| DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 7/31/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
| STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265160 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LEWIS & CLARK GARDENS | STREET ADDRESS, CITY, STATE, ZIP 1221 BOONSLICK ROAD | |||||||||
| 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) | |
|---|---|---|
| F 0558 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | Reasonably accommodate the needs and preferences of each resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** |
| DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 7/31/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
| STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265160 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LEWIS & CLARK GARDENS | STREET ADDRESS, CITY, STATE, ZIP 1221 BOONSLICK ROAD | |||||||||
| 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) | |
|---|---|---|
| F 0558 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | (continued… from page 1) Observation on 3/19/18 at 8:10 A.M. showed the following: -No call light was available for the resident; -An adaptor was plugged into the call light wall unit without a cord connected to unit. Observation on 3/20/18 at 5:24 A.M. showed the following: -No call light was available for the resident; -An adaptor was plugged into the call light wall unit wall without a cord connected to the unit. Observation on 3/21/18 at 11:54 A.M. showed the following: -No call light was available for the resident; -An adaptor was plugged into the call light wall unit with no cord attached. During an interview on 3/18/18 4:31 P.M., the resident said someone took his/her call light last week. A Certified Nurse Aide (CNA) said the resident used it too much and ripped it out of the wall. During an interview on 3/21/18 at 1:56 P.M., the Assistant Director of Nursing (ADON) said the following: -He/she expected staff to ensure residents’ call lights were in reach at all times; -He/she expected staff to check for placement of the call lights when they walked down the hall, each time they checked on a resident and after resident care; -He/she did not notice Resident #28’s call light was missing when she was in the resident’s room; -Staff should have noticed Resident #28’s call light was not there and should have had it replaced. 3. Observation on 3/20/18 at 9:24 A.M. in dually occupied resident room [ROOM NUMBER], showed the call light for bed B did not operate when tested . Further observations showed Resident #43 sat in his/her wheelchair by his/her bed (bed A). The call light for Resident #43 (bed A) was within the sheets of the made bed with the cord pulled down between the wall and the mattress. The call light was tucked underneath the mattress. The cord was distressed with the wires inside the call light cord easily visible where the outer sleeve was missing for approximately two inches near where the cord plugged into the wall. This observation was confirmed by the Maintenance Supervisor. During interview on 3/20/18 at 9:27 A.M., Resident #43 said he/she was unable to access the call light and needed assistance in his/her room. He/she depended on the use of the call light for help. 4. Observation on 03/21/18 at 1:50 P.M. in occupied room [ROOM NUMBER], showed no call light was attached to the wall above the resident’s bed (bed A). 5. Observation on 3/20/18 at 11:30 A.M. showed the call light in occupied resident room [ROOM NUMBER] did not operate when tested . This observation was confirmed by the Maintenance Supervisor. 6. During an interview on 3/21/18 at 3:30 P.M., the Director of Nursing said staff should ensure every resident had access to a functioning call light when they were in their rooms. | |
| F 0569 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | Notify each resident of certain balances and convey resident funds upon discharge, eviction, or death. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** |
| DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 7/31/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
| STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265160 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LEWIS & CLARK GARDENS | STREET ADDRESS, CITY, STATE, ZIP 1221 BOONSLICK ROAD | |||||||||
| 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) | |
|---|---|---|
| F 0569 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 2) discharged residents (Residents #2, #470, #471, #478, and #479) within five days following discharge and failed to convey the remaining resident balance to the state or the probate jurisdiction administering the resident’s estate within 30 days of death for 14 residents (Residents #459, #463, #464, #465, #466, #467, #468, #469, #472, #473, #474, #475, #476, and #477), in a review of 19 additional residents. The facility census was 107. 1. Review of the facility’s guidelines for maintaining the resident funds account policy, dated [DATE], showed the following: -Remaining personal funds for a deceased resident: Upon death of a resident, we will first contact the Probate court. If there is not an estate, then we are required by law to submit a written account of the remaining personal funds for any deceased resident who has received aid, care, assistance or services paid by the Department of Social Services. For purposes of this guideline, personal funds of the deceased resident shall include all the resident’s remaining personal funds held in whatever title the account or accounts may be known. This includes general account. Since we collect patient surplus in advance, if a resident expires before the end of the month, many times they will end up with a credit balance on the books. When this happens, you should request a refund check made payable to the resident trust fund for the resident. The check would be deposited into the trust fund and reported along with any other remaining trust fund balance to the Division of Medical Services. The regulation requires that this is done within 60 days of death. The regulation should not be violated. -Remaining personal funds for a discharged resident. If a resident discharges and the facility was their representative payee, any and all funds in the resident trust account, cash on hand or in the operations account-the conserved funds are to be returned to social security. The facility has five calendar days to give a complete accounting of personal funds and the balance of the funds to be compliant with state regulations. 2. Review of Resident #467’s nurse’s notes showed the resident expired on [DATE]. Review of the facility’s current balance report for the resident funds account, dated [DATE], showed the resident had a balance of $100.95. 3. Review of Resident #478’s nurse’s notes showed the resident was discharged on [DATE]. Review of the facility’s current balance report for the resident funds account, dated [DATE], showed the resident had a balance of $38.00. 4. Review of Resident #476’s nurse’s notes showed the resident expired on [DATE]. Review of the facility’s current balance report for the resident funds account, dated [DATE], showed the resident had a balance of $372.46. 5. Review of Resident #472’s nurse’s notes showed the resident expired on [DATE]. Review of the facility’s current balance report for the resident funds account, dated [DATE] showed, the resident had a balance of $101.33. 6. Review of Resident #475’s nurse’s notes showed the resident expired on [DATE]. Review of the facility’s current balance report for the resident funds account, dated [DATE], showed the resident had a balance of $27.23. 7. Review of Resident #477’s nurse’s notes showed the resident expired on [DATE]. Review of the facility’s current balance report for the resident funds account, dated [DATE], showed the resident had a balance of $1807.89. 8. Review of Resident #464’s nurse’s notes showed the resident expired on [DATE]. Review of the facility’s current balance report for the resident funds account, dated [DATE], showed the resident had a balance of #14.08. 9. Review of Resident #463’s nurse’s notes showed the resident expired on [DATE]. Review of the facility’s current balance report for the resident funds account, dated [DATE], showed the resident had a balance of $636.30. |
| DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 7/31/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
| STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265160 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LEWIS & CLARK GARDENS | STREET ADDRESS, CITY, STATE, ZIP 1221 BOONSLICK ROAD | |||||||||
| 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) | |
|---|---|---|
| F 0569 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 3) 10. Review of Resident #470’s nurse’s notes showed the resident was discharged from the facility on [DATE]. Review of the facility’s current balance report for the resident funds account, dated [DATE], showed the resident had a balance of $180.00. 11. Review of Resident #479’s nurse’s notes showed the resident was discharged on [DATE]. Review of the facility’s current balance report for the resident funds account, dated [DATE], showed the resident had a balance of $2.00. 12. Review of Resident #2’s nurse’s notes showed the resident was discharged on [DATE]. Review of the facility’s current balance report for the resident funds account, dated [DATE], showed the the resident had a balance of $38.00. 13. Review of Resident #473’s nurse’s notes showed the resident expired on [DATE]. Review of the facility’s current balance report for the resident funds account, dated [DATE], showed the resident had a balance of $25.00. 14. Review of Resident #465’s nurse’s notes showed the resident expired on [DATE]. Review of the facility’s current balance report for the resident funds account, dated [DATE], showed the resident had a balance $507.07. 15. Review of Resident #474’s nurse’s notes showed the resident expired on [DATE]. Review of the facility’s current balance report for the resident funds account, dated [DATE], showed the resident had a balance of $348.72. 16. Review of Resident #459’s nurse’s notes showed the resident expired on [DATE]. Review of the facility’s current balance report for the resident funds account, dated [DATE], showed the resident had a balance of $200.00. 17. Review of Resident #468’s nurse’s notes showed the resident expired on [DATE]. Review of the facility’s current balance report for the resident funds account, dated [DATE] showed the resident had a balance of $304.91. 18. Review of Resident #466’s nurse’s notes showed the resident expired on [DATE]. Review of the facility’s current balance report for the resident funds account, dated [DATE], showed the resident had a balance of $80.00. 19. Review of Resident #469’s nurse’s notes showed the resident expired on [DATE]. Review of the facility’s current balance report for the resident funds account, dated [DATE], showed the resident had a balance of $536.25. 20. Review of Resident #471’s nurse’s notes showed the resident was discharged from the facility on [DATE]. Review of the facility’s current balance report for the resident funds account, dated [DATE], showed the resident had a balance of $150.00. 21. During interview on [DATE] at 11:12 A.M., the business office manager/bookkeeper said when a resident expires or is discharged , he/she immediately contacts the state in writing and by phone about any funds left in the residents funds account. He/she was unaware Residents #467, #478, #476, #472, #475, #477, #464, #463, #470, #479, #2, #473, #465, #474, #459, #468, #466, #469, and #471 still had a resident fund balance. He/She just started at the facility three weeks ago. She was aware the facility only had 30 days to return or send to the state all monies an expired or discharged resident has in the resident fund account. During interview on [DATE] at 11:14 A.M., the corporate financial consultant said he/she expected the state to be notified immediately if a resident expired or was discharged and still had money in the resident funds account. He/she was unaware Residents #467, #478, #476, #472, #475, #477, #464, #463, #470, #479, #2, #473, #465, #474, #459, #468, #466, #469, and #471 still had a resident fund balances. He/she was aware the facility only had 30 days to return or send to the state all monies an expired or discharged resident has in |
| DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 7/31/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
| STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265160 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LEWIS & CLARK GARDENS | STREET ADDRESS, CITY, STATE, ZIP 1221 BOONSLICK ROAD | |||||||||
| 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) | |
|---|---|---|
| F 0569 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 4) the resident funds account. During interview on [DATE] at 11:16 A.M., the administrator said she expected any monies a resident has in the resident funds account to be returned or sent to the state immediately if a resident is discharged or expires. She was unaware Residents #467, #478, #476, #472, #475, #477, #464, #463, #470, #479, #2, #473, #465, #474, #459, #468, #466, #469, and #471 still had a resident fund balances. | |
| F 0657 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** |
| DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 7/31/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
| STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265160 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LEWIS & CLARK GARDENS | STREET ADDRESS, CITY, STATE, ZIP 1221 BOONSLICK ROAD | |||||||||
| 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) | |
|---|---|---|
| F 0657 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 5) comprehensive care plan will be based on a thorough assessment that includes, but not limited to, the MDS. Assessments of each resident is ongoing process and the care plan will be revised as changes occur in the resident’s condition. -The interdisciplinary care plan team is responsible for the periodic review and updating of care plans when a significant change in the resident’s condition has occurred. At least quarterly. When changes occur that impact the resident’s care (i.e. change in diet, discontinuation of therapy, changes in care areas that do not require a significant change assessment). 3. Record review of Resident #101’s nurse’s notes showed the following: -On 1/25/18, staff sent the resident to the emergency room due to pain in the left hip. The resident had difficulty bearing weight and was sent by ambulance; -On 1/28/18, the resident was readmitted and returned to the facility with family members due to a left [MEDICAL CONDITION]. Surgical repair was performed on the hip on 1/25/18. The resident was on hip precautions for 12 weeks and was weight bearing as tolerated to the left leg. Review of the resident’s physician orders, dated 1/29/18, showed the following: -Left [MEDICAL CONDITION]; -Non-weight bearing to the right arm; -Weight bearing as tolerated to the left leg. Review of the resident’s Significant Change in Status Minimum Data Set (MDS), a federally mandated assessment instrument required to be completed by facility staff, dated 2/5/18, showed the following: -Required extensive assistance of one staff for transfer and toilet use; -No urinary appliances used; -Occasionally incontinent of bowel and bladder. Review of the resident’s comprehensive care plan, dated 2/9/18, showed the following: -[DIAGNOSES REDACTED]. -The resident experienced bladder incontinence related to memory loss, weakness, and gait instability; -Provide assistance for toileting; -Provide incontinence care after each incontinent episode; -The resident needed assistance from staff for activities of daily living related to a fractured right arm; -Monitor pain; -Encourage activities; -Assist to and from the wheelchair and with mobility. The resident’s care plan, dated 2/9/18, did not address the resident required extensive assistance of one to transfer and use the toilet or the non-weight bearing status of the resident’s right arm. Review of the resident’s nurse’s notes showed the following: -On 2/21/18 at 6:00 A.M., staff found the resident on the floor. The resident was sent to the hospital; -On 2/23/18, the resident returned to the facility. Review of the resident’s baseline care plan, dated 2/23/18, showed the following: -The baseline care plan is to be completed within 48 hours of admission; -After completion, print and file the following community protocols; -Follow community protocols for catheter care. Review of the resident’s physician order [REDACTED]. Review of the resident’s five-day MDS, dated [DATE], showed the resident had an indwelling |
| DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 7/31/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
| STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265160 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LEWIS & CLARK GARDENS | STREET ADDRESS, CITY, STATE, ZIP 1221 BOONSLICK ROAD | |||||||||
| 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) | |
|---|---|---|
| F 0657 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 6) urinary catheter. Review of the resident’s physician orders, dated 3/6/18, showed the following: -Weight bearing as tolerated to the upper extremity; -Non-weight bearing on the left lower extremity; -There was no order for an indwelling urinary catheter. Observation throughout the survey from 3/18/18 until 3/21/18 showed the resident had a urinary catheter in place. During an interview on 3/21/18 at 10:12 A.M., Occupational Therapist (OT) E said the resident has had the urinary catheter for quite a while and thought the resident had the urinary catheter since January, after he/she had been hospitalized for [REDACTED]. The resident was currently non-weight bearing to the left leg. During an interview on 3/21/18 at 10:15 A.M., Licensed Practical Nurse (LPN) F said he/she was not certain how long the resident has had the urinary catheter but thought he/she had the catheter when he/she returned from the hospital after hip surgery in January. Review on 3/21/18 of the resident’s comprehensive care plan, dated 2/9/18, located in the resident’s chart, showed no update the resident had an indwelling urinary catheter or instructions for its care and maintenance. The care plan did not address the resident’s non-weight bearing status to the left leg and weight bearing as tolerated status to the right arm. 4. Review of the Resident #44’s care plan, dated 9/22/17, showed the following: -The resident required a urinary catheter related to skin issues; -Change the resident’s catheter per physician orders; -Staff to provide assistance for catheter cares every shift and as needed. Review of the resident’s quarterly MDS, dated [DATE], showed he/she required an indwelling urinary catheter. Review of the resident’s physician orders, dated 2/2/18, showed the following: -The resident was readmitted from the hospital with [DIAGNOSES REDACTED]. -On 2/2/18, an order for [REDACTED]. Review of the resident’s physician orders [REDACTED]. -On 2/22/18, Compartmental Syndrome (a condition caused by pressure buildup from internal bleeding or swelling of tissues; -On 2/22/18, apply Xeroform (a petroleum based gauze) dressing daily; On 3/7/18, discontinue previous treatment. Apply Santyl and Silver Alginate (a [MEDICATION NAME] agent); -On 3/16/18, discontinue previous treatment. Apply Santyl and [MEDICATION NAME] (an antibiotic) 1% gel to the wound, cover with an ABD (absorbent dressing) and tape. Review of the resident’s care plan showed no update for urinary tract infection, use of an antibiotic or wound care. 5. Review of Resident #12’s nurse’s notes, dated 10/25/17 at 10:22 A.M., showed the resident was transferred by a mechanical lift. Review of the resident’s MDS, dated [DATE], showed no documentation the resident required assistance from two staff members and an assistive device for transfers. Review of the resident’s hospice admission papers, dated 12/11/17, showed the resident was admitted to hospice care on 12/11/17. Review of the resident’s POS, dated (MONTH) (YEAR), showed an order for [REDACTED]. Review of the resident’s care plan, dated 03/10/18, showed no documentation of the resident receiving hospice care, no documentation the resident required a mechanical lift for transfers and no documentation the resident was to wear heel protectors while in bed and while in his/her chair. |
| DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 7/31/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
| STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265160 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LEWIS & CLARK GARDENS | STREET ADDRESS, CITY, STATE, ZIP 1221 BOONSLICK ROAD | |||||||||
| 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) | |
|---|---|---|
| F 0657 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 7) Observation on 3/20/18 at 7:23 A.M. showed two staff transferred the resident into a broda chair (a tilt and recline wheelchair) from his/her bed with a mechanical lift. The resident wore no have heel protectors. Observation on 03/20/18 at 12:38 P.M. showed two staff assisted the resident into his/her bed from his/her broda chair with a mechanical lift. The resident wore no heel protectors. Observation on 03/21/18 at 07:47 A.M. showed the resident in bed with no heel protectors in place. During interview on 03/21/18 at 07:52 A.M., Certified Nurse Assistant (CNA) A said three or four months ago the resident went to the hospital and when he/she returned to the facility he/she required total assistance and required a mechanical lift for transfers. 6. Review of Resident #29’s admission MDS, dated [DATE], showed the following: -[DIAGNOSES REDACTED]. -Ability to make daily decisions was moderately impaired; -The resident had two or more falls without injury since admission; -The resident had one fall with major injury since admission; -Required limited assistance of one staff for bed mobility, transfers, toilet use, and hygiene. Review of the resident’s care plan, dated 12/1/18, showed the following: -The resident had a history of [REDACTED].>-The resident fell out of bed on 11/15/17. An intervention of a bolstered mattress was added on this date; -Equip the resident with a device that monitors rising. Observation throughout the survey from 3/18/18 until 3/21/18 showed the resident did not have a bolstered mattress in place on his/or bed and did not have any device that monitored rising of the resident on the bed or on the resident’s chair. During an interview on 3/21/18 at 8:10 A.M., Licensed Practical Nurse (LPN) F said the resident did not utilize any device that monitored rising. The facility did not utilize alarms of any kind and hadn’t for several months. LPN F was not sure if the resident had a bolstered mattress. During an interview on 3/21/18 at 10:10 A.M., the Director of Nursing (DON) said the resident was at high risk for falls and had several things in place as interventions to prevent falls. The DON said the facility did not utilize alarms or devices that alerted staff of a resident’s rising. The DON said he/she thought the resident had a bolstered mattress on his/her bed. During interview on 3/21/18 at 8:39 A.M., the care plan coordinator said she updated the resident care plans for change of conditions, braces, lifts, and catheters for long-term care residents. The MDS coordinator updated the resident care plans for residents receiving Medicare Part A. Any nurse can update the resident care plans. She updated the resident care plans when changes were brought to her attention. She was responsible for ensuring the resident care plans were accurate and she did this every three months or as needed. During interview on 03/21/18 at 8:46 A.M., the MDS coordinator said she updated the resident care plan for the residents receiving Medicare Part A. She was responsible to update the care plan for any changes in the resident’s condition or care needs if the resident have been out of the facility and return to the facility under Medicare Part A. She changes the care plans when she does her assessments or when someone makes her aware there has been a change with the resident. She completes her assessments within eight days, 14 days, 30 days, 60 days, 90 days, and with a change of therapy or change of condition. The floor nurses are responsible to complete a 48-hour interim care plan when a resident returns from the hospital. |
| DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 7/31/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
| STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265160 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LEWIS & CLARK GARDENS | STREET ADDRESS, CITY, STATE, ZIP 1221 BOONSLICK ROAD | |||||||||
| 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) | |
|---|---|---|
| F 0657 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 8) During interview on 3/21/18 at 8:16 A.M., the DON said she, the assistant director of nursing (ADON), the MDS coordinator, and the care plan coordinator updated the care plans in the residents’ charts. The care plan nurse did the updates in the residents’ electronic chart. She expected the residents’ care plans to be updated as the resident’s condition changed. She expected the residents’ care plans to show the residents used lifts, braces, heel protectors, and any other devices that were needed for their care. She expected the care plan to show what type of assistance the resident needed for activities of daily living (ADLs) and how many staff it took to provide those cares. | |
| F 0677 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | Provide care and assistance to perform activities of daily living for any resident who is unable. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** |
| DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 7/31/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
| STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265160 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LEWIS & CLARK GARDENS | STREET ADDRESS, CITY, STATE, ZIP 1221 BOONSLICK ROAD | |||||||||
| 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) | |
|---|---|---|
| F 0677 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | (continued… from page 9) -Gently open all the skin folds and wash the inner area (urinary meatus and vaginal area) from front to back; -Rinse the area well, start from the innermost area and proceed outward; -Wash and rinse the anal area; -Pat the peri area dry. 3. Review of the Nurse Assistant in a Long Term Care Facility manual, revised 2001, showed the following: -Purposes of oral hygiene (mouth care)-A clean mouth and properly functioning teeth are essential for physical and mental well-being of the resident: Prevent infections in mouth, Remove food particles and plaque, Stimulate circulation of gums, Eliminate bad taste in mouth; thus food is more appetizing; -Give oral care before breakfast, after meals, and also at bedtime; -Specific observations to make: tooth decay, any loose or broken teeth; red or swollen gums; sores or white patches in the mouth or on the tongue; changes in eating habits; and poorly fitting dentures; -A clean mouth is very important to the physical and mental well-being of the resident. Oral care can prevent infections, the buildup of plaque, and bad breath. It can even influence the resident’s appetite. Remember to observe the resident during oral care to identify potential problems. 4. Review of Resident #74’s quarterly Minimum Data Set (MDS), a federally mandated assessment instrument required to be completed by facility staff, dated 1/26/18, showed the following: -Long-term and short-term memory problems; -Required extensive assistance of one staff for toilet use and personal hygiene; -Frequently incontinent of bladder and bowel. Review of the resident’s care plan, revised on 1/26/18, showed the following: -[DIAGNOSES REDACTED]. -Required moderate assistance with dressing, transfers, toileting, hygiene, and bathing related to a stroke with [MEDICAL CONDITION]; -At risk for skin break down due to decreased mobility and incontinence; -Provide incontinence care after each incontinence episode; -Minimize skin exposure to moisture. The resident’s care plan did not address oral care. Observation on 3/20/18 at 5:39 A.M. showed the following: -The resident lay in bed in a gown. There was a strong odor of urine in the room; -Certified Nurse Aide (CNA) B and CNA C entered the resident’s room to provide morning care; -CNA B removed covers from the resident. The resident was incontinent of urine; -CNA C used wash cloths and perineal wash and wiped the resident’s front perineal area; -CNA B and CNA C rolled the resident to the left side and washed the resident’s buttocks; -CNA B and CNA C assisted the resident to his/her back; -Without washing the resident’s right or left thighs, CNA B placed a clean brief under the resident; -CNA C secured the brief. A very strong odor of urine remained in the room; -CNA B and CNA C dressed the resident and sat him/her on the side of the bed; -CNA B and CNA C transferred the resident to the wheelchair with a gait belt; -CNA B bagged the soiled linen and left the room; -CNA C brushed the resident’s hair and washed the resident’s face; -CNA C wheeled the resident out of the room in the wheelchair to the dining room; |
| DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 7/31/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
| STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265160 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LEWIS & CLARK GARDENS | STREET ADDRESS, CITY, STATE, ZIP 1221 BOONSLICK ROAD | |||||||||
| 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) | |
|---|---|---|
| F 0677 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | (continued… from page 10) -Neither CNA B nor CNA C offered or assisted the resident with oral care. During an interview on 3/20/18 at 6:08 A.M., CNA C said he/she was not sure if the resident had any teeth or not. The resident was incontinent of urine that morning and the resident’s bed was wet with urine. CNA C said staff should ensure all areas of the resident are cleaned after incontinence. CNA C did not realize he/she did not wash the resident’s left or right hips. CNA C said he/she did not offer the resident any oral care because he/she didn’t think the resident had any teeth. Observation and interview on 3/20/18 at 8:32 A.M. showed the resident sat in his/her room in the wheelchair. The resident said he/she did not have teeth. No one had assisted him/her to clean his/her mouth. Observation showed the resident’s breath had a foul odor. 5. Review of Resident #101’s MDS, dated [DATE], showed the following: -[DIAGNOSES REDACTED]. -Made decisions tasks of daily life with modified independence, some difficulty in new situations only; -Required limited assistance of one staff for personal hygiene; -Had his/her own teeth. Review of the resident’s care plan, last revised on 2/9/18, showed the following: -The resident required assistance with activities of daily living related to a fractured right arm, weakness, and joint pain; -The resident required assistance with dressing and all activities of daily living. Observation and interview on 3/19/18 at 8:33 A.M. showed the resident sat in a wheelchair in his/her room. The resident said he/she had been to the dining room for breakfast. The resident said he/she had his/her own teeth. Observation showed the resident’s breath had a foul odor. The resident said he/she had not had any assistance to brush his/her teeth that morning and that was typical most days. Observation on 3/20/18 at 8:01 A.M. showed the following: -CNA D assisted the resident to dress as the resident sat on his/her bed; -CNA D put a gait belt on the resident and transferred him/her to the wheelchair; -CNA D provided the resident with a wet wash cloth for his/her face, and combed the resident’s hair; -CNA D gave the resident his/her glasses and pushed the resident to the dining room in the wheelchair; -CNA D did not offer or assist the resident with any oral care. During an interview on 3/20/18 at 8:14 A.M., CNA A said he/she assisted the resident that morning with dressing and transfer to the dining room. CNA A said he/she was not sure if the resident had his/her own teeth or not. CNA A said he/she did not offer or provide any oral care for the resident that morning. During an interview on 3/21/18 at 3:30 P.M., the Director of Nursing (DON) said he/she would expect staff to wash all areas of a resident’s skin that had been in contact with urine or stool. The DON said staff should provide or assist residents with oral care when the get them up in the morning, at bedtime, and as needed or requested. | |
| F 0688 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | 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: 7/31/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
| STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265160 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LEWIS & CLARK GARDENS | STREET ADDRESS, CITY, STATE, ZIP 1221 BOONSLICK ROAD | |||||||||
| 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) | |
|---|---|---|
| F 0688 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | (continued… from page 11) evaluate and provide services to address limited range of motion and proper positioning for two residents (Residents #47 and #84), in a review of 22 sampled residents. The facility census was 107. 1. Review of Resident #84’s quarterly Minimum Data Set (MDS), a federally mandated assessment instrument required to be completed by facility staff, dated 2/1/18, showed the resident had limited range of motion on one side of the body to both the upper and lower extremity. Review of the resident’s care plan, last reviewed on 2/2/18, showed the following: -[DIAGNOSES REDACTED].>-The resident required assistance from one staff member for activities of daily living related to a stroke with left sided [MEDICAL CONDITION] (paralysis of one side of the body); -Assist with dressing and personal hygiene; -Assist with transfers. The resident could propel self once in the wheelchair. The resident’s care plan did not address any restorative or therapy services for range of motion or positioning devices to maintain proper positioning for the resident’s [MEDICAL CONDITION]. Observation and interview on 3/18/18 at 6:15 P.M. showed the resident sat in a wheelchair in his/her room. The resident was completely flaccid (hanging limply) on his/her right side (the resident’s care plan indicated the resident was paralyzed on the left side). The resident said he/she was not receiving any therapy and no one was working with him/her to regain any movement. The resident had one footrest on his/her wheelchair on the right side. The resident’s right foot rested on the floor. The resident responded with a frustrated no when asked if his/her right foot would stay on the footrest. Observation on 3/20/18 at 7:36 A.M. showed the resident propelled himself/herself backwards down the hall. The resident’s right foot had fallen off the foot rest and drug the floor. A staff member stopped and put the resident’s right foot back on the foot rest. The resident indicated it would not stay on the footrest. The resident’s right arm was flaccid and laid in the wheelchair next to the resident’s right hip. Observation on 3/20/18 at 11:47 A.M. showed the Assistant Director of Nursing (ADON) placed the resident’s right arm in a sling. During an interview on 3/20/18 at 11:50 A.M., the ADON said there was no order and it was not on the resident’s care plan to wear the sling but the resident had requested to wear it. The ADON would call the resident’s physician for an order and see if physical therapy (PT) could evaluate him/her to see if the sling was on correctly. During an interview on 3/20/18 at 1:19 P.M., the resident said the sling helped to keep his/her arm comfortable and he/she liked to have it on. Observation on 3/20/18 at 2:22 P.M. showed the resident propelled himself/herself in the hallway in the wheelchair. The resident’s right foot was off the footrest and drug the floor. Observation on 3/21/18 at 7:54 A.M. showed the resident sat in wheelchair in his/her room and had a sling in place to his/her right arm. During an interview on 3/21/18 at 8:08 A.M., Licensed Practical Nurse (LPN) F said therapy staff brought the sling over for the resident on 3/19/18. LPN F was not sure why therapy staff brought the sling for the resident but said the resident had been wearing it and seemed happy with the sling. During an interview on 3/21/18 at 9:39 A.M., the Director of the Therapy Department said the resident asked him/her for the sling and he/she provided the sling earlier in the week. Nursing staff got an order from the physician for the sling. The therapy department would evaluate the resident to ensure nursing staff placed it on the resident correctly |
| DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 7/31/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
| STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265160 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LEWIS & CLARK GARDENS | STREET ADDRESS, CITY, STATE, ZIP 1221 BOONSLICK ROAD | |||||||||
| 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) | |
|---|---|---|
| F 0688 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | (continued… from page 12) and to ensure it fit. The resident had never been seen by therapy in the past because he/she did not qualify due to insurance coverage. The therapy director did not think a restorative program had been attempted for the resident. During an interview on 3/21/18 at 10:02 A.M. Certified Nurse Aide/Restorative Aide (CNA/RA) said he/she had worked with the resident previously applying hot packs and providing massage to the resident’s right shoulder but had not worked with the resident in over a year. The resident had not always been willing to participate in the past. 2. Review of Resident #47’s care plan, dated 12/15/16, showed the resident was to wear bilateral palm protectors for contracture management. Review of the resident’s readmission face sheet, dated 5/23/17, showed the resident’s [DIAGNOSES REDACTED]. Review of the resident’s Restorative Nursing, dated 8/17/17, showed [DIAGNOSES REDACTED]. Bilateral hand splints for up to four to six hours or to resident’s tolerance of hand hygiene. Review of the resident’s admission MDS, dated [DATE], showed the following: -He/she did not ambulate or transfer; -The resident required extensive assistance on one staff member for bed mobility; -He/she required total assistance of one staff member to dress, eat, toilet, and for personal hygiene. -He/she had limited range of motion/impairment of both upper extremities. Review of the resident’s physician order [REDACTED]. -an order for [REDACTED].>-A line marked through the order with no date and marked discontinue (DC). During an interview on 4/3/18 at 2:39 P.M., the Director of Nursing (DON) said she could not find any written order for the resident’s bilateral hand splints to be discontinued. She said the facility had a licensed practical nurse (LPN) come into the facility to recap orders but does not know why the LPN would have drawn a line through the order and write discontinue without a date. She did not believe the facilty had an order to discontinue. Observation on 03/19/18 at 8:08 A.M. showed the resident lay in bed. Both of the resident’s hands were contracted. The resident was not wearing splints or braces on his/her hands. Observation on 03/19/18 at 1:50 P.M. showed the resident did not wear splints or braces on his/her hands. Review of the resident’s Treatment Administration Record (TAR), dated 3/19/18, showed the following: -Resident to wear bilateral hand splints at all times as tolerated; -A blank area with no signature for the 6:00 A.M. to 2:00 P.M. -Staff initialed the resident’s TAR for the 2:00 P.M. to 10:00 P.M. shift as completed; -Staff initialed the resident’s TAR for the 10:00 P.M. to 6:00 A.M. shift as completed; Observation on 03/20/18 at 5:20 A.M. showed the resident lay in bed, he/she did not have splints on his/her hands. Observation on 03/20/18 at 6:15 A.M. showed the resident in bed, the resident did not have splints or braces on his/her hands. Observation on 03/20/18 at 7:10 A.M. showed the resident lay in bed, he/she did not have splints or braces on his/her hands. Observation on 03/20/18 at 7:45 A.M. showed the resident lay in bed, he/she did not have splints or braces on his/her hands. Review of the resident’s Treatment Administration Record (TAR) at 10:37 A.M. showed the following: |
| DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 7/31/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
| STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265160 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LEWIS & CLARK GARDENS | STREET ADDRESS, CITY, STATE, ZIP 1221 BOONSLICK ROAD | |||||||||
| 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) | |
|---|---|---|
| F 0688 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | (continued… from page 13) -Resident to wear hand splints at all times as tolerated; -Staff signed the TAR as completed. Observation on 3/20/18 at 12:32 P.M. showed the resident did not have splints or braces on his/her hands. Observation on 3/20/18 at 1:00 P.M. showed the following: -Occupational Therapist (OT) E found a set of gray wrist, hands and finger orthotic (WHFO) brace in the resident’s closet; -He/she did not put the braces on the resident, he/she put them back in the closet. During an interview on 3/20/18 at 1:00 P.M., OT E said he/she was not aware the resident had hand braces (since he/she started work at the facility in (MONTH) (YEAR)). He she/he said due to staff and management changes and lack of communication between nursing and therapy, he/she did not know if the residents got what they needed. During an interview on 3/20/18 at 2:40 P.M., LPN J said the following: -The resident wore braces on his/her left hand; -He/she did not have time to put the braces on the resident today; -He/she documented he/she put the braces on the resident today but did not put them on. Observation on 03/21/18 at 8:00 A.M. showed the resident sat in his/her wheelchair. The resident did not have splints or braces on his/her hands. During an interview on 03/21/18 at 9:42 A.M., LPN H said the following: -The resident had a blue hand splint for his/her right hand and a wash cloth for his/her left hand; A CNA put these on this morning; -The blue splints were the facility’s splints (not ordered special by therapy); -He/she was not aware the resident had splints ordered by therapy; -He/she did not know why the resident did not have any splints on his/her hands on 3/19/18. During an interview on 03/21/18 at 10:24 A.M., OT E said to his/her knowledge the resident had specified splints the evaluating therapist ordered. During an interview on 03/21/18 at 2:02 P.M., the ADON said the following: -Staff should know what braces residents are to wear; -If a resident had an order for [REDACTED].>-This should be on the resident’s TAR and care plan; -He/she expected staff to document on the TAR when the brace was put on the resident;. During an interview on 3/21/18 at 3:30 P.M., the DON said she would expect staff to provide Resident #84 with devices to maintain proper positioning without him/her having to ask. The DON expected staff to apply braces and other positioning devices as ordered by the physician and to document appropriately on the treatment administration record. Staff should not document something as completed if it wasn’t and should document the reason an ordered treatment was not completed. | |
| F 0690 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | 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: 7/31/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
| STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265160 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LEWIS & CLARK GARDENS | STREET ADDRESS, CITY, STATE, ZIP 1221 BOONSLICK ROAD | |||||||||
| 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) | |
|---|---|---|
| F 0690 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 14) and failed to identify the presence of and purpose for an indwelling urinary catheter in the medical record for one resident (Resident #101), in a review of 22 sampled residents. The facility identified nine residents with urinary catheters. The facility census was 107. 1. Review of the Nurse Assistant in a Long-Term Care Facility, Student Reference, 2001 Revision, showed the Steps of Procedure for Giving Peri Care with a Catheter (a sterile tube inserted and left in the bladder to drain urine) included the following instructions: -More frequent care is required for residents who have an indwelling catheter; -Expose the perineal area; separate the labia of the female resident and gently wash around the opening of the urethra with soap and water; -Wash the catheter tubing from the opening of the urethra outward four inches and further if needed; -Using a fresh wash cloth continue washing and rinsing the peri area; -The bladder is considered sterile, the catheter, drainage tubing, and bag are a sterile system; -Drainage tubing/bags must not touch the floor; always hook to unmovable part of the bed frame or chair; -When transferring residents from bed to chair, always move the drainage bag over to the chair before moving the resident; -The drainage bag should always be below the level of the bladder; -If moved above, urine could flow back into the bladder. Review of the 2001 revision of the Nurse Assistant In a Long Term Care Facility manual, showed the procedures staff were to follow when they provided peri care for female included the following: -For the female resident included the following: -Cover the resident; -Expose the peri area, wash the inner legs and outer peri area along the outside of the labia (Labia Majora); -Use a clean area of the washcloth for each wipe of the peri area; -Wash the outer skin folds from front to back; -Wash the inner labia (Labia Minora) from front to back; -Gently open all the skin folds and wash the inner area (urinary meatus and vaginal area) from front to back; -Rinse the area well, start from the innermost area and proceed outward; -Wash and rinse the anal area; -Pat the peri area dry. Review of the 2001 revision of the Nurse Assistant In A Long Term Care Facility manual, showed the procedures staff were to follow when they provided peri care for a male included the following: -Cover the resident; -Expose the perineal areas included, wash the penis from the tip downward, rinse, and dry (specific instructions for uncircumcised); -Wash and rinse the scrotum; -Wash and rinse other skin areas between the legs; -Wash and rinse the anal area; -Pat the area dry. Also needs to include for male resident so it isn’t clear to the reader the sex of the residents in the SOD. **added** 2. Review of the facility’s Catheter Care policy from the Nursing Guidelines Manual, dated (MONTH) (YEAR), showed the following: |
| DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 7/31/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
| STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265160 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LEWIS & CLARK GARDENS | STREET ADDRESS, CITY, STATE, ZIP 1221 BOONSLICK ROAD | |||||||||
| 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) | |
|---|---|---|
| F 0690 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 15) -The purpose is to prevent infection and reduce irritation; -For the female, use a clean washcloth with warm water and soap to cleanse the labia; -Use one area of the wash cloth for each downward, cleansing stroke;; -Change the position of the wash cloth with each downward stroke; -Next, change the position of the cloth and cleanse around the urethral meatus; -With a clean washcloth, rinse with warm water using the above technique; -Use a clean wash cloth with warm soapy water to cleanse the catheter from the insertion site to approximately four inches outward; -Secure catheter utilizing a leg band (optional); -Check drainage tubing and bag to ensure that the catheter is draining properly. 3. Review of Resident #101’s nurse’s notes showed on 1/19/18, the resident had increased confusion. The resident’s family requested laboratory studies be obtained to check for a urinary tract infection [MEDICAL CONDITION]. Staff received new orders from the physician to obtain a urinary analysis (UA, a test of a urine sample that can reveal problems of the urinary tract, such as infections). Review of the resident’s UA, dated 1/19/18, showed the resident’s urine was positive for the presence of bacteria. There were no culture and sensitivity results found in the resident’s record for the UA dated 1/19/18. Review of the resident’s nurse’s notes showed on 1/20/18, staff received new orders from the physician [MEDICATION NAME](oral antibiotic) 500 milligrams (mg) for three days pending the culture and sensitivity report (C and S, further microscopic study of the urine to determine the presence of specific bacteria). Review of the resident’s Significant Change in Status Minimum Data Set (MDS), a federally mandated assessment instrument required to be completed by facility staff, dated 2/5/18, showed the following: -Required extensive assistance of one staff for transfer and toilet use -Limited assistance of one staff for personal hygiene; -No urinary appliances used; -Occasionally incontinent of bowel and bladder. Review of the resident’s comprehensive care plan, dated 2/9/18, showed the following: -[DIAGNOSES REDACTED]. -The resident experienced bladder incontinence related to memory loss, weakness, and gait instability; -Provide assistance for toileting; -Provide incontinence care after each incontinent episode; -Report signs of urinary tract infection [MEDICAL CONDITION]. Review of the resident’s UA with C and S, dated 2/20/18, showed the resident’s urine was positive for [MEDICATION NAME] faecalis (bacterial species found in human feces). Review of the resident’s nurse’s notes showed the following: -On 2/21/18 at 6:00 A.M., staff found the resident on the floor. The resident was sent to the hospital; -On 2/23/18, the resident returned to the facility. Review of the resident’s baseline care plan, dated 2/23/18, showed the following: -The baseline care plan is to be completed within 48 hours of admission; -After completion, print and file the following community protocols; -Follow community protocols for catheter care. Review of the resident’s physician order [REDACTED]. Review of the resident’s UA with C and S, dated 3/3/18, showed the resident’s urine was again positive for [MEDICATION NAME] faecalis, as well as staphylococcus aureus (a |
| DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 7/31/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
| STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265160 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LEWIS & CLARK GARDENS | STREET ADDRESS, CITY, STATE, ZIP 1221 BOONSLICK ROAD | |||||||||
| 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) | |
|---|---|---|
| F 0690 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 16) bacterium found on human skin and is the leading cause of skin and soft tissue infections). Review of the resident’s five day MDS, dated [DATE], showed the resident had an indwelling urinary catheter. Review of the resident’s nurse’s note, dated 3/3/18, show staff reported the results of the C and S to the resident’s physician and received an order for [REDACTED]. Review of the resident’s nurse’s note, dated 3/17/18, showed the resident’s urinary catheter was patent and drained amber urine with sediment. Observations of the resident showed the following: -On 3/18/18 at 1:26 P.M., the resident sat in a wheelchair in his/her room. The resident had a urinary catheter. The catheter tubing was on the floor under the wheelchair; -On 3/18/18 from 5:29 P.M. until 5:57 P.M., the resident sat in the dining room in a wheelchair. His/her catheter tubing lay on the floor underneath the wheelchair; -On 3/18/18 at 5:57 P.M., the resident’s visitor wheeled the resident back to his/her room from the dining room. The catheter tubing drug the floor under the wheelchair. The urine in the catheter tubing was cloudy yellow with sediment present; -On 3/19/18 at 11:59 A.M., the resident sat in the common area at a table eating with a visitor. The resident’s catheter tubing lay on the floor underneath the wheelchair. The urine in the catheter tubing was cloudy, amber in color, with sediment; -On 3/19/18 at 2:08 P.M., the resident remained seated in the common area with a visitor. The resident’s catheter tubing remained on the floor under the resident’s wheelchair. Observation of the resident on 3/19/18 at 2:34 P.M. showed the following: -The resident sat in a wheelchair is his/her room. The resident’s catheter tubing lay in the floor under his/her wheelchair; -Certified Nurse Aide (CNA) D entered the resident’s room to transfer the resident to bed; -CNA D removed the catheter bag from under the resident’s wheelchair and clipped the catheter bag to the waist band of his/her pants, well above the level of the resident’s bladder. Urine was observed to back flow in the tubing; -CNA D applied a gait belt on the resident and assisted him/her to stand and pivot from the chair to the bed; -CNA D removed the catheter bag from his/her pants and attached it to the bed frame. The resident’s urine was dark amber and cloudy; -The resident requested to get back into the wheelchair; -CNA D again attached the resident’s catheter bag to his/her pants, well above the level of the resident’s bladder, and transferred the resident from the bed to the wheelchair; -CNA D secured the catheter bag under the resident’s wheelchair. The catheter tubing was in contact with the floor underneath the wheelchair. Observation on 3/19/18 at 3:34 P.M. showed the resident wheeled himself/herself down the hall in the wheelchair. The resident’s catheter tubing drug the floor under the chair. Several staff passed by the resident and did not adjust the placement of the tubing. Observation on 3/20/18 at 6:21 A.M. showed the resident lay in his/her room on a low bed. The catheter bag was in a cloth privacy cover which lay on the fall mat on the floor next to the bed. Observation on 3/20/18 at 8:01 A.M. showed the following: -CNA A was in the room with the resident assisting him/her to get dressed; -CNA A assisted the resident to sit on the side of the bed and transferred the resident from the bed to the wheelchair; -CNA A removed the catheter bag from the bed frame and slid it across the floor under the wheelchair and secured the bag under the chair; |
| DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 7/31/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
| STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265160 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LEWIS & CLARK GARDENS | STREET ADDRESS, CITY, STATE, ZIP 1221 BOONSLICK ROAD | |||||||||
| 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) | |
|---|---|---|
| F 0690 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 17) -The resident’s catheter tubing was on the floor; -CNA A pushed the resident to the dining room in the wheelchair while the catheter tubing drug the floor underneath the resident. During an interview on 3/20/18 at 8:14 A.M., CNA A said catheter bags and tubing should be kept off the floor and below the level of the resident’s bladder. He/She was not aware the resident’s catheter tubing was on the floor. Observations of the resident on 3/20/18 showed the following: -At 8:18 A.M., the resident sat in the wheelchair in the dining room. The catheter tubing lay on the floor underneath him/her. -At 8:45 A.M., the resident had finished eating and propelled himself/herself out of the dining room towards his/her room. The catheter tubing drug the floor under the wheelchair; -At 2:37 P.M., the resident’s visitor wheeled him/her out of the dining room. The |
| DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 7/31/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
| STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265160 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LEWIS & CLARK GARDENS | STREET ADDRESS, CITY, STATE, ZIP 1221 BOONSLICK ROAD | |||||||||
| 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) | |
|---|---|---|
| F 0690 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 18) Observation on 03/19/18 at 4:09 P.M. showed the resident sat in his/her room in his/her wheelchair with the catheter tubing on the floor. Observation on 03/20/18 at 6:09 A.M. showed the resident in his/her bed with the catheter tubing on floor. The catheter drainage bag was hooked to side of his/her bed with the lower part of bag touching the floor. Observation on 03/20/18 at 8:45 A.M. showed LPN F pushed the resident in his/her wheelchair. The resident’s catheter tubing drug the floor. Observation on 03/20/18 showed the following: -At 10:30 A.M., the resident sat in wheelchair in the dining room; the catheter tubing lay on the floor. -At 11:10 A.M., the catheter tubing remained on the floor; -At 12:40 P.M., the catheter tubing remained on the floor; -At 1:00 P.M., the resident sat in his/her wheelchair in his/her room with the catheter tubing on floor. During interview on 03/20/18 at 1:14 P.M., CNA H said catheter tubing should not be on the floor and the bag should be below the level of the bladder. 5. Review of the Resident #44’s care plan, dated 9/22/17, showed the following: -The resident required a urinary catheter related to skin issues; -Staff to provide assistance for catheter cares every shift and as needed. Review of the resident’s quarterly MDS, dated [DATE], showed the following: -He/she required an indwelling catheter; -He/she required assistance of two staff members for toilet use and personal hygiene. Review of the resident’s physician orders, dated 2/2/18, showed the following: -The resident readmitted from the hospital with [DIAGNOSES REDACTED].>-On 2/2/18 an order for [REDACTED]. Observation on 03/19/18 at 9:51 A.M. showed the following: -LPN H gathered supplies for urinary catheter care; -He/she used a soapy wash cloth and wiped the resident’s left groin with a brown/yellow debris left on the cloth after wiping; -He/she/she did not wipe the area again; -He/she used a soapy wash cloth and wiped the resident’s right groin with a brown/yellow debris left on the cloth after wiping; -He/she/she did not wipe the area again; -He/she used a new wash cloth and wiped the resident’s meatus and urinary catheter tubing one time only; -A brown, yellow stain was observed on the wash cloth; -He/she did not wipe the area again; -He/she changed gloves. Staff turned the resident to his/her side. LPN H did not wipe the resident’s posterior peri area, rectum or buttocks. During an interview on 03/21/18 at 9:46 A.M., LPN H said the following: -When providing catheter care he/she should clean the left and right groin and wipe the skin folds front to back; -Rinse thoroughly, repeat steps to rinse, and use the towel to dry; -During the resident’s pericare, he/she should have rinsed the wash cloth and repeated each process until no visible debris. 6. Review of Resident #157’s physician orders [REDACTED]. Review of the resident’s baseline care plan, dated 3/16/18, showed the following: -Required assistance from one staff with toileting and grooming/hygiene; -Sometimes incontinent of bowel; |
| DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 7/31/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
| STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265160 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LEWIS & CLARK GARDENS | STREET ADDRESS, CITY, STATE, ZIP 1221 BOONSLICK ROAD | |||||||||
| 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) | |
|---|---|---|
| F 0690 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 19) -Urinary catheter; -Urinary catheter care; -Assist with appliance as per protocols (catheter). Observation on 3/20/18 at 6:43 A.M. showed the following: -CNA G and CNA M transferred the resident to his/her wheelchair and took him/her into the bathroom; -CNA M assisted the resident to stand, removed the catheter drainage bag from inside the dignity bag attached to the wheelchair and lay the drainage bag directly on the bathroom floor; -CNA M put socks on the resident, guided the catheter through the resident’s pant legs and placed the catheter drainage bag back on the floor. 7. During an interview on 3/21/18 at 3:30 P.M., the Director of Nursing (DON) said she expected staff to maintain a resident’s catheter bag and tubing up off the floor and below the level of the resident’s bladder. He/she would expect staff to wash all areas of a resident’s skin that had been in contact with urine or stool. Surveyor: Terri Cordray | |
| F 0761 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** |
| DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 7/31/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
| STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265160 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LEWIS & CLARK GARDENS | STREET ADDRESS, CITY, STATE, ZIP 1221 BOONSLICK ROAD | |||||||||
| 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) | |
|---|---|---|
| F 0761 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 20) facility on 1/10/18. Observation on 3/20/18 at 11:45 A.M. of the medication room on the 100 hall showed the following medications for the resident: -Carvidilol (blood pressure medication) 3.125 mg tablet, one card containing 30 tablets, second card containing 17 tablets, and third card containing 25 tablets; -[MEDICATION NAME] (blood pressure medication) 40 mg tablet, one card containing two tablets and another card containing 30 tablets; -Atorvastatin (cholesterol medication) 40 mg tablet, one card containing 29 tablets; -Vitamin D3 a supplement) 5000 unit capsule, one card containing 16 capsules. 6. Review of Resident #260’s face sheet showed the resident was discharged from the facility on 1/4/18. Observation on 3/20/18 at 11:45 A.M. of the medication room on the 100 hall showed the following medications for the resident: -[MEDICATION NAME] 3 mg tablet, one card containing two tablets; -[MEDICATION NAME] 2.5 mg tablet, one card containing four tablets; -Fludrocortisone (used to treat adrenogential syndrome and postural [MEDICAL CONDITION]) 1 mg tablet, one card containing six tablets, a second card containing six tablets, and a third card containing 15 tablets; -[MEDICATION NAME] 4 mg tablet, one card containing five tablets and a second card containing 12 tablets; -[MEDICATION NAME] 6 mg tablet, one card containing eight tablets. 7. Review of Resident #459’s nurse’s notes showed the resident expired on 12/10/17. Observation on 03/20/18 at 12:41 P.M. of the 300 hall medication room showed one bottle of [MEDICATION NAME] sulfate (liquid iron), labeled for the resident. 8. Review of Resident #457’s nurse’s notes showed the resident expired on 02/13/18. Observation on 03/20/18 at 12:41 P.M. of the 300 hall medication room showed one bottle of swish and spit (an oral treatment for [REDACTED]. 9. Review of Resident #7’s physicians orders showed the following: -The (MONTH) and (MONTH) (YEAR) physician order sheets showed no physician order for [REDACTED].>-An order dated 12/20/17 to discontinue [MEDICATION NAME] (blood pressure medication) 0.1 mg; -An order dated 2/28/18 to discontinue [MEDICATION NAME] (prostate medication) 0.4 mg. Observation on 03/20/18 at 12:41 P.M. of the 300 hall medication room showed a paper bag labeled please destroy. The bag contained the resident’s medications including one card of 14 tablets of [MEDICATION NAME] 40 mg; one card containing 22 tablets of [MEDICATION NAME] 0.1 mg (expiration date of 02/06/18); one card containing 21 tablets of [MEDICATION NAME] 10 mg; and one card containing five tablets of [MEDICATION NAME] 0.4 mg. 10. Review of Resident #25’s physician orders showed the following: -The (MONTH) and (MONTH) (YEAR) physician orders sheet showed no physician order for [REDACTED].>-An order dated 11/21/17 to discontinue [MEDICATION NAME] 5 mg. Observation on 03/20/18 at 12:41 P.M. of the 300 hall medication room showed a paper bag labeled please destroy. The bag contained the following medications for the resident: One card of 27 tablets of Astrovastatin 10 mg, and one card of five tablets of [MEDICATION NAME] 5 mg. 11. Review of Resident #458’s nurse’s notes showed the resident expired on 01/05/18. Observation on 03/20/18 at 12:41 P.M. of the facility 300 hall medication room showed a paper bag labeled please destroy. The bag contained the following for the resident: One card of 28 tablets of Tylenol (a pain reliever) 650 mg, and a second card containing 30 tablets of Tylenol 650 mg. |
| DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 7/31/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
| STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265160 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LEWIS & CLARK GARDENS | STREET ADDRESS, CITY, STATE, ZIP 1221 BOONSLICK ROAD | |||||||||
| 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) | |
|---|---|---|
| F 0761 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 21) 12. Review of Resident #461’s nurses notes on 03/21/18 at 10:09 A.M. showed the resident’s family had contacted the facility on 01/28/18 to notify the facility the resident had expired. Observation on 03/21/18 at 10:02 A.M. of medication cart number one, for the 200 hall, showed one card containing one tablet of [MEDICATION NAME] (a high blood pressure medication) 100 mg, labeled for the resident. 13. Observation on 3/20/18 at 11:29 A.M. of the medication room on the 100 hall showed the following expired medications/supplements: -Three boxes of Boost (nutritional supplement), expired 9/2/17; -One open bottle of [MEDICATION NAME] (pain reliever) 220 mg, containing 44 tablets, expired (MONTH) (YEAR); -An 8-ounce bottle of NephroTherapeutic nutrition, expired on 9/1/17; -An 8-ounce can of Ensure Plus, expired (MONTH) (YEAR). 14. During interview on 03/21/18 at 8:22 A.M., the Director of Nursing (DON), said she expected expired medications to be removed from the medication carts. She expected expired medications in the medication rooms to either be destroyed or sent back to the pharmacy. If a resident expires, if the residents medications expire, or medications are discontinued, she expected the nurses to either send the medication back to the pharmacy or destroy them within a week. | |
| F 0800 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | Provide each resident with a nourishing, palatable, well-balanced diet that meets his or her daily nutritional and special dietary needs. Based on observation, interview, and record review, the facility failed to ensure food was |
| DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 7/31/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
| STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265160 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LEWIS & CLARK GARDENS | STREET ADDRESS, CITY, STATE, ZIP 1221 BOONSLICK ROAD | |||||||||
| 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) | |
|---|---|---|
| F 0800 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | (continued… from page 22) -Food Thickener: ? cup and 2 teaspoons; -Step 4. Blend 1 teaspoon of bulk food thickener per serving and process until smooth. -Note: Amount of thickener required may vary relative to liquid content of cooked vegetable. For best results, alternate adding thickener with processing, checking product consistency periodically. Observation and interview on 3/19/18 at 1:10 P.M. showed Dietary Staff Q scooped cooked black-eye peas into a small pan. He/she removed six servings of peas with a #8 scoop into the pan and then dumped the peas into the blender bowl. Dietary Staff Q said the recipe called for adding 1 tablespoon of food thickener per portion, so he/she could add 6 tablespoons in total. He/she liked to start with 3 tablespoons first and see how the mixture looked. Observation showed he/she added 3 tablespoons of thickener to the peas and started the blender. Dietary Staff Q stopped the blender after approximately 30 seconds, added one more tablespoon of thickener then re-started the blender. After approximately 30 seconds, he/she added one more tablespoon and re-started the blender. After approximately 30 seconds had passed, he/she stopped the blender and added one more tablespoon for a total of 6 tablespoons and re-started the blender. After approximately 30 seconds, he/she stopped the blender and said the mixture should be smooth and a texture of refried beans or mashed potato consistency. The mixture appeared to be thick, dense, and pasty. 3. During an interview on 3/20/18 at 10:30 A.M., the Dietary Manager said staff was to utilize recipe books, weekly menu lists and diet spreadsheets to know how to prepare food items as well as how to know what items need to be prepared for each meal. | |
| F 0803 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** |
| DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 7/31/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
| STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265160 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LEWIS & CLARK GARDENS | STREET ADDRESS, CITY, STATE, ZIP 1221 BOONSLICK ROAD | |||||||||
| 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) | |
|---|---|---|
