HospitalInspections.org

Based on record review and interview, the facility failed to ensure that emergency procedures, and training of staff in handling emergencies were maintained to ensure an acceptable level of safety and quality for all patients, staff and guests. Findings include:

A review of the facility's fire drill reports showed there were missing fire drills for the night shift in the first quarter of 2015, and both day and night shifts for the second quarter of 2015.

During an interview on 2/9/16, at 10:29 a.m., staff member U stated they missed some fire drills.

Based on observation, interview and record review, the facility failed to meet the applicable provisions of the 2000 edition of the Life Safety Code. Findings include:

- Proper separation of fire walls at two hour walls. Refer to K 11.
- Corridor walls and doors. Refer to K 17.
- Doors in exit passageways, stairway enclosures, horizontal exits, or smoke barriers. Refer to K 21.
- Exit signs. Refer to K 22.
- Smoke barriers. Refer to K 25.
- Self closing doors. Refer to K 29
- Hard path surfaces at all exits to a public way. Refer to K 38.
- Maintenance of exit signs. Refer to K 47.
- Maintenance record of all required fire drills. Refer to K 50.
- Identification of Fire Alarm Control Panel and connection means. Refer to K 52.
- Maintenance of sprinkler system. Refer to K 62.
- Means of egress. Refer to K 72.
- Medical gas storage. Refer to K 76.
- Piped in medical gas systems. Refer to K 77.
- Electrical wiring in accordance with NFPA 70. Refer to K 147.
- All Alcohol Based Hand Rub dispensers located properly. Refer to K 211.

Based on record review and interview, the facility failed to ensure four of seven registered nurses received and/or renewed their specialized competency trainings per their job descriptions, to ensure all patient care needs were met. Finding include:

Review of the facility's policy titled, Competency, Licensure, Certification or Registration of Personal and Medical Staff reflected the competence of staff members was defined by their job descriptions designed by their supervisor and the human resources manager. Competency was assessed to assure that an individual in their current position meets at least the minimal requirements set out in the position's job description.

Review of the facility's job description titled, Registered Nurse reflected the Basic Life Support (BLS) certification was required at time of hire. The following certifications were required within 12 months of hire: Advanced Cardiac Life Support (ACLS), Pediatric Advanced Life Support (PALS), and Trauma Nursing Core Course (TNCC) and/or Emergency Nursing Pediatric Course (ENPC).

During an interview on 2/10/16 at 9:15 a.m., staff member Q stated the facility required the STABLE certification for their labor and delivery nurses, which provided education on the newborn baby's status.

During an interview on 2/10/16 at 9:30 a.m., staff member B stated staff members F, O, and P were their labor and delivery nurses, until newer nurses could complete their training requirements.

Review of the employee files for registered nurses for training certifications reflected:
-Staff member F was hired on 12/8/14, and lacked evidence of certifications in ACLS, PALS, and STABLE.
-Staff member N was hired on 6/1/06, and lacked evidence of certifications in ACLS, PALS, TNCC and/or ENPC.
-Staff member O was hired on 1/23/01, and lacked evidence of certification in STABLE.
-Staff member P had an expired certification in ENCP, which ended in 1/2016.

During an interview on 2/10/16 at 1:05 p.m. staff member B stated staff member's F, N, O, and P were missing their certifications, as noted above.

During an interview on 2/10/16 at 1:10 p.m., staff member Q stated the facility obtained their registered nurse training certifications through two hospitals. Staff member Q stated the facility did not have contracts to ensure their employees were guaranteed training spots. She said if either hospitals needed the training space for their own employees, the facility employees got bumped.

Based on observation, record review and interview, the facility failed to have evidence of providing informed admission consents or a discharge summary for 5 (#s 1, 9, 10, 24 and 37) of 37 sampled and supplemental patients. Findings include:

1. Patient #10 was admitted to the facility's Acute Care Medical Surgical Inpatient unit from 4/29/15 - 5/1/15.

During record review for patient #10, staff member Q assisted by navigating the electronic system. The record lacked evidence that the patient or his representative were provided admission consent forms to review and sign.

