) Siltussin 100 mg/5 ml expiration date 3/26/17. (Resident #27) Siltussin 100 mg/5 ml expiration date 5/14/17. (Resident #28) Clindamyocin 300 mg expiration date 6/23/17. (Resident #29) Interview on 9/22/17 at approximately 8:20 a.m. with Staff D and Staff C (Medication Nurse Assistant) confirmed that the above medications were expired. Interview on 9/22/17 at approximately 2:30 p.m. with Staff B (Director of Nurses) revealed that there was not a facility policy and procedure for discarding expired medications. Observation on 9/21/17 at approximately 3:00 p.m., of the Medication Room refrigerator on Lighthouse Lane, revealed an opened vial of Tuberculin Purified Protein Derivative, which was not dated. Review on 9/21/17 of the Manufacturer's instructions for the Tuberculin Purified Protein Derivative revealed that A vial of Tubersol which has been entered and in use for 30 days should be discarded. Interview on 9/21/17 at approximately 3:00 p.m. with Staff G (Licensed Practical Nurse) confirmed that all multidose vials were to be dated when opened and that this multidose vial was not dated.",2020-09-01
62,HAVENWOOD-HERITAGE HEIGHTS,305016,33 CHRISTIAN AVENUE,CONCORD,NH,3301,2017-09-22,441,D,0,1,NEVL11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and policy review, it was determined that the facility failed to prevent the potential for cross contamination during blood glucose monitoring on 1 of 2 units and that the professional standard of practice for hand hygiene was implemented to reduce the spread of infection and prevent cross contamination for 3 of 3 residents observed during medication pass observation. (Resident identifiers are #16, #17 and #18) Findings include Resident #16 Observation on 9/22/17 at approximately 7:30 a.m. of the medication pass on Lighthouse Lane B revealed Staff F, MNA (Medication Nursing Assistant) administering medications to Resident #16. The medications administered to Resident #16 were Tylenol tablets and Artificial Tears eye drops. Staff F administered the Tylenol and then donned gloves to administer the eye drops. Staff F removed the gloves after administering the eye drops and did not wash hands or apply hand sanitizer when done. Staff F walked over to the medication cart to start pouring medications for the next resident, Resident #17. Resident #17 Observation on 9/22/17 at approximately 7:40 a.m. of the medication pass on Lighthouse Lane B revealed Staff F, who had just finished administering medications to Resident #16, go over to the medication cart and started pouring medications for Resident #17. Staff F did not wash hands or apply hand sanitizer before pouring the medications for Resident #17. Staff F brought the medications, which included several tablets as well as Refresh eye drops, to Resident #17. Staff F administered the tablets and then donned gloves to administer the eye drops. Staff F removed the gloves after administering the eye drops and did not wash hands or apply hand sanitizer when done. Staff F walked over to the medication cart to start pouring medications for the next resident, Resident #18. Resident #18 Observation on 9/22/17 at approximately 7:50 a.m. of the medication pass on Lighthouse Lane B revealed Staff F, who had just finished administering medications to Resident #17, go over to the medication cart and started pouring medications for Resident #18. Staff F did not wash hands or apply hand sanitizer before pouring the medications for Resident #18. Staff F brought the medications, which included several tablets as well as Nasal Spray and [MEDICATION NAME] inhaler, to Resident #18. Staff F administered the tablets and then donned gloves to administer the Nasal Spray and the inhaler. Staff F removed the gloves after administering the eye drops and did not wash hands or apply hand sanitizer when done. Review on 9/22/17 of the Facility Policy, Titled Administration of Medications. Date 9/5/02 revealed Procedure: Action .Wash hands using proper hand washing technique. Don gloves when appropriate. Rationale .Decreases transfer of microorganisms when there is any chance of exposure to resident body secretions. Lessens transfer of microorganisms . Interview on 9/22/17 at approximately 2:00 p.m. with Staff B (Director of Nursing) confirmed that hand hygiene was supposed to be done between residents during medication administration. Observation on 9/22/17 at approximately 8:00 a.m. of the glucometer on[NAME]Lane medication cart revealed a brown/red dried substance on the back of the Glucometer. Interview on 9/22/17 at approximately 8:00 a.m. with Staff C (Medication Nurse Assistant) and Staff D (Licensed Practical Nurse) revealed that the glucometer was ready for use. Staff D confirmed that there was a brown/red dried substance adhered on the back of the meter.",2020-09-01
63,DOVER CENTER FOR HEALTH & REHABILITATION,305018,307 PLAZA DRIVE,DOVER,NH,3820,2018-04-13,552,D,0,1,WGWA11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview it was determined that the facility failed to inform 1 resident in a standard survey sample of 22 residents of the increased risk of mortality in patients with a [DIAGNOSES REDACTED].e. Black Box Warning) in advance of treatment involving an antipsychotic medication (Resident identifier is #50.) Findings include: Resident #50 Review on 4/13/18 at approximately 11:00 am of Resident #50's medical record revealed a physicians order for [MEDICATION NAME] 5 mg tablet (ARIPiprazole) give 5 mg by mouth one time a day for Major [MEDICAL CONDITION], dated 2/23/18. Further review of resident #50's medical record revealed that there was no documentation that Resident #50 was informed of the increased risk of mortality in patients with a [DIAGNOSES REDACTED].e. Black Box Warning) prior to the administration of [MEDICATION NAME]. Interview on 4/13/18 at approximately 11:15 am with Staff H (Unit Manager) confirmed the above findings for the administration of Abilfy.",2020-09-01
64,DOVER CENTER FOR HEALTH & REHABILITATION,305018,307 PLAZA DRIVE,DOVER,NH,3820,2018-04-13,625,B,0,1,WGWA11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed notify the resident of the facility's bed hold policy for 1 of 1 transferred residents in a sample of 22 residents. (Resident identifier #55) Findings include: Review of Resident #55's progress notes on 4/13/18 at 08:56 am revealed Resident #55 was transferred to the hospital on [DATE]. Further review of the resident's medical record revealed [REDACTED]. Interview with Staff I (Regional Director of Operations) on 4/13/18 03:02 pm confirmed that there was no written evidence of notification of the bed hold policy for Resident #55 on 4/9/18. Interview further revealed that it is the facility notifies residents of the facility's bed hold policy on admission and not at transfer.",2020-09-01
65,DOVER CENTER FOR HEALTH & REHABILITATION,305018,307 PLAZA DRIVE,DOVER,NH,3820,2018-04-13,656,C,0,1,WGWA11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and interview, it was determined that the facility failed to develop comprehensive care plans that included medical, nursing and psychosocial needs for 6 residents in a standard survey sample of 22 residents. (Resident identifiers are #5, #25, #52, #66, #80 and #185.) Findings include: Resident #66 Observation on 4/11/18 at approximately 10:35 a.m. revealed that Resident #66 was using oxygen that was being administered through a nasal cannula. Review on 4/13/18 of Resident #66's current care plan revealed that there was no care plan for Resident #66's use of oxygen. Interview on 4/13/18 at approximately 11:30 a.m. with Staff [NAME] confirmed that a care plan should be in place for Resident #66's use of oxygen. Resident #80 Interview on 4/12/18 at approximately 9:00 a.m. with Resident #80 revealed that Resident #80 does not feel that they are getting good pain relief with the pain medications being administered. Resident #80 revealed that an acceptable pain level for them after medication would be about a 5 or 6 out of 10. Review on 4/13/18 of Resident #80's current care plan revealed that the goal for Resident #80's acute pain was written as The resident will voice a level of comfort of (SPECIFY residents states range of comfort) out of (SPECIFY) through the review date. Date initiated: 03/30/2018 . Interview on 4/13/18 at approximately 1:20 p.m. with Staff F (Registered Nurse) confirmed that Resident #80's care plan did not specify what the acceptable goal level of pain was for Resident #80. Resident #185 Observation of Resident #185 in their room on 4/11/18 at 8:35 am revealed the resident has extreme swelling in their hands and feet. Review of Resident #185's progress notes on 4/13/18 at approximately 7:45 am revealed a progress note from 3/25/18 stating that Resident #185 was sent to the hospital for [MEDICAL CONDITION]. Review of Resident #185's current care plan on 4/13/18 at approximately 7:45 am revealed no goals or interventions for [MEDICAL CONDITION]. Interview with Staff A (Director of Nursing) on 4/13/15 at approximately 12:45 pm confirmed Resident #185 had [MEDICAL CONDITION] and there were no goals or interventions for [MEDICAL CONDITION] on Resident #185's care plan. Resident #52 On 4/12/18 at10:15 a.m. an interview with resident #52 revealed that Resident #52 is a smoker and keeps smoking supplies on his person. Resident #52 verbalizes understanding that supplies are to be kept at the nurses station as per facility policy, and that smoking privelages can be lost for non-compliance with the policy. Resident #52 also stated that he/she goes outside to a designated area to smoke, and verbalized keeping smoking materials on his/her person, or in the side of the wheelchair, but not at the nurses station. Review of the care plan for Resident #52, and Policy & Procedure for Resident Smoking on 4/12/18 at 1:30 p.m. revealed that all smoking materials must be returned to the Nurses Station immediately after use. Review of Resident #52's Care Plan on 4/13/18 at approximately 10:30 a.m. revealed that the smoking care plan for Resident #52 is addressed with interventions in place, however, the care plan is not individualized and updated for this specific resident as indicated by the following 2 entries on the care plan: 1.) Resident requires flame retardant apron while smoking: An interview with Staff A, Director of Nursing at 9:55 a.m. revealed that the resident does not require a flame retardant apron while smoking. This is reinforced by a smoking evaluation mentioned below. Staff A, DON, stated that this statement should not be on the care plan as it is not true for this Resident. Resident #52 was observed on 4/11/18 at 2:30 p.m., 4/12/18 at 2:30 p.m. and 4/13/18 at 7:30 a.m. and 9:00 a.m. to be outside in the smoking area. He was not donning a flame retardant apron. 2.) Smoking materials to be held by nursing staff: Interview with Staff A, DON, and Staff D, Licensed Nursing Assistant (LNA) on 4/13/18 at 10:00 a.m. revealed that the smoking materials are to be kept in a locked cabinet at the nurses station when not in use. When Staff D LNA was asked to reveal the contents of the smoking cabinet, there were no smoking materials belonging to Resident #52 observed in the cabinet. Interview on 4/13/18 at 10:40 a.m. with Resident #52 resulted in the resident producing the smoking materials when reqested. The materials were being held by Resident #52 on his/her person. Staff D, LNA also stated when asked, that staff on this unit do not have or use a method for tracking when smoking materials are taken from the nurses station by a resident, or when/if they are returned to the nurses station after use. This statement was confirmed with Staff A, DON. A smoking evaluation was performed on 3/26/18. Review of this document on 4/13/18 at 1:35 p.m. revealed that Resident #52 is safe to handle his/her own smoking materials while in use, but the smoking evaluation stated that the facility Smoking Policy must be followed. Review of Smoking Policy and Procedure on 4/13/18 at 1:40 p.m. revealed that the policy states that the materials are to be kept at the nurses station when not in use by the resident. An interview with Staff A, DON on 04/13/18 at 1:50 p.m. was conducted regarding the discrepancies between assessments offered, policy and procedure, care plan, and what is actually happening with this resident regarding smoking practices. Staff A stated that the facility smoking process for residents was part of a recent Performance Improvement Plan (PIP) of the facility conducted on 3/20/18, and that they had addressed these issues at the time, and the PIP was considered to be completed. Staff A stated that they will need to put a monitoring system in place, as this was part of the PIP, which stated: The Unit Managers will review patient compliance with returning smoking materials., and there was no monitoring system in place as verified by Staff D, LNA and Staff A, DON. Resident #5 Review on 4/12/18 at approximately 11:56 am of Resident #5's medical record revealed a physicians order written on 1/3/18 for an indwelling Foley catheter. Review of Resident #5's care plan on 4/12/18 revealed that there was no documented evidence addressing the indwelling Foley catheter. Interview on 4/12/18 at approximately 12:15 pm with Staff H (Unit Manager) confirmed that there was no documented evidence addressing Resident #5's indwelling Foley catheter. Resident #25 Review on 4/13/18 at approximately 9:42 am of Resident #25's medical record revealed a physicians order dated 12/29/17 for a [MEDICAL CONDITION] pump to be placed on Resident #25's legs for 1 hour in the morning while reclining. Review of Resident #25's care plan on 4/13/18 revealed that there was no documented evidence in the care plan addressing the [MEDICAL CONDITION] pump. Interview on 4/13/18 at approximatley 10:00 am with Staff H (Unit Manager) confirmed that there was no documented evidence in Resident #25's care plan addressing the [MEDICAL CONDITION] pump.",2020-09-01
