cms_WY: 8
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 8 | GRANITE REHABILITATION AND WELLNESS | 535013 | 3128 BOXELDER DRIVE | CHEYENNE | WY | 82001 | 2019-04-11 | 690 | E | 1 | 1 | TYBQ11 | > Based on observation, medical record review, and staff interviews, the facility failed to ensure toileting and incontinence care were provided as needed for 4 of 6 sample residents (#8, #40, #52, #110) reviewed for incontinence. The findings were: 1. Review of the 1/17/19 significant change MDS assessment showed resident #8 had severe cognitive impairment and required extensive or total assistance with all ADLs including toileting and personal hygiene care. Further review showed the resident was always incontinent of bladder and bowel. Review of the care plan interventions, revised 8/29/18, showed staff were directed to check the resident frequently and assist with toileting as needed. The following concerns were identified: a. Observation on 4/7/19 from 4:45 PM to 8:40 PM (almost 4 hours) showed the resident sat in his/her wheelchair in the dining/common area. During the continuous observation staff did not offer or provide toileting assistance, check for incontinence, or provide incontinence care. Observation at 8:40 PM showed CNA #6 and CNA #8 transferred the resident to bed, removed his/her urine- and feces-soiled disposable brief, then provided incontinence care. At that time, an uncovered pressure ulcer on the resident's coccyx area was observed. b. Continuous observation on 4/8/19 from 8:50 AM to 2:30 PM (5 hours and 50 minutes) showed the resident sat in his/her wheelchair in the dining/common area. During the observation staff did not offer or provide toileting assistance, check for incontinence, or provide incontinence care until the resident was transferred to bed at 2:30 PM. At that time CNA #2 and CNA #9 removed the urine-soaked disposable brief and exposed the uncovered pressure ulcer on the resident's coccyx area. 2. Review of the 3/21/19 quarterly MDS assessment showed resident #110 had severe cognitive impairment and required extensive or total assistance with all ADLs including toileting and personal hygiene care. Further review showed the resident was always incontinent of bladder and bowel. Review of the care plan interventions for ADL self-care performance deficit, revised 2/1/19 showed the resident required assistance with toilet use and grooming/hygiene. The following concerns were identified: a. Observation on 4/7/19 from 4:45 PM to 9:45 PM, showed the resident rested in bed. During the observation staff fed the resident and periodically offered fluids. However, during the 5 hour observation, staff did not offer or provide toileting assistance, check for incontinence, or provide incontinence care until 9:45 PM. At that time, incontinence care provided by CNA #6 and CNA #8 included removing the disposal brief worn by the resident and changing the urine-soiled bed linen. b. Observation on 4/8/19 from 8:50 AM to 1 PM (over 4 hours) showed the resident rested in bed without being provided incontinence care or toileting assistance. At 1 PM, continuous observation showed CNA #2 and CNA #9 removed the urine-soiled disposable brief and bed linen when they provided incontinence care for the resident. 3. Review of the 2/19/19 annual MDS assessment showed resident #52 had a BIMS score of 5 (indicating cognitive impairment); required extensive assistance with toileting and personal hygiene care; and was always incontinent of bowel and bladder. Review of the care plan, revised 1/5/19, showed the resident had ADL self-care performance deficit due to weakness and required assistance with personal hygiene care and toileting. Observation on 4/7/19 from 4:45 PM to 9:30 PM (over 5 hours) showed the resident sat in his/her wheelchair in the dining/common area. During the continuous observation staff did not offer or provide toileting assistance, check for incontinence, or provide incontinence care. Observation at 9:30 PM showed CNA #6 and the DON transferred the resident to bed, removed his/her urine- and feces-soiled disposable brief, and provided incontinence care. 4. Review of the 2/14/19 quarterly MDS assessment showed resident #40 had severe cognitive impairment and required limited assistance with transfers, toileting, and personal hygiene care. Further review showed the resident had frequent urine incontinence and occasional bowel incontinence. Review of the care plan interventions for bladder incontinence due to dementia and decreased mobility, revised 2/25/19, showed staff were directed to clean peri-area with each incontinence episode and ensure the resident had an unobstructed path to the bathroom. Further review showed instructions to monitor for signs and symptoms of a urinary tract infection. Observation on 4/8/19 at 8:50 AM showed the resident was sitting on the bedside. At that time wet urine-stained areas on the groin and buttocks areas were observed on his/her pajamas. Continuous observation showed the resident wore the wet pajamas until 10:34 AM. At that time CNA #2 and CNA #9 assisted the resident to the bathroom and removed his/her wet brief and pajamas. 5. Interview on 4/8/19 at 2:30 PM with CNA #2 and CNA #9 revealed they tried to check and toilet residents every two hours, but they were unable to get to all the residents in a prompt manner when there was an insufficient number of staff on duty. Interview on 4/9/19 at 10:55 AM with the Special Care Director revealed she routinely helped the CNAs, but she was not a nurse and could not assist with toileting or personal care needs. | 2020-09-01 |