On 2/11/16 at 12:00 p.m., staff member A was given a written request for evidence that patient #10 was provided informed consents. No additional information was provided.

2. Swing-bed patient #1 was admitted to the facility's on 8/5/15 - 8/8/15 and 8/13/15 - 9/2/15.

During record review for patient #1, staff member Q assisted by navigating the electronic system. The record lacked evidence that the resident or his representative were provided admission consent forms to review and sign.

On 2/11/16 at 12:00 p.m., staff member A was given a written request for evidence that patient #1 was provided informed consent forms.

On 2/12/16 the facility faxed the state agency patient #1's Patient Progress Notes from 8/6/15 - 8/8/15 and 8/13/15 - 9/2/15, which lacked evidence that the patient was provided informed consent forms.

3. Patient #24 was admitted to the facility's surgical services on 9/7/15.

During the record review for patient #24, staff member Q assisted by navigating the electronic system. The record lacked evidence that the patient or his representative were provided admission consent forms to review and sign.

On 2/11/16 at 12:00 p.m., staff member A was given a written request for evidence that patient #24 was provided informed consents.

On 2/12/16 the facility faxed the state agency additional records for patient #24, which included surgical and anesthesia consent forms. The records reflected a lack of the facility's general admission consent forms.

4. Patient #9 was admitted to the facility's Acute Care Medical Surgical Inpatient unit from 10/27/15 - 10/28/15.

During record review for patient #9, staff member Q assisted in the review by navigating the electronic system. The record lacked evidence of a discharge summary.

On 2/11/16 at 12:00 p.m., staff member A was given a written request for evidence that patient #9 was provided a discharge summary. No additional information was provided.

5. During an observation on 2/9/16 at 11:30 a.m., patient #37 was being admitted to the emergency department. Staff member R was processing the admission consent forms and asked patient #37 to sign the forms on a hand-held electronic signature device. A clip board with the consent forms were placed on a bedside table at the foot of the patient's bed. The patient signed the electronic signature device before verbal instruction was given by staff regarding the content of the forms and before the patient read the forms. Staff member R told the patient if she wanted copies of the forms to just let her know.

During an interview on 2/11/16 at 10:50 a.m., staff member R stated the admission forms were in the computer program. When the patient signed their name on the electronic signature device, the staff saved the signature imagine, and the admission form and signature were saved together in the medical record. Staff member R stated all patients signed three admission forms, the Condition of Participation, the Notice of Privacy Practice, and the Patient's Rights. If the patient was in the emergency department, they sign an additional Emergency Service form. If a patient was unable to sign these forms their representative could sign for them. Generally these admission forms were the responsibility of the registration office, but when the registration office was closed the nursing staff completed these forms.

During an interview on 2/11/16 at 11:15 a.m., staff member T stated the nursing staff completed admission forms when the registration office was closed.

Based on record review and interview, the facility failed to provide evidence that swing bed patients received information on their resident's rights for 3 (#s 1, 3 and 4) of 4 sampled Swing-bed patients. Findings include:

1. Swing bed patient #1 was admitted to the facility's Swing-bed services on 8/5/15 - 8/8/15 and 8/13/15 - 9/2/15.

During the record review for swing bed patient #1, staff member Q assisted in the review by navigating the electronic system. The record lacked evidence that the patient or his representative were provided oral and written information on his resident's rights.

On 2/11/16 at 12:00 p.m., staff member A was given a written request for evidence that patient #1 was informed of his resident's rights.

On 2/12/16 the facility faxed the state agency patient #1's Patient Progress Notes from 8/6/15 - 8/8/15 and 8/13/15 - 9/2/15, which lacked evidence that the patient was informed of his resident's rights.

2. Swing bed patient #3 was admitted to the facility's Swing-bed program from 1/1/16 - 1/14/16.

During the record review for patient #3, staff member Q assisted in the review by navigating the electronic system. The record lacked evidence that the patient or his representative were provided oral and written information on his resident rights.

