| 67 |
LAS VEGAS POST ACUTE & REHABILITATION |
295006 |
2832 S. MARYLAND PARKWAY |
LAS VEGAS |
NV |
89109 |
2019-02-08 |
551 |
D |
1 |
0 |
YZ1W11 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on interview and record review, the facility failed to obtain a resident representative for a resident for 1 of 5 sampled residents (Resident #2). Findings include: Resident #2 Resident #2 (R2) was admitted on [DATE], with [DIAGNOSES REDACTED]. The admission orders [REDACTED]. A Social Worker note dated 09/16/17, revealed R2 cognition was severely impaired and Brief Interview for Mental Status score was 3. R2 had no relative sources available. The Quarterly Minimum Data Set (MDS) assessment dated [DATE], documented R2 had no guardian or legally authorized representative. 1) A physician order [REDACTED]. The admission orders [REDACTED]. A Resident Care Plan, Flu Vaccine dated 01/12/18, documented to administer Influenza vaccine per physician order [REDACTED]. The Immunization Record for R2 revealed the Influenza vaccine was administered to R2 on 11/17/18. The medical record lacked documented evidence an informed consent had been obtained prior to the administration of the Influenza vaccine to R2. 2) A physician order [REDACTED]. [MEDICATION NAME] 25 milligrams (mg) by oral route daily in the morning for [MEDICAL CONDITION], yelling every shift; [MEDICATION NAME] 50 mg by oral route daily in the evening for [MEDICAL CONDITION], yelling every shift; [MEDICATION NAME] 250 mg by oral route twice daily for [MEDICAL CONDITION] and mood swings. The Medication Administration Record [REDACTED]. The medical record lacked documented evidence an Acknowledgment of Psychoactive Medication Use explaining the potential benefits and risks of using the above psychoactive medications had been signed by a resident representative for R2. 3) The Comprehensive Care Plan for Resident Code Status revised (MONTH) (YEAR), documented a code status was signed by the resident or resident representative in the active medical record. The Do Not Resuscitate (DNR)/Full Code Request Form indicated R2 was a full code. The form had been signed by the Physician but did not have a signature for the resident or responsible party. The Physician order [REDACTED]. 4) R2's medical record documented the following: On 04/20/17, R2 had an unwitnessed fall. The resident had been observed sitting on the floor mattress at bedside. The resident's tab alarm was alarming. On 08/06/17, R2 was observed sitting on the floor in the activity room. R2 sustained a skin tear to the left ring finger and hematoma to left side of the forehead. On 11/05/18, R2 had been observed outside of the building and was observed lying on the outside the door. On 11/18/18, R2 had an elopement incident and was observed lying on the ground. On 11/27/18, R2 was sent to the acute hospital for evaluation of change in mental status and Oxygen saturation of 82%. On 12/05/18, R2's left hip x-ray result revealed an acute [MEDICAL CONDITION]. The medical record lacked documented evidence the above incidents were relayed to a resident representative. 5) A Social Worker note dated 12/16/16, documented R2 would continue to remain at the current placement at the facility. The resident had no relative sources available. R2 had been referred to the Public Guardian's office. A Social Worker note dated 06/16/17, documented R2 would continue to remain at the current placement at the facility. The resident had no relative sources available. A Social Worker note dated 09/16/17, documented R2 would continue to remain at the current placement at the facility. The resident had no relative sources available. A Social Worker note dated 09/16/18, documented R2 would continue to remain at the current placement at the facility. The resident had no relative sources available. The Interdisciplinary Team Conference Note dated 01/08/19, documented R2 had no relative resources and had been at the facility for several years. On 01/10/19 at 11:25 AM, the Ombudsman revealed the facility had not informed their office regarding R2's lack of representative. The Ombudsman indicated if their office was not made aware, then there would be no other way for them to know what the resident needed. On 01/10/19 at 2:10 PM, the Licensed Practical Nurse (LPN) indicated being familiar with R2. R2 could not communicate needs and was often confused. The LPN indicated R2 was not capable of making decisions and would benefit from guardianship in the absence of family. On 01/10/19 at 2:24 PM, the Social Worker indicated the Public Guardian's office had stopped accepting residents over a year ago. The Social Worker confirmed there had been no assistance provided for R2 to obtain legal guardianship or another representative since (YEAR). On 01/10/19 at 2:37 PM, the Director of Nursing (DON) acknowledged the Influenza vaccine should not have been administered to R2 without consent, [MEDICAL CONDITION] medications should not have been given to R2 without consent. The DON confirmed the POLST and DNR/Full Code should have a resident representative's signature. The DON acknowledged the facility failed to obtain a resident representative for R2 to oversee the resident's healthcare needs. On 02/08/19 at 3:40 PM, a Public Guardian Case Management Supervisor indicated their office did not stop accepting residents/patients. The Supervisor explained two years ago when a facility would call them to apply for legal guardianship for a resident, the Public Guardian's office would start the process and submit the application to petition the court. The Public Guardian office no longer submits the application because it had to be the facility's responsibility to submit the application and petition the court to appoint the Public Guardian's office to be the legal guardian for a resident. The process had been changed because the court had to appoint the Public Guardian's office first and give them authority before a resident's medical records could be obtained by the Guardian's office. The Supervisor indicated a facility also had the option to have a Private Guardian for a resident. The Supervisor indicated prior to these changes, hospitals and other medical facilities were provided inservices about the new process; and information would have been relayed to the facilities if they called the Public Guardian's office. |
2020-09-01 |