DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 7/12/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265130 |
| (X3) DATE SURVEY COMPLETED 02/28/2018 | |||||||
NAME OF PROVIDER OF SUPPLIER BIG BEND WOODS HEALTHCARE CENTER | STREET ADDRESS, CITY, STATE, ZIP 110 HIGHLAND AVENUE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0584 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | Honor the resident’s right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 7/12/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265130 |
| (X3) DATE SURVEY COMPLETED 02/28/2018 | |||||||
NAME OF PROVIDER OF SUPPLIER BIG BEND WOODS HEALTHCARE CENTER | STREET ADDRESS, CITY, STATE, ZIP 110 HIGHLAND AVENUE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0584 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 1) -Multiple dents in the wall, with exposed dry wall over the bed rail of the second bed; -In room [ROOM NUMBER]: -Two black zip ties protruding out of the wall near the cove base to the left of the entrance to the room; -Paint chipped off both corners at the vanity; -Multiple horizontal scratches covered the lower 3 feet of the bathroom door; -In rooms [ROOM NUMBERS], large rectangular unfinished and unpainted areas with exposed white surfaces near newly installed light fixtures; -In room [ROOM NUMBER]: -Multiple black horizontal scratches on the lower 8 inches of the room door; -A large rectangular hole cut out in the exterior wall of the closet for the first bed, near a newly installed light fixture; -The left top drawer missing from the vanity/dresser; -In room [ROOM NUMBER]: -The wall leading to the bathroom with multiple dents and areas of chipped paint, with exposed dry wall; -Multiple horizontal scratches towards the bottom of the interior of the restroom door; -In rooms [ROOM NUMBERS]: -Inside the room doors, large rectangular unfinished and unpainted areas with exposed white surfaces inside the doors near newly installed light fixtures; -Multiple areas over the beds with paint peeled off the wall and exposed dry wall; -In the therapy room: -Four chipped floor tiles with missing pieces; -An area of peeled paint measured approximately 4 inches by 2 inches on the wall behind the fire extinguisher; -In room [ROOM NUMBER]: -A large square unfinished and unpainted area with an exposed white surface to the right of the door near a newly installed light fixture; -Several horizontal scratches on the bottom of the exterior of the restroom door; -In room [ROOM NUMBER]: -Inside the door, a large rectangular unfinished and unpainted area, with an exposed white surface to the right of the door near a newly installed light fixture; -Multiple horizontal black scratches on the bottom of the restroom door. During an interview on 2/27/18 at 12:39 P.M., Housekeeper I said he/she received training to notify the maintenance director if something needed to be repaired. The maintenance director kept a log of what needed to be fixed. During an interview on 2/28/18 at 8:50 A.M., the maintenance director said staff fill out work orders available at every nurses station. He picks them up daily. Administration also does daily rounds to look at resident rooms and identify any issues. This information is then relayed to him. He also does daily rounds. The van driver also does weekly rounds and helps with some of the needed repairs. The maintenance director said he finally had some help but it had just been him for a long time. Review of the provided work orders, showed the following: -A work order, dated 4/26/17, for a wheel chair repair; -A work order, dated 9/14/17, for clogged toilet; -A work order, dated 10/24/17, for clogged toilet; -No documentation of any issues for (YEAR). During an interview on 2/28/18 at 9:30 A.M., the administrator said he does morning rounds on a daily basis. The maintenance director and van driver also do rounds and have their |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 7/12/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265130 |
| (X3) DATE SURVEY COMPLETED 02/28/2018 | |||||||
NAME OF PROVIDER OF SUPPLIER BIG BEND WOODS HEALTHCARE CENTER | STREET ADDRESS, CITY, STATE, ZIP 110 HIGHLAND AVENUE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0584 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 2) own assessment of what needs to be repaired. He is aware of the water damage in room [ROOM NUMBER]. The roofers were supposed to begin repairs earlier in the week, but did not show up. | |
F 0658 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | Ensure services provided by the nursing facility meet professional standards of quality. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 7/12/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265130 |
| (X3) DATE SURVEY COMPLETED 02/28/2018 | |||||||
