cms_RI: 38
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 38 | APPLE REHAB WATCH HILL | 415015 | 79 WATCH HILL ROAD | WESTERLY | RI | 2891 | 2020-02-12 | 689 | G | 1 | 0 | T0R811 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on surveyor observation, record review, and staff interview, it is determined the facility failed to ensure that each resident receives adequate supervision and assistance devices to prevent accidents for 1 of 5 residents reviewed (ID #1). Findings are as follows: Resident ID #1 was originally admitted to the facility on [DATE]. Current [DIAGNOSES REDACTED]. Of note is that the resident's medical regimen included the administration of [MEDICATION NAME] (a blood thinner) due to the [DIAGNOSES REDACTED]. The resident's functional ability was assessed as requiring extensive or total assistance for all activities of daily living and personal hygiene. A review of the resident's clinical record revealed she/he sustained a witnessed fall out of bed on 12/26/2019 at 7:35 AM. The resident was attended by a certified nurse assistant (Staff A), who had rolled the resident onto his/her side to provide incontinence care. Staff A supported the resident's position with her hand on the resident's back and reached for a clean brief. She then observed the resident rolling off the edge of the bed and landing on both knees. The resident's knees and head hit the bedside table and the resident's left elbow went into the wastebasket. Staff A called out for help and was assisted by a nurse (Staff B) to remove the resident's elbow from the wastebasket and to roll him/her onto his/her back. Emergency service (911) was called and the resident was transported to a hospital emergency room (ER) for assessment. In the ER, the resident was examined for a possible head injury and pain of the left leg. An x-ray of his/her left knee was obtained and revealed a minimally displaced, closed [MEDICAL CONDITION] femur of the left leg. The x-ray also revealed a prior total knee replacement, which remained in alignment. A CT scan was then obtained, which showed the fracture, the total knee hardware, and a complex appearing mass in the back of the knee described as most likely a hematoma (a collection of blood outside of blood vessels) or popliteal cyst (a fluid-filled cyst formed at the back of the knee). In consultation with the resident's daughter, a decision was made to forgo surgery and return the resident back to the facility. A 12/26/2019 nursing progress note states: resident returned from hospital e.d. approx. 2:30 pm s/p fall from bed early this am. e.d. evaluation conclusive for left femur fracture . immobilizer is in place to left leg . resident requires total care with assist of 2 per care card to meet all (his/her) adl needs. A [DATE]19 nursing progress note, written at 7:55 AM, states: Resident rested in bed this night. Immobilizer to left leg intact . Observed right foot to be adducted (turned in) and resident clutching right leg. The resident was transported back to theER on [DATE], following x-ray results of the right knee showing an acute [MEDICAL CONDITION] femur of the right leg. A review of the hospital records revealed lab results demonstrating significant [MEDICAL CONDITION] which is thought to be due to blood loss from both femur fractures. Transfusion was initiated in the ER. On 2/11/2020 at 1:45 PM, the surveyor interviewed Staff A who was with the resident when he/she rolled out of bed. Staff A confirmed the events leading up to the resident's fall out of bed and transfer to the ER. When questioned, Staff A revealed that the resident's bed was not equipped with siderails (SRs). Staff A, who has been employed by the facility for [AGE] years, further stated that the SRs had been removed some years earlier. Further surveyor review of the resident's clinical record revealed a 10/11/2019 care plan with a focus of: I require assistance with all of my ADL's. I am incontinent of B&B (bowel and bladder). Interventions include: Assist me to be in a safe position while performing my daily bathing and dressing. My daily bathing and dressing are completed when I am in bed . I currently require A2 (assist of 2) with my bed mobility . Please put 2 half side rails up . to help with bed positioning . Review of quarterly and annual care plans from 1/13/2018 - 7/12/2019 revealed the same focus and interventions. Surveyor review of the 1/13/2018 Apple Comprehensive Siderail Assessment, V1.1 revealed the resident required two people to turn in bed and recommended the use of two siderails to enable the resident to assist in bed mobility. A 5/7/2019 Apple Comprehensive Siderail Assessment, V1.1 revealed the resident required two people to turn in bed and recommended no siderails due to resident decline. Subsequent siderail assessments from 8/3/2018 to 4/24/2019 again recommended the use of two siderails to enable the resident to assist in bed mobility and that the resident required two people to turn in bed. Siderail assessments were missing from 4/24/2019 to the present. The clinical record also contained an undated and unsigned nursing request for Physical Therapy (PT) to screen the resident and to Please evaluate bed mobility . Rails removed . Hand contractures. A Physical Therapy Screening Form, with a due date of 5/4/2018, indicated the recommendation for a full PT evaluation and that the appropriate nursing home personnel was contacted for order A 5/7/2018 PT assessment and plan of care indicated the resident required moderate assistance of 2 people for bed mobility, rolling side to side and was at high risk for falls. A 5/18/2018 PT - Therapist Progress & Discharge Summary assessed the resident as still requiring moderate assistance of 2 people for bed mobility, rolling side to side, and at high risk for falls. The PT also recommended the staff follow through to . include 2 person assist with B (bilateral) rolling due to removal of HR (handrails). The Director of Nurses (DON) was interviewed on 2/12/2020 at approximately 11:00 AM. She could not provide evidence of a rational for removing the resident's siderails, nor explain why the handrails were not re-installed after side rail assessments from 8/13/2018 to 4/24/2019 determined the need for their use. The DNS could also not explain why only 1 staff provided incontinence care to the resident in bed on 12/26/2019, although the care plans from 1/13/2018 to 10/11/2019 specified the need for two staff. | 2020-09-01 |