66,DOVER CENTER FOR HEALTH & REHABILITATION,305018,307 PLAZA DRIVE,DOVER,NH,3820,2018-04-13,658,B,0,1,WGWA11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, it was determined that the facility failed to obtain and follow physician orders for 2 residents in a standard survey sample of 22 residents. (Resident identifiers are #66 and #185.) Findings include: Professional reference: Potter, [NAME] [NAME], and Anne Griffin Perry. Fundamentals of Nursing. 7th ed. St. Louis, Missouri: Mosby Elsevier, 2009. Page 336-Physicians' Orders The physician is responsible for directing medical treatment. Nurses follow physicians' orders unless they believe the orders are in error or harm clients. Therefore you need to assess all orders, and if you find one to be erroneous or harmful, further clarification from the physician is necessary . Resident #66 Observation on 4/11/18 at approximately 10:35 a.m. revealed that Resident #66 was using oxygen that was being administered through a nasal cannula. Review on 4/13/18 of Resident #66's Active Physician Orders revealed no physician order for [REDACTED].>Review on 4/13/18 of Resident #66's Health Status Progress note, dated 3/17/18, revealed a note which read .O2 (oxygen saturation) 92% 2L (on 2 liters) NC (nasal cannula.) Review on 4/13/18 of Resident #66's Respiratory therapy progress note, dated 3/15/18, revealed a note which read .Patient has required supplemental O2 to normalize O2 saturations . Interview on 4/13/18 at approximately 11:30 a.m. with Staff [NAME] (Respiratory Therapist) confirmed that there should have been a physician order in place for Resident #66's use of oxygen. Resident #55 Review on 4/13/18 at 8:56 am of the physician orders dated 3/28/18 revealed an order for [REDACTED]. Review on 4/13/18 at approximately 9:00 am of Resident #55's progress notes revealed the following: on 4/9/18 the resident was receiving O2 at 3 LPM, on 4/8 the resident was receiving O2 at 4 LPM, on 4/6/18 the resident was receiving O2 at 3 LPM, on 4/5/18 the resident was receiving O2 at 3 LPM, on 4/3/18 the resident was receiving O2 at 3 LPM, and on 4/2/18 the resident was receiving O2 at 3 LPM. Interview with Staff A (Director of Nursing) on 4/13/18 at approximately 2:15 pm confirmed the above findings.",2020-09-01
67,DOVER CENTER FOR HEALTH & REHABILITATION,305018,307 PLAZA DRIVE,DOVER,NH,3820,2018-04-13,690,D,0,1,WGWA11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, and interview, the facility failed to ensure that a resident with an indwelling catheter was assessed for removal of the catheter as soon as possible unless the resident's clinical condition demonstrates that catheterization is necessary, for 1 of 2 residents reviewed for catheters in a sample of 22 residents (Resident identifier is #185). Findings include: Observation of Resident #185 on 4/11/18 at 8:36 am revealed the resident had a urinary catheter. Review of physician orders [REDACTED].#185 revealed an order dated 4/8/18 for catheter 16 French with 10 cc balloon to straight drainage. Review of Resident #185's list of [DIAGNOSES REDACTED]. Interview with Staff J (Licensed Practical Nurse) on 4/13/18 at 9:37 am revealed that Resident #185 had a catheter when admitted from the hospital on [DATE] and the reason for the catheter was patient request. Interview with Staff A (Director of Nursing) on 4/13/17 at approximately 1:30 am confirmed there was no clinical [DIAGNOSES REDACTED].",2020-09-01
68,DOVER CENTER FOR HEALTH & REHABILITATION,305018,307 PLAZA DRIVE,DOVER,NH,3820,2018-04-13,695,B,0,1,WGWA11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, it was determined that the facility failed to provide and document that they maintained their schedule for changes in oxygen tubing for 4 residents in a standard survey sample of 22 residents. (Resident identifiers are #18, #23, #66 and #68.) Findings include: Resident #18 Observation on 4/11/18 at approximately 9:55 a.m. of Resident #18 revealed that Resident #18, who was on precautions for [MEDICAL CONDITION] ([MEDICAL CONDITION] Resistant Staph Aureus,) had oxygen tubing attached to an oxygen tank that Resident #18 was using and another oxygen tubing attached to an oxygen concentrator that they were not presently using. Neither of the two oxygen tubings had dates on them. Review on 4/13/18 of Resident #18's (MONTH) (YEAR) Treatment Administration Record revealed that there was no documentation that Resident #18's oxygen tubing was changed on 4/6/18, when it was due to be changed. The box for the nurses initials, documenting the change, was blank for 4/6/18. Review on 4/13/18 of Resident #18's (MONTH) (YEAR) Treatment Administration Record revealed that the last documented date that Resident #18's oxygen tubing was changed was on 3/27/18. Resident #23 Observation on 4/11/18 at approximately 9:40 a.m. of Resident #23 revealed an oxygen concentrator that was running next to Resident #23's bed as Resident #23 was laying in bed sleeping. The oxygen tubing had a piece of tape on the tubing that read 3/31/18. Review on 4/13/18 of Resident #23's Active Physician Orders revealed that Resident #23 had an order for [REDACTED]. Review on 4/13/18 of Resident #23's (MONTH) (YEAR) Medication Administration Record and Treatment Administration Record revealed that there was no documentation of changes to Resident #23's oxygen tubing. Resident #66 Observation on 4/11/18 at approximately 10:35 a.m. revealed that Resident #66 was using oxygen that was being administered through a nasal cannula. The oxygen tubing had tape attached to it that had the resident initials and room number on it, but no date. Review on 4/13/18 of Resident #66's Active Physician Orders revealed no physician order for [REDACTED].#66. Review on 4/13/18 of Resident #66's (MONTH) (YEAR) Medication Administration Record and Treatment Administration Record revealed that there was no documentation of changes to Resident #66's oxygen tubing. Resident #68 Observation on 4/11/18 at approximately 10:30 a.m. revealed that Resident #68 was using oxygen that was being administered through a nasal cannula. The oxygen tubing had tape attached to it that had the date of 3/29/18 on it. Review on 4/13/18 of Resident #68's (MONTH) (YEAR) Medication Administration Record and Treatment Administration Record revealed that there was no documentation of changes to Resident #68's oxygen tubing. Interview on 4/13/18 at approximately 12:00 p.m. with Staff A (Director of Nursing) revealed that there was no facility policy for care of oxygen and tubing, but stated that oxygen tubing was to be changed every week and the change was to be documented on the Medication Administration Record. Review on 4/13/18 of the facility's Performance Improvement Action Plan, dated 3/13/18, revealed the .Topic/Opportunity/Problem . was .Respiratory Equipment Oxygen tubing/infection control . The Plan identified that .oxygen tubing is not always signed off when changed on TAR (Treatment Administration Record) . The Systematic Changes that were put in place were .The staff nurse will sign off weekly on 11-7 shift and document on TAR .The unit managers will monitor weekly that tubing changes has (sic) been signed off per facility infection control practice . The Plan's follow up revealed .Mock survey completed by (Proper Noun) 4/3/18-4/4/18 and identified compliance with facility oxygen tubing change policy .",2020-09-01
69,DOVER CENTER FOR HEALTH & REHABILITATION,305018,307 PLAZA DRIVE,DOVER,NH,3820,2018-04-13,697,D,0,1,WGWA11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, it was determined that the facility failed to provide sufficient pain management to 2 residents in a standard survey sample of 22 residents. (Resident identifiers are #80 and #329.) Findings include: Resident #80 Observation on 4/12/18 at approximately 9:00 a.m. of Resident #80 revealed that Resident #80's facial expressions looked as though they were uncomfortable while laying in bed. Interview on 4/12/18 at approximately 9:00 a.m. with Resident #80 revealed that Resident #80 stated that they are not getting good pain relief from the medications that are being administered to them by the facility. Resident #80 reported that an acceptable pain level for them would be 5-6 out of 10. Review on 4/12/18 of Resident #80's (MONTH) (YEAR) Medication Administration Record [REDACTED]. Review also revealed that Resident #80 had an order for [REDACTED]. Review on 4/12/18 of Resident #80's (MONTH) (YEAR) Medication Administration Record [REDACTED]. Review on 4/12/18 of Resident #80's (MONTH) (YEAR) Medication Administration Record [REDACTED]. Interview on 4/13/18 at approximately 10:10 a.m. with Resident #80 revealed that when they complained of pain, the nurses would bring in [MEDICATION NAME], but Resident #80 stated that Resident #80 preferred [MEDICATION NAME]. Interview on 4/13/18 at approximately 1:20 p.m. with Staff F (Registered Nurse) confirmed that documentation revealed that the parameters, put in place for Resident #80's pain medications were not being followed, and that the parameters should be followed. Resident #329 Interview on 4/11/18 at approximately 1:30 p.m. with Resident #329's granddaughter revealed that Resident #329 complains of not getting relief from pain medications administered for Resident #329's back pain. Review on 4/12/18 of Resident #329's (MONTH) (YEAR) Medication Administration Record [REDACTED]. Review revealed that Resident #329 also had an order for [REDACTED].#329 had orders for [MEDICATION NAME] HCL Tablet 50 mg Give 50 mg by mouth every 6 hours as needed for moderate pain 4-7. Review on 4/12/18 of Resident #329's (MONTH) (YEAR) Medication Administration Record [REDACTED]. Review revealed that Resident #329 received [MEDICATION NAME] on 4/8/18 for a pain level of 3 and on 4/11/18 for a pain level of 4. Review also revealed that Resident #329 received [MEDICATION NAME] on 4/7/18 and 4/11/18 with no documented pain level prior to administration and that the results of the 4/11/18 administration of [MEDICATION NAME] was documented as unknown. Interview on 4/13/18 at approximately 1:20 p.m. with Staff F confirmed that there was no clear indication of when to administer [MEDICATION NAME] or [MEDICATION NAME] to Resident #329 and that documentation revealed that the parameters that were ordered were not being followed, which they should have been.",2020-09-01
70,DOVER CENTER FOR HEALTH & REHABILITATION,305018,307 PLAZA DRIVE,DOVER,NH,3820,2018-04-13,812,E,0,1,WGWA11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, review of the facility's policy and procedure, and interview, it was determined that the facility failed to ensure that perishable food was not stored later than use by date and when food appeared to be spoiling. Findings include: Observation on [DATE] at approximately 8:15 a.m. during kitchen tour in the walk in refrigerator revealed the following: 1 box of romaine lettuce that was discolored brown. 1 pan of meatballs with a use by date of [DATE]. 1 container of brown oranges. 1 box of withered apples. Interview on [DATE] at approximately 8:15 a.m. with Staff B (Cook) revealed that the food in the walk-in refrigerator was stored later than use by date and when food appeared to be spoiling. Interview on [DATE] at approximately 9:05 a.m. with Staff C (Dietary Manager) revealed that the expired items were supposed to be removed from the refrigerator the night before. Review on [DATE] of the facility's policy and procedure titled, Food Storage, Revised date ,[DATE] revealed: Policy: It is the policy of this facility that sanitary conditions should be maintained in all storage areas of food. . Proper Food Preparation: 7. Food that is outdated or of questionable quality will be discarded.",2020-09-01
71,DOVER CENTER FOR HEALTH & REHABILITATION,305018,307 PLAZA DRIVE,DOVER,NH,3820,2018-04-13,842,B,0,1,WGWA11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of Resident #76's medical record , and interview it was determined that the facility failed have a baseline assessment for a seat belt for 1 resident in a standard survey sample of 22 residents (Resident identifier is #76.) and it was determined that the facility failed to document the notification of the physician of drug warnings triggered for 2 residents in a standard survey sample of 22 residents. (Resident identifiers are #35 and #329.) Findings include: Resident #76 Interview on 4/11/18 at approximately 9:15 a.m. with Resident #76 revealed that Resident #76 used a seatbelt whenever they are in their wheelchair. Review on 4/13/18 of Resident #76's medical record revealed that on the 24 hour positioning plan there was a seat belt iniated on 3/2/18 for positioning. There was no baseline assessment done for the residents ability to self release the seat belt. Interview on 4/13/18 at approximately 11:45 a.m. with Staff A (Director of Nursing) revealed that there was no assessment for Resident #76's use of a seat belt while in wheelchair. Resident #329 Review on 4/13/18 of Resident #329's (MONTH) (YEAR) Medication Administration Record [REDACTED]. Review revealed that Resident #329 also had an order for [REDACTED]. Review revealed that Resident #329 also hadan order for [REDACTED].