NAME OF PROVIDER OF SUPPLIER BIG BEND WOODS HEALTHCARE CENTER | STREET ADDRESS, CITY, STATE, ZIP 110 HIGHLAND AVENUE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0658 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 3)[MEDICATION NAME] (T4) and triiodothyronine (T3) into the blood). Review of the treatment administration records (TARs), from September, (YEAR) through February, (YEAR), showed no documentation regarding med pass administration. Review of the MARs, from September, (YEAR) through February, (YEAR), showed no documentation regarding med pass administration. Review of the complete electronic chart and paper chart, showed no results of blood tests completed on 2/1/18 or through the month of February. During an interview on 2/28/18 at 9:30 A.M., the DON and the ADON said when a second order is written concerning the same medication or treatment, then it is the nurse’s responsibility to discontinue the previous order. Med pass is ordered by the amount of cubic centimeters (cc) to be administered and the nurse would be responsible for obtaining clarification with the physician. All blood work results are kept in the paper chart after reviewed by the physician and after looking for the blood work ordered on [DATE], they were unable to locate any results. 3. Review of Resident #198’s admission MDS, dated [DATE], showed the following: -Extensive assistance needed for dressing, toileting and personal hygiene; -[DIAGNOSES REDACTED]. Review of the resident’s POS, dated (MONTH) (YEAR), showed the following: -An order, dated 1/22/18, to weigh him/her daily and fax the weight log weekly on Mondays to the physician, related to heart failure; -An order, dated 1/22/18, to fax weight log weekly to the physician, in the morning every Monday, related to heart failure. Review of the resident’s MAR, dated (MONTH) (YEAR), showed the following: -An order to weigh daily and fax the log weekly on Mondays related to heart failure. Staff did not document a weight on 2/14/18 through 2/16/18, 2/18/18, 2/19/18, 2/21/18 through 2/24/18 and 2/26/18; -An order to fax weight log weekly every Monday morning related to heart failure. Staff left Monday 2/19/18 and 2/26/18, blank with no documentation of faxed weekly log. During an interview on 2/28/18 at 9:25 A.M., the DON said she expected all physician’s orders [REDACTED]. RTA H is trying to get them done now. The resident’s daily weights and documentation of weekly faxes to the physician were requested, but not provided, as late as 3:00 P.M. on 2/28/18. 4. Review of Resident #38’s annual MDS, dated [DATE], showed the following: -BIMS score of three, which showed severe impairment; -[DIAGNOSES REDACTED]. -Received hospice services. Review of the individual resident narcotic record, dated 3/19/17, showed the following: -One 30 milliliter (ml) bottle of [MEDICATION NAME] (narcotic [MEDICATION NAME]), 20 milligrams (mg)/ml, administer 0.25 ml under the tongue every two hours as needed for pain; -On 3/29/17 the nurse administered 0.25 ml, leaving 29.75 ml; -On 3/30/17 the nurse administered 0.25 ml. leaving 29.5 ml; -No further administrations recorded and on 5/10/17, the count read 26 ml.; -On 9/24/17 the nurse administered 0.25 ml. leaving 25.75 ml. -No further administrations recorded and on 10/8/17 the count read 22 ml with the word ‘corrected’ written beside the number 22; -An undated corrected count of 21 ml; -No further administrations recorded and on 12/4/17 at 6:00 P.M., the count read 17 ml.; -On 12/27/17 at 2:00 P.M., the DON and ADON counted the medication and recorded 22 ml |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 7/12/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265130 |
| (X3) DATE SURVEY COMPLETED 02/28/2018 | |||||||
NAME OF PROVIDER OF SUPPLIER BIG BEND WOODS HEALTHCARE CENTER | STREET ADDRESS, CITY, STATE, ZIP 110 HIGHLAND AVENUE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0658 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 4) remained in the bottle. During an interview on 2/28/18 at 9:00 A.M. the DON and ADON said the bottles of[MEDICATION NAME] hospice provides are more difficult to read than the bottles from their pharmacy and staff have a very hard time reading the bottles. They both recently counted the [MEDICATION NAME] to provide an accurate count, and have inserviced the nurses to draw the medication out of the bottle with a syringe to obtain an accurate count and then replace it in the bottle. They said the medication is not counted on a daily basis, only when a dose is administered. Observation of the [MEDICATION NAME] bottle on 2/28/18 showed approximately 22 ml in the bottle. The measurement guide on the side of the bottle marks every five milliliters, rather than every milliliter. 