On 2/11/16 at 12:00 p.m., staff member A was given a written request for evidence that swing bed patient #3 was informed of his resident's rights.

On 2/12/16 the facility faxed the state agency swing bed patient #3's Patient Progress Notes from 1/1/16 - 1/14/16, which reflected a lack of evidence that the patient was informed of his resident's rights.

3. Swing bed patient #4 was admitted to the facility's Swing-bed program from 5/13/15 - 5/18/15.

During record review for swing bed patient #4, staff member Q assisted in the review by navigating the electronic system. The record lacked evidence that the patient or his representative were provided oral and written information on his resident's rights.

On 2/11/16 at 12:00p.m., staff member A was given a written request for evidence that patient #4 was informed of his resident's rights.

On 2/12/16 the facility faxed additional medical records regarding patient #4 to the state agency, which reflected a lack of evidence that the patient was informed of his resident's rights.

During an interview on 2/11/16 at 10:50 a.m., staff member R stated the Resident Rights and Responsibilities form were among the three consents forms to be reviewed and signed on general admission. The Resident Rights and Responsibilities reflected 27 focus areas, a signature area for the patient or their representative and staff, and included acknowledgement of understanding.

If a patient was unable to sign the Resident's Rights and Responsibilities form, their representative could sign for them. The admission forms were the responsibility of the registration office, but when the registration office was closed the nursing staff completed the forms.

During an interview on 2/11/16 at 11:15 a.m., staff member T stated the nursing staff completed admission forms when the registration office was closed.

Based on record review and interviews, the facility failed to provide evidence of informing patients in writing of their rights to accept or refuse medical or surgical treatments, Medicaid rights, and their right to be informed and to be provided written information on advanced directives for 3 (#s 1, 3 and 4) of 4 sampled Swing-bed patients. Findings include:

1. Swing bed patient #1 was admitted to the facility's Swing Bed services on 8/5/15 - 8/8/15 and 8/13/15 - 9/2/15.

During the record review for patient #1, staff member Q assisted by navigating the electronic system. The record lacked evidence that the patient or his representative were provided written information on their Medicaid rights, medical and surgical rights, or advance directives.

On 2/11/16 at 12:00 p.m., staff member A was given a written request for evidence that swing bed patient #1 was given information on advanced directives or consent for treatment.

On 2/12/16 the facility faxed the state agency swing bed patient #1's Patient Progress Notes from 8/6/15 - 8/8/15 and 8/13/15 - 9/2/15.

Swing bed patient #1's Patient Progress Notes reflected a lack of written evidence that the facility provided the patient or his representative in writing of his right to be:
-Informed on Medicaid benefits, and which services provided at the facility were not covered.
-Informed on patient rights to accept or reject medical and surgical treatments.
-Informed on the right to formulate advance directives.

2. Swing bed patient #3 was admitted to the facility's Swing-bed program from 1/1/16 - 1/14/16.

During the record review of swing bed patient #3, staff member Q assisted in the review by navigating the electronic system. The record lacked evidence that the patient or his representative were provided written information on their Medicaid rights, medical and surgical rights, or advance directives.

On 2/11/16 at 12:00 p.m., staff member A was given a written request for evidence that swing bed patient #3 was informed of his resident's rights and consents for treatment.

On 2/12/16 the facility faxed the state agency swing bed patient #3's Living Will Declaration and Directions for My Care, which provided medical direction in the event he was unable to direct his care. Additionally, his Patient Progress Notes from 1/1/16 - 1/14/16 were sent.

Swing bed patient #3's Patient Progress Notes reflected a lack of written evidence that the facility informed the patient or his representative in writing of his right to be informed on his Medicaid rights, or his medical and surgical rights.

