| 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 |