5. Review of the narcotic count book located on the 100 hall on 2/27/18 at 9:00 A.M., showed one sheet of paper at the front of the book, dated 2/2/18 through 2/26/18, that contained resident names, names of narcotics and other medications that are required to be stored under lock and key, nurses signatures and the number of medication cards. During an interview on 2/27/18 at 9:00 A.M., Licensed Practical Nurse (LPN) G said the pharmacy delivers different cards of medications for resident’s use and if the medication is required to be secured behind lock and key, the nurse has to sign it in. He/she said all of the cards are counted at the end of the shift and all are kept in the locked cabinet. When a new card arrives for the resident the nurse adds the number of the cards to the count and if a medication is discontinued, or a resident is discharged , that card is deducted from the count. Further review of the form, showed the following: -On 2/14/18, a nurse accepted a card of [MEDICATION NAME] (used to treat anxiety) which brought the count of cards to 38; -On 2/16/18 at 6:00 A.M., staff drew a line through the form and the number of cards remained 38; -On 2/19/18 at 4:00 P.M., staff removed a card of [MEDICATION NAME] (narcotic [MEDICATION NAME]) and the count read 36. Staff provided no documentation as to why the count went to 36 instead of 37. During an interview on 2/28/18 at 9:30 A.M., the DON and ADON said they had no idea why the count went to 36 instead of 37. They believed a nurse had removed a card to return to the pharmacy and believed the nurse forgot to record it. | |
F 0661 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | Ensure necessary information is communicated to the resident, and receiving health care provider at the time of a planned discharge. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 7/12/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265130 |
| (X3) DATE SURVEY COMPLETED 02/28/2018 | |||||||
NAME OF PROVIDER OF SUPPLIER BIG BEND WOODS HEALTHCARE CENTER | STREET ADDRESS, CITY, STATE, ZIP 110 HIGHLAND AVENUE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0661 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 5) -A Brief Interview of Mental Status (BIMS, a brief screener of cognitive impairment) score of 14, a score of 13-15, indicates cognitively intact; -Supervision of one staff for transfers; -Limited assistance of one staff for dressing; -Set up help for eating; -Extensive assistance of one staff for bathing; -Occasionally incontinent of bowel and bladder. Review of the (MONTH) (YEAR), physician order [REDACTED].>-A discharge order dated 12/21/17, to home with home health and physical and occupational therapy and all medications; -Medications included insulin, aspirin, [MEDICATION NAME] (used to treat dementia) Ezetimibe (used to treat high cholesterol), fish oil, mirabegron (used to treat over active bladder), [MEDICATION NAME] (used to treat heartburn), [MEDICATION NAME] (an anti depressant) Calcium with D, [MEDICATION NAME] (used to treat high cholesterol),[MEDICATION NAME] (a muscle relaxer) [MEDICATION NAME] ( an antidepressant used to treat depression and anxiety disorders), vitamin D, [MEDICATION NAME] (used to treat anxiety),[MEDICATION NAME] 5/325 (a narcotic pain medication) and [MEDICATION NAME] (used to treat nerve pain); -[DIAGNOSES REDACTED]. Review of the nurse’s notes, showed on 12/7 (time not known) the resident got got his/her insulin as ordered but did not eat. His/her blood sugar dropped to the 40s (normal 60-99). The staff contacted the physician. Review of the care plan dated 12/18/17, showed: – A diabetic diet, 1800 calories and 60 grams of carbohydrates; -fell at home prior to admission; -Lives at home with [AGE] year old spouse, who rooms with him/her at the facility. Review of the Social Services note dated 12/5/17, showed he/she still did not know if the nursing home stay would be permanent. No further notes. Review of the nurse’s notes showed the last entry dated 12/18/17. No note about the discharge on 12/21/17. Review of the discharge paper dated 12/21/17, showed a list of the resident’s medications, but it did not indicate if/or how many pills were sent home with the resident. The discharge paper did not include any education or training for the resident, or information he/she knew how to take his/her medications or what follow up and services were needed to go back home. During interview on 2/23/18 at 1:48 P.M. and 2:23 P.M., with the Director of Nurses (DON) and the Assistant Director of Nurses (ADON), the DON said the medication list should list the prescription number and the number of pills released. There should be a training and education sheet filled out on discharge. She could not find a discharge summary in the nurse’s notes. The last note was 12/18/17. She did not find a social service note or recapitulation of stay. There is a book at the nurse’s station that goes step by step what to do for a discharge and it does show to include number of pills and directions and a progress note. Home health was set up for the resident prior to discharge. | |