3. Swing bed patient #4 was admitted to the facility's Swing-bed program from 5/13/15 - 5/18/15.

During the record review for swing bed patient #4 , staff member Q assisted by navigating the electronic system. The record lacked evidence that the patient or his representative were provided written information on his Medicaid rights and medical and surgical rights.

On 2/11/16 at 12:00 p.m., staff member A was given a written request for evidence that swing bed patient #4 was provided his resident's rights.

On 2/12/16 the facility faxed additional medical records to the state agency regarding swing bed patient #4's, which reflected a lack of evidence that the patient was informed of his rights under Medicaid, and right to accept or refuse medical or surgical treatments.

During an interview on 2/11/16 at 10:50 a.m., staff member R stated the Resident's Rights and Responsibilities were among three admission forms for general admission. The Resident's Rights and Responsibilities reflected 27 focus areas including advanced directives, the right to accept or refuse medical or surgical treatments and Medicaid rights (attached).

If a patient was unable to sign the the Resident's Rights and Responsibilities form, their representative could sign for them. The admission forms were the responsibility of the registration office, but when the registration office was closed the nursing staff completed the forms.

During an interview on 2/11/16 at 11:15 a.m., staff member T stated the nursing staff completed the admission forms when the registration office was closed.

Based on record review and interview, the facility failed to ensure the resident received sufficient discharge planning to facilitate a coordinated team effort to meet the resident's future care needs for 3 (#s 1, 2 and 4) of 4 sampled Swing-bed patients. Findings include:

1. Swing bed patient #1 was admitted to the facility's Swing-bed services on 8/5/15 - 8/8/15 and 8/13/15 - 9/2/15.

During the record review for swing bed patient #1, staff member Q assisted by navigating the electronic system. The record lacked evidence that the patient was provided orientation and preparation for discharge.

On 2/11/16 at 12:00 p.m., staff member A was given a written request for evidence that patient #1 was provided discharge planning.

On 2/12/16 the facility faxed the state agency patient #1's Patient Progress Notes from 8/6/15 - 8/8/15 and 8/13/15 - 9/2/15, which lacked evidence that the patient was provided orientation and preparation for discharge.

2. Swing bed patient #4 was admitted to the facility's Swing-bed program from 5/13/15 - 5/18/15.

During the record review for patient #4, staff member Q assisted by navigating the electronic system. The record lacked evidence that the patient was provided discharge planning.

On 2/11/16 at 12:00p.m., staff member A was given a written request for evidence that swing bed patient #4 was provided discharge planning.

On 2/12/16 the facility faxed additional medical records to the state agency regarding swing bed patient #4's discharge planning.

The Nursing Orders reflected:
-Initiate the Discharge Care Plan. Patient #4's record reflected a lack of a discharge care plan.

The Physical Therapy Swing Bed Initial Evaluation, dated 5/14/15 reflected:
-The patient lives in a home with stairs, lives alone, and family might come and stay with him for a short while. The patient may benefit from a family member staying with him for a short while, and cardiac rehabilitation when appropriate.

The Discharge Instructions and Patient Progress Notes for 5/13/15 - 5/18/15 reflected:
-On 5/18/15 the patient was discharged from the facility with instructions and ambulated out with family members. The medical record lacked evidence of preparation, planning and orientation to prepare the patient for a successful discharge.

The medical record for resident #4 reflected a lack of additional discharge planning after the Physical Therapy Swing Bed Initial Evaluation. The record did not clarify if family members were going to stay with the resident post-discharge, if he had a home study to determine if the stairs in his home or other physical structures might cause safety or functional concerns. Additionally, the record reflected a lack of information about cardiac rehabilitation or medication management especially related to his Coumadin therapy.

3. Swing bed patient #2 was admitted to the facility's Swing-bed program from 10/7/15 - 10/13/15.

During the record review for swing bed patient #2, staff member Q assisted by navigating the electronic system. One Physician Progress Note reflected the patient would be discharged to a long term care facility. The medical record reflected a lack of additional orientation and preparation for discharge.

On 2/11/16 at 12:00 p.m., staff member A was given a written request for evidence that swing bed patient #2 was provided discharge planning.

