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Based on record review and interview the facility failed to address or provide information on Advance Directives in 4 (Patients #3, 6, 7, 9) out of a total sample of 10.

Findings:

Review of facility policy "Advance Directives and Do Not Resuscitate (DNR) Orders" last revised 12/16 revealed in part,under Policy A 1. To provide written information to each patient concerning his/her rights under state law to make decisions concerning his/her care, including the right to accept/refuse medical or surgical treatment and the right to formulate advance directives. 2. To document in a patient's medical record whether or not an advance directive has been executed and activated."

Admission paperwork revealed, under the section titled, "Advance Directives" an area for initials of the patient or Power of Attorney and lines to select; ___I do have advance directives: ____a copy has been provided to Lakeview or my advance directive is located at__________. ____I do not have advance directives ____I would like additional information on advanced directives.

Review of Patient #3's medical record on 10/24/2019 at 1:30PM revealed an admission on 5/29/2019 with respiratory failure. The Admission paperwork had initials in the section, "Advance Directives" with no check in any of the boxes indicating whether they had Advance Directives, where they were located, or if additional information was requested. The lack of answers to the Advance Directive section was confirmed with Admissions Director G on 10/24/2019 at 4:15PM .

Review of Patient #6's medical record on 10/24/2019 at 2:25PM revealed an admission on 8/28/2019 with a Traumatic Brain Injury. The Admission paperwork had initials in the section, "Advance Directives" with no check in any of the boxes indicating whether they had Advance Directives, where they were located, or if additional information was requested. The lack of answers to the Advance Directive section was confirmed with Admissions Director G on 10/24/2019 at 4:15PM .

Review of Patient #7's medical record on 10/24/2019 at 2:55PM revealed an admission on 7/5/2019 with a Traumatic Brain Injury and brain bleed. The Admission paperwork had initials in the section, "Advance Directives" with no check in any of the boxes indicating whether they had Advance Directives, where they were located, or if additional information was requested. The lack of answers to the Advance Directive section was confirmed with Admissions Director G on 10/24/2019 at 4:15PM .

Review of Patient # 9 medical record on 10/24/2019 at 3:20PM revealed a 4/19/2019 admission for cardiomyopathy (heart disease). The Admission paperwork had initials in the section, "Advance Directives" with no check in any of the boxes indicating whether they had Advance Directives, where they were located, or if additional information was requested. The lack of answers to the Advance Directive section was confirmed with Admissions Director G on 10/24/2019 at 4:15PM .

In interview with Admissions Director G on 10/24/2019 at 4:15PM when asked the question of information regarding Advance Directives, replied, "we give a brochure at admission that explains Power of Attorney and we should be completing the questions under the Advance Directives section. I have two new people who might not be aware of that."

Based on record review, observation and interview the facility failed to provide a safe environment by monitoring and ensuring ongoing interventions to protect 1 of 5 patients (Patient #1), who was deemed a high fall risk, in a total sample of 5.

Findings:

Review of the facility policy "Video Monitoring" last reviewed 12/16 stated the purpose, "Video monitoring is to be used for patients who require increased visual monitoring to promote individual patient safety." Under Procedure 2. Patients placed on video monitoring must have the consent signed in the patient chart that addresses the use of video monitoring. 3. In addition to the consent for video monitoring, video monitoring can only be initiated by a physician order."

Review of Patient #1's medical record on 10/24/2019 at 12:50PM revealed a physician order at admission dated 8/30/2019 at 3:40PM for bed alarms and video monitoring in room. A verbal consent from the Power of Attorney for video monitoring was in the medical record. The Fall Prevention and Safety Care Plan for Patient #1 initiated on 8/30/2019 at 3:40PM indicated a score of 90 for fall risk; the scale specifies >46 as a high fall risk. The Fall Prevention and Safety Care Plan in the medical record revealed in part, bed/chair alarms and video monitoring as individualized safety interventions.

Review on 10/24/2019 of the facility Fall Incident Investigation for Patient #1 revealed under comments, in part, "pt did not have a bed alarm on his/her bed." Review of the "Nursing Stand Up report" that was sent to staff on 9/3/2019 at 6:09AM revealed Patient #1 was not on the list of patients having video monitoring.

Interview with DON on10/24/2019 revealed that the supervisor that completed the "Nursing Stand Up Report" on 9/2/2019 was "a prn staff and not familiar with where to verify what patients were on video monitoring."