F 0677 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | Provide care and assistance to perform activities of daily living for any resident who is unable. |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 7/12/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265130 |
| (X3) DATE SURVEY COMPLETED 02/28/2018 | |||||||
NAME OF PROVIDER OF SUPPLIER BIG BEND WOODS HEALTHCARE CENTER | STREET ADDRESS, CITY, STATE, ZIP 110 HIGHLAND AVENUE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0677 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 6) **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure proper perineal care (peri-care, cleansing of the surface area between the thighs, extending from the pubic bone to the tail bone) for three of three observations (Residents #55, #85 and #74). The census was 97. 1. Review of Resident #55’s annual Minimum Data Set (MDS), a federally mandated assessment instrument completed by facility staff, dated 1/19/18, showed the following: -Brief interview for mental status (BIMS, a screening tool used to assess cognitive impairment) score of 0 out of 15, which showed severe impairment; -Maximum care required for bed mobility and personal hygiene; -Incontinent of bowel and bladder; -[DIAGNOSES REDACTED]. Observation on 2/23/18 at 10:04 A.M., showed Certified Nurse Aide (CNA) B transferred the resident to his/her bed and removed the urine saturated brief. CNA B wiped the left and right groin once on each side from front to back without changing areas of the cloth. With a new cloth, he/she wiped the inner genital area six times front to back without changing areas of the cloth. During an interview on 2/23/18 at 10:15 A.M., CNA B said to always wipe from front to back and change areas of the cloth with each wipe or change to a new cloth. 2. Review of Resident # 85’s quarterly MDS, dated [DATE], showed the following: -BIMS score of 9 out of 15, which showed moderate cognitive impairment; -[DIAGNOSES REDACTED]. -Dependent on staff for personal care and mobility; -Frequently incontinent of bowel and bladder. Observation on 2/23/18 at 11:03 A.M., showed the resident lay in bed on his/her back. Certified Nurse Aid (CNA) D turned the resident to his/her left side and removed the urine and dried stool saturated chux (disposable bed pad) from under the resident. He/she returned resident to his/her back and cleansed the front peri area, then turned him/her to the left side and cleansed the right buttock two times, wiping back to front. He/she turned the resident to the right side and cleansed the left buttock two times from back to front, then the inner buttock two times back to front, wiping stool toward the genitals with each wipe. During an interview on 2/23/18 CNA D said when providing peri-care, always wipe front to back and change areas of the cloth or obtain a new cloth for each wipe. CNA D then said oh my gosh, I did it wrong. 3. Review of Resident #74’s significant change MDS, dated [DATE], showed the following: -BIMS score of 3 out of 15, which showed severe impairment; -Limited assistance required for personal hygiene; -Occasionally incontinent of bowel and bladder. Observation on 2/26/18 at 5:25 A.M., showed CNA C obtained a warm wet cloth, applied peri cleanser to the cloth and cleansed the resident’s peri area from front to back six times without changing areas of the cloth and then, with a dry cloth, repeated the procedure. He/she turned the resident to his/her right side and cleansed the inner and outer buttocks from front to back, approximately six times without changing areas of the cloth and then, with a dry cloth, repeated the procedure. CNA C changed gloves and applied barrier cream to front peri area in back and forth motion. During an interview on 2/26/18 at 5:35 A.M., CNA C said when providing peri-care, to always wipe from the front to the back and change areas of the cloth with each wipe or obtain a new cloth. |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 7/12/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265130 |
| (X3) DATE SURVEY COMPLETED 02/28/2018 | |||||||
NAME OF PROVIDER OF SUPPLIER BIG BEND WOODS HEALTHCARE CENTER | STREET ADDRESS, CITY, STATE, ZIP 110 HIGHLAND AVENUE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0677 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 7) 4. During an interview on 2/28/18 at 9:30 A.M., the Director of Nursing said when using a washcloth, the area of the cloth needs to be changed with each wipe and when disposable cloths are used, each cloth must be used for only one pass. | |
F 0688 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 7/12/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265130 |
| (X3) DATE SURVEY COMPLETED 02/28/2018 | |||||||