On 2/12/16 the facility faxed the state agency additional medical records pertaining to swing bed patient #2's discharge plan.

The Nursing Orders reflected:
-Initiate the Discharge Care Plan. The record reflected a lack of a discharge care plan.

The Patient Progress Notes from 10/7/15 - 10/31/15 reflected a lack of evidence that the patient was provided orientation and preparation for discharge, whether the patient was being admitted to a long term care facility, or if referrals and/or counseling was provided.

During an interview on 2/11/16 at 9:20 a.m., staff member S stated the facility used to have a discharge planner, but the floor nurses now provided discharge planning. She said the discharge plan started at admission, and after three inpatient days the nurses would need to start planning the patient's discharge needs. Staff member S stated the discharge activities would probably not be documented in the medical record.

During an interview on 2/11/16 at 10:55 a.m., staff member H stated discharge planning should always be documented in the medical record.

Based on record review and interview, the facility failed to ensure routine education on abuse and neglect was provided to all staff, which had the potential to affect all patients and swing-bed patients. Findings include:

Review of the facility's policy titled, Suspected or Identified Abuse, Neglect and Exploitation reflected staff education on suspected or identified abuse, neglect and exploitation will include:
-The education for all employees during orientation including information on the screening criteria and appropriate reporting.
-The registered nurses and social service staff will be trained for assessment, care, reporting, and referral of suspected or identified abuse, neglect and exploitation.
-The annual competencies trainings will include assessment evaluations.

During random interviews, three of five staff members stated the facility had not provided them with training on abuse and neglect:
-On 2/9/16 at 7:25 a.m., staff member F stated she never received abuse and neglect training, except while she was in school.
-On 2/9/16 at 7:45 a.m., staff member E stated the facility provided yearly orientation to employees but was not sure if it covered the abuse and neglect training.
-On 2/9/16 at 7:50 a.m., staff member G stated the facility did not provide routine abuse and neglect trainings.

During an interview on 2/11/16 at 8:30 a.m., staff member D stated the facility was without a human resource manager between 4/15 and 10/15. Staff member D stated she found no evidence of abuse and neglect training in the employee human resource files. She stated the facility discontinued the old electronic employee training system on 11/30/15, and their new system would begin on 3/1/16. The new electronic employee training system will include abuse and neglect trainings.

During an interview on 2/11/16 at 8:45 a.m., staff member B stated she had started orienting new nursing staff to the policy and procedure on abuse and neglect on 11/15, but did not believe she had any evidence that the trainings had occurred.

During an interview on 2/11/16 at 9:05 a.m., staff member A stated the human resource coordinator made her aware that their employee files contained no evidence of abuse and neglect trainings. Staff member A stated the previously human resource manager had left abruptly on 4/15 and had not returned. Staff member A stated she recalled seeing the abuse and neglect training records but had not been able to locate them.

On 2/11/16 at 12:00 p.m., staff member A was given a written request for evidence of abuse training between 12/2/14 and 1/25/16, for the following nursing staff members H, I, J, K, and L. No evidence was provided.

Based on record review and interview, the facility failed to ensure background checks were completed on all employees, which had the potential to affect all patients and Swing-bed patients. Findings include:

Review of the facility's policy titled, Suspected or Identified Abuse, Neglect and Exploitation reflected individuals would not be employed if they had been found guilty by the court of law, or had a finding against them regarding abuse, neglect or exploitation entered into the Department of Health and Human Service CNA Registry.

Review of the facility's policy titled, Background Checks, reflected potential employees prior to scheduling an interview would be screened through the HHS/OIG list of excluded individuals, the Montana Department of Corrections Offender Web Data Base, and National Sex Offender Web Data Base.

During a review of nursing staff hired between 6/23/11 and 10/25/15, two of five of the their human resource files did not contain background checks for staff members B and F. Background checks were later processed on 2/9/16 for staff members B and F and placed into their employee files.

