cms_VT: 66
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| rowid | facility_name | facility_id | address | city | state | zip | inspection_date | deficiency_tag | scope_severity | complaint | standard | eventid | inspection_text | filedate |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 66 | BURLINGTON HEALTH & REHAB | 475014 | 300 PEARL STREET | BURLINGTON | VT | 5401 | 2017-12-14 | 657 | E | 0 | 1 | 0QUX11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based upon observations, record review and interview the facility failed to assure that the plan of care for 3 residents (80, 51 & 143) was revised to reflect necessary care and services. Findings include: 1). Per observation and interview on 12/11/17 at 2:45 P.M., Resident #143 had a bandage on the left foot near the great toe. The resident stated that the toe nail got ripped off when staff were putting on ([NAME]) stockings, but had seen the physician and is healing. Per record review, on 11/06/17 the nursing progress note stated that therapy alerted nursing staff of dried blood surrounding the left great toe. A new order to cleanse, apply triple antibiotic ointment and Band-Aid every day shift until healed was issued. Resident had stated I don't know when my stockings have not been taken off. A new order was placed to remove stockings at bedtime. The Resident was made aware of new orders. On 11/18/2017, a Skilled Nursing Therapy progress note states ''Rx per MD order to right foot great toe which is presenting as a nail off with scant amount of serosanguinous drainage. It is tender to the touch. PT (physical therapy) and nursing is in agreement that TED hose should not be worn until wound completely heals . Two days later on 11/20/17 at 10:37 [NAME]M. entry in eMAR progress notes states Apply Jobst stocking in the AM and remove at HS .Rinse stockings and hang up to dry every day and evening shift for [MEDICAL CONDITION] Resident states 'My toenail is going to come off with those on. I don't think I should have them on.' Resident elevates bilateral legs in chair in room. Trace of [MEDICAL CONDITION] present. Per record review of the current (and recently revised) care plan demonstrates that the resident is to use TEDS stockings. Per interview on 12/12/17 at 3:28 P.M., the Unit Manager was unable to answer if the stockings were applied as indicated by the 11/20/17 eMar PN entry note, although acknowledged there was an order not use the stockings at that time. Additionally, the Unit Manager confirmed that the care plan and Kardex needed to be revised to reflect that the resident is not using compression stockings to ensure all staff follow the written plan of care. 2). Per record review of a note written by the Registered Dietician (RD), Resident #51 was changed to a Liberalized Renal Diet on 11/22/17 from a Liberalized Regular Diet. The resident is also on an 1,100 milliliter fluid restriction. There is no nutrition care plan found in the comprehensive care plan. There is no mention in any section of the plan of care of the change in diet, including in the End Stage [MEDICAL CONDITION] segment containing [MEDICAL TREATMENT] information. In an interview on 12/12/17 the RD stated that she does not complete a nutrition care plan on every resident, the diet change was requested by the [MEDICAL TREATMENT] RD, and that the resident is cognizant and is able to follow and direct her restrictions. 3) Per record review, the care plan for Resident #80 states to assess and record blood glucose levels twice a day. However, on 9/13/17 the physician discontinued the order to have blood glucose levels checked twice a day. On 9/14/17 a new order was written to begin blood glucose levels checks one time a day on Monday and Thursday. On 10/16/17 the physician discontinued the order to have blood glucose checked at all. On 12/14/17 in an interview with the unit manager s/he confirmed that blood glucose monitoring had been discontinued, but the care plan was never revised. | 2020-09-01 |