cms_NH: 74
Data source: Big Local News · About: big-local-datasette
| rowid | facility_name | facility_id | address | city | state | zip | inspection_date | deficiency_tag | scope_severity | complaint | standard | eventid | inspection_text | filedate |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 |