NAME OF PROVIDER OF SUPPLIER BIG BEND WOODS HEALTHCARE CENTER | STREET ADDRESS, CITY, STATE, ZIP 110 HIGHLAND AVENUE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0688 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 8) Review of the resident’s (MONTH) (YEAR) restorative/maintenance nursing program record, showed the following: -Date restorative initiated: 2/19/18; -Duration of program: three months; -Frequency of program: four times a week; -Approach: -Walk with wheeled walker with gait belt; -Transfer with stand by assist but decreased safety; -Staff documented the resident received RT one time between 2/19/18 and 2/27/18. 3. Review of Resident #50’s quarterly MDS, dated [DATE], showed the following: -Severe cognitive impairment; -[DIAGNOSES REDACTED]. -Total dependence on staff for all activities of daily living (ADLs); -Received PROM RT for three out of seven days assessed. Review of the resident’s (MONTH) (YEAR) POS, showed an order, dated 2/19/18, for RT three times a week for three months to BUE and BLE for strengthening and PROM/active ROM (AROM, resident/patient performs the exercise to move the joint without any assistance) in order to avoid contractures and decreased strength. Review of the resident’s (MONTH) (YEAR) restorative/maintenance nursing program record, showed the following: -Date restorative initiated: 11/7/17; -Duration of program: three months; -Frequency of program: three times a week; -Approach: BUE and BLE strengthening exercises in all planes. Twenty repetitions with active assist; -No documentation staff provided RT for the month of February. 4. Review of Resident #45’s admission MDS, dated [DATE], showed the following: -[DIAGNOSES REDACTED]. -Required extensive assistance with transfers, walking, dressing and toileting. Review of the resident’s (MONTH) (YEAR) POS, showed an order, dated 1/24/18, to ride bike for 15 minutes to maintain BUE and BLE strengthening and BUE and BLE strengthening exercises to improve and maintain strength three times a week. Review of the resident’s (MONTH) and (MONTH) (YEAR) restorative/maintenance nursing program record, showed the following: -Duration of program: three months; -Frequency of program: three times a week; -Approach: -Ride bike for 15 minutes; -BUE and BLE exercises with three pound weights in order to improve and maintain strength; -Staff documented RT provided two times from 1/24/18 through 1/31/18; -Staff documented RT provided one time from 2/1/18 through 2/27/18. 5. Review of Resident #248’s admission MDS, dated [DATE], showed the following: -[DIAGNOSES REDACTED]. -Independent with most activities of daily living. Review of the resident’s (MONTH) (YEAR) POS, showed an order, dated 2/9/18, for RT three times a week for three months for walking with caregiver and wheeled walker. Review of the resident’s (MONTH) (YEAR) restorative/maintenance nursing program record, showed the following: |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 7/12/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265130 |
| (X3) DATE SURVEY COMPLETED 02/28/2018 | |||||||
NAME OF PROVIDER OF SUPPLIER BIG BEND WOODS HEALTHCARE CENTER | STREET ADDRESS, CITY, STATE, ZIP 110 HIGHLAND AVENUE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0688 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 9) -Date RT Initiated: 2/9/18; -Frequency: three times a week; -Approach: ambulate resident with gait belt and wheeled walker and follow with wheelchair; -Staff documented RT provided one time from 2/9/18 through 2/27/18. 6. During an interview at 12:15 A.M. on 2/27/18, Restorative aide (RTA) H said the main RTA left a week or so ago. He/she is the back-up RTA and worked on the floor 99% of the time. He/she had been off for a few days and came back yesterday. When he/she tried to do RT with someone, he/she would be called to the floor because another staff member called in. He/she had not had a chance to talk to the administration about it. 7. During an interview on 2/28/18 at 9:25 A.M., the Director of Nursing said the RTA left with very little notice a week or so ago. RTA A was doing what he/she could to get the restorative therapy done. They are looking to hire someone. | |
F 0690 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 7/12/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265130 |
| (X3) DATE SURVEY COMPLETED 02/28/2018 | |||||||