>Review on 4/13/18 of Resident #329's (MONTH) (YEAR) Medication Administration Record [REDACTED]. Review on 4/13/18 of Resident #329's Progress notes revealed an order note, dated 4/4/18, which was time stamped at 17:34 (5:34 p.m.) and read .The order you have entered [MEDICATION NAME] Tablet 200 mg Give 200 mg by mouth every 6 hours as needed for pain/fever Has (sic) triggered the following drug protocol alerts/warning(s): Drug to Drug Interaction. The system has identified a possible drug interaction with the following orders: [MEDICATION NAME] Sodium Solution 30 mg/0.3 ml Inject 30 mg subcutaneously one time a day for blood thinner Severity: Severe Interaction: The risk of bleeding induced by [MEDICATION NAME] Sodium Solution 30 mg/0.3 ml may be increased by coadministration of [MEDICATION NAME] Tablet 200 mg, including the development of procedure-related [MEDICATION NAME] or spinal hematomas . Aspirin Tablet 325 mg give 325 mg by mouth one time a day for heart Severity: Severe Interaction: Regular use of [MEDICATION NAME] Tablet 200 mg may decrease the antiplatelet effects of Aspirin Tablet 325 mg. Reduced antiplatelet efficacy in patients with underlying cardiovascular risk may occur. Additionally, the potential for gastrointestinal side effects, including bleeding, may be increased with regular use of full-dose or low-dose aspirin. Review on 4/13/18 of Resident #329's Progress notes revealed an order note, dated 4/4/18, which was time stamped at 18:58 (6:58 p.m.) and read .The order you have entered [MEDICATION NAME] Sodium Solution 30 mg/0.3 ml (milliliters) Inject 30 mg subcutaneously one time a day for blood thinner until 04/09/2018 23:59 (11:59 p.m.) Has (sic) triggered the following drug protocol alerts/warning(s): Drug to Drug Interaction. The system has identified a possible drug interaction with the following orders: Aspirin Tablet 325 mg give 325 mg by mouth one time a day for heart Severity: Severe Interaction: The risk of bleeding in [MEDICATION NAME] Sodium Solution 30 mg/0.3 ml treated patients may be increased by Aspirin Tablet 325 mg, including the development of procedure-related [MEDICATION NAME] or spinal hematomas. [MEDICATION NAME] Tablet 200 mg Give 20 mg by mouth every 6 hours as needed for pain/fever Severity: Severe Interaction: The risk of bleeding induced by [MEDICATION NAME] Sodium Solution 30 mg/0/3 ml may be increased by coadministration of [MEDICATION NAME] Tablet 200 mg , including the development of procedure-related [MEDICATION NAME] or spinal hematomas . Review on 4/13/18 of Resident #329's Progress notes revealed that there was no documented evidence that the facility notified Resident #329's physician of these warnings. Interview in 4/13/18 at approximately 1:20 p.m. with Staff F (Registered Nurse) confirmed that there was no documented evidence that Resident #329's physician was notified of the warnings, and that the physician should have been notified. Resident #35 Review of Resident #35's physician orders [REDACTED]. Review on 04/13/18 at 8:05 am of Resident #35's Medication Administration Record [REDACTED]. Review on 4/13/18 at 12:49 pm of Resident #35's progress notes revealed on 3/22/18 an order for [REDACTED]. Interview with Staff H (Registered Nurse, Unit Manager) on 4/13/18 at 11:03 am revealed when orders are entered into the computer, nurses immediately receive an alert if there are pharmacy irregularities. Staff H revealed that Staff H notifies the provider knows when Staff H recieves alerts of pharmacy irregularites but does not have the provider sign anything. Interview with Staff I (Licensed Practical Nurse) on 4/13/18 at 11:17 am revealed that when Staff I receives an alert of a pharmacy irregularity Staff I would call the provider and notify them of the interactions and document the notification in the electronic medical record but they do not have the provider sign anything.",2020-09-01
72,DOVER CENTER FOR HEALTH & REHABILITATION,305018,307 PLAZA DRIVE,DOVER,NH,3820,2019-05-13,804,E,0,1,5N2V11,"Based on observation, resident interviews and resident council it was determined that the facility failed to provide foods that are palatable, attractive and at an appropriate temperature. (Resident identifiers are: #5, #56, #66, #79, and #244) Findings include: Observation on 5/8/19 at 1:00 p.m. during mealtime observations meal carts on the Glennwood unit arrived over an hour late. The carts were to arrive at 12:00 p.m. but instead arrived at 1:00 p.m. Staff on the unit stated to surveyor that this happens a lot and it's difficult to care for residents and for staff to schedule their lunch breaks when the food cart come to the floor so late. Several residents on the unit during interviews stated that the food is cold lots of time, staff will heat it up but then it gets tough and chewy because it has to be microwaved. Interview on 5/9/19 at 2:04 p.m. with Staff A (Administrator), Staff B (Regional manager), and Staff C (Director of food services from Massachusetts) confirmed that all food products are canned foods and are not cooked to order just poured out of a can and heated. Observation on 5/9/19 at 11:30 a.m. of the Foods prepared were Turkey stew, Diced Pork with Gravy, Mashed potatoes, etc A test tray was performed at this time, the foods that was served were Diced Turkey with Gravy, Mashed potatoes along with a salad and Pear Crisp with Topping. The diced Turkey with gravy was none palatable and looked and tasted like ham. Also the potatoes were bland, and non palatable. These findings were told to Staff C and Staff A at the time of the test tray being performed. Staff C also questioned the looks of the Turkey and the taste along with the potatoes, stating they need to work outside the food menu that is provided by corporate to have these foods taste better. Interview on 05/09/19 8:38 a.m. with three kitchen staff, regarding times the cart gets to the units, and food temperatures, and what may be the cause. One staff member spoke up Staff D (Cook), who revealed that the right side of the main steam tray line is not as hot as it used to be. At this time food was removed from the steam cart and water temp was tested the right bay temperature closest to the oven tested at 120 degrees and the other two bays were over 140 degrees but could not continue hold the thermometer due to temperature of steam. Interview on 5/10/19 10:41 a.m. with Staff C and Staff D (Cook) regarding meal times and times of cart services were asked if the main dining room is served their meals at 12 p.m. how do you service Glennwood's meals since on the Meal Delivery Times shows that Glennwood is being served trays at 12 p.m. and 12:15 p.m. Staff D said they do their best to get the trays out but sometimes they have to stop tray services to the units at 12 p.m. and serve the main dining room then they will start tray line again to the units which does cause trays to be late. A Resident's Council meeting of 5/9/19 revealed that all twelve residents present felt that the food at the facility was not palatable. Residents who attended this meeting mentioned mystery meat being served at the facility meaning they didn't know from tasting it what kind of meat had been served. They felt that this was because of the poor quality of the food. Resident #244. Interview on 5/8/19 at approximately 10:30 a.m. with Resident #244 revealed that the facility's food is cold and that staff do offer to heat the food but when they do it is over cooked or dried out so that you don't want to eat it. Resident #244 reported that the food was bland no taste and that family brings in food. Resident #244 also reported at this time that the coffee is warm not hot and that when asked the staff will heat it up. Resident #79 Interview on 5/8/19 at approximately 10:00 a.m. with Resident #79 revealed, The food is not good and when you call the kitchen staff to ask for something they are rude and then hang up on you. Resident #56 Interview on 5/8/19 at approximately 11:30 am. with Resident #56 revealed, The food is often times cold and food is not very good. I ordered pancakes today and as soon as I took the cover off of them, I put butter on them and it just sat there - it didn't melt. Resident #66 Interview on 5/8/19 at approximately 9:45 a.m. with Resident #66 revealed Supper meals have changed and are not appetizing, this has come up at council and no changes have been made. We have been asking for oranges for months and there still aren't any available and they run out of what is on the menu all the time. Interview on 5/8/19 at approximately 12:15 p.m. with Staff [NAME] (Medication Nurse Assistant) revealed, The food trucks are late most of the time. Interview on 5/8/19 at approximately 12:20 p.m. with Staff F (Licensed Practical Nurse) revealed, The food trucks are more late than not. It makes it difficult for nursing to assist with toileting with residents from the dining room. They are coming back to the unit when the food trucks are just getting here. Staff are having a hard time taking their own lunches because of this too. Resident #5 Interview on 5/9/19 at approximately 7:35 a.m. with Resident #5 revealed, The food is often cold and doesn't taste well at all.",2020-09-01
73,DOVER CENTER FOR HEALTH & REHABILITATION,305018,307 PLAZA DRIVE,DOVER,NH,3820,2019-05-13,812,E,0,1,5N2V11,"Based on observation and interview it was determined that the facility failed to prepare, distribute and serve food in accordance with professional standards for food serviced safely. Findings include: Observation on 5/8/19 during the initial tour of the kitchens walk in refrigerator at 9:00 a.m. revealed two different jars of pickles one B---- slices 1/8 smooth pickles with multiple use by dates of 11/15, 3/19, 3/17/19, and 4/25/19. The jar itself internally had buildup on the inside of the glass and cover. This finding was shown to Staff A (Administrator) who discarded the product right away. The second jar of (K----- Dill Pickles) with a use by date of 3/22/19 and 4/19/19. This product was also discarded by Staff A at time of finding. Observation on 5/8/19 at 10:25 a.m. revealed a counter mounted can opener that was ready for use covered with food product that was not properly cleaned. Staff A was also shown this who removed it from services. Observation on 5/9/19 11:30 a.m. while observing the tray line for the test tray it seemed very non-functional. The kitchen aide starts the tray set up with pellet warmer, utensils, and meal ticket. Then the tray is slid down on a steel table to the cook who reads the meal ticket off the tray touching the ticket with their gloved hand, then distributes the foods they read off the ticket and then places the plate onto the tray. During this time several items had been missed which were picked up by other staff and corrected. During these observations multiple times kitchen staff are reaching and placing items from different areas to meet the needs of the resident's meal tickets but failing to maintain safe food handling by touching multiple different surface areas and not changing gloves.",2020-09-01
74,DOVER CENTER FOR HEALTH & REHABILITATION,305018,307 PLAZA DRIVE,DOVER,NH,3820,2018-12-07,580,D,1,1,9HC411,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on interview and record review, it was determined that the facility failed to notify resident representatives when a resident made an allegation of abuse and when a resident pulled out a urinary catheter, prior to insertion of another catheter, for 2 residents in a standard survey sample of 22 residents. (Resident identifiers are #41 and #55.) Findings include: Resident #41 Review on 12/4/18 of the Facility Report to the Long Term Care Ombudsman, dated 11/13/18, revealed that Resident #41 reported to therapy staff on 11/13/18 that they were assaulted by the male night staff. Resident #41 reported that .a man came in my room and was touching me inappropriately .Resident reported that he was not alone . The report revealed that staff member, Staff B (Licensed Practical Nurse) .was assisting with rounds on this resident Staff B reported that they had Staff D (Licensed Nursing Assistant) .assisting (pronoun for Staff B) with rounds on this resident. They changed resident (sic) brief at this time . Further review of the Facility Report revealed that there was no documentation indicating that Resident #41's guardian was notified of the allegation. Review on 12/6/18 of Resident #41's current care plan revealed that Resident #41 has a guardian from the Office of Public Guardian. Review on 12/6/18 of the Facility's investigation, and the nurses notes for Resident #41 revealed that there was no documented evidence that Resident #41's guardian was notified of the allegation of abuse made by Resident #41 or of the investigation that followed. Review on 12/7/18 of the Facility's policy, titled Abuse, revised on 3/18, revealed that the Facility's Reporting/Documentation Requirements were that .family or responsible party are to be notified immediately after the incident has occurred . Interview on 12/7/18 at approximately 8:30 a.m. with Staff [NAME] (Director of Nursing) confirmed that there was no documented evidence that Resident #41's guardian was notified of the allegation or the investigation, and that there should have been documented evidence. Resident #55 Review on 12/6/18 of Resident #55's nursing progress notes revealed a note, dated 9/11/18 at 2:11 a.m., that read Resident pulled out .foley catheter and stated, 'I don't want it.' Refused to allow insertion of new catheter. Dr notified. Review on 12/6/18 of Resident #55's Physician orders [REDACTED]. Review on 12/6/18 of Resident #55's Physician Order, dated 1/5/18, revealed an order that read Activate DPOA . Review on 12/6/18 of Resident #55's nursing progress notes revealed a note, dated 9/11/18 at 2:19 p.m., that read Foley catheter 16 French with 10 cc (cubic centimeter) balloon was placed via (by way of) sterile technique. Catheter is patent and draining yellow urine without issue . There was no documented evidence that Resident #55's DPOA was notified of Resident #55 pulling out their catheter or that there was a discussion about the plan of care for Resident #55. Interview on 12/7/18 at approximately 8:30 a.m. with Staff [NAME] confirmed that there was no documented evidence of notification of Resident #55's DPOA or discussion regarding plan of care, and that there should have been.",2020-09-01