During an interview on 2/9/16, staff member D stated on 10/15, she started background checks for all new employees, but had not completed a full review of all current employees.

Based on observation, record review and interview, the facility failed to ensure Swing-bed patients were routinely offered and/or encouraged to participate in activities based on individual assessments and functional status, including programmed activities scheduled at a contracted distance site, which had the potential to affect all Swing-bed patients. Findings include:

Review of the facility's document titled, What to Expect While in a Swing Bed reflected the facility contracted with social services to advise on available activities, and activities would be offered on a daily basis.

During an observation on 2/11/16 at 11:00 a.m., the facility's activity cart was stored in the respiratory therapy department. The activity cart had a very limited number of activity options. The cart contained four to six boxes of puzzles, two to four children cartoon magazines, two to four adult cross word or word games magazines, one box of dominoes, and a deck of cards.

1. Swing bed patient #1 was admitted to the facility's Swing-bed Program on 8/5/15 - 8/8/15 and 8/13/15 - 9/2/15.

During the record review for swing bed patient #1, staff member Q assisted by navigating the electronic system. The record lacked evidence that the patient had an activity assessment completed or was informed and/or encouraged to engage in activities.

On 2/11/16 at 12:00p.m., staff member A was given a written request for evidence that swing bed patient #1 was offered activities.

On 2/12/16 the facility faxed the state agency swing bed patient #1's Patient Progress Notes for 8/6/15 - 8/8/15
which reflected:
-Resting in bed, approximately nine entries.
-Family visit, approximately one entry
-Watching television and reading a book, approximately two entries.

Review of swing bed patient #1's faxed Patient Progress Notes from 8/13/15 - 9/2/15 reflected:
-Resting and/or resting in bed, approximately 33 entries.
-Sitting up in room, approximately 28 entries.
-Walks occasionally short distances, approximately 23 entries.
-Family visit, approximately five entries.
-Watching television, reading a book, or engaging in a cross word puzzle, approximately five entries.

Swing bed patient #1's medical record reflected a lack of a Swing Bed Activity Assessment to determine his interests. His Patient Progress Notes lacked evidence that the patient was provided an activity assessment, or informed and/or encouraged to engage in formal group activities contracted through a distant site.

2. Swing bed patient #4 was admitted to the facility's Swing-bed program from 5/13/15 - 5/18/15.

During the record review for swing bed patient #4, staff member Q assisted by navigating the electronic system. The record lacked evidence that the patient was informed and/or encouraged to engage in activities.

On 2/11/16 at 12:00 p.m., staff member A was given a written request for evidence that swing bed patient #4 was offered activities.

On 2/12/16 the facility faxed additional medical records to the state agency regarding swing bed patient #4's activities.

The Nursing Orders reflected:
-May be released for activities from alcohol.
-May be released from activities from dietary.

The Patient Progress Notes reflected:
-Resting in bed, approximately seven entries
-Sitting in room, approximately two entries.
-Family visit, approximately two entries.
-Watching television, approximately three entries.
-Engaging in a cross word puzzle, approximately one entry.
-Walks occasionally short distances, approximately five entries.
-Walks frequently, approximately three entries.

The Swing Bed Activity Assessment reflected 22 possible activity interests, and swing bed patient #4's assessment reflected cards and sports interests.

Swing bed patient #4's medical record reflected an interest in cards and sports, but lacked evidence that the patient was encouraged to engage in those activities, or provided notice of formal group activities contracted through the distant site.

3. Swing bed patient #2 was admitted to the facility's Swing-bed program from 10/7/15 - 10/13/15.

During the record review for swing bed patient #2, staff member Q assisted by navigating the electronic system. The medical record reflected a lack of evidence the patient was given an activity assessment, or offered activities.

On 2/11/16 at 12:00 p.m., staff member A was given a written request for evidence that swing bed patient #2 was offered activity choices.

On 2/12/16 the facility faxed the state agency additional medical records pertaining to swing bed patient #2's activities.