NAME OF PROVIDER OF SUPPLIER BIG BEND WOODS HEALTHCARE CENTER | STREET ADDRESS, CITY, STATE, ZIP 110 HIGHLAND AVENUE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0690 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | (continued… from page 10) -Total dependence on staff for transfers, dressing, toilet use, personal hygiene and bathing; -Upper and lower extremity impairment on both sides; -Indwelling urinary catheter; -One Stage II (partial thickness loss of dermis presenting as a shallow open ulcer with a red-pink wound bed without slough. (MONTH) also present as an intact or open/ruptured blister) pressure ulcer (injury to the skin and/or underlying tissue, as a result of pressure or friction); -[DIAGNOSES REDACTED]. Observations of the resident, showed the following: -On 02/26/18 at 11:49 A.M., the resident sat in a wheelchair at a dining room table with the urine collection bag contained in a privacy bag and the entire bottom of the bag rested on the floor under the wheelchair; -On 02/28/18 at 8:49 A.M., the resident lay in bed with the urine collection bag contained in a privacy bag, the catheter tubing looped in a figure eight and approximately 4 inches of urine unable to drain into the collection bag. 3. During an interview on 2/28/17 at 9:25 A.M., the Director of Nursing said the urine collection bag should be positioned below the bladder in a privacy bag. The bag should not be on the floor and the urine should be able to flow freely into the collection bag, for infection control purposes. The resident’s care plan should include the indwelling urinary catheter and there should be an order for [REDACTED]. | |
F 0693 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 7/12/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265130 |
| (X3) DATE SURVEY COMPLETED 02/28/2018 | |||||||
NAME OF PROVIDER OF SUPPLIER BIG BEND WOODS HEALTHCARE CENTER | STREET ADDRESS, CITY, STATE, ZIP 110 HIGHLAND AVENUE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0693 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 11) -Document total intake, separate into formula and water flush, on Medication Administration Record [REDACTED]. 1. Review of Resident #50’s quarterly Minimum Data Set (MDS), a federally mandated assessment instrument completed by facility staff, dated 1/9/18, showed the following: -Severe cognitive impairment; -[DIAGNOSES REDACTED]. -Total dependence on staff for all activities of daily living (ADLs); -Nutrition provided through tube feeding. Review of the resident’s physician order [REDACTED]. -An order, dated 7/10/17 and discontinued on 2/8/18, for [MEDICATION NAME] 1.5 (type of tube feeding formula) at 45 cubic centimeters (cc) an hour and 200 cc water flush every six hours; -An order, dated 2/3/18, for every day and night shift to record intake via [DEVICE] and clear the machine at the end of each shift; -An order, dated 2/19/18, to increase tube feeding to 50 cc an hour, every morning and at bedtime due to weight loss; -Staff did not clarify with the physician the formula name or strength. Review of the resident’s dietary recommendation, dated 2/19/18, showed his/her weight with minimal changes. He/she received [MEDICATION NAME] 1.5 at 45 cc an hour with water flush at 200 cc every six hours. Review of the MAR, dated 2/1/18 through 2/28/18, showed the following: -On 2/3/18 through 2/7/18, staff failed to record intake for either shift; -On 2/8/18, day shift recorded an intake of 1140 cc and night shift recorded an intake of 450 cc; -On 2/9/18, day shift recorded an intake of 450 cc and night shift recorded an intake of 654 cc; -On 2/10/18, day shift recorded an intake of 1150 cc and night shift recorded an intake of 1112 cc; -On 2/11/18, day shift recorded an intake of 1112 cc and night shift recorded an intake of 1 cc; -On 2/12/18, day shift recorded an intake of 1175 cc and night shift recorded an intake of 1800 cc; -On 2/13/18, day shift recorded an intake of 1700 cc and night shift recorded an intake of 225 cc; -On 2/14/18, staff failed to record intake for either shift; -On 2/15/18, day shift recorded an intake of 1140 cc and night shift recorded an intake of 1522 cc; -On 2/16/18, day shift recorded an intake of 1200 cc and night shift recorded an intake of 560 cc; -On 2/17/18, day shift recorded an intake of 450 cc and night shift recorded an intake of 1749 cc; -On 2/18/18, day shift recorded an intake of 450 cc and night shift recorded an intake of 1200 cc; -On 2/19/18, day shift recorded an intake of 1400 cc and night shift did not record an intake; -On 2/20/18, day shift recorded an intake of 1400 cc and night shift recorded an intake of 720 cc; -On 2/21/18, day shift did not record an intake and night shift recorded an intake of 650 cc; |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 7/12/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265130 |
| (X3) DATE SURVEY COMPLETED 02/28/2018 | |||||||