75,DOVER CENTER FOR HEALTH & REHABILITATION,305018,307 PLAZA DRIVE,DOVER,NH,3820,2018-12-07,610,D,1,1,9HC411,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on interview, record review and facility policy review, it was determined that the facility failed to thoroughly investigate an alleged violation of abuse and to implement appropriate corrective actions to prevent further allegations of abuse for 1 resident in a standard survey sample of 22 residents. (Resident identifier is #41.) Findings include: Interview on 12/4/18 at approximately 11:30 a.m. with Resident #41 revealed that Resident #41 stated that a couple of weeks ago, they were inappropriately touched in their perineal area by a male staff member. Resident #41 stated that this male had also groped them several times since this original incident. While explaining the groping, Resident #41 was rubbing their chest area, indicating that it was their chest area that was groped. Resident #41 stated that this staff member was in their room last night and had groped their chest area again. Review on 12/4/18 of the Facility Report to the Long Term Care Ombudsman, dated 11/13/18, revealed that Resident #41 reported to therapy staff on 11/13/18 that they were assaulted by the male night staff. Resident #41 reported that .a man came in my room and was touching me inappropriately .Resident reported that he was not alone . The report revealed that staff member, Staff B (Licensed Practical Nurse) .was assisting with rounds. Staff B reported that (pronoun) had Staff D (Licensed Nursing Assistant) .assisting (pronoun) with rounds on this resident. They changed resident (sic) brief at this time . The Facility Report also revealed that Resident #41's care plan was reviewed and updated to have only female caregivers and two for ADL's (Activities of Daily Living.) Review on 12/6/18 of the Facility's investigation regarding the allegation made by Resident #41 revealed a statement, dated 11/13/18, which was written by Staff [NAME] (Director of Nursing) and had a verbal explanation given to Staff [NAME] by Staff B, the alleged perpetrator. In the statement, Staff B reported that on the 11-7 shift on 11/12/18 (the shift started at 11:00 p.m. on 11/12/18 and ended at 7:00 a.m. on 11/13/18) they were walking by Resident #41's room and saw Resident #41 ambulating by themselves. Staff B stated that they assisted Resident #41 back to bed. They stated that Staff C (Licensed Practical Nurse) heard them ask for assistance and Staff C immediately responded. Staff B reported that Resident #41 told Staff B to get out now. Staff B reported that they left at that time and did not provide personal care to Resident #41. There was nothing in the statement about the incontinent care that Staff B and Staff D had provided to Resident #41 earlier in the shift. Review on 12/6/18 of the Facility's investigation regarding the allegation made by Resident #41 revealed another statement. This statement was also written by Staff E, but signed and dated on 11/12/18, (Resident #41 did not report the incident to staff until 11/13/18) by Staff C. In that report, Staff C stated that Staff B was returning from break and saw Resident #41 walking by themselves. Staff B immediately got Staff C to assist Resident #41 back to bed. Staff B placed their hand on Resident #41's shoulder for assistance. The statement also revealed that Staff B was the only male staff member on 11/12/18 and was not alone in the room. Review on 12/6/18 of the Facility's investigation regarding the allegation made by Resident #41 revealed that there was no statement from Staff D. There was no evidence in the investigation file that Staff D was ever interviewed regarding the interaction that occurred when Staff B and Staff D changed Resident #41's brief. Interview on 12/7/18 at approximately 7:10 a.m. with Staff C revealed that Staff C stated that on 11/12/18, Staff B saw Resident #41 going to the bathroom by themselves and asked Resident #41 to wait for help. Staff B called out in the hallway but did not go in to Resident #41's room. Staff C took over and assisted Resident #41. Interview on 12/7/18 at approximately 7:15 a.m. with Staff B revealed that Staff B stated that they did not know anything about the incident on 11/12/18. Staff B reported that they were not even working on that night. Staff B denied having provided incontinent care to Resident #41 with Staff D. Staff B stated that the incident was not discussed with them by Staff [NAME] and that they knew that there were to be no male caregivers, but had only heard that through the grapevine a while later. Review of the Facility's Daily Attendance report revealed that Staff B did work from 10:45 p.m. until 7:15 a.m. on 11/12/18. Interview on 12/7/18 at approximately 10:10 a.m. with Staff D revealed that Staff D stated that on 11/12/18, they assisted Staff B, who was working as an LNA that night, to change Resident #41's incontinent brief. Staff D stated that later on in the shift, Staff D was told by Staff C that Staff B saw Resident #41 ambulating in their room by themselves. When Staff B called for assistance, Staff C responded and Staff C and Staff B assisted Resident #41 to the bathroom and provided care. Staff D reported that they had not been interviewed about anything that had occurred on 11/12/18 by any Administrative staff. They also stated they they were aware that there were to be no male caregivers, but only heard that through the grapevine about a week later, when they also heard that there was an allegation made by Resident #41. Staff D stated that they were not aware of how many staff were to care for Resident #41. Review on 12/6/18 of Resident #41's (MONTH) (YEAR) and (MONTH) (YEAR) Medication Administration and Treatment Administration Records revealed that there was documentation that Staff B checked placement of Resident 41's [MEDICATION NAME] on 11/26/18, on 12/3/18 with the documented placement on Resident #41's chest, and on 12/4/18 with the documented placement on Resident #41's chest. Review on 12/6/18 of Resident #41's (MONTH) (YEAR) and (MONTH) (YEAR) Medication Administration and Treatment Administration Records revealed that there was also documentation that another male staff member, Staff F (Licensed Practical Nurse,) performed procedures on Resident #41. The documentation revealed that Staff F applied barrier cream to Resident #41's buttocks on 11/16/18, 11/19/18, 11/23/18, 11/24/18, and 11/25/18, Staff F did a skin check on Resident #41 on 11/19/18. Staff F also checked [MEDICATION NAME] placement on Resident #41 on 11/25/18, cleansed a wound on Resident #41's right knee on 11/23/18, removed compression stockings on Resident #41 on 11/16/18, 11/19/18, 11/23/18, 11/24/18, 11/25/18, and 12/4/18, and applied warm compresses to Resident #41's right knee on 11/16/18, 11/19/18, 11/23/18, 11/24/18 and 11/25/18. Review on 12/6/18 of the Facility's Policy titled Abuse, revised on 3/18, revealed that The administrative staff .assumes responsibility for .Immediate investigation into the alleged incident .Interview staff member implicated. Have employee document their knowledge/version of incident in written narrative that is dated and signed Interview witnesses or other available witnesses. Witnesses are to document incident in a written narrative that is dated and signed. Supervisory staff to discuss written statements with employee . Facility investigation will be completed within 72 hours of the incident .Immediately after the incident occurs an interim conference is to be held to develop interventions to ensure the resident does not experience any physical harm, pain or mental anguish . Interview on 12/7/18 with Staff [NAME] confirmed that the facility policy for an investigation was to get statements from all staff involved. If they were unable to get a written statement, they would get a verbal one, which was followed up by a written statement, dated and signed, as soon as possible. Staff [NAME] confirmed that there were no statements written by Staff B or Staff C and that there was no statement at all for Staff D. Staff [NAME] also confirmed that Staff B did work on the night of 11/12/18 and did provide incontinent care to Resident #41 with Staff D, earlier in the shift before Resident #41 was found ambulating independently in their room. Staff [NAME] also confirmed that as part of the follow up plan, no physical care to Resident #41 should have been provided by male staff. Staff [NAME] stated that there were always female nurses in the building and that male staff could always get a female to perform the tasks and to document them.",2020-09-01
76,DOVER CENTER FOR HEALTH & REHABILITATION,305018,307 PLAZA DRIVE,DOVER,NH,3820,2018-12-07,641,B,0,1,9HC411,"Based on record review and and interview, it was determined that the facility incorrectly coded the Minimum Data Set assessment for one resident, in a survey sample of 22 residents. (Resident identifier is #7.) Findings include: Resident #7 Interview with this resident on 12/5/18 p.m. revealed that they had a below knee amputation and a Charcot foot 5 years ago, and since then they have a prosthesis for the right lower extremity and they use a boot for the left lower extremity. Review on 12/6/18 p.m. of Resident #7's medical record revealed that both the 6/13/18 and the 9/8/18 quarterly Minimum Data Set assessments code the resident in Section G as having no Limp prosthesis. However, record review of the 5/9/18 Admission/Readmission Evaluation document reveals at Section F.m. that the resident does have a prosthesis.",2020-09-01
77,DOVER CENTER FOR HEALTH & REHABILITATION,305018,307 PLAZA DRIVE,DOVER,NH,3820,2018-12-07,726,D,1,1,9HC411,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on record review and interview, it was determined that the facility failed to ensure an aide in training was properly supervised during the administration of care for one resident in a survey sample of 22 residents. (Resident identifier is #7.) Findings include: Resident #7 Interview on 12/5/18 a.m. with this resident revealed that on 10/2/18 a new male aide put Resident #7 to bed against Resident #7's will and hurt Resident #7 by doing it roughly, and when the resident asked him to stop he didn't until Resident #7 yelled. Then he sponge bathed her peri area but didn't use dry sponge as resident requested; he put on a brief but he made a wound in the area. At next shift the (another) aide said the brief was put on incorrectly and changed it and the resident had pain and is still being treated for [REDACTED].#7 identified the aide, Staff J (LNA), by name and that the resident .was aware that . (Staff J) was a newly licensed nursing assistant and that he had only been working for about a week Review on 12/6/18 a.m. of the wound weekly observation tools for 10/9/18, for Resident #7, revealed right posterior upper thigh superficial abrasion acquired 10/9/18 and left posterior upper thigh superficial abrasion acquired 10/9/18. Record review of the 10/9/18 Skin/Wound Note reveals . skin check was done on resident's buttocs (sic) and upper legs Two superficial skin abrasions observed . right posterior thigh left posterior thigh Wound consult order was also obtained Interview on 12/7/18 a.m. with Staff [NAME] (director of nursing), revealed that Staff J started in the kitchen as a dietary aide, until he was certified as nurse aide. Review on 12/07/18 a.m. of Staff J's employee record revealed a Personnel Action Form for Dietary Aide effective date 5-11-18 lists date employed as 5-11-18. The NH (New Hampshire) State Police Criminal Records Unit check completed 5/8/18 found no record. The BEAS (bureau of elderly and adult services) State Registry check completed 5/11/18 was no finding. The OIG (office of inspector general) search conducted 11/23/18 was negative. And the NH Online Licensing printout reveals the issue date for LNA as 10/12/18. Review on 12/07/18 p.m. of the Mandatory Competency Check off List for Staff J revealed most Skills were rated Acceptable on 11/1/18; but Peri / Incontinence Care, Indwelling Catheter Care, Mouth Care and Nail care were all rated Unacceptable on 11/1/18, with a Re-demonstration Date of 11/15/18. Interview on 12/07/18 01:08 PM with Staff [NAME] revealed Staff J was in training (still enrolled in LNA class at that time and was competent to do that care from that class) when he did the peri-care to the resident on 10/2/18, he was doing that care alone but should not have been as he wasn't cleared to be on the floor but Resident #7 wanted him to come in and do the care and the resident knew he was in training. The buttock abrasions are not related to that 10/2/18 care as they did not appear until some days later. The 10/2/18 incident was reported to Staff [NAME] that day or shortly after. Staff J was off the floor and not working alone while the incident was investigated. His abuse training was on 5/11/18.",2020-09-01
