HospitalInspections.org

Based on staff interviews and review of competency checks and compiled data, the facility failed to ensure all nursing staff were adequately trained and competent to provide patient care. The findings were:

According to the facility's POC for the 10/14/10 recertification survey, the date selected for compliance of all deficiencies was 12/7/10.
Interview with the person responsible for the QA program and review of compiled data on 12/16/10 at 1:45 PM revealed evaluations and/or competency checks had not been completed by that date for seven nursing staff. The delinquent evaluations ranged from a few months to two years, and staff members included the DON, RNs, an LPN, and CNAs. In addition, review of competency checks showed not all agency staff had completed them by 12/7/10. In interviews on 12/16/10 at 3 PM and 3:45 PM and at 10 AM on 12/17/10, the DON confirmed the evaluations and competency checks had not been completed.

Based on observation, medical record review, and staff interview, the facility failed to ensure medications were administered as ordered for 2 of 4 patients (#13, #18) observed during medication passes. Two errors out of twenty opportunities for error resulted in an error rate of ten percent. The findings were:

1. Observation on 12/16/10 showed RN #2 prepared and administered a sliding scale dose of Humalog insulin at 5:40 PM for patient #18. At that time the patient stated s/he would walk to the dining room for dinner at 6 PM. Reconciliation of the medication pass revealed the physician's order was to administered the dose "...after dinner..." On 12/17/10 at 9:20 AM the RN stated she was unaware of the order to specifically administer the insulin after the evening meal. She reviewed the orders and confirmed she had administered the dose incorrectly.

2. On 12/17/10 at 8:17 AM, RN #2 was observed to administer morning medications, including Citracal + D (calcium 630 milligrams + vitamin D 400 milligrams), for patient #13. Reconciliation of the medication pass showed the physician's orders failed to indicate the specific dose the patient was to receive. At 8:46 AM that morning, RN #4 reviewed the information on Citracal + D and verified it came in several different doses. She confirmed the error and stated the order should have been clarified.

















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Based on medical record review and staff interview, the facility failed to ensure patient specific care plans were developed and implemented for 2 of 2 sample acute care patients (#23, #24) whose medical records were reviewed for care plans. The findings were:

According to the POC for the 10/14/10 survey, by 12/7/10 all patients would have current, individualized care plans with measurable goals. Failure to implement this plan was identified in the following instances:
a. According to the medical record, patient #23 was admitted on 12/8/10 for diagnoses including a bowel obstruction, nausea, vomiting, and diarrhea. Review of the admission orders and the nursing documentation showed the patient was placed on NPO (nothing by mouth) status, a nasogastric (NG) tube was inserted, and intravenous (IV) medications were administered. Further review of the orders showed the physician's assistant ordered Viscous Lidocaine for throat pain at 10:30 AM that day, and at 5:55 PM he ordered medications for a headache. Review of the care plans showed a generic one for "Alteration in Nutrition: Less Than Body Requirements" related to nausea and vomiting and the patients NPO status; a second generic care plan for "Alteration in Comfort: Pain" was also included in the medical record. However, none of the interventions listed on either care plan were specifically indicated, the NG tube and the IV were not addressed, the care plan to alleviate pain failed to address throat pain from the NG tube and the patient's headache, and measurable goals were not identified.
b. Medical record review showed patient #24 was admitted on 12/810 for complaints of pain in the right knee after a fall and right ear pain consistent with mastoiditis. Detailed review of the medical record showed a care plan had not been developed.
c. As the DON was unavailable on 12/17/10 at 10:37 AM, interview with the person responsible for the QA program confirmed the lack of appropriate care plans for the aforementioned patients.

Based on review of internal documents and staff interview, the facility failed to ensure the "Swing Bed Notice of Transfer/Discharge" contained all required elements. The findings were:

According to the POC for the 10/14/10 recertification survey, the facility would implement an appropriate transfer/discharge notice for swing bed patients by 12/7/10. Review of the "Swing Bed Notice of Transfer/Discharge" showed it failed to include a statement that the patient had the right to appeal the action to the State. Interview with RN #4, one of the coordinators of the swing bed program, on 12/21/10 at 11:35 AM confirmed the statement was lacking. The RN stated she was unaware of the requirement to include it in the notice.