NAME OF PROVIDER OF SUPPLIER BIG BEND WOODS HEALTHCARE CENTER | STREET ADDRESS, CITY, STATE, ZIP 110 HIGHLAND AVENUE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0693 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 12) -On 2/22/18, day shift did not record an intake and night shift recorded an intake of 972 cc; -On 2/23/18, day shift recorded an intake of 460 cc and night shift recorded an intake of 650 cc; -On 2/24/18, day shift recorded an intake of 1340 cc and night shift recorded an intake of 600 cc; -On 2/25/18, day shift did not record an intake and night shift recorded an intake of 758 cc; -On 2/26/18, day shift recorded an intake of 1460 cc and night shift recorded an intake of 1035 cc; -On 2/27/18, day shift recorded an intake of 1450 cc and night shift recorded an intake of 355 cc; -The MAR indicated [REDACTED]. Observations of the resident, showed the following: -On 2/22/18 at 11:39 A.M. and 3:16 P.M., the resident’s tube feeding infused via [DEVICE]. The bag of formula and water both showed a handwritten date of 2/20/18, and no other information included on the bag; -On 2/23/18 at 11:20 A.M., the same formula bag and water bag with a date of 2/20/18 in use; -On 2/26/18 at 5:34 A.M. and 8:30 A.M., the resident’s tube feeding infused via [DEVICE]. The formula bag had a label, which showed a date of 2/26/18 at 1:30 A.M., [MEDICATION NAME] 1.5 and a staff initial; -On 2/27/18 at 8:16 A.M. and 2:12 P.M. and 2/28/18 at 7:02 A.M., the formula bag with a date of 2/26/18 remained in use; -Staff failed to change the formula and water bag every 24 hours and include the name of the resident, date, time, type, strength of formula used and rate infused. 2. Review of Resident #29’s MDS, dated [DATE], showed the following: -[DIAGNOSES REDACTED]. -Dependent on staff for personal hygiene and bed mobility. Review of the POS [REDACTED] -An order, dated 2/1/18, to administer [MEDICATION NAME] 1.5 via [DEVICE] at 65 cc an hour every day and night shift. Stop the feeding at 12:00 A.M. and resume at 6:00 A.M.; -No order for the administration of water flushes. Review of the MAR, dated 2/1/18 through 2/28/18, showed the following: -On 2/8/18, night shift intake recorded as 587 cc; -On 2/9/18, day shift intake recorded as 550 cc and night shift intake as 1170 cc; -On 2/10/18, day shift intake not recorded and night shift intake recorded as 2215 cc; -On 2/11/18, day shift intake not recorded and night shift intake recorded as 2225 cc; -On 2/12/18, day shift intake not recorded and night shift intake recorded as 1288 cc; -On 2/13/18, day shift intake recorded as 1450 cc and night shift intake recorded as 332 cc; -On 2/14/18, day shift intake recorded as 1200 cc and night shift intake recorded as 390 cc; -On 2/15/18, day shift intake recorded as 1780 cc and night shift intake recorded as 4530 cc; -On 2/16/18, day shift intake not recorded and night shift intake recorded as 1 cc; -On 2/17/18, day shift intake recorded as 1780 cc and night shift intake not recorded; -On 2/18/18, day shift intake recorded as 990 cc and night shift intake not recorded; -On 2/19/18, day shift intake recorded as 200 cc and night shift intake not recorded; |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 7/12/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265130 |
| (X3) DATE SURVEY COMPLETED 02/28/2018 | |||||||
NAME OF PROVIDER OF SUPPLIER BIG BEND WOODS HEALTHCARE CENTER | STREET ADDRESS, CITY, STATE, ZIP 110 HIGHLAND AVENUE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0693 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 13) -On 2/20/18, day shift intake not recorded and night shift intake recorded as 770 cc; -On 2/21/18, day shift intake recorded as 1300 cc and night shift intake recorded as 450 cc; -On 2/22/18, day shift intake recorded as 1300 cc and night shift intake recorded as 100 cc; -On 2/23/18, day shift intake recorded as 1300 cc and night shift intake recorded as 520 cc; -On 2/24/18, day shift intake not recorded and night shift intake recorded as 1475 cc; -On 2/25/18, day shift intake recorded as 365 cc and night shift intake recorded as 753 cc; -On 2/26/18, day shift intake recorded as 200 cc and night shift intake recorded as 390 cc; -On 2/27/18, day shift intake not recorded and night shift intake recorded as 390 cc; -On 2/28/18, day shift intake recorded as 1200 cc and night shift intake not recorded; -The MAR indicated [REDACTED]. Observations on 2/22/18 at 11:16 AM. and 3:50 P.M. and 2/23/18 at 10:40 A.M., showed two bags hanging on the feeding pump, one contained water and one contained formula. The formula infused via the pump at 65 cc an hour. Neither the bag that contained the formula or the bag that contained the water contained a label with the resident’s name, the name of the formula, the date or the time hung. Observations on 2/26/18 at 7:00 A.M. and 10:10 A.M., 2/27/18 at 6:58 A.M. and 2:05 P.M. and 2/28/18 at 7:37 A.M., showed the formula infused via the pump at 65 cc an hour, the label attached to the formula bag read [MEDICATION NAME] 1.5 at 65 cc/hour, hung at 6:00 A.M. on 2/26/18. Staff noted no information on the water bag. 3. Review of Resident #15’s significant change MDS, dated [DATE], showed the following: -[DIAGNOSES REDACTED]. -Dependent on