78,DOVER CENTER FOR HEALTH & REHABILITATION,305018,307 PLAZA DRIVE,DOVER,NH,3820,2018-12-07,880,B,0,1,9HC411,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and interview the facility failed to ensure Transmission Based Contact Precautions were maintained with Personal Protective Equipment for two of two residents in a survey sample of 22 residents, failed to ensure a facility wide Infection Control surveillance and documentation was completed. (Resident identifiers are #41 and #292.) Findings include: Resident #292. Review on 12/6/18 of Resident #292's medical record showed that Resident #292 was admitted to the facility on [DATE] with the multiple [DIAGNOSES REDACTED]. Resident #292 was placed on Transmission Based Contact Precautions at the time of admission due to [MEDICAL CONDITION]. Observation 12/4/18 13:28 p.m. showed an individual (non staff member) in Resident #292's room without any gown or gloves (Personnel Protective Equipment) on for Transmission Based Contact Precautions going several times in & out of Resident #292's bathroom. Observation on 12/5/18 at approximately 12:30 P.M. showed two visitors in Resident #292's room with gowns & gloves on. Interview with these two individuals, identified by Resident #292 as son & daughter of Resident #292, revealed that these two individuals reported they know what to wear when visiting due to white index card attached to yellow over the door precaution supply of PPE. The son reported that at the hospital there was a sign posted on . (Resident #292) door indicating See nurse before entering and hospital staff would tell visitors what PPE was needed when visiting in (Resident #292's) room. Interview & observation on 12/6/18 at 1:30 p.m. with Staff A (Licensed Practical Nurse) confirmed that the PPE supplies contained in the yellow multi-pouched over the door hanger with a piece of white paper attached on the front of this yellow PPE supply container indicating STOP was checked off in boxes on this white paper indicating Gown, Gloves and wash hands. Staff A (LPN) confirmed that a gown & gloves would be worn by individuals when entering room to visit Resident #292 Observation on 12/5/18 at 1:30 p.m. with Staff A ( LPN) revealed that when Resident #292's room door is open the white sheet of paper indicating PPE is not visible and that visitors can enter Resident #292's room and visit without wearing PPE. Staff A ( LPN) agreed and reported no other signs or information is visible or posted to ensure individuals entering Resident #292's room wear gown and gloves to comply with Contact Precaution protocol. Observation and interview on 12/6/18 at approximately 3:25 p.m showed a female and male visitor in Resident #292's room with no gowns or gloves ( PPE) . Resident #292 introduced the female as his wife and the male visitor as a good friend. Wife reported that they don't have to use . (PPE) available on Resident #292's door because they told me at the hospital we only had to do that (pointing to the PPE) for 10 days and the 10 days are up. Resident #292 confirmed that the son & daughter visiting yesterday, 12/5/18, had the gowns and gloves on during the visit. Interview on 12/4/18 at approximately 11:30 a.m. with Staff I (Registered Nurse, Infection Control), revealed that walking rounds do not include the kitchen or the laundry. Staff I explained that she/he does walking rounds every Monday which consists of all the nursing areas. She/he does not go into the kitchen or the laundry as this is done by the maintenance staff for review of life safety and fire hazards, not infection control. Staff I presented a form, titled Facility Unit Rounds, this includes the areas that Staff I inspects every Monday for her/his walking rounds and do not include the kitchen, laundry or rehabilitation areas. Interview on 12/7/18 at approximately 2:30 p.m. with Staff [NAME] (Director of Nursing), revealed that walking rounds do not include the kitchen or the laundry. Staff [NAME] provided a form, titled Facility Unit Rounds, this includes the areas that are considered walking rounds that are currently reviewed by Staff I. This form consists of nursing unit specific areas only. At this time, the kitchen, laundry and rehabilitation areas are not being reviewed for potential infection control issues. Resident #41 Interview on 12/4/18 at approximately 9:30 a.m. with Staff G (Unit Manager) revealed that Resident #41 was on droplet precautions [MEDICAL CONDITIONS] in the nares, and that when entering the room a gown, gloves and a mask must be worn. Observation on 12/4/18 at approximately 11:15 a.m. revealed that Resident #41 was laying in their bed. Staff H (Housekeeper) was cleaning Resident #41's room, and was standing right next to Resident #41's bed using a mop to clean under the bed. Staff H was wearing a gown and gloves and was also wearing a mask, but the mask was only covering Staff H's mouth, it was not covering Staff H's nose. Interview on 12/4/18 at approximately 11:20 a.m. with Staff G (Unit Manager) confirmed that Staff H's mask should have been covering both their mouth and their nose.",2020-09-01
79,EDGEWOOD CENTRE (THE),305022,928 SOUTH STREET,PORTSMOUTH,NH,3801,2019-02-01,609,D,0,1,XVXH11,"Based on medical record review, and interview, it was determined that the facility failed to report a case of neglect, to the state survey agency for 1 of 1 resident in a final survey sample of 21 residents. (Resident identifier is #33.) Findings include: Review on 1/31/19 at 9:06 a.m. of Resident #33's nurses note dated 6/26/18 revealed Resident heard calling for help from South wing whirlpool room. Staff entered to find resident sliding down in tub filed with water. Tub drain opened and several staff members assisted holding resident while Hoyer pad was placed under (resident). At no time was (resident's) face or head under water. Resident then Hoyer transferred to w/c (wheelchair) and back to bed to get dressed. No pain or apparent injures noted to resident. Facility DON (Director of Nurses) and POA (Power of Attorney) notified of incident. Review on 1/31/19 at 9:59 a.m. of Resident # 33's care plan revealed under (focus) care area for ADLs (Activities of Daily Living): I have an ADL self-care performance deficit r/t (related to) left parietal intraparenchymal hemorrhage, right hemipligia, and decreased strength Date initiated: 7/12/17 Under (interventions) states Bathing/showering: I require extensive assistance by one staff with bathing/showering. Interview on 1/31/19 at 10:04 a.m. with Resident #33, Resident #33 stated I was so scared I almost drowned Resident #33 was asked if anyone was with (Resident #33) at the time of the event Resident #33 stated no. Resident #33 also said since that event I have not had a tub since, and I love having tubs. Maybe if someone stayed with me I could try again. Interview on 1/31/19 at 11:51 a.m. with Staff A (Administrator), Staff B (Director of Nurses). and Staff C (Unit manger) confirmed that the event as written occurred and that the staff member who was caring for Resident #33 was not in the tub room at time of the event. Since this incident, the staff member has quit due to the what had occurred. The Administrator also was asked if the event was sent to the state survey agency? The administrator stated, no, because the resident was not hurt and it was not felt to be reportable.",2020-09-01
80,EDGEWOOD CENTRE (THE),305022,928 SOUTH STREET,PORTSMOUTH,NH,3801,2019-02-01,689,D,0,1,XVXH11,"Based on medical record review and interview, it was determined that the facility failed to ensure that 1 of 1 resident receives adequate supervision to prevent accidents in a final survey sample of 21 residents. (Resident identifier is #33.) Findings include: Review on 1/31/19 at 9:06 a.m. of Resident #33's nurses note dated 6/26/18 at 11:37 states Resident heard calling for help from South wing whirlpool room. Staff entered to find resident sliding down in tub filed with water. Tub drain opened and several staff members assisted holding resident while Hoyer pad was laced under him. At no time was (residents) face or head under water. Resident they Hoyer transferred to w/c and back to bed to get dressed. No pain or apparent injures noted to resident. Facility DON (Director of Nurses) and POA (Power of Attorney) notified of incident. Review on 1/31/19 at 09:59 a.m. Resident #33's care plan states under (focus) care area for ADLs (Activities of Daily Living): I have an ADL self-care performance deficit r/t (related to) left parietal intraparenchymal hemorrhage, right hemipligia, and decreased strength Date initiated: 7/12/17 Under (interventions) states Bathing/showering: I require extensive assistance by one staff with bathing/showering. Interview on 1/31/19 at 10:04 a.m. Resident #33 stated I was so scared I almost drowned Resident #33 was asked if anyone was with him at the time of the event Resident #33 stated no. Resident #33 also said since that event I have not had a tub since, and I love having tubs. Maybe if someone stayed with me I could try again. Interview on 1/31/19 at 11:51 a.m. with Staff A (Administrator), Staff B (Director of Nurses). and Staff C (Unit manger) confirmed that the event as written occurred and that the staff member who was caring for Resident #33 was not in the tub room at time of the event. Since this incident, the staff member has quit due to the what had occurred.",2020-09-01
81,EDGEWOOD CENTRE (THE),305022,928 SOUTH STREET,PORTSMOUTH,NH,3801,2017-02-10,329,D,0,1,FQ0H11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview it was determined that the facility failed to adequately monitor residents with identified target behaviors for the effects and potential adverse consequences of antipsychotic medications for 2 of 2 residents receiving antipsychotic medications in a survey sample of 22 residents. (Resident identifiers are #3 and #5.) Findings include: Resident #5. Record review on 2/7/17 and 2/8/17 of the MEDICATION ADMINISTRATION RECORD (MAR) for Resident #5 dated 1/1/17 and 2/1/17 revealed the following physician orders [REDACTED]. [MEDICATION NAME] 12.5 mg by mouth every morning and at bedtime related to Hallucinations [MEDICATION NAME] 0.5 mg by mouth every 4 hours as needed for [MEDICAL CONDITION]/restlessness PRN (as needed) [MEDICATION NAME] 12.5 mg by mouth every 24 hours as needed for distressing hallucinations PRN. Review of the (MONTH) MAR revealed the following physician orders: [MEDICATION NAME] 0.5 mg by mouth every 4 hours as needed for [MEDICAL CONDITION]/restlessness PRN [MEDICATION NAME] 12.5 mg by mouth every 24 hours as needed for distressing hallucinations PRN. Further record review showed no documented evidence of ongoing monitoring with an identified target behavior for the prescribed antipyschotic medications listed above for Resident #5. During interview on 2/8/17 at approximately 4:45 p.m. with Staff A (Registered Nurse) after Staff A reviewed the above listed physician orders, the (MONTH) and (MONTH) MAR and computer E-MAR (Electronic Medication Administration Record), Staff A stated that there was no documented evidence of ongoing monitoring with an identified target behavior for the prescribed antipsychotic medications for Resident #5 during the months of (MONTH) and (MONTH) (YEAR). Resident #3 Record review on 2/7/17of the MAR dated 2/1/17-2/28/17 revealed the following physician orders [REDACTED]. There was no documented evidence of behavior monitoring in the medical record or the MAR with an identified target behavior for the prescribed antipsychotic medications.",2020-09-01
82,EDGEWOOD CENTRE (THE),305022,928 SOUTH STREET,PORTSMOUTH,NH,3801,2017-02-10,371,E,0,1,FQ0H11,"Based on observation and interview the facility failed to ensure safe sanitation practices, including kitchen personnel wearing hairnet covering all hair and food handling processes. Findings include: During the kitchen tour on 2/7/17 at approximately 9:40 a.m. with Staff [NAME] (Food Service Director) it was observed that the high temp dishwasher rinse cycle only reached 176 degrees Fahrenheit after 4 empty trays were processed through. Review of the facility's temperature logs revealed the following below range entries: 1/27/17 the rinse cycle reached 160 degrees Fahrenheit, 1/29/17 the rinse cycle reached 140 degrees Fahrenheit, 2/1/17 the rinse cycle reached 160 degrees Fahrenheit, 2/2/17 the rinse cycle reached 160 degrees Fahrenheit. During interview with Staff [NAME] on 2/7/17 at approximately 9:50 a.m., Staff [NAME] confirmed the above findings and stated that the rinse cycle did not reach the required temperature of at least 180 degrees Fahrenheit. During tour of the kitchen on 2/7/17 at approximately 9:55 a.m. with Staff E, the meat slicer was observed to be covered with a plastic cover. This surveyor asked Staff [NAME] if the meat slicer was ready for use and Staff [NAME] stated that it was ready for use. The plastic cover was lifted to view the entire surface area of the meat slicer and it was discovered that the back side of the meat slicer blade in the center of the blade had a ring around the blade of a thick, light brown thick, greasy substance that was easily scraped off when touch by this surveyor. Interview at approximately 10:00 a.m. with Staff [NAME] confirmed the above findings. During tour of the kitchen on 2/7/17 at approximately 10:15 a.m. with Staff E, the walk-in cooler/large walk-in refrigerator, observation revealed a small box of take-out Chinese food and a container of what was labeled as Japanese Soy Product that were sitting among other food items in this cooler. These items did not contain a date. Interview on 2/7/17 at approximately 10:20 a.m. with Staff E, Staff [NAME] stated that these items were left over from the Japanese New Year. Staff [NAME] removed these items from the walk-in cooler and threw them in the trash.",2020-09-01
83,EDGEWOOD CENTRE (THE),305022,928 SOUTH STREET,PORTSMOUTH,NH,3801,2017-02-10,441,E,0,1,FQ0H11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations and interview it was determined that the facility failed to ensure an environment that is safe and sanitary by not implementing a facility wide surveillance of infection control practices and investigations throughout the facility that provides a safe, sanitary and comfortable environment. (Resident identifier is #11.) Findings include: Observation on 2/8/17 during a medication pass with Staff B (Licensed Practical Nurse) at approximately 9:20 a.m. showed Staff B entered Resident #11's room with prepared medications. Staff B donned a pair of gloves and proceeded to perform trach suctioning on this ventilated resident. When this procedure was completed Staff B proceeded to assemble items to administer medications through Resident #11's [DEVICE] (gastrostomy). Staff B with the unchanged gloves proceeded to open the top drawer in the resident's storage bureau and retrieved a plastic 30 cc syringe. Staff B was observed numerous times touching her (Staff B) face and her (Staff B) clothing with the gloved hands related to the heat in the room. Staff B was observed flushing and administering the prescribed medications through Resident #11's [DEVICE] and when finished proceeded to assemble and prepare the pump and tubing for the continuous [DEVICE] enteral feed solution. Following this procedure Staff B with the same unchanged gloves proceeded to administer prescribed eye drops to Resident #11's left eye. Staff B then discarded the appropriate used items in the trash along with the pair of gloves worn throughout this observation. Staff B failed to change gloves and perform hand hygiene following each direct resident contact to prevent cross contamination between the trach suctioning, administration of medications through the [DEVICE], the preparation and assembling of the [DEVICE] enteral feed solution, after touching her (Staff B) own face and clothing and after the administration of eye drops to Resident #11. During interview on 2/10/17 with Staff C (Infection Control Registered Nurse) at approximately 1:00 p.m. Staff C stated that no infection control surveillance, like walking rounds are done in the facility kitchen, laundry, rehabilitation area. Staff C also stated that there is no documentation of infection control surveillance related to medication pass observation techniques. Cross reference F371. During tour of the rehabilitation department on 2/7/17 at approximately 10:15 a.m. this surveyor observed a wedge cushion that had numerous cracks in the outside plastic covering exposing the foam of the cushion. The entire end of the wedge presented with orange duct tape. The seat cushion on a rolling stool had numerous cracks in the outside plastic covering exposing the foam of the cushion. These cushions cannot be cleaned due to the poor surface integrity. During interview with Staff D (Rehabilitation Director) on 2/7/17 at approximately 10:35 a.m. Staff D confirmed the above findings.",2020-09-01