| F 0803 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 23) a resident on a pureed diet. Observation on 3/19/18 at 12:23 P.M. showed meal service had been completed. All residents on a pureed diet received a whole peeled baked potato and did not receive pureed baked potatoes as directed by the dietary spreadsheet. 2. Record review of the facility diet report, dated 3/19/18, showed six residents had a physician ordered pureed diet and 14 residents had a physician order [REDACTED].>Record review of the facility diet spreadsheet (Fall/Winter (YEAR), Week 5 Day 30) for lunch on 3/19/18, showed the following: -Residents on a pureed diet were to receive a #8 scoop of pureed meatloaf and 2-ounces of gravy; -Residents on a mechanical soft diet were to receive a #8 scoop of ground meatloaf and 2-ounces of gravy. Observation on 3/19/18 at 11:11 A.M. showed Dietary Staff P started plating lunch trays in the kitchen. Further observation showed pureed meatloaf and ground meatloaf were visible on the steamtable; however, no gravy was observed on the steam table. Observation on 3/19/18 at 11:32 A.M. showed Dietary Staff P plated a mechanical soft diet tray with a #8 scoop of ground meatloaf. No gravy or sauce was placed on the ground meat or anywhere on the tray. Observation on 3/19/18 at 11:34 A.M. showed Dietary Staff P plated a pureed tray with a #8 scoop of pureed meatloaf, however, no sauce or gravy was placed on the meatloaf. Observation on 3/19/18 at 12:23 P.M. showed meal service had been completed. All residents on a pureed diet or on a mechanical soft diet received the appropriate texture of meatloaf; however, no gravy or sauce was prepared or served with the pureed meatloaf or the ground meatloaf as directed by the dietary spreadsheet. 3. During an interview on 3/20/18 at 10:30 A.M., the Dietary Manager said staff was expected to utilize recipe books, weekly menu lists and diet spreadsheets to know how to prepare food items correctly and how to know what items need to be prepared for each meal. Residents on a pureed diet were supposed to have been given a whole baked potato with the skin removed. The gravy wasn’t prepared because the residents don’t like the brown gravy on the meatloaf and just prefer ketchup. The Dietary Manager confirmed the dietary spreadsheet showed the mechanical and pureed diets indicated gravy was supposed to be served with the meatloaf. During an interview on 3/20/18 at 11:20 A.M., the facility’s Dietician said residents on a pureed diet should not have received a whole peeled baked potato for lunch. The potato should have been pureed or should have been substituted for instant mashed potatoes. Residents on both mechanical and pureed diets should have been served gravy on top of the ground meatloaf and on top of the pureed meatloaf. Ketchup would not provide the same nutritional content as gravy would provide. Gravy should have been prepared and served. | |
| F 0812 Level of harm – Minimal harm or potential for actual harm Residents Affected – Many | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, and record review, the facility failed to ensure staff |
| DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 7/31/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
| STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265160 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LEWIS & CLARK GARDENS | STREET ADDRESS, CITY, STATE, ZIP 1221 BOONSLICK ROAD | |||||||||
| 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) | |
|---|---|---|
| F 0812 Level of harm – Minimal harm or potential for actual harm Residents Affected – Many | (continued… from page 24) in the food preparation areas. The facility census was 107. 1. Observation and interview on 3/19/18 at 1:10 P.M. showed Dietary Staff Q used a paper towel to wipe water out a small steam table pan, lifted the trash can lid and threw the paper towel away. Dietary Staff Q did not wash his/her hands after touching the trash can lid and put on a new pair of gloves. He/she began to scoop black-eyed peas from a large pan and placed them into a smaller pan. He/she removed scoops of black-eyed peas from the small pan and placed them in a blender to prepare pureed black-eyed peas. Observation on 3/19/18 at 1:14 P.M. showed Dietary Staff Q wore gloves and rinsed a small dirty steam table pan under running water from the three-compartment sink faucet. Dietary Staff Q removed his/her gloves, lifted the trash can lid, and threw his/her gloves in the trash. He/she did not wash his/her hands and put on a new pair of gloves. Dietary Staff Q scraped pureed black-eyed peas into a steam table pan and covered the pan with plastic wrap. Observation on 3/19/18 at 2:50 P.M. showed Dietary Staff Q wore gloves and began to slice ham and then weighed the ham slices with a scale. He/she removed his/her gloves, lifted the trash can lid with bare fingers and threw the dirty gloves in the trash can. Dietary Staff Q did not wash his/her hands and put on a new pair of gloves. He/she removed a clean steam table pan from the storage rack and used his/her gloved hands to place slices of ham into the pan. Dietary Staff Q removed his/her gloves, lifted the trash can lid and threw the gloves into the trash can. He/she reached above the food preparation counter, picked an iced coffee drink off the top of the shelf, took a drink of coffee and walked to the rear of the kitchen. Record review of the facility policy, Glove Use, dated (MONTH) 2011, showed the following guidelines: -To ensure safe and proper food handling during food preparation and service. -Hand washing per guidelines should occur between each task; -Gloves should be worn if handling food is necessary. Extra caution should be taken when multiple tasks are being completed; -Gloves should be removed when changing or walking away from specific tasks and hands should be washed per guidelines; -Note: Hands should be washed after disposing of trash or food; after handling dirty dishes; after handling raw meat, poultry or eggs; when changing tasks; and any other time deemed necessary. 2. Observation on 3/19/18 at 2:56 P.M. showed the maintenance shop, located next to the main dining room and the kitchen, had an upright freezer. The external display showed the internal temperature in the unit was +10 degrees F. A thermometer inside the freezer showed an internal temperature of +20 degrees F. The freezer contained approximately 20 or more cream pies, four bags of whipped topping, two boxes of cookie dough, and garlic bread sticks. All items were soft to the touch inside the freezer and were not frozen solid. Observation on 3/19/18 at 3:49 P.M. of the upright freezer in the maintenance shop showed the external display showed the internal temperature in the unit was +8 degrees F. The thermometer inside the freezer showed a temperature of +18 degrees F. Items inside the freezer were soft to the touch and not frozen solid. Observation on 3/20/18 at 9:15 A.M. showed the upright reach-in freezer inside the maintenance shop had an internal thermometer temperature of +15 degrees F. Food items were soft to touch inside the freezer and were not frozen solid. Observation on 3/20/18 at 10:29 A.M. showed the reach-in freezer in the maintenance shop had an exterior display that showed an internal temperature of +8 degrees F. The thermometer inside the freezer showed a temperature of +12 degrees F. Food items inside |
| DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 7/31/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
| STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265160 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LEWIS & CLARK GARDENS | STREET ADDRESS, CITY, STATE, ZIP 1221 BOONSLICK ROAD | |||||||||
| 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) | |
|---|---|---|
| F 0812 Level of harm – Minimal harm or potential for actual harm Residents Affected – Many | (continued… from page 25) were soft and not frozen. Record review of the facility policy, Refrigerator and Freezer Temperatures, dated (MONTH) 2011, showed temperatures of freezers should be 0 degrees F or below. 3. Observation and interview on 3/19/18 at 1:10 P.M. showed Dietary Staff Q used a paper towel to wipe water out of a small steam table pan. He/she placed scoops of black-eyed peas into the pan. Observation on 3/19/18 at 1:12 P.M. showed Dietary Staff P dried the inside of clean serving scoops and both sides of sharp knives off with a paper towel. The items had been placed on the drying on rack after being removed from the three-compartment sink. He/she placed the knives on the knife magnetic knife wall holder and stored the serving scoops in a drawer. 4. Observation on 3/19/18 at 2:50 P.M. showed a large plastic cup/lid with iced coffee inside and a set of car keys sat on top of a metal storage cabinet above the spice storage shelf and over a food preparation metal countertop. Two large whole chunks of ham sat below the personal items on the food preparation counter. The ham was unwrapped from the packaging that sat in a steam table pan. Dietary Staff Q sliced and weighed ham slices with a scale, directly underneath the coffee and car keys. He/she removed a clean steam table pan from the storage rack and placed slices of ham into the pan. Dietary Staff Q finished moving slices of ham into the pan and threw his/her gloves in the trash. He/she reached above the food preparation counter, picked up the iced coffee drink off the top shelf, took a drink of coffee and walked to the rear of the kitchen. Record review of the facility policy, Handwashing-Additional Guidelines, dated (MONTH) 2011, showed the following: -Eating and drinking in the dietary department is to occur in designated areas only; -Personal items are to be located in a designated area away from preparation, service and storage areas. 5. During an interview on 3/20/18 at 10:30 A.M., the Dietary Manager said staff should wash their hands as much as possible during working hours and in between glove use. He/she said the facility had some newer dietary staff members that probably needed some additional training. Dishware, utensils etc. that has been washed, should be air dried and not dried with paper towels. Freezers should be maintained at 0 degrees F or colder. Temperatures were checked twice a day (at approximately 4:30 A.M. and 4:00 or 5:00 P.M.) If temperatures were elevated, he/she would have someone look at the unit. He/she thought some items on the top shelf of the freezer in the maintenance shop were blocking the air vents from working correctly. Staff personal items and beverages should not be in the food preparation areas. In the past, he had allowed drinks with lids in the kitchen, but beverages were not supposed to be in a food preparation area. 6. During an interview on 3/20/18 at 11:20 A.M., the facility’s dietician said dishware should be air dried and not towel dried. Freezer temperatures should be maintained at 0 degrees F or below. Staff was expected to wash their hands between glove use and clean/dirty tasks. | |
| F 0880 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | Provide and implement an infection prevention and control program. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** |
| DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 7/31/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
| STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265160 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LEWIS & CLARK GARDENS | STREET ADDRESS, CITY, STATE, ZIP 1221 BOONSLICK ROAD | |||||||||
| 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) | |
|---|---|---|
