The information below comes from the statement of deficiencies compiled by health inspectors and provided to AHCJ by the Centers for Medicare and Medicaid Services. It does not include the steps the hospital plans to take to fix the problem, known as a plan of correction. For that information, you should contact the hospital, your state health department or CMS. Accessing the document may require you to file a Freedom of Information Request. Information on doing so is available here.
|CRESTWYN BEHAVIORAL HEALTH||9485 CRESTWYN HILLS COVE MEMPHIS, TN 38125||Oct. 12, 2020|
|VIOLATION: RN SUPERVISION OF NURSING CARE||Tag No: A0395|
|**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on policy review, medical record review and interview, the facility failed to ensure a registered nurse maintained the responsibility of addressing the bathing and hygiene needs of each patient for 1 of 3 (Patient #1) sampled patients.
The findings included:
1. Review of the facility's policy, "Personal Hygiene Assistance," revealed, "POLICY: To provide ADLs [activities of daily living] to patients to prevent disability and maintain health and personal hygiene. The nursing staff of the hospital will assist patients as needed with personal hygiene, to include tub baths, showers, or bed baths to ensure patient cleanliness...POLICY STATEMENT: Each patient will be assessed on admission by a Registered Nurse [RN] for ability to maintain ADLs independently. An individualized program of assistance with ADLs is implemented upon admission. The assigned RN will monitor of ADL compliance and documentation...PROCEDURE...When a patient refuses a bath/shower, the unit staff will document this in the medical record and notify the patient's nurse...If a patient refuses ADLs, the patient's nurse will be notified...In addition to bathing, ADLs will include...Hair care daily...Shampoo as indicated..."
2. Medical record review for Patient #1 revealed an admission date of [DATE] with diagnoses which included Schizoaffective Disorder, Depressive Type, Psychosis, [DIAGNOSES REDACTED], and Gastroesophageal Reflux Disease.
The Nursing assessment dated [DATE] revealed Patient #1 bathed 2 times daily prior to admission and functionally independent with bathing.
Patient #1 submitted a request to be discharged against medical advice on 9/21/20.
Patient #1's admission status was changed to involuntary admission with the FIRST CERTIFICATE OF NEED FOR EMERGENCY INVOLUNTARY ADMISSION completed on 9/21/20 and the SECOND CERTIFICATE OF NEED FOR EMERGENCY INVOLUNTARY ADMISSION completed on 9/23/20.
The Nursing Reassessment dated [DATE], 9/22/20, and 9/27/20 revealed Patient #1's appearance was assessed as disheveled.
The Nursing Reassessment dated [DATE] revealed Patient #1's appearance was assessed as disheveled, poor hygiene and bizarre.
The Nursing Reassessment dated [DATE], 9/28/20, and 9/29/20 revealed Patient #1's appearance was assessed as disheveled and poor hygiene.
The Nursing Reassessment dated [DATE] revealed RN #1 documented, "...Hair looks disheveled & [and] greasy..."
There was no documentation Patient #1 bathed or performed hair care during the facility stay. There was no documentation Patient #1 refused bathing or ADL care. There was no documentation staff attempted to assist Patient #1 with bathing or ADL care. There was no documentation an RN monitored Patient #1 for ADL compliance and documentation or addressed Patient #1's need for personal hygiene.
3. In an interview in the Chapel on 10/12/20 at 11:34 AM, the Interim Director of Nursing (DON) stated Patient #1 was independent with bathing and ADL care. When asked how she would expect staff to address a patient who had been assessed as independent with bathing and ADL care but did not perform personal hygiene, the Interim DON stated staff should try to encourage them to bathe, and if the patient needed assistance, the staff should assist them.
In an interview in the Chapel on 10/12/20 at 2:38 PM, RN #1 stated she would encourage a patient to perform bathing and ADL care if they could independently manage personal hygiene. When asked what she would do if a patient still did not perform bathing or ADL care, RN #1 stated she would talk to the therapist and document that the patient refused to get cleaned up in the medical record.