84,EDGEWOOD CENTRE (THE),305022,928 SOUTH STREET,PORTSMOUTH,NH,3801,2017-11-15,278,B,0,1,L8GV11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, it was determined that the facility failed to ensure that the MDS (Minimum Data Set) assessments were accurate with the election of the hospice benefit for 2 residents in a survey sample of 23 residents. (Resident identifiers are #4 and #7.) Findings include: Resident #4 Review on 11/14/17 of Resident #4's Significant Change MDS assessment dated [DATE] it was noted that the MDS section entitled J1400 Prognosis-Life expectancy less than 6 months is answered no. The MDS section O100 special treatments and programs in column 2. is answered with k. Hospice. A prognosis of less than 6 months life expectancy is a general prerequisite of acceptance into a hospice program and these two assessment areas should be in agreement. Interview on 11/ 15/17 at approximately 4:30 p.m. Staff B (Registered Nurse) concurred that the prognosis did not support the election of the Hospice benefit, as written. Resident #7 Review on 11/14/17 of Resident #7's Quarterly MDS assessment dated [DATE] revealed that section entitled J1400 Prognosis-Life expectancy less than 6 months was answered no. The MDS section O100 Special Treatments and Programs column 2, line K was checked the resident receiving Hospice services. A prognosis of less than 6 months life expectancy is a requirement of acceptance into a hospice program and these two assessment areas need to be in agreement. Review of Resident #7's medical record revealed that Resident #7 is receiving the hospice benefit. Interview on 11/15/17 at approximately 1:30 p.m. with Staff C (Director Of Nurses/Registered Nurse) confirmed that the prognosis did not support the election of the hospice benefit.",2020-09-01
85,EDGEWOOD CENTRE (THE),305022,928 SOUTH STREET,PORTSMOUTH,NH,3801,2017-11-15,281,B,0,1,L8GV11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, it was determined that the facility failed to provide parameters for PRN (as needed) pain medications for 8 resident in a standard survey sample of 24 residents. (Resident identifiers are #2, #6, #8, #9, #11, #12, #17, and #19.) Findings Include: Potter, [NAME] [NAME], and Anne Griffin Perry. Fundamentals of Nursing. 7th ed. St. Louis, Missouri: Mosby Elsevier, 2009. Pages 699 Prescriber must document the diagnosis, condition, or need for use for each medication ordered Page 708 The prescriber often gives specific instructions about when to administer a medication Resident #2 Review of the Medication Administration Record [REDACTED] [MEDICATION NAME] Tablet 400 mg (milligrams). Give 400 mg by mouth every 6 hours as needed for pain/fever. Tylenol tablet 325 mg. Give 2 tablets by mouth every 4 hours as needed for pain or elevated temperature. Resident #12 Review of the MAR indicated [REDACTED] [MEDICATION NAME] Tablet 325 mg. Give 2 tablets by mouth (PO) every 4 hours as needed for pain/elevated temp. [MEDICATION NAME] Solution 20 mg/ml (milliliters). Give 5 mg PO every 4 hours as needed for pain/dyspnea. Interview on 11/14/17 at approximately 3:00 p.m. with Staff C (Director of Nursing), confirmed that the PRN pain orders were missing indications/parameters for administration. Resident #17 Review 11/15/17 of Resident #17's MAR for (MONTH) (YEAR), revealed that this resident had an order for [REDACTED]. Administer 650 mg. PO q4h (every 4 hours) PRN for pain or elevated temperature, per standing order. Review 11/15/17 of Resident #17's MAR for (MONTH) (YEAR), also reveals that this resident has an order for [REDACTED]. should be administered. Interview on 11/15/17 at approximately 4:40 p.m. with Staff A (Registered Nurse/Resource Nurse) acknowledged that this issue has come to their attention and they are working to make sure all residents have parameters for the administration of pain medications. Resident #8 Review on 11/13/17 of resident # 8's MAR for (MONTH) (YEAR) revealed an order for [REDACTED]. Review on 11/13/17 of resident #8's MAR indicated [REDACTED]. There were no parameters for when to give the medication. Interview on 11/15/17 at approximately 1:00 p.m. with Staff C (Director of Nursing) confirmed the above findings. Resident #19 Review on 11/14/17 of Resident #19's MAR for (MONTH) (YEAR) revealed an order for [REDACTED]. Interview on 11/15/17 at approximately 1:00 p.m. with Staff C (Director of Nursing) confirmed the above findings. Resident #9 Review of Resident #9's MAR indicated [REDACTED] Tylenol tablet 325 MG ([MEDICATION NAME]) Give 2 tablets by mouth every 6 hours as needed for pain scale 1-3. Start Date 10/10/17 1200 and a second PRN pain medication as listed below was noted to be missing a parameter/pain severity for use: [MEDICATION NAME] Tablet 50 MG ([MEDICATION NAME] HCI) (sic) Give 1 tablet by mouth as needed for pain (MONTH) use BID (twice a day) Interview on 11/15/17 at approximately 1:40 p.m. with Staff C (Director of Nursing) confirmed the above findings. Resident #11 Review on 11/14/17 of Resident #11's MAR indicated [REDACTED]. Resident #11 also had an order for [REDACTED]. Interview on 11/14/17 at approximately 11:30 a.m. with Staff F (Unit Manager) confirmed that there was no clear indication of whether to give Tylenol or [MEDICATION NAME] for pain.",2020-09-01
86,EDGEWOOD CENTRE (THE),305022,928 SOUTH STREET,PORTSMOUTH,NH,3801,2017-11-15,514,B,0,1,L8GV11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, it was determined that the facility failed to ensure that residents received the black box warning information for antipsychotic medication prescribed for them for 2 residents in a standard survey sample of 25 residents. (Resident identifiers are #6, and #10.) Findings include: Professional reference: Per FDA US Food and Drug Administration (8/15/13) .FDA is requiring the manufacturers of conventional antipsychotic drugs to add a Boxed Warning and Warning to the drugs ' prescribing information about the risk of mortality in elderly patients treated for [REDACTED]. (See https://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm 0.htm accessed 11/27/2017.) Resident #6 Review on 11/13/17 of Resident #6's Medication Administration Record [REDACTED]. If ineffective use [MEDICATION NAME] 25 mg by mouth every 6 hours PRN delusions. The start date on this order was 10/19/17 and the discontinue date was 10/25/17. There was no documented evidence that Resident #6 or Resident #6's POA (Power of Attorney) had received the black box warning information for this medication. Interview on 11/14/17 at approximately 11:00 a.m. with Staff G (Registered Nurse) confirmed that there was no documented evidence that Resident #6 or Resident #6's POA had been given the black box warning information for antipsychotic medications. Resident #10 Review on 11/14/17 of Resident #10's Medication Administration Record [REDACTED]. Start date 5/24/17. There was documented evidence that Resident #10 signed the Psychoactive Drug Administration Consent Form on 5/24/14, but there was no documented evidence that Resident #10 had received the black box warning information for this medication. Interview on 11/14/17 at approximately 11:30 a.m. with Staff F (Unit Manager) confirmed that there was no documented evidence that Resident #10 had been given the black box warning information for antipsychotic medications.",2020-09-01
87,ROCHESTER MANOR,305024,40 WHITEHALL ROAD,ROCHESTER,NH,3867,2017-04-13,160,B,0,1,K2IK11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of the resident trust fund and interview, it was determined that the facility failed to convey resident funds within 30 days to the individual(s) or probate jurisdiction administering the resident's estates for 5 out of sample residents. (Resident identifiers are #23, #24, #25, #26, and #27.) Findings include: Review of the following accounts revealed the following: Resident #23 had expired on [DATE] with a balance of $18.74 remaining in this resident's account. Probate paperwork for Resident #23 was filed on [DATE]. Resident #24 had expired on [DATE] with a balance of $35.00 remaining in this resident's account. Probate paperwork for Resident #24 has not been filed as of [DATE]. Resident #25 had expired on [DATE] with a balance of $1697.10 remaining in this resident's account. Probate paperwork for Resident #25 has not been filed as of [DATE]. Resident #26 had expired on [DATE] with a balance of $2,129.24 remaining in this resident's account. Probate paperwork for Resident #26 was filed on [DATE]. Resident #27 had expired on [DATE] with a balance of $368.76 remaining in this resident's account. Probate paperwork for Resident #27 was filed on [DATE]. Interview on [DATE] at approximately 11:30 a.m. with Staff A (Business Office Manager) confirmed that probate paperwork wasn't filed in thirty days.",2020-09-01
88,ROCHESTER MANOR,305024,40 WHITEHALL ROAD,ROCHESTER,NH,3867,2017-04-13,279,D,0,1,K2IK11,"Based on record review and interview, it was determined that the facility failed to develop a coordinated/integrated Plan of Care for 2 of 2 residents receiving Hospice services in a survey sample of 17 residents. (Resident identifier's are #12 and #16.) Findings include: Review on 4/13/17 of Resident #12 and Resident #16 medical record revealed that Resident's #12 and #16 were receiving Hospice services. Record review revealed that the facility failed to show a coordinated Plan of Care as evidenced by not including or documenting the Hospice goals and interventions in order to ensure that facility staff is providing consistent care when Hospice staff are not scheduled in the facility. Resident #16 Review on 4/13/17 of Resident #16's hospice care plan with a start date of 8/25/16 revealed the following disciplines visiting Resident #16: skilled nurses, Medical social worker, Nurses aide, and a chaplain. Review on 4/13/17 of Resident #16's facility's care plan revealed a hospice care plan with a start date of 8/25/16. Under the interventions section it revealed the hospice nursing assistant to compliment ADL (activities of daily living) care, provide comfort and companionship .Provide resident with food & fluids as desired for physical & emotional comfort Hospice nursing along with Center Staff Nurses to assess and manage symptoms, comfort/pain, bowel function. Interview on 4/13/17 at 1:00 p.m. with Staff B (Director of Nurses) after review of Resident's #16's current facility and the hospice care plans Staff B revealed that the care plans did not include the frequency of services provided by the hospice agency for the skilled nurse, licensed nursing aide, social worker, and spiritual. Staff B confirmed that the facility's was unaware of all the services that the hospice was providing via the care plan. Staff B also confirmed that the facility's and the hospice care plans did not coordinated/integrated with each other. Resident #12 Review on 4/13/17 of Resident #12's care plan revealed a hospice care plan with a start date of 3/5/17. Under the intervention section it revealed the Hospice nursing assistant to compliment ADL care, provide comfort. Provide ADL support, companionship and other interventions as desired by pt (patient) to promote comfort. Hospice Nursing .to assess and manage symptoms comfort/pain, bowel function. Review on 4/13/17 of Resident #12's Hospice Team Care Plan revealed the following disciplines are visiting Resident #12: volunteer, social worker and a chaplain. The frequency of services were not present on the care plan for this hospice resident.",2020-09-01
89,ROCHESTER MANOR,305024,40 WHITEHALL ROAD,ROCHESTER,NH,3867,2017-04-13,280,D,0,1,K2IK11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and interview, it was determined that the facility failed to update a care plan for 1 residents in a standard survey sample of 17 residents. (Resident identifier is #1.) Findings include: Resident #1 Review on 4/11/17 of Resident #1's Medication Administration Record [REDACTED]. Review on 4/11/17 of Resident #1's physician orders [REDACTED]. Further review of the medical record revealed a physician order [REDACTED].#1's DPOA and obtain permission for the DNR. Review on 4/11/17 of Resident #1's care plan completed on 3/31/2017 with a focus area of Advance directives is as follows: Resident has an established advanced directive that has been invoked, code status is full code. with a revision on 4/28/16. Interview on 4/11/17 at 3:30 p.m. with Staff B (Director of Nurses) confirmed that Resident #1's Advance directives care plans had not been updated since Resident #1's full code has been changed on 4/4/17 to a DNR. Staff B found the new order written on 4/4/17 to be a DNR.",2020-09-01