The Nursing Orders reflected:
-May be released for activities from dietary.

The Patient Progress Notes from 10/7/15 - 10/31/15 reflected:
-Resting in bed, approximately three entries.
-Sitting in room, approximately three entries.
-Family visit, approximately two entries.
-Watching television, approximately two entries.
-Walks occasionally short distances and in the hall, approximately 11 entries.

Swing bed patient #2's medical record reflected a lack of a Swing-bed Activity Assessment to determine her interests. Her Patient Progress Notes lacked evidence that the patient was provided with an activity assessment, or informed and/or encouraged to engage in formal group activities contracted through the distant site.

During an interview on 2/10/16 at 11:00 a.m., staff member B stated the facility had a contract with a local long term care facility to provide formal activity programs to the Swing-bed patients. The contracted distant site would send an activity calendar to the facility every month and should be available at the nursing station. The staff offered patient activity options, and if interested in attending the facility staff would provide transportation.

During an interview on 2/10/16 at 4:00 p.m., staff member Q stated the facility used to have a staff person who was responsible for activities. When she left the facility, she was never replaced. The nursing staff were now responsible for offering activities to patients.

During an interview on 2/11/16 at 9:20 a.m., staff member S stated Swing-bed patients were offered formal activities at the contracted distant site depending on their ability to participate. Staff member S stated activities available at the facility were watching television, reading, and ambulating in the hall. She said she documented patient's activities either under 'Activities' or in the nursing notes.

During an interview on 2/11/16 at 10:55 a.m., staff member H stated she was aware that activities should be offered to patients in the Swing-bed program. She said that presently the facility did not have a list of activities offered through the contracted distant site, because the facility did not have any current Swing-bed patients.

Review of the policy titled, Swing Bed Activities reflected the facility would contract with long term care facility to provide a licensed activities director to plan and direct activities at the facility through an appointed activity director at the facility. An Activity Assessment would be completed by nursing on admission for each Swing-bed patient. An Activity Care Plan would be completed by nursing for each Swing-bed patient. Activities offered and/or participation would be documented daily on the Activity Sheet.

Based on record review and interviews, the facility failed to provide nutritional screenings and assessments for 1 (#1) of 4 sampled Swing-bed patients. Findings include:

1. Patient #1 was admitted to the facility's Swing-bed services on 8/5/15 - 8/8/15 and 8/13/15 - 9/2/15.

During the record review for patient #1, staff member Q assisted by navigating the electronic system. The record lacked evidence that the patient received a nutritional screening at admission, or a standardized nutritional assessment as part of the initial comprehensive assessment.

On 2/11/16 at 12:00 p.m., staff member A was given a written request for evidence that patient #1 was given a nutritional screening or assessment.

Review of patient #1's faxed Patient Progress Notes from 8/13/15 - 9/2/15 reflected:
-Denies any nausea and vomiting, approximately 27 entries.
-Eats most of every meal, approximately 13 entries.
-Eats half of most meals, approximately 23 entries
-Feeds self, approximately 30 entries.

Patient #1's Patient Progress Notes lacked evidence that the patient received an admission nutritional screening, a standardized nutritional assessment, or interventions for the patient's poor appetite on 23 occasions.

During an interview on 2/11/16 at 9:20 a.m., staff member S stated acute care and Swing-bed patients received nutritional assessment started by nursing within 24 hours of their inpatient admission. The dietician would receive an electronic notification of the assessment and would call the facility if she had questions or concerns.

Review of the facility's policy titled, Admission and Comprehensive Assessments for Swing-bed patients reflected comprehensive assessments, including nutritional assessments to be completed within five days of admission.

Review of the policy titled, Nutritional Assessments reflected all patients would receive a nutritional screening at the time of admission and be completed on all Swing-bed patients within seven days. The nutritional assessment included 26 areas including weight, normal or ideal weight, condition of gums and teeth, swallowing problems, nutritional problems, and the supervisor's and the consultant dietician's signatures.