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Based on staff interview and record review, the facility failed to ensure that a nursing care plan was kept current for 1 of 20 sampled clients (Client 14). The document titled, "Service/Health Care Objectives and Plans," for "Gastrostomy Status" did not reflect the physician's orders as it related to the size of Client 14's gastrostomy tube (a tube placed through the abdominal wall into the stomach for nutrition and /or medications). This failure had the potential for an incorrectly sized tube being inserted.


Findings:

Client 14's record was reviewed on 7/31/17. Client 14 had diagnoses that included dysphagia (difficulty swallowing) and a gastrostomy tube was in place. Physician's orders, dated 7/20/17 at 10:42 a.m., indicated the following: Gastrostomy tube change: "Use sliding ring #18 Fr. (French)..." [ French is a scale used to measure the size of the tube].

Review of the nursing care plan titled, "Service/Health Care Objectives and Plans," contained the condition, "Gastrostomy Status." Documentation indicated, use sliding ring # 20 Fr. The nursing care plan did not reflect the size tubing the physician ordered.

During an interview with RN 3 on 7/31/17 at 2:55 p.m., RN 3 stated, "I will fix it."

Based on interview and record review, the facility failed to have two doctors actively carry out the functions of the Utilization Review Committee. This failure had the potential to lead to decreased oversight in the appropriate use of resources at the facility.

Findings:

An 8/2/17 review of the Utilization Review Committee minutes, for meeting dates 5/19/17, 2/13/17, 11/14/16 and 8/1/16 was conducted. Two doctors were noted in the listing of committee members present or absent. Medical Doctor 1 (MD 1), the committee chair person, was present at all meetings. MD 2, the only other doctor listed on all of the meeting minutes reviewed, was not in attendance at any of these committee meetings.

An 8/3/17, 10:15 a.m. interview with Registered Nurse 2 (RN 2), the Utilization Review Nurse, was conducted. She was asked if she had any documentation showing that MD 2 was actively involved in the Utilization Review Committee over the past year, such as acknowledgement of review of the committee meeting minutes, or anything related to MD 2 offering input or being consulted in any way in regards to the utilization review process. RN 2 replied, "I don't think so, but I will check. I really doubt it." RN 2 was asked to reach out to MD 1 for the same documentation. Neither party offered any such documentation. Quality Assurance (QA) Staff 1, a QA Coordinator, reported on 8/3/17 at 3:15 p.m., that MD 1 had stated that MD 2 had not reached out to him regarding any of the committee meeting minutes.

An 8/2/17, 11:25 a.m. interview with Administrator 3, the Acting Medical Director, revealed that MD 2 was recently replaced on the committee by another doctor. Administrator 3 indicated that non-participation in the quarterly committee meetings of a regulatory required member was not acceptable.