90,ROCHESTER MANOR,305024,40 WHITEHALL ROAD,ROCHESTER,NH,3867,2017-04-13,364,E,0,1,K2IK11,"Based on observation, interview, and resident council review, it was determined that the facility failed to assure that food is palatable, attractive and at the proper temperature to ensure resident's satisfaction. (Resident identifier is Resident #5.) Findings include: Observations on 4/13/17 at 7:37 a.m. of food service performed identified that the holding temperature on the steam table of the oatmeal prior to being served was 178 degrees Fahrenheit. The holding temperature of the scrambled eggs on the steam table prior to being served was 168 degrees Fahrenheit. A test tray was prepared at 7:45 a.m. and left the kitchen at 7:46 a.m. for the B Unit. The last tray was served to a resident at 7:59 a.m. and the test tray was pulled from the tray cart. At that time the oatmeal temperature of 149 degrees Fahrenheit and the scramble eggs had a temperature of 162 degrees Fahrenheit. The hot water for tea had a temperature of of 153 degrees Fahrenheit. The orange juice on the test tray had a temperature of 73 degrees Fahrenheit and did not maintain a cold temperature below 41 degrees Fahrenheit that was palatable, attractive and at the proper temperature to ensure resident's satisfaction. Interview on 4/13/17 at 1:15 p.m. with Resident #5 revealed that Resident #5 indicated the food is always the same chicken or fish, and is always cold. Resident #5 confirmed that for an alternate meal choices you can get peanut butter & jelly or grilled cheese as an alternate when you don't like the main menu, then stated their preference to have soup more. Interview on 4/12/17 at 10:00 a.m. with the resident council members revealed that several of the residents in attendance felt that the meals that they receive are often cold, especially on Unit B. When questioned, the residents responded that breakfast is frequently not hot enough. The residents did state that the staff would heat up a meal, but that it is not the same. Many residents stated that Unit A was always served before Unit B and that the kitchen frequently ran out of the first meal choice before Unit B was served. The residents reported that the food does not taste good, especially the scrambled eggs.",2020-09-01
91,ROCHESTER MANOR,305024,40 WHITEHALL ROAD,ROCHESTER,NH,3867,2017-04-13,441,D,0,1,K2IK11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and interview, it was determined that the facility failed to follow infection control practice while providing care to 1 out of sample resident with a peripherally inserted central catheter in a survey sample of 17 residents. (Resident identifier is out of sample #19.) Findings include: Record review on 4/13/17 of the Medication Administration Record (MAR) for Resident #19 revealed an order for [REDACTED]. Observation on 4/13/17 with Staff C (Registered Nurse) at approximately 10:15 a.m. showed Staff C prepared the physician ordered medication Azireonam 1 GM (gram) intravenously (IV) for Resident #19. Staff C prepared the IV solution and intravenous tubing to attach to the IV pump. The double lumen Peripherally Inserted Central Catheter (PICC) was located on Resident #19's left upper chest. Staff C donned gloves and proceeded to cleanse each of the individual dual lumen ports with a separate alcohol wipe. One port was cleansed with a alcohol wipe and discarded on Resident #19's over the bed table. The second port was cleansed with a alcohol wipe and this was discarded on Resident #19's over the bed table. This over the bed table had multiple books and personal items of Resident #19. Further observation revealed as Staff C was connecting the IV tubing to the IV pump Staff C encountered air in the IV tubing. Staff C proceeded to disconnect the tubing from the pump and prime the tubing more to eliminate the air in the tubing. Staff C proceeded to attach the IV tubing to the pump. Staff C with donned gloves still in place proceeded to cleanse one of the PICC ports with one of the discarded used alcohol wipes. After cleansing Staff C discarded this alcohol wipe on the resident's over the bed table and picked up the second discarded used alcohol wipe and proceeded to cleanse the other PICC port with this used alcohol wipe and again discarded this wipe on the resident's over the bed table. Interview on 4/13/17 with Staff C confirmed the above listed findings that aseptic technique was not maintained to prevent cross contamination by using the individual discarded alcohol wipes a second time to cleanse each individual PICC line port for Resident #19.",2020-09-01
92,ROCHESTER MANOR,305024,40 WHITEHALL ROAD,ROCHESTER,NH,3867,2017-04-13,456,D,0,1,K2IK11,"Based on observation, manufacturer's instruction for use and interview, it was determined that the facility failed to follow manufacturer's instructions for dating glucometer testing solutions opened for 2 of 5 medication carts and cleaning of 1 anticoagulation meter. Findings include: Observation on 4/11/17 at approximately 9:30 a.m. of the opened glucometer quality control high and low testing solutions on 2 of the 2 A wing unit medication carts, it was revealed that the high and low quality control testing solutions were not dated with either the open date of the solutions or the discard date of the solutions. Manufacturer's instructions dated 06/01/96, state under section titled, Storage and handling the following directions, Do not use if the expiration date has passed. Discard any unused control solution 90 days after first opening or after the expiration date. Interview on 4/11/17 at approximately 9:45 a.m. with Staff B (Director of Nursing/Registered Nurse) who confirmed the control solutions were not dated when they were opened. Observation on 4/11/17 at approximately 9:35 a.m. of the anticoagulation meter on the A wing, revealed a dried brown substance on the right hand side of the meter and a 1 inch by 2 inch piece of clear plastic tape with the writing in blue pen, Unit A on the back of the meter. Interview on 4/11/17 at approximately 9:37 a.m. with Staff B regarding the cleaning of this meter, Staff B stated that the meter is cleaned with the bleach wipes after each use. Staff B agreed that the meter did have a dried brown substance on the right hand side of the meter. Staff B also agreed that the tape on the back of the meter precluded the machine from being cleaned effectively to ensure no transmission of infection could occur.",2020-09-01
93,ROCHESTER MANOR,305024,40 WHITEHALL ROAD,ROCHESTER,NH,3867,2017-04-13,516,D,0,1,K2IK11,"Based on observation and interview it was revealed that the facility failed to safeguard resident information on 1 of 7 medication cart computers. Findings include: Observation on 4/12/17 at approximately 11:30 a.m. revealed an unattended medication cart on Unit [NAME] The medication cart had a computer on top of it. The screen on the computer was still open with pictures of residents, as well as their medication information. This information was easily accessible to anyone. After approximately 5 minutes, Staff C (Licensed Practical Nurse) came over to the medication cart and stated that she forgot to lock the screen, and locked it. Observation on 4/12/17 at approximately 11:55 a.m. revealed the same medication cart, again unattended, with the computer screen open with resident information. After approximately 3 minutes, Staff C came over to the medication cart and asked if she had forgotten to lock it again. Staff C stated that she would just log out and that would ensure that it would be locked. Interview on 4/13/17 at approximately 2:00 p.m. with Staff B (Director of Nursing) confirmed that the medication cart computer screens should always be locked when not in attendance.",2020-09-01
94,ROCHESTER MANOR,305024,40 WHITEHALL ROAD,ROCHESTER,NH,3867,2019-07-11,580,D,0,1,NENQ11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and interview, it was determined the facility failed to notify the resident's physician and/or representative when treatment has been discontinued or delayed for 2 residents in a final sample of 20 residents (Resident identifiers are #22 and #183). Findings include: Resident #183 Interview on 7/8/19 at 12:38 p.m. with Resident #183 revealed the resident was admitted on [DATE] and had not received all of their prescribed pain medications and the resident was upset because they were having constant moderate to severe pain. Review on 7/10/19 of Resident #183's Medication Administration Record [REDACTED]. There were notes for the first 10 administration times that indicated the medication was not given because it was not available from the pharmacy. There was no documentation of notification of the missed administration to Resident #182's physician. Resident #183 received [MEDICATION NAME] starting on 7/9/19. Interview on 7/10/19 at 12:00 p.m. with Staff A (Director of Nursing) confirmed there was no documentation that the physician was notified in the delay of Resident #183 receiving the above medication. Resident #22 Interview on 7/8/19 at approximately 12:10 p.m. with Resident #22's DPOA (Durable Power of Attorney) revealed that the facility had stopped Resident #22's orders for medications, and that they needed to be restarted as Resident #22 had some health issues, in particular acid reflux, without the medications. Resident #22's DPOA stated that they were not aware that the medications were being discontinued and that when they realized it, they asked to have them restarted. Review on 7/10/19 of Resident #22's Physician order [REDACTED]. Review on 7/10/19 of Resident #22's (MONTH) 2019 Medication Administration Record [REDACTED]. Review on 7/11/19 of the facility policy, titled, Communication of Health Status, last reviewed on 3/1/16, revealed that it was the facility's policy to .Advise patient and /or health care decision maker of any change in his/her medical condition, medication orders or treatment orders . Interview on 7/11/19 at approximately 10:35 p.m. with Staff B (Unit Manager) confirmed that some of Resident #22's medications were discontinued, because they were on Hospice, and that their DPOA was not notified of the discontinuation. Staff B confirmed that when they found out, they asked that the medications be restarted. Staff B also confirmed that the DPOA should have been notified of the medication change.",2020-09-01
95,ROCHESTER MANOR,305024,40 WHITEHALL ROAD,ROCHESTER,NH,3867,2019-07-11,658,D,0,1,NENQ11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and interview, it was determined that the facility failed to follow professional standards to ensure that a resident did not receive 4 times the dose ordered for a medication used to treat CAD ([MEDICAL CONDITION]) for 1 resident in a final survey sample of 30 residents. (Resident identifier is #43.) Findings include: Professional reference: [NAME] [NAME] Potter and Anne Griffin Perry, Fundamentals of Nursing. 7th ed. St. Louis, Missouri: Mosby Elsevier, 2009. Page 336-Physicians' Orders The physician is responsible for directing medical treatment. Nurses follow physicians' orders unless they believe the orders are in error or harm clients. Therefore you need to assess all orders, and if you find one to be erroneous or harmful, further clarification from the physician is necessary . Observation on 7/9/19 at approximately 7:43 a.m. during medication pass revealed that Staff C (Licensed Practical Nurse) popped a [MEDICATION NAME] 40 mg (milligram) tablet from a medication card into a medicine cup. After popping the medication into the cup, Staff C put the medication card back into the medication cart drawer. Review on 7/9/19 at approximately 7:43 a.m. of Resident #43's Medication Administration Record [REDACTED]. The review also revealed that Resident #43 did not have an order for [REDACTED].>Interview on 7/9/19 at approximately 7:50 a.m. with Staff C revealed that they said that they had taken the [MEDICATION NAME] 40 mg from another resident's medication card in error. Observation on 7/9/19 at approximately 7:50 a.m. of Resident #43's medication cup revealed that Staff C, after being interviewed, reached into the medication cup and removed the [MEDICATION NAME] tablet and discarded it. Staff C then went back into the medication cart drawer and removed Resident #43's [MEDICATION NAME] 10 mg from the correct medication card and popped it into the medication cup. Interview on 7/9/19 at approximately 9:20 a.m. with Staff A (Director of Nursing) confirmed that Staff C should have been more careful in taking the right medications for each resident.",2020-09-01
96,ROCHESTER MANOR,305024,40 WHITEHALL ROAD,ROCHESTER,NH,3867,2018-10-16,641,B,1,0,4FNO11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on observation, record review, and interview, it was determined that the facility failed to accurately reflect the resident's status using the Resident Assessment Instrument (RAI) for 2 residents reviewed with wander alarms in a survey sample of 6 residents. (Resident identifiers are #4 and #5.) Findings include: Resident #4 Record review on 10/16/18 at approximately 11:30 a.m. revealed Resident #4 had a physician order [REDACTED]. Review on 10/16/18 of Resident #4's Minimum Data Set (MDS) Annual assessment on 8/17/18 and Quarterly assessments on 5/18/18, 3/6/18, and 12/14/17 revealed in Section P (Restraints and Alarms) that wander/elopement alarms were not used. Interview on 10/16/18 at approximately 11:45 a.m. with Staff B (Director of Nursing) confirmed the above findings and revealed that the MDS should have reflected that wander/elopement alarms were used daily. Observation on 10/16/18 at approximately 1:00 p.m. revealed that Resident #4 had a wander alarm on their right ankle. Review of the medical record of Resident #5 on 10/16/18 at approximately 10:45 am revealed an order dated 9/14/18 for placement of a Wander-Guard wander/elopment device (a device used to protect residents from elopment/leaving the building unattended) on the ankle of Resident #5 due to poor safety awareness. Interview with Staff B, (DON) on 10/16/18 at approximately 11:00 am revealed that the Wander-Guard security device was placed on Resident #5's ankle on 9/14/18. Further record review on 10/16/18 at 11:15 am revealed that the last quarterly MDS (Minimum Data Set)comprehensive assessment was performed on 9/18/18. The MDS dated [DATE] under Section P (Restraints and Alarms); Item E: (Wandering/elopment Alarm): stated that there was no wandering/elopment alarm in use for Resident #5. An interview on 10/16/18 with Staff B at approximately 11:30 am revealed that the MDS assessment was not coded correctly and should have reflected that Resident #5 was wearing the Wander-Guard wander/elopment device.",2020-09-01