staff for all personal care and bed mobility; -Nutrition provided by feeding tube. Review of the (MONTH) (YEAR) POS, showed the following: -An order, dated 2/10/18, to administer Glucerna 1.2 (type of tube feeding) via [DEVICE] at 60 cc every day and night shift; -Flush [DEVICE] every four hours; -No order regarding what to flush the [DEVICE] with or the amount. Review of the MAR, dated 2/1/18 through 2/28/18, showed the following: -Intake not recorded on the day shift from 2/1/18 through 2/28/18; -Intake not recorded on the night shift from 2/1/18 through 2/27/18; -Intake of 5320 cc recorded on the night shift of 2/28/18. Observations on 2/22/18 at 12:48 P.M. and 4:12 P.M., 2/23/18 at 6:28 A.M. and 2:02 P.M., 2/26/18 at 4:57 A.M., 2/27/18 at 11:12 A.M. and 1:51 P.M. and 2/28/18 at 7:07 A.M., showed two bags hanging on the pump, one bag with water and the other with formula. The formula infused via the pump at 60 cc an hour. Neither the formula bag or the water bag contained a label with the resident’s name, the name of the formula, the date or the time hung. 4. During an interview on 2/28/18 at 9:30 A.M., the Director of Nursing said she expected staff to follow orders. If an order is unclear, she expected the nurse taking the order to clarify with the physician. Open enteral feeding bags should be replaced every 24 hours. The Assistant Director of Nursing said staff should include the resident’s name, date and time on the formula bag when it is hung. It is not necessary to include the formula name and strength because the formula is kept in the resident’s room so staff are aware of the formula infusing. An order should include the type and strength of formula because staff |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 7/12/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265130 |
| (X3) DATE SURVEY COMPLETED 02/28/2018 | |||||||
NAME OF PROVIDER OF SUPPLIER BIG BEND WOODS HEALTHCARE CENTER | STREET ADDRESS, CITY, STATE, ZIP 110 HIGHLAND AVENUE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0693 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 14) would not know what to put in the bag. Intake should be documented as ordered and even if there is no order to record intake they would expect it to be done. The intake of formula and the intake of water should be recorded separately. The feeding pumps have two separate gauges to record formula amount and water amount. It is the nurse’s responsibility to clear the pumps at the end of their shift and record that amount. | |
F 0698 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | Past noncompliance – remedy proposed **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** | |
F 0730 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | Observe each nurse aide’s job performance and give regular training. Based on interview and record review, the facility failed to ensure certified nurse aides |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 7/12/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265130 |
| (X3) DATE SURVEY COMPLETED 02/28/2018 | |||||||
NAME OF PROVIDER OF SUPPLIER BIG BEND WOODS HEALTHCARE CENTER | STREET ADDRESS, CITY, STATE, ZIP 110 HIGHLAND AVENUE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0730 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 15) During an interview on 2/23/18 at 12:39 P.M., Licensed Practical Nurse Q, who is in charge of CNA training, said she just took over in (MONTH) (YEAR). She was not aware of what the 12 hours should include. She does not know where the records prior to her starting might be. She does not have them. | |
F 0759 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | Ensure medication error rates are not 5 percent or greater. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** | |
F 0812 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation and interview, the facility failed to serve food under sanitary |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 7/12/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265130 |
| (X3) DATE SURVEY COMPLETED 02/28/2018 | |||||||
NAME OF PROVIDER OF SUPPLIER BIG BEND WOODS HEALTHCARE CENTER | STREET ADDRESS, CITY, STATE, ZIP 110 HIGHLAND AVENUE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0812 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 16) showed Cook L behind the steam cart serving breakfast. He/she donned gloves without first washing his/her hands. He/she then used gloved hands to pull biscuits from the serving pan and then pull it apart and place it on a plate. He/she would then cover the biscuit with gravy. The plates were then served to residents. 4. During an interview on 2/28/18 at 1:33 P.M., the dietary manager said she thought as long as staff had on gloves and did not go from food to food, it was permissible to use hands instead of utensils to serve food. | |