cms_WY: 9
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 9 | GRANITE REHABILITATION AND WELLNESS | 535013 | 3128 BOXELDER DRIVE | CHEYENNE | WY | 82001 | 2019-04-11 | 725 | F | 1 | 1 | TYBQ11 | > Based on observation, resident and family interviews, staff interview, review of the facility assessment, and review of facility staffing documentation, the facility failed to ensure an adequate number of staff was provided to meet resident needs. The census was 118. The findings were: Review of the facility assessment staffing plan showed the total number of nurses and CNAs required to meet basic staffing needs was 10 licensed nurses and 18 CNAs. Non-licensed and non-certified staff were not separately accounted for. The following concerns were identified: 1. Review of the facility staffing sheets from 2/1/19 through 2/28/19 revealed the facility failed to have the minimum required nurse staffing on 22 of the 28 days (78%). 2. Review of the facility staffing sheets from 3/1/19 through 3/31/19 revealed the facility failed to have the minimum required nurse staffing on 28 of the 31 days (90%). 3. Review of the facility staffing sheets from 4/1/19 through 4/7/19 revealed the facility failed to have the minimum required nurse staffing on 5 of the 7 days (71%). 4. Review of the facility staffing sheets from 2/1/19 through 4/7/19 revealed the facility failed to have the minimum required CNA staffing on all days reviewed (100%). 5. Interview on 4/8/19 at 3:30 PM with 7 residents revealed they had concerns about lengthy wait times for call lights to be answered, and lack of showers. 6. Interview on 4/8/19 at 2:26 PM with a family member of resident #77 revealed there was no system for getting residents up and the only time the resident's face was washed was during a bath. She further stated there was only 1 CNA for 19 residents. 7. Interview on 4/10/19 at 2:11 PM with a family member of resident #15 revealed the resident did not receive a bath during the first two weeks after s/he was admitted . The family member stated s/he felt the staff was overwhelmed with care, especially in the evening, when they were getting residents to bed and other residents were unattended in the dining room. The spouse also stated the resident's room had not been cleaned in 3 days. 8. Interviews with facility staff revealed the following: a. Interview on 4/9/19 at 4:07 PM with LPN #1 revealed only 2 CNAs provided care for each hall and no bath aide. She stated baths got missed , fluids were not passed to residents, and residents were not assisted with meals. She stated she did not understand the staffing related to the numbers, and why resident acuity did not factor into staffing. She added there were residents who required total care, were a total lift for transfers, and those residents took additional time and extra staff. She further stated there were nights when only one CNA worked in the secure unit. b. Interview on 4/9/19 at 4:46 PM with HSA #1 revealed she was scheduled with a CNA in the secure unit, but when the CNA took a break she was left alone with the residents. She stated if an unsafe situation occurred she pressed the HELP button, which is located by the nurse's station by the clock. She stated she had been alone in a room with an upset resident, and she had to wait for the resident to calm down, because she had no way to get help. c. Interview on 4/10/19 at 4:08 PM with HSA #1 revealed she was vomiting and tried to call in sick and the facility told her she had to work. She added she talked to the DON who told her to find her own coverage if she was sick. The HSA stated she did not have any of the other staff phone numbers at home. d. 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. e. Interview on 4/11/19 at 8:28 AM with the infection control nurse revealed she had been working on the floor and had not been able to devote time to all of the infection control nurse duties. She stated she started the surveillance and periodic audit system for monitoring dressing changes, ADLs, and hand hygiene, but the most current audits were completed in (MONTH) (YEAR). She stated she started developing the antibiotic stewardship program, but it had not been fully implemented. f. Interview on 4/10/19 at 12:41 PM with CNA #7 revealed she was the bath aide for the first floor. During the timeframe in (MONTH) when the showers were not being done she had been pulled to work in other areas of the building and no one had showered the residents in her absence. 9. Staff inability to respond promptly to residents's toileting and incontinence needs was noted during the following observations: a. Observation on 4/7/19 from 4:45 PM to 8:40 PM (almost 4 hours) showed resident #8 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 until 8:40 PM when CNA #6 and CNA #8 provided urine and fecal incontinence care. 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 2:30 PM. b. Observation on 4/7/19 from 4:45 PM to 9:45 PM, showed resident #110 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. Observation on 04/08/19 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. c. Observation on 4/7/19 From 4:45 PM to 9:30 PM (over 5 hours) showed resident #52 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. d. Observation on 4/8/19 at 8:50 AM showed resident #40 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. 10. Please refer to F677 for details of concerns regarding resident showers and oral hygiene. 11. Interview with the staffing coordinator on 4/11/19 at 12:21 PM revealed the PPD was determined by the facility's corporation and the NHA and they gave her the number. She stated HSA (non-licensed, non-certified staff members) hours were figured in with the nursing hours. She confirmed the facility was short-staffed, and the past couple months had been terrible because of illness. She also stated the management staff helped on the resident units. 8. Interview on 4/11/19 at 2:15 PM with the NHA confirmed HSA hours were counted with nursing hours. She also stated when staffing was critical all managers were pulled to work on the resident units. She stated they have had turnover due to holding staff accountable to the attendance policy. She stated the facility currently had 9 CNA position openings and 4 full-time nursing position openings. She stated they monitored potential admissions and did not accept residents with higher acuity. | 2020-09-01 |