97,MAPLE LEAF HEALTH CARE CENTER,305030,198 PEARL STREET,MANCHESTER,NH,3104,2018-03-16,880,B,0,1,OZ7411,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and interview, the facility failed to implement an infection prevention practice to prevent the potential transmission of influenza for 1 out of 2 residents who received nasal swabs for influenza during the standard survey. (Resident identifier is #61.) Findings include: Observation on 3/14/18 at approximately 10:00 a.m. of Resident #61 revealed that Resident #61 was short of breath and had frequent coughing. Review on 3/15/18 of Resident #61's nurses notes, dated 3/14/18, revealed that Resident #61 .complained of 'not feeling well' .non prod (non productive) cough .had a temperature of 100.2. Review on 3/15/18 of Resident #61's Physician Telephone Orders, dated 3/14/18, revealed an order for [REDACTED].>Review on 3/15/18 of Resident #61's nurses notes, dated 3/14/18, revealed a note which documented .Flu Swab A & B collected. Observation on 3/15/18 at approximately 3:00 p.m. of Resident #61's room revealed that there was nothing indicating that Resident #61 was placed on precautions. Interview on 3/15/18 at approximately 3:00 p.m. with Staff A (Registered Nurse, Unit Manager) confirmed that Resident #61 had not been placed on precautions. Review on 3/16/18 of the facility's Infection Control Manual, dated 12-98, revised 10-1-08, revealed that In addition to Standard Precautions, use Droplet Precautions, or the equivalent, for a patient known or suspected to be infected with microorganisms transmitted by droplets .that can be generated by the patient during coughing, sneezing, talking, or the performance of procedures . Interview on 3/16/18 at approximately 12:00 p.m. with Staff B (Licensed Practical Nurse, Infection Control) confirmed that Resident #61 should have been placed on Droplet Precautions when Resident #61 was suspected of having influenza.",2020-09-01
98,MAPLE LEAF HEALTH CARE CENTER,305030,198 PEARL STREET,MANCHESTER,NH,3104,2019-05-03,658,D,0,1,2O0511,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, review of physicians orders, manufacturers instructions and it was determined that the facility failed to follow physicians orders for 1 out of 4 residents observed during medication administration and 1 of 3 residents reviewed for pain in a final sample of 23. (Resident identifier is #17 and #57.) Findings include: Potter, [NAME] [NAME], and Anne Griffin Perry. Fundamentals of Nursing. 7th ed. St. Louis, Missouri: Mosby Elsevier, 2009. Page 336-Physicians' Orders The physician is responsible for directing medical treatment. Nurses follow physicians' orders unless they believe the orders are in error or harm clients. Therefore you need to assess all orders, and if you find one to be erroneous or harmful, further clarification from the physician is necessary . Resident #57 Observation on 5/1/19 at approximately 8:20 a.m. with Staff A, Licensed Practical Nurse (LPN) during medication pass with Resident #57 revealed that Resident #57 had a [MEDICATION NAME] adhered to the lower back dated 4/30. Review on 5/1/19 of Resident #57's physicians orders revealed the following: (pronoun omitted) [MEDICATION NAME] 4% adhesive patch. Apply 1 patch topically to low back (remove after 8 hours). Apply 8 a.m. and remove 4 p.m. Interview on 5/1/19 at approximately 8:25 a.m. with Staff A revealed that the [MEDICATION NAME] should have been removed at 4:00 p.m. on 4/30. Review on 5/2/19 of the manufacturer's instructions for (pronoun omitted) [MEDICATION NAME] 4% adhesive patch revealed: . Directions . Remove patch from the skin at most 8-hour application Resident #17 Review on 5/3/19 of Resident #17's physician orders [REDACTED]. Review on 5/3/19 of Resident #17's Medication Administration Record [REDACTED]. Interview on 5/3/19 at 12:48 p.m. with Staff B (Unit Manager) confirmed the it was not documented that Resident #17's patch was removed on 4/10/19 and 4/24/19.",2020-09-01
99,MAPLE LEAF HEALTH CARE CENTER,305030,198 PEARL STREET,MANCHESTER,NH,3104,2019-05-03,880,E,0,1,2O0511,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, it was determined that the facility failed establish and follow written policies and procedures for standard and transmission-based precautions and when and how isolations should be used for a resident for 4 of 4 residents observed on precautions. (Resident identifiers are #18, #53, #99, #205.) Findings include: Resident #18 Observation on 4/30/19 at 9:40 a.m. revealed a precaution sign outside of room [ROOM NUMBER]. Interview on 4/30/19 at approximately 9:45 a.m. with Staff B (Unit Manager) revealed that Resident #18 in room [ROOM NUMBER] was on precautions for [MEDICAL CONDITION]. Observation on 4/30/19 at 10:20 a.m. revealed a staff changing Resident #18's bed with gown hanging off of the staff's shoulders. Observation on 4/30/19 at 10:50 a.m. revealed housekeeping cleaning room and mopping floor around Resident #18's bed not wearing a gown or gloves. Observation on 4/30/19 at 1:50 p.m. revealed two Licensed Nursing Assistants (LNA) in Resident #18's room not wearing a gown or gloves. Staff C (LNA) removed the garbage bag from the trash container that contained used gowns and took it down the hallway to the soiled utility room. Observation on 5/1/19 at 8:30 a.m. revealed staff went to deliver food to Resident #18. Staff put food on top of the precaution cart in the hallway and put on a mask and brought the tray into Resident #18 who was in bed. Review on 5/3/19 of Resident #18's care plan dated 4/29/19 revealed that the resident is on contact precautions. Review on 5/3/19 of Resident #18's physician orders [REDACTED]. Interview 5/3/19 at 12:50 p.m. with Staff D (Infection Preventionist) revealed that for some residents on contact precautions, staff only need wear gloves and gowns during direct care, that residents can attend activities and dining and some residents would need to stay in their room and require staff to wear gloves and gowns whenever they enter the resident's room. Staff D revealed the differences in procedure is not reflected in facility policy, on signs, or in the resident's care plan. Staff D revealed that a mask is not a recommendation for contact precautions but is available for use if staff want to wear one. Resident #99 Interview on 4/30/19 at approximately 8:55 a.m. with Staff B (Registered Nurse) revealed that there is a question of bed bugs in Resident #99's room, and the room has been treated for [REDACTED]. Observation on 4/30/19 at 10:22 a.m. of this room revealed there is a precaution cabinet outside the room with PPE (personal protective equipment), but there is no precautions signage or Stop/see Nurse signage at the room entrance. Interview on 4/30/19 at approximately 9:15 a.m. with Staff I (clinical) revealed that instruction was to wear gown and gloves to go into the room. Observation on 4/30/19 at 10:50 a.m. revealed a visitor, without donning any personal protective equipment (PPE), walked into the room and spoke with Resident #99, then carried 2 framed pictures, one at a time, out of the room into the hallway, showing them to people in the hall, then returning the pictures to the room. Interview on 4/30/19 at approximately noon with Staff B revealed gown and gloves indicated when contacting linens/residents, the room was treated for [REDACTED]. Interview on 5/3/19 in the afternoon with Staff G (Director of Nursing) revealed the bed bugs were for Resident #99, they found a couple live bed bugs that Staff G thinks may have come in with Resident #99, he has one treatment to go. Interview on 5/3/19 at 2:04 p.m. with Staff J (clinical) confirmed Resident #99 has one treatment to go. Observation on 5/3/19 at approximately 12:43 p.m. revealed there was a Stop signage at the doorway to Resident #99''s room, there was still a PPE cabinet outside the room but no precaution sign on the PPE cabinet. Resident #205 Interview on 4/30/19 at approximately 8:55 a.m. with Staff B (Registered Nurse) revealed that Resident #205 is on precautions for [MEDICAL CONDITION]. Observation on 4/30/19 at 11:12 a.m. revealed a precaution cabinet outside of Resident #205's room with Contact Precautions signage and a Stop sign at the doorway. Staff K (clinical) was observed at this time in the room near the doorway without PPE on. Staff K exited the room and interview at that time with Staff K revealed Staff K had a mask on as they were only talking to the resident, and they had just removed it, Staff K related gloves are only needed if touching/doing care, if entering the room and only talking just need a mask. Observation on 4/30/19 until 11:24 a.m. revealed, after Staff K exited the room, a visitor was observed in the room with Resident #205, the resident was not visualized as they were behind a pulled curtain. The visitor came into view, and was observed wearing a mask and gloves but no gown. The visitor was touching things in the room including a grasping tool. Interview on 4/30/19 at approximately noon with Staff B revealed that for Resident #205, one should wear gown and gloves when contacting linens, the resident; and a mask is not needed in the room. Interview on 5/1/19 at approximately 1:54 p.m. with the resident's daughter revealed Resident #205 is presently on precautions for [DIAGNOSES REDACTED] ([MEDICAL CONDITION]); after staff finish care the staff discard their gown/gloves in the trash then remove the liner and replace it; after the resident uses the bedside commode the staff puts the contents in a bag and removes it. Observation of the room at time of this interview revealed the bathroom in the room is located on the roommate's side of the room, by the room entrance. There is only one sink in the room which is not in the bathroom but is in the room itself, again on the roommate's side. Resident #205's bed is at the far side of the room, by the window, separated from the roommate by a pulled curtain. There is a portable commode located between Resident #205's bed and the window wall, and the waste basket, which has a plastic liner, is also adjacent to the window wall. Record review on 5/2/19 at 9:22 a.m. of Resident #205's Discharge Summary for Date of Service 4/15/19 reveals Metabolic [MEDICAL CONDITION] due to [DIAGNOSES REDACTED] and secondary active [DIAGNOSES REDACTED]. Record review on 5/2/19 at 12:27 p.m. of the Admission Minimum Data Set assessment dated [DATE] revealed that that Resident #205 has frequent incontinence of urine and bowel, and Section I codes [DIAGNOSES REDACTED]. Interview on 5/3/19 at 9:37 a.m. with Staff B revealed Staff usually have bags with them that they put their PPE into when they are done, and then take the bag out of the room; similarly after commode use, the liner with waste is taken out of the room to the dirty utility. Record review on 5/3/19 at 12:24 p.m. of Resident #205's physician's orders [REDACTED]. Record review of the facility's [DIAGNOSES REDACTED]icile-Contact Precautions sheet, provided on survey, and dated 5/1/18, reveals, in part, that gloves are to be used When giving direct care. Also, The use of gowns when giving direct care will depend on site of infection and residents sign & symptoms. Resident #53 Observation on 4/30/19 at approximately 9:30 a.m. of Resident #53 revealed Resident #53 was sitting in a common area of the 3rd floor wing. There was a precautions cart and a sign identifying that the purpose for the cart was Droplet Precautions. The cart was located outside of a room that had four resident occupants. Staff was queried as to whom the precautions were for, the staff identified Resident #53 who was sitting in the common area. At the same time that the observation was taking place, a member of the Laundry staff delivered laundry items to the room in question. Laundry staff did not don Personal Protection Equipment prior to entering the room. Interview on 4/30/19 at 10:15 with Staff H (3rd floor Unit Manager) revealed that Resident #53 had Upper Respiratory Infection (URI) symptoms. Resident #53 was given an influenza test that resulted negative. Observations that occured at 9:30 a.m. were revealed to Staff H. Staff H responded that the concerns would be addressed. Interview on 5/3/19 at 12:10 PM with Staff D (Infection Preventionist) and Staff G, Registered Nurse, revealed that facility staff is empowered to initiate precautions if it is suspected by staff that infection prevention is needed. Staff D revealed that Resident #53 was suspected of requiring droplet precautions and that unit staff were finding it difficult to keep a mask on her or monitoring Resident #53's movements in the hallway.",2020-09-01
100,COURVILLE AT NASHUA,305037,22 HUNT STREET,NASHUA,NH,3060,2017-03-02,225,D,0,1,O8XB11,"Based on resident group interview, and review of facility generated reports, it was determined that the facility failed to report misappropriation of property to the state agency as required by regulation. Findings include: Interview on 3/1/17 at 10:30 a.m. with the resident group, revealed residents had complaints regarding items going missing such as jewelry, and money. Review of the grievance log from 5/20/16 to 3/2/17 revealed that there were no reports of jewelry or money missing. There was Resident #21's cell phone that was recorded as missing on the grievance log on 2/12/17. Interview on 3/2/17 at approximately 9:30 a.m. with Staff A (Social Worker) confirmed that missing items on the grievance log had not been reported to the state. Interview on 3/2/17 at approximately 10:45 a.m. Staff A stated, We ask the resident if they want us to call the police department. If they do not want us to call the police, then we don't. If we don't call the police then we don't notify the State(of NH). Staff A further stated: If the resident is alert and oriented and making their own decisions we do not continue to search if the resident says they misplaced it (the object).",2020-09-01