| F 0880 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | (continued… from page 26) touching items with soiled hands and gloves, and when indicated by professional standards of practice during personal care for one resident (Residents #74), in a review of 22 sampled residents. The facility also failed to apply appropriate contact precautions for a resident (Resident #209) with [MEDICAL CONDITION] ([MEDICAL CONDITION], a bacterium that causes diarrhea and more serious intestinal conditions such as [MEDICAL CONDITION].) The facility census was 107. 1. Review of the facility’s Handwashing Policy from the Nursing Guideline Manual, dated (MONTH) (YEAR), showed the following: -Purpose: To reduce transmission of organisms from resident to resident, nursing staff to resident and resident to nursing staff; -Equipment: Soap, comfortably hot water, and disposable hand towel; -Guidelines: Turn on water and adjust temperature, soap hands well, rub hands briskly, paying special attention to area between fingers. Use a brush to clean under nails as necessary. Rinse with hands lowered to allow soiled water to drain directly into the sink. Do not splash water onto clothing. Do not allow hands to touch sink. Use disposable hand towel to turn off faucet and dry hands well, especially between fingers. Apply moisture barrier if desired. 2. Review of the facility’s policy, Gloves from the Nursing Guidelines Manual, dated (MONTH) (YEAR), showed the following: -Wear gloves when it can be reasonably anticipated that hands will be in contact with mucous membranes, non-intact skin, any moist body substances (blood, urine, feces, wound drainage, oral secretions, sputum, vomitus, or items/surfaces soiled with these substances) and/or persons with a rash. Gloves must be changed between residents and between contacts with different body sites of the same resident; -REMEMBER: Gloves are not a cure-all. They should reduce the likelihood of contaminating the hands, but gloves cannot prevent penetrating injuries due to needles or sharp objects. Dirty gloves are worse than dirty hands because microorganisms adhere to the surface of a glove easier than to the skin on your hands. Handling medical equipment and devices with contaminated gloves is not acceptable; -Change gloves between contacts (as defined above) with different residents or with different body sites of the same resident. 3. Review of the facility’s policy on [MEDICAL CONDITIONS], from the Infection Control Manual, dated (MONTH) (YEAR), showed the following: -Purpose: To provide guidelines for the care of persons with [MEDICAL CONDITION] and to prevent the transmission of [MEDICAL CONDITION] to others; -Equipment: Gloves, gown, disinfectant (ensure disinfectant kills [MEDICAL CONDITION] spores), and biohazard waste containers; -Prevention: Wash the resident’s hands when soiled with feces, after they handle items which may be contaminated and before self-feeding; -Wear gowns when potential for soiling of clothing is likely; -Disinfect any visible fecal contamination; -Contain all fecal soiling; -The resident’s clothing and bedding should be placed in a biohazard container and laundered separately; -All focally contaminated articles must be considered potentially infectious. 4. Review of the facility’s policy on body substance precautions regarding resident placement, activity restriction, and the use of private rooms for infection control, dated (MONTH) of (YEAR), showed the following: -The physician and person responsible for infection control should assesses individual |
| DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 7/31/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
| STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265160 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LEWIS & CLARK GARDENS | STREET ADDRESS, CITY, STATE, ZIP 1221 BOONSLICK ROAD | |||||||||
| 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) | |
|---|---|---|
| F 0880 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | (continued… from page 27) residents as to the potential for transmitting infectious organisms. Room assignments and restriction of activities are determined by this assessment; -Coherent residents, colonized or infected with a specific pathogen, may participate in nursing home activities and may eat in the dining hall. All residents should have wounds or invasive sites cleansed and covered and have their hands washed before leaving their rooms; -Each resident should be assessed individually. 5. Review of Resident #209’s discharge summary from the hospital, dated 3/8/18, showed the resident’s discharge [DIAGNOSES REDACTED]. Review of the resident’s admission physician order [REDACTED]. -No diagnoses listed; -[MEDICATION NAME] (antibiotic) 50 milligrams (mg) per milliliter (ml) solution, give 2.5 ml by mouth every six hours for 14 days for [MEDICAL CONDITION]. Review of the resident’s admission baseline care plan, dated 3/8/18, showed the following: -The resident was on [MEDICAL CONDITION] precautions and to follow the community protocols for [MEDICAL CONDITION]; -The resident required the assistance of one staff member for toileting and hygiene; -The resident was sometimes incontinent of bowel. Review of the resident’ Medication Administration Record [REDACTED]. Observation on 3/18/18 at 1:55 P.M. showed there was no cart containing personal protective equipment inside or outside the resident’s room. Observation on 3/18/18 at 2:52 P.M. showed the resident propelled himself/herself up and down the 300 hall (the hall opposite of the location of his/her room) in a wheelchair. The resident stopped and turned every door knob and opened every closed door on the 300 hall. The resident picked up a drinking glass of clear liquid that sat in the hallway on an over bed table, took several drinks through a straw, and returned the glass to the over bed table Observation on 3/18/18 at 4:44 P.M. showed the resident again propelled himself/herself up and down the 300 hall and turned the door knobs on all the closed doors and opened them. Observation on 03/19/18 at 1:25 P.M. showed the resident was moved to a different room on the 100 hall. There was no personal protective equipment inside or outside the room. During an interview on 3/20/18 at 10:35 A.M., Licensed Practical Nurse (LPN) J said he/she was the charge nurse on the resident’s unit. The resident was admitted on [DATE] and tested positive for [MEDICAL CONDITION]. To his/her knowledge, the resident had never been on any precautions. LPN J had never observed any personal protective equipment (PPE) such as gowns, gloves, disinfectants, or biohazard bags or barrels inside or outside of the resident’s room. The resident was moved to a different room on the same unit either one or two days ago, after he/she went into another resident’s room and flooded the toilet with either a brief or clothing. LPN J had not observed any PPE or biohazards bags or barrels inside or outside of either room. During an interview on 3/20/18 at 11:00 A.M., Certified Nurse Aide/Certified Medication Technician (CNA/CMT) K said he/she had not observed any PPE or biohazard bags or barrels inside or outside of the resident’s room. When a resident was on precautions for [MEDICAL CONDITION], it meant staff should wear a gown and gloves when working with the resident in their room. Usually these items were placed on a cart outside of the resident’s room and biohazard bags were placed in the resident’s room for clothing, linen, and trash. CNA/CMT K had not seen these items in the resident’s room but thought the resident had been positive for [MEDICAL CONDITION] when he/she was first admitted . CNA/CMT K said the resident required assistance in the bathroom and was incontinent of bowel at times, but |
| DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 7/31/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
| STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265160 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LEWIS & CLARK GARDENS | STREET ADDRESS, CITY, STATE, ZIP 1221 BOONSLICK ROAD | |||||||||
| 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) | |
|---|---|---|
| F 0880 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | (continued… from page 28) would often take himself/herself to the bathroom unassisted. During an interview on 3/20/18 at 11:50 A.M., the Assistant Director of Nursing (ADON) said the resident was on contact precautions for [MEDICAL CONDITION]. Observation and interview on 3/20/18 at 11:55 A.M. with the ADON of both the resident’s current and previous rooms showed no PPE or biohazard bags or barrels in either room. The ADON said maybe the PPE and biohazard barrels were not moved with the resident when his/her room was changed. During interview 03/20/18 at 1:09 P.M., CNA H said he/she started two weeks ago and worked the 100 short hall last week where the resident resided. There were no PPE inside or outside the resident’s room at that time. CNA H said he/she heard this resident had [MEDICAL CONDITION]. Another staff told him/her this resident should have PPE available when providing care. During interview 03/20/18 at 2:10 P.M., CNA I said he/she was not aware of any precautions for the resident. He/she was just asked to come and help on the hall where the resident resided. During an interview on 3/21/18 at 10:10 A.M., the Director of Nursing said the resident was admitted to the facility with [MEDICAL CONDITION] and was originally placed in a room on the 200 hall and was on contact precautions at that time. Contact precautions for [MEDICAL CONDITION] consisted of PPE outside or inside of the resident’s room as well as biohazard container for the resident’s laundry and trash. The resident was moved approximately five days to a week ago to a different room on a different hall in the facility after another resident had complained of him/her opening up his/her room door. The DON thought the resident remained on contact precautions after the first room change. The resident was again moved to another room on the same hall the night of 3/18/18, after he/she went into another resident’s room and flooded his/her toilet by attempting to flush a brief or item of clothing. The DON said he/she thought this second room change was when staff did not move the contact precaution items along with the resident. The DON said he/she felt it was a breakdown in communication among staff. 6. Review of Resident #74’s quarterly MDS, dated [DATE], showed the following: -Required extensive assistance of one staff for toilet use and personal hygiene; -Frequently incontinent of bladder; -Frequently incontinent of bowel. Review of the resident’s care plan, revised on 1/26/18, showed the following: -Diagnoses included [MEDICAL CONDITION] (paralysis of one side of the body) following a stroke affecting the left side, lack of coordination, need for assistance with personal care, dementia, and muscle weakness; -Required moderate assistance with dressing, transfers, toileting, hygiene, and bathing related to a stroke with [MEDICAL CONDITION]; -At risk for skin break down due to decreased mobility and incontinence; -Provide incontinence care after each incontinence episode; -Minimize skin exposure to moisture. Observation on 3/20/18 at 5:39 A.M. showed the following: -The resident lay in bed in a gown; -CNA B and CNA C entered the resident’s room to provide morning care; -CNA B and CNA C washed their hands and put on gloves; -CNA B removed the covers from the resident. The resident was incontinent of urine; -CNA C wiped the resident’s front perineal area; -CNA B and CNA C rolled the resident to the left side and washed the resident’s buttocks; -CNA B removed and bagged the soiled linen from under the resident; |
| DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 7/31/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
| STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265160 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LEWIS & CLARK GARDENS | STREET ADDRESS, CITY, STATE, ZIP 1221 BOONSLICK ROAD | |||||||||
| 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) | |
|---|---|---|
| F 0880 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | (continued… from page 29) -Without removing their gloves, CNA B and CNA C assisted the resident to his/her back, CNA B placed a clean brief under the resident, and CNA C secured the brief; -Without removing their soiled gloves, CNA B and CNA C dressed the resident, assisted him/her to sit on the side of the bed, and transferred the resident to the wheelchair with a gait belt; -Without removing his/her soiled gloves, CNA B took the soiled linen and left the room. -CNA C removed his/her gloves and washed his/her hands. During an interview on 3/20/18 at 6:08 A.M., CNA C said the resident was incontinent of urine that morning and the resident’s bed linen was wet with urine. CNA C said staff should wash their hands before starting care and once care is finished before they leave the room. 7. During an interview on 3/21/18 at 3:30 P.M., the Director of Nursing (DON) said staff should wash their hands prior to any resident contact, between glove changes, and after care had been completed. The DON said staff should change their gloves and wash their hands after touching soiled items before they touched any clean items